Andrea Deregibus

Muscle tenderness in different headache types and its relation to anxiety and depression.

Abstract To assess in patients with migraine and tension type headache, both episodic and chronic, the extent to which muscle tenderness may relate to anxiety and depression, 459 patients with Episodic Migraine (EM, 125), Chronic Migraine (CM, 97), Episodic Tension Type Headache (ETTH, 82), Chronic Tension Type Headache (CTTH, 83), and EM+ETTH (72) were enrolled. For each patient, a psychological assessment on the Axis 1 of the DSM‐IV and muscle palpation of pericranial and cervical muscles were carried out. A Pericranial Muscle Tenderness Score (PTS) and a Cervical Muscle Tenderness Score (CTS) were calculated (range 0–3). Logistic and linear regression analyses were employed to assess relations between muscle tenderness, the demographic variables and psychiatric disorders in the different patient groups. Odds ratio for ‘male gender’ was higher in groups with tension type headache. Only EM patients showed a positive association with increasing age. Anxiety and depression were significantly associated to CM. A significant negative correlation of PTS and CTS was observed in EM patients. In relation to male gender, the PTS was significantly lower in EM, ETTH and CTTH; CTS was significantly lower in EM, CM, and CTTH. Anxiety and, even more, anxiety and depression combined were positively associated to higher PTS and CTS in EM patients. Anxiety and depression were also positively associated to higher CTS in patients with EM+ETTH. In CTTH patients, PTS only was positively associated to anxiety and depression. We conclude that in patients with EM, the presence of anxiety or anxiety and depression combined considerably increases the level of muscle tenderness in the head and, even more, in the neck, and might facilitate the evolution into CM.

Efficacy of clear aligners in controlling orthodontic tooth movement: A systematic review

OBJECTIVE To assess the scientific evidence related to the efficacy of clear aligner treatment (CAT) in controlling orthodontic tooth movement. MATERIALS AND METHODS PubMed, PMC, NLM, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Knowledge, Scopus, Google Scholar, and LILACs were searched from January 2000 to June 2014 to identify all peer-reviewed articles potentially relevant to the review. Methodological shortcomings were highlighted and the quality of the studies was ranked using the Cochrane Tool for Risk of Bias Assessment. RESULTS Eleven relevant articles were selected (two Randomized Clinical Trials (RCT), five prospective non-randomized, four retrospective non-randomized), and the risk of bias was moderate for six studies and unclear for the others. The amount of mean intrusion reported was 0.72 mm. Extrusion was the most difficult movement to control (30% of accuracy), followed by rotation. Upper molar distalization revealed the highest predictability (88%) when a bodily movement of at least 1.5 mm was prescribed. A decrease of the Littles Index (mandibular arch: 5 mm; maxillary arch: 4 mm) was observed in aligning arches. CONCLUSIONS CAT aligns and levels the arches; it is effective in controlling anterior intrusion but not anterior extrusion; it is effective in controlling posterior buccolingual inclination but not anterior buccolingual inclination; it is effective in controlling upper molar bodily movements of about 1.5 mm; and it is not effective in controlling rotation of rounded teeth in particular. However, the results of this review should be interpreted with caution because of the number, quality, and heterogeneity of the studies.

Frontal lobe dysfunction in patients with chronic migraine: a clinical-neuropsychological study

Neuropsychological tests have demonstrated a frontal lobe dysfunction in several psychiatric and neurological disorders. Our purpose was to examine whether similar functional differences would be found in patients with chronic migraine. The Gambling Task (GT), the Tower of Hanoi-3 (TOH-3) and the Object Alternation Test (OAT) were administered to 23 female patients previously treated for chronic migraine and to 23 healthy women who were similar to the patients in age and educational level, and the mean test scores of the two groups were compared (Students t and Pearson correlation coefficient). The patient group scored significantly higher than the controls on the TOH-3 and, especially, the OAT. In the patients, no significant relationship was found between the neuropsychological test scores and those for the Minnesota Multiple Personality Inventory (MMPI), the Spielberg State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). In conclusion, the data suggest a relation between chronic headache and dorsolateral function (as tested by the TOH-3) and orbitofrontal function (as tested by the OAT). The decision-making function related to ventromedial prefrontal cortex (tested by the GT) did not show a statistically significant difference between patients and controls. These neuropsychological findings seem to be partly independent of the patients psychological traits and psychiatric disorders.

The Temperament and Character Inventory in women with migraine

The purpose of this work was to investigate: (1) the differences in temperament and character between 49 women with migraine and 49 controls using the Temperament and Character Inventory (TCI), and (2) the extent to which these differences were related to migraine or to the presence of comorbid depression. The migraine patients scored significantly higher than the controls in two temperament dimensions—Harm Avoidance (HA) and Persistence (P)—and significantly lower in one character dimension—Self-Directedness (SDir) (Student’s t). After multiple logistic regression, the TCI P and HA dimensions were significantly associated with the presence of migraine. The HA dimension was also related to the presence of depression. Our results show that in migraine the higher HA score could be partly associated to comorbid depression while the high P dimension seems to be solely related to the presence of migraine.

Diagnostic accuracy and measurement sensitivity of digital models for orthodontic purposes: A systematic review

INTRODUCTION Our objective was to assess the accuracy, validity, and reliability of measurements obtained from virtual dental study models compared with those obtained from plaster models. METHODS PubMed, PubMed Central, National Library of Medicine Medline, Embase, Cochrane Central Register of Controlled Clinical trials, Web of Knowledge, Scopus, Google Scholar, and LILACs were searched from January 2000 to November 2014. A grading system described by the Swedish Council on Technology Assessment in Health Care and the Cochrane tool for risk of bias assessment were used to rate the methodologic quality of the articles. RESULTS Thirty-five relevant articles were selected. The methodologic quality was high. No significant differences were observed for most of the studies in all the measured parameters, with the exception of the American Board of Orthodontics Objective Grading System. CONCLUSIONS Digital models are as reliable as traditional plaster models, with high accuracy, reliability, and reproducibility. Landmark identification, rather than the measuring device or the software, appears to be the greatest limitation. Furthermore, with their advantages in terms of cost, time, and space required, digital models could be considered the new gold standard in current practice.

Reproducibility of surface EMG in the human masseter and anterior temporalis muscle areas

Abstract The aim of this study was to test the hypothesis that surface electromyography (sEMG) recordings, made at mandibular rest position from the masseter and temporalis anterior areas, are intraand inter-session reproducible. A template was designed and built to permit the correct electrode placement from one session to the next session. A sample of 18 subjects was examined. Two groups, homogeneous for age, sex, and craniofacial morphology were selected. The first group included asymptomatic subjects with no signs or symptoms of temporomandibular joint dysfunction (TMD) and the second group included patients suffering from muscle-related TMD. Data were obtained from different sEMG recordings made at mandibular rest position in the same session and in different sessions, repositioning the electrodes using a template designed for that purpose. The electromyograph used in this study is part of the EMG K6-l Win Diagnostic System. Results showed that reproducibility of sEMG signals from the masseter and anterior temporalis areas at mandibular rest position is possible.

Myoelectric manifestations of jaw elevator muscle fatigue and recovery in healthy and TMD subjects

The effects of muscle pain and fatigue on the control of jaw elevator muscles are not well known. Furthermore, the myoelectric manifestations of fatigue and recovery from fatigue in the masticatory muscles are not reported in literature. The main aims of this study were (i) to evaluate the possible use of surface electromyography (sEMG) as an objective measure of fatigue of the jaw elevator muscles, (ii) to compare the myoelectric manifestations of fatigue in the temporalis anterior and masseter muscles bilaterally, (iii) to assess recovery of the investigated muscles after an endurance test and (iv) to compare fatigue and recovery of the jaw elevator muscles in healthy subjects and patients with muscle-related temporomandibular disorders (TMD). The study was performed on twenty healthy volunteers and eighteen patients with muscle-related TMD. An intra-oral compressive-force sensor was used to measure the voluntary contraction forces close to the intercuspal position and to provide visual feedback of submaximal forces to the subject. Surface EMG signals were recorded with linear electrode arrays during isometric contractions at 20%, 40%, 60% and 80% of the maximum voluntary contraction force, during an endurance test and during the recovery phase. The results showed that (i) the slope of the mean power spectral frequency (MNF) and the initial average rectified value (ARV) could be used to monitor fatigue of the jaw elevators, (ii) the temporalis anterior and masseter muscle show the same myoelectric manifestations of fatigue and recovery and (iii) the initial values of MNF and ARV were lower in patients with muscle-related TMD. The assessment of myoelectric manifestations of fatigue in the masticatory muscles may assist in the clinical assessment of TMDs.

Agreement between clinical and portable EMG/ECG diagnosis of sleep bruxism.

The aim of this study was to compare clinical sleep bruxism (SB) diagnosis with an instrumental diagnosis obtained with a device providing electromyography/electrocardiography (EMG/ECG) recordings. Forty-five (N = 45) subjects (19 males and 26 females, mean age 28 ± 11 years) were selected among patients referring to the Gnathology Unit of the Dental School of the University of Torino. An expert clinician assessed the presence of SB based on the presence of one or more signs/symptoms (i.e., transient jaw muscle pain in the morning, muscle fatigue at awakening, presence of tooth wear, masseter hypertrophy). Furthermore, all participants underwent an instrumental recording at home with a portable device (Bruxoff; OT Bioelettronica, Torino, Italy) allowing a simultaneous recording of EMG signals from both the masseter muscles as well as heart frequency. Statistical procedures were performed with the software Statistical Package for the Social Science v. 20.0 (SPSS 20.0; IBM, Milan, Italy). Based on the EMG/ECG analysis, 26 subjects (11 males, 15 females, mean age 28 ± 10 years) were diagnosed as sleep bruxers, whilst 19 subjects (7 males, 12 females, mean age 30 ± 10 years) were diagnosed as non-bruxers. The correlation between the clinical and EMG/ECG SB diagnoses was low (ϕ value = 0.250), with a 62.2% agreement (28/45 subjects) between the two approaches (kappa = 0.248). Assuming instrumental EMG/ECG diagnosis as the standard of reference for definite SB diagnosis in this investigation, the false-positive and false-negative rates were unacceptable for all clinical signs/symptoms. In conclusion, findings from clinical assessment are not related with SB diagnosis performed with a portable EMG/ECG recorder.

Confirmation of the distinction between chronic migraine and chronic tension-type headache by the McGill Pain Questionnaire

Objective.—To investigate if the McGill Pain Questionnaire confirms the distinction between chronic migraine and chronic tension‐type headache.

Periodontal health during clear aligners treatment: a systematic review

BACKGROUND Clear aligner treatment (CAT) has been cited as a safe and comfortable orthodontic procedure for adult patients. However, the available evidence is scarce. OBJECTIVE To perform a systematic review of the existing literature in order to assess periodontal health during CAT. SEARCH METHODS AND SELECTION CRITERIA Pubmed, Pubmed Central, National Library of Medicines Medline, Embase, Cochrane Central Register of Controlled Clinical trials, Web of Knowledge, Scopus, Google Scholar, and LILACS were searched from January 1945 to September 2014 to identify all peer-reviewed papers potentially relevant to the review. DATA COLLECTION AND ANALYSIS After duplicate selection and extraction procedures, the risk of bias was assessed according to the Centre for Reviews and Dissemination criteria, and a 3-point grading system, as described by the Swedish Council on Technology Assessment in Health Care (SBU), was used to rate the methodological quality of the selected papers. A PICOS table was used for data extraction. RESULTS Five relevant articles were selected from the 1247 identified articles. The level of evidence was moderate for all the studies. A significant improvement of the periodontal health indexes was revealed, in particular when CAT was compared to fixed appliances. No periodontal CAT adverse effects were observed in the selected studies. CONCLUSIONS Periodontal health indexes were significantly improved during CAT. The results of this review should be interpreted with some caution because of the number, quality, and heterogeneity of the included studies.