Tag: nevin manimala

J Oral Facial Pain Headache. 2025 Sep;39(3):163-171. doi: 10.22514/jofph.2025.058. Epub 2025 Sep 12.

ABSTRACT

BACKGROUND: Temporomandibular disorders (TMD) are common, particularly in females of reproductive age, but it remains unclear if TMD and female reproductive traits directly influence each other. Previous studies have suggested links between reproductive factors, such as the menstrual cycle and menopause, and TMD, yet any causal link is unconfirmed. This study seeks to delineate the reciprocal causal interplay between female reproductive traits and TMD.

METHODS: A bidirectional Mendelian randomization (MR) approach was applied to assess five reproductive traits-age at menarche, first sexual intercourse, first birth, last birth, and menopause-considering TMD as the outcome in one analysis and the exposure in the reverse. Statistical methods, including the inverse variance-weighted method, MR Egger, MR Pleiotropy Residual Sum and Outlier (MR-PRESSO), Cochran’s Q test, and leave-one-out analyses, were used to examine pleiotropy and heterogeneity.

RESULTS: Later age at first sexual intercourse (odds ratio (OR) = 0.51, 95% confidence intervals (CI) 0.37-0.71, p = 6.46 × 10^-5), first birth (OR = 0.86, 95% CI 0.78-0.95, p = 0.003), and last birth (OR = 0.37, 95% CI 0.17-0.78, p = 0.009) were identified to be protective against TMD. No significant associations emerged for age at menarche or menopause. However, TMD onset may contribute to delayed menarche (Beta = 0.04, 95% CI 0.01-0.06, p = 0.035) without affecting other reproductive traits.

CONCLUSIONS: Genetically determined later timing of first sexual intercourse, first birth, and last birth may protect against TMD, while TMD onset may delay menarche, suggesting a bidirectional relationship between reproductive timing and TMD.

PMID:41070577 | DOI:10.22514/jofph.2025.058

J Oral Facial Pain Headache. 2025 Sep;39(3):145-151. doi: 10.22514/jofph.2025.056. Epub 2025 Sep 12.

ABSTRACT

BACKGROUND: In everyday clinical practice, the screening of specific genes for awake bruxism (AB) is not a sustainable and feasible practice; most of the time, the only information that clinicians can rely on is investigating the family history of bruxism. Nevertheless, little is known about the relationship between the reported history and AB frequency. The aim of the present paper is to assess the existence of any differences in the frequency of self-reported AB behaviors between healthy young individuals with and without a positive report of family history of bruxism.

METHODS: Participants were recruited within the community of the University of Siena by advertising the possibility of taking part in the investigation through the academic website and mail. All the participants performed a seven-day monitoring of the frequency of self-reported AB via the ecological momentary assessment (EMA). Moreover, for the assessment of bruxism family history, participants were asked to fill out a short questionnaire taken from the Standardized Tool for the Assessment of Bruxism (STAB).

RESULTS: The final sample was composed of 117 individuals (32 males and 85 females, mean age 22.3 ± 2.3). Of the total amount of participants, 48.7% reported a positive family history of bruxism. The Mann-Whitney U test showed a statistically significant difference in the reported frequency of all AB behaviors (i.e., teeth contact, mandible bracing, teeth clenching, teeth grinding) between the two groups (p < 0.05). Conversely, no significant difference in the frequency of AB behaviors was present between individuals with a positive report of family history in first-degree relatives compared to second-degree relatives (p > 0.05).

CONCLUSIONS: Based on these findings, clinicians are recommended to not underestimate a positive family history of bruxism, as it can be an indicator of an ongoing AB.

PMID:41070575 | DOI:10.22514/jofph.2025.056

J Oral Facial Pain Headache. 2025 Sep;39(3):133-144. doi: 10.22514/jofph.2025.055. Epub 2025 Sep 12.

ABSTRACT

BACKGROUND: The study aimed to retrospectively evaluate the clinical efficacy of a computer-aided design/computer-aided manufacturing (CAD/CAM)-fabricated occlusal splint combined with manual therapy in patients diagnosed with anterior disc displacement without reduction (ADDwoR) of the temporomandibular joint (TMJ).

METHODS: The medical records of 65 adult patients with ADDwoR, treated between March 2022 and March 2023, were reviewed and allocated into three treatment groups based on the interventions they received, namely, occlusal splint therapy alone (n = 22), occlusal splint therapy combined with manual therapy (n = 22), or health education alone (n = 21). All participants received standardized health education. Clinical outcomes, including Maximum Mouth Opening (MMO), Visual Analog Scale (VAS) for pain, and the Mandibular Functional Impairment Questionnaire (MFIQ), were assessed at baseline and one and three months post-treatment by blinded evaluators. Statistical analyses were conducted using Python with Welch’s analysis of variance (ANOVA) and repeated measures ANOVA, and significance was set at p < 0.05.

RESULTS: The baseline demographic and clinical characteristics were similar among the three groups (all p > 0.05). At the three-month follow-up, no significant changes were observed in the health education group (p > 0.05). In contrast, both the occlusal splint group and the combined treatment group demonstrated significant improvements in MMO, VAS and MFIQ scores at both one and three months compared to baseline (all p < 0.05). Moreover, the combined treatment group showed significantly greater improvement in all measured outcomes than the splint-only group at each follow-up, with the most substantial differences observed at the three-month follow-up (all p < 0.05).

CONCLUSIONS: This short-term non-randomized retrospective study suggests that combining CAD/CAM-fabricated occlusal splint therapy with manual therapy yielded superior pain relief and functional improvement compared to splint therapy alone or health education in patients with ADDwoR.

PMID:41070574 | DOI:10.22514/jofph.2025.055

J Oral Facial Pain Headache. 2025 Sep;39(3):113-120. doi: 10.22514/jofph.2025.053. Epub 2025 Sep 12.

ABSTRACT

BACKGROUND: Burning mouth syndrome (BMS) is a chronic pain disorder affecting the oral mucosa, often accompanied by psychological comorbidities. Higher levels of mindfulness have been associated with reduced pain and fewer emotional symptoms in some chronic pain conditions, but its role in BMS remains inadequately explored.

METHODS: 146 patients diagnosed with BMS, according to the International Classification of Orofacial Pain, 1st edition, were recruited from the Department of Oral Medicine at a stomatology hospital. Mindfulness, pain intensity and psychological symptoms were assessed using the Five Facet Mindfulness Questionnaire, visual analog scale, and self-report screening tools, respectively. Spearman’s correlation and multiple regression analyses were conducted to evaluate the relationships between mindfulness and levels of pain, anxiety, and depression.

RESULTS: Mindfulness showed significant negative correlations with pain (r = -0.204, p < 0.05), anxiety (r = -0.309, p < 0.01), and depression (r = -0.299, p < 0.01). After controlling for confounding variables, higher overall mindfulness remained significantly associated with lower pain intensity (β = -0.268, p < 0.05), although the associations with anxiety and depression were no longer statistically significant (p > 0.05). Among the mindfulness facets, higher scores on the “describing” facet were associated with reduced pain intensity (β = -0.231, p < 0.05). Additionally, higher scores on the “non-judging” (Odds Ratio (OR) = 0.871, p < 0.05) and “non-reactivity” (OR = 0.869, p < 0.05) facets were associated with fewer anxiety symptoms, while the “acting-with-awareness” facet was significantly associated with fewer depressive symptoms (OR = 0.869, p < 0.05).

CONCLUSIONS: The overall mindfulness level and the “describing” facet appear to be associated with pain severity, whereas the “non-judging” and “non-reactivity” facets are related to anxiety symptoms, and the “acting-with-awareness” facet is linked to depressive symptoms, suggesting that mindfulness-based interventions may offer a beneficial approach in the management of BMS.

PMID:41070572 | DOI:10.22514/jofph.2025.053

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