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  • 1.
    Aisaiti, Adila
    et al.
    Nanjing Medical University, China.
    Zhou, Yanli
    Nanjing Medical University, China.
    Wen, Yue
    Nanjing Medical University, China.
    Zhou, Weina
    Nanjing Medical University, China.
    Wang, Chen
    Nanjing Medical University, China.
    Zhao, Jing
    Nanjing Medical University, China.
    Yu, Linfeng
    Nanjing Medical University, China.
    Zhang, Jinglu
    Nanjing Medical University, China.
    Wang, Kelun
    Nanjing Medical University, China; Aalborg University, Denmark; Aarhus University, Denmark.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus University, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.
    Effect of photobiomodulation therapy on painful temporomandibular disorders2021In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 9049Article in journal (Refereed)
    Abstract [en]

    To evaluate the effect of photobiomodulation therapy (PBMT) on painful temporomandibular disorders (TMD) patients in a randomized, double-blinded, placebo-controlled manner. Participants were divided into a masseter myalgia group (n = 88) and a temporomandibular joint (TMJ) arthralgia group (n = 87) according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Both groups randomly received PBMT or placebo treatment once a day for 7 consecutive days, one session. The PBMT was applied with a gallium-aluminum-arsenide (GaAlAs) laser (wavelength = 810 nm) at pre-determined points in the masseter muscle (6 J/cm2, 3 regions, 60 s) or TMJ region (6 J/cm2, 5 points, 30 s) according to their most painful site. Pain intensity was rated on a 0–10 numerical rating scale (NRS) and pressure pain thresholds (PPT) and mechanical sensitivity mapping were recorded before and after the treatment on day 1 and day 7. Jaw function was assessed by pain free jaw opening, maximum unassisted jaw opening, maximum assisted jaw opening, maximum protrusion and right and left excursion. Data were analyzed with a mixed model analysis of variance (ANOVA). Pain intensity in arthralgia patients decreased over time (P < 0.001) for both types of interventions, however, PBMT caused greater reduction in pain scores than placebo (P = 0.014). For myalgia patients, pain intensity decreased over time (P < 0.001) but without difference between interventions (P = 0.074). PPTs increased in both myalgia (P < 0.001) and TMJ arthralgia patients over time (P < 0.001) but without difference between interventions (P ≥ 0.614). Overall, PBMT was associated with marginally better improvements in range of motion compared to placebo in both myalgia and arthralgia patients. Pain intensity, sensory function and jaw movements improve after both PBMT and placebo treatments in myalgia and arthralgia patients indicating a substantial non-specific effect of PBMT.

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  • 2.
    Aiyar, Akila
    et al.
    Section for Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Denmark.
    Shimada, Akiko
    Department of Prosthetic Dentistry, Graduate School of Biomedical Sciences, Nagasaki University; Department of Geriatric Dentistry, Osaka Dental University, Japan.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section for Orofacial Pain and Jaw function, Department of Dentistry and Oral Health, Aarhus University, Denmark.
    Assessment of masticatory efficiency based on glucose concentration in orthodontic patients - a methodological study2022In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 49, no 10, p. 954-960Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Treatment for malocclusion can cause discomfort and pain in the teeth and periodontium, which may impair masticatory efficiency. The glucose concentration method is widely used to assess masticatory efficiency for its convenience in the clinical situation, although its validity has not been shown.

    OBJECTIVE: The aims were to determine the validity of the glucose concentration method and investigate if this method can be applicable to orthodontic patients with braces.

    DESIGN: Sixteen healthy individuals (7 men, 9 women, and 26±5 years old) and 16 patients with malocclusions needing orthodontic treatment (5 men, 11 women, and 26±4 years old) participated. Glucose concentration was measured after 5-, 10-, and 15-s mastication of gummy jelly and compared to Hue values obtained from the color-changing gum method (reference method). In addition, all participants were asked to fill out the Oral Health Impact Profile questionnaire (OHIP) to assess differences in perception related to the mouth before and after the placement of braces.

    RESULTS: = 0.711, P < 0.001) Masticatory efficiency assessed by both methods was significantly lower in orthodontic patients compared to controls (P<0.05), even though it was not affected by bonding (P>0.09). In addition, OHIP scores in physical pain dimension and psychological disability were higher in orthodontic patients than in the control group (P<0.005).

    CONCLUSION: Measurement of glucose concentration was confirmed as a reliable and convenient method for assessing masticatory efficiency. Furthermore, it appears that this method is applicable to patients with braces whose perception in the oral cavity could change.

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  • 3.
    Boscato, Noeli
    et al.
    Univ Fed Pelotas, Sch Dent, Dept Restorat Dent, Pelotas, RS, Brazil.;Aarhus Univ, Dept Dent & Oral Hlth, Sect Orofacial Pain & Jaw Funct, Aarhus, Denmark..
    Exposto, Fernando G.
    Aarhus Univ, Dept Dent & Oral Hlth, Sect Orofacial Pain & Jaw Funct, Aarhus, Denmark.;Scandinavian Ctr Orofacial Neurosci SCON, Aarhus, Denmark..
    Costa, Yuri M.
    Aarhus Univ, Dept Dent & Oral Hlth, Sect Orofacial Pain & Jaw Funct, Aarhus, Denmark.;Univ Estadual Campinas, Piracicaba Dent Sch, Dept Biosci, Piracicaba, Brazil..
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus Univ, Dept Dent & Oral Hlth, Sect Orofacial Pain & Jaw Funct, Aarhus, Denmark.;Scandinavian Ctr Orofacial Neurosci SCON, Aarhus, Denmark..
    Effect of standardized training in combination with masseter sensitization on corticomotor excitability in bruxer and control individuals: a proof of concept study2022In: Scientific Reports, E-ISSN 2045-2322, Vol. 12, no 1, article id 17469Article in journal (Refereed)
    Abstract [en]

    Recently, it has been proposed that bruxism could represent an overlearned behavior due to the absence of corticomotor plasticity following a relevant tooth-clenching task (TCT). This study assessed the modulatory effects of a nerve growth factor (NGF) injection on masseter muscle corticomotor excitability, jaw motor performance, pain, and limitation in bruxer and control participants following a TCT. Participants characterized as definitive bruxers or controls were randomly assigned to have injected into the right masseter muscle either NGF or isotonic saline (IS), resulting in a study with 4 arms: IS_Control (n = 7), IS_Bruxer (n = 7); NGF_Control (n = 6), and NGF_Bruxer (n = 8). The primary outcome was the masseter motor evoked potential (MEP) amplitude measured at baseline and after a TCT. After the interventions, significantly higher and lower MEP amplitude and corticomotor map area were observed, respectively, in the IS_Control and NGF_Control groups (P < 0.05). Precision and accuracy depended on the series and target force level with significant between-group differences (P < 0.01). NGF-induced masseter muscle sensitization, in combination with a training-induced effect, can significantly impact the corticomotor excitability of the masseter muscle in control participants indicating substantial changes in corticomotor excitability, which are not observed in bruxers. These preliminary findings may have therapeuthic implications for the potential to "detrain" and manage bruxism, but further studies with larger sample sizes will be needed to test this new concept.

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  • 4.
    Boscato, Noeli
    et al.
    Univ Fed Pelotas, Sch Dent, Dept Restorat Dent, Goncalves Chaves St 457, BR-96015560 Pelotas, RS, Brazil.;Aarhus Univ, Dept Dent & Oral Hlth, Sect Orofacial Pain & Jaw Funct, Aarhus, Denmark..
    Exposto, Fernando
    Aarhus Univ, Dept Dent & Oral Hlth, Sect Orofacial Pain & Jaw Funct, Aarhus, Denmark.;Scandinavian Ctr Orofacial Neurosci SCON, Aarhus, Denmark..
    Nascimento, Gustavo G.
    Aarhus Univ, Dept Dent & Oral Hlth, Sect Periodontol, Aarhus, Denmark..
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus Univ, Dept Dent & Oral Hlth, Sect Orofacial Pain & Jaw Funct, Aarhus, Denmark.;Scandinavian Ctr Orofacial Neurosci SCON, Aarhus, Denmark..
    Costa, Yuri M.
    Aarhus Univ, Dept Dent & Oral Hlth, Sect Orofacial Pain & Jaw Funct, Aarhus, Denmark.;Univ Estadual Campinas, Piracicaba Dent Sch, Dept Biosci, Piracicaba, Brazil..
    Is bruxism associated with changes in neural pathways?: A systematic review and meta-analysis of clinical studies using neurophysiological techniques2022In: Brain Imaging and Behavior, ISSN 1931-7557, E-ISSN 1931-7565, Vol. 16, p. 2268-2280Article, review/survey (Refereed)
    Abstract [en]

    This study aimed to systematically review the literature to identify clinical studies assessing neuroplasticity changes induced by or associated with bruxism or a tooth-clenching task using neurophysiological techniques. Searches were performed in five electronic databases (PubMed, EMBASE, Scopus, Web of Science, and Google Scholar) in April 2020. This review included clinical studies using neurophysiological techniques to assess neuroplasticity changes in healthy participants before and after a tooth-clenching task or comparing bruxers and non-bruxers. The quality assessment was performed with the Joanna Briggs Institute tool and Grading of Recommendations Assessment, Development, and Evaluation. Meta-analyses were conducted with studies reporting similar comparisons regarding masseter motor evoked potential amplitude and signal change outcomes. Of 151 articles identified in the searches, nine were included, and five proceeded to meta-analysis. Included studies presented moderate to very low methodological quality. From these included studies, eight evaluated bruxers and non-bruxers, of which five of them observed brain activity differences between groups, and three found no differences. Even so, all studies have suggested distinct difference in the central excitability between bruxers and non-bruxers, the meta-analysis revealed no statistically significant differences (P > 0.05). It appears that bruxism seems, indeed, to be associated with distinct differences in the neural pathways related to the control of the jaw-closing muscles, but that considerable variability in terms of classification of bruxism and assessment of neuroplasticity hamper a definite conclusion. Future research projects should take these concerns into consideration in order to further the understanding of bruxism physiology and pathophysiology.

  • 5.
    Boscato, Noeli
    et al.
    Univ Fed Pelotas, Sch Dent, Dept Restorat Dent, Pelotas, RS, Brazil.;Aarhus Univ, Sect Orofacial Pain & Jaw Funct, Dept Dent & Oral Hlth, Aarhus, Denmark..
    Hayakawa, Hidetoshi
    Aarhus Univ, Sect Orofacial Pain & Jaw Funct, Dept Dent & Oral Hlth, Aarhus, Denmark.;Nihon Univ, Div Oral Funct & Rehabil, Dept Oral Hlth Sci, Sch Dent Matsudo, Matsudo, Chiba, Japan..
    Iida, Takashi
    Nihon Univ, Div Oral Funct & Rehabil, Dept Oral Hlth Sci, Sch Dent Matsudo, Matsudo, Chiba, Japan..
    Costa, Yuri M.
    Aarhus Univ, Sect Orofacial Pain & Jaw Funct, Dept Dent & Oral Hlth, Aarhus, Denmark.;Univ Estadual Campinas, Piracicaba Dent Sch, Dept Biosci, Piracicaba, Brazil..
    Kothari, Simple Futarmal
    Aarhus Univ, Sect Orofacial Pain & Jaw Funct, Dept Dent & Oral Hlth, Aarhus, Denmark.;Aarhus Univ, Hammel Neurorehabil Ctr, Dept Clin Med, Aarhus, Denmark.;Aarhus Univ, Univ Res Clin, Dept Clin Med, Aarhus, Denmark.;Scandinavian Ctr Orofacial Neurosci SCON, Aarhus, Denmark..
    Kothari, Mohit
    Aarhus Univ, Hammel Neurorehabil Ctr, Dept Clin Med, Aarhus, Denmark.;Aarhus Univ, Univ Res Clin, Dept Clin Med, Aarhus, Denmark.;Scandinavian Ctr Orofacial Neurosci SCON, Aarhus, Denmark.;JSS Acad Higher Educ & Res, JSS Dent Coll & Hosp, Mysore, Karnataka, India..
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus Univ, Sect Orofacial Pain & Jaw Funct, Dept Dent & Oral Hlth, Aarhus, Denmark.;Scandinavian Ctr Orofacial Neurosci SCON, Aarhus, Denmark..
    Impact of oral motor task training on corticomotor pathways and diadochokinetic rates in young healthy participants2022In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 49, no 9, p. 924-934Article in journal (Refereed)
    Abstract [en]

    Background Studies addressing the training-induced neuroplasticity and interrelationships of the lip, masseter, and tongue motor representations in the human motor cortex using single syllable repetition are lacking. Objective This study investigated the impact of a repeated training in a novel PaTaKa diadochokinetic (DDK) orofacial motor task (OMT) on corticomotor control of the lips, masseter, and tongue muscles in young healthy participants. Methods A total of 22 young healthy volunteers performed 3 consecutive days of training in an OMT. Transcranial magnetic stimulation was applied to elicit motor evoked potentials (MEPs) from the lip, masseter, tongue, and first dorsal interosseous (FDI, internal control) muscles. MEPs were assessed by stimulus-response curves and corticomotor mapping at baseline and after OMT. The DDK rate from PaTaKa single syllable repetition and numeric rating scale (NRS) scores were also obtained at baseline and immediately after each OMT. Repeated-measures analysis of variance was used to detect differences at a significance level of 5%. Results There was a significant effect of OMT and stimulus intensity on the lips, masseter, and tongue MEPs compared to baseline (p < .001), but not FDI MEPs (p > .05). OMT increased corticomotor topographic maps area (p < .001), and DDK rates (p < .01). Conclusion Our findings suggest that 3 consecutive days of a repeated PaTaKa training in an OMT can induce neuroplastic changes in the corticomotor pathways of orofacial muscles, and it may be related to mechanisms underlying the improvement of orofacial fine motor skills due to short-term training. The clinical utility should now be investigated.

  • 6.
    Boscato, Noéli
    et al.
    Federal University of Pelotas, Pelotas, RS, Brazil.
    Nascimento, Gustavo G
    Aarhus University, Aarhus, Denmark.
    Leite, Fabio R M
    Aarhus University, Aarhus, Denmark.
    Horta, Bernardo L
    Federal University of Pelotas, Pelotas, RS, Brazil.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus University, Aarhus, Denmark.
    Demarco, Flavio F
    Federal University of Pelotas, Pelotas, RS, Brazil.
    Role of occlusal factors on probable bruxism and orofacial pain: Data from the 1982 Pelotas birth cohort study.2021In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 113, article id 103788Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study aimed to explore the association between occlusal features and temporomandibular disorder (TMD) pain complaints and probable awake or sleep bruxism METHODS: Path analysis was used to estimate direct, indirect and total effects of occlusal features on probable bruxism and pain-related TMD in adults aged 31 years from the 1982 Pelotas Birth Cohort. A total of 539 cohort members had an oral examination in 2013. Occlusal features were assessed through the Dental Aesthetic Index (DAI), orofacial pain complaints through the TMD pain screener and probable bruxism based on self-reports in combination with clinical findings.

    RESULTS: Malocclusions were found in 28.8% of the participants, while awake bruxism was reported in 35.2%, sleep bruxism in 15.2%, and pain-related TMD in 52.5% of the sample. Occlusion had no direct effect on either awake bruxism [standardized coefficient (SC) -0.002; p = 0.995] or pain-related TMD (SC -0.06; p = 0.115). Conversely, probable awake bruxism was associated with pain-related TMD (SC 0.35; p < 0.001). Similar results were found when sleep bruxism was set as the mediator of interest, as malocclusion did not directly affect sleep bruxism (SC 0.05; p= 0.220) nor pain-related TMD (SC -0.06; p = 0.167). A direct effect of sleep bruxism on pain-related TMD was observed with an SC of 0.16 (p < 0.001).

    CONCLUSION: Our findings suggested that malocclusion during adulthood did not directly influence probable awake or sleep bruxism nor TMD pain complaints. Instead, probable awake and sleep bruxism was associated with TMD pain complaints.

    CLINICAL SIGNIFICANCE: Malocclusion did not impact the presence of bruxism nor TMD complaints in adulthood, but awake and sleep bruxism were associated with TMD pain complaints. The significance of malocclusion should be reconsidered in contemporary dentistry and oral rehabilitation.

  • 7.
    Bracci, Alessandro
    et al.
    Department of Neuroscience, School of Dentistry, University of Padova, Padova, Italy.
    Lobbezoo, Frank
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Colonna, Anna
    Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy.
    Bender, Steven
    Department of Oral and Maxillofacial Surgery, Texas A&M School of Dentistry, Dallas, Texas, USA.
    Conti, Paulo C R
    Bauru School of Dentistry, University of Sao Paulo, São Paulo, Brazil.
    Emodi-Perlman, Alona
    Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Telaviv, Israel.
    Häggman-Henrikson, Birgitta
    Malmö University, Faculty of Odontology (OD).
    Klasser, Gary D
    Department of Diagnostic Sciences, Louisiana State University School of Dentistry, New Orleans, Louisiana, USA.
    Michelotti, Ambra
    Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics and Temporomandibular Disorders, University of Naples Federico II, Naples, Italy.
    Lavigne, Gilles J
    Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal, and Universite de Montreal, Montreal, Quebec, Canada.
    Svensson, Peter
    Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
    Ahlberg, Jari
    Department of Oral and Maxillofacial, Diseases, University of Helsinki, Helsinki, Finland.
    Manfredini, Daniele
    Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy.
    Research routes on awake bruxism metrics: implications of the updated bruxism definition and evaluation strategies.2024In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 51, no 1, p. 150-161Article, review/survey (Refereed)
    Abstract [en]

    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.

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  • 8.
    Caetano, Joao Pedro
    et al.
    Fed Univ Pelotas UFPel, Grad Program Dent, Pelotas, RS, Brazil..
    Goettems, Marilia Leao
    Fed Univ Pelotas UFPel, Grad Program Dent, Pelotas, RS, Brazil..
    Nascimento, Gustavo G.
    Natl Dent Res Inst Singapore, Natl Dent Ctr Singapore, Singapore, Singapore.;Duke NUS Med Sch, Oral Hlth Acad Clin Programme, Singapore, Singapore..
    Jansen, Karen
    Catholic Univ Pelotas UCPel, Grad Program Hlth & Behav, Pelotas, RS, Brazil..
    da Silva, Ricardo Azevedo
    Catholic Univ Pelotas UCPel, Grad Program Hlth & Behav, Pelotas, RS, Brazil..
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus Univ, Dept Dent & Oral Hlth, Sect Orofacial Pain & Jaw Funct, Aarhus, Denmark.;Scandinavian Ctr Orofacial Neurosci SCON, Aarhus, Denmark..
    Boscato, Noeli
    Fed Univ Pelotas UFPel, Grad Program Dent, Pelotas, RS, Brazil.;Univ Fed Pelotas, Sch Dent, Dept Restorat Dent, Grad Program Dent, Goncalves Chaves 457, Room 505, Pelotas, Brazil..
    Influence of malocclusion on sleep bruxism and orofacial pain: data from a study in school children2024In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 28, no 2, article id 142Article in journal (Refereed)
    Abstract [en]

    Objectives This cross-sectional school-based study explored the influence of malocclusion on temporomandibular disorders (TMD) pain complaints, and whether this association would be mediated by sleep bruxism in a representative sample of 7- to 8-year-old children. Methods Path analysis estimated direct, indirect, and total effects of occlusal features on sleep bruxism and TMD pain in 7- to 8-year-old children. Occlusal features were assessed with Dental Aesthetic Index (DAI), orofacial pain complaints using the TMD pain screener, possible sleep bruxism based on self-reports, and probable sleep bruxism based on self-reports combined with clinical findings. Structural equation modeling analyzed data with confounding factors. Results From 580 participants, possible sleep bruxism was observed in 136 children (31.5%), probable sleep bruxism in 30 children (6.7%), and TMD pain complaints in 78 children (13.8%). Malocclusion had no direct effect on either possible sleep bruxism [standardized coefficient (SC) 0.000; p = 0.992], or TMD pain complaints (SC - 0.01; p = 0.740). When probable sleep bruxism was set as the mediator of interest, malocclusion did not directly affect probable sleep bruxism (SC 0.01; p = 0.766), nor TMD pain complaints (SC - 0.02; p = 0.515). A direct effect of probable sleep bruxism on TMD pain complaints was observed with an SC of 0.60 (p < 0.001). However, in neither case, malocclusion indirectly affected TMD pain complaints via bruxism. Conclusion Malocclusion in 7- to 8-year-old children did not directly influence possible or probable sleep bruxism or TMD pain complaints. Instead, probable sleep bruxism was strongly associated with TMD pain complaints. Clinical significance The impact of occlusal features on TMD pain complaints and bruxism has been a long-standing controversy in dentistry. However, the scientific literature linking this association may be inconsistent, mainly due to biased sample selection methods with inadequate consideration of confounders. Further research should try to identify additional risk factors for TMD pain in addition to probable sleep bruxism in children.

  • 9. Conti, Paulo César Rodrigues
    et al.
    Bonjardim, Leonardo Rigoldi
    Stuginski-Barbosa, Juliana
    Costa, Yuri Martins
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD).
    Pain complications of oral implants: is that an issue?2021In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 48, no 2, p. 195-206Article in journal (Refereed)
    Abstract [en]

    The use of oral implants as a form of replacing missing teeth in partial or total edentulous patients is considered the gold standard in oral rehabilitation. Although considered a history of success in contemporary dentistry, surgical complications may occur, as excessive bleeding, damage to the adjacent teeth and mandibular fractures. Persistent pain and abnormal somatosensory responses after the surgery ordinary healing time are also potential problems and may lead to the development of a condition named posttraumatic trigeminal neuropathic pain (PTNP). Though relatively rare, PTNP has a profound impact on patient’s quality of life. Appropriated previous image techniques, effective anaesthetic procedures and caution during the surgical procedure and implant installation are recommended for the prevention of this condition. In case of the PTNP, different management modalities, including antidepressant and membrane stabilizer medications, as well as peripheral strategies, as the use of topical medication and the botulin toxin are presented and discussed.

  • 10.
    Costa, Yuri M
    et al.
    University of Campinas, Piracicaba, Brazil; Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark; Bauru Orofacial Pain Group, Bauru, Brazil.
    Bonjardim, Leonardo R
    Bauru Orofacial Pain Group, Bauru, Brazil; University of Sao Paulo, Bauru, Brazil.
    Conti, Paulo César R
    Bauru Orofacial Pain Group, Bauru, Brazil; University of Sao Paulo, Bauru, Brazil.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.
    Psychophysical evaluation of somatosensory function in orofacial pain: achievements and challenges2021In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 48, no 9, p. 1066-1076Article in journal (Refereed)
    Abstract [en]

    AIM: This critical review describes key methodological aspects for a successful orofacial psychophysical evaluation of the somatosensory system and highlights the diagnostic value of somatosensory assessment and management perspectives based on somatosensory profiling.

    METHODS: This topical review was based on a non-systematic search for studies about somatosensory evaluation in orofacial pain in PubMed and Embase.

    RESULTS: The recent progress regarding psychophysical evaluation of somatosensory function was largely possible due to the development and application of valid, reliable, and standardized psychophysical methods. Qualitative sensory testing may be useful as a screening tool to rule out relevant somatosensory abnormalities. Nevertheless, the patient should preferably be referred to a more comprehensive assessment with the quantitative sensory testing battery if confirmation of somatosensory abnormalities is necessary. Moreover, the identification of relevant somatosensory alterations in chronic pain disorders that do not fulfill the current criteria to be regarded as neuropathic has also increased the usefulness of somatosensory evaluation as a feasible method to better characterize the patients and perhaps elucidate some underpinnings of the so-called "nociplastic" pain disorders. Finally, an additional benefit of orofacial pain treatment based on somatosensory profiling still needs to be demonstrated and convincing evidence of somatosensory findings as predictors of treatment efficacy in chronic orofacial pain awaits further studies.

    CONCLUSION: Psychophysical evaluation of somatosensory function in orofacial pain is still in its infancy but with a clear potential to continue to improve the assessment, diagnosis and management of orofacial pain patients.

  • 11. Costa, Yuri M
    et al.
    Exposto, Fernando G
    Castrillon, Eduardo E
    Conti, Paulo César R
    Bonjardim, Leonardo R
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD).
    Local anaesthesia decreases nerve growth factor induced masseter hyperalgesia2020In: Scientific Reports, E-ISSN 2045-2322, Vol. 10, no 1, article id 15458Article in journal (Refereed)
    Abstract [en]

    The aim of this investigation was to evaluate the effects of local anaesthesia on nerve growth factor (NGF) induced masseter hyperalgesia. Healthy participants randomly received an injection into the right masseter muscle of either isotonic saline (IS) given as a single injection (n = 15) or an injection of NGF (n = 30) followed by a second injection of lidocaine (NGF + lidocaine; n = 15) or IS (NGF + IS; n = 15) in the same muscle 48 h later. Mechanical sensitivity scores of the right and left masseter, referred sensations and jaw pain intensity and jaw function were assessed at baseline, 48 h after the first injection, 5 min after the second injection and 72 h after the first injection. NGF caused significant jaw pain evoked by chewing at 48 and 72 h after the first injection when compared to the IS group, but without significant differences between the NGF + lidocaine and NGF + IS groups. However, the mechanical sensitivity of the right masseter 5 min after the second injection in the NGF + lidocaine group was significantly lower than the second injection in the NGF + IS and was similar to the IS group. There were no significant differences for the referred sensations. Local anaesthetics may provide relevant information regarding the contribution of peripheral mechanisms in the maintenance of persistent musculoskeletal pain.

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  • 12.
    Dawson, Andreas
    et al.
    Malmö University, Faculty of Odontology (OD).
    Bendixen, Karina
    Tran, Andreas
    Malmö University, Faculty of Odontology (OD).
    van Bui, Tuan
    Malmö University, Faculty of Odontology (OD).
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD).
    List, Thomas
    Malmö University, Faculty of Odontology (OD).
    Effects of Acute Experimental Stress on Pain Sensitivity and Cortisol Levels in Healthy Participants: A Randomized Crossover Pilot Study2020In: Journal of oral & facial pain and headache, ISSN 2333-0384, Vol. 34, no 3, p. 281-290Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate pain sensitivity in the masseter muscle and index finger in response to acute psychologic stress in healthy participants. Methods: Fifteen healthy women (23.7 +/- 2.3 years) participated in two randomized sessions: in the experimental stress session, the Paced Auditory Serial Addition Task (PASAT) was used to induce acute stress, and in the control session, a control task was performed. Salivary cortisol, perceived stress levels, electrical and pressure pain thresholds (PTs), and pain tolerance levels (PTLs) were measured at baseline and after each task. Mixed-model analysis was used to test for significant interaction effects between time and session. Results: An interaction effect between time and session occurred for perceived stress levels (P < .001); perceived stress was significantly higher after the experimental task than after the control task (P < .01). No interaction effects occurred for salivary cortisol levels, electrical PTs, or pressure PTLs. Although significant interactions did occur for electrical PTL (P < .05) and pressure PT (P < .001), the simple effects test could not identify significant differences between sessions at any time point. Conclusion: The PASAT evoked significant levels of perceived stress; however, pain sensitivity to mechanical or electrical stimuli was not significantly altered in response to the stress task, and the salivary cortisol levels were not altered in response to the PASAT. These results must be interpreted with caution, and more studies with larger study samples are needed to increase the clinical relevant understanding of the pain mechanisms and psychologic stress.

  • 13.
    Dawson, Andreas
    et al.
    Malmö högskola, Faculty of Odontology (OD). Center for Oral Rehabilitation, Östergötland County Council, Linköping, Sweden; Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; Department of Dentistry, Aarhus University, Aarhus, Denmark.
    Stensson, Niclas
    Ghafouri, Bijar
    Gerdle, Björn
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD). Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; Department of Dentistry, Aarhus University, Aarhus, Denmark; Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD). Center for Functionally Integrative Neuroscience (CFIN), MindLab, Aarhus University Hospital, Aarhus, Denmark; Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; Department of Dentistry, Aarhus University, Aarhus, Denmark; Section of Clinical Oral Physiology, Department of Dentistry, Aarhus University, Aarhus, Denmark; Section of Orofacial Pain and Jaw Function, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Ernberg, Malin
    Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; Department of Dentistry, Aarhus University, Aarhus, Denmark; Section of Orofacial Pain and Jaw Function, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Dopamine in plasma: a biomarker for myofascial TMD pain?2016In: Journal of Headache and Pain, ISSN 1129-2369, E-ISSN 1129-2377, Vol. 17, no 1, article id 65Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Dopaminergic pathways could be involved in the pathophysiology of myofascial temporomandibular disorders (M-TMD). This study investigated plasma levels of dopamine and serotonin (5-HT) in patients with M-TMD and in healthy subjects. METHODS: Fifteen patients with M-TMD and 15 age- and sex-matched healthy subjects participated. The patients had received an M-TMD diagnosis according to the Research Diagnostic Criteria for TMD. Perceived mental stress, pain intensity (0-100-mm visual analogue scale), and pressure pain thresholds (PPT, kPa) over the masseter muscles were assessed; a venous blood sample was taken. RESULTS: Dopamine in plasma differed significantly between patients with M-TMD (4.98 ± 2.55 nM) and healthy controls (2.73 ± 1.24 nM; P < 0.01). No significant difference in plasma 5-HT was observed between the groups (P = 0.75). Patients reported significantly higher pain intensities (P < 0.001) and had lower PPTs (P < 0.01) compared with the healthy controls. Importantly, dopamine in plasma correlated significantly with present pain intensity (r = 0.53, n = 14, P < 0.05) and perceived mental stress (r = 0.34, n = 28, P < 0.05). CONCLUSIONS: The results suggest that peripheral dopamine might be involved in modulating peripheral pain. This finding, in addition to reports in other studies, suggests that dopaminergic pathways could be implicated in the pathophysiology of M-TMD but also in other chronic pain conditions. More research is warranted to elucidate the role of peripheral dopamine in the pathophysiology of chronic pain.

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  • 14.
    de Holanda, Thiago Azario
    et al.
    Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.
    Marmitt, Luana Patrícia
    Graduate Program in Biosciences and Health, University of the West of Santa Catarina, Joaçaba, Santa Catarina, Brazil.
    Cesar, Juraci Almeida
    Graduate Program in Public Health, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.
    Boscato, Noéli
    Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.
    Sleep Bruxism in Puerperal Women: Data from a Population-Based Survey2023In: Maternal and Child Health Journal, ISSN 1092-7875, E-ISSN 1573-6628, Vol. 27, no 2, p. 262-273Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the self-reported SB prevalence and explore associated risk factors in puerperal women who had given birth in Rio Grande, Southern Brazil.

    METHODS: A single, standardized questionnaire was given within the 48 h postpartum period. Self-reported SB was the main outcome investigated. Chi-square test was used to compare proportions, and Poisson regression with robust variance adjustment was used in the multivariate analysis.

    RESULTS: A total of 2225 women were included. Only 79 (3.6%) of these reported clenching or grinding their teeth during sleep. Adjusted analysis showed that the higher education level of the mothers (PR = 3.07; 95% CI 1.49-6.28; P = 0.006); living with three or more persons in the household (PR = 0.54; 95% CI 0.34-0.84; P = 0.007); medication intake during pregnancy (PR = 1.68; 95% CI 1.09-2.58; P = 0.017); smoking (PR = 1.93; 1.16-3.23; P = 0.024), or ever smoked (PR = 1.82; 95% CI 0.85-3.90; P = 0.024); severe anxiety (PR = 1.36; 95% CI 0.61-3.02; P = 0.005); and headache upon waking (PR = 4.19; 95% CI 1.95-9.00; P < 0.001) were significantly associated with self-reported SB.

    CONCLUSION FOR PRACTICE: Our data pointed towards new factors in a specific group of women that may be relevant for preventing sleep-related behaviors in the pregnancy-puerperal cycle. The higher levels of education, medication intake, smoking or even smoked, severe anxiety, the higher the probability of puerperal woman to self-report SB. The nighttime tooth clenching strongly increased headache upon waking.

  • 15.
    Donskov, A. O.
    et al.
    Department of Neurology, Aarhus University Hospital, Aarhus, Region midt, Denmark.
    Shimada, A.
    Department of Geriatric Dentistry, Osaka Dental University, Osaka, Japan.
    Vinge, L.
    Department of Neurology, Aarhus University Hospital, Aarhus, Region midt, Denmark.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Denmark.
    Andersen, H.
    Department of Neurology, Aarhus University Hospital, Aarhus, Region midt, Denmark.
    Oral function in patients with myasthenia gravis2021In: PeerJ, E-ISSN 2167-8359, Vol. 9, article id e11680Article in journal (Refereed)
    Abstract [en]

    Myasthenia Gravis (MG) is characterised by muscle weakness and increased fatigability. The aim of this pilot study was to investigate if patients with MG demonstrate different functional chewing patterns and report more complaints related to mastication as compared with healthy controls. Twelve patients (median 60 years Q1–Q3: 46–70) with generalised MG and nine healthy controls (median 57 years Q1–Q3: 55–63) participated. All participants underwent dental and oral examination and were asked to fill in a questionnaire concerning oral health. Static maximum bite force was measured with a bite force transducer, electromyography in the masseter, temporalis, and suprahyoid muscles were recorded, and jaw movement was tracked, during a 5-minute gum chewing test. The patients had more oral complaints (oral health impact profile total score 22.6 vs 7.5 P < 0.01) and had lower peak bite force than controls (18.8kgf (11.1;26.4) (95% CI) vs 29.5 kgf (21.6; 37.4) (P = 0.04)). In contrast, fatigability of the masticatory muscles, as defined by number of chewing cycles during the gum-chewing test, did not differ between patients and controls (P = 0.10). In conclusion, patients had more oral complaints and lower bite force than controls, but did not show significantly different functional chewing patterns. Future studies should aim at integrating measurement of peak force into functional tests. Attention should be given to oral complaints of patients with MG. © Copyright 2021 Donskov et al.

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  • 16.
    Durham, Justin
    et al.
    School of Dental Sciences Newcastle University Newcastle UK;Newcastle Hospitals' NHS Foundation Trust Newcastle UK.
    Ohrbach, Richard
    Oral Diagnostic Sciences University at Buffalo School of Dental Medicine Buffalo New York USA.
    Baad‐Hansen, Lene
    Department of Dentistry and Oral Health, Section for Orofacial Pain and Jaw Function Aarhus University Aarhus Denmark.
    Davies, Stephen
    Division of Dentistry University of Manchester UK Manchester UK.
    De Laat, Antoon
    Department Oral health Sciences KU Leuven and Department Dentistry UZ Leuven Belgium.
    Goncalves, Daniela Godoi
    School of Dentistry, Araraquara São Paulo State University (Unesp) Araraquara Brazil.
    Gordan, Valeria V.
    Restorative Dental Sciences Department University of Florida College of Dentistry Gainesville Florida USA.
    Goulet, Jean‐Paul
    Faculty of Dental Medicine Laval University Quebec Quebec Canada.
    Häggman-Henrikson, Birgitta
    Malmö University, Faculty of Odontology (OD).
    Horton, Michael
    College of General Dentistry UK (CGDent) London UK.
    Koutris, Michail
    Department of Orofacial Pain and Dysfunction Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands.
    Law, Alan
    Endodontist, The Dental Specialists Woodbury Minnesota USA;Research Professor, Division of Endodontics University of Minnesota Minneapolis Minnesota USA.
    List, Thomas
    Malmö University, Faculty of Odontology (OD). Skåne University Hospital, Specialized Pain Rehabilitation Lund Sweden.
    Lobbezoo, Frank
    Department of Orofacial Pain and Dysfunction Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands.
    Michelotti, Ambra
    Department of Neurosciences, School of Orthodontics, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy.
    Nixdorf, Donald R.
    Division of TMD &amp; Orofacial Pain, School of Dentistry and Department of Radiology, Medical School University of Minnesota Minneapolis Minnesota USA.
    Oyarzo, Juan Fernando
    TMD and Orofacial Pain Program, Faculty of Odontology Universidad Andres Bello Santiago Chile.
    Peck, Chris
    Faculty of Dentistry National University of Singapore Singapore Singapore.
    Penlington, Chris
    School of Dental Sciences Newcastle University Newcastle UK;Newcastle Hospitals' NHS Foundation Trust Newcastle UK.
    Raphael, Karen G.
    Department of Oral and Maxillofacial Pathology, Radiology &amp; Medicine New York University College of Dentistry New York New York USA.
    Santiago, Vivian
    Department of Oral and Maxillofacial Pathology, Radiology &amp; Medicine New York University College of Dentistry New York New York USA.
    Sharma, Sonia
    Oral Diagnostic Sciences University at Buffalo School of Dental Medicine Buffalo New York USA.
    Svensson, Peter
    Department of Dentistry and Oral Health, Section for Orofacial Pain and Jaw Function Aarhus University Aarhus Denmark.
    Visscher, Corine M.
    Department of Orofacial Pain and Dysfunction Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands.
    Yoshiki, Imamura
    Department of Oral Diagnostic Sciences Nihon University School of Dentistry Tokyo Japan.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD). Skåne University Hospital, Specialized Pain Rehabilitation Lund Sweden.
    Constructing the brief diagnostic criteria for temporomandibular disorders (bDC/TMD) for field testing2023In: Journal of Oral Rehabilitation, E-ISSN 1365-2842Article in journal (Refereed)
    Abstract [en]

    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.

  • 17.
    Ekberg, EwaCarin
    et al.
    Malmö University, Faculty of Odontology (OD).
    Nilsson, Ing-Marie
    Malmö University, Faculty of Odontology (OD). Center for Oral Rehabilitation, FTV Östergötland, Norrköping, Sweden.
    Michelotti, Ambrosina
    chool of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy.
    Al-Khotani, Amal
    Dental Department, East Jeddah Hospital, Ministry of Health, Jeddah, Saudi Arabia; Scandinavian Center for Orofacial Neurosciences, Malmö, Sweden.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD). Scandinavian Center for Orofacial Neurosciences, Malmö, Sweden; Dental Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden .
    Conti, Paulo Cesar Rodrigues
    Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, Brazil; Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.
    Durham, Justin
    Newcastle School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
    Goulet, Jean-Paul
    aculty of Dental Medicine, Laval University, Quebec, Canada.
    Hirsch, Christian
    Clinic of Pediatric Dentistry, University of Leipzig, Leipzig, Germany.
    Kalaykova, Stanimira
    Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
    Kapos, Flavia P
    Department of Epidemiology, University of Washington, Seattle, Washington, USA; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.
    King, Christopher D
    Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
    Komiyama, Osamu
    Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, Japan.
    Koutris, Michail
    Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    List, Thomas
    Malmö University, Faculty of Odontology (OD). Scandinavian Center for Orofacial Neurosciences, Malmö, Sweden.
    Lobbezoo, Frank
    Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;.
    Ohrbach, Richard
    Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA.
    Palermo, Tonya M
    Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine; Seattle Children's Research Institute, Seattle, Washington, USA.
    Peck, Christopher C
    Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
    Penlington, Chris
    Newcastle School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
    Restrepo, Claudia
    CES-LPH Research Group, Universidad CES, Medellin, Colombia.
    Rodrigues, Maria Joao
    Institute for Occlusion and Orofacial Pain, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
    Sharma, Sonia
    Malmö University, Faculty of Odontology (OD). Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA.
    Svensson, Peter
    Section for Orofacial Pain and Jaw Function, School of Dentistry and Oral Health, Aarhus, Denmark.
    Visscher, Corine M
    Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Wahlund, Kerstin
    Department of Orofacial Pain and Jaw Function, Kalmar County Hospital, Kalmar, Sweden.
    Rongo, Roberto
    International Network for Orofacial Pain and Related Disorders Methodology (INfORM), a Network within the International Association for Dental Research (IADR).
    Diagnostic Criteria for Temporomandibular Disorders - INfORM recommendations: Comprehensive and short-form adaptations for adolescents.2023In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 50, no 11, p. 1167-1180Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for use in adults is in use worldwide. Until now, no version of this instrument for use in adolescents has been proposed.

    OBJECTIVE: To present comprehensive and short-form adaptations of the adult version of DC/TMD that are appropriate for use with adolescents in clinical and research settings.

    METHODS: International experts in TMDs and experts in pain psychology participated in a Delphi process to identify ways of adapting the DC/TMD protocol for physical and psychosocial assessment of adolescents.

    RESULTS: The proposed adaptation defines adolescence as ages 10-19 years. Changes in the physical diagnosis (Axis I) include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for adolescents, (ii) adding two general health questionnaires, one for the adolescent patient and one for their caregivers, and (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire. Changes in the psychosocial assessment (Axis II) include (i) adapting the language of the Graded Chronic Pain Scale to be developmentally appropriate for adolescents, (ii) adding anxiety and depression assessment that have been validated for adolescents, and (iii) adding three constructs (stress, catastrophizing and sleep disorders) to assess psychosocial functioning in adolescents.

    CONCLUSION: The recommended DC/TMD, including Axis I and Axis II for adolescents, is appropriate to use in clinical and research settings. This adapted first version for adolescents includes changes in Axis I and Axis II requiring reliability and validity testing in international settings. Official translations of the comprehensive and short-form to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

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  • 18.
    Exposto, Fernando G
    et al.
    Aarhus University, Aarhus, Denmark.
    Bendixen, Karina H
    Aarhus University, Aarhus, Denmark.
    Ernberg, Malin
    Karolinska Institutet.
    Bach, Flemming W
    Aarhus University Hospital, Aarhus, Denmark.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus University, Aarhus, Denmark.
    Assessment of Pain Modulatory and Somatosensory Profiles in Chronic Tension-Type Headache Patients2021In: Pain medicine, ISSN 1526-2375, E-ISSN 1526-4637, Vol. 22, no 10, p. 2356-2365Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to thoroughly phenotype a group of chronic tension-type headache (CTTH) patients.

    METHODS: Fifteen CTTH patients diagnosed according to the International Classification of Headache Disorders-3 and 15 healthy controls were included in this study. Furthermore, 70 healthy controls were included to establish normative values. Quantitative sensory testing (QST), including temporal summation of pain (TSP), conditioned pain modulation (CPM), and psychological and sleep variables, was assessed in a single session. TSP and CPM were then combined to build pain modulation profiles (PMP) for each individual.

    RESULTS: No difference was found between groups for PMP, TSP, and CPM. However, 10 CTTH patients showed a pronociceptive PMP, with 8 related to a deficient CPM and 2 to both a deficient CPM and increased TSP. Increased cold detection thresholds were the most common sensory disturbance found in CTTH patients. Significant differences were seen between groups for pain catastrophizing, depression, and sleep quality although not all patient's scores were above the clinically meaningful cutoffs.

    CONCLUSIONS: In summary, CTTH patients presented with different PMP. These PMP may be related to increased TSP, deficient CPM, alterations in thermal detection that may be related to autonomic dysregulation, or a combination of all three. Overall, this suggests that due to their heterogeneous pathophysiology, CTTH patients should be managed according to their underlying pathophysiology and not with a one-size-fits-all approach.

  • 19.
    Exposto, Fernando G
    et al.
    Aarhus University, Aarhus, Denmark.
    Castrillon, Eduardo E
    Aarhus University, Aarhus, Denmark.
    Exposto, Cristina R
    Aarhus University, Aarhus, Denmark.
    Costa, Dyna Mara F
    University of São Paulo, Bauru, Brazil.
    Gøkhan, Muhammed A
    Aarhus University, Aarhus, Denmark.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus University, Aarhus, Denmark.
    Costa, Yuri M
    Aarhus University, Aarhus, Denmark; University of Campinas, Piracicaba, Brazil.
    Remote physical examination for temporomandibular disorders.2022In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 163, no 5, p. 936-942Article in journal (Refereed)
    Abstract [en]

    ABSTRACT: There is a need to further develop telemedicine approaches due to the immediate and perhaps long-term consequences of the coronavirus disease 2019. Thus, a remote protocol for assessment of patients with temporomandibular disorders (TMD) was developed, and the agreement of this protocol was compared to the guidelines of the diagnostic criteria for temporomandibular disorders (DC/TMD). A total of 16 individuals were first assessed by a reference standard examination (RSE) and three other examinations applied in a random order by three examiners: standard physical examination (standard examination), physical examination keeping 2 m distance (physical distanced examination) and examination done with the aid of video communication technology (video communication examination). The primary outcomes were the diagnoses of myalgia of the masseter and temporalis muscles, and arthralgia. The diagnoses of intra-articular joint disorders were considered secondary outcomes because of less impact on psychosocial functioning and quality of life when compared with the pain-related diagnoses. The Fleiss kappa coefficient and its 95% confidence interval were computed to determine the level of agreement in diagnoses between each examination protocol and the RSE. There was substantial to almost perfect agreement between the RSE and all the examination protocols for the diagnoses of myalgia (0.86 to 1.00) and arthralgia (0.86 to 0.87) (p<0.001). On the other hand, there was an overall poor agreement (0.30 to 0.58) between the RSE and all the protocols for the diagnosis of disc displacement with reduction. Remote assessment of patients with pain-related TMD is feasible and presents a high degree of accuracy.

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  • 20.
    Exposto, Fernando G
    et al.
    Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Denmark ; Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.
    Huang, Miranda
    Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Haasnoot, Talita
    Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Koutris, Michail
    Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Lobbezoo, Frank
    Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Bendixen, Karina H
    Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, , Denmark. ; Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark..
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, , Denmark. ; Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark..
    Location of mechanically-evoked referred sensations within the trigeminal region are not altered following a heterotopic painful stimulus.2022In: Scientific Reports, E-ISSN 2045-2322, Vol. 12, no 1, article id 21181Article in journal (Refereed)
    Abstract [en]

    To investigate whether the location, area and frequency of referred sensations occurring during palpation of the masseter muscle can be influenced by application of a conditioning painful stimulus to the temporalis muscle. Thirty healthy participants were included in this cross-over study, performed in two sessions with > 48 h in between. At each session, palpation of the masseter muscle was performed before and after 0.2 ml of glutamate (1 mol/L) or isotonic saline (control) were injected into the anterior portion of the temporalis muscle. Palpation of the masseter muscle was done using four different forces (0.5 kg, 1 kg, 2 kg and 4 kg). Participants rated the perceived intensity of the palpation and any referred sensations on a 0-50-100 numeric rating scale, the perceived pain intensity following the injections on an electronic visual analogue scale and drew any referred sensations they experienced. No difference in referred sensations location, area and frequency was shown r during palpation either before or after injections (P > 0.05). A moderate correlation was found between perceived sensation scores and referred sensations intensity for the temporalis muscle following glutamate injection (r = 0.407, P < 0.05). Moreover, significantly more participants reported referred sensations for glutamate injections into the temporalis muscle when compared to isotonic saline (P < 0.05). Finally, a significant decrease in the perceived intensity of palpation of the masseter muscle was seen after glutamate injection in the temporalis muscle (P < 0.05). In the current study, location, area and frequency of referred sensations following mechanical stimulation of the masseter muscle were not altered by the application of a painful stimulus to the temporalis muscle. In addition, there seems to be a positive relationship between painful stimuli and referred sensations frequency and intensity elicited from the temporalis muscle.

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  • 21.
    Exposto, Fernando G.
    et al.
    Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON).
    Renner, Nicole
    Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON).
    Bendixen, Karina H.
    Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON).
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON).
    Pain in the temple? Headache, muscle pain or both: A retrospective analysis2021In: Cephalalgia, ISSN 0333-1024, E-ISSN 1468-2982, Vol. 41, no 14, p. 1486-1491, article id 03331024211029234Article in journal (Refereed)
    Abstract [en]

    Aim Headache attributed to temporomandibular disorders and myalgia are two diagnoses included in the diagnostic criteria for temporomandibular disorders (DC/TMD). However, it is not clear if these two diagnoses are different clinical entities given their similar presentation and way in which they are diagnosed, when the myalgia is within the temporalis muscle. The purpose of this retrospective study was to assess the overlap between headache attributed to temporomandibular disorders and myalgia of the temporalis muscle. Methods The charts of 671 patients seeking treatment at the Section of Orofacial Pain and Jaw Function, Aarhus University, Denmark, between January 2015 and February 2020 were screened for a diagnosis of headache attributed to temporomandibular disorders, myalgia of the temporalis muscle, or both. Results A total of 89 patients fulfilled the DC/TMD criteria for either headache attributed to TMD, myalgia of the temporalis or both. Of these, two had a diagnosis of headache attributed to TMD, 16 of myalgia of the temporalis, and 71 were diagnosed with both. In 97.3% of the times that headache attributed to temporomandibular disorders was diagnosed, the patient was also diagnosed with myalgia of the temporalis. The Jaccard index was 0.8, indicating a substantial overlap between the two diagnoses. Finally, the overlap of pain location between the two diagnoses was substantial, with a Jaccard index of 0.9. Conclusions In the present study, headache attributed to temporomandibular disorders was almost exclusively diagnosed together with myalgia of the temporalis. Therefore, we propose that headache attributed to temporomandibular disorders and myalgia of the temporalis muscle have more clinical similarities than differences and as such could be considered one single clinical entity. Further studies will be needed to address the clinical consequences of this proposal.

  • 22. Fan, Ruyi
    et al.
    Gou, Huiqing
    Wang, Xiaoqian
    Li, Lu
    Xu, Yan
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD).
    Wang, Kelun
    Microcirculation and somatosensory profiling of patients with periodontitis: a preliminary case control report2021In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 25, p. 1223-1233Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The purpose of this preliminary study was to explore blood microcirculation and somatosensory profiles in periodontitis patients before and after non-surgical periodontal therapy.

    MATERIALS AND METHODS: Twenty patients (10 men and 10 women, 20 to 30 years old) and 20 age- and gender-matched healthy controls were included. Non-surgical periodontal therapy was performed for all patients. Clinical examination including pocket probing depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP) were performed at baseline (BL), 1 week (1W), and 4 weeks (4W) after non-surgical periodontal therapy on 6 sites of tooth 32 and 42. Laser Doppler flowmetry (LDF) and quantitative sensory testing (QST) were applied at the attached gingiva of tooth 32 and 42 at BL, 1W, and 4W after non-surgical periodontal therapy. Data were analyzed with a two-way mixed-model of ANOVA.

    RESULTS: The PPD, CAL and BOP significantly improved after non-surgical periodontal therapy (p < 0.001). Periodontitis patients demonstrated a higher tissue microvascular blood cell concentration (p = 0.015) and a significant gain in thermal (p = 0.037) and mechanical (p = 0.003) somatosensory function compared to controls. After non-surgical periodontal therapy, the flux (p = 0.002) and speed (p = 0.008) of blood flow decreased significantly and thermal (p = 0.029) and mechanical (p < 0.001) somatosensory function were reversed.

    CONCLUSION: Gingival microcirculation and somatosensory function seem impaired in patients with periodontitis and are reversed following non-surgical periodontal therapy.

    CLINICAL RELEVANCE: LDF and QST may be appropriate tools to further characterize gingival inflammation and treatment responses in periodontitis.

  • 23. Gou, Huiqing
    et al.
    Fan, Ruyi
    Chen, Xu
    Li, Lu
    Wang, Xiaoqian
    Xu, Yan
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD).
    Wang, Kelun
    Adjunctive effects of laser therapy on somatosensory function and vasomotor regulation of periodontal tissues in patients with periodontitis: A randomized controlled clinical trial2020In: Journal of Periodontology, ISSN 0022-3492, E-ISSN 1943-3670, Vol. 91, no 10, p. 1310-1317Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The purpose of this prospective study was to compare the changes in periodontal somatosensory function and microcirculation in patients with periodontitis following initial treatment with scaling and root planing (SRP) with or without adjuvant laser therapy.

    METHODS: Twenty-four patients suffering from periodontitis were recruited and randomly allocated into a split-mouth design to either SRP combined laser therapy side (test side) or SRP only side (control side). All treatments were performed by the same investigator at a single visit. Laser Doppler Flowmetry (LDF) and Quantitative Sensory Testing (QST) were performed at baseline (W0), 1 week (1W), 2 weeks (2W), and 4 weeks (4W) after treatment on both sides of the attached gingiva of the maxillary lateral incisor. Clinical examination including pocket probing depth (PPD) and bleeding on probing (BOP) was performed at W0, 2W, and 4W on both sides. Data were analyzed with two-way analysis of variance (ANOVA).

    RESULTS: The PPD and BOP significantly improved after treatment (P <0.001). The LDF values were significantly decreased on both sides at all follow-up time points (P <0.001), temperature was increased only on the test side (P = 0.017) whereas there was no significant change on the control side (P = 0.792). Significantly less sensitivity was observed for all QST parameters (P <0.030) except for warmth detection after treatment.

    CONCLUSION: Adjunctive use of laser therapy did not provide any significant clinically advantage or additional effects on the recovery of periodontal somatosensory function or gingival microcirculation in the present study. This article is protected by copyright. All rights reserved.

  • 24.
    Hammoudi, Wedad
    et al.
    Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; Specialist in Dental Prosthetics, Department of Prosthetic Dentistry, Folktandvården Eastmaninstitutet, Stockholm, Sweden.
    Trulsson, Mats
    Division of Oral Diagnosis and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden;.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus university, Aarhus, Denmark.
    Smedberg, Jan-Ivan
    Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; Specialist in Dental Prosthetics, Department of Prosthetic Dentistry, Folktandvården Eastmaninstitutet, Stockholm, Sweden.
    Long-term results of a randomized clinical trial of 2 types of ceramic crowns in participants with extensive tooth wear2022In: The Journal of prosthetic dentistry (Print), ISSN 0022-3913, E-ISSN 1097-6841, Vol. 127, no 2, p. 248-257, article id S0022-3913(20)30651-XArticle in journal (Refereed)
    Abstract [en]

    STATEMENT OF PROBLEM: Evidence is sparse regarding the long-term outcomes of restorative treatment of patients with extensive tooth wear.

    PURPOSE: The purpose of this long-term prospective randomized clinical trial was to evaluate the performance and success rate of pressed lithium disilicate (LD) and translucent zirconia (TZ) crowns in participants with extensive tooth wear.

    MATERIAL AND METHODS: A total of 62 participants with extensive tooth wear (17 women, 45 men; mean age 44.8 years; range 25-63 years) received a total of 713 crowns, LD=362 and TZ=351. Both types of crowns had chamfer preparations and were adhesively luted with dual-polymerizing composite resin cement (PANAVIA F 2.0; Kuraray Noritake Dental Inc). The restorations were clinically reevaluated on average 14, 31, 39, 54, and 65 months after insertion of the crowns according to the modified United States Public Health Service (USPHS) criteria.

    RESULTS: After an observation period of up to 6 years, the survival rate for both types of crowns was 99.7%, with 1 lost LD crown after 1 year as a result of loss of retention and 1 lost TZ crown after 3 years because of tooth fracture at the cemento-enamel junction. The success rates were similar for both types of crowns: 98.6% for LD and 99.1% for TZ. Reasons for failures were that 3 participants in each group developed apical lesions, minimal ceramic fractures, or their crowns were rebonded after loss of adhesion. Assessment of color at baseline was significantly different with a better match for LD (84.8% Alfa, 15.2% Bravo) than for TZ crowns (36.5% Alfa, 63.5% Bravo), including TZ crowns with veneered porcelain (P<.001). Secondary caries and cracks did not occur. A post hoc analysis of clinical performance did not indicate any significant differences between extensive tooth wear with primarily mechanical or chemical factors.

    CONCLUSIONS: No differences were found between the 2 types of ceramic materials concerning the long-term success and clinical performance, except that TZ crowns were rated by a blinded clinician as less esthetic than LD crowns. The use of high-strength ceramic materials, as well as reliable adhesive bonding, are probably the key factors in the long-term success of ceramic crowns in participants with extensive tooth wear independent of the specific etiology.

  • 25.
    Hayakawa, Hidetoshi
    et al.
    Nihon University School of Dentistry at Matsudo, Japan.
    Iida, Takashi
    Nihon University School of Dentistry at Matsudo, Japan.
    Honda-Sakaki, Mika
    Nihon University School of Dentistry at Matsudo, Japan.
    Masuda, Manabu
    Nihon University School of Dentistry at Matsudo, Japan.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). arhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.
    Komiyama, Osamu
    Nihon University School of Dentistry at Matsudo, Japan.
    Drop homotopic effects of masseter-muscle pain on somatosensory sensitivity in healthy participants2021In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 10575Article in journal (Refereed)
    Abstract [en]

    Current pain classifications use 1.0-kg palpation of the masseter muscle to distinguish between "pain patients" and "healthy controls" but a thorough understanding of the normal physiological responses to various somatosensory stimuli is lacking. The aim of this study was to investigate somatosensory function of the skin over the masseter muscle in healthy participants that were divided into a masseter pain prone group (MPP) (n = 22) and non-MPP group (n = 22), according to the response to a 1.0-kg palpation. Quantitative sensory testing (QST) was performed at the skin above the right masseter muscle (homotopic). In an additional experiment, 13 individuals each from MPP and non-MPP received application of 60% topical lidocaine tape to the skin over the masseter muscle for 30 min. Immediately after, mechanical pain sensitivity (MPS), dynamic mechanical allodynia, and pressure pain threshold were tested. Homotopic MPS was significantly higher and PPTs significantly lower in MPP than in N-MPP (P < 0.05). Strikingly, no other differences in QST outcomes were observed between the groups (P > 0.05). After lidocaine application, no significant differences in homotopic MPS were observed between groups. The presence or absence of acute provoked pain in masseter muscle is exclusively associated with differences in homotopic MPS which is decreased following topical anesthesia.

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  • 26.
    Herrero Babiloni, Alberto
    et al.
    Division of Experimental Medicine, McGill University, CIUSSS Nord Ile de Montreal, Center for Advance Research in Sleep Medicine, Montreal, Canada.
    Exposto, Fernando G.
    Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Scandinavian Center for Orofacial Neuroscience, Aarhus, Denmark.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Scandinavian Center for Orofacial Neuroscience, Aarhus, Denmark.
    Lavigne, Gilles J.
    Department of Dental Medicine, Universite de Montreal and CIUSSS Nord Ile de Montreal, Center for Advance Research in Sleep Medicine, CIUSSS Nord Ile Montreal and Stomatology, CHUM, Montreal, QC, Canada.
    Sleep bruxism2023In: Encyclopedia of Sleep and Circadian Rhythms / [ed] Clete A. Kushida, Elsevier, 2023, 2nd, p. 632-641Chapter in book (Refereed)
    Abstract [en]

    Sleep bruxism (SB) is an activity characterized by teeth grinding or clenching. SB can have different dental and orofacial consequences. While in otherwise healthy individuals it is considered a behavior, when it is associated to sleep or neurological disorders and/or presenting harmful consequences it is categorized as a disorder. SB etiology and mechanisms are multifactorial. The diagnosis of SB is based on self-report (possible), clinical examination (probable) and electromyographic for disorder suspected cases (definitive). The management of SB is multimodal and based on a multidisciplinary approach. The identification of phenotypes will be essential in the next future.

      

  • 27. Iida, Takashi
    et al.
    Kothari, Mohit
    Sekihata, Satoshi
    Shimada, Akiko
    Komiyama, Osamu
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD).
    Plasticity in corticomotor pathways linked to a jaw protrusion training task: Potential implications for management of patients with obstructive sleep apnea.2020In: Brain Research, ISSN 0006-8993, E-ISSN 1872-6240, Vol. 1749, article id 147124Article in journal (Refereed)
    Abstract [en]

    This study investigated the effect of a repeated and standardized jaw protrusion training (JPT) task on corticomotor excitability as assessed by motor evoked potentials (MEPs) in masseter and tongue muscle with the use of transcranial magnetic stimulation (TMS). Sixteen healthy participants performed three series of a standardized JPT task on three consecutive days. Each day participants performed 41-min of JPT consisting of three series. In all series, participants were instructed to target 50% and 100% of the maximum jaw protrusion positions. In the first and third series without any feedback but during the second series, participants were provided a custom-made mandibular advancement device to help achieve the correct protruded position. Single pulse TMS was applied to elicit MEPs from right masseter, right tongue and right first dorsal interosseous muscles (FDI) (as control), pre and post-task on Day-1 and -3. Masseter MEPs and tongue MEPs were significantly dependent on stimulus intensity (P < 0.001) and on task session (P < 0.001). Amplitude of masseter and tongue MEPs at post-task Day-3 were significantly higher compared to baseline values (pre-task Day-1) (P < 0.005). FDI MEPs were dependent on stimulus intensity only (P < 0.001) but not on task session (P = 0.677). Our novel findings suggest that participants performing an active and repeated JPT task demonstrate neuroplasticity in terms of increased corticomotor excitability not only in masseter muscles but also in tongue muscles. This finding may have implications for patients with obstructive sleep apnea treated by a mandibular advancement device where the lower jaw is passively held in a protruded position.

  • 28.
    Ikoma, Tomoko
    et al.
    Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan.
    Bendixen, Karina Haugaard
    Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
    Arima, Taro
    Section of International Affairs, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan.
    Dawson, Andreas
    Malmö University, Faculty of Odontology (OD). Scandinavian Center for Orofacial Neurosciences (SCON), Denmark , Sweden; Centre for Oral Rehabilitation, Östergötland County Council, Linköping, Norrköping, Sweden.
    Yamaguchi, Taihiko
    Department of Crown and Bridge Prosthodontics, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan.
    List, Thomas
    Malmö University, Faculty of Odontology (OD). Scandinavian Center for Orofacial Neurosciences (SCON), Denmark.
    Svensson, Peter
    Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Effects of Low-Intensity Contractions of Different Craniofacial Muscles in Healthy Participants: An Experimental Cross-Over Study2018In: Headache, ISSN 0017-8748, E-ISSN 1526-4610, Vol. 58, no 4, p. 559-569Article in journal (Refereed)
    Abstract [en]

    Objective.-Repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible, ie, bruxism, is traditionally linked to pain and unpleasantness in the active muscles. The aim of this study was to investigate the effects of standardized craniofacial muscle contractions on self-reported symptoms. Methods.-Sixteen healthy volunteers performed six 5-minute bouts of 20% maximal voluntary contraction task of the jaw-closing (Jaw), the orbicularis-oris (O-oris), and the orbicularis-oculi (O-oculi) muscles. Participants rated their perceived pain, unpleasantness, fatigue, and mental stress levels before, during, and after the contraction tasks on 0-10 Numeric Rating Scales (NRS). Each muscle contraction task (= 1 session) was separated by at least 1 week and the order of the sessions was randomized in each subject. Results.-All muscle contraction tasks evoked significant increases in NRS scores of pain (mean +/- SD: Jaw; 3.8 +/- 2.7, O-oris; 1.9 +/- 2.2, O-oculi; 1.4 +/- 1.3, P < .014), unpleasantness (Jaw; 4.1 +/- 2.5, O-oris; 2.1 +/- 1.9, O-oculi; 2.9 +/- 1.8, P<.001), fatigue (Jaw; 5.8 +/- 2.0, O-oris; 3.2 +/- 2.3, O-oculi; 3.6 +/- 1.9, P<.001), and mental stress (Jaw; 4.1 +/- 2.1, O-oris; 2.2 +/- 2.7, O-oculi; 2.9 +/- 2.2, P<.001). The Jaw contractions were associated with higher NRS scores compared with the O-oris and the O-oculi contractions (P<.005) without differences between the O-oris and the O-oculi (P>.063). All symptoms disappeared within 1 day (P>.469). Conclusions.-The results showed that submaximal static contractions of different craniofacial muscle groups could evoke transient, mild to moderate levels of muscle pain and fatigue and increased stress scores. The fatigue resistance may differ between different muscle groups. Further studies are warranted to better understand the contribution of specific craniofacial muscle groups for the characteristic presentation of musculoskeletal pain conditions in the head.

  • 29.
    Ishii, Yuki
    et al.
    Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, 2-870-1, Sakaecho-nishi, Matsudo, Chiba 271-8587, Japan; Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Denmark.
    Iida, Takashi
    Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, 2-870-1, Sakaecho-nishi, Matsudo, Chiba 271-8587, Japan.
    Honda-Sakaki, Mika
    Department of Anatomy, Nihon University School of Dentistry at Matsudo, Japan.
    Yoshida, Kazuhiro
    Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, 2-870-1, Sakaecho-nishi, Matsudo, Chiba 271-8587, Japan; Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Denmark.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.
    Komiyama, Osamu
    Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, 2-870-1, Sakaecho-nishi, Matsudo, Chiba 271-8587, Japan.
    Comparison of masticatory muscle activity between young adults and elderly participants using a novel standardized bite device.2024In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 143, article id 104887Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Standardized bite training is required to prevent oral hypofunction in elderly individuals. We aimed to compare masticatory muscle activity between 24 young adults and 16 pre-elderly individuals during a biting task using a novel standardized bite device (BD).

    METHODS: The BD was made of silicone rubber and included a high-force or low-force plate spring or no plate spring (dummy). The compressive stiffness of the material in each BD was measured using a texture analyzer. All participants performed a biting task 50-times at a rate of 1/s each using the three types of BDs on the right first molar. Electromyographic (EMG) activity was recorded bilaterally from the masseter and temporalis muscles. The variability of each biting training session was calculated as the coefficient of variance (CV) from the EMG activity during each biting task for each muscle. Masticatory muscle fatigue was assessed using a numerical rating scale (NRS).

    RESULTS: Compressive stiffness was significantly different between each BD (P < 0.001). The CV and NRS scores were not significantly different between the groups. The EMG activities during each bite task in all muscles were not significantly different for any measurement item between the age groups. The EMG activities of high- and low-force BDs in the right temporalis (ipsilateral) muscle were significantly higher than those of the dummy BD (P < 0.001).

    CONCLUSIONS: Compressive stiffness of the BD affected EMG activity only in the ipsilateral temporalis muscle, but not in the masseter or contralateral temporalis muscles, without any age effect.

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  • 30.
    Iwata, Yoshihiro
    et al.
    Department of Oral Function and Fixed Prosthodontics Nihon University School of Dentistry at Matsudo Chiba Japan.
    Nishimori, Hideta
    Department of Oral Function and Fixed Prosthodontics Nihon University School of Dentistry at Matsudo Chiba Japan.
    Iida, Takashi
    Department of Oral Function and Fixed Prosthodontics Nihon University School of Dentistry at Matsudo Chiba Japan.
    Masuda, Manabu
    Department of Oral Function and Fixed Prosthodontics Nihon University School of Dentistry at Matsudo Chiba Japan.
    Yoshida, Kazuhiro
    Department of Oral Function and Fixed Prosthodontics Nihon University School of Dentistry at Matsudo Chiba Japan.
    Ishii, Yuki
    Department of Oral Function and Fixed Prosthodontics Nihon University School of Dentistry at Matsudo Chiba Japan.
    Yamakawa, Yuichirou
    Department of Oral Function and Fixed Prosthodontics Nihon University School of Dentistry at Matsudo Chiba Japan.
    Hayakawa, Hidetoshi
    Department of Oral Function and Fixed Prosthodontics Nihon University School of Dentistry at Matsudo Chiba Japan.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health Aarhus University Aarhus Denmark;Scandinavian Center for Orofacial Neurosciences (SCON) Aarhus Denmark.
    Komiyama, Osamu
    Department of Oral Function and Fixed Prosthodontics Nihon University School of Dentistry at Matsudo Chiba Japan.
    Effect of clinical experience and training with visual feedback on standardized palpation outcomes: Potential implications for assessment of jaw muscle sensitivity2024In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 51, no 3, p. 601-610Article in journal (Refereed)
    Abstract [en]

    Background: The evaluation of muscle pain and sensitivity by manual palpation is an important part of the clinical examination in patients with myalgia. However, the effects of clinical experience and visual feedback on palpation of the masticatory muscles with or without a palpometer are not known.

    Objective: To estimate the effects of clinical experience and visual feedback on the accuracy of palpation in standardized settings.

    Methods: Thirty-two dentists (age 35 ± 11 years) classified as either specialists (n = 16) or generalists (n = 16) participated in this experiment. All dentists were instructed to target force levels of 500- or 1000-gf, as determined on an electronic scale using either standardized palpometers or manual palpation (MP). All dentists participated in four different tests: MP, MP with visual feedback (MPVF), palpometer (PAL) and PAL with visual feedback (PALVF). Actual force values for each type of palpation from 0 to 2, 2 to 5 and 0 to 5 s were analysed by calculating target force level.

    Results: The relative differences during 2-5 and 0-5 s with 1000 gf were significantly lower for generalists than for specialists (p < .05). In generalists and specialists, the coefficients of variation and the relative differences during 2-5 s were significantly lower for PAL and PALVF than for MP (p < .05).

    Conclusions: These findings suggest that the use of a palpometer, but not clinical experience with palpation of masticatory muscles, increases the accuracy of palpation, and ≥2 s of palpation with a palpometer is optimal for masticatory muscles.

  • 31. Jounger, Sofia Louca
    et al.
    Christidis, Nikolaos
    Hedenberg-Magnusson, Britt
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Svensson, Peter
    Department of Dental Medicine, Section of Orofacial Pain and Jaw Function, Karolinska Institutet, and the Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Huddinge, Sweden; Section of Orofacial Pain and Jaw Function, School of Dentistry, University of Aarhus, and the Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus C, Denmark.
    Schalling, Martin
    Ernberg, Malin
    Influence of Polymorphisms in the HTR3A and HTR3B Genes on Experimental Pain and the Effect of the 5-HT3 Antagonist Granisetron2016In: PLOS ONE, E-ISSN 1932-6203, Vol. 11, no 12Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate experimentally if 5-HT3 single nucleotide polymorphisms (SNP) contribute to pain perception and efficacy of the 5-HT3-antagonist granisetron and sex differences. Sixty healthy participants were genotyped regarding HTR3A (rs1062613) and HTR3B (rs1176744). First, pain was induced by bilateral hypertonic saline injections (HS, 5.5%, 0.2 mL) into the masseter muscles. Thirty min later the masseter muscle on one side was pretreated with 0.5 mL granisetron (1 mg/mL) and on the other side with 0.5 mL placebo (isotonic saline) followed by another HS injection (0.2 mL). Pain intensity, pain duration, pain area and pressure pain thresholds (PPTs) were assessed after each injection. HS evoked moderate pain, with higher intensity in the women (P = 0.023), but had no effect on PPTs. None of the SNPs influenced any pain variable in general, but compared to men, the pain area was larger in women carrying the C/C (HTR3A) (P = 0.015) and pain intensity higher in women with the A/C alleles (HTR3B) (P = 0.019). Pre-treatment with granisetron reduced pain intensity, duration and area to a lesser degree in women (P < 0.05), but the SNPs did not in general influence the efficacy of granisetron. Women carrying the C/T & T/T (HTR3A) genotype had less reduction of pain intensity (P = 0.041) and area (P = 0.005), and women with the C/C genotype (HTR3B) had less reduction of pain intensity (P = 0.030), duration (P = 0.030) and area compared to men (P = 0.017). In conclusion, SNPs did not influence experimental muscle pain or the effect of granisetron on pain variables in general, but there were some sex differences in pain variables that seem to be influenced by genotypes. However, due to the small sample size further research is needed before any firm conclusions can be drawn.

  • 32.
    Kothari, Simple F.
    et al.
    Aarhus Univ, Hammel Neurorehabil Ctr, Dept Clin Med, Hammel, Denmark.;Aarhus Univ, Univ Res Clin, Dept Clin Med, Hammel, Denmark.;Aarhus Univ, Dept Dent & Oral Hlth, Sect Orofacial Pain & Jaw Funct, Hammel, Denmark.;Scandinavian Ctr Orofacial Neurosci SCON, Aarhus, Denmark..
    Devendran, Anupriyadarshini
    Aarhus Univ, Dept Dent & Oral Hlth, Sect Orofacial Pain & Jaw Funct, Hammel, Denmark..
    Sorensen, Astrid B.
    Aarhus Univ, Hammel Neurorehabil Ctr, Dept Clin Med, Hammel, Denmark.;Aarhus Univ, Univ Res Clin, Dept Clin Med, Hammel, Denmark..
    Nielsen, Jorgen Feldbaek
    Aarhus Univ, Hammel Neurorehabil Ctr, Dept Clin Med, Hammel, Denmark.;Aarhus Univ, Univ Res Clin, Dept Clin Med, Hammel, Denmark..
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus Univ, Dept Dent & Oral Hlth, Sect Orofacial Pain & Jaw Funct, Hammel, Denmark.;Scandinavian Ctr Orofacial Neurosci SCON, Aarhus, Denmark..
    Kothari, Mohit
    Aarhus Univ, Hammel Neurorehabil Ctr, Dept Clin Med, Hammel, Denmark.;Aarhus Univ, Univ Res Clin, Dept Clin Med, Hammel, Denmark.;Aarhus Univ, Hammel Neurorehabil Ctr, Voldbyvej 15, DK-8450 Hammel, Denmark.;Aarhus Univ, Univ Res Clin, Voldbyvej 15, DK-8450 Hammel, Denmark..
    Occurrence, presence and severity of bruxism and its association with altered state of consciousness in individuals with severe acquired brain injury2024In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 51, no 1, p. 143-149Article in journal (Refereed)
    Abstract [en]

    Background: Excessive jaw muscle activity is a frequent complication after acquired brain injury (ABI).

    Objective: The study aimed to identify the occurrence and severity of jaw muscle activity and its association with altered state of consciousness in patients with ABI.

    Methods: A total of 14 severe ABI patients with varied altered state of consciousness were recruited. A single-channel electromyographic (EMG) device was used to assess the jaw muscle activity for three consecutive nights during Week 1 and Week 4 following admission. Differences in number of EMG episodes/h between Week 1 and 4 were analysed using non-parametric tests and association between the EMG activity and altered state of consciousness were analysed using Spearman's correlation test.

    Results: Nine of fourteen (64%) patients showed indications of bruxism (cutoff: >15 EMG episodes/h). The average EMG episodes/h at admission were 44.5 ± 13.6 with no significant changes after Week 4 of admission (43 ± 12.9; p = .917). The EMG episodes/h ranged from 2 to 184 during Week 1 and 4-154 during Week 4. There were no significant correlations between the number of EMG episodes/h during the three nights and the individuals altered state of consciousness during Week 1 and Week 4.

    Conclusion: Patients with ABI had a conspicuously high but variable level of jaw muscle activity at admission and it tend to remain high after 4 week of hospitalisation which could potentially lead to adverse effects such as excessive tooth wear, headaches and pain in jaw muscles. The lack of associations between individuals altered level of consciousness and EMG activity could be due to low sample size and further studies are clearly warranted in this patient group with special needs. Single-channel EMG devices can record jaw muscle activity early in the hospitalisation period and might be a helpful tools for early detection of bruxism in ABI patients.

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  • 33. Kothari, Simple Futarmal
    et al.
    Dagsdóttir, Lilja Kristin
    Kothari, Mohit
    Blicher, Jakob Udby
    Kumar, Abhishek
    Buchholtz, Poul Erik
    Ashkanian, Mahmoud
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD).
    Effect of repetitive transcranial magnetic stimulation on altered perception of One's own face2020In: Brain Stimulation, ISSN 1935-861X, E-ISSN 1876-4754, Vol. 13, no 3, p. 554-561, article id S1935-861X(20)30001-2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chronic orofacial pain (COP) patients often perceive the painful face area as "swollen" without clinical signs; such self-reported illusions of the face are termed perceptual distortion (PD). The pathophysiological mechanisms underlying PD remain elusive.

    OBJECTIVE: To test the neuromodulatory effect of repetitive transcranial magnetic stimulation (rTMS) on PD in healthy individuals, to gain insight into the cortical mechanisms underlying PD.

    METHODS: PD was induced experimentally by injections of local anesthetic (LA) around the infraorbital nerve and measured as perceived size changes of the affected area. Participants were randomly allocated to inhibitory rTMS (n = 26) or sham rTMS (n = 26) group. The participants rated PD at baseline, 6 min after LA, immediately, 20 and 40 min after rTMS. The rTMS (inhibitory and sham) was applied to face (lip) representation area of primary somatosensory cortex (SI) as an intervention at 10 min after the LA, when the magnitude of PD is large. As inhibitory rTMS, continuous theta-burst stimulation paradigm (50 Hz) for 40s was employed to inhibit cortical activity.

    RESULTS: We demonstrated a significant decrease in the magnitude of PD immediately and 20 min after the application of inhibitory rTMS compared with sham rTMS (P < 0.006). In two control experiments, we also showed that peripheral muscle stimulation and stimulation of a cortical region other than the lip representation area had no effect on the magnitude of the PD.

    CONCLUSIONS: Inhibitory rTMS applied to a somatotopical-relevant cortical region modulates PD of the face in healthy individuals and could potentially have therapeutic implications for COP patients.

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  • 34.
    Kothari, Simple Futarmal
    et al.
    Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON); Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.
    Visser, Meike
    University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Timmerman, Kimberley
    University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Baad-Hansen, Lene
    Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON).
    Koutris, Michail
    University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Lobbezoo, Frank
    University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON).
    Painful and non-painful symptoms evoked by experimental bracing and thrusting of the mandible in healthy individuals2021In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 48, no 9, p. 1004-1012Article in journal (Refereed)
    Abstract [en]

    Background Bruxism may involve bracing and thrusting of the mandible, in addition to clenching or grinding of the teeth. It is unclear how bracing and thrusting may contribute to potential musculoskeletal symptoms associated with bruxism. Objective To examine the effect of experimental bracing and thrusting of the mandible on the development of musculoskeletal symptoms in healthy volunteers. Methods Thirty healthy volunteers performed six trials of 5 min of repeated bracing and thrusting of the mandible. Bracing involved forcefully maintaining maximum protruded position (5 s with 1 s rest in between), whereas thrusting involved forcefully moving the mandible in a forward direction and back (1 Hz). The participants rated pain, unpleasantness, soreness, fatigue, tension, stiffness, stress and headache on 10-cm visual analogue scales (VAS) before, immediately and 24 h after the tasks. Pain drawings were obtained and maximum voluntary protrusive force (MVPF) was determined before and after the tasks. The outcome parameters for each task were compared between the time points. Results There was a significant increase in the VAS scores (2-4/10) of pain, unpleasantness, soreness, fatigue, tension, stiffness and stress immediately following the tasks compared to baseline and 24 h after the tasks (p < .008). Pain was frequently reported in masseter muscles. MVPF values were significantly higher immediately (p < .001) and 24 h after thrusting (p < .001) and bracing (p = .012) tasks compared to the baseline. Conclusions Experimental bracing and thrusting of the mandible evoked transient, mild-to-moderate levels of muscle pain, fatigue, tension and stiffness and increased unpleasantness and stress scores in healthy volunteers.

  • 35.
    Lam, Julia
    et al.
    Malmö University, Faculty of Odontology (OD).
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD).
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Internet-Based Multimodal Pain Program With Telephone Support for Adults With Chronic Temporomandibular Disorder Pain: Randomized Controlled Pilot Trial2020In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 22, no 10, article id e22326Article in journal (Refereed)
    Abstract [en]

    Background: Chronic pain from temporomandibular disorders remains an undertreated condition with debate regarding the most effective treatment modalities. Objective: The aim of the study was to investigate the treatment effect of an internet-based multimodal pain program on chronic temporomandibular disorder pain and evaluate the feasibility of a larger randomized controlled trial. Methods: An unblinded randomized controlled pilot trial was conducted with 43 participants (34 females, 9 males; median age 27, IQR 23-37 years) with chronic temporomandibular pain. Participants were recruited within the Public Dental Health Service and randomized to intervention (n=20) or active control (n=23). The intervention comprised a dentist-assisted internet-based multimodal pain program with 7 modules based on cognitive behavior therapy and self-management principles. The control group received conventional occlusal splint therapy. Primary outcomes included characteristic pain intensity, pain-related disability, and jaw functional limitation. Secondary outcomes were depression, anxiety, catastrophizing, and stress. Outcomes were self-assessed through questionnaires sent by mail at 3 and 6 months after treatment start. Feasibility evaluation included testing the study protocol and estimation of recruitment and attrition rates in the current research setting. Results: Only 49% of participants (21/43) provided data at the 6-month follow-up (internet-based multimodal pain program: n=7; control: n=14). Of the 20 participants randomized to the internet-based multimodal pain program, 14 started treatment and 8 completed all 7 modules of the program. Between-group analysis showed no significant difference for any outcome measure at 3- or 6-month follow-up-characteristic pain intensity (3 months: P=.58; 6 months: P=.41), pain-related disability (3 months: P=.51; 6 months: P=.12), jaw functional limitation (3 months: P=.45; 6 months: P=.90), degree of depression (3 months: P=.64; 6 months: P=.65), anxiety (3 months: P=.93; 6 months: P=.31), stress (3 months: P=.66; 6 months: P=.74), or catastrophizing (3 months: P=.86; 6 months: P=.85). Within-group analysis in the internet-based multimodal pain program group showed a significant reduction in jaw functional limitation score at the 6-month follow-up compared to baseline (Friedman: chi 2=10.2, P=.04; Wilcoxon: z=-2.3, P=.02). In the occlusal splint group, jaw function limitation was also reduced at the 6-month follow-up (Friedman: chi 2=20.0, P=.045; Wilcoxon: z=-2.3, P=.02), and there was a reduction in characteristic pain intensity at the 3- and 6-month follow-up (Friedman: chi 2=25.1, P=.01; Wilcoxon 3 months: z=-3.0, P=.003; Wilcoxon 6 months: z=-3.3, P=.001). Conclusions: This study was not able to demonstrate a difference in treatment outcome between an internet-based multimodal pain program and occlusal splint therapy in patients with chronic temporomandibular pain. However, the findings suggested that the internet-based multimodal pain program improves jaw function. The results also confirmed the treatment effect of occlusal splint therapy for chronic temporomandibular pain. Furthermore, because of the high attrition rate, this pilot study showed that a randomized controlled trial with this design is not feasible.

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  • 36.
    Lavigne, Gilles
    et al.
    Faculty of Dental Medicine Universite de Montreal & CIUSSS Nord Ile de Montreal, Center for Advance Research in Sleep Medicine &amp; Stomatology CHUM Montreal QC Canada.
    Kato, Takafumi
    Department of Oral Physiology Graduate School of Dentistry Sleep Medicine Center Osaka University Hospital Osaka University Suita Japan.
    Herrero Babiloni, Alberto
    Division of Experimental Medicine McGill University Montreal QC Canada;CIUSSS Nord Ile de Montreal, Center for Advance Research in Sleep Medicine Montreal QC Canada.
    Huynh, Nelly
    Faculty of Dental Medicine Universite de Montreal and CHU Saint‐Justine Research Center Montreal QC Canada.
    Dal Fabbro, Cibele
    Faculty of Dental Medicine Universite de Montreal &amp; CIUSSS Nord Ile de Montreal, Center for Advance Research in Sleep Medicine &amp; Stomatology CHUM Montreal QC Canada.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section of Orofacial Pain and Jaw Function Department of Dentistry and Oral Health Aarhus University Aarhus Denmark.
    Aarab, Ghizlane
    Department of Orofacial Pain and Dysfunction Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands.
    Ahlberg, Jari
    Department of Oral and Maxillofacial Diseases University of Helsinki Helsinki Finland.
    Baba, Kazuyoshi
    Department of Prosthodontics School of Dentistry Showa University Tokyo Japan.
    Carra, Maria Clotilde
    UFR of Odontology Garanciere Université de Paris and Service of Odontology Rothschild Hospital (AP‐HP) Paris France.
    Cunha, Thays Crosara A.
    Department of Genetics and Biochemistry Federal University of Uberlandia Uberlandia Brazil.
    Gonçalves, Daniela A. G.
    Department of Dental Materials and Prosthodontics School of Dentistry São Paulo State University (Unesp) Araraquara Brazil.
    Manfredini, Daniele
    Department of Biomedical Technologies School of Dentistry University of Siena Siena Italy.
    Stuginski‐Barbosa, Juliana
    Bauru Orofacial Pain Group Bauru Brazil.
    Wieckiewicz, Mieszko
    Department of Experimental Dentistry Wroclaw Medical University Wroclaw Poland.
    Lobbezoo, Frank
    Department of Orofacial Pain and Dysfunction Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands.
    Research routes on improved sleep bruxism metrics: Toward a standardised approach2021In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 30, no 5, article id e13320Article, review/survey (Refereed)
    Abstract [en]

    A recent report from the European Sleep Research Society's task force "Beyond AHI" discussed an issue that has been a long-term subject of debate - what are the best metrics for obstructive sleep apnoea (OSA) diagnosis and treatment outcome assessments? In a similar way, sleep bruxism (SB) metrics have also been a recurrent issue for >30 years and there is still uncertainty in dentistry regarding their optimisation and clinical relevance. SB can occur alone or with comorbidities such as OSA, gastroesophageal reflux disorder, insomnia, headache, orofacial pain, periodic limb movement, rapid eye movement behaviour disorder, and sleep epilepsy. Classically, the diagnosis of SB is based on the patient's dental and medical history and clinical manifestations; electromyography is used in research and for complex cases. The emergence of new technologies, such as sensors and artificial intelligence, has opened new opportunities. The main objective of the present review is to stimulate the creation of a collaborative taskforce on SB metrics. Several examples are available in sleep medicine. The development of more homogenised metrics could improve the accuracy and refinement of SB assessment, while moving forward toward a personalised approach. It is time to develop SB metrics that are relevant to clinical outcomes and benefit patients who suffer from one or more possible negative consequences of SB.

  • 37.
    Liu, Jingjing
    et al.
    Department of Orthodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China; Sino-Denmark Orofacial Pain & TMD Research Unit, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China.
    Hou, Wei
    Department of Orthodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China.
    Gu, Jingke
    Plastic & Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China.
    Chen, Wenjing
    Department of Orthodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China.
    Wang, Kelun
    Sino-Denmark Orofacial Pain & TMD Research Unit, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China; Center for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.
    Yan, Bin
    Department of Orthodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China.
    Effects of short-term motor training on accuracy and precision of simple jaw and finger movements after orthodontic treatment and orthognathic surgery: A case-control study2023In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 50, no 8, p. 635-643Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Orthognathic surgery has been performed with increasing frequency for the treatment of severe malocclusion, yet the postsurgical neuromuscular recovery of patients has been inadequately studied.

    OBJECTIVE: To investigate the effect of short-term and simple jaw motor training on accuracy and precision of jaw motor control in patients following orthodontic treatment and orthognathic surgery.

    METHODS: ) to describe the motor performance. Furthermore, the changes in amplitude before and after training were measured in percentage.

    RESULTS: of simple jaw and finger movements significantly decreased after motor training (p ≤ .018) in all groups. The relative changes in finger movements were higher than jaw movements (p < .001) but with no differences among the groups (p ≥ .247).

    CONCLUSION: Both accuracy and precision of simple jaw and finger movements improved after short-term motor training in all three groups, demonstrating the inherent potential for optimization of novel motor tasks. Finger movements improved more than jaw movements but with no differences between groups, suggesting that changes in occlusion and craniofacial morphology are not associated with impaired neuroplasticity or physiological adaptability of jaw motor function.

  • 38.
    Louca Jounger, Sofia
    et al.
    Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Christidis, Nikolaos
    Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Hedenberg-Magnusson, Britt
    Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; Department of Orofacial Pain and Jaw Function, Folktandvården Eastmaninstitutet, Stockholm, Sweden.
    List, Thomas
    Malmö University, Faculty of Odontology (OD).
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, University of Aarhus, Aarhus, Denmark.
    Schalling, Martin
    Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ernberg, Malin
    Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Polymorphisms in the HTR2A and HTR3A Genes Contribute to Pain in TMD Myalgia2021In: Frontiers in Oral Health, E-ISSN 2673-4842, Vol. 2Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to investigate if single nucleotide polymorphisms (SNPs) related to monoaminergic neurotransmission, in particular the serotonergic pathway, contribute to pain perception in patients with temporomandibular disorder (TMD) myalgia and if there is a correlation to jaw function as well as psychosocial factors such as stress, anxiety and depression.

    Materials and Methods: One hundred and seventeen individuals with TMD myalgia were included. A venous blood or saliva sample was taken for genetic analyses and genotyped regarding HTR2A (rs9316233) HTR3A (rs1062613), HTR3B (rs1176744), SERT (5-HTTLPR) and COMT (rs4680). A clinical examination according to Diagnostic Criteria for TMD (DC/TMD) was performed and axis II data (psychosocial factors) were compared between participants with different genotypes for each gene using Kruskall–Wallis test. The characteristic pain intensity (CPI) was tested for correlations to scores for the Perceived Stress Scale, Generalized Anxiety Disorder, and Patient Health Questionnaires using Spearman's rank correlation test with Bonferroni correction for multiple testing. To further explore data factor analysis was performed to identify latent factors associated to the outcome variables.

    Results: Participants carrying at least one copy of the rare allele of the HTR2A (rs9316233) and HTR3A (rs1062613) had higher CPI compared with the participants with the homozygous common genotype (P = 0.042 and P = 0.024, respectively). Correlation analyses showed several significant positive correlations between CPI on one hand, and self-reported psychosocial distress and jaw function on the other hand for several genotypes that mostly were weak to moderate. The factor analysis identified two latent variables. One was positively correlated to the HTR3B gene, jaw function and self-reported parafunctions, and the other was positively correlated to psychological distress and negatively correlated to SERT.

    Conclusion: Taken together, the polymorphism rs1062613 in the HTR3A gene contributes to pain intensity in TMD myalgia. This together with positive interactions between pain variables and psychological factors in genotypes strengthens that pain and psychological distress are related. Further research is needed to explore this as well as the influence of gene-to-gene interactions on pain and psychological distress.

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  • 39.
    Lövgren, A
    et al.
    Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden..
    Häggman-Henrikson, Birgitta
    Malmö University, Faculty of Odontology (OD). Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden..
    Fjellman-Wiklund, A
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden..
    Begic, A
    Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden..
    Landgren, H
    Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden..
    Lundén, V
    Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden..
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark..
    Österlund, C
    Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden..
    The impact of gender of the examiner on orofacial pain perception and pain reporting among healthy volunteers2022In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 26, p. 3033-3040Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Pain on palpation of jaw muscles is a commonly used diagnostic criterion when examining patients with orofacial pain. It is not known, however, if pain reports are affected by the gender of the examiner. Our aim was to investigate if pressure pain threshold (PPT), pressure pain tolerance (PTol), and pain intensity assessed over the masseter muscles in healthy individuals are affected by the gender of the examiner.

    MATERIALS AND METHODS: Healthy, pain-free individuals were recruited on a voluntary basis. PPT and PTol were assessed using pressure algometry. At the PTol level, participants also rated pain intensity on a 0-10 numeric rating scale. Assessments of PPT and PTol were conducted with six repeated measurements performed twice, separately by one female and one male examiner, on each participant.

    RESULTS: In total, 84 participants (43 women; median age 24, IQR 6) were included. With a female examiner, women reported higher pain intensity than men (Mann Whitney U, p = 0.005). In the multivariable analysis, significantly higher PTol was predicted by male examiner. Also, a higher ratio between PTol and reported pain intensity was predicted by male examiner.

    CONCLUSIONS: The gender of the examiner influences pain reporting and perception in an experimental setting. This effect on pain perception related to gender of the examiner is probably related to normative gender behaviors rather than to biological alterations within the examined individual.

    CLINICAL RELEVANCE: In clinical and experimental settings, gender of the examiner may affect not only pain perception but also pain reporting, with potential implications for diagnostics in patients with pain.

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  • 40.
    Madhan, Sivaranjani
    et al.
    Aarhus University, Denmark.
    Nascimento, Gustavo G
    Aarhus University, Denmark.
    Ingerslev, Janne
    University Hospital of Southern Denmark, Denmark.
    Cornelis, Marie
    University of Melbourne, Australia.
    Pinholt, Else Marie
    University Hospital of Southern Denmark, Denmark.
    Cattaneo, Paolo M
    University of Melbourne, Australia; University Hospital of Southern Denmark, Denmark.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus University, Denmark.
    Associations between Temporomandibular Disorders, Pain, Jaw and Masticatory Function in Dentofacial Deformity Patients: a Cross-sectional Study.2023In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 50, no 9, p. 746-757Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with dentofacial deformity often present with impaired masticatory function, orofacial pain, and temporomandibular disorders (TMD). This study investigates the relationship between TMD, pain, jaw, and masticatory function at different stages of orthognathic surgical (OS) treatment.

    METHOD: A total of 120 OS patients were prospectively recruited and grouped as pre-orthodontic (group 1), pre-surgery (group 2), 4-month post-surgery (group 3), 24-month post-surgery (group 4), in addition to 30 controls (group 0). Outcomes were assessed using: Jaw Function Limitation Scale (JFLS), McGill pain questionnaire, DC/TMD instrument, voluntary maximum bite force (MVBF), and masticatory efficiency (ME) using two-colored chewing gum. Data were analyzed using structural equation modeling.

    RESULTS: The prevalence of non-painful TMD did not differ between groups (P = 0.827). However, the prevalence of painful TMD differed between groups (P = 0.001). Amongst the painful TMDs, the highest prevalence was observed for masseter myalgia in group 2 (P = 0.031), and importantly group 4 did not differ from group 0 (P = 0.948). The MPQ score was significantly higher in group 1 (P = 0.001) compared to group 0, and the JFLS score was significantly higher in group 1, 2 and 3 compared to group 0. Notably MPQ (P = 0.756) and JFLS (P = 0.572) scores in group 4 were not different from group 0. However, MVBF (P = 0.996) and ME (P = 0.991) did not differ between groups 1 and 4. Association of self-reported pain and jaw function with masticatory function was observed in OS patients.

    CONCLUSION: OS was not associated with a negative impact on TMD. Jaw function and pain levels were similar to controls at the 24-month follow-up. Masticatory function was further affected by the surgery and seems to require a longer recovery time. Moreover, it was confirmed that pain and TMD were associated with limitations in jaw function and impacts on masticatory function.

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  • 41.
    Madhan, Sivaranjani
    et al.
    Aarhus Univ, Fac Hlth, Dept Dent & Oral Hlth, Sect Orthodont & Orofacial Pain & Jaw Funct, Aarhus, Denmark.;Univ Hosp Southern Denmark, Dept Oral Maxillofacial Surg, Esbjerg, Denmark.;Aarhus Univ, Fac Hlth, Dept Dent & Oral Hlth, Sect Orthodont, Vennelyst Blvd 9, DK-8000 Aarhus, Denmark..
    Nascimento, Gustavo G.
    Aarhus Univ, Fac Hlth, Dept Dent & Oral Hlth, Sect Periodontol, Aarhus, Denmark.;Duke NUS Med Sch, Natl Dent Res Inst Singapore, Singapore, Singapore..
    Ingerslev, Janne
    Univ Hosp Southern Denmark, Dept Oral & Maxillofacial Surg, Esbjerg, Denmark..
    Cornelis, Marie
    Univ Melbourne, Melbourne Dent Sch, Fac Med Dent & Hlth Sci, Melbourne, Vic, Australia..
    Pinholt, Else Marie
    Univ Hosp Southern Denmark, Dept Oral & Maxillofacial Surg, Esbjerg, Denmark.;Univ Southern Denmark, Inst Reg Hlth Res, Fac Hlth Sci, Odense, Denmark..
    Cattaneo, Paolo M.
    Univ Hosp Southern Denmark, Dept Oral & Maxillofacial Surg, Esbjerg, Denmark.;Univ Melbourne, Melbourne Dent Sch, Fac Med Dent & Hlth Sci, Melbourne, Vic, Australia..
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus Univ, Fac Hlth, Dept Dent & Oral Hlth, Sect Orofacial Pain & Jaw Funct, Aarhus, Denmark..
    Health-related quality of life, jaw function and sleep-disordered breathing among patients with dentofacial deformity2024In: Journal of Oral Rehabilitation, ISSN 0305-182X, Vol. 51, no 4, p. 684-694Article in journal (Refereed)
    Abstract [en]

    Background and ObjectivesPatients with dentofacial deformity (DFD) requiring orthognathic treatment have poor aesthetics, jaw function and psychological well-being, which potentially affect the quality of life. This study aimed to investigate the health-related general, oral and orthognathic quality of life, jaw function and sleep-disordered breathing at different stages of orthognathic surgical treatment.MethodsA total of 120 consecutive patients with DFD were recruited and grouped as pre-orthodontic treatment (group 1), pre-surgery (group 2), 4 months post-surgery (group 3), 24 months post-surgery (group 4) and in addition 30 controls without DFD (group 0). Outcomes were assessed using general health Short Form Survey (SF-36), Oral Health Impact (OHIP-14), Orthognathic Quality of Life Questionnaire (OQLQ), STOP-Bang and Jaw Function Limitation Scale (JFLS) questionnaires. In addition, presence or absence of pain was recorded. Data were tested with analysis of variance, Kruskal-Wallis test, Tukey post hoc test and structural equation modelling (SEM).ResultsResults revealed SF-36 (p = .814) and STOP-Bang (p = .143) total scores did not differ between control and treatment groups. In contrast, OHIP-14, OQLQ and JFLS total scores differed between groups (p = .001). Higher scores were observed in groups 1 (p = .001), 2 (p = .001) and 3 (p = .041) compared to group 0, indicating poor oral health in patients with DFD. Importantly, in group 4, oral health-related quality of life was better, and OHIP-14 (p = .936) and JFLS (p = .572) scores did not differ from controls. OQLQ scores of group 4 were significantly lower than group 1 (p = .001) but higher than group 0 (p = .013). SEM results revealed a significant negative associations of pain with JFLS and OQLQ; OHIP-14 with OQLQ; OHIP-14 with SF-36; and finally STOP-Bang with SF-36. Positive associations were observed between JFLS and OHIP-14; OHIP-14 and OQLQ.ConclusionOral health-related quality of life and jaw function appears to be improved 24 months after orthognathic surgery. Pain and limitation in jaw function had a negative association with health-related quality of life. Through structural modelling equation, we identified negative association of pain and limitation in jaw function with oral health, which further has negative effects on general health in patients with detofacial deformity. Our finding revealed significant decrease in OHIP-14, OQLQ and JFLS scores at 24 months follow-up indicate an improvement in oral health and limitation in jaw function after bimaxillary orthognathic surgery.image

  • 42.
    Manfredini, Daniele
    et al.
    Department of Biomedical Technologies, School of Dentistry University of Siena Siena Italy.
    Ahlberg, Jari
    Department of Oral and Maxillofacial, Diseases University of Helsinki Helsinki Finland.
    Aarab, Ghizlane
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands.
    Bender, Steven
    Department of Oral and Maxillofacial Surgery Texas A&amp;M School of Dentistry Dallas Texas USA.
    Bracci, Alessandro
    School of Dentistry University of Padova, Padova Italy.
    Cistulli, Peter A.
    Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia;Department of Respiratory &amp; Sleep Medicine Royal North Shore Hospital Sydney New South Wales Australia.
    Conti, Paulo Cesar
    Bauru School of Dentistry University of Sao Paulo Bauru Brazil.
    De Leeuw, Reny
    Department of Oral Health Science, Orofacial Pain Center, College of Dentistry University of Kentucky Lexington Kentucky USA.
    Durham, Justin
    Newcastle University's School of Dental Sciences Newcastle UK.
    Emodi‐Perlman, Alona
    Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel.
    Ettlin, Dominik
    Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine University of Berne Berne Switzerland.
    Gallo, Luigi M.
    Clinic of Masticatory Disorders, Center of Dental Medicine University of Zurich Zurich Switzerland.
    Häggman-Henrikson, Birgitta
    Malmö University, Faculty of Odontology (OD).
    Hublin, Christer
    Finnish Institute of Occupational Health Helsinki Finland.
    Kato, Takafumi
    Department of Oral Physiology Osaka University Graduate School of Dentistry Suita Japan.
    Klasser, Gary
    Department of Diagnostic Sciences Louisiana State University School of Dentistry New Orleans Louisiana USA.
    Koutris, Michail
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands.
    Lavigne, Gilles J.
    Faculty of Dental Medicine Universite de Montréal Quebec Montréal Canada.
    Paesani, Daniel
    School of Dentistry University of Salvador/AOA Buenos Aires Argentina.
    Peroz, Ingrid
    Department for Prosthodontics, Gerodontology and Craniomandibular Disorders, Charité Centre for Oral Sciences Charité ‐ University Medicine of Berlin Berlin Germany.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health Aarhus University Aarhus Denmark.
    Wetselaar, Peter
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands.
    Lobbezoo, Frank
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands.
    Standardised Tool for the Assessment of Bruxism2024In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 51, no 1, p. 29-58Article, review/survey (Refereed)
    Abstract [en]

    Objective: This paper aims to present and describe the Standardised Tool for the Assessment of Bruxism (STAB), an instrument that was developed to provide a multidimensional evaluation of bruxism status, comorbid conditions, aetiology and consequences.

    Methods: The rationale for creating the tool and the road map that led to the selection of items included in the STAB has been discussed in previous publications.

    Results: The tool consists of two axes, specifically dedicated to the evaluation of bruxism status and consequences (Axis A) and of bruxism risk and etiological factors and comorbid conditions (Axis B). The tool includes 14 domains, accounting for a total of 66 items. Axis A includes the self-reported information on bruxism status and possible consequences (subject-based report) together with the clinical (examiner report) and instrumental (technology report) assessment. The Subject-Based Assessment (SBA) includes domains on Sleep Bruxism (A1), Awake Bruxism (A2) and Patient's Complaints (A3), with information based on patients' self-report. The Clinically Based Assessment (CBA) includes domains on Joints and Muscles (A4), Intra- and Extra-Oral Tissues (A5) and Teeth and Restorations (A6), based on information collected by an examiner. The Instrumentally Based Assessment (IBA) includes domains on Sleep Bruxism (A7), Awake Bruxism (A8) and the use of Additional Instruments (A9), based on the information gathered with the use of technological devices. Axis B includes the self-reported information (subject-based report) on factors and conditions that may have an etiological or comorbid association with bruxism. It includes domains on Psychosocial Assessment (B1), Concurrent Sleep-related Conditions Assessment (B2), Concurrent Non-Sleep Conditions Assessment (B3), Prescribed Medications and Use of Substances Assessment (B4) and Additional Factors Assessment (B5). As a rule, whenever possible, existing instruments, either in full or partial form (i.e. specific subscales), are included. A user's guide for scoring the different items is also provided to ease administration.

    Conclusions: The instrument is now ready for on-field testing and further refinement. It can be anticipated that it will help in collecting data on bruxism in such a comprehensive way to have an impact on several clinical and research fields.

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  • 43.
    Manfredini, Daniele
    et al.
    Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy..
    Ahlberg, Jari
    Department of Oral and Maxillofacial, Diseases, University of Helsinki, Helsinki, Finland..
    Aarab, Ghizlane
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands..
    Bracci, Alessandro
    School of Dentistry, University of Padova, Padova, Italy..
    Durham, Justin
    Newcastle University's School of Dental Sciences, Newcastle, UK..
    Emodi-Perlman, Alona
    Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel..
    Ettlin, Dominik
    Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Berne, Berne, Switzerland..
    Gallo, Luigi M
    Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Zurich, Switzerland..
    Häggman-Henrikson, Birgitta
    Malmö University, Faculty of Odontology (OD). Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå, Umeå, Sweden..
    Koutris, Michail
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands..
    Peroz, Ingrid
    Department for Prosthodontics, Charité-University Medicine of Berlin, Charité Centre for Dentistry, Gerodontology and Craniomandibular Disorders, Berlin, Germany..
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark..
    Wetselaar, Peter
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands..
    Lobbezoo, Frank
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands..
    The development of the Standardised Tool for the Assessment of Bruxism (STAB): An international road map.2024In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 51, no 1, p. 15-28Article, review/survey (Refereed)
    Abstract [en]

    This paper summarises the background reasoning and work that led to the selection of the items included in the Standardised Tool for the Assessment of Bruxism (STAB), also introducing the list of items. The instrument is currently being tested for face validity and on-field comprehension. The underlying premise is that the different motor activities included in the bruxism spectrum (e.g. clenching vs. grinding, with or without teeth contact) potentially need to be discriminated from each other, based on their purportedly different aetiology, comorbidities and potential consequences. Focus should be on a valid impression of the activities' frequency, intensity and duration. The methods that can be used for the above purposes can be grouped into strategies that collect information from the patient's history (subject-based), from the clinical assessment performed by an examiner (clinically based) or from the use of instruments to measure certain outcomes (instrumentally based). The three strategies can apply to all aspects of bruxism (i.e. status, comorbid conditions, aetiology and consequences). The STAB will help gathering information on many aspects, factors and conditions that are currently poorly investigated in the field of bruxism. To this purpose, it is divided into two axes. Axis A includes the self-reported information on bruxism status and potential consequences (subject-based report) together with the clinical (examiner report) and instrumental assessment (technology report). Axis B includes the self-reported information (subject-based report) on factors and conditions that may have an etiological or comorbid role for bruxism. This comprehensive multidimensional assessment system will allow building predictive model for clinical and research purposes.

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  • 44.
    Manfredini, Daniele
    et al.
    Department of Medical Biotechnologies, School of Dentistry, University of Siena, Siena, Italy.
    Ahlberg, Jari
    Department of Oral and Maxillofacial, Diseases, University of Helsinki, Helsinki, Finland.
    Lavigne, Gilles J
    Faculty of Dental Medicine, Center for Advance Research in Sleep Medicine, Université de Montréal & CIUSSS Nord Ile de Montréal, Montréal, Québec, Canada.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
    Lobbezoo, Frank
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Five years after the 2018 consensus definitions of sleep and awake bruxism: An explanatory note2024In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 51, no 3, p. 623-624Article in journal (Other academic)
  • 45.
    Masuda, Manabu
    et al.
    Nihon University School of Dentistry at Matsudo, Japan.
    Hayakawa, Hidetoshi
    Nihon University School of Dentistry at Matsudo, Japan.
    Boudreau, Shellie Ann
    Aalborg University, Aalborg, Denmark.
    Iida, Takashi
    Nihon University School of Dentistry at Matsudo, Japan.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON).
    Komiyama, Osamu
    Nihon University School of Dentistry at Matsudo, Japan.
    Standardized palpation of the temporalis muscle evoke referred pain and sensations in individuals without TMD2022In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 26, p. 1241-1249Article in journal (Refereed)
    Abstract [en]

    Objectives This study aimed to determine if standardized palpations of the temporalis muscle evoke referred pain and/or sensations in individuals without TMD. Materials and methods This was a randomized, single-blinded study. The mechanical sensitivity of the right temporalis muscle was assessed in 32 participants without TMD with nine different stimulations to 15 test sites using palpometers (different stimulus intensities (0.5, 1.0, and 2.0 kg) and durations (2, 5, and 10 s). After each stimulus, participants were asked to score perceived pain intensity and intensity of unpleasantness on a 0-100 numeric rating scale as an indicator of mechanical sensitivity in the temporalis muscle and to indicate any areas of referred pain/sensations on a body chart. Results Pain intensity significantly differed between palpation durations, intensities, and test sites (P < 0.001). In contrast, unpleasantness significantly differed between palparation duration and intensities (P < 0.001), but not test sites. Participants more frequently reported referred pain/sensations evoked by the 10-s (34.4%) as opposed to the 2-s (6.3%) and 5-s (15.6%) palpation duration at the 2.0-kg stimulus intensity (P < 0.05). Conclusions Our present results indicate that referred pain/sensations in the orofacial region can be evoked by standardized palpation of the temporalis muscle and influenced by the palpation duration in individuals without TMD.

  • 46.
    Matsuzaki, Satoshi
    et al.
    Aarhus University, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON); Osaka Dental University, Japan.
    Shimada, Akiko
    Osaka Dental University, Japan.
    Tanaka, Junko
    Osaka Dental University, Japan.
    Kothari, Mohit
    Aarhus University, Denmark; JSS Academy of Higher Education and Research, Mysore, India.
    Castrillon, Eduardo
    Aarhus University, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON).
    Iida, Takashi
    Nihon University School of Dentistry at Matsudo, Japan.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus University, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON).
    Effect of mandibular advancement device on plasticity in corticomotor control of tongue and jaw muscles2021In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 17, no 9, p. 1805-1813Article in journal (Refereed)
    Abstract [en]

    STUDY OBJECTIVES: This study aims to investigate if the use of a mandibular advancement device (MAD) is associated with neuroplasticity in corticomotor control of tongue and jaw muscles.

    METHODS: Eighteen healthy individuals participated in a randomized crossover study with 3 conditions for 2 weeks each: baseline, wearing an oral appliance (OA: sham MAD) or MAD during sleep. The custom-made MAD was constructed by positioning the mandible to 50% of its maximal protrusion limit. Transcranial magnetic stimulation (TMS) was applied to elicit motor evoked potentials (MEPs). The MEPs were assessed by constructing stimulus-response curves at four stimulus intensities: 90%, 100%, 120%, and 160% of the motor threshold (MT) from the right tongue and right masseter, and the first dorsal interosseous muscles (FDI, control) at baseline, after the first and the second intervention.

    RESULTS: There was a significant effect of condition and stimulus intensity both on the tongue and as well as on masseter MEPs (P < 0.01). Tongue and masseter MEPs were significantly higher at 120% and 160% following the MAD compared to the OA (P < 0.05). There were no effects of condition on FDI MEPs (P = 0.855).

    CONCLUSIONS: The finding suggests that MAD induces neuroplasticity in the corticomotor pathway of the tongue and jaw muscles associated with the new jaw position. Further investigations are required in patients with obstructive sleep apnea (OSA) to see if this cortical neuroplasticity may contribute or perhaps predict treatment effects with MADs in OSA.

  • 47.
    May, Arne
    et al.
    Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Benoliel, Rafael
    Rutgers School of Dentistry, New Jersey, USA.
    Imamura, Yoshiki
    Department of Oral Medicine, School of Dentistry, Nihon University Tokyo, Tokyo, Japan.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Baad-Hansen, Lene
    Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
    Hoffmann, Jan
    Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK; Department of Neurology, King's College London, London, UK.
    Orofacial pain for clinicians: A review of constant and attack-like facial pain syndromes2023In: Cephalalgia, ISSN 0333-1024, E-ISSN 1468-2982, Vol. 43, no 8, article id 3331024231187160Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Primary headache syndromes such as migraine are among the most common neurological syndromes. Chronic facial pain syndromes of non-odontogenic cause are less well known to neurologists despite being highly disabling. Given the pain localization, these patients often consult dentists first who may conduct unnecessary dental interventions even if a dental cause is not identified. Once it becomes clear that dental modalities have no effect on the pain, patients may be referred to another dentist or orofacial pain specialist, and later to a neurologist. Unfortunately, neurologists are also often not familiar with chronic orofacial pain syndromes although they share the neural system, i.e., trigeminal nerve and central processing areas for headache disorders.

    CONCLUSION: In essence, three broad groups of orofacial pain patients are important for clinicians: (i) Attack-like orofacial pain conditions, which encompass neuralgias of the cranial nerves and less well-known facial variants of primary headache syndromes; (ii) persistent orofacial pain disorders, including neuropathic pain and persistent idiopathic facial/dentoalveolar pain; and (iii) other differential diagnostically relevant orofacial pain conditions encountered by clinicians such as painful temporomandibular disorders, bruxism, sinus pain, dental pain, and others which may interfere (trigger) and overlap with headache. It is rewarding to know and recognize the clinical picture of these facial pain syndromes, given that, just like for headache, an internationally accepted classification system has been published and many of these syndromes can be treated with medications generally used by neurologists for other pain syndromes.

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  • 48.
    Moriguchi, Daisuke
    et al.
    Osaka University Graduate School of Dentistry, Japan.
    Ishigaki, Shoichi
    Osaka University Graduate School of Dentistry, Japan.
    Lin, Xiaoyu
    Osaka University Graduate School of Dentistry, Japan.
    Kuyama, Kotaro
    Osaka University Graduate School of Dentistry, Japan.
    Koishi, Yukiko
    Osaka University Graduate School of Dentistry, Japan.
    Takaoka, Ryota
    Osaka University Graduate School of Dentistry, Japan.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus University, Aarhus, Denmark.
    Yatani, Hirofumi
    Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, 1-8, Yamadaoka, Suita, Osaka, 565-0871, Japan.
    Clinical identification of the stimulus intensity to measure temporal summation of second pain2022In: Scientific Reports, E-ISSN 2045-2322, Vol. 12, no 1, article id 12915Article in journal (Refereed)
    Abstract [en]

    Temporal summation of second pain (TSSP) has been suggested as a psychophysical index for central sensitization, one of the critical mechanisms in the chronification of pain. However, there is no gold standard for protocols to measure TSSP. The purpose was to establish the stimulus intensity for measuring TSSP. Female patients with chronic myofascial temporomandibular disorders pain (n = 16) and healthy female volunteers with no pain (n = 15) participated. Pain thresholds (PT °C) were measured, and repetitive heat stimuli at three stimulus intensities (PT °C, PT + 1 °C, PT + 2 °C) were applied. TSSP parameters were quantified as TSSP magnitude (TSm) and TSSP frequency (TSf). In healthy female volunteers, pain ratings significantly decreased at PT °C (p < 0.050), besides TSm and TSf at PT + 2 °C were significantly higher than those at PT °C (p < 0.025). In chronic pain patients, pain ratings significantly increased at PT + 1 °C and PT + 2 °C (p < 0.050). At PT + 2 °C, TSm and TSf in chronic pain patients were significantly higher than those in healthy volunteers (p < 0.050). It could be helpful to measure TSSP with the stimulus intensity adjusted individually to the patient’s pain thresholds + 2 °C for assessing central sensitization.

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  • 49.
    Nilsson, Ing-Marie
    et al.
    Malmö University, Faculty of Odontology (OD). Center for Oral Rehabilitation, FTV Östergötland, Norrköping, Sweden.
    Ekberg, EwaCarin
    Malmö University, Faculty of Odontology (OD).
    Michelotti, Ambrosina
    School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy.
    Al-Khotani, Amal
    Dental Department, East Jeddah Hospital, Ministry of Health, Jeddah, Saudi Arabia.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD). Dental Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Conti, Paulo Cesar Rodrigues
    Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, Brazil; Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.
    Durham, Justin
    Newcastle School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
    Goulet, Jean-Paul
    Faculty of Dental Medicine, Laval University, Quebec, Canada.
    Hirsch, Christian
    Clinic of Pediatric Dentistry, University of Leipzig, Leipzig, Germany.
    Kalaykova, Stanimira
    Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
    Kapos, Flavia P
    Center for Child Health, Behavior and Development, Seattle Children's Research Institute , Seattle, Washington, USA.
    King, Christopher D
    Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
    Komiyama, Osamu
    Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, Japan.
    Michail, Koutris
    Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    List, Thomas
    Malmö University, Faculty of Odontology (OD).
    Lobbezoo, Frank
    Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Ohrbach, Richard
    Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA.
    Palermo, Tonya M
    Center for Child Health, Behavior and Development, Seattle Children's Research Institute , Seattle, Washington, USA; Department of Anesthesiology and Pain Medicine, University of Washington School of MedicineSeattle, Washington, USA .
    Peck, Christopher C
    Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
    Penlington, Chris
    Newcastle School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
    Restrepo, Claudia
    CES-LPH Research Group, Universidad CES, Medellin, Colombia.
    Rodrigues, Maria Joao
    Institute for Occlusion and Orofacial Pain, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
    Sharma, Sonia
    Malmö University, Faculty of Odontology (OD).
    Svensson, Peter
    Section for Orofacial Pain and Jaw Function, School of Dentistry and Oral Health, Aarhus, Denmark.
    Visscher, Corine
    Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Wahlund, Kerstin
    Department of Orofacial Pain and Jaw Function, Kalmar County Hospital, Kalmar, Sweden.
    Rongo, Roberto
    School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy.
    Diagnostic Criteria for Temporomandibular Disorders - INfORM recommendations: Comprehensive and short-form adaptations for children2023In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 50, no 2, p. 99-112Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) are used worldwide in adults. Until now, no adaptation for use in children has been proposed.

    OBJECTIVE: To present comprehensive and short-form adaptations of Axis I and II of the DC/TMD for adults that are appropriate for use with children in clinical and research settings.

    METHODS: Global Delphi studies with experts in TMDs and in pain psychology identified ways of adapting the DC/TMD for children.

    RESULTS: The proposed adaptation is suitable for children aged 6-9 years. Proposed changes in Axis I include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for children, (ii) adding a general health questionnaire for children and one for their parents, (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire, and (iv) modifying the clinical examination protocol. Proposed changes in Axis II include (i) for the Graded Chronic Pain Scale, to be developmentally appropriate for children, and (ii) adding anxiety and depression assessments that have been validated in children, and (iii) adding three constructs (stress, catastrophizing, and sleep disorders) to assess psychosocial functioning in children.

    CONCLUSION: The recommended DC/TMD, including Axis I and Axis II, for children aged 6-9 years, is appropriate for use in clinical and research settings. This adapted first version for children includes changes in Axis I and Axis II changes requiring reliability and validity testing in international settings. Official translations to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

  • 50.
    Pigg, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Baad-Hansen, Lene
    Aarhus universitet, Danmark; Scandinavian Center for Orofacial Neurosciences (SCON).
    Svensson, Peter
    Aarhus universitet, Danmark; Scandinavian Center for Orofacial Neurosciences (SCON).
    Skjelbred, Per
    Oslo universitetssykehus, Norge.
    Larheim, Tore A
    Universitetet i Oslo, Norge.
    Neuropatisk orofacial smärta: diagnostik och hantering2015In: Tandläkartidningen, ISSN 0039-6982, Vol. 107, no 3, p. 56-62Article, review/survey (Refereed)
    Abstract [en]

    In addition to patients with the more familiar and common orofacial pain conditions, the dentist will occasionally encounter patients with neuropathic pain. The article describes and explains the clinical presentation of neuropathic pain and gives an overview of painful conditions in the trigeminal region attributed to neuropathic causes with a varying degree of certainty. Aetiology, pain mechanisms, prevalence, diagnosis, evidence-based management and prognosis are reviewed, with the aim to enable the dentist to recognize and diagnose neuropathic pain, thereby facilitating correct management.

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