BACKGROUND AND AIM:Occlusal splints are commonly used to manage temporomandibular disorders (TMDs), yet their efficacy remains controversial. This study aimed to summarise and assess the methodological quality of available systematic reviews (SRs) regarding occlusal splint therapy in TMD patients. MATERIALS AND METHODS:Following a PROSPERO-registered protocol (CRD42021276856), a comprehensive search was conducted across PubMed, Scopus, Lilacs, and Cochrane. SRs focused on TMD management with occlusal splints were included. Two independent operators performed the review process, and the risk of bias was assessed using AMSTAR-2. Primary outcomes were pain intensity and maximum mouth opening (MMO). RESULTS:After screening of 1740 abstracts followed by full text assessment, 21 SRs were included with diverse methodological quality ranging from critically low (5 SRs) to high (4 SRs). The majority of the included SRs (12) compared occlusal splint with other conservative treatments, with four of these reporting effective reduction in pain intensity, while three SRs did not. Furthermore, five SRs concluded that there was insufficient evidence for or against occlusal splint therapy over other active interventions for TMD treatment. Only one SR compared the effect of occlusal splint versus no treatment, supporting no differences in pain reduction in the jaw joint area. One SR compared the effects of different occlusal splint designs. Three SRs assessed the effects of occlusal splint in specific treatment settings or populations (in adolescents, compared to arthrocentesis, compared to jaw exercises). CONCLUSION:The majority of findings from the existing SRs report small beneficial or neutral effects following OS therapy in TMD patients.

Objectives Burning mouth syndrome (BMS) is defined as a chronic intraoral burning sensation occurring in the absence of identifiable local or systemic causes. Several classification systems have proposed diagnostic criteria for BMS, including the International Classification of Headache Disorders (ICHD-3), the International Classification of Diseases (ICD-11), the International Classification of Orofacial Pain (ICOP-1), and the World Congress of Oral Medicine (WCOM). However, none of these have been validated. This study aims to evaluate the diagnostic performance of ICHD-3, ICD-11, ICOP-1, and WCOM criteria for BMS and to suggest optimized diagnostic criteria. Methods We assessed 76 consecutive patients referred for burning oral pain. Of these, 34 (28 women) were diagnosed with BMS according to the reference standard, and 42 (37 women) had other oral mucosal pain conditions. Two control groups were also recruited: 31 TMD patients (28 women) and 30 pain-free participants (26 women). Assessment involved self-report questionnaires and comprehensive clinical examinations. All patients with burning oral pain underwent additional laboratory tests. Consensus-based diagnosis constituted the reference standard, and a blinded examiner applied each set of different diagnostic criteria as the index tests. We calculated sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and positive and negative likelihood ratios (LR + and LR-), and the area under the ROC curve for each index tests. Because some ICHD-3 criteria were ambiguously defined, we created operational definitions and tested three versions of the criteria. Results No significant group differences were found in age, sex, or smoking status. None of the criteria exhibited both high sensitivity and specificity. WCOM showed the highest sensitivity (91.2%), NPV (99.2%), LR- (0.14), and AUC (0.717). In contrast, ICHD-3 definition 3 showed the highest specificity (93.2%), PPV (8.2%), and LR + (5.2), but the lowest sensitivity (35.3%). Based on these findings, we developed an optimized version of the ICOP criteria. The new criteria showed the highest sensitivity (94.1%), NPV (99.9), LR- (0.07), and AUC (0.874), while maintaining acceptable specificity (79.6%), PPV (7.4%), and LR + (4.4). Conclusion Substantial variation exists in the diagnostic performance of current BMS criteria, with each set showing either high sensitivity or specificity. This study provides the first data-driven proposal for modified diagnostic criteria for BMS, offering a foundation for improving future versions of ICHD and ICOP.

Background/AimPersistent idiopathic facial pain (PIFP) is a rare condition with a lifetime prevalence of approximately 0.03%. It is characterized by persistent daily facial pain without identifiable cause and presents diagnostic and therapeutic challenges due to unknown pathophysiology, symptom overlap with other painful disorders, and limited evidence-based treatments. The aim of this Delphi study was to establish international consensus-derived guidelines for the management of patients with PIFP.MethodsA three-round Delphi study was conducted with 16 international pain experts, each with ≥10 years of clinical experience in pain management and extensive peer-reviewed publications. The first round involved open-ended questions, and the qualitative data were analyzed using systematic text condensation, resulting in a quantitative questionnaire with 42 statements. Subsequent rounds employed Likert-scale responses to these statements. Consensus was defined as ≥80% agreement or disagreement. In addition, if 11-12 (68-75 percent) out of the 16 experts agreed or disagreed, consensus was not reached, but a majority was considered to have a particular opinion.ResultsConsensus was reached in 35 out of the 42 statements (83%), emphasizing multidisciplinary collaboration and avoidance of invasive procedures in the treatment of PIFP. In an additional three statements (7%) a majority of the experts agreed with each other. In four statements (10%), no consensus or majority was reached. Pharmacological treatments, including tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and gabapentinoids, may be considered; however, opioids should generally be avoided in the treatment of PIFP. Patient education and behavioral therapies are important interventions, and the most important measure of therapeutic success is improved quality of lifeConclusionThe present Delphi study has established internationally derived consensus guidelines and recommendations for the evaluation and comprehensive management of patients with PIFP. This is a first step in gathering knowledge for future evidence-based guidelines and more specific treatment recommendations. These international expert consensus guidelines recommend a multi- or interdisciplinary approach in managing PIFP, avoiding invasive interventions and prioritizing patient-centered outcomes.

BACKGROUND AND OBJECTIVES:Temporomandibular disorders (TMDs) is an umbrella term for pain and dysfunction involving jaw muscles and/or the temporomandibular joint, with whiplash trauma suggested to be one risk factor. The aim was to evaluate prevalence and relative risk of TMDs in the acute and chronic stages after whiplash trauma. DATABASES AND DATA TREATMENT:This review was registered in Prospero (CRD42023407091) and followed the PRISMA guidelines. A literature search in PubMed, Scopus and Web of Science on 10 March 2023 and updated 29 April 2024 identified studies reporting prevalence of TMD after whiplash trauma. Risk of bias was assessed with Joanna Briggs Institute Prevalence Critical Appraisal Tool. A random effect meta-analysis was performed for prevalence of TMD pain. RESULTS:After screening of 671 identified studies, 96 articles were assessed in full text. Fourteen studies, with 840 cases in the acute and 8293 cases in the chronic stage (i.e., > 3 months post-trauma) were included in a qualitative analysis together with 1591 controls. Nine studies, including 449 cases in the acute and 7912 individuals in the chronic stage after trauma, together with 515 controls, were included in the meta-analysis. Mean prevalence for TMD pain was 18.9% (95% CI 9.71-29.98) in the acute case group, 26.8% (95% CI 15.07-38.79) in the chronic case group, and 5.7% (95% CI 3.08-8.96) in the control group. CONCLUSIONS:The higher prevalence of TMD pain already in the early stage after whiplash trauma, emphasises the need for early comprehensive clinical assessment as well as targeted research to understand underlying mechanisms. SIGNIFICANCE:The prevalence of Temporomandibular disorder pain was high already in the acute stage after whiplash trauma, and there was no evidence of any decrease from the acute to the chronic stage. This finding suggests that early assessment and management rather than a 'wait-and see' approach should be recommended when patients present with orofacial pain related to whiplash trauma.

Objectives This study aimed to identify baseline factors that predict Health-Related Quality of Life (HRQoL) in patients with TMD 8 years later. Materials and Methods 401 participants (333 women, mean age 45.8 years) from a multicenter cohort were examined using the Diagnostic Criteria for TMD (DC/TMD) and questionnaires. The main outcome was the 12-item Short Form Health Survey (SF-12), a HRQoL measure that provides physical (PCS) and mental (MCS) summaries. Baseline predictors included age, gender, self-reported health, Jaw Functional Limitation Scale (JFLS), pain intensity, pain frequency, and pain duration. Regression analysis with stepwise modeling identified predictive factors. Results 54.3% had painful TMD, 15.7% had nonpainful TMD, and 27.7% were healthy controls. For the painful TMD group, the regression model was significant (R² = .25, F = 4.3, P < .01), with age and favorable general health predicting PCS scores. In the nonpainful TMD group, the model was significant (R² = .58, F = 3.8, P < .01), with JFLS and favorable general health (predicting PCS scores. The MCS model was significant in healthy controls (R2 = .22, F = 1.8, P = .05), with JFLS as only predictor. Conclusion Predictors of mental HRQoL: JFLS in healthy controls, but no predictors were found in TMD groups. Predictors of physical HRQoL: General health in both TMD groups, JFLS in the nonpainful TMD group, and age in the painful TMD group.

BACKGROUND:Temporomandibular disorder (TMD) pain in adolescents is common, has a negative impact on quality of life, and is a predictor of pain in young adulthood. A common and symptomatic treatment is occlusal appliance therapy (OAT). Internet-based behavioural therapy (IBT) is a novel, multimodal, and patient-centred self-management therapy for adolescents with TMD pain. OBJECTIVE:To evaluate the adherence and effect of IBT compared to OAT in adolescents with TMD pain. METHODS:Participants were recruited from public dental care and specialist clinics in orofacial pain in Sweden between January 2016 and March 2020. Screening of adolescents, 13-19 years, was performed using three questions for TMD (3Q/TMD). Eligible subjects were examined according to the DC/TMD and randomly allocated to IBT or OAT. The IBT group performed the 7-week programme online with individualised feedback through phone after each section. The OAT group used a stabilisation splint night time for 3 months. A 3-month questionnaire follow-up on pain intensity, pain disability, and psychosocial outcomes was conducted. RESULTS:In total, 52 patients were randomised to IBT and 48 to OAT. There was a low adherence to IBT with a 75% drop-out. Positive expectations of treatment were significantly (p = 0.001) greater in the OAT group. OAT was related to better outcomes for characteristic pain intensity (p = 0.047) and pain-related disability (p = 0.049) when compared to IBT. No significant difference within or between the groups regarding the psychosocial outcomes was observed. CONCLUSIONS:The current version of IBT was overly comprehensive for adolescents with TMD pain and needs to be revised.

While muscle overload is commonly implicated in musculoskeletal pain conditions, real-time assessment of associated behavioural and physiological features is challenging. This study aims to investigate the relationship between self-reported awake bruxism using Ecological Momentary Assessment (EMA) and jaw muscle activity registered by surface electromyography (sEMG), and differences between individuals with and without temporomandibular disorder (TMD) pain. Seventy participants (38 women, 32 men), of which 31% reported pain, completed 3-day EMA using a smartphone application combined with a sEMG device only for day 1. Overload, defined as muscle activity exceeding 20% of maximum voluntary contraction (MVC), was evaluated for duration and area under curve (AUC). A strong correlation was observed between EMA-reported bruxism and sEMG overload duration (ρ = 0.62, p < 0.001). AUC showed a correlation with EMA only in the TMD group. Participants with TMD pain exhibited shorter high-intensity bursts (60–79% MVC, p ≤ 0.005) but prolonged low-intensity muscle activity (20–39% MVC, p < 0.001). Bruxism behaviour and stress levels were higher in women and in individuals with pain. The results suggest that combining EMA and sEMG provides valid assessment of musculoskeletal overload, capturing both perceptual and physiological dimensions. Incorporating EMA in pain management can identify pain-related risk behaviours, thus supporting tailored patient-centred interventions.

BACKGROUND:The multifactorial nature of chronic pain should be reflected in pain assessment. The aim of this observational study comparing samples from three generations assessed at different times was to present differences in pain, stress and mental well-being. METHODS:Pain sites, widespread pain, stress (Perceived Stress Scale-4) and mental well-being (30-item General Health Questionnaire) were described across generations from the Malmö neck and shoulder study (parents, Generation 1, n = 12,607), Malmö offspring study, and Malmö Offspring pain study (children and grandchildren, Generation 2, n = 1572; Generation 3, n = 936). RESULTS:Pain prevalence remained comparable across generations. In all generations, women reported more pain sites compared to men, mean difference 1.0 (95% CI 0.9-1.1) in Generation 1, mean difference 1.3 (95% CI 1.0-1.6) in Generation 2, and mean difference 0.9 (95% CI 0.5-1.3) in Generation 3. The frequency of widespread pain for women and men was 28% and 16% in Generation 1, 27% and 12% in Generation 2, and 22% and 15% in Generation 3, respectively. Perceived stress levels were consistently higher in Generation 2 and 3 compared to Generation 1 for both women and men. Among women, mental well-being remained stable between Generation 1 and 2 but declined significantly in Generation 3 (mean difference 3.2, 95% CI 2.4-4.3). CONCLUSIONS:The results suggest significant gender disparities, with women consistently reporting more pain sites, higher stress levels, and reduced mental well-being compared to men. Furthermore, the findings suggest that generational differences in coping-or other factors-may mitigate the impact of psychosocial distress on pain prevalence, warranting further research. SIGNIFICANCE:This study highlights the comparability of pain prevalence across generations despite increasing stress and declining mental well-being, particularly in women. These findings emphasise the importance of integrating mental health support and gender-specific coping strategies into pain management, offering insights into biopsychosocial mechanisms underlying the interactions between pain and perceived stress.

To compare pain characteristics, impact of pain and characteristics of patients with painful root-filled teeth with and without signs of inflammatory dental disease. This cross-sectional study was performed in the Public Dental Health services, Region Örebro County, Sweden. Adult patients with ≥1 root-filled tooth identified at their regular check-up were included and assigned to one of two groups; those with ≥1 sign of inflammatory dental disease (DD+) and those without any such sign (DD-). Patients/teeth were compared regarding pain characteristics (intensity, frequency, duration, quality and provoking factors), impact of pain (medication intake, impact on life) and patient characteristics as background factors (general health, other bodily and orofacial pain). Statistics included descriptive data (frequency tables) and group comparisons (Chi-square, Fisher's Exact and Mann-Whitney U-tests). The DD+ group included 27 participants (30 teeth) and the DD- group 22 participants (23 teeth). On average, pain intensity was mild, the frequency most often recurrent, and the impact was low. Average pain duration since onset exceeded 2 years in both groups. The only observed between-group differences were average pain intensity; 3.1 (0-10 Numerical Rating Scale (NRS)) in DD- group compared to 1.6 for DD+ (p = 0.030), and tenderness to apical palpation; only reported in the DD+ group. The similarities in clinical presentation between the two groups underscore the difficulties in correctly distinguishing between pain of odontogenic and non-odontogenic origin in root-filled teeth with a standard clinical investigation. Additional diagnostic methods need to be investigated for their ability to differentiate between tooth pain or discomfort of different origins.

BACKGROUND:Despite advances in temporomandibular disorders' (TMDs) diagnosis, the diagnostic process continues to be problematic in non-specialist settings.OBJECTIVE:To complete a Delphi process to shorten the Diagnostic Criteria for TMD (DC/TMD) to a brief DC/TMD (bDC/TMD) for expedient clinical diagnosis and initial management.METHODS:An international Delphi panel was created with 23 clinicians representing major specialities, general dentistry and related fields. The process comprised a full day workshop, seven virtual meetings, six rounds of electronic discussion and finally an open consultation at a virtual international symposium.RESULTS:Within the physical axis (Axis 1), the self-report Symptom Questionnaire of the DC/TMD did not require shortening from 14 items for the bDC/TMD. The compulsory use of the TMD pain screener was removed reducing the total number of Axis 1 items by 18%. The DC/TMD Axis 1 10-section examination protocol (25 movements, up to 12 sets of bilateral palpations) was reduced to four sections in the bDC/TMD protocol involving three movements and three sets of palpations. Axis I then resulted in two groups of diagnoses: painful TMD (inclusive of secondary headache), and common joint-related TMD with functional implications. The psychosocial axis (Axis 2) was shortened to an ultra-brief 11 item assessment.CONCLUSION:The bDC/TMD represents a substantially reduced and likely expedited method to establish (grouping) diagnoses in TMDs. This may provide greater utility for settings requiring less granular diagnoses for the implementation of initial treatment, for example non-specialist general dental practice.

BACKGROUND:The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for use in adults is in use worldwide. Until now, no version of this instrument for use in adolescents has been proposed.OBJECTIVE:To present comprehensive and short-form adaptations of the adult version of DC/TMD that are appropriate for use with adolescents in clinical and research settings.METHODS:International experts in TMDs and experts in pain psychology participated in a Delphi process to identify ways of adapting the DC/TMD protocol for physical and psychosocial assessment of adolescents.RESULTS:The proposed adaptation defines adolescence as ages 10-19 years. Changes in the physical diagnosis (Axis I) include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for adolescents, (ii) adding two general health questionnaires, one for the adolescent patient and one for their caregivers and (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire. Changes in the psychosocial assessment (Axis II) include (i) adapting the language of the Graded Chronic Pain Scale to be developmentally appropriate for adolescents, (ii) adding anxiety and depression assessment that have been validated for adolescents and (iii) adding three constructs (stress, catastrophizing and sleep disorders) to assess psychosocial functioning in adolescents.CONCLUSION:The recommended DC/TMD, including Axis I and Axis II for adolescents, is appropriate to use in clinical and research settings. This adapted first version for adolescents includes changes in Axis I and Axis II requiring reliability and validity testing in international settings. Official translations of the comprehensive and short-form to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

Introduction: Oral appliance (OA) therapy in obstructive sleep apnea (OSA) could be a risk factor for normal jaw function, given the prolonged effect of an OA in keeping the mandible in a protruded position away from a normal position. This study aimed to assess changes in symptoms and clinical findings related to jaw function after 1 year of treating OSA with an OA. Methods: In this follow-up clinical trial, 302 patients with OSA were assigned to treatment with either monobloc or bibloc OA. Baseline and 1-year follow-up assessment included using the Jaw Functional Limitation Scale, self-reported symptoms and signs related to jaw function. The clinical examination of jaw function included mandibular mobility, dental occlusion, and tenderness in the temporomandibular joints and masticatory muscles. Descriptive analyses of variables are presented for the per-protocol population. To evaluate differences between the baseline and the 1-year follow-up, paired Student t tests and the McNemar change test was used. Results: One-hundred and ninety-two patients completed the 1-year follow-up (male 73%, mean aged 55 6 11 years). There was no change in the Jaw Functional Limitation Scale score at the follow-up (nonsignificant). The patients described no change in symptoms at the follow-up, except for improvements in morning headache (P \0.001) and increased frequency of difficulties in opening the mouth or chewing on awakening (P = 0.002). Subjectively reported changes in dental occlusion during biting/chewing increased significantly at the follow-up (P = 0.009). Conclusions: No changes in measurements of jaw mobility, dental occlusion, or pain on palpation of the tempo-romandibular joints or masticatory muscles were seen at the follow-up. Thus, using an OA in treating OSA had limited influence on jaw functions and related symptoms. Moreover, the risk of developing pain and functional impairment in the masticatory system was infrequent, indicating that this treatment is safe and can be recommended. (Am J Orthod Dentofacial Orthop 2023;164:682-9)

Clinical pain is often linked to poor body mechanics, with individuals sometimes presenting multiple painful disorders. Such disorders may be influenced by behaviors that affect the general resiliency and health of the musculoskeletal system. We aimed to develop a self-reported scale using the Malmo Diet and Cancer Study questions on work-related body mechanical exposures. An expert panel identified 41 variables having content validity for musculoskeletal problems. Exploratory factor analysis was conducted on a random selection of 50% of the cohort (n = 6,789 adults); the remaining was reserved for confirmatory factor analyses (CFA), item response theory (IRT) item calibration, and differential item functioning investigations. Supported by standard measure development methods and fit criteria, the final unidimensional item bank contains 13 items. Overall CFA statistics (root mean square error of approximation = .09; comparative fit index = .96; Tucker-Lewis index = .96; standardized root mean residuals = .05) indicated excellent single-factor model fit and appropriateness of IRT modeling and calibration. Expert review and item information values (score-precision) guided selection of an 8-item short form with acceptable score-level reliabilities (>=.70) for T-scores = 39-80+. This measure provides reliable assessment of body mechanics strain in adults and can be useful when evaluating different contributions to musculoskeletal problems affecting pain-treatment success in future clinical research. Perspective: This article presents the development and psychometric properties of a new measure, "Work-related Body Mechanics and Strain Scale (WR-BMSS)." The scale has 13-items or alternatively an 8-item short form. This measure could potentially help clinicians who seek to assess how musculoskeletal problems may contribute to patient pain and disability. (c) 2022 by United States Association for the Study of Pain, Inc.

AIMS:To assess differences in catastrophizing and kinesiophobia in relation to areas of pain and somatic symptoms among participants with temporomandibular disorders (TMDs) and controls.METHODS:In total, 401 participants (333 women, 68 men, mean age: 45.8 years) in the TMJ Impact Project were examined in accordance with the Diagnostic Criteria for TMD, including clinical examination (Axis I) and psychosocial assessment (Axis II) augmented with imaging of the temporomandibular joint (TMJ). Of these, 218 participants had a painful TMD pain diagnosis, 63 had a nonpainful TMD diagnosis, and 111 had no TMD. Nine participants had missing data. Participants completed the Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Areas of Pain figure, and the Patient Health Questionnaire-15 for assessing somatic symptoms.RESULTS:Compared to controls, participants with TMD pain showed higher levels of catastrophizing (P = .017), kinesiophobia (P < .001), areas of pain (P < .001), and somatic symptoms (P < .001). Participants with nonpainful TMD showed a higher level of kinesiophobia (P < .001) than controls. There was a positive correlation between catastrophizing and kinesiophobia for participants with TMD pain (r = 0.33, P < .001) and nonpainful TMD (r = 0.42, P < .001).DISCUSSION:The results suggest more fear of movement, as well as an association between catastrophizing and fear of movement, in participants with TMD pain and in participants with nonpainful TMD compared to controls. Assessment and management of fear of movement as well as catastrophizing may be useful as part of individualized treatment strategies for patients with TMD.

Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact-the dimensions of oral health-related quality of life-capture dental patients' oral health problems worldwide and regardless of whether the patient currently suffers from oral diseases or intends to prevent them in the future. Using scores for these dimensions, the project Mapping Oral Disease Impact with a Common Metric (MOM) aims to provide four-dimensional oral health impact information across oral diseases and settings. In this article, project authors summarize MOM's findings and provide recommendations about how to improve standardized oral health impact assessment. Project MOM's systematic reviews identified four-dimensional impact information for 189 adult and 22 pediatric patient populations that were contained in 170 publications. A typical functional, pain-related, aesthetical, and psychosocial impact (on a 0-8 impact metric based on two items with a response format 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, 4 = very often) was about 2 to 3 units. Project MOM provides five recommendations to improve standardized oral health impact assessment for all oral diseases in all settings.

AIMSTo compare the prevalence of facial pain and headache across various regions in Sweden.METHODSThis study involved a comparison of cross-sectional questionnaire studies over a period of 10 years including 128,193 individuals and assessed facial pain, pain on function, and headache. Participants included (1) all Public Dental Service patients aged 16 to 90 years in Västerbotten (n = 57,283) and Gävleborg (n = 60,900); and (2) random samples of residents in Kalmar (n = 3,560) and Skåne (n = 6,450). Facial pain and pain on function were assessed for all participants, and headache was also assessed for participants in Kalmar and Skåne. Descriptive statistics were used to estimate unadjusted prevalence estimates and demographic characteristics. Prevalence estimates were adjusted for age and sex using weighted distributions from the 2015 data in the Swedish population registry before comparisons across the regions.RESULTSOverall, the prevalence of facial pain and headache were significantly higher in female than in male participants (P < .01). The standardized prevalence of facial pain was 4.9% in Västerbotten, 1.4% in Gävleborg, 4.6% in Kalmar, and 7.6% in Skåne. For headache, the standardized prevalence was 18.9% in Kalmar and 21.3% in Skåne. In Skåne, individuals with facial pain had a 15-fold higher odds of headache than those without.CONCLUSIONIn the present Swedish epidemiologic study, the prevalence of facial pain ranged from 1.4% in Gävleborg to 7.6% in Skåne. Besides different sampling frames and other population characteristics, the presence of a high number of immigrants in Skåne may account for some differences in pain prevalence across the Swedish regions.

Background: The aim of this study was to investigate if single nucleotide polymorphisms (SNPs) related to monoaminergic neurotransmission, in particular the serotonergic pathway, contribute to pain perception in patients with temporomandibular disorder (TMD) myalgia and if there is a correlation to jaw function as well as psychosocial factors such as stress, anxiety and depression. Materials and Methods: One hundred and seventeen individuals with TMD myalgia were included. A venous blood or saliva sample was taken for genetic analyses and genotyped regarding HTR2A (rs9316233) HTR3A (rs1062613), HTR3B (rs1176744), SERT (5-HTTLPR) and COMT (rs4680). A clinical examination according to Diagnostic Criteria for TMD (DC/TMD) was performed and axis II data (psychosocial factors) were compared between participants with different genotypes for each gene using Kruskall–Wallis test. The characteristic pain intensity (CPI) was tested for correlations to scores for the Perceived Stress Scale, Generalized Anxiety Disorder, and Patient Health Questionnaires using Spearman's rank correlation test with Bonferroni correction for multiple testing. To further explore data factor analysis was performed to identify latent factors associated to the outcome variables. Results: Participants carrying at least one copy of the rare allele of the HTR2A (rs9316233) and HTR3A (rs1062613) had higher CPI compared with the participants with the homozygous common genotype (P = 0.042 and P = 0.024, respectively). Correlation analyses showed several significant positive correlations between CPI on one hand, and self-reported psychosocial distress and jaw function on the other hand for several genotypes that mostly were weak to moderate. The factor analysis identified two latent variables. One was positively correlated to the HTR3B gene, jaw function and self-reported parafunctions, and the other was positively correlated to psychological distress and negatively correlated to SERT. Conclusion: Taken together, the polymorphism rs1062613 in the HTR3A gene contributes to pain intensity in TMD myalgia. This together with positive interactions between pain variables and psychological factors in genotypes strengthens that pain and psychological distress are related. Further research is needed to explore this as well as the influence of gene-to-gene interactions on pain and psychological distress.

Pain is a common symptom in endodontic conditions, but differential diagnostic procedures are often needed to exclude other pain origins. Thus, general dentists and endodontists need to be aware of alternative painful orofacial conditions and be able to identify them. The new International Classification of Orofacial Pain (ICOP) is the first comprehensive classification that uniquely deals with orofacial pain. The ICOP is a hierarchical classification modeled on the International Classification of Headache Disorders and covers pain in dentoalveolar and anatomically related tissues, muscle pain, temporomandibular joint pain, neuropathic pain affecting cranial nerves, pain resembling primary headaches, and idiopathic pain in the orofacial region. A description of each condition is given, and structured diagnostic criteria for each condition are proposed based on research data when available. This narrative review aims (1) to give an overview and brief explanation of the ICOP system, (2) to describe and give examples of how it can be of use to general dentists and endodontists with special attention to differential diagnosis of tooth pain, and (3) to highlight how endodontic research can contribute to validation and improvement of the classification. A comparison to other classification and diagnostic systems is also included.

Abstract Objectives To compare the frequency of patients’ oral health problems and prevention needs among Slovenian and international dentists with the aim to validate the four oral health-related quality of life (OHRQoL) dimensions across six clinical dental fields in all World Health Organization (WHO) regions. Methods An anonymous electronic survey in the English language was designed using Qualtrics software. A probability sampling for Slovenia and a convenience sampling strategy for dentist recruitment was applied for 31 countries. Dentists engaged in six dental fields were asked to categorize their patients’ oral health problems and prevention needs into the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact). Proportions of patients’ problems and prevention needs were calculated together with the significance of Slovenian and international dentists’ differences based on dental fields and WHO regions. Results Dentists (n=1,580) from 32 countries completed the survey. There were 223 Slovenian dentists (females: 68%) with a mean age (SD) of 41 (10.6) years and 1,358 international dentists (females: 51%) with a mean age (SD) of 38 (10.4). Pain-related problems and prevention needs were the most prevalent among all six dental fields reported by dentists; Slovenian (37%) and 31 countries (45%). According to Cohen, differences between Slovenia, the broader European Region, and 31 countries were considered non-significant (<0.1). Conclusion According to the dentists’ responses, the frequency of patients’ oral health problems and prevention needs are proportionate between Slovenia and 31 countries, regionally and globally. The four OHRQoL dimensions can be considered universal across all dental fields.

Background Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the four oral health-related quality of life (OHRQoL) dimensions (4D) or areas in which oral disorders impact pediatric patients. Using their dentists' assessment, the study aimed to evaluate whether pediatric dental patients' oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct. Methods Dentists who treat children from 32 countries and all WHO regions were selected from a web-based survey of 1580 international dentists. Dentists were asked if their pediatric patients with current or future oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct. Proportions of all pediatric patients’ oral health problems and prevention needs were computed. Findings Data from 101 dentists treating children only and 523 dentists treating children and adults were included. For 90% of pediatric patients, their current oral health problems fit well in the four OHRQoL dimensions. For 91% of oral health problems they intended to prevent in the future were related to these dimensions as well. Both numbers increased to at least 96% when experts analyzed dentists´ explanations of why some oral health problems would not fit these four categories. Conclusions The study revealed the four fundamental components of dental patients, i.e., the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact) are also applicable for pediatric patients, regardless of whether they have current or future oral health concerns, and should be considered when measuring OHRQoL in the pediatric dental patient population.