Shehryar N. Khawaja

Infield masticatory muscle activity in subjects with pain‐related temporomandibular disorders diagnoses

OBJECTIVES Pain-related temporomandibular disorders (TMDs) are the most prevalent conditions among TMDs. There is contrasting evidence available for association of pain-related TMD and masticatory muscle activity (MMA). The present investigation assesses the associations between MMA levels of masseter and temporalis muscles during awake and sleep among pain-related TMD diagnostic groups. SETTING AND SAMPLE POPULATION The department of Oral Diagnostic Sciences, University at Buffalo. Twenty females and six males participated in this study. MATERIAL AND METHODS Using the diagnostic criteria for temporomandibular disorders (DC-TMDs), participants were diagnostically categorized. Subjects used a custom monitoring system, which recorded infield muscle activities. A factorial model tested for association between independent variable (muscle, time period, MMA level, and diagnostic group) effects and the logarithm of MMA. Greenhouse-Geisser test was used to determine any statistically significant associations (p≤0.003). RESULTS No statistically significant association was found between four-way, three-way, and two-way analyses. However, among the main effects, range of magnitudes was the only variable to be statistically significant. Although the data suggest a trend of increased masseter MMA in the pain-related TMD diagnoses group both during awake and sleep time periods, such observation is not maintained for the temporalis muscle. In addition, temporalis MMA was found to be higher in the pain-related TMD diagnoses group only at extreme activity levels (<25 and ≥80% ranges). CONCLUSION This data support the association between masticatory muscle hyperactivity and painful TMD conditions.

Nonsurgical Management of Pediatric Temporomandibular Joint Dysfunction

Temporomandibular disorders (TMD) are a subgroup of craniofacial pain problems involving the temporomandibular joint (TMJ), masticatory muscles, and associated head and neck musculoskeletal structures. These disorders are subclassified into TMJ articular disorders and masticatory muscle disorders. Patients with TMD most commonly present with pain, restricted or asymmetric mandibular motion, and TMJ sounds during mandibular movements. The prevalence tends to increase with age. Management of TMJ articular disorders consists of a combination of patient education, home-care plan, biobehavioral therapy, physical therapy, orthotic jaw appliance therapy, pharmacotherapy, and/or surgery. The goal is to increase function, reduce pain, and improve quality of life.

Facial pain associated with cardiac origin

BACKGROUND Ischemic heart disease manifests as pain on the left side, in the retrosternal or the precordial region, with subsequent radiation to the ipsilateral shoulder, face, and cervical region. Less frequently, it may manifest solely as face pain. CASE DESCRIPTION A 57-year-old man sought care at the Massachusetts General Hospital Oral and Maxillofacial Pain Center with a symptom of pain in the mandibular left posterior region, in the medial aspect of the ipsilateral eye, and in the left side of the neck. The pain had started approximately 8 months previously as a mild, constant dull ache in the mandibular left posterior region. However, it became severe in intensity and sharp in quality and radiated toward the medical aspect of the ipsilateral eye and lateral neck region after intense physical activity. Results from comprehensive diagnostic evaluation and a series of diagnostic tests suggested that the facial pain was associated with cardiovascular disease. There was complete resolution of pain symptoms after the patient received appropriate pharmacotherapy. PRACTICAL IMPLICATIONS Association of pain with exercise and termination of pain with rest and the presence of risk factors for cardiovascular disease necessitate a thorough investigation of rare and fatal causes of facial pain.

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.

Association between Arthralgia and Imaging Findings of Effusion in the Temporomandibular Joints: A Systematic Review

The temporomandibular disorders (TMD) encompass a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joints (TMJs), the masticatory muscles, and associated tissues [1]. Common manifestations of TMD consist of pain of a persistent, recurring, or chronic nature in the TMJ, masticatory muscles, or in the adjacent structures; limitation or other alterations in the range of mandible motion; and TM joint noises [2]. It has been suggested that differential diagnosis of TMDs should be based primarily on information obtained from the patient’s history, clinical examination, and when TMJ imaging procedures indicated [1]. Magnetic resonance imaging (MRI) is an example of such imaging procedures. It provides excellent representation of soft tissues in anatomical and semi-functional relationships. In addition, it may also be used for detection of the presence of joint effusion with acceptable levels of reliability [3]. Some authors have also suggested use of MRI for assessment of hard tissues; however the reliability has been shown to be poor [3-5]. Joint effusion is defined as a collection of fluid in the joint space. It is manifested as areas of high intensity signal in the TMJ space, on T2-weighted images [3-5]. It has been suggested that this accumulation of fluid could be a surrogate of an inflammatory process that may activate or sensitize nociceptive afferent neurons within the joint [4-6]. Alternatively, it could result in increased intra-articular pressure, which may cause mechanical trauma, leading to hypoxia and other inflammation induced changes within the joint space, and eventually leads arthralgia [7]. Several studies have been conducted on the association of joint effusion and TMJ pain associated with TMD. However, the results have been inconsistent. While the majority of studies have reported a statistically significant association [4-26], others have reported inconclusive findings [5-30]. Due to this difference in reporting, a systematic review was conducted to determine if there is an association between joint effusion and self-reported TMJ-pain during examination, as well as between joint effusion and arthralgia as defined by the Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD) [31].