Nevin Manimala

J Oral Facial Pain Headache. 2025 Sep;39(3):105-112. doi: 10.22514/jofph.2025.052. Epub 2025 Sep 12.

ABSTRACT

BACKGROUND: Temporomandibular disorders (TMD) encompass musculoskeletal and neuromuscular conditions affecting the temporomandibular joint (TMJ), masticatory muscles and other associated structures. While all dentists, regardless of their specialty, should possess a comprehensive understanding of TMD diagnosis and treatment, there is a limited number of studies assessing the knowledge and attitudes of pediatric dentists on this subject. The objective was to evaluate the knowledge and attitudes of pediatric dentists regarding the diagnosis and management of TMD in pediatric patients.

METHODS: This observational, analytical, cross-sectional study included 266 pediatric dentists who completed a 41-item questionnaire. Of these, 35 items assessed knowledge, while six evaluated attitudes. Descriptive statistics were analysed, and the chi-square test was applied for comparisons, with statistical significance set at p < 0.05.

RESULTS: The mean correct response rate across the four assessed domains was 49.5%. The lowest accuracy was observed in the pathophysiological domain (33%), followed by the psychophysiological domain (50%), the psychiatric disorders domain (64.1%) and the chronic pain domain (50.4%).

CONCLUSIONS: Pediatric dentists exhibited limited knowledge of TMD but expressed positive attitudes toward its diagnosis and treatment. Morever, they demonstrated a lack of awareness regarding their role in preventive education on this condition.

PMID:41070571 | DOI:10.22514/jofph.2025.052

J Oral Facial Pain Headache. 2025 Sep;39(3):77-83. doi: 10.22514/jofph.2025.049. Epub 2025 Sep 12.

ABSTRACT

BACKGROUND: Restrictive lingual frenula, commonly referred to as ankyloglossia, are well documented in pediatric literature, with established impacts on breastfeeding, swallowing, reflux, speech, maxillary development, breathing, and sleep in children. However, data on its effects in adolescents and adults remains limited. This study aimed to investigate the correlation between restrictive lingual frenula and the development of temporomandibular disorders (TMD) in an adult population.

METHODS: A total of 129 patients (aged 18-80 years; 41 males and 88 females) were assessed for TMD signs and symptoms using the three Lövgren screening questions, supplemented by a clinical examination following the German Association for Craniomandibular Function and Diagnostics (DGFDT) screening protocol. The presence and severity of ankyloglossia were evaluated using the Tongue Range of Motion Ratio (TRMR 2019) and Kotlow’s free tongue classification. Association between variables were analyzed using Chi-square tests.

RESULTS: TMD was identified in 49.1% of the cohort, while ankyloglossia was observed in 46.7% based on the TRMR. No significant association was found between TMD and either anterior (39.6%) or posterior (34.9%) tongue restriction using the TRMR criteria. However, when categorized according to Kotlow’s classification, mild to severe ankyloglossia (59.2%) showed a statistically significant association with TMD (p = 0.026). Age and sex were not significantly associated with the presence of ankyloglosson, while TMD occurrence was found to be correlated with sex.

CONCLUSIONS: A weak but significant correlation was observed between TMD and the degree of ankyloglossia, particularly when assessed using Kotlow’s method. Further studies with larger sample sizes, stratified by age and sex, incorporating occlusal factors, and employing a standardized validated assessment tool adapted for adults, accounting for both anatomical and functional criteria are warranted to explore potential causal relationships.

PMID:41070568 | DOI:10.22514/jofph.2025.049

J Oral Facial Pain Headache. 2025 Sep;39(3):13-26. doi: 10.22514/jofph.2025.043. Epub 2025 Sep 12.

ABSTRACT

Migraine is a primary headache disorder affecting about 14% of the global population. The knowledge about migraine pathophysiology is increasing constantly; however, there are still many unknowns and uncertainties. Intestinal microbiota builds the gut environment together with metabolites and the immune system. Its connections with disorders outside the digestive system have been described, mainly neuropsychiatric diseases, due to the existence of the microbiota-gut-brain axis. Therefore, it is suggested that migraine is also correlated with changes in the microbiome. The review aimed to summarize the available literature related to the topic. We performed an electronic article search through the Embase Database and PubMed Database, and included 14 articles after analysis under the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Subsequently, a meta-analysis of randomized controlled clinical trials summarizing probiotics’ effect on migraine prevention was conducted based on the same guidelines and resulted in including 2 adequate trials. Microbiome alterations have been observed in migraine patients with an influence on clinical presentation. Preclinical studies suggested a direct connection between migraine and microbiome changes. The meta-analysis has shown the influence of probiotics on migraine frequency (p = 0.003; Hedges’ g = 1.22; standard error (SE) = 0.41), and no impact on migraine severity (p = 0.069; Hedges’ g = 1.10; SE = 0.61) and attacks’ duration (p = 0.149; Hedges’ g = 0.18; SE = 0.15). However, the former was close to the statistical significance. The following work demonstrates a correlation between migraine and microbiome, which has a putative positive impact on migraine management. Moreover, probiotic supplementation can alleviate migraine symptoms. However, the main limitation is the limited number of studies, together with high heterogeneity and limited methodological consistency in the meta-analysis.

PMID:41070562 | DOI:10.22514/jofph.2025.043

Mov Disord. 2025 Oct 10. doi: 10.1002/mds.70084. Online ahead of print.

ABSTRACT

BACKGROUND: Friedreich’s ataxia is a rare, neurodegenerative, multisystem disorder. While ataxia is a hallmark, non-ataxia signs, including muscle weakness, spasticity, and dysphagia are equally disabling. The Inventory of Non-Ataxia Signs (INAS) is a symptom list transformable to a 16-item count.

OBJECTIVE: To evaluate the responsiveness of a modified INAS in this population.

METHODS: Participants were drawn from the European Friedreich’s Ataxia Consortium for Translational Studies (EFACTS). The modified INAS count (presence/absence, 0-16 scale) and modified INAS sum (severity-weighted, 0-84 scale) were evaluated using linear mixed-models and standardized response means (SRMs). Items rare (<5%) and uncharacteristic in Friedreich’s ataxia were excluded (chorea, myoclonus, fasciculations, resting tremor, rigidity) RESULTS: A total of 1129 participants (mean age, 32.3 years) were assessed for up to 12 years. The mean modified INAS count was 4.6 (±2.2) and modified INAS sum 15.1 (± 9.9). Both correlated strongly with existing outcome measures. Longitudinally, the modified INAS count increased by 0.13 points/year (95% CI 0.12, 0.14; P < 0.001) and modified INAS sum by 0.68 points/year (95% CI 0.64, 0.72; P < 0.001). The modified INAS sum demonstrated greater responsiveness, with SRMs of 0.26, 0.38, 0.53, and 0.80 at 1, 2, 3, and 5 years, respectively, compared with 0.16, 0.27, 0.31, and 0.46 for the modified INAS count. In non-ambulatory patients and children, responsiveness of the modified INAS sum was higher (SRM 0.82 and 1.7 at 5 years, respectively).

CONCLUSIONS: The modified INAS sum showed good responsiveness over 5 years but not over 1-3 years. It may supplement existing outcome measures, contributing to holistic assessment of this multisystem disease, especially in non-ambulatory patients, in whom ataxia-focused measures may show ceiling effects, and children, who typically progress faster. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

PMID:41070559 | DOI:10.1002/mds.70084

J Oral Facial Pain Headache. 2025 Jun;39(2):202-209. doi: 10.22514/jofph.2025.039. Epub 2025 Jun 12.

ABSTRACT

BACKGROUND: This study investigated how cumulative lifetime stress, as measured by the Stress and Adversity Inventory (STRAIN) scale, relates to salivary cortisol levels in temporomandibular disorders (TMD) patients compared to controls. Furthermore, to determine which specific lifetime stress domains are the strongest predictors of TMD.

METHODS: The study was conducted with 110 participants (55 TMDs patients, 55 controls). Lifetime stress was assessed using the STRAIN questionnaire, and salivary cortisol levels were measured at two time points (7 AM and 10 AM) using Enzyme-Linked Immunosorbent Assay (ELISA). Statistical analyses included t-tests, Analysis of variance (ANOVA) and multiple regression to identify significant stress predictors for TMD.

RESULTS: The TMDs patients had significantly higher stress scores (11.10 ± 3.26) compared to the controls (1.43 ± 0.99) (p = 0.001). Myalgia showed highest stress levels (11.69 ± 3.72), while patients with myofascial pain had the lowest (8.80 ± 1.14) (p = 0.043). Cortisol levels were highest in the of disc displacement without reduction with limited mouth opening (DDWoR with LO) group (82.49 ± 124.34) and lowest in myalgia patients (4.69 ± 3.90) (p = 0.001). Significant stress predictors for TMDs included relationship stress (p = 0.04), humiliation (p = 0.02), marital/partner stress (p < 0.001) and death-related stress (p = 0.01).

CONCLUSIONS: TMDs patients experience significantly higher lifetime stress and cortisol levels than controls. Myalgia patients showed a complex psychological and physiological stress link, whereas the DDWoR with LO subgroup exhibited a distinct physiological stress response. Specific life stressors, particularly relationship- and partner-related stress, are key predictors of TMDs. These findings reinforce the importance of a biopsychosocial approach in understanding and managing TMDs. Future research should focus on longitudinal and interventional studies to further elucidate causal mechanisms and effective therapeutic strategies.

PMID:41070548 | DOI:10.22514/jofph.2025.039

J Oral Facial Pain Headache. 2025 Jun;39(2):175-182. doi: 10.22514/jofph.2025.036. Epub 2025 Jun 12.

ABSTRACT

BACKGROUND: Masseter muscle hypertrophy is characterized by either symmetrical or asymmetrical enlargement of the muscle, often associated with bruxism and other parafunctional habits. Traditional methods for assessing muscle hypertrophy, such as palpation and visual inspection, can be subjective and heavily dependent on the clinician’s experience. In contrast, devices like MyotonPRO offer a standardized, objective and reproducible approach, enhancing the precision and reliability of clinical diagnostics. The primary aim of our study was to evaluate the intra- and inter-rater reliability of the MyotonPRO device in assessing the viscoelastic properties of the masseter muscle. Additionally, we sought to investigate the potential correlation between subjective assessments of masseter hypertrophy and objective measurements obtained through myotonometry.

METHODS: A clinical examination using muscle palpation was conducted to identify masseter hypertrophy, categorizing participants into Normal Muscle Volume (NMV) and Muscle Hypertrophy (MH) groups. The viscoelastic properties of their masseter muscles were then measured using MyotonPRO in both relaxed and maximal contraction states. Two experienced operators performed the myotonometry on the same day, with the first operator repeating the procedure 7 days later.

RESULTS: Among the 58 participants, 51.7% were female, with a mean age of 28.6 years. The inter-rater reliability of masseter muscle measurements using MyotonPRO ranged from moderate to excellent, both at rest and during contraction, while intra-rater reliability ranged from moderate to good. The MH group showed higher levels of tension and stiffness, along with reduced relaxation time and creep during contraction, compared to the NMV group. The only statistically significant difference in relaxation between the groups was observed in muscle elasticity.

CONCLUSIONS: The MyotonPRO device effectively detects statistically significant differences (p < 0.05) between the MH and NMV groups for certain viscoelastic parameters. However, these differences were primarily significant during contraction, with elasticity being the only parameter showing a significant difference in the relaxed state.

PMID:41070545 | DOI:10.22514/jofph.2025.036

J Oral Facial Pain Headache. 2025 Jun;39(2):124-136. doi: 10.22514/jofph.2025.031. Epub 2025 Jun 12.

ABSTRACT

BACKGROUND: Migraine is a chronic neurological disorder affecting over one billion individuals globally. It is a leading cause of disability, significantly impacting daily functioning, social relationships and work-related productivity. This study aims to explore the impact of migraine-related disability in everyday life in terms of missed days and productivity loss, as well as to identify work-related difficulties associated with migraine and the potential factors that exacerbate these difficulties.

METHODS: This cross-sectional study was conducted from October 2023 to June 2024, involving 604 adult patients with migraine in Greece, selected through a convenience sampling method. Data collected included socio-demographic and clinical information, obtained using two validated self-reported questionnaires: the Migraine Disability Assessment (MIDAS) and the HEADWORK questionnaire. Statistical analysis was performed using IBM SPSS (Version 20.0), and descriptive statistics, chi-square tests, t-tests and Spearman’s correlation were employed to evaluate the relationship between disability and work-related challenges.

RESULTS: The MIDAS score revealed a high level of disability, with 52.2% of participants classified in the Severe Disability grade. HEADWORK scores highlighted moderate-to-severe work-related difficulties, particularly concerning stress management and environmental factors such as noise and brightness. Females, patients experiencing migraine with aura, and individuals with chronic migraine exhibited higher MIDAS and HEADWORK scores.

CONCLUSIONS: This study reveals the substantial impact of migraine on professional productivity and social relationships, emphasizing challenges in work-related performance and daily activities. The findings underscore the need for workplace accommodations and targeted interventions to improve the quality of life of individuals with migraine.

PMID:41070540 | DOI:10.22514/jofph.2025.031

J Oral Facial Pain Headache. 2025 Jun;39(2):101-111. doi: 10.22514/jofph.2025.029. Epub 2025 Jun 12.

ABSTRACT

BACKGROUND: Temporomandibular disorder (TMD) is a prevalent condition associated with pain and dysfunction of the temporomandibular joint (TMJ) and surrounding structures. Sleep disturbances are common in TMD patients, yet the bidirectional causal relationship between specific sleep behaviors and TMD remains unclear. This study aimed to investigate this relationship using a two-sample Mendelian randomization (MR) approach.

METHODS: A bidirectional two-sample MR analysis was conducted using genome-wide association study (GWAS) summary statistics for seven sleep behaviors and TMD/TMD related pain (TMD-pain). Single nucleotide polymorphisms (SNPs) were used as instrumental variables. The analysis included data from the UK Biobank and FinnGen Consortium, focusing on individuals of European ancestry. Statistical methods included inverse variance weighting (IVW), MR-Egger regression and sensitivity analyses to ensure robust findings.

RESULTS: The analysis identified that genetically predicted “morning person” status reduced the risk of TMD (β: -0.173, p = 0.014), while longer sleep duration decreased the risk of TMD-pain (β: -0.382, p = 0.015). In reverse MR analysis, TMD-pain increased the risk of insomnia, obstructive sleep apnea (OSA) and sleep disorders (p < 0.05). No significant associations were found between other sleep behaviors and TMD or TMD-pain.

CONCLUSIONS: This study demonstrates a bidirectional relationship between sleep behaviors and TMD. Being a morning person and having longer sleep duration protect against TMD and TMD-pain, respectively, while TMD-pain increases the risk of certain sleep disorders. These findings highlight the importance of addressing sleep issues in TMD management.

PMID:41070538 | DOI:10.22514/jofph.2025.029

J Oral Facial Pain Headache. 2025 Jun;39(2):48-65. doi: 10.22514/jofph.2025.025. Epub 2025 Jun 12.

ABSTRACT

BACKGROUND: Understanding the global prevalence and characteristics of a given health problem is essential for sizing its global and regional burden, estimating treatment needs, prioritizing healthcare services, and formulating targeted policies. This systematic review and meta-analysis aimed to estimate the global prevalence of temporomandibular disorders (TMDs) by gender, age, and continent, and the prevalence of specific categories such as myalgia, arthralgia, clicking/joint sounds, and limited mouth opening.

METHODS: A comprehensive search was conducted across three databases-PubMed, Scopus and Web of Science and supplemented by manual search up to June 2024. TMD diagnoses were based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) or Diagnostic Criteria for Temporomandibular Disorders (DC/TMD).

RESULTS: The database search yielded 15,628 records, from which 27 studies involving 20,971 subjects, including 6075 diagnosed with TMDs, were selected for final analysis. All meta-analyses utilized a random effects model. It is estimated that nearly a third of the global population (29.5%) suffers from TMDs. TMDs affected females at a significantly higher rate compared to males (36.7% versus 26.7%), representing a 1.75-fold greater likelihood among females. Prevalence among individuals under 18 years of age is 38.5%, compared to 34.1% in those 18 and older. TMDs are most prevalent in Europe (33.8%), followed by Asia (27.9%) and South America (27.3%); the lowest prevalence was in North America (19.4%). The most frequently reported signs and symptoms of TMDs are myalgia (37.2%), clicking/joint sounds (29.8%), and arthralgia (16.8%), with limited mouth opening/locking being the least prevalent (8.1%).

CONCLUSIONS: TMDs represent a significant and largely unrecognized health burden. Although conducting further primary studies is urgent for confirmation, this current research underscores that TMDs might constitute a silent epidemic that has not garnered the urgent attention it deserves from healthcare providers, the local community, and researchers.

THE PROSPERO REGISTRATION: PROSPERO number is CRD42024583777.

PMID:41070533 | DOI:10.22514/jofph.2025.025

Turk Psikiyatri Derg. 2025;36:57. doi: 10.5080/u27671.

ABSTRACT

OBJECTIVE: The aim of this study was to compare cognitive flexibility and executive functions in adolescents diagnosed with social anxiety disorder (SAD) who have autistic traits with those who do not, and to investigate whether there is a significant difference compared to healthy controls.

METHOD: The study included 36 adolescents diagnosed with SAD and 36 healthy controls. All participants completed the Cognitive Flexibility Scale (CFS), and the Liebowitz Social Anxiety Scale was administered to the SAD group. Neuropsychological tests including the Stroop Test TBAG Form, the Wisconsin Card Sorting Test (WCST), Raven&rsquo;s Standard Progressive Matrices Test, and Visual-Auditory Digit Span Test-B were applied. Autistic traits were assessed using the Autism Spectrum Quotient-Adolescent&rsquo;s Version (AQ-Adolescent) and the Childhood Autism Rating Scale.

RESULTS: There was no statistically significant difference in CFS scores between the social anxiety disorder and control groups. The SAD group showed poorer performance in the subdomains of the WCST. Additionally, in all subtestes of the Stroop test, the SAD group took significantly longer to complete the test. The AQ-Adolescent scores were significantly higher in the SAD group compared to the controls. In 25% (n=9) of the cases, autistic traits were above the cutoff. There were no significant difference in neuropsychological test results between the groups who have and do not have autistic traits within the case group. A weak negative correlation was found between the Liebowitz total and avoidance subscale scores and the AQ-imagination and attention to detail scores, while no correlation was found between the Liebowitz dimensions and CFS scores.

CONCLUSION: This is the among the first studies to examine autistic traits and executive functions among adolescents with SAD. While no difference was found in cognitive flexibility scale scores between the SAD and control groups, the SAD group showed poorer performance in tests measuring other executive functions. However, this difference was not significantly influenced by the presence of autistic traits.

PMID:41070518 | DOI:10.5080/u27671