| 1. |
- Durham, Justin, et al.
(författare)
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Constructing the brief diagnostic criteria for temporomandibular disorders (bDC/TMD) for field testing
- 2024
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842. ; 51:5, s. 785-794
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 2. |
- Ekberg, EwaCarin, et al.
(författare)
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Diagnostic Criteria for Temporomandibular Disorders - INfORM recommendations : Comprehensive and short-form adaptations for adolescents.
- 2023
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842. ; 50:11, s. 1167-1180
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Tidskriftsartikel (refereegranskat)abstract
- 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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| 3. |
- Exposto, Fernando G, et al.
(författare)
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Location of mechanically-evoked referred sensations within the trigeminal region are not altered following a heterotopic painful stimulus.
- 2022
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Ingår i: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- 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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| 4. |
- Kothari, Simple Futarmal, et al.
(författare)
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Painful and non-painful symptoms evoked by experimental bracing and thrusting of the mandible in healthy individuals
- 2021
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 48:9, s. 1004-1012
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 5. |
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| 6. |
- Manfredini, Daniele, et al.
(författare)
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Standardised Tool for the Assessment of Bruxism
- 2024
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 51:1, s. 29-58
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Forskningsöversikt (refereegranskat)abstract
- 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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| 7. |
- Manfredini, Daniele, et al.
(författare)
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The development of the Standardised Tool for the Assessment of Bruxism (STAB) : an international road map
- 2024
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 51:1, s. 15-28
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Forskningsöversikt (refereegranskat)abstract
- 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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| 8. |
- Nilsson, Ing-Marie, et al.
(författare)
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Diagnostic Criteria for Temporomandibular Disorders - INfORM recommendations : Comprehensive and short-form adaptations for children
- 2023
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 50:2, s. 99-112
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 9. |
- Pillai, Rajath Sasidharan, et al.
(författare)
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Feasibility and reliability of intraorally evoked "nociceptive-specific" blink reflexes
- 2020
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Ingår i: Clinical Oral Investigations. - : Springer. - 1432-6981 .- 1436-3771. ; 24, s. 883-896
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The “nociceptive-specific” blink reflex (nBR) evoked by extraoral stimulation has been used to assess trigeminal nociceptive processing in patients with trigeminal nerve damage regardless of the site of damage. This study aimed to test the feasibility of nBR elicited by intraoral stimulation, compare intraoral and extraoral nBR and assess the intrarater and interrater reliability of the intraoral nBR for the maxillary (V2) and mandibular (V3) branches of the trigeminal nerve. Materials and methods: In 17 healthy participants, nBR was elicited by stimulation of two extraoral and two intraoral sites by two operators and repeated intraorally by one operator. Main outcome variables were intraoral stimulus-evoked pain scores and nBR R2 responses at different stimulus intensities. Intraclass correlation coefficients (ICC) were used to assess reliability. Results: Dependent on the stimulus intensity, intraoral stimulation evoked R2 responses in up to 12/17 (70.6%) participants for V2 and up to 8/17 (47.1%) participants for V3. Pain scores (p < 0.003) and R2 responses (p < 0.004) increased with increasing intensities for V2, but not V3. The R2 responses were significantly smaller with intraoral stimulation compared to extraoral stimulation (p < 0.014). Overall, ICCs were fair to excellent for V2 but poor for V3. Conclusion: Intraorally evoked nBR was feasible in a subset of healthy participants and was less responsive than nBR with extraoral stimulation. The V2 nBR showed better reliability than V3. Clinical relevance: The nBR can be used to assess nerve damage to the maxillary intraoral regions, though other measures may need to be considered for the mandibular intraoral regions.
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| 10. |
- Rongo, Roberto, et al.
(författare)
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Diagnostic criteria for temporomandibular disorders (DC/TMD) for children and adolescents : An international Delphi study—Part 1‐Development of Axis I
- 2021
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 48:7, s. 836-845
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To develop new instruments and to adapt the diagnostic criteria for temporomandibular disorders (DC/TMD) for the evaluation of TMD in children and adolescents.METHOD: A modified Delphi method was used to seek international consensus among TMD experts. Fourteen clinicians and researchers in the field of orofacial pain and TMD worldwide were invited to participate in a workshop initiated by the International Network for Orofacial Pain and Related Disorders Methodology (INfORM scientific network) at the General Session of the International Association for Dental Research (IADR, London 2018), as the first step in the Delphi process. Participants discussed the protocols required to make physical diagnoses included in the Axis I of the DC/TMD. Thereafter, nine experts in the field were added, and the first Delphi round was created. This survey included 60 statements for Axis I, and the experts were asked to respond to each statement on a five-item Likert scale ranging from "Strongly disagree" to "Strongly agree". Consensus level was set at 80% agreement for the first round, and at 70% for the next.RESULTS: After three rounds of the Delphi process, a consensus among TMD experts was achieved and two adapted DC/TMD protocols for Axis I physical diagnoses for children and adolescents were developed.CONCLUSION: Through international consensus among TMD experts, this study adapted the Axis I of the DC/TMD for use in evaluating TMD in children and adolescents.
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| 11. |
- Rongo, Roberto, et al.
(författare)
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Diagnostic criteria for temporomandibular disorders in children and adolescents: An international Delphi study-Part 2-Development of Axis II
- 2022
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Ingår i: Journal of Oral Rehabilitation. - : WILEY. - 1365-2842 .- 0305-182X. ; 49:5, s. 541-552
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Tidskriftsartikel (refereegranskat)abstract
- Background Unlike the psychosocial assessment established for adults in the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), a standardised psychosocial assessment for children and adolescents with TMD complaints has not yet been established. Objectives To develop a new standardised instrument set to assess the psychosocial functioning in children and adolescents by adapting the psychosocial status and pain-related disability (Axis II) of the adult DC/TMD and by including new instruments. Methods A modified Delphi method was used to survey 23 international TMD experts and four international experts in pain-related psychological factors for consensus regarding assessment tools for psychosocial functioning and pain-related disability in children and adolescents. The TMD experts reviewed 29 Axis II statements at round 1, 13 at round 2 and 2 at round 3. Agreement was set at 80% for first-round consensus level and 70% for each of the second and third rounds. The psychological experts completed a complementary Delphi survey to reach a consensus on tools to use to assess more complex psychological domains in children and adolescents. For the psychological experts, the first round included 10 open-ended questions on preferred screening tools for depression, anxiety, catastrophising, sleep problems and stress in children (ages 6-9 years old) and adolescents (ages 10-19 years old) as well as on other domains suggested for investigation. In the second round, the psychological experts received a 9-item questionnaire to prioritise the suggested instruments from most to least recommended. Results The TMD experts, after three Delphi rounds, reached consensus on the changes of DC/TMD to create a form to evaluate Axis II in children and adolescents with TMD complaints. The psychological experts added tools to assess depression and anxiety, sleep disorders, catastrophising, stress and resilience. Conclusion Through international expert consensus, this study adapted Axis II of the adult DC/TMD to assess psychosocial functioning and pain-related disability in children and adolescents. The adapted Axis II protocols will be validated in the target populations.
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| 12. |
- Zhang, Yuanxiu, et al.
(författare)
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Comparison of Pain-Generated Functional Outcomes in Experimental Models of Delayed-Onset Muscle Soreness and Nerve Growth Factor Injection of the Masticatory Muscles
- 2020
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Ingår i: The Journal of Oral & Facial Pain and Headache. - : Quintessence. - 2333-0384 .- 2333-0376. ; 34:4, s. 311-322
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To compare two pain models of myalgic TMD, delayed-onset muscle soreness (DOMS) and injections of nerve growth factor (NGF), in terms of pain-related and motor function outcomes, as well as activity-related temporal summation. Methods: Fifty age- and gender-matched healthy participants were recruited and randomized into one of three groups: to a repeated eccentric contraction task to cause DOMS (n = 20), to receive NGF injections into the masseter muscle (n = 20), or to a control group (n = 10). Mechanical sensitivity of masticatory muscles, chewing parameters, jaw function limitation, maximum bite force, and activity-related temporal summation were assessed at baseline and at days 1, 2, and 7 following the intervention. Results: Compared to baseline, both model groups showed increased mechanical sensitivity, jaw function limitation, pain on chewing, and decreased chewing efficiency, lasting longer in the NGF group than in the DOMS group (P < .05). Furthermore, also compared to baseline, the NGF group showed increased pain on maximum bite and decreased pain-free maximum opening (P < .05). No increases in activity-related temporal summation were shown for any of the model groups when compared to baseline or the control group (P > .05). Conclusion: Both models produced similar pain-related outcomes, with the NGF model having a longer effect. Furthermore, the NGF model showed a more substantial effect on motor function, which was not seen for the DOMS model. Finally, neither of the models were able to provoke activity-related temporal summation of pain.
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