Objective: To present a list of key points for good Temporomandibular Disorders (TMDs) clinical practice on behalf of the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) group of the International Association for Dental, Oral and Craniofacial Research (IADR).

Methods: An open working group discussion was held at the IADR General Session in New Orleans (March 2024), where members of the INfORM group finalized the proposal of a list of 10 key points.

Results: The key points covered knowledge on the etiology, diagnosis, and treatment. They represent a summary of the current standard of care for management of TMD patients. They are in line with the current need to assist general dental practitioners advance their understanding and prevent inappropriate treatment.

Conclusions: The key points can be viewed as a guiding template for other national and international associations to prepare guidelines and recommendations on management of TMDs adapted to the different cultural, social, educational, and healthcare requirements.

OBJECTIVES: In recent years, a smartphone-based ecological momentary assessment (EMA) approach for assessing awake bruxism (AB) has attracted growing interest, both in clinical and research settings. The present study was designed to investigate subjects' experience using an EMA-based smartphone application to detect factors that could hamper or facilitate its use for clinical and research purposes.

MATERIALS AND METHODS: Thirty-two patients with temporomandibular disorders (TMDs) pain (14 males, 18 females; mean age 28.3 ± 12.1 years) were recruited at the Orofacial Pain Unit of the University of Siena, Siena, Italy. They were monitored for one week to collect data on their AB behaviors. Time investment, feelings, encountered difficulties, and reasons for not using the app were assessed in a diary with 5-point Likert scales. Descriptive analysis of quantitative data was assessed, and content analysis of textual data was performed.

RESULTS: Quantitative data showed a good experience with the app (median of 4). The main motivation to use the EMA-based smartphone application was to gain insight into their own AB behaviours. The most negative experience was the short time window available to answer to the alert.

CONCLUSION: The EMA-based smartphone application was well accepted for multiple day evaluation.

CLINICAL RELEVANCE: These results open up important clinical scenarios for AB evaluation as well as the possibility to carry out large-scale studies on general population samples and/or on selected subpopulations.

Orexin-A (OXA), a neuropeptide produced in the hypothalamus, is recognized for its role in modulating orofacial nociception and regulating feeding behaviors, as well as its impact on psychophysiological responses. This study investigated the role of orexin-1 receptors (OX1R) in modulating nociceptive behaviors induced by noxious stimulation of the temporomandibular joint (TMJ) and the associated changes in mood and feeding behaviors in rats with complete Freund's adjuvant (CFA)-induced temporomandibular disorders (TMDs). Bilateral cannulation of the lateral ventricles was performed in rats. To induce nociception, CFA was injected unilaterally into the left TMJ of the rats. Nociceptive behaviors were assessed using the hot plate and tail flick tests, while anxiety-like behavior and food intake were evaluated using an elevated plus maze (EPM) and a food preference device, respectively. The results demonstrated a significant increase in nociceptive scores and anxiety-like behaviors, along with reductions in water and food consumption following CFA injection. However, post-treatment with OXA at concentrations of 50 and 100 pM/rat significantly decreased thermal nociceptive scores, alleviated anxiety-like behavior, and increased water and food intake. These beneficial effects were reversed when OXA was co-administered with SB-334867 (40 nM/rat), an OX1R antagonist. Collectively, our findings suggest that OX1R signaling plays a role in the modulation of anxiety-like behavior and abnormalities in food intake in CFA-treated rats. Understanding the involvement of OXA and its receptors in CFA-induced TMJ nociception and behavioral changes may pave the way for potential therapeutic interventions targeting OX1R signaling in the management of TMD-associated symptoms.

Background: Bruxism is a jaw-muscle activity characterized by teeth grinding and clenching. While many of its negative consequences (e.g., jaw-muscle pain, tooth fractures) are of particular interest to dentists, new insights underline the need for physicians to be knowledgeable about bruxism. In order to facilitate transfer of knowledge across disciplines, our objective was to assess what top-ranking medical journals have published on bruxism. Besides, we tested the insights described there against current science regarding the definition, assessment, epidemiology, etiology, consequences, comorbidities, and management of bruxism.

Results: In the past century, the four top-ranking medical journals have provided their readership with various bits and pieces of information on bruxism. While some of these insights have withstood the test of time, others are somewhat outdated. Further, the identified publications provide an incomplete picture of what physicians should know. The present article helps reduce this knowledge gap.

Conclusion: The role of the physician with regard to bruxism focuses mainly on its assessment and management, while insight into risk factors and comorbid conditions of bruxism is essential to high-level patient care. It is hoped that this article will contribute to improve the long-needed interdisciplinary collaboration between physicians and dentists regarding the assessment and management of bruxing patients.

Background: Despite advances in temporomandibular disorders' (TMDs) diagnosis, the diagnostic process continues to be problematic in non-specialist settings.

Objective: To complete a Delphi process to shorten the Diagnostic Criteria for TMD (DC/TMD) to a brief DC/TMD (bDC/TMD) for expedient clinical diagnosis and initial management.

Methods: An international Delphi panel was created with 23 clinicians representing major specialities, general dentistry and related fields. The process comprised a full day workshop, seven virtual meetings, six rounds of electronic discussion and finally an open consultation at a virtual international symposium.

Results: Within the physical axis (Axis 1), the self-report Symptom Questionnaire of the DC/TMD did not require shortening from 14 items for the bDC/TMD. The compulsory use of the TMD pain screener was removed reducing the total number of Axis 1 items by 18%. The DC/TMD Axis 1 10-section examination protocol (25 movements, up to 12 sets of bilateral palpations) was reduced to four sections in the bDC/TMD protocol involving three movements and three sets of palpations. Axis I then resulted in two groups of diagnoses: painful TMD (inclusive of secondary headache), and common joint-related TMD with functional implications. The psychosocial axis (Axis 2) was shortened to an ultra-brief 11 item assessment.

Conclusion: The bDC/TMD represents a substantially reduced and likely expedited method to establish (grouping) diagnoses in TMDs. This may provide greater utility for settings requiring less granular diagnoses for the implementation of initial treatment, for example non-specialist general dental practice.

OBJECTIVE: In line with a similar recent proposal for sleep bruxism (SB), defining clinically oriented research routes to implement knowledge on awake bruxism (AB) metrics is important for an enhanced comprehension of the full bruxism spectrum, i.e. better assessment and more efficient management.

METHODS: We summarised current strategies for AB assessment and proposed a research route for improving its metrics.

RESULTS: Most of the literature focuses on bruxism in general or SB in particular, whilst knowledge on AB is generally fragmental. Assessment can be based on non-instrumental or instrumental approaches. The former include self-report (questionnaires, oral history) and clinical examination, whilst the latter include electromyography (EMG) of jaw muscles during wakefulness as well as the technology-enhanced ecological momentary assesment (EMA). Phenotyping of different AB activities should be the target of a research task force. In the absence of available data on the frequency and intensity of wake-time bruxism-type masticatory muscle activity, any speculation about the identification of thresholds and criteria to identify bruxers is premature. Research routes in the field must focus on the improvement of data reliability and validity.

CONCLUSIONS: Probing deeper into the study of AB metrics is a fundamental step to assist clinicians in preventing and managing the putative consequences at the individual level. The present manuscript proposes some possible research routes to advance current knowledge. At different levels, instrumentally-based and subject-based information must be gathered in a universally accepted standardized approach.