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.

A CDA C.E. quiz is online for this article: www.cdapresents360.com/learn/catalog/view/20The practice worksheet is available online: https://doi.org/10.1080/19424396.2025.2590968

Oral dysesthesia (OD) is a diagnosis of exclusion that manifests as an unpleasant and abnormal sensation of the oral mucosa without any noticeable oral lesions. Burning sensation is one of the manifestations of OD which may advocate for similar pharmacotherapeutic options to burning mouth syndrome (BMS), resulting in possible adverse events. The aim of these case reports was to illustrate the significance and rationale for the use of oral devices as a mechanical/physical barrier and a safe approach in the management of OD, without experiencing any antagonistic effects from pharmacotherapeutic agents. Two patients with spontaneous and evoked (following dental procedures) OD symptoms in the right posterior mandibular quadrant and anterior hard palatal areas were evaluated. Additionally, their OD symptoms were associated with hyposalivation and taste changes. A thorough history and complete head and neck examination, with the exclusion of oral lesions and systemic conditions, were performed. These patients were previously prescribed topical clonazepam rinses. An in-office trial, with application of orthodontic wax to the affected area, was performed as a preliminary test in order to justify the fabrication of an oral device for possible symptomatic relief. Conclusion: The case reports demonstrated significant improvement of OD symptoms and amelioration of pain following fabrication of oral devices in two patients with no undesirable effects from pharmacotherapy. Additionally, the oral devices aided as a mechanical/physical barrier, potentially exerting a placebo effect while facilitating an improved quality of life. Furthermore, the cost-effectiveness and ease of fabricating the oral device has been advantageous over other systemic medications. This encourages the need for a detailed prospective study.

The management of patients with orofacial pain and temporomandibular disorders is challenging. Recognizing the opportunity to advance patient care, in 2019 the National Academies of Science, Engineering, and Medicine (NASEM) convened representatives from the Food and Drug Administration, Medical Device Epidemiology Network (MDEpiNet), patient advocacy groups, oral and maxillofacial surgeons, and orofacial pain experts to identify specific steps to improve care for patients. In response, the American Association of Oral and Maxillofacial Surgeons (AAOMS) created the Special Committee on Temporomandibular Joint Care (SCTMJC) whose assignment was to develop contemporary evidence-based guidelines for the management of patients with orofacial pain and temporomandibular disorders. These guidelines represent the findings and recommendations of that committee.

BACKGROUND:With time, due to the poor knowledge on it epidemiology, the need to focus on awake bruxism as a complement of sleep studies emerged.OBJECTIVE:In line with a similar recent proposal for sleep bruxism (SB), defining clinically oriented research routes to implement knowledge on awake bruxism (AB) metrics is important for an enhanced comprehension of the full bruxism spectrum, that is better assessment and more efficient management.METHODS:We summarised current strategies for AB assessment and proposed a research route for improving its metrics.RESULTS:Most of the literature focuses on bruxism in general or SB in particular, whilst knowledge on AB is generally fragmental. Assessment can be based on non-instrumental or instrumental approaches. The former include self-report (questionnaires, oral history) and clinical examination, whilst the latter include electromyography (EMG) of jaw muscles during wakefulness as well as the technology-enhanced ecological momentary assesment (EMA). Phenotyping of different AB activities should be the target of a research task force. In the absence of available data on the frequency and intensity of wake-time bruxism-type masticatory muscle activity, any speculation about the identification of thresholds and criteria to identify bruxers is premature. Research routes in the field must focus on the improvement of data reliability and validity.CONCLUSIONS:Probing deeper into the study of AB metrics is a fundamental step to assist clinicians in preventing and managing the putative consequences at the individual level. The present manuscript proposes some possible research routes to advance current knowledge. At different levels, instrumentally based and subject-based information must be gathered in a universally accepted standardised approach.

OBJECTIVE:This paper aims to present and describe the Standardised Tool for the Assessment of Bruxism (STAB), an instrument that was developed to provide a multidimensional evaluation of bruxism status, comorbid conditions, aetiology and consequences.METHODS:The rationale for creating the tool and the road map that led to the selection of items included in the STAB has been discussed in previous publications.RESULTS:The tool consists of two axes, specifically dedicated to the evaluation of bruxism status and consequences (Axis A) and of bruxism risk and etiological factors and comorbid conditions (Axis B). The tool includes 14 domains, accounting for a total of 66 items. Axis A includes the self-reported information on bruxism status and possible consequences (subject-based report) together with the clinical (examiner report) and instrumental (technology report) assessment. The Subject-Based Assessment (SBA) includes domains on Sleep Bruxism (A1), Awake Bruxism (A2) and Patient's Complaints (A3), with information based on patients' self-report. The Clinically Based Assessment (CBA) includes domains on Joints and Muscles (A4), Intra- and Extra-Oral Tissues (A5) and Teeth and Restorations (A6), based on information collected by an examiner. The Instrumentally Based Assessment (IBA) includes domains on Sleep Bruxism (A7), Awake Bruxism (A8) and the use of Additional Instruments (A9), based on the information gathered with the use of technological devices. Axis B includes the self-reported information (subject-based report) on factors and conditions that may have an etiological or comorbid association with bruxism. It includes domains on Psychosocial Assessment (B1), Concurrent Sleep-related Conditions Assessment (B2), Concurrent Non-Sleep Conditions Assessment (B3), Prescribed Medications and Use of Substances Assessment (B4) and Additional Factors Assessment (B5). As a rule, whenever possible, existing instruments, either in full or partial form (i.e. specific subscales), are included. A user's guide for scoring the different items is also provided to ease administration.CONCLUSIONS:The instrument is now ready for on-field testing and further refinement. It can be anticipated that it will help in collecting data on bruxism in such a comprehensive way to have an impact on several clinical and research fields.

Temporomandibular disorders (TM Ds) encompass a number of different musculoskeletal disorders often accompanied by pain and dysfunction. Most TM Ds are acute, but can become chronic leading to disability and quality of life issues. There is wide variation in treatment of TM Ds, including both conservative/reversible therapies as well as invasive/irreversible treatments, which present difficulties for clinicians, patients, and third-party payers as to what constitutes appropriate care. Data sources: A recent report by the National Academies of Sciences, Engineering, and Medicine high-lighted a number of deficiencies, most notably in the education of TMDs within United States of America dental schools at both the predoctoral and postdoctoral (dental) levels as well as addressing the historic inconsistencies in both diagnosis and treatment. New areas for research and interprofessional collaboration should assist in the understanding of TMDs, and updated clinical practice guidelines should help reducevariation in the delivery of evidence-based care. Recently, the American Dental Association recognized orofacial pain as a specialty, which should increase the level and availability of expertise in treating these issues. Summary: Based on the current best evidence, this report is an attempt to alert the profession to discontinue irreversible and invasive therapies for the vast majority of TM Ds and recognize that the majority of these dis-orders are amenable to conservative, reversible interventions.

OBJECTIVES:To determine the effectiveness of systemic pharmacotherapeutic interventions compared to placebo in burning mouth syndrome (BMS) randomized controlled trials (RCTs) based on the core outcome domains recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT).METHODS:A systematic literature review of RCTs, concerning systemic pharmacotherapeutic interventions for BMS, published from January 1994 through October 2019, and meta-analysis was performed.RESULTS:Fourteen RCTs (n = 734 participants) were included. Of those, nine were eligible for the quantitative assessment due to the availability/homogeneity of data for at least one of the IMMPACT domains. Pain intensity was the only domain reported in all RCTs. Weighted mean changes in pain intensity, based on visual analogue scale (ΔVAS), were reported in three RCTs at 6 ± 2 weeks and only one RCT at 10+ weeks follow-ups. Quantitative assessment, based on ΔVAS, yielded very low evidence for the effectiveness of alpha-lipoic acid and clonazepam, low evidence for effectiveness of trazodone and melatonin, and moderate evidence for herbal compounds.CONCLUSIONS:Based on the RCTs studied, variable levels of evidence exist that suggest that select pharmacological interventions are associated with improved symptoms. However, the underreporting of IMMPACT domains in BMS RCTs restricts the multidimensional assessment of systemic interventions outcomes. Standardized outcome measures need to be applied to future RCTs to improve understanding of intervention outcomes.

BackgroundBurning mouth disorder (BMD) is a complex medical condition characterized by a burning sensation in the mouth of fluctuating intensity. BMD is considered a diagnosis of exclusion, as oral burning can occur secondary to local or systemic conditions. Parkinson's disease (PD) is one such condition. ObjectiveTo provide a scoping review of the literature by assessing all articles written in English that investigated the relationship between BMD and PD. Materials and MethodsVarious databases (PubMed, Ovid, Web of Science, Science Direct and Scopus) and a search platform (EBSCOhost) were searched following similar investigative approaches. Duplicates were removed and reference lists of original studies were scrutinized for additional articles. Any decision about the inclusion/exclusion in the review was by consensus among the co-authors. ResultsTwenty-five original articles and one supplemental article were included in the final review, of which 13 met the inclusion criteria. These were further divided into five categories based on the study design/article, which included Prevalence studies (n = 6), Letter to the editor (n = 1), Incidence study (n = 1), Case reports (n = 2) and Experimental studies (n = 3). Strongest data was provided by epidemiological studies, which suggest BMD and PD are poorly associated. ConclusionsA scoping review of the existing literature does not suggest that PD patients are any more at risk of developing BMD compared to the general population. While there may be a link through the dopaminergic system as determined by imaging studies, it is unlikely that the pathogenesis of PD disease shares significant commonality with BMD.

Background. Numb chin syndrome (NCS) is a rare sensory neuropathy involving the mental nerve. Symptoms of NCS are often overlooked because of their apparent innocent nature; however, owing to the frequent association of NCS with malignancies, the opposite should be the rule. Oral health care professionals may be the first to encounter patients with NCS and should be aware of its clinical characteristics in an effort to decrease patient morbidity and mortality.Types of Studies Reviewed. A search in PubMed (MEDLINE) and the Cochrane Library was performed using the terms numb chin syndrome, numb chin, mental neuropathy, mental nerve neuropathy, and malignant mental nerve neuropathy, yielding 2,374 studies. After inclusion and exclusion criteria were applied, 102 studies remained. Descriptive statistics were performed, analyzing the etiology responsible for NCS, characteristics of NCS including associated symptoms, unilateral or bilateral nature, and information on professionals visited and examinations requested to make a diagnosis.Results. NCS was associated with malignancy in 29% through 53% of the published cases. Twenty-eight percent of patients initially consulted an oral health care professional with the symptom of a numb chin. Patients more likely to have NCS were those from the ages of 61 through 70 years; 74% were unilateral; and the most common symptoms reported were numbness (100%), paresthesia (18%), and pain (17%). Forty-seven percent of the NCS cases were associated with a recurrent malignancy, and the most prevalent associated diagnoses were breast cancer (32%) and lymphoma and leukemia (24%).Conclusions. Oral health care professionals should be aware of the characteristics of NCS as they may be the first health care providers consulted for these symptoms.Practical Implications. A thorough medical and dental history as well as a complete cranial nerve screening should be performed on all patients, especially those with numbness, as this may prevent misdiagnosis and allow a timely referral and a substantial improvement of treatment course and prognosis.

Purpose of ReviewTo provide an overview and highlight recent updates in temporomandibular disorders (TMDs) and their comorbidity with headache disorders regarding pathophysiology and management.Recent FindingsIn the last decade, there have been great advancements in the understanding of TMDs and their relationship with neurovascular pains such as headaches. Understanding of TMDs is necessary for the context of its comorbidity with primary headache disorders. The literature regarding management of these comorbidities is scarce but points to combination therapy including pharmacological and non-pharmacological approaches to optimize management. The use of CGRP receptor-targeted monoclonal antibodies or CGRP receptor antagonists should be explored for the management of chronic TMDs. It could also be used as a novel monotherapy or in combination with non-pharmacological approaches for TMDs' comorbidity with headache, particularly migraine.Research is needed to support evidence-based management protocols. A team involving neurology (headache medicine) and dentistry (orofacial pain) is critical for optimal management.

Designing classification systems and developing diagnostic criteria for temporomandibular disorders is difficult. An appreciation of the utility and applicability of these entities requires an understanding of the importance of each, the differences between the two, and how they may be optimally operationalized for both clinical and research activities in light of their inherent advantages and limitations. In addition, consideration for adopting newer approaches, such as following ontological and precision-based medicine principles, accounting for genetics/epigenetic and neurobiological factors, and the inclusion of biomarkers will potentially result in more thorough and comprehensive classification systems and diagnostic criteria.

In 2020, the Commission for Dental Accreditation (CODA) approved Revised Standard 2-24k to include the teaching of temporomandibular disorders (TMDs) in the predoctoral curriculums of all US dental schools by 2022. In addition, the American Academy of Orofacial Pain (AAOP) developed a competency-based core curriculum framework for predoctoral education in TMDs to train future clinicians how to provide excellent evidence-based care for their patients with TMDs. This commentary describes the background and rationale for establishing this educational standard and the associated curriculum. Dr. Fricton is a professor emeritus, University of Minnesota, Minneapolis and St. Paul, MN. Dr. Chen is an assistant professor, Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, N333 Dental Sciences Building, 801 Newton Rd, Iowa City, IA 52242 Dr. Shaefer is the president of the American Academy of Orofacial Pain, an assistant professor, Harvard University School of Dental Medicine, and an assistant professor, Division of Orofacial Pain, Department of Surgery, Massachusetts General Hospital, Boston, MA. Dr. Mackman is the past president of the American Academy of Orofacial Pain, TMJ and Orofacial Pain Treatment Centers of Wisconsin, Wauwatosa, WI. Dr. Okeson is a professor and the dean, College of Dentistry, University of Kentucky, Lexington, KY. Dr. Ohrbach is a professor, Oral Diagnostic Sciences, School of Dental Medicine, State University of New York, University at Buffalo Buffalo, NY. Dr. Klasser is a professor, Department of Diagnostic Sciences, School of Dentistry, Louisiana State University Health Sciences Center, New Orleans, LA. Dr. Hawkins is the orofacial pain program director and an associate professor, Orofacial Pain, Uniformed Services University of the Health Sciences Postgraduate Dental College, Naval Medal Leader and Professional Development Command, Bethesda, MD. Dr. Hasel is an associate professor and an associate dean emeritus, College of Dental Medicine, Western University of Health Sciences, Pomona, CA. Dr. Heir is a professor and the program and clinical director, Center for Temporomandibular Disorders and Orofacial Pain, Rutgers University School of Dental Medicine, Newark, NJ.

OBJECTIVES:To assess the effectiveness of topical interventions in the management of burning mouth syndrome (BMS), based on the core outcome domains recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). METHODS:A systematic literature review of RCTs on topical interventions for the management of BMS, published in PubMed, Web of Science, PsycInfo, Cochrane Database/Central, and Google Scholar through May 2021 was performed. RESULTS:Eight RCTs (n = 358 study participants) were included in this study. Due to underreporting of IMMPACT domains, publication bias, high degree of heterogeneity between studies, meta-analysis was not undertaken. Based on changes in visual analogue pain scores (ΔVAS), the most reported outcome, the effectiveness of the topical interventions was demonstrated; however, it is low level of evidence. CONCLUSIONS:High levels of variability (interventions, outcomes, outcome measurement tools, and intervention effects evaluated), heterogeneity, publication bias, and underreporting of IMMPACT domains were observed across the RCTs. This systematic review highlights the need for application of standardized outcome measures to future RCTs. At the present time, there is lack of moderate-strong evidence on short- and long-term outcomes to support or refute the use of any particular topical intervention in managing BMS. Future RCTs with standardized outcome measures are needed.

Chorea-acanthocytosis is a rare neurological disorder that produces involuntary body movements, along with a condition of misshapen red blood cells that is characterized by appearing in early adulthood. There are numerous orofacial manifestations linked to chorea-acanthocytosis that the dental practitioner must consider in early and late stages of the disease, such as chronic oral ulcerations, chronic mouth grinding, difficulty swallowing, and biting the lip and tongue, among others. This case, the first to the authors' knowledge to address the area of orofacial pain, provides general signs and symptoms of the disorder and management following a multidisciplinary approach. The life span of patients with this disorder is generally shortened, and correct management is essential to improve the quality of life.

Chmieliauskaite, Mildaa,*; Stelson, Elisabeth A.b; Epstein, Joel B.c; Klasser, Gary D.d; Farag, Arwae; Carey, Barbaraf; Albuquerque, Ruif; Mejia, Linag; Ariyawardana, Anurah,i; Nasri-Heir, Cibelej; Sardella, Andreak; Carlson, Charlesl; Miller, Craig S.m Author Information