Browsing by Subject "Temporomandibular disorders"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Altered Brain Responses to Noxious Dentoalveolar Stimuli in High-Impact Temporomandibular Disorder Pain Patients
    (2022-01) Peck, Connor
    High-impact temporomandibular disorder (TMD) pain may involve brain mechanisms related to central sensitization. We investigated brain responses to stimulation of trigeminal sites not typically associated with TMD pain by applying noxious dentoalveolar pressure to high- and low-impact TMD pain cases and pain-free controls during functional magnetic resonance imaging (fMRI). Fifty female participants were recruited and assigned to one of three groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and Graded Chronic Pain Scale: controls (n=17), low-impact (n=17) and high-impact TMD (n=16). Multimodal whole-brain MRI was acquired following the Human Connectome Project protocol, including stimulus-evoked fMRI scans during which painful dentoalveolar pressure was applied to the buccal gingiva of participants. Group analyses were performed using non-parametric permutation tests for parcellated cortical and subcortical neuroimaging data. There were no significant between-group differences for brain activations/deactivations evoked by the noxious dentoalveolar pressure. For individual group mean activations/deactivations, a gradient in the number of parcels surviving thresholding was found according to the TMD pain grade, with the highest number seen in the high-impact group. Among the brain regions activated in chronic TMD pain groups were those previously implicated in sensory-discriminative and motivational-affective pain processing. These results suggest that dentoalveolar pressure pain evokes abnormal brain responses to sensory processing of noxious stimuli in high-impact TMD pain participants, which supports the presence of maladaptive brain plasticity in chronic TMD pain.
  • Thumbnail Image
    Item
    Association between Temporomandibular Disorders Pain, Oral Behaviors, Anxiety and Stress
    (2019-03) Thakur, Preetanjali
    Aims: Oral behaviors, anxiety and stress are believed to be related to temporomandibular disorders (TMD) pain. The aims of the study were to investigate the association of TMD pain intensity with oral behaviors, anxiety and stress, and the association of oral behaviors with anxiety and stress. Methods: From among the clinical and community-based participants in the multi-site Validation Project, 721 subjects were included in this study who had completed self-report questionnaires that reported pain intensity (Characteristic Pain Intensity [CPI]), oral behaviors (Oral Behavior Checklist [OBC]), anxiety (Symptom Checklist - 90 revised [SCL-ANX]) and stress (Perceived Stress Scale [PSS]) experienced during the previous month; and anxiety experienced during the previous week. Participants were divided into four groups based on the CPI report: no pain, mild, moderate and severe pain, and were compared using analysis of variance (ANOVA). Statistical differences between groups were evaluated using an F-test for continuous variables and Chi-square test for categorical variables. Spearman correlation coefficients were computed to examine the association of (1) CPI with OBC, SCL-ANX and PSS and (2) OBC with SCL-ANX and PSS. Simple linear regression analysis was used to investigate the bivariate relationships for outcomes CPI and OBC. The multivariate regression analysis with age and sex adjustment was conducted to examine relationship between CPI and dependent variables, and OBC and dependent variables. Results: Using CPI as a categorical variable, pain intensity was associated by a dose-response curve relationship for each of the independent variables: OBC, SCL-ANX, and PSS (ANOVA; p<0.0001). Positive correlations were found between CPI versus OBC (r=0.44, n=721), SCL-ANX (r=0.30, n=720), and PSS (r=0.21, n=721) with p<0.0001 for all correlations. Positive correlations between OBC with SCL-ANX (r=0.38, n=720) and PSS (r=0.32, n=721) with p<0.0001 were found. Using simple linear regression, OBC accounted for 18% of the variance of CPI versus SCL-ANX and PSS that explained 10% and 5% of CPI, respectively. SCL-ANX and PSS accounted for 12% and 11% of the variance of OBC, respectively. The multivariate regression model estimated that with 1SD increase of OBC, CPI will increase by 9 after adjusting for SCL-ANX, PSS, age and gender. For 1 SD increase in SCL-ANX, CPI will increase by 5 after adjusting for OBC, PSS, age and gender. For 1 SD increase in SCL-ANX, OBC will increase by 2.27 and for 1 SD increase in PSS, OBC will increase by 1.63 after adjusting for age, sex and each other. These statistically significant associations are positive and range from weak-moderate with correlation coefficients of 0.21 to 0.44. Together, these variables with age and sex adjustment explain 22% of the TMD pain intensity variability. Together, anxiety and stress with age and sex adjustment explain 19% of the variability of oral behaviors. Conclusion: Participants with severe TMD pain intensity reported significantly higher frequency of oral behaviors and higher levels of anxiety and stress compared to participants with no and mild pain. Participants with higher frequency of oral behaviors reported significantly higher anxiety and stress compared to participants with lower frequency of oral behaviors. Participants with the highest frequency of oral behaviors (tercile III of OBC) had clinically significantly more TMD pain than those with the lowest frequency of oral behaviors (tercile I of OBC). As predicted by the biopsychosocial model, TMD pain is associated with many factors beyond those assessed in the present study.
  • Thumbnail Image
    Item
    Cross-Sectional Study of The Association of Masticatory Muscle Pain Diagnostic Subgroups with Biopsychosocial Factors
    (2021-05) VARUN, SARANYA
    Aim: Clinically, it would be useful to determine if the varied temporomandibular disorders differ in their biopsychosocial characteristics. The aim of this study was to assess differences in biopsychosocial factors among participants with masticatory myofascial pain (MFP) with referral, myalgia without referral, and community controls. Methods: The original Validation Project sample included 196 participants with MFP with referral (Group 1), 299 with myalgia without referral (Group 2), and 87 community controls (Group 3). Two calibrated examiners at each of 3 sites rendered these consensus-based diagnoses. Data regarding biological factors was collected including pain duration, number of painful sites to palpation and pressure pain thresholds (PPT) at 12 masticatory muscle sites, 2 trigeminal controls sites and 2 non-trigeminal control sites. Psychosocial factors were also assessed including anxiety, depression, and nonspecific physical symptoms using the Symptom Checklist-90 Revised (SCL-90R), stress using the Perceived Stress Scale (PSS) and health related quality of life (HRQoL) using the Short Form Health Survey (SF-12). Multivariable linear regression was used for comparisons among the three groups adjusting for age, sex, race, education, and income. For subsequent pairwise-comparisons, the significance threshold was set at p=0.05/3=0.017. Results: Participants with MFP with referral had significantly greater pain duration, lower PPTs in trigeminal sites, and thus the highest pain sensitivity, as well as more painful sites, compared to participants with myalgia without referral and controls. Participants with MFP with referral also had significantly greater symptoms of anxiety, depression, nonspecific physical symptoms, and impaired physical health. Although stress was higher and the mental component of HRQoL was lower for myofascial pain with referral as compared to the myalgia without referral and control groups, the differences between the two muscle pain groups were not statistically significant. Conclusion: These findings suggest that the clinical diagnosis of MFP with referral has clinical utility in the identification of masticatory muscle pain patients with the highest pain sensitivity and most complex biopsychosocial characteristics. Patients with this diagnosis may benefit from treatments specifically addressing these characteristics.
  • Thumbnail Image
    Item
    Relationship between Unilateral Temporomandibular Joint Arthralgia and Disc Positions and Degenerative Joint Changes- A Cross Sectional Study
    (2021-05) SHRIVASTAVA, MAYANK
    Background: This study simultaneously assessed for both temporomandibular joint (TMJ) disc displacement (DD) and degenerative joint disease (DJD) in participants with unilateral TMJ arthralgia using TMJ MRI and CBCT.Methods: In the multi-center TMJ Impact Project, 401 subjects were examined by calibrated examiners that included rendering a diagnosis of TMJ arthralgia. All subjects had bilateral TMJ MRIs and CTs. Two radiologists rendered a consensus diagnosis of normal, DD with reduction (DDwR), or DD without reduction (DDw/oR) using MRI. CBCT consensus diagnoses included normal or grade I DJD and grade II DJD. Radiologist reliability was assessed by kappa. Descriptive analysis was performed using generalized linear mixed models. Models include a random intercept to account for correlations within subject. The level of significance is p< 0.05. Results: Of the 401 subjects, 58 subjects had a clinical diagnosis of unilateral arthralgia. In 58 joints with arthralgia, 11(19%) had normal disc position, 19 (33%) had DDwR and 28 (48%) had DDw/oR compared to 58 joints without arthralgia: 13 (22%) were normal, 25 (43%) had DDwR and 20 (34%) had DDw/oR (p=0.32). In joints with arthralgia, 25 (43%) had normal osseous morphology and 33 (57%) had DJD compared to joints without arthralgia 32 (55%) had normal osseous morphology and 26 (44%) had DJD (p=0.20). Radiologist reliability was kappa: 0.73 (CI: 0.64–0.83) for DD and 0.76 (CI: 0.68-0.83) for DJD. Conclusion: The presence of arthralgia is not significantly related to the radiographic findings of DD and DJD.