Psychometric properties of the Dutch version of the Orofacial Esthetic Scale (OES‐NL) in dental patients with and without self‐reported tooth wear

The aim of this study was to test the psychometric properties of the Dutch version of the Orofacial Esthetic Scale (OES) in dental patients with and without self‐reported tooth wear. The English version of the OES was translated into Dutch, following established guidelines for cross‐cultural adaptation of health‐related quality of life measures. The reliability of the resulting OES‐NL was tested in a test–retest study on 343 subjects; its validity was tested with the use of convergent validity on 582 subjects. The test–retest reliability of the OES‐NL showed intra‐class correlation coefficients (ICC) that ranged from 0·76 to 0·82, which can be qualified as excellent. The Cronbach's alpha revealed that the overall internal consistency of the scale was good (α = 0·89). Convergent validity was confirmed by the association between the OES‐NL summary scores and three questions of the Dutch version of the Oral Health Impact Profile (OHIP‐NL). The calculated Spearman's rank correlation coefficients ranged from −0·43 to −0·54 and were all significant (P < 0·001). The Dutch version of the Orofacial Esthetic Scale (OES‐NL) showed good psychometric properties, making it suitable for the assessment of self‐perceived aesthetics in Dutch dental patients with and without self‐reported tooth wear.     

Normative values for the oro‐facial Esthetic Scale in Sweden

This study reports the findings and challenges of the assessment of oro‐facial aesthetics in the Swedish general population and the development of normative values for the self‐reporting Orofacial Esthetic Scale (OES). In a Swedish national sample of 1406 adult subjects (response rate: 47%), OES decile norms were established. The influence of sociodemographics (gender, age, and education), oral health status and general health status on OES scores was analysed. Mean ± standard deviation of OES scores was 50·3 ± 15·6 units (0, worst score; 70, best score); <1% of the subjects had the minimum score of 0, and 11% had the maximum score of 70 OES units. Orofacial Esthetic Scale score differences were (i) substantial (>5 OES units) for subjects with excellent/very good versus good to poor oral or general health status; ii) small (2 units), but statistically significant for gender (P = 0·01) and two age groups (P = 0·02), and (iii) absent for subjects with college versus no college education (P = 0·31) or with and without dentures (P = 0·90). To estimate normative values for a self‐reporting health status, instrument is considered an important step in standardisation, and the developed norms provide a frame of reference in the general population to interpret the Orofacial Esthetic Scale scores.     

Recognition of patient‐reported impairment in oral aesthetics

The objectives of this study were to investigate the degree of effective recognition by professionals of patient‐estimated oral aesthetic impairment and the most reliable aspects in such recognition. Participants consisted of 95 patients with partial dentition in need of prosthodontic replacements. The oral aesthetics was professionally evaluated using the Prosthetic Esthetic Index (PEI), compiling 13 aesthetic aspects and an overall evaluation. The patient‐reported impairment was evaluated using the Oral Health Impact Profile Aesthetic (OHIP‐Aes) and the Oral Esthetic Scale (OES). Background variables were as follows: gender, age, work situation, education level, marital status, number and location of teeth, wearing a removable dental prosthesis (RDP) and smile line. A significant correlation was found between the overall professional evaluation and the OHIP‐Aes score (R = 0·43, P < 0·05), the OES score (R = 0·46, P < 0·05) and the overall patient evaluation (0·35, P < 0·05). Correlations of the 13 specific aspects of the PEI with the patient‐reported evaluations were generally small to moderate: the aspect ‘discoloration of the teeth’ showed the highest correlation. The multivariate analyses showed that up to 57% of the patient‐reported impairment could be explained by the professionally evaluated oral aesthetic in combination with background variables. Discoloration of the teeth was the greatest explanatory variable, but also dental arch symmetry, and position and colour of the teeth were significant aspects. A high percentage of the patient‐reported aesthetic impairment can be recognised by the professionals. The most reliable aspect is discoloration of the teeth, but also dental arch symmetry, and the position and colour of the teeth are important for recognising the aesthetic impairment.     

Validity of the 'protocol of oro-facial myofunctional evaluation with scores' for young and adult subjects

Summary The aims of this study were to analyse the validity, sensitivity and specificity of the protocol of oro‐facial myofunctional evaluation with scores (OMES) for oro‐facial myofunctional disorder (OMD) diagnosis in young and adult subjects. Eighty subjects were examined. The OMES was validated against the Nordic Orofacial Test‐Screening (NOT‐S) protocol (criterion validity) (Spearman correlation test). The construct validity was tested by analysis of the ability of the OMES (i) to differentiate healthy subjects (n = 22) from temporomandibular disorder (TMD) patients (n = 22), which frequently have OMD (Mann–Whitney test) and (ii) to measure the changes that occurred in a subgroup with TMD between the period before and after oro‐facial myofunctional therapy (T group, n = 15) (Wilcoxon test). Two speech therapists trained with the OMES participated as examiners (E). There was a statistically significant correlation between the OMES and NOT‐S protocols, which was negative because the two scales are inverse (r = ?0·86, P < 0·01). There was a significant difference between the healthy and TMD subjects regarding the oro‐facial myofunctional status (OMES total score, P = 0·003). After therapy, the T group showed improvement in the oro‐facial myofunctional status (OMES total score, P = 0·001). Inter‐ and intra‐examiner agreement was moderate, and the reliability coefficients ranged from good to excellent. The OMES protocol presented mean sensitivity and specificity = 0·80, positive predictive value = 0·76 and negative predictive value = 0·84. Conclusion: The OMES protocol is valid and reliable for clinical evaluation of young and adult subjects, among them patients with TMD.     

Development of a new instrument for determining the level of chewing function in children

This study aimed to develop a chewing performance scale that classifies chewing from normal to severely impaired and to investigate its validity and reliability. The study included the developmental phase and reported the content, structural, criterion validity, interobserver and intra‐observer reliability of the chewing performance scale, which was called the Karaduman Chewing Performance Scale (KCPS). A dysphagia literature review, other questionnaires and clinical experiences were used in the developmental phase. Seven experts assessed the steps for content validity over two Delphi rounds. To test structural, criterion validity, interobserver and intra‐observer reliability, two swallowing therapists evaluated chewing videos of 144 children (Group I: 61 healthy children without chewing disorders, mean age of 42·38 ± 9·36 months; Group II: 83 children with cerebral palsy who have chewing disorders, mean age of 39·09 ± 22·95 months) using KCPS. The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was used for criterion validity. The KCPS steps arranged between 0–4 were found to be necessary. The content validity index was 0·885. The KCPS levels were found to be different between groups I and II (χ² = 123·286, P < 0·001). A moderately strong positive correlation was found between the KCPS and the subscales of the BPFAS (r = 0·444–0·773, P < 0·001). An excellent positive correlation was detected between two swallowing therapists and between two examinations of one swallowing therapist (r = 0·962, P < 0·001; r = 0·990, P < 0·001, respectively). The KCPS is a valid, reliable, quick and clinically easy‐to‐use functional instrument for determining the level of chewing function in children.     

Reliability and validity of a tool to measure the severity of tongue thrust in children: the Tongue Thrust Rating Scale

This study aimed to develop a scale called Tongue Thrust Rating Scale (TTRS), which categorised tongue thrust in children in terms of its severity during swallowing, and to investigate its validity and reliability. The study describes the developmental phase of the TTRS and presented its content and criterion‐based validity and interobserver and intra‐observer reliability. For content validation, seven experts assessed the steps in the scale over two Delphi rounds. Two physical therapists evaluated videos of 50 children with cerebral palsy (mean age, 57·9 ± 16·8 months), using the TTRS to test criterion‐based validity, interobserver and intra‐observer reliability. The Karaduman Chewing Performance Scale (KCPS) and Drooling Severity and Frequency Scale (DSFS) were used for criterion‐based validity. All the TTRS steps were deemed necessary. The content validity index was 0·857. A very strong positive correlation was found between two examinations by one physical therapist, which indicated intra‐observer reliability (r = 0·938, P < 0·001). A very strong positive correlation was also found between the TTRS scores of two physical therapists, indicating interobserver reliability (r = 0·892, P < 0·001). There was also a strong positive correlation between the TTRS and KCPS (r = 0·724, P < 0·001) and a very strong positive correlation between the TTRS scores and DSFS (r = 0·822 and r = 0·755; P < 0·001). These results demonstrated the criterion‐based validity of the TTRS. The TTRS is a valid, reliable and clinically easy‐to‐use functional instrument to document the severity of tongue thrust in children.     

Validity of the Oral Behaviours Checklist: correlations between OBC scores and intensity of facial pain

The first purpose of this study was to translate the Oral Behaviours Checklist (OBC) into Dutch and to examine its psychometric properties. The second purpose was to examine the correlations between scores on the OBC and facial pain, while controlling for the possible confounding effects of psychosocial factors, such as stress, depression, somatisation and anxiety. The OBC was translated, following the international RDC/TMD consortium guidelines. Its psychometric properties were examined by assessing the test–retest reliability and concurrent validity [correlations between the OBC and the previously developed Oral Parafunctions Questionnaire (OPQ)]. Participants were 155 patients with TMD (77% female; mean age and s.d. = 43·6 and 14·4 years). The translation of the OBC into Dutch proceeded satisfactorily. The psychometric properties of the Dutch OBC were good; test–retest reliability was excellent (ICC = 0·86, P < 0·001). Concurrent validity was good: the correlation between the OBC and OPQ was high (r = 0·757, P < 0·001), while the correlations between individual items ranged from 0·389 to 0·892 (P < 0·001). Similar to previous Dutch studies using the OPQ, no significant correlation was found between oral parafunctions and facial pain (r = 0·069, P = 0·892). No significant correlations could be found between oral parafunctional behaviours and facial pain.     

Exploratory factor analysis of the Oral Health Impact Profile

Although oral health‐related quality of life (OHRQoL) as measured by the Oral Health Impact Profile (OHIP) is thought to be multidimensional, the nature of these dimensions is not known. The aim of this report was to explore the dimensionality of the OHIP using the Dimensions of OHRQoL (DOQ) Project, an international study of general population subjects and prosthodontic patients. Using the project's Learning Sample (n = 5173), we conducted an exploratory factor analysis on the 46 OHIP items not specifically referring to dentures for 5146 subjects with sufficiently complete data. The first eigenvalue (27·0) of the polychoric correlation matrix was more than ten times larger than the second eigenvalue (2·6), suggesting the presence of a dominant, higher‐order general factor. Follow‐up analyses with Horn's parallel analysis revealed a viable second‐order, four‐factor solution. An oblique rotation of this solution revealed four highly correlated factors that we named Oral Function, Oro‐facial Pain, Oro‐facial Appearance and Psychosocial Impact. These four dimensions and the strong general factor are two viable hypotheses for the factor structure of the OHIP.     

Evaluation of oro‐facial function in young subjects with temporomandibular disorders

The aim of this study was to evaluate bite force (BF) and oro‐facial functions at different dentition phases (initial‐mixed, intermediate‐mixed, final‐mixed and permanent dentition) in children and adolescents diagnosed with temporomandibular disorders (TMDs). The sample was selected from four public schools in Piracicaba, São Paulo, Brazil. Of the 289 participants recruited, aged 8–14 years old, 46 were placed into the TMD group. TMD was diagnosed using Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (2011). Oro‐facial functions were evaluated using the Nordic Orofacial Test‐Screening (NOT‐S), which involves both an interview and a clinical examination. BF was measured using a digital gnathodynamometer. Age and body mass index (BMI) were also considered. The data were analysed by the following tests: Kolmogorov–Smirnov test, Student's t‐test, Spearman and Pearson coefficients, Qui‐square test, Fisher's exact or binomial test, as indicated. Moreover, univariate and multivariable logistic regression were applied. For the TMD group, scores associated with NOT‐S interview and NOT‐S total were higher than for the control group (P = 0·033 and P = 0·0062, respectively). No differences in BF between genders or groups (P > 0·05) were detected. Variables included in the multivariate logistic regression were BMI and NOT‐S total. Based on this analysis, NOT‐S total was associated with TMDs. Reported sensory function was the specific domain within NOT‐S interview that established the significant difference between the groups (P = 0·021). The TMD group also had a greater number of alterations in the face‐at‐rest domain of the NOT‐S exam (P = 0·007). Concluding, it did not detect an association between TMDs and either dentition phase or BF. Instead, BF correlated with age and BMI. Oro‐facial dysfunction was associated with TMD in the studied sample, but this association may be bidirectional, requiring further researches.     

Oral health‐related quality of life,oral aesthetics and oral function in head and neck cancer patients after oral rehabilitation

Head and neck cancer (HNC) is diagnosed in more than 500 000 patients every year worldwide with increasing prevalence. Oral rehabilitation is often needed after HNC treatment to regain oral function, aesthetics and oral health‐related quality of life (OHRQoL). The objectives were to evaluate OHRQoL, oral aesthetics and oral function after oral rehabilitation in HNC patients and compare it to that of non‐HNC patients. Eighteen patients treated for HNC who subsequently had oral rehabilitation (2014‐2017), and a control group of eighteen age‐ and gender‐matched non‐HNC patients treated with removable prostheses (2014‐2018) were included in a cross‐sectional study. The OHRQoL was assessed by the Oral Health Impact Profile 49 questionnaire (OHIP‐49), the oral aesthetics by the Prosthetic Esthetic Index (PEI) and the Orofacial Esthetic Scale (OES), and the oral function by the Nordic Orofacial Test‐Screening (NOT‐S). The HNC patients had worse oral function and OHRQoL than the control patients (mean NOT‐S score 4.56 vs 0.56, P < 0.01 and mean OHIP‐49 score 42.50 vs 20.94, P = 0.050). When including number of replaced teeth and type of prosthesis in the tests, no significant difference in OHRQoL was found between the groups. No difference was found in the overall aesthetic outcomes (mean PEI total score 32.28 vs 30.67, P = 0.367 and mean OES total score 48.78 vs 53.56, P = 0.321). Multiple regression analyses showed that being HNC patient compared to control patient impaired the oral function. Oral function is significantly impaired in HNC patients compared to non‐HNC patients after oral rehabilitation.     

Confirmatory factor analysis of the Oral Health Impact Profile

Previous exploratory analyses suggest that the Oral Health Impact Profile (OHIP) consists of four correlated dimensions and that individual differences in OHIP total scores reflect an underlying higher‐order factor. The aim of this report is to corroborate these findings in the Dimensions of Oral Health‐Related Quality of Life (DOQ) Project, an international study of general population subjects and prosthodontic patients. Using the project's Validation Sample (n = 5022), we conducted confirmatory factor analyses in a sample of 4993 subjects with sufficiently complete data. In particular, we compared the psychometric performance of three models: a unidimensional model, a four‐factor model and a bifactor model that included one general factor and four group factors. Using model‐fit criteria and factor interpretability as guides, the four‐factor model was deemed best in terms of strong item loadings, model fit (RMSEA = 0·05, CFI = 0·99) and interpretability. These results corroborate our previous findings that four highly correlated factors – which we have named Oral Function, Oro‐facial Pain, Oro‐facial Appearance and Psychosocial Impact – can be reliably extracted from the OHIP item pool. However, the good fit of the unidimensional model and the high interfactor correlations in the four‐factor solution suggest that OHRQoL can also be sufficiently described with one score.     

Oral health‐related quality of life in patients with non‐metal clasp dentures: a randomised cross‐over trial

We investigated the efficacy of non‐metal clasp dentures (NMCDs) with regard to the oral health‐related quality of life (OHRQoL) and compare the findings with those for conventional metal clasp‐retained dentures (MCDs). This single‐centre, randomised controlled, two‐phase, open label, cross‐over trial included 28 partially dentate individuals. The patients were randomised to receive MCDs followed by NMCDs, or the opposite sequence (n = 14 in each group); each denture was worn for 3 months. OHRQoL was evaluated using the Oral Health Impact Profile‐Japanese version (OHIP‐J) at entry (T‐entry; before treatment with the first denture) and at 3 months after treatment with each denture (T3). An examiner evaluated denture stability, oral appearance and surface roughness before denture delivery (T0) and at T3 and denture hygiene at T3. A total of 24 patients completed the trial. There were no complications related to the dentures, abutment teeth or denture‐bearing mucosa during the follow‐up periods for both dentures. The mean OHIP summary score was lower for NMCDs than for MCDs, and the difference (9 points) was greater than the minimal important difference (6 points), indicating the difference was clinically relevant. The effect size was medium (0·70). Statistical analyses with linear mixed models found a significant effect of the denture type on the OHIP summary score and scores for the Oro‐facial appearance, Oro‐facial pain and Psychological impact domains (NMCD < MCD; P < 0·05). The results of our study suggest that NMCDs allow for better OHRQoL compared with MCDs.     

Cross‐cultural adaptation,reliability and construct validity of the Tampa scale for kinesiophobia for temporomandibular disorders (TSK/TMD‐Br) into Brazilian Portuguese

Fear of movement (kinesiophobia) seems to play an important role in the development of chronic pain. However, for temporomandibular disorders (TMD), there is a scarcity of studies about this topic. The Tampa Scale for Kinesiophobia for TMD (TSK/TMD) is the most widely used instrument to measure fear of movement and it is not available in Brazilian Portuguese. The purpose of this study was to culturally adapt the TSK/TMD to Brazilian Portuguese and to assess its psychometric properties regarding internal consistency, reliability, and construct and structural validity. A total of 100 female patients with chronic TMD participated in the validation process of the TSK/TMD‐Br. The intraclass correlation coefficient (ICC) was used for statistical analysis of reliability (test–retest), Cronbach's alpha for internal consistency, Spearman's rank correlation for construct validity and confirmatory factor analysis (CFA) for structural validity. CFA endorsed the pre‐specified model with two domains and 12‐items (Activity Avoidance – AA/Somatic Focus – SF) and all items obtained a loading factor greater than 0·4. Acceptable levels of reliability were found (ICC > 0·75) for all questions and domains of the TSK/TMD‐Br. For internal consistency, Cronbach's α of 0·78 for both domains were found. Moderate correlations (0·40 < r < 0.60) were observed for 84% of the analyses conducted between TSK/TMD‐Br scores versus catastrophising, depression and jaw functional limitation. TSK/TMD‐Br 12 items and two‐factor demonstrated sound psychometric properties (transcultural validity, reliability, internal consistency and structural validity). In such a way, the instrument can be used in clinical settings and for research purposes.     

The cause of drooling in children with cerebral palsy – hypersalivation or swallowing defect?

Summary. Objective. To determine whether or not drooling in children with cerebral palsy is due to hypersalivation. Population and methods. The study population consisted of 10 children with cerebral palsy who were identified as having severe drooling, and a matched control group composed of 10 unaffected children who had no known physical or mental disabilities. Salivary flow rate was compared between the cerebral palsied children and the control group using the chin‐cup collection drool quantification method described by Sochanjwskyj. Components of the system included a cup‐like collection device, a vacuum pump, plastic tubing, an airtight collection chamber, and calibrated test tubes held against the subject's chin with elastic straps attached to an orthodontic head bonnet. Statistical analysis was completed using the Student's t‐test and Fisher's Exact Probability test. Results. The ages of the population ranged from 5·2 to 15·6 years, mean age (± SE) of 10·56 ± 1·13 years. There was no statistically significant difference in the rate of salivary flow rate between the two groups’ mean ± SE: cerebral palsy group 0·220 ± 0·018; control group 0·334 ± 0·052 (P = 0·053). The results were further confirmed by comparing the buffering capacity (P = 1·00) and concentrations of the sodium (P = 0·065) and potassium ions (P = 0·058) in the saliva of the study groups. Conclusions. Children with cerebral palsy who drool do not appear to produce excess saliva. Their salivation is similar to the control children.     

The effect of oral appliances that advanced the mandible forward and limited mouth opening in patients with obstructive sleep apnea: A systematic review and meta‐analysis of randomised controlled trials

Oral appliances (OAs) have demonstrated efficacy in treating obstructive sleep apnea (OSA), but many different OA devices are available. The Japanese Academy of Dental Sleep Medicine supported the use of OAs that advanced the mandible forward and limited mouth opening and suggested an evaluation of their effects in comparison with untreated or CPAP. A systematic search was undertaken in 16 April 2012. The outcome measures of interest were as follows: Apnea Hypopnea Index (AHI), lowest SpO₂, arousal index, Epworth Sleepiness Scale (ESS), the SF‐36 Health Survey. We performed this meta‐analysis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Five studies remained eligible after applying the exclusion criteria. Comparing OA and control appliance, OA significantly reduced the weighted mean difference (WMD) in both AHI and the arousal index (favouring OA, AHI: ?7·05 events h^?1; 95% CI, ?12·07 to ?2·03; P = 0·006, arousal index: ?6·95 events h^?1; 95% CI, ?11·75 to ?2·15; P = 0·005). OAs were significantly less effective at reducing the WMD in AHI and improving lowest SpO₂ and SF‐36 than CPAP, (favouring OA, AHI: 6·11 events h^?1; 95% CI, 3·24 to 8·98; P = 0·0001, lowest SpO₂: ?2·52%; 95% CI, ?4·81 to ?0·23; P = 0·03, SF‐36: ?1·80; 95% CI, ?3·17 to ?042; P = 0·01). Apnea Hypopnea Index and arousal index were significantly improved by OA relative to the untreated disease. Apnea Hypopnea Index, lowest SpO₂ and SF‐36 were significantly better with CPAP than with OA. The results of this study suggested that OAs improve OSA compared with untreated. CPAP appears to be more effective in improving OSA than OAs.     

DEEP Study: does EQ‐5D‐5L measure the impacts of persistent oro‐facial pain?

The EQ‐5D‐5L is a generic quality of life (QOL) measure widely used throughout the world, which has the advantage that it allows health‐state preferences to be elicited. The aim of this study was to examine whether: a) variation in the standardised reference period for EQ‐5D‐5L from ‘today’ to ‘the last month’ had a minimal clinically meaningful difference; (b) EQ‐5D‐5L had convergent validity with a multidimensional pain measure in quantifying the impacts of pain. As part of a larger study into the effectiveness and efficiency of care pathways for persistent orofacial pain (POFP) ( http://research.ncl.ac.uk/deepstudy ), participants with POFP (n = 100) completed two versions of the EQ‐5D‐5L at the same time with different reference periods (‘today’ vs. ‘last month’). Participants also completed the first section of the West Haven–Yale Multidimensional Pain Inventory (v3) to assess convergent validity. Two‐tailed nonparametric inferential statistics, intra‐class correlation coefficients (ICC), and within‐subject change scores were used to compare the two EQ‐5D‐5L versions. Convergent validity was assessed using Spearman's rho correlation coefficients. Health‐state valuations were significantly different (P < 0·01), and there was good similarity between the two versions' ICC 0·86 (95% CI 0·79–0·91). The within‐subject mean change was 0·03 (95% CI 0·01–0·06). For convergent validity, all relationships were significant (P < 0·05) and in the expected directions. EQ‐5D‐5L demonstrates sufficient convergent validity to be used with POFP, and a change in the standard reference period may be unnecessary if a multidimensional pain measure is also used.     

Oral health and caries related microflora in children during the first three months following renal transplantation

There is little information on the oral health of children undergoing renal transplantation during the early transplant period. Methods. Twenty‐four children undergoing renal transplantation aged 4–13·2 years and their matched controls were recruited. The dmfs, dmft, DMFS and DMFT, plaque, gingivitis and gingival enlargement scores were recorded. The oral microflora was sampled and cultured for S. mutans, Lactobacllus species and Candida species. Results. There was a significantly lower mean dmfs (0·3 ± 0·9; P = 0·03), dmft (0·3 ± 0·9; P = 0·03), DMFS (2·3 ± 5·3; P = 0·01) and DMFT (1·5 ± 2·6; P = 0·02), respectively, in the transplant group. There was a significantly greater mean plaque score (14·7 ± 11) for the permanent dentition, at baseline only, compared with 90 days post‐transplantation (9·4 ± 10·4; P = 0·02). There was a significantly greater gingival enlargement score (1·8 ± 1·4; P = 0·04) 90 days post‐transplantation compared with baseline. The S. mutans and Lactobacillus counts were significantly lower both at baseline (P = 0·0001 and P = 0·004) and 90 days post‐transplantation (P = 0·02; and P = 0·05), respectively, compared with the controls. Conclusions. The transplant children had less active dental disease than the controls although gingival enlargement needs careful monitoring.     

Correlation between the levels of non‐specific physical symptoms and pressure pain thresholds measured by algometry in patients with temporomandibular disorders

Recent studies showed that patients with chronic TMD pain also feature increased sensitivity in other craniofacial regions, and even in remote peripheral areas, suggesting that nociceptive processing is centrally facilitated in this patient population. The aim of this study was to investigate the existence of a negative correlation between the levels of non‐specific physical symptoms and pressure pain thresholds measured by algometry at sites distant from the chief complaint of oro‐facial pain in patients with TMD. A total of 20 female patients were evaluated comprising 11 patients diagnosed with myofascial pain (Group I of RDC/TMD) and 9 patients with arthralgia (Group III of RDC/TMD), with both reporting chronic TMD pain for at least 3 months. Patients were tested by the pressure algometry technique, and, in the same visit, clinical diagnosis and levels of non‐specific physical symptoms, including pain‐related issues or not, were obtained. The raw scores were then standardised into a T‐score. The possible correlation between the dependent variable levels of non‐specific physical symptoms and pressure pain thresholds measured by algometry at sites distant from the chief complaint of oro‐facial pain was assessed with Spearman's correlation coefficient. Results were considered statistically significant, which stood a lower than 5% probability of occurring by chance (P < 0·05). A statistically significant (P = 0·02) negative correlation (?0·51) was found to exist between the levels of non‐specific physical symptoms, only if including issues involving pain‐related symptoms, and experimental pressure pain thresholds in patients with painful TMD.     

Efficacy of low‐level laser therapy in the treatment of TMDs: a meta‐analysis of 14 randomised controlled trials

This study was designed to evaluate the efficacy of low‐level laser therapy (LLLT) in the treatment of temporomandibular disorders (TMDs). We searched electronic databases and references lists of relevant articles, retrieved all of the published randomised controlled trials in regard to these issues and then performed a meta‐analysis. Fourteen highly qualified RCTs reporting on a total of 454 patients, which evaluated the effectiveness of LLLT for patients suffering from TMDs were retrieved. The results indicated that LLLT was not better than placebo in reducing chronic TMD pain (weighted mean difference = ?19·39; 95% confidence interval = ?40·80–2·03; P < 0·00001; I² = 99%). However, the LLLT provided significant better functional outcomes in terms of maximum active vertical opening (MAVO) (weighted mean difference = 4·18; 95% confidence interval = 0·73–7·63; P = 0·006; I² = 73%), maximum passive vertical opening (MPVO) (weighted mean difference = 6·73; 95% confidence interval = 01·34–12·13; P = 0·06; I² = 73%), protrusion excursion (PE) (weighted mean difference = 1·81; 95% confidence interval = 0·79–2·83; P = 0·59; I² = 0%) and right lateral excursion (RLE) (weighted mean difference = 2·86; 95% confidence interval = 1·27–4·45; P = 0·01; I² = 73%). The results of our meta‐analysis have provided the best evidence on the efficacy of LLLT in the treatment of TMDs. This study indicates that using LLLT has limited efficacy in reducing pain in patients with TMDs. However, LLLT can significantly improve the functional outcomes of patients with TMDs.     

The effect of sociodemographic factors on dental anxiety in children seen in a suburban Nigerian hospital

Summary. Objective. This paper attempts to determine the sociodemographic factors that relate to dental anxiety in suburban African children. Methods. A short form of the Dental subscale of the Child Fear Survey schedule (DFSS_SF) was administered to 81 patients (first time attendees at the clinic) between the ages of eight and 13 years. The psychometric scale was used after determining its reliability and validity to ensure that it was culturally appropriate. Age, gender, sociodemographic status were also recorded. The dental anxiety score distribution, its threshold level as well as the relationship between the sociodemographic variables and patients’ anxiety were determined. Results. There was no statistically significant association between age (P = 0·856), gender (P = 0·124), socio‐economic status of the children (P= 0.12) and level of dental anxiety. However, a statistically significant relationship did exist between the type of school the child attended and the anxiety level (P = 0·009). Also, 18 (14·8%) of the children were found to have high anxiety levels. Conclusions. Further studies involving larger non‐clinic samples are needed to examine the issues raised by the findings of this study.