Jeffry Shaefer

Pressure-pain thresholds and MRI effusions in TMJ arthralgia.

It has been suggested that MRI-depicted effusions identify patients with TMJ arthralgia. The Research Diagnostic Criteria (RDC) propose a pressure-pain threshold (PPT) of 1 pound for the identification of TMJ arthralgia. The hypotheses in this study were that: (1) there is no association between MRI-depicted effusions and TMJ arthralgia, and (2) a PPT of 1 pound does not discriminate between subjects with and those without arthralgia. Thirty females with TMJ disc displacement with reduction were divided into two groups based on the presence or absence of the self-report of TMJ pain. Bilateral TMJ PPTs and MRIs were obtained. Increasing palpation pressure from 1 to 3 pounds increased the sensitivity for identifying arthralgia from 22% to 100%, with a corresponding decrease in the specificity from 100% to 81%. The sensitivity and specificity of effusions for identifying arthralgia were 85% and 28%, respectively. These results suggest that the use of palpation pressures greater than 1 pound is a valid test for TMJ arthralgia. However, TMJ effusions lack adequate specificity for identifying TMJ arthralgia and were not associated with pain.

The temporomandibular joint: clinical and surgical aspects.

Advances in imaging techniques have greatly enhanced the ability to visualize the internal anatomy of the temporomandibular joint and have increased understanding of the etiology of many temporomandibular disorders. When used together with careful history and physical examination, this knowledge can contribute to better treatment outcomes.

Pain and Temporomandibular Disorders: A Pharmaco-Gender Dilemma

Gender is the biggest risk factor in the development of temporomandibular disorders (TMD) and orofacial pain. Gender differences in pain thresholds, temporal summation, pain expectations, and somatic awareness exist in patients with chronic TMD or orofacial pain. There are gender differences in pharmacokenetics and pharmacodynamics of medications used to treat pain. A better understanding of the mechanisms that contribute to the increased incidence and persistence of chronic pain in females is needed. Future research will elucidate the sex effects on factors that protect against developing pain or prevent debilitating pain. Gender-based treatments for TMD and orofacial pain treatment will evolve from the translational research stimulated by this knowledge.

Interprofessional Education for the Dentist in Managing Acute and Chronic Pain

Dental education is at the intersection of affordable health care, opioid-abuse crisis, and collaborative practice benefits. Students must engage in interprofessional education (IPE) for pain management. Graduates must recognize appropriate management of acute dental pain and understand the dentists role in interprofessional treatment of chronic disease, including management of temporomandibular disorders and orofacial neuropathic pain, chronic pain in general, and the consideration of opioids. This article reviews accreditation standards, compares these standards with recommendations from the International Association for the Study of Pain and regulatory boards, and presents examples of enhanced pain education.

Occlusal splints may be of benefit in TMD, but there is little evidence for the use of occlusal adjustment

Objective A systematic review of occlusal splints and occlusal adjustments in the treatment of temporomandibular disorders (TMD).Data sources Medline (1966–1999), Embase, Index Medicus (1966–1980), Cochrane Controlled Trial Register, DARE and reference lists of retrieved papers. There were no language exclusions.Study selection Studies were included if they were randomised comparisons of occlusal splint therapy or occlusal adjustments to treat TMD and placebo, no-treatment or other interventions. Studies were scored for quality.Results Eighteen studies met the inclusion criteria, 14 of splint therapy and four of occlusal adjustment. The overall quality of the trials was fairly low: the mean quality score was 0.43 (range, 0.12–0.78) out of a maximum score of 1.00. The most obvious methodological shortcomings were inadequate blinding, small sample sizes, short follow-up times, great diversity of outcome measures and numerous control treatments, some of unknown effectiveness. Splint therapy was found to be superior to three and comparable to 12 control treatments, and superior or comparable to four passive controls. Occlusal adjustment was found to be comparable to two and inferior to one control treatment, and comparable to the passive control in one study.Conclusion Occlusal splints may be of some benefit in the treatment of TMD but evidence for the use of occlusal adjustment is lacking. There is obviously a need for well-designed controlled studies to analyse current clinical practices.

Sex, Gender, and Orofacial Pain

This review examines gender prevalence in orofacial pain to elucidate underlying factors that can explain such differences. This review highlights how gender affects (1) the association of hormonal factors and pain modulation; (2) the genetic aspects influencing pain sensitivity and pain perception; (3) the role of resting blood pressure and pain threshold; and (4) the impact of sociocultural, environmental, and psychological factors on pain.