Corine M. Visscher

Myofascial temporomandibular disorder pain, parafunctions and psychological stress

Associations of evening and morning masticatory muscle pain and nocturnal electromyography (EMG) activity with psycho-behavioural factors and occlusal splint therapy were studied during a 20-week study-protocol. Over a period of almost 2 years, only eight of the 120 eligible patients were willing to enroll the study protocol. Further, four of the eight participants dropped out during the study, and approximately 20-30% of the nocturnal EMG recordings failed. Because of the impractical and unworkable nature of the protocol, the study was prematurely terminated and the results of the four remaining individuals are reported here as single-patient clinical trials. Univariate and multiple regression analyses revealed that in three of the four patients, changes in nocturnal EMG activity were associated with the period of splint therapy. However, no associations were found between the changes in nocturnal EMG activity and the observed changes in muscle pain. In two patients, the changes in muscle pain were associated with the period of splint therapy and with the changes in psychological stress. Within the limitations of single-patient clinical trials, it can be concluded that changes in chronic masticatory muscle pain seem to be more related to changes in psychological stress than to those in parafunctional activities.

Team players against headache: multidisciplinary treatment of primary headaches and medication overuse headache

Multidisciplinary approaches are gaining acceptance in headache treatment. However, there is a lack of scientific data about the efficacy of various strategies and their combinations offered by physiotherapists, physicians, psychologists and headache nurses. Therefore, an international platform for more intense collaboration between these professions and between headache centers is needed. Our aims were to establish closer collaboration and an interchange of knowledge between headache care providers and different disciplines. A scientific session focusing on multidisciplinary headache management was organised at The European Headache and Migraine Trust International Congress (EHMTIC) 2010 in Nice. A summary of the contributions and the discussion is presented. It was concluded that effective multidisciplinary headache treatment can reduce headache frequency and burden of disease, as well as the risk for medication overuse headache. The significant value of physiotherapy, education in headache schools, and implementation of strategies of cognitive behavioural therapy was highlighted and the way paved for future studies and international collaboration.

Impaired health status, sleep disorders, and pain in the craniomandibular and cervical spinal regions

This study investigated the relationship between health status (i.e., physical well‐being and quality of life), sleep disorders (e.g., insomnia, sleep‐related depression and anxiety), and musculoskeletal pain in the craniomandibular and cervical spinal regions. The number of painful body areas below the cervical spine (i.e., widespread pain) was also taken into account. Two questionnaires, viz., the RAND 36‐item Health Survey Questionnaire and the Dutch Sleep Disorders Questionnaire (SDQ), were administered to 103 persons who could unequivocally be classified into one of four mutually exclusive groups: No pain, craniomandibular pain (CMP), cervical spinal pain (CSP), and both CMP and CSP. Body drawings were used for the self‐report of widespread pain. Multivariate analysis of variance showed effects of gender, group, and widespread pain on the questionnaire scales; not of age. As shown by univariate analysis of variance, men suffered more from sleep apnea than did women. No other gender differences were found. Simple contrast analyses following univariate analyses of the group and widespread pain effects showed that, in general, more questionnaire scales, both of the RAND‐36 and of the SDQ, reached statistical significance with an increase in the number of painful areas. It was concluded that both musculoskeletal pain in the trigemino‐cervical area and widespread body pain are associated with an increased impairment of health status. Also, sleep disorders are frequently found in patients with chronic pain in the craniomandibular and cervical spinal regions as well as in patients with widespread pain. The more painful areas there are, the likelier it is that sleep disorders are present.

The Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD)

&NA; For musculoskeletal disorders like low back pain and fibromyalgia, evidence is growing for fear of movement to play an important role in the development of chronic pain. In temporomandibular disorder (TMD) patients, however, this construct has not received any attention yet. Therefore, in this paper, (1) a generally used instrument to measure fear of movement, the Dutch version of the Tampa Scale for Kinesiophobia (TSK), was adapted for its use in TMD patients (and translated for equivalence to English), (2) the psychometric properties of the Dutch version of the TSK‐TMD were assessed, and (3) the association of various symptoms of TMD (i.e., pain, joint sounds, and limited jaw movements) with fear of movement was evaluated. In a sample of TMD patients (N = 301), confirmatory factor analysis indicated that a two‐factor model based on 12 items provides the best fit of the TSK‐TMD, with activity avoidance and somatic focus as its subscales. This two‐factor solution of the Dutch TSK‐TMD has generally good reliability and convergent validity. Multiple regression analysis showed that TMD functional problems (i.e., temporomandibular joint sounds or a stuck/locked feeling) were more strongly associated with fear of movement than with pain. This finding leads to new perspectives regarding the interplay between musculoskeletal complaints, cognition, and avoidance behavior. The results provide a basis for use of the 12‐item version for routine assessment of fear of movement in TMD patients, and for future clinical studies, for example, to the role of fear of movement in TMD‐treatment success.

Time-variant nature of sleep bruxism outcome variables using ambulatory polysomnography: implications for recognition and therapy evaluation.

The aim of this study was to quantify the time-variant nature of sleep bruxism (SB) and to discuss its consequences. Six clinically diagnosed bruxers and six non-bruxers participated. Four ambulatory polysomnographic (PSG) recordings were obtained for every participant. As SB outcome variables, the number of episodes per hour of sleep (Epi h(-1)), the number of bursts per hour (Bur h(-1)) and the bruxism time index (BTI: the percentage of total sleep time spent bruxing) were established. To quantify the time-variant nature of SB, standard errors of measurement (SEMs) were calculated. For the non-bruxers, the SEMs for Epi h(-1), Bur h(-1) and BTI were 1.0, 5.7 and 0.1. For the bruxers, the respective values were 2.1, 14.9 and 0.4. In the discussion, arguments are given that because of the time-variant nature of the PSG recordings, cut-off bands around cut-off points might be useful for the recognition of SB.

Bruxism and associated factors among Dutch adolescents.

OBJECTIVES To assess the prevalence rates of self-reported sleep bruxism and awake bruxism and their associations with several demographical, exogenous, and psychosocial factors among Dutch adolescents. METHODS In a cross-sectional questionnaire survey, 4285 questionnaires were completed, with an about equal gender distribution and with ages ranging from 10 to 22 years. RESULTS In the group of 4235 12- to 18-year-old adolescents, sleep bruxism had a reported prevalence of 14.8% and awake bruxism of 8.7%. Logistic regression analyses revealed that sleep bruxism was associated with female gender [OR = 1.49 (95% CI = 1.23-1.81)], pain or tense feeling in the jaws upon awakening in the morning [OR = 1.47 (95% CI = 1.17-1.86)], clicking joint sounds [OR = 1.31 (95% CI = 1.03-1.65)], stress [OR = 1.25 (95% CI = 1.00-1.55)], and depressive mood [OR = 1.35 (95% CI = 1.10-1.65)]. Awake bruxism was associated with orofacial pain [OR = 1.49 (95% CI = 1.16-1.91)], clicking joint sounds [OR = 1.50 (95% CI = 1.13-1.98)], scraping joint sounds [OR = 2.03 (95% CI = 1.21-3.37)], stress [OR = 1.36 (95% CI = 1.03-1.78)], depressive mood [OR = 1.82 (95% CI = 1.42-2.35)], and smoking [OR = 1.42 (95% CI = 1.06-1.89)]. CONCLUSIONS Sleep bruxism and awake bruxism are common conditions among Dutch adolescents, with self-reported prevalence rates that are slightly higher than those derived from most large-scale studies on adults. Several predictor variables were found to be exclusively associated with either form of bruxism, corroborating the common suggestion that both circadian manifestations are, at least in part, different entities.

Is temporomandibular pain in chronic whiplash associated disorders part of a more widespread pain syndrome

Objectives:The prevalence of temporomandibular disorders in patients with chronic whiplash-associated disorder is a controversial issue that may be influenced by the widespread pain character and psychologic distress frequently observed in patients with chronic pain. The aim of this study was to determine the prevalence of temporomandibular disorder pain, widespread pain, and psychologic distress in persons with chronic whiplash-associated disorder pain, using a controlled, single blind study design. The prevalence of temporomandibular disorder pain in the chronic whiplash-associated disorder pain group was compared with 2 control groups: a chronic neck pain group and a no neck pain group. Methods:From 65 persons, a standardized oral history was taken, a physical examination of the neck and the masticatory system was performed, widespread pain was investigated by tender point palpation, and psychologic distress was measured with a questionnaire (SCL-90). Because the recognition of temporomandibular disorder pain and neck pain remains a matter of debate, 3 well-defined classification systems were used: one based on the oral history, a second on a combination of oral history and pain on active movements and palpation, and a third one based on a combination of oral history and function tests. Results:Irrespective of the classification system used, the chronic whiplash-associated disorder pain group more often suffered from temporomandibular disorder pain (0.001 < P < 0.028) and widespread pain (0.001 < P < 0.003) than the no neck pain group. Moreover, patients with whiplash-associated disorder showed more psychologic distress (0.000 < P < 0.044) than the other 2 groups. Discussion:The higher prevalence of widespread pain and psychologic distress in patients with chronic whiplash-associated disorder suggests that the higher prevalence of temporomandibular disorder pain in these patients is part of a more widespread chronic pain disorder.

Temporomandibular pain and jaw dysfunction at different ages covering the lifespan : A population based study

Temporomandibular pain and jaw dysfunction can have a negative effect on daily life, but these conditions are not well recognized in the health care systems. The general aim was to examine the cross‐sectional prevalence of frequent temporomandibular pain and jaw dysfunction in men and women across the lifespan.

The effect of raising the bite without mandibular protrusion on obstructive sleep apnoea

It has recently been suggested that wearing a maxillary occlusal splint (i.e. a hard acrylic resin dental appliance that covers the occlusal surfaces of the maxillary dentition and that is being indicated for the treatment of, e.g. temporomandibular pain) may be associated with a risk of aggravating obstructive sleep apnoea (OSA). The present study tested the hypothesis that raising the bite without mandibular protrusion in OSA patients is associated with an increase in the apnoea-hypopnoea index (AHI). Eighteen OSA patients (13 men; 49·5 ± 8·1 years old) received a mandibular advancement device in 0% protrusion of the mandible (0%MAD). The MAD caused a bite rise of 6 mm as measured interincisally. Polysomnographic recordings were obtained at baseline and with the 0%MAD in situ. No statistically significant difference in AHI was noted between the baseline night and the 0%MAD night. However, nine patients had an aggravation in AHI during the night they used the 0%MAD. Taking into account the previously established smallest detectable difference of 12·8 in AHI, the AHI increased in only two of the patients. The outcomes of this study suggest that an increased jaw gape without mandibular protrusion might be associated with a risk of aggravation of OSA for some, but not for all OSA patients. Dental practitioners should be aware of this possible association when treating patients with oral devices that raise the bite.

Dental status and oral health-related quality of life: a population-based study

Oral health-related quality of life (OHRQoL) is associated with tooth wear and tooth loss. This study investigated the association between OHRQoL and dental status (in terms of natural dentition, partial or complete dentures, or edentulism). Sixteen hundred and twenty-two persons who participated in a large-scale Dutch dental survey were interviewed. Dentate persons (n = 1407) were additionally invited for a clinical examination (response rate: 69%). Dental status was based upon the combined data from this clinical examination and the questionnaire (seven dental status groups were defined). OHRQoL was measured by the Dutch translation of the short version of the Oral Health Impact Profile, the OHIP-NL14. Kruskal-Wallis tests and Mann-Whitney U tests were used to investigate differences in OHRQoL between the dental status groups. For all OHIP-NL14 scales, differences in OHRQoL were found between the dental status groups (all P-values <0·001). The Mann-Whitney U tests revealed no differences between persons with a complete natural dentition and persons with a fixed prosthetic replacement. The latter group, however, did show a significantly better OHRQoL as compared to persons with a removable partial denture. Surprisingly, edentulous persons with an overdenture had a more impaired OHRQoL than edentulous persons with non-supported complete dentures. The results demonstrated that impaired dental status is associated with deteriorations in OHRQoL, especially concerning functional limitations, physical pain and social disability.