Search Results (94)

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: This study aimed to investigate the association between occlusal splint use and several key parameters, including body position perception, tongue pressure, temporomandibular joint dysfunction (TMD) severity, jaw functional limitation, and neck muscle endurance. Methods: A total of 157 individuals diagnosed with bruxism were screened, and 52 eligible participants were enrolled and divided into two groups: occlusal splint users (n = 26) and non-users (n = 26). Body position perception was assessed with a digital inclinometer, tongue pressure was measured using the Iowa Oral Performance Instrument (IOPI), and neck muscle endurance was evaluated by the Cranio-Cervical Flexion Test (CCFT). TMD severity and jaw functional limitation were assessed via the Fonseca Anamnestic Questionnaire and Jaw Functional Limitation Scale-20, respectively. Gender-based analyses showed higher TMD severity and mandibular limitation scores in females using occlusal splints than in males. Results: No statistically significant differences were found between the splint and non-splint groups in body position perception, tongue pressure and neck muscle endurance (p > 0.05). However, significant differences were observed in the Jaw Functional Limitation Scale (CFKS) subscales. Splint users reported higher functional limitations in chewing, mobility, and expression compared to non-splint users (all p = 0.000), with small effect sizes (d = 0.23–0.29). Conclusions: Occlusal splint use was not associated with better proprioception, orofacial muscle function, or TMD-related symptoms compared with non-splint users. However, splint users were associated with higher mandibular functional limitation based on CFKS subscale scores. 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

Aim: This study aimed to assess self-reported oral and orofacial health, hygiene habits, and oral health knowledge among Croatian athletes, and to determine factors influencing that knowledge. Differences between contact and non-contact sports, as well as the occurrence of dental trauma and temporomandibular joint (TMJ) symptoms, were also examined. Methods: A cross-sectional, questionnaire-based study was conducted among 1007 athletes (56% male, 44% female) aged 18–42 years, recruited through national sports federations and university sports clubs. The instrument comprised 85 items divided into five domains: sociodemographic data, oral hygiene habits, self-assessed oral health, TMJ symptoms, and oral health knowledge. Data were analysed using descriptive statistics, Chi-square and Fisher’s exact tests, and generalised linear modelling (p < 0.05). Results: Athletes demonstrated moderate oral health knowledge (mean score 11.3 ± 4.4/18). While 92.2% recognised that poor oral hygiene leads to caries and periodontitis, only 52.4% correctly identified the ideal time to replant an avulsed tooth. Female participants, older age groups, and those with higher education had significantly better knowledge (p ≤ 0.05). Recreational athletes scored higher than amateurs (p = 0.002), and those with prior dental trauma experience also showed greater awareness (p = 0.028). No significant difference was found between contact and non-contact sports (p = 0.287). Despite good brushing habits (86.9% brushed twice daily), only 25.4% regularly used dental floss or interdental brushes. A small proportion of athletes reported symptoms related to temporomandibular joint function, most commonly joint clicking (18.2%), tooth wear (13.4%), and nocturnal bruxism (14.3%). There were no significant differences between contact and non-contact sports, except for muscle stiffness near the temples (p = 0.024) and daytime or stress-related teeth grinding (p = 0.013 and p = 0.018). Conclusions: Croatian athletes demonstrated moderate oral health knowledge and satisfactory hygiene habits, but preventive practices remain inadequate. Education level, gender, and previous dental trauma were key determinants of knowledge. Systematic preventive programmes and targeted education are necessary to improve oral health awareness in sports populations. 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/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 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

Introduction: Infrared thermography (IRT) is a non-invasive, non-ionizing imaging modality capable of rapidly capturing surface temperature variation. In dentistry, particularly orthodontics and TMD evaluation, IRT may serve as a valuable complementary tool to be added in conventional diagnostic protocols. Objective: Correlate possible relationships between thermographic findings of orofacial structures and cephalometric landmarks. Methods: An infrared imaging camera, FLIR^® i7, was used to record the regions of interest, correspondent to the temporal, masseter and orbicular oris muscles, in adolescents (n = 22). Bilateral temperature differences were considered as thermal asymmetries with a conventional threshold of 0.3 °C to distinguish an eventual hyperactivity or hyperfunctions of detrimental structures. The Trevisi cephalometric parameters that were taken into consideration for the study were SNA, SNB, ANB, OccltoSn, Wits relation to base and Molar/canine classes. Results: Most of the participants showed a normal temperature difference ΔΤ for the upper and lower orbicular oris muscle, right vs. left, 96% and 92%, respectively. The other ROIs presented a mixed pattern of thermal asymmetries; however, no statistically significant differences were found when crossed with the cephalometric landmarks. Conclusions: Asymmetrical patterns of infrared thermography can aid on the diagnosis and treatment plan of an orthodontic appointment, since the actual stability of pos-orthodontic treatment is highly dependent on the muscular activity of the tongue and lips, in particular when the patient has atypical swallowing. Our findings suggest that this technique can be used to quantify anatomical landmarks relevant to craniofacial morphology in specific populations, particularly at ages where muscular functional activity is strongly correlated with dentoskeletal development. Full article

VPS13A disease is a rare, autosomal-recessive, neurodegenerative disorder characterized by involuntary movements, orofacial dystonia, seizures, psychiatric symptoms, and the presence of spiky, deformed red blood cells (acanthocytes). The disease is caused by mutations in the VPS13A gene, which encodes the VPS13A protein (previously known as chorein). This protein is a member of the family of bridge-like lipid transport proteins, involved in bulk lipid transfer between membranes and intracellular vesicle trafficking. We describe the case of a 37-year-old woman with gait instability, semi-flexed legs, and involuntary distal muscle movements. Genetic testing was performed using next-generation sequencing (NGS), followed by molecular analysis. Fibroblasts from the patient, her mother, and a healthy control were analyzed by immunofluorescence and Western blotting. NGS identified a novel homozygous 2.8 kb deletion encompassing exons 69–70 (69–70del) of the VPS13A gene (NM_033305.3). The same variant was detected in the patient’s mother in a heterozygous state and her brother in a homozygous state. Although other deletions in the gene have been described, a comprehensive search of population variant databases and the existing literature did not reveal previous reports of this deletion. Fibroblasts from the patient, her mother and a healthy control were characterized. Functional assays showed a complete absence of the VPS13A protein in the patient’s fibroblasts. This study expands the mutational spectrum of VPS13A-linked VPS13A disease and underlines the importance of comprehensive genetic analysis in atypical cases. Full article

Background: Crisponi/cold-induced sweating syndrome (CS/CISS) is a rare autosomal recessive disorder characterized by severe neonatal manifestations including paroxysmal muscle contractions, tendency for hyperthermia, and feeding and swallowing difficulties with high neonatal mortality. Pathogenic variants in the Cytokine Receptor-Like Factor 1 (CRLF1) gene have been associated with CS/CISS. These variants result in a loss of function of the encoded protein, which disrupts the formation of a functional heterodimer with Cardiotrophin-Like Cytokine Factor 1 (CLCF1). This complex is essential for the development of autonomic and sensory nervous systems, as well as for bone remodeling. We report two patients affected by CS harboring pathogenic variants in the CRLF1 gene. Methods—case reports: The first patient was diagnosed postnatally, presenting with non-epileptic paroxysmal events characterized by opisthotonus and orofacial contractions. He survived beyond infancy, later developing scoliosis and persistent episodes of hyperthermia. In the second patient, a prenatal ultrasound at 20 weeks of gestation revealed bilateral camptodactyly, also referred to as the ‘horn’s sign’, raising early suspicion of CS. The diagnosis was subsequently confirmed both clinically and genetically. After birth, the infant developed severe dysphagia, apnea, and paroxysmal events not associated with epileptiform activity on EEG. Sanger sequencing identified a homozygous c.708_709delinsT frameshift variant in the CRLF1 gene. The patient died at 30 days of age due to respiratory failure. Results and conclusions: With this manuscript, we aim to further delineate the phenotypic spectrum of this rare condition and propose the ‘horn’s sign’ as a targeted prenatal marker for early diagnosis in populations with known founder mutations or familial risk factors. Full article

Background and Objective: Rheumatoid arthritis (RA) is a systemic autoimmune disease affecting synovial joints including the temporomandibular joint (TMJ). This study aimed to assess the prevalence and characteristics of temporomandibular disorders (TMDs) in RA patients and correlate these findings with disease activity markers. Materials and Methods: This cross-sectional study included 40 RA patients meeting the 2010 ACR/EULAR criteria and 40 healthy subjects (HSs). Research diagnostic criteria for TMD were used to assess TMD. RA severity was evaluated using ESR, CRP, rheumatoid factor (RF), anti-CCP antibodies, Disease Activity Score (DAS) 28, and disease duration. Results: TMD prevalence was significantly higher in RA patients (75%) than in HS. Orofacial pain was a predominant TMD reported in 82.5% of RA patients. In RA patients there was a difference in myofascial pain, TMJ pain, and TMJ sounds in comparison to HS. All masticatory muscles were painful on palpation in RA patients and the pain intensity was higher in RA than in HS. The most painful muscles were the medial pterygoid muscles, the anterior belly of digastric muscle, and the tendon of the temporal muscle. Slight crepitations were the most frequent. Maximal active mouth opening was reduced and negatively correlated with CRP levels. The most frequent jaw function limitations were chewing and yawning difficulties and tinnitus. There were no correlations between TMD and DAS, RF, and disease duration. Conclusions: Active inflammation in RA is a crucial factor reducing mouth opening. TMD screening independent of disease duration should be integrated into RA management protocols, particularly for patients with elevated inflammatory markers, to eliminate other pathological factors contributing to faster TMJ functional changes, TMJ involvement, and the severity of TMD during RA course. Full article

Background: Orofacial myofunctional therapy (OMT) is frequently applied to correct atypical swallowing, yet its therapeutic strategies remain heterogeneous and poorly standardized. Objective: This scoping review aimed to characterize the strategies described in the literature for OMT in individuals diagnosed with atypical swallowing. Methods: Following Joanna Briggs Institute and PRISMA-ScR guidelines, and with a registered protocol, we included clinical and experimental studies without age restriction, conducted in clinical or research contexts. Studies were retrieved from PubMed, EMBASE, and Cochrane Library using MeSH terms and specific keywords. Data were extracted using a standardized form and summarized descriptively. Results: Twelve studies published between 1989 and 2024, involving 164 participants aged 5–26 years, were included. Interventions were mainly performed by speech-language pathologists in pediatric and adolescent populations, combining tongue posture exercises, muscle strengthening, orofacial mobility, and functional swallowing training. Treatment duration ranged from 8 weeks to 6 months, with weekly sessions and home practice recommendations. In 83% of studies, improvements in swallowing patterns and tongue posture were reported, especially when combined with orthodontic treatment. Conclusions: OMT is characterized as a multifactorial intervention integrating muscle training and functional re-education, but variability in protocols and lack of standardization limit clinical comparability. Future multicenter studies with greater methodological control are needed. Full article

Objective: Accurate measurement of orofacial muscle strength is essential for phenotyping patients with obstructive sleep apnea (OSA), and particularly those with hypotonic phenotypes. High costs associated with gold standard devices such as the Iowa Oral Performance Instrument (IOPI^®) limit their clinical use. This study aims to validate the Sandway^® manometer, a low-cost alternative to the IOPI^®, by comparing its performance against the IOPI^® and the Tongue Digital Spoon (TDS) in both laboratory and clinical settings. Methods: We conducted a two-phase study. In the laboratory phase, pressure readings from the IOPI^® and Sandway^® devices were compared using standardized force application methods. In the clinical phase, 60 patients with moderate-to-severe untreated OSA underwent orofacial strength evaluation using IOPI^®, Sandway^®, and TDS devices. Intraclass Correlation Coefficient (ICC), Bland–Altman analysis, and Pearson correlation were used to assess reliability and agreement. Results: The Sandway^® showed excellent reliability for anterior tongue and lip strength measures (ICC = 0.978). Bland–Altman plots revealed minimal bias and narrow limits of agreement compared to the IOPI^®, indicating strong agreement for both tongue and lip measurements. A high correlation was also observed between Sandway^® and TDS results (r = 0.863, p < 0.001), supporting secondary validation. Conclusions: The Sandway^® manometer demonstrates high reliability and strong agreement with gold standard instruments, representing a valid, accessible alternative for objective assessment of orofacial muscle strength in clinical practice. Full article

Background/Objectives: Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal conditions affecting the temporomandibular joints and masticatory muscles. In recent years, autogenous injections have been investigated as minimally invasive therapeutic options to alleviate pain and improve function. However, the clinical effectiveness of such therapies across different TMD phenotypes remains uncertain. Methods: Electronic searches were performed in MEDLINE, Embase, and Web of Science for articles published between January 2015 and May 2025. Studies involving intra-articular or intra-muscular autogenous injections in TMD patients were included. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool and the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Results: Thirteen studies met the inclusion criteria. Six were randomized controlled trials (RCTs) and seven were non-randomized clinical studies. Ten studies evaluated intra-articular conditions such as disc displacement or Temporomandibular Joint (TMJ) osteoarthritis, while three focused on myofascial pain. Platelet-Rich Plasma (PRP) was the most frequently investigated agent. Most studies reported statistically significant reductions in pain and improvements in mandibular mobility following autogenous injections, with PRP generally outperforming comparators such as hyaluronic acid, corticosteroids, or saline. No serious adverse events were reported. Conclusions: All PRP and Platelet-Rich Fibrin (PRF) injection protocols reviewed were effective in reducing pain and improving mobility in patients with TMD. However, differences in protocols and follow-up times prevented a meta-analysis from being conducted. More standardized RCTs are needed to determine clear clinical guidelines. Full article

Aim: Pacifiers play a critical role in the early stages of craniofacial and palate development during infancy. While they provide comfort and aid in soothing, their use can also have significant impacts on the growth and function of the oral cavity. This study aimed to simulate and predict the behavior of six different types of pacifiers and their functional interaction with the tongue and palate, with the goal of understanding their potential effects on orofacial growth and development. Materials and Methods: Biomechanical analysis using Finite Element Analysis (FEA) mathematical models was employed to evaluate the behavior of six different commercial pacifiers in contact with the palate and tongue. Three-dimensional solid models of the palate and tongue were based on the mathematical framework from a 2007 publication. This allowed for a detailed investigation into how various pacifier designs interact with soft and hard oral tissues, particularly the implications on dental and skeletal development. Results: The findings of this study demonstrate that pacifiers exhibit different interactions with the oral cavity depending on their geometry. Anatomical–functional pacifiers, for instance, tend to exert lateral compressions near the palatine vault, which can influence the hard palate and contribute to changes in craniofacial growth. In contrast, other pacifiers apply compressive forces primarily in the anterior region of the palate, particularly in the premaxilla area. Furthermore, the deformation of the tongue varied significantly across different pacifier types: while some pacifiers caused the tongue to flatten, others allowed it to adapt more favorably by assuming a concave shape. These variations highlight the importance of selecting a pacifier that aligns with the natural development of both soft and hard oral tissues. Conclusions: The results of this study underscore the crucial role of pacifier geometry in shaping both the palate and the tongue. These findings suggest that pacifiers have a significant influence not only on facial bone growth but also on the stimulation of oral functions such as suction and feeding. The geometry of the pacifier affects the soft tissues (tongue and muscles) and hard tissues (palate and jaw) differently, which emphasizes the need for careful selection of pacifiers during infancy. Choosing the right pacifier is essential to avoid potential negative effects on craniofacial development and to ensure that the benefits of proper oral function are maintained. Therefore, healthcare professionals and parents should consider these biomechanical factors when introducing pacifiers to newborns. Full article