OBJECTIVE:Embouchure dystonia is a rare task-specific orofacial movement disorder affecting wind instrumentalists and may mimic temporomandibular disorder-like or dental complaints. This study described its clinical features, diagnostic pitfalls, assessment methods, and management in an oral and maxillofacial surgery clinic. METHODS:This retrospective case series included 37 patients clinically diagnosed with embouchure dystonia. Diagnosis was based on instrument-specific involuntary contraction, abnormal movement, or loss of fine motor control; task specificity; reproducibility during similar musical tasks; and exclusion of dental, temporomandibular, occlusal, bruxism-related, prosthetic, or structural findings sufficient to account for the symptoms. Temporomandibular disorders and bruxism were assessed clinically. RESULTS:The study included 27 women and 10 men. All patients reported difficulty playing. Previous diagnoses included temporomandibular disorders, bruxism, and psychiatric disease. CONCLUSIONS:Embouchure dystonia should be considered in wind instrumentalists with instrument-specific orofacial motor symptoms unexplained by dental or temporomandibular findings.
OBJECTIVE:Temporomandibular disorders (TMDs) are musculoskeletal conditions causing pain and functional limitations. This scoping review aimed to map therapeutic exercise interventions described in clinical studies on TMDs. METHODS:Following Joanna Briggs Institute methodology, searches were conducted in MEDLINE, Cochrane Central, Scopus, CINAHL, Embase, PEDro, Google Scholar, and OpenGrey. RESULTS:Seventy-six studies were included, most prescribing oral opening movements and motor control exercises. Daily home practice was frequently prescribed, predominantly involving multiple exercise sessions per day. Guidance on whether pain should be avoided or permitted during exercise was inconsistently reported. CONCLUSION:Future studies should adopt standardized terminology and pain-parameter reporting, compare single versus multi-session approaches, and assess adherence to exercises to enable meta-analysis.
OBJECTIVE:To translate, culturally adapt, and validate the measurement properties of the Migraine Interictal Burden Scale-4 (MIBS-4) for Brazilian Portuguese. METHODS:This methodological study included 130 adults with migraine aged 18-55 years: 30 in translation/cross-cultural adaptation and 100 in validation. Participants completed sociodemographic, HIT-6, and MIDAS assessments. Content, construct, convergent, and criterion validity; reliability; sensitivity; and floor/ceiling effects were evaluated. . RESULTS:The MIBS-4 Brazil demonstrated content validity and comprehensibility (Cohen's κ=0.742, p=.004), acceptable internal consistency (α=0.714), and moderate-to-good test-retest reliability (ICC=0.737; n=52). Confirmatory factor analysis supported a unidimensional structure (CFI=1.000; RMSEA=0.000). Moderate correlations were observed with HIT-6 (r=0.496) and MIDAS (r=0.458). The MIBS-4 explained 30.2% of their combined variance (R2=0.302, p < .001). ROC analysis showed excellent accuracy for HIT-6 (AUC=0.924) and good accuracy for MIDAS (AUC=0.777). No significant floor (11%) or ceiling (2%) effects were found. . CONCLUSION:The MIBS-4 Brazil is a valid and reliable instrument for assessing interictal migraine burden.
OBJECTIVES:To synthesize the clinical pathway of occlusal dysesthesia (OD), emphasizing recognition failure, repeated dental intervention, provider switching, and iatrogenic risk. MATERIALS AND METHODS:Five databases, trial registries, and supplementary searches were completed through 1 August 2026. PRISMA-ScR narrative synthesis used study-ID denominators and assessed cohort overlap. RESULTS:Thirty-four records were included. Patient-level sources reported 752 participants; cohort overlap precluded deduplication. Among applicable records, delay was reported in 15/18, provider switching in 14/18, occlusal adjustment in 15/16, prosthetic treatment in 14/16, orthodontic treatment in 8/16, and persistence or worsening after dental intervention in 16/16. These fractions are not prevalence estimates. Twenty-three of 32 records (71.9%) were CEBM level 4-5; no eligible or ongoing randomized trial was identified. CONCLUSIONS:Results are consistent with a proposed escalation pathway but establish neither frequency nor causality. After structural assessment, early recognition, avoiding irreversible occlusal treatment, and coordinated biopsychosocial care may reduce iatrogenic burden.
BACKGROUND:Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication associated with antiresorptive and antiangiogenic agents. This study evaluated regional differences in MRONJ diagnosis and surgical management in Korea. METHODS:Using the National Health Insurance Service-Health Screening Cohort, individuals aged ≥50 years between 2010 and 2019 were analyzed. MRONJ cases were identified using KCD-7 diagnosis and procedure codes. RESULTS:A total of 4,493 MRONJ diagnoses and 1,671 surgical treatments were identified. Diagnoses and surgeries were most frequent in Gyeonggi-do, Seoul, and Gyeongsangbuk-do, whereas relative burden was higher in several non-metropolitan regions. Care was concentrated in tertiary general hospitals and dental hospitals. Region-out diagnosis and surgery rates were highest in Gyeonggi-do (40.8% and 28.4%, respectively), with significant regional differences in healthcare utilization (p < .001). . CONCLUSIONS:Regional disparities exist in MRONJ diagnosis and surgical management in Korea, suggesting imbalances in healthcare resources, specialized care access, and referral patterns.
OBJECTIVE:To assess nocturnal glycemic burden across sleep stages in adults with polysomnographically confirmed sleep bruxism. METHODS:95 adults underwent polysomnography, bilateral masseter electromyography, and continuous glucose monitoring. 70 participants with BEI ≥2 events/h formed the sleep bruxism group and 25 with BEI <2 were controls. Glycemic burden was calculated as glucose AUC (mg·h/dL). RESULTS:Fasting glucose, glycated hemoglobin, sleep architecture, respiratory indices, and oxygenation did not differ. Glycemic burden was higher with bruxism during total sleep time (690.06 vs. 634.08 mg·h/dL; p = .008) and non-rapid eye movement sleep (524.89 vs. 489.20 mg·h/dL; p = .046). Mean nocturnal glucose and glycemic variability were similar. In 15 participants with BEI >4, glucose during RMMA-related bruxism periods was higher than outside them (102.60 ± 13.06 vs. 97.07 ± 9.37 mg/dL; p = .044). . CONCLUSION:Sleep bruxism was associated with higher nocturnal glycemic burden, particularly during non-rapid eye movement sleep, but causality and independence from confounding require confirmation.
BACKGROUND:Temporomandibular disorders (TMD) are frequently associated with structural alterations of the temporomandibular joint (TMJ). This systematic review evaluated morphological changes in TMJ components including condyle, articular disc, joint space, glenoid fossa, and articular eminence in individuals with TMD. METHODS:The systematic review included studies done in adult subjects with any one sign or symptom of TMD or studies done in subjects diagnosed with TMD, not limited to DC/TMD criteria, RDC/TMD criteria, using three-dimensional imaging. Systematic searches were conducted in 8 databases from inception to December 2025. Analytical observational studies were selected, and critical appraisal was performed. Joanna Briggs Institute (JBI) guidelines for systematic effectiveness reviews were followed for data appraisal, extraction, and synthesis. RESULTS:190 articles are included in the systematic review. Most studies reported alterations in various components of the TMJ in patients with temporomandibular disorder. CONCLUSION:TMD appears to be associated with significant osseous and soft-tissue changes, including condylar flattening, erosions, osteophyte formation, sclerosis, reduced condylar volume, glenoid fossa variations, altered articular eminence morphology and inclination, disc displacement, disc morphological alterations, and changes in joint space dimensions.
BACKGROUND:Disc displacement with reduction (DDwR) and disc displacement without reduction (DDwoR) are recognized as distinct diagnostic entities, but comparative data on their functional and physical parameters remain limited. OBJECTIVE:To compare functional and physical parameters between DDwR and chronic DDwoR patients. METHODS:This cross-sectional study included 204 patients with TMJ internal derangement per DC/TMD criteria (91 DDwR, 113 DDwoR). Pain, chewing efficiency, joint sounds, mandibular range of motion, muscle palpation, and occlusal parameters were assessed. RESULTS:DDwoR patients showed greater masticatory pain (p = .013), lower chewing efficiency (p = .004), higher masseter tenderness (p < .001), and more restricted mouth opening and movement (p < .001) than DDwR patients. No differences emerged in pain intensity, activity interference, joint sounds, temporal tenderness, tinnitus, deviation, or midline discrepancy (p > .05). . CONCLUSIONS:DDwoR carries a greater functional and mechanical burden than DDwR. Beyond pain alone, mandibular mobility, masseter tenderness, and occlusal features may improve subtype-specific diagnosis and treatment.
OBJECTIVES:To evaluate short-term clinical and ultrasonographic changes in the masseter muscle following botulinum toxin type A (BoNT-A) injection in participants clinically assessed as having bruxism. METHODS:Seventeen participants received standardized bilateral BoNT-A injections. Masseter muscle thickness was measured by ultrasonography at baseline, 14 days, and 90 days. Pain intensity (VAS), histogram parameters, and fractal dimension were also assessed. Bilateral measurements were averaged for statistical analysis. RESULTS:VAS scores and masseter muscle thickness decreased significantly at days 14 and 90 compared with baseline, with no significant difference between follow-up visits. Histogram and fractal dimension analyses showed no significant changes over time. CONCLUSION:BoNT-A significantly reduced pain and masseter muscle thickness, whereas ultrasonographic texture parameters remained unchanged during the 90-day follow-up.Clinical trials number: NCT07545200.
BACKGROUND:Accelerated bone healing in patients with traumatic brain injury (TBI) is well documented in long bone fractures but remains poorly studied in mandibular fractures. This study compared mandibular fracture healing rates in patients with and without TBI using high-frequency ultrasonography. METHODS:A prospective comparative study was conducted from June 2020 to November 2021 at a single tertiary care center. All patients with mandibular fractures were enrolled in the study. They were divided into two groups as Group 1-with TBI-and Group 2-without TBI. All patients underwent either open reduction and internal fixation or intermaxillary fixation. Fracture healing was assessed weekly for four weeks using high-frequency ultrasonography (6-15 MHz) to evaluate callus formation patterns. RESULTS:A total of 77 patients were enrolled in the study, of which 22 were in Group 1 and 55 in Group 2. Groups were comparable for age (33.23 ± 13.48 vs. 35.80 ± 13.65 years, p = 0.391) and gender distribution (p = 0.977). Mean time to initial callus formation was significantly shorter in Group 1 (15.45 ± 1.96 days) compared to Group 2 (19.98 ± 3.04 days, p < 0.001). By the second week, soft callus was evident in 27.3% of TBI patients versus 9.1% without TBI (p = 0.007). By the fourth week, 72.7% of Group 1 showed hard callus formation compared to 27.3% in Group 2 (p < 0.001). Glasgow Coma Scale scores showed significant inverse correlation with callus formation timing (p < 0.001). CONCLUSIONS:Mandibular fractures demonstrate accelerated healing in patients with TBI, with callus formation occurring approximately 4.5 days earlier. Ultrasonography provides an effective, radiation-free method for serial fracture assessment. These findings may inform surgical timing and follow-up protocols in polytrauma patients.
This study conducts a comparative analysis of surgical outcomes in patients who underwent FSF repair by a plastic surgeon versus an ENT using a national database. A retrospective analysis was conducted on patients who underwent surgical treatment of FSFs by a plastic or ENT surgeon using the de-identified American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Patients were identified based on surgical CPT codes. Data extracted included primary surgeon specialty and patient demographics, comorbidities, and surgical outcomes. Statistical analysis was performed using Fisher’s Exact test and the Wilcoxon Rank-Sum test, with a p-value < 0.05 representing statistical significance. A total of 111 patients were analyzed, of which 85.6% were male. The mean age was 30.0 years [22.0, 48.0]. There were 70 patients (63.1%) treated by an ENT and 41 (36.9%) by a plastic surgeon. The median operative time was 131.0 min for ENT and 115.0 min for plastic surgery (p = 0.19). The median length of postoperative stay was 1.0 day for both groups. Postoperative complications included surgical site infection (SSI), wound disruption, and sepsis in five patients (4.5%). There was no statistically significant difference in the rate of complications between patients who underwent surgery with an ENT surgeon versus a plastic surgeon (p = 0.16). There were no statistically significant differences in operative time, length of stay, or complications between patients who underwent FSF repair by an ENT or by a plastic surgeon. Surgeon specialty training does not appear to influence intraoperative or postoperative outcomes. Studies with larger sample sizes may demonstrate statistically significant differences in outcomes.
Craniomaxillofacial trauma (CMFt) poses a significant burden, yet in many countries the evidence base is fragmented across single-center hospital series without specialized registry. Using Chile as a case study, we demonstrate a dual-synthesis approach to construct a national CMFt profile. Six databases were searched through February 2026 (PROSPERO: CRD420261290860). Two reviewers independently screened studies. Risk of bias was assessed with the JBI critical appraisal tool. Fracture-site proportions were pooled via random-effects meta-analysis and synthesized using GRADE. DEIS trauma discharges (2001-2024) were analyzed with negative binomial interrupted time-series. Nineteen studies were included. CMFt represented 2.6-6.1% of emergency consultations. CMFt admissions were 54.2/1000 trauma discharges; this rate dropped during 2020-2021 and rebounded post-2022. Pooled fracture-site distributions were highest for mandibular (45.3%) and zygomatic (24.2%) fractures. CMFt disproportionately affected males across both hospital series and national discharge data. According to DEIS, low-energy accidental injuries were the predominant etiology, followed by transport-related high-energy injuries and interpersonal violence, contrasting with hospital series where interpersonal violence predominated among adult surgical cohorts. Fracture admissions had longer length of stay (LOS) than soft-tissue CMFt (+0.94 days), with mean LOS ranging from 2.08 (nasal) to 8.35 days (multiple skull/facial fractures). These findings support prioritizing surgical preparedness and training in common fracture patterns, while strengthening trauma surveillance, referral pathways, and service planning in health systems without dedicated CMFt registries.
OBJECTIVE:To report central sleep apnea (CSA) as an underrecognized cause of respiratory morbidity in pediatric posterior fossa tumors and highlight the benefit of CPAP. METHODS:A 3-year-old child with metastatic medulloblastoma involving the fourth ventricle underwent resection, radiotherapy, and chemotherapy. The course was complicated by recurrent respiratory failure, multiple PICU admissions, and unexplained desaturations initially attributed to seizures. Persistent daytime somnolence and episodic apnea prompted polysomnography. RESULTS:Polysomnography showed severe CSA (respiratory event index 68.3/hour; nadir SpO₂ 75%), unifying the prior hypoxic episodes. CPAP (5 cm H₂O) produced rapid improvement, with restored sleep architecture, fewer respiratory events (index 6.3/hour), stable saturation (~97%), and no further prolonged intensive care admissions. The patient completed oncologic therapy and remained stable on domiciliary CPAP. CONCLUSION:CSA should be considered in children with posterior fossa or brainstem-adjacent lesions presenting with unexplained respiratory events; recognition has important implications for multidisciplinary management and long-term outcomes.
BACKGROUND:This study evaluated whether stressful life events (SLE) and stress reactivity (SR) influence treatment selection and outcomes in patients with masticatory myofascial pain (MMFP). CASE DESCRIPTION:Thirty-five patients with MMFP completed the Social Readjustment Rating Scale and the Stress Reactivity Index-32 (IRE-32). Patients received either conventional treatment (cyclobenzaprine plus physiotherapy; n = 15) or the same treatment plus botulinum toxin (BT) infiltration (n = 20). Pain intensity, pressure pain thresholds, and mandibular range of motion were assessed before and after treatment. . RESULTS:SLE scores did not differ between groups and were unrelated to treatment outcomes. Patients receiving conventional treatment showed higher cognitive, emotional, and global SR scores. In this group, greater SR was associated with poorer improvements in pain and mandibular function, whereas no such associations were observed in the BT group. CONCLUSIONS:SR, rather than SLE, may be a clinically relevant predictor of treatment selection and response in patients with masticatory myofascial pain. PRACTICAL IMPLICATIONS:Assessing SR may support personalized treatment decisions.
OBJECTIVE:To estimate obstructive sleep apnea (OSA) risk among Palestinian adults in the West Bank and examine associations with snoring and upper-airway symptoms. METHODS:In this cross-sectional study, 1,000 adults completed a modified Arabic STOP-Bang questionnaire with additional items on nasal obstruction, mouth breathing during sleep, drooling, recurrent tonsillitis/sore throat, and upper-airway surgery. OSA risk was classified as low, intermediate, or high. Logistic regression analyses identified factors associated with snoring and OSA risk. RESULTS:Overall, 68.1% were classified as low risk, 24.1% as intermediate risk, and 7.8% as high risk for OSA. Snoring was independently associated with male sex, extreme obesity, witnessed apnea/choking, nasal obstruction with mouth breathing, drooling, and recurrent tonsillitis/sore throat. Nasal obstruction with mouth breathing showed the strongest association with intermediate (OR=2.7) and high OSA risk (OR=8.0). CONCLUSION:Approximately one-third of participants screened as intermediate-to-high risk for OSA. Upper-airway symptoms, particularly nasal obstruction with mouth breathing, may help identify individuals requiring further diagnostic evaluation.
OBJECTIVE:This study describes MRI characteristics of TMD patients and explores their correlation with clinical symptoms. MATERIALS AND METHODS:Ninety-three patients (186 TMJs) diagnosed with TMD per DC/TMD criteria were enrolled. Clinical symptoms (clicking, pain, limited mouth opening <40mm) were assessed. Bilateral TMJ MRI was performed. Two blinded radiologists evaluated disc position (Drace), disc morphology (Murakami), and joint effusion (Larheim). Chi-square and Fisher's exact tests were used. . RESULTS:Joint effusion significantly correlated with clicking (p < 0.05). Disc morphology correlated with both pain and limited mouth opening; circular morphology was associated with higher limited mouth opening than biconvex morphology. No correlation was found between disc position and symptoms. . CONCLUSIONS:This study describes key MRI phenotypes of TMD patients, including joint effusion and disc morphological changes, and reveals their association with clinical symptoms, indicating MRI's potential value in TMD diagnosis and evaluation.
BACKGROUND:Temporomandibular disorders (TMD) is the most common cause of pain in oro-facial region that is of non-dental origin. Signs and symptoms involve pain on masticatory muscles, temporomandibular joint or both. This study aimed to compare the effectiveness of Ultrasound therapy (UST) with Low-Level Laser Therapy (LLLT) in reducing pain related to TMD. MATERIALS AND METHODS:Forty-six patients with TMD (Myalgia of masseter and temporalis, and arthralgia of TMJ) were included in this study. Patiens were assigned into Group A (LLLT) and Group B (UST). Numerical Rating Scale (NRS) and maximum mouth opening were measured over five sessions. RESULTS:Both groups showed significant reductions in NRS scores and improvements in maximum mouth opening (p < 0.05), with no significant differences between groups. CONCLUSION:Based on obtained data, both LLLT and UST were associated with reductions in pain in patients with TMJ arthralgia and myalgia of the masseter and temporalis muscles.
OBJECTIVES:This study compared temporomandibular disorders (TMD) prevalence and its association with oral behaviors and psychological factors between Chinese and U.S. university students. METHODS:A cross-sectional survey of 435 students (224 China, 211 U.S.) assessed TMD (5Ts), oral behaviors (OBC-21), depression (PHQ-9), and anxiety (GAD-7). Adjusted multivariable logistic regression evaluated associations. RESULTS:Chinese students showed significantly higher TMD prevalence (OR = 3.214, 95%CI: 2.094-4.991, p < .001) and more TMD symptoms (IRR = 1.951, 95%CI: 1.602-2.382, p < .001) than U.S. students. Higher PHQ-9 scores (OR = 1.092, 95%CI: 1.018-1.175, p = .015) and OBC-21 scores (OR = 1.025, 95%CI: 1.002-1.049, p = .037) were positively associated with the odds of screen-positive TMD symptoms. Country significantly moderated the depression-TMD association: each 1-unit increase in PHQ-9 was associated with higher odds of TMD among Chinese students (OR = 1.191, 95%CI: 1.069-1.328, p = .002) than U.S. students (OR = 1.047, 95%CI: 0.970-1.131, p = .238), with an OR ratio of 1.138 (95% CI: 1.018-1.277, p = .025). CONCLUSIONS:Chinese students exhibited higher TMD burden with a stronger depression-TMD link. These cohort differences remain hypothesis-generating and require longitudinal clinical confirmation.
BACKGROUND:Predoctoral dental education in temporomandibular disorders (TMD) remains inconsistent and highly variable despite CODA's mandate. This study examined how different TMD educational models (based on orofacial pain [OFP] postgraduate program affiliation, presence of OFP faculty offering TMD patient exposure, or absence of OFP faculty and clinical exposure) influence student confidence and perceived challenges. METHODS:An anonymous survey was distributed to third- and fourth-year students at U.S. CODA-accredited dental schools through the Hispanic Student Dental Association and American Student Dental Association. Students rated confidence in TMD-related skills (1-5 scale, 5="most confident") and identified educational challenges. Data were analyzed using ANOVA, chi-square tests, and correlation analyses across four educational models. RESULTS:Among 136 respondents, overall confidence was low-to-moderate (2.4 ± 0.8), with only 26.3% reaching a sufficient threshold (≥3). Confidence was highest for screening and lowest for advanced procedures. Educational model type showed no significant effect on overall confidence (p = .099), whereas prior TMD patient exposure was associated with higher confidence (2.7 ± 0.7 vs. 2.1 ± 0.7, p < .001; r = .384, p < .001). Common challenges included limited patient availability (61.8%), insufficient faculty expertise (42.3%), and poor interdisciplinary integration (46.3%). Students without OFP faculty and clinical exposure reported significantly greater clinical challenges (p < .001). CONCLUSION:Lack of clinical exposure to TMD patients is strongly associated with low student confidence. Faculty calibration and integration of TMD screening and management into routine care are critical to improving competence and confidence in dental training.
