Search Results (225)

Background: Burning Mouth Syndrome (BMS) is a chronic orofacial pain condition characterized by a burning sensation in the oral cavity without identifiable lesions. It predominantly affects women (especially postmenopausal) but can occur in men. BMS is considered a multifactorial neuropathic pain disorder involving both peripheral small-fiber neuropathy and central dysregulation, often accompanied by taste alterations (dysgusia) and xerostomia despite normal oral exams. Treatment is challenging, with modest responses to agents like clonazepam, tricyclic antidepressants, or gabapentinoids. Observations: We present a 67-year-old male with recalcitrant primary BMS who showed complete remission temporally associated with occipital nerve blockade, likely affecting central trigeminocervical pathways. Initial therapy with amitriptyline (25 mg) and gabapentin (900 mg/day) yielded ~30% pain relief. Given suspected central sensitization, greater and lesser occipital nerve (GON) blocks were administered in series. After the first, second, and third ON blocks, pain was reduced by ~50%, 80%, and 100%, respectively. Remission persisted at one-year follow-up under continued medications. A mild recurrence (~20% of baseline pain) responded fully to a fourth GON block, maintaining another year of pain-free status. Lessons: This case underscores the complex central mechanisms in BMS and illustrates that modulating central pain circuits via occipital nerve blockade, through trigeminocervical convergence mechanisms, without direct trigeminal intervention. We discuss the diagnostic challenges of BMS, the rationale of occipital neuromodulation, and how this novel therapeutic strategy compares with current literature, supporting the hypothesis of central sensitization in BMS. Full article

Headache is a very common disorder in children and adolescents. While migraine and tension headaches are well-known and diagnosed by pediatricians, a group of primary headaches in children, rare in frequency, are poorly understood and likely underestimated by physicians, resulting in delayed diagnosis and treatment. This review aims to provide an updated overview of these clinical forms, considering new evidence. We will present the main clinical, therapeutic, and pathophysiological aspects and possible future hypotheses, with specific reference to pediatric cases of the following clinical forms: cough headache, thunderclap headache, cold headache, primary stabbing headache, nummular headache, hypnic headache, red ear syndrome, and non-odontogenic orofacial pain. These clinical forms currently pose a major diagnostic challenge for pediatricians and represent a source of serious disability for children and adolescents. Full article

When fabricating custom-made mouthguards for children, tooth replacement is an important factor for dentists to consider. In addition, orofacial myofunctional disorders and deleterious oral habits—such as incompetent lip seal and tongue thrusting—are relatively common among children and are associated with an increased risk of oral and dental trauma. Therefore, individual oral functional characteristics should be taken into account when designing custom-made mouthguards for pediatric patients. This report presents a case involving the design, fabrication, and appliance management of a custom-made mouthguard for a Japanese boy exhibiting incompetent lip seal and tongue thrusting. In this case, the anterior palate region of the mouthguard was left uncut, and multiple holes were created using a carbide bur to permit tongue–palate contact and provide sensory feedback related to tongue elevation. Over a 20-month follow-up period, no oral or dental trauma was observed. During appliance use, the patient demonstrated improved tongue elevation and an increased frequency of lip seal at rest. This case illustrates a custom mouthguard design that incorporates individual oral functional characteristics in a pediatric patient. Full article

Background: Temporomandibular disorders (TMD) and bruxism are prevalent conditions managed by dentists. However, treatment choices—especially concerning botulinum toxin (BTX)—often lack consistency. This study aimed to develop and assess a structured clinical decision-making algorithm for BTX use in patients with TMD and bruxism. Methods: A treatment algorithm was designed through a qualitative analysis of the literature and aligned with German S3 guidelines. A total of 227 dentists assessed three clinical case vignettes reflecting routine clinical practice. Each vignette was evaluated first without and subsequently with the algorithm, focusing on typical indications for botulinum toxin treatment. Data were collected via online survey (SurveyMonkey) and analyzed using Microsoft Excel. Participants were stratified by gender and clinical experience (≤5 years vs. >5 years). Results: Of the 227 dentists contacted, 103 responded, and 56 completed the survey (57.1% male; mean age: 34.5 ± 10.6 years). BTX decision accuracy significantly improved for Case 1 (62.5% → 87.5%, p = 0.0013) and Case 2 (14.3% → 87.5%, p < 0.0001), but not for Case 3 (44.6% → 46.4%, p = 1.000). Confidence increased, and uncertainty decreased, particularly among less experienced dentists. The algorithm also significantly influenced both first- and second-line treatment choices, aligning them more closely with guideline-based therapy. Usefulness was confirmed by 78.6% of respondents, with no significant differences based on gender or experience. Conclusions: The proposed algorithm significantly improved diagnostic accuracy, treatment consistency, and confidence in the use of BTX for TMD and bruxism. It facilitates evidence-based, experience-independent decision-making and potentially represents a useful clinical tool in dental practice. Full article

Background: Craniocervical pain and temporomandibular disorders (TMDs) are prevalent, interconnected conditions. While Movement Representation Techniques (MRTs) are cognitive interventions targeting central pain mechanisms, their specific efficacy here lacks synthesis. This study systematically analyzes the effectiveness of MRTs, such as motor imagery (MI) and action observation (AO), on pain and function in individuals with craniocervical and orofacial pain. Methods: A systematic review of RCTs (PROSPERO: CRD420251155428) was conducted following PRISMA guidelines. Four databases were searched for studies applying MRTs (MI, AO, laterality discrimination) to adults with craniocervical or orofacial pain. Primary outcomes were pain and functionality. Methodological quality was assessed using the PEDro scale and Cochrane RoB 2 tool. Results: Eight RCTs (n = 362) were included. Methodological quality was high (PEDro scores 8–9). MRTs significantly increased Pressure Pain Threshold (PPT) in the masseter, trapezius, and cervical regions. Functional improvements included enhanced cervical range of motion and sensorimotor control. AO consistently demonstrated superior outcomes. However, results for orofacial variables were derived from asymptomatic subjects. Results for cervical muscle strength were inconsistent. Conclusions: MRTs, especially AO, show potential to reduce pain and improve function in craniocervical disorders. Evidence in symptomatic orofacial pain populations is non-existent. Protocol heterogeneity and limited research groups necessitate further high-quality, multicenter RCTs to establish robust clinical guidelines. Full article

Background/Objectives: Considering that the kinematics of the temporomandibular joints (TMJs) is concomitant with head movements and that temporomandibular joint disorders (TMDs) are frequently associated with neck pain in clinics but seldom or never investigated, the aim of this study was to develop a reliable in vivo measurement protocol of the simultaneous amplitudes of the mandible and of the skull. The development of such a protocol is part of a project to build an accurate kinematic assessment tool for clinicians in the orofacial field who treat patients suffering from TMD. Methods: Mouth opening, laterotrusion and protrusion movements for three different positions of the head (neutral, slouched and military) on 12 asymptomatic voluntary subjects (5 men and 7 women, mean 33.6 yo +/− 11.1) were recorded using 20 markers palpated and taped and 14 optoelectronic cameras. The acquisition frequency was set at 150 hertz. The inter- and intra-examiner reliability of marker palpation in mm was calculated using standard deviation (SD), mean difference (MD) and standard error (SE). Amplitudes of movement according to axes defined by the International Society of Biomechanics (ISB) are given for the mandible and skull segments. The propagation of error on the amplitudes was calculated with the root mean square propagation error (RMSPE) in degrees. Repeated-measures ANOVA or Friedman tests were used to assess the influence of the position of the head on the amplitudes of the jaw. Power analysis of the sample size was estimated with Cohen’s f3 size effect test. Steady-state plots (SSPs) and normalized motion graphs between the skull and the mandible motion were performed to study the coordination of their maximum amplitude over time. Results: The protocol demonstrated good intra-examiner reliability (1.5 < MD < 5.8; 2.6 < SD < 7.8; 2.0 < SE < 3.8), good inter-examiner reproducibility (0.2 < MD < 4.0; 3.5 < SD < 4.6; 2.0 < SE < 2.5) and small error propagation (0.0 < RMSPE intra < 2.8; 0.0 < RMSPE inter < 1.0). The amplitudes of the jaw and head found during the three types of movements correspond to the values reported in the literature. Head positions did not appear to significantly influence the amplitudes of jaw movements, which could be explained by the power estimation of our sample (Type II error β = 0.692). The participation of head movements in those of the jaw, for all motions and in all positions, was demonstrated and discussed in detail. Conclusions: The accuracy, test–retest reliability, and intra-individual variability of the TMJ kinematic analysis, including head movements, was ensured. The small sample size and the absence of standardized head positions for the subjects limit the scope of the intra- and inter-group analysis results. Given the natural biological and complex coordination of jaw–head movement, the authors consider its evaluation useful in clinical intervention and would like to further develop the present protocol. The next step should be to test the feasibility of its clinical application with a larger group of asymptomatic subjects compared to patients suffering from TMD. Full article

Temporomandibular disorders (TMDs) are common musculoskeletal chronic orofacial pain conditions involving peripheral and central sensitization within trigeminal nociceptive pathways, manifesting as mechanical allodynia and functional impairment. Botulinum toxin type A (BoNT-A) has been explored as a treatment targeting both muscle hyperactivity and nociceptive modulation. Preclinical and clinical evidence demonstrate that BoNT-A reduces peripheral neurotransmitter release, neurogenic inflammation, and central neuronal excitability, leading to attenuation of mechanical allodynia in TMD models and patients. Clinical trials show modest and variable analgesic effects, with patients displaying sensory sensitization appearing to respond more favorably, though methodological heterogeneity limits definitive conclusions. Safety concerns related to muscle weakening, changes in bone density, and structural changes underscore the need for standardized protocols optimizing dosing and monitoring, in addition to prospective studies. These findings suggest that BoNT-A may serve as an adjunctive, mechanism-based therapy within multimodal TMD management. Future research should focus on standardized sensory phenotyping and trial design to clarify BoNT-A’s role in modulating central sensitization and improving patient outcomes. Full article

Background/Objectives: Migraine is a complex neurological headache disorder, and transcutaneous auricular vagus nerve stimulation (taVNS) can effectively relieve headache symptoms, but its mechanism of effect is still unclear. This study aimed to explore the regulatory effects of taVNS on the locus coeruleus (LC) and the norepinephrine (NE) system in migraine mice. Methods: C57/BL6 mice were randomly assigned to four experimental groups: the control group, model group, taVNS group, and sham taVNS group. A migraine model was established by administration of nitroglycerin. Headache behaviors were assessed using the orofacial stimulation test (OST) and the mouse grimace scale (MGS). Immunofluorescence staining was conducted to evaluate the expression of NE neurons in the LC, while Western blotting was used to determine the expression levels of α-2A adrenergic receptors in the spinal trigeminal nucleus caudalis (Sp5C). Additionally, fiber-optic recording was employed to monitor the real-time dynamics of NE release in Sp5C. Results: After taVNS intervention, the drinking time of OST in the model mice was significantly prolonged(p < 0.05), and facial expression scores were reduced (p < 0.05). TaVNS increased the number of NE neurons in the LC (p < 0.05), promoted the release of NE in Sp5C (p < 0.05), and upregulated the expression of α-2A adrenergic receptors in Sp5C (p < 0.05). Conclusions: The analgesic effects of taVNS are related to the activation of the LC-NE system and the inhibition of the decrease in Sp5C in migraine mice. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder characterized by repeated episodes of upper airway obstruction during sleep, leading to intermittent hypoxia and fragmented sleep architecture. Orofacial myofunctional therapy (OMT) has emerged as a promising non-invasive approach to improving airway patency in individuals with mild-to-moderate OSA. However, the role of sleep ergonomics—including sleep posture and pillow support—in enhancing OMT outcomes remains underexplored. This study aimed to evaluate whether ergonomic interventions could augment the therapeutic effects of OMT in adult patients with mild-to-moderate OSA. Methods: A 12-week prospective cohort study was conducted involving 60 adult participants diagnosed with mild-to-moderate OSA. All participants underwent a structured orofacial myofunctional therapy (OMT) program comprising exercises for tongue elevation, lip seal enhancement, and soft palate strengthening. In addition, ergonomic instructions were provided regarding optimal sleeping posture and pillow adjustment. Compliance with ergonomic practices was monitored weekly using infrared night-vision cameras and reviewed by a blinded sleep technician. Pre- and post-intervention assessments included apnea–hypopnea index (AHI), Pittsburgh Sleep Quality Index (PSQI), and Ep-worth Sleepiness Scale (ESS). Results: Statistically significant improvements were observed in all measured parameters following the intervention. AHI scores reduced from 18.2 ± 4.5 to 10.6 ± 3.9 events/hour (p < 0.001), PSQI scores improved from 11.3 ± 2.1 to 6.5 ± 1.8 (p < 0.001), and ESS scores declined from 13.7 ± 2.6 to 7.4 ± 2.0 (p < 0.001). Participants with high adherence to ergonomic recommendations demonstrated significantly greater clinical improvements compared to less adherent individuals. Conclusions: The combination of ergonomic sleep posture interventions with OMT was associated with positive improvements in sleep-related outcomes, comparable to or in some cases better than those reported in previous studies evaluating these interventions independently. As an observational cohort without a control arm, this study cannot establish causality but provides preliminary evidence to guide the design of future randomized clinical trials. Full article

Introduction: Temporomandibular disorders (TMDs), neck pain (NP), and cervicogenic headache (CGH) frequently co-occur. We aimed to assess TMD prevalence and orofacial clinical features in adults with NP or CGH versus asymptomatic controls. Methods: We searched PubMed, CINAHL, Web of Science, and Scopus from inception to 31 July 2025. Eligible designs were analytical cross-sectional studies comparing TMD prevalence, signs, or symptoms between NP/CGH patients and controls. Outcomes included TMD prevalence, jaw mobility, masticatory muscle pressure pain thresholds (PPT), and palpation findings. Risk of bias was appraised with the JBI analytical cross-sectional checklist. Random-effects meta-analyses synthesized odds ratios (ORs) for dichotomous and mean/standardized mean differences (MDs/SMDs) for continuous outcomes; heterogeneity was quantified with I² (and τ² where available). Small-study effects were inspected visually (k < 10). Certainty of evidence was assessed with GRADE. Results: From 4130 records, nine studies met the criteria (eight NP, 400 subjects; one CGH, 44 subjects). NP was associated with higher TMD prevalence versus controls (OR 3.64, 95% CI 1.35–9.84; I² = 13%). Jaw mobility was reduced in either pain-free opening (one study), unassisted opening (one study), or maximum assisted opening (three studies; MD −6.16 mm, 95% CI −10.05; −2.28; I² = 83%). PPTs were lower in symptomatic groups for masseter (SMD −1.11, 95% CI −1.89 to −0.32; three studies; I² = 92.6%) and temporalis (SMD −0.77, 95% CI −1.04 to −0.50; five studies; I² = 69%). Myofascial trigger points and pain on palpation of masticatory muscles or TMJ were more frequent in experimental groups. Discussion: The findings suggest consistent associations between NP/CGH and TMD prevalence with signs of orofacial dysfunctions. Certainty of evidence was very low due to the cross-sectional design, incomplete confounding control, and moderate heterogeneity for several outcomes. Conclusions: Adults with NP/CGH show higher TMD prevalence and reduced jaw mobility with lower masticatory PPTs. The results support integrated assessment, and prospective longitudinal studies are needed. Full article

Background: Orofacial myofunctional therapy (OMT) is an emerging adjunctive treatment for obstructive sleep apnea (OSA), but its effects on upper airway structural support, particularly the hyoid complex, are not well defined. This study assessed the short-term effects of OMT on hyoid bone position and sleep-related indices in adults with mild to moderate OSA. Methods: In this assessor-blinded randomized controlled trial (ClinicalTrials.gov Identifier: NCT06079073), 13 adults with mild to moderate OSA were randomized to a 12-week web-based OMT program (n = 9) or a waitlist control group (n = 4). Cone-beam computed tomography (CBCT) and three-night home sleep testing were performed at baseline and follow-up. The primary outcome was change in axis-based cephalometric hyoid position measures; secondary outcomes included sleep parameters such as the apnea–hypopnea index (AHI). Results: No significant within- or between-group differences were observed in AHI, oxygen desaturation index, or mean nocturnal SpO₂ after 12 weeks (all p > 0.05). However, several cephalometric variables showed significant between-group differences. The waitlist group exhibited greater posterior–inferior hyoid displacement than the OMT group, with large effect sizes across multiple vector measures (all p ≤ 0.045; r = 0.56–0.66). Posterior and inferior hyoid displacement was associated with higher AHI and lower SpO₂, whereas increased lower pharyngeal airway width was associated with lower AHI. Conclusions: Short-term OMT did not improve sleep-disordered breathing indices but was associated with stabilization of hyoid bone position. These findings suggest that structural stabilization may precede functional improvement and highlight the clinical relevance of vector-based hyoid analysis. Full article

Background: Temporomandibular disorders (TMDs) are the most common source of non-dental orofacial pain, with peak prevalence during adolescence and young adulthood—the same age group when orthodontic treatment is typically initiated. Although orthodontics is not a proven cause of TMD, pre-existing dysfunction may be aggravated during treatment, creating clinical and medico-legal risks. Objective: This paper proposes a structured diagnostic questionnaire and scoring framework for pre-orthodontic TMD assessment. The protocol aims to enhance the early recognition of high-risk patients, facilitate interdisciplinary communication, and lay a foundation for systematic validation. Methods: The framework was developed through synthesis of international diagnostic criteria (DC/TMD), a targeted narrative review of the literature, and expert clinical input. Diagnostic categories were selected based on prevalence, impact on orthodontic outcomes, and medico-legal significance. Weighted scoring stratifies patients into three pathways: (1) proceed with orthodontics without concern, (2) proceed with monitoring, or (3) defer orthodontics until TMD is managed. Results: The proposed questionnaire is designed to address inconsistencies in the literature by applying standardized diagnostic items and objective thresholds (e.g., jaw opening < 38 mm) and structured follow-up intervals. Case scenarios illustrate how risk stratification guides decision-making. The questionnaire includes intra-articular and pain-related TMD entities such as disk displacement, degenerative joint disease, myalgia, myofascial pain, arthralgia, headache, and trismus. The framework provides orthodontists with defensible baseline documentation while supporting safe and individualized patient care. Conclusions: Inconsistent diagnostic frameworks, malocclusion classifications, and outcome measures have fragmented the evidence base in orthodontics and TMD. The framework aims to provide orthodontists with structured baseline documentation that may support clinical decision-making and medico-legal risk management. Validation studies are required to establish psychometric reliability and international applicability. Full article

Background/Objective: Emerging evidence indicates that temporomandibular disorders (TMD) patients may present features of nociplastic pain (NP), characterized by central sensitization (CS)-related symptoms. This study aims to identify factors associated with CS-related symptoms and pain sensitivity in patients with TMD and NP-related features. Methods: In this cross-sectional study, 43 TMD patients were assessed for CS-related symptoms (CSI), proximal, distal, global pressure pain threshold (PPTs, algometer), orofacial pain intensity (VAS), jaw impairment (FAI), maximal isometric strength of four muscle groups (dynamometer), resting heart rate (RHR, chest band), kinesiophobia (TKS-11), physical activity level (IPAQ), anxiety (HADS), and sleep quality (PSQI). Associations were analyzed using linear regression models adjusted for gender, age, and symptoms duration. Results: Multivariate analysis showed that higher CSI was significantly associated with greater jaw impairment (Estimate 0.09, 95% CI 0.01 to 0.18) and higher pain intensity (Estimate 0.26, 95% CI 0.14 to 0.38). Lower PPT was significantly associated with lower grip strength (Proximal: Estimate 0.03, 95% CI 0.01 to 0.05; Distal: Estimate 0.07, 95% CI 0.01 to 0.14; Global: Estimate 2.44, 95% CI 0.57 to 4.31), and proximal PPT with higher RHR (Estimate −0.02, 95% CI −0.03 to 0). Conclusions: Association was found between CS-related symptoms and pain intensity and jaw impairment, while lower PPTs were related to decreased maximal isometric grip strength and elevated RHR, thus highlighting the need for multimodal treatment in TMD patients. Full article

Background: Temporomandibular disorders (TMDs) are increasingly understood within the biopsychosocial framework, which highlights the interplay of biological, psychological, and social factors in their onset and persistence. Within this context, orofacial myofunctional disorders (OMDs) represent a significant biological component, reflecting structural and functional disturbances of the orofacial system that may contribute to temporomandibular dysfunction. Objectives: This pilot study evaluated the effectiveness of orofacial myofunctional therapy (OMT) in improving functional parameters and reducing pain in adults with myogenous TMD accompanied by OMDs. Methods: In this prospective single-arm pilot study, twenty-five adults (aged 25–39 years) with myogenous TMD and coexisting OMDs, diagnosed according to DC/TMD criteria by a dentist trained in DC/TMD assessment and referred for the intervention, completed three biweekly OMT sessions. The therapy comprised myofascial release, oromotor exercises, functional retraining of breathing, chewing, and swallowing, as well as mandibular stabilization and dissociation exercises, complemented by home-based practice. Functional parameters—maximum mouth opening (MAX) and tongue mobility (TRMR-TIP, TRMR-LPS)—were measured before and after each session. Pain intensity (VAS) and quality of life (SF-36) were assessed at baseline and post-intervention. Data were analyzed using the Shapiro–Wilk test, paired t-test, and Wilcoxon signed-rank test. Results: Statistically significant improvements (p < 0.001) were observed across all evaluated parameters. Participants demonstrated increased maximum mouth opening and tongue mobility, along with decreased pain intensity and improved quality of life following the intervention. Conclusions: This pilot study provides preliminary evidence that short-term OMT can yield measurable functional improvements and pain reduction in adults with TMD and associated OMDs. These findings underscore the relevance of addressing orofacial myofunctional impairments as part of the biological dimension within the biopsychosocial model and support the integration of OMT into interdisciplinary TMD management. Full article

Background: Temporomandibular disorders (TMDs) are associated with altered masticatory muscle function and pain. Although electromyographic parameters have been extensively studied, the rate of force development (RFD) remains an underexplored biomarker in this context. Objective: Analyze the RFD differences in women diagnosed with and without TMD. As a secondary outcome, the masseter and temporalis muscle pre-activation values were compared between groups based on the biting force onset. Additionally, neuromuscular efficiency analysis was also performed. Methods: A retrospective analysis of 62 medical records (41 with TMD, 21 controls) was conducted. Electromyographic activity and bite force were measured during three 5-s maximal biting tasks using synchronized surface electromyography (sEMG) and a laboratory-grade load cell. RFD was computed from force–time curves. Muscle pre-activation was assessed based on sEMG activity immediately preceding contraction onset. Results: The TMD group showed a significantly smaller RFD (mean = 85.5 N/s) compared to controls (mean = 109.0 N/s; p = 0.03; Cohen’s d = 0.5). No significant differences were found in neuromuscular efficiency and pre-activation or post-activation levels of the masseter and temporalis muscles between groups. Conclusions: RFD distinguishes women with TMD from healthy controls and may represent a sensitive biomechanical marker of neuromuscular adaptation in TMD, although confirmatory studies are needed. The absence of neuromuscular efficiency and pre-activation differences suggests compensatory neuromuscular mechanisms. Further prospective studies are needed to validate these findings and explore clinical applications. Full article