ABSTRACTBackground Oral appliance therapy is commonly used in the management of temporomandibular disorders (TMDs) and bruxism.Discussion This article discusses the evidence base for oral appliance therapy in the treatment of TMD and bruxism and offers practical advice for incorporation of oral appliances into clinical practice.Conclusion Despite ambiguous evidence regarding its use in the treatment of TMD and bruxism, oral appliance therapy is an important treatment modality for these conditions. If oral appliance therapy is to be provided, it should be done in a manner that is conservative, reversible, logical to the patient’s presenting complaint, and part of a larger overall treatment plan. Dentists should be mindful of both the specific and the nonspecific treatment effects of oral appliance therapy in order to optimize total treatment benefit.Continuing Education Credit Available: The practice worksheet is available as supplemental material for this article: https://doi.org/10.1080/19424396.2023.2176975.A CDA Continuing Education quiz is online for this article: https://www.cdapresents360.com/learn/catalog/view/20

ABSTRACTBackgroundPain catastrophising is a maladaptive cognitive response characterised by an exaggerated negative interpretation of pain experiences. It has been associated with greater disability and poorer outcomes in chronic pain, to include several specific oro‐facial pain conditions. The goal of this study was to examine pain catastrophising at a military oro‐facial pain specialty clinic.MethodsThis retrospective chart review (RCR) examined information collected at initial examination from 699 new patients seen between September 2016 and August 2019 at the Orofacial Pain Center at the Naval Postgraduate Dental School (Bethesda, MD). Pain catastrophising, pain characteristics, psychosocial factors and sleep were assessed using standardised scales. Linear regression was used to evaluate associations of patient characteristics and pain intensity with pain catastrophising. Mediation analyses were done to characterise the extent to which the relationship between pain intensity and pain catastrophising may be explained by anxiety, depression and insomnia.ResultsHigher pain intensity, depression, anxiety, insomnia and younger age were each associated with higher pain catastrophising (all p < .05). A primary diagnosis of neuropathic pain was the strongest independent predictor of higher pain catastrophising. The relationship between pain intensity and pain catastrophising was partially mediated by anxiety, depression and insomnia.ConclusionsIn this RCR of a population of oro‐facial pain patients, those diagnosed with neuropathic pain were most likely to display high levels of pain catastrophising, a characteristic which is associated with poor long‐term pain outcomes. This is the first study to show that, independent of other patient characteristics, those suffering from neuropathic pains displayed the highest levels of pain catastrophising. This highlights the importance of also addressing psychosocial factors in the treatment of neuropathic pain conditions, which are commonly treated using a predominantly biomedical approach. Additionally, anxiety, depression and insomnia each partially explains the relationship between pain intensity and pain catastrophising.

Paroxysmal hemifacial pain (PHFP) is the orofacial counterpart to paroxysmal hemicrania headaches. This paper reports the cases of two patients suffering from episodic attacks of severe unilateral facial pain. In both cases, pain attacks were absolutely responsive to therapeutic doses of indomethacin. Both patients were diagnosed with PHFP, as per the International Classification of Orofacial Pain diagnostic guidelines. The diagnosis of PHFP, and a trial of indomethacin, must be considered in cases of severe unilateral facial pains not clearly explained by more common diagnoses.

Trigeminal neuralgia is a pain condition that is frequently misdiagnosed and challenging to manage. We present the case of a patient with trigeminal neuralgia with multiple misdiagnoses and poorly managed pain. Despite the presence of trigger zones both inside and outside her mouth, complete symptom resolution was ultimately achieved through onabotulinumtoxinA injections, delivered solely intraorally.