Marcello Melis

Atypical Odontalgia: A Review of the Literature

Objective.—To review previous reports of cases of atypical odontalgia to examine its epidemiological and clinical characteristics and to explore the etiology and pathophysiology of the disease.

Clinical measurement of normal maximum mouth opening in children.

Abstract This study was designed to find a method of assessing maximum mouth opening (MMO), using a tool that is proportional to the body size. One hundred two (102) children were selected to participate in the study. MMO, the width of three fingers (index, middle and ring fingers), four fingers (index, middle, ring and little fingers), body height, weight and age of each child were recorded, and the ability of each subject to position the fingers, vertically aligned between the upper and lower central incisors with the mouth maximally open, was documented. All subjects were able to position three fingers between the upper and lower central incisors, while only 37 (36.3%) were able to position four fingers. MMO was significantly different from the width of three and four fingers and was positively correlated with both weight and height and with age. Height, weight, and age showed a moderate to strong correlation with all finger measurements; no gender significant difference was observed for MMO. The findings of this study suggest that the ability to position three fingers between the upper and lower incisors with the mouth wide open can be considered a simple method to quickly evaluate MMO, but that it is not highly reliable.

Use of Theraflex-TMJ Topical Cream for the Treatment of Temporomandibular Joint and Muscle Pain

Abstract This randomized, double-blind study was designed to evaluate the effectiveness of the topical cream Theraflex-TMJ (NaBob/Rx, San Mateo, CA) in patients with masseter muscle pain and temporomandibular joint (TMJ) pain. Fifty-two subjects (5 males and 47 females) were instructed to apply a cream over the afflicted masseter muscle(s) or over the jaw joint(s) twice daily for two weeks. Theraflex-TMJ cream was used by the experimental group, while a placebo cream was used by the control group. The means of pain ratings were calculated prior to the application of the cream (baseline), after ten days of tx (period 1), and 15 days of tx (period 2) days of treatment and five days after stopping the treatment (follow-up). There was a significant decrease in reported pain levels from baseline in the experimental group for period 1 (p<0.01), period 2 (p<0.001), and follow-up (p<0.01). For the control group, no significant differences were found between the different time periods (p>0.05). There was evidence of minor side effects such as skin irritation and/or burning on the site of the application in two subjects in the experimental as well as two subjects in the control groups. The data strongly suggest that Theraflex-TMJ topical cream is safe and effective for reducing pain in the masseter muscle and the temporomandibular joint.

Effect of cigarette smoking on pain intensity of TMD patients: a pilot study.

Abstract To evaluate the effect of cigarette smoking (CS) on pain intensity in a sample of temporomandibular disorder (TMD) patients, 352 clinical charts were reviewed. Subjects were first divided into two groups: smokers (YS) and nonsmokers (NS); then, YS were further divided into three subgroups: light smokers (LS), moderate smokers (MS), and heavy smokers (HS). Overall TMD pain intensity was higher in YS, compared to NS, and a correlation was found between pain intensity and the number of cigarettes smoked in a day by each subject. A significant difference was evident between NS and HS. The results were not evident in males; age was not correlated either with smoking or pain intensity, and the effect of CS on pain intensity was not correlated with any particular TMD diagnosis. CS seems to be a relevant factor affecting the intensity of TMD pain, thus, control of smoking habits should be considered when treating TMD patients.

The Role of Mandibular Third Molars on Lower Anterior Teeth Crowding and Relapse after Orthodontic Treatment: A Systematic Review

Aims. To evaluate the role of third molars in the development of crowding or relapse after orthodontic treatment in the anterior segment of the dental arch. Methods. PubMed search of the literature was performed selecting all the articles relevant to the topic and limiting the studies to controlled trials on humans and written in English language. Systematic review was conducted according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement. Results. A total of 12 clinical studies were included in the review. A high risk of bias was found in most of the articles, either because the relative items assessed were inadequate or because they were unclearly described. The third molars were not correlated with more severe anterior tooth crowding in most of the studies. However, four of them described a different outcome. Conclusion. Definitive conclusions on the role of the third molars in the development of anterior tooth crowding cannot be drawn. A high risk of bias was found in most of the trials, and the outcomes were not consistent. However, most of the studies do not support a cause-and-effect relationship; therefore, third molar extraction to prevent anterior tooth crowding or postorthodontic relapse is not justified.

Temporomandibular joint disk fracture: a case report.

Abstract A case of a patient with a fracture of the temporomandibular joint (TMJ) disk is reported. The patient presented with posterior bilateral open-bite and difficulty to chew due to lack of contact between the posterior teeth. Diagnosis of disk fracture of the right TMJ was made based on magnetic resonance imaging (MRI), with posterior displacement of the posterior fragment of the disk, causing the posterior open-bite, and anterior displacement of the anterior fragment of the disk. TMJ manipulation failed to reposition the posterior fragment of the disk, and the patient refused to undergo TMJ arthroscopy to try to remove it. After four months, the posterior open-bite was reduced, probably because of remodeling of the posterior TMJ capsule and extrusion of the molars and premolars. Contact with the patient was lost after that time.

Headache associated with refractive errors: overestimated or overlooked?

differ significantly for tizanidine (32.4%) versus placebo (30.2%). We agree that these numbers are important. All drugs have adverse effects, and those adverse effects that differed from placebo were properly noted: somnolence (46.5%), dizziness (23.9%), dry mouth (22.5%), and asthenia (19.7%). As for industry funding, this study was funded as acknowledged. However, the protocol and study design were created by ourselves, the data was collected and interpreted by the investigators, and the article was written in its entirety by its authors. Finally, regarding the alternate title suggested by Dr. Warner, we prefer the title as written. The title describes the headache disorder treated, drug investigated, and study design. Double-blind, placebo-controlled, multicenter outcome studies such as this one represent the generally accepted standard for a physician to critically evaluate the possible usefulness of a pharmacological agent. Unfortunately, few such studies exist for the problem of CDH. We provided sufficient data to assist a physician in determining whether the possible benefits of tizanidine would be worth exploring with patients. To apply the results of a scientific study to medical practice, an interested reader must read more than a title to gain the essence of scientific work. The title is not meant to be a synopsis of the study, and physicians who simply “skim the title of articles” do themselves and their patients a disservice.