ABSTRACT Background Photobiomodulation (PBM) is increasingly used as an adjunctive therapy across oral medicine conditions. However, clinical translation remains protocol‐driven and disease‐oriented, while biological and clinical heterogeneity is often viewed as a limitation rather than a basis for individualized decision‐making. Objective To propose a mechanism‐based framework that shifts PBM implementation toward biology‐driven patient selection and rehabilitation‐oriented reasoning. Methods This evidence‐informed narrative review synthesized biological knowledge, clinical evidence, guidelines, systematic reviews, meta‐analyses, randomized trials and mechanistic studies across major oral medicine conditions. Evidence was mapped using shared domains, including disease biology, PBM‐responsive therapeutic target, biological suitability, therapeutic objectives, evidence maturity and clinical applicability. Results Most studies, reviews, meta‐analyses and guidelines evaluated PBM by disease category, efficacy, outcomes and irradiation parameters. Across conditions, they commonly reported protocol heterogeneity, variable responses and differences in evidence strength. Comparative evidence mapping identified recurring biological decision domains across otherwise heterogeneous oral medicine conditions, suggesting that variability in PBM outcomes reflects biological diversity as well as methodological differences. Conclusions This review proposes the principle that patient selection should precede protocol selection because PBM acts on biologically responsive targets, not on diagnostic labels alone. Rather than seeking a universally optimal laser regimen, clinicians may first consider whether the individual patient presents a biologically plausible and potentially recoverable therapeutic target. Heterogeneity may therefore be reframed as an opportunity for personalized PBM implementation. Prospective studies are needed to evaluate the framework's clinical utility.
ABSTRACT Background Temporomandibular disorders appear to involve central sensory processing, including the thalamus and brainstem trigeminal complex. Objective To explore task‐based fMRI activity of the trigeminal system in asymptomatic individuals with MRI‐confirmed temporomandibular joint disc displacement versus controls. Methods Seventeen asymptomatic participants were included: controls without temporomandibular complaints or MRI evidence of disc displacement (Group 1, n = 10) and individuals with disc displacement without pain or functional limitation (Group 2, n = 7). fMRI was acquired during centric‐occlusion clenching versus relaxed jaw (block design; cluster‐corrected z > 3.1). Activation maps were intersected voxel‐wise with trigeminally relevant ROIs of the Adil et al. brainstem atlas. In an exploratory case‐level approach, overlap volume, peak z and percentage BOLD signal change were reported per activated ROI; group comparisons were descriptive only. Results In Group 1, trigeminally relevant activation was limited to the atlas region ‘thalamus excluding pulvinar’ (substantive in 4/10 controls; bilateral in one; peak z 4.24–5.15; BOLD change 0.79%–1.28%). In Group 2, one participant with right‐sided complete anterior disc displacement showed a medullary cluster overlapping the left spinal trigeminal tract (24 voxels, peak z 5.06, 0.95%) and nucleus interpolaris (35 voxels, peak z 5.60, 1.13%), among several adjacent structures; no thalamic activation occurred in this group. No between‐group difference was statistically significant. Conclusions A medullary activation cluster overlapping the left spinal trigeminal tract and nucleus interpolaris, among several adjacent medullary structures, was observed in one participant with asymptomatic TMJ disc displacement. This single‐case, hypothesis‐generating observation requires confirmation in larger cohorts using brainstem‐optimized fMRI.
ABSTRACT Objectives To investigate the association between three‐dimensional (3D) condylar resorption pattern and obstructive sleep apnea (OSA) severity in adults, and to explore its structural implications within the craniofacial skeletal phenotype (CSP) framework. Methods Condylar morphology was classified using a two‐axis system integrating the degree of resorption and cortical remodelling pattern. Patients were grouped into no resorption (NR), adaptive remodelling (AR), and severe resorption (SR) categories. Dentoskeletal, temporomandibular joint (TMJ), and polysomnographic variables were compared among groups. Multivariable regression analyses were adjusted for age, sex, and body mass index, and hierarchical regression was used to examine the contribution of condylar grouping beyond CSP. Results Severe condylar resorption was identified in 23.9% of the sample and was more prevalent (54.0%) in patients with CSP features. The SR group demonstrated greater skeletal discrepancy and higher apnea–hypopnea index (AHI), respiratory disturbance index (RDI), and arousal index (ArI) values (all, p < 0.05). After adjustment for age, sex, and body mass index and false discovery rate correction, SR remained significantly associated with higher AHI, RDI, and ArI, whereas TMJ pain history, condylar angulation, and oxygenation‐related indices showed no significant associations. In hierarchical models, the overall incremental contribution of condylar grouping beyond CSP was not significant after multiple‐testing correction; however, SR remained significantly associated with higher AHI and RDI after additional adjustment for CSP (both, FDR‐adjusted p = 0.045). Conclusions Severe condylar resorption was associated with greater skeletal discrepancy and higher OSA burden. Three‐dimensional TMJ assessment may complement conventional skeletal phenotyping in adult OSA.
ABSTRACT Background Taking a holistic approach to the health outcomes of extremely preterm (EPT) adolescents, where oral health is a part of general health, is important to ensure lifelong wellbeing. Objective This interdisciplinary cross‐sectional survey investigated oral health aspects, including temporomandibular disorders (TMD) pain, desire for orthodontic treatment, dental fear and anxiety (DFA), and oral health behaviour in adolescents born before 27 weeks of gestation. Comparisons were made with term‐born controls (≥ 37 weeks of gestation). Methods Structured telephone interviews were conducted with adolescents and their parents. The questionnaire included validated screening questions on TMD pain and DFA, as well as questions on subjective orthodontic treatment need and oral health behaviour. Group comparisons were performed using chi‐square and Fisher's exact tests. Logistic regression analyses were used to estimate crude and adjusted odds ratios (ORs), controlling for sex, age, and dental fear. Results A total of 198 EPT adolescents (mean age 15.8) and 152 controls (mean age 15.7) participated. The odds of reporting TMD pain were 2.43 times higher in the EPT group than in controls ( p = 0.002), and the odds of reporting a desire for orthodontic treatment were 3.48 times higher ( p = 0.001). Additionally, the EPT group showed significantly higher Children's Fear Survey Schedule‐Dental Subscale (CFSS‐DS) scores, indicating higher DFA and less stable toothbrushing habits than controls. Conclusion EPT adolescents showed a less favourable oral health profile than controls. These findings highlight the need for increased awareness in dental care, tailored preventive interventions, and support during the transition to adult healthcare to promote lifelong oral health and wellbeing.
