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.

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.

It has been suggested that sleep bruxism may interrupt sleep continuity, hence potentially influencing sleep quality. The aim of this study was to systematically review the relationship between possible, probable, and definite sleep bruxism and sleep quality in otherwise healthy individuals. A systematic search on sleep bruxism and sleep quality was performed in seven databases until 19 December 2022. Eligible articles were screened, and quality assessment was performed via the Joanna Briggs Institute Scale. Of 3681 articles screened, 13 were included in this study. Of these, six evaluated the relationship between sleep quality and possible sleep bruxism, three with probable sleep bruxism, and four with definite sleep bruxism. An association between poor sleep quality and sleep bruxism was found among those individuals diagnosed with possible and probable sleep bruxism. However, the studies conducted in individuals with definite sleep bruxism failed to demonstrate any association. With more reliable measures to evaluate sleep bruxism, a relationship between sleep bruxism and sleep quality was not evident.

This presentation describes a patient's extensive and expensive search for relief of pain in the orofacial area. The journey includes many diagnostic errors and failed and likely unnecessary treatments. A systematic approach to problem definition and rule-out reasoning for the differential diagnoses based on the International Classification of Orofacial Pain is described. Conservative treatment was implemented with satisfactory results. Common pitfalls in the management and treatment of complex pain patients are discussed.

Background Pre-dental students’ perception and awareness about current technology in dentistry can influence their motivation and maturity during the learning experience and affect their dental education outcome. This observational survey aimed to examine pre-dental student's cognitive and behavioral traits as perception measures toward digital dentistry. The survey covered areas that the authors believed to impact dental education and future investments in institutional decision making. The survey was distributed over all pre-dental students representing two US dental schools in the state of Kentucky. The survey included four main categories: (1) career vision, (2) perception of digital dentistry, (3) prior knowledge of digital dentistry, and (4) personal intelligence. Results The feedback was positive toward the future use of digital dentistry. The findings are discussed in light of the implications of pre-dental students' perception to support teaching and learning in dental education. Conclusions Despite the expected enthusiasm of pre-dental students toward digital technology, the results highlight the need to emphasize structured self-learning, self-evaluation, and a deeper understanding of research within the dental curricula.

Currie, Charlotte C.; Ohrbach, Richard; De Leeuw, Reny; Forssell, Heli; Imamura, Yoshiki; Jääskeläinen, Satu; Koutris, Michail; Nasri-Heir, Cibele; Tan, Huann; Renton, Tara; Svensson, Peter; Durham, Justin Author Information

Objective To develop a beta version of a preliminary set of empirically derived research diagnostic criteria (RDC) for burning mouth syndrome (BMS) through expert consensus, which can then be taken into a test period before publication of a final RDC/BMS. Design A 6 round Delphi process with twelve experts in the field of BMS was used. The first round formed a focus group during which the purpose of the RDC and the definition of BMS was agreed upon, as well as the structure and contents. The remaining rounds were carried out virtually via email to achieve a consensus of the beta version of the RDC/BMS. Results The definition of BMS was agreed to be 'an intraoral burning or dysaesthetic sensation, recurring daily for more than 2 hours per day over more than 3 months, without evident causative lesions on clinical examination and investigation'. The RDC was based upon the already developed and validated RDC/TMD and formed three main parts: patient self-report; examination; and psychosocial self-report. A fourth additional part was also developed listing aspirational biomarkers which could be used as part of the BMS diagnosis where available, or to inform future research. Conclusion This Delphi process has created a beta version of an RDC for use with BMS. This will allow future clinical research within BMS to be carried out to a higher standard, ensuring only patients with true BMS are included. Further validation studies will be required alongside refinement of the RDC as trialling progresses.

AIMS:To test if patients with masticatory myofascial pain, local myalgia, centrally mediated myalgia, disc displacement, capsulitis/synovitis, or continuous neuropathic pain differed in self-reported satisfaction with life. The study also tested if satisfaction with life was similarly predicted by measures of physical, emotional, and social functioning across disorders.METHODS:Satisfaction with life, fatigue, affective distress, social support, and pain data were extracted from the medical records of 343 patients seeking treatment for chronic orofacial pain. Patients were grouped by primary diagnosis assigned following their initial appointment. Satisfaction with life was compared between disorders, with and without pain intensity entered as a covariate. Disorder-specific linear regression models using physical, emotional, and social predictors of satisfaction with life were computed.RESULTS:Patients with centrally mediated myalgia reported significantly lower satisfaction with life than did patients with any of the other five disorders. Inclusion of pain intensity as a covariate weakened but did not eliminate the effect. Satisfaction with life was predicted by measures of physical, emotional, and social functioning, but these associations were not consistent across disorders.CONCLUSIONS:Results suggest that reduced satisfaction with life in patients with centrally mediated myalgia is not due only to pain intensity. There may be other factors that predispose people to both reduced satisfaction with life and centrally mediated myalgia. Furthermore, the results suggest that satisfaction with life is differentially influenced by physical, emotional, and social functioning in different orofacial pain disorders.

AIMS:To investigate the prevalence of suicidal ideation (SI), depression, and anxiety in patients with a chronic temporomandibular disorder (TMD).METHODS:The sample consisted of 1,241 consecutive patients diagnosed with muscle or joint pain, consistent with the Research Diagnostic Criteria for TMD (RDC/TMD), and assigned to one of three groups: Muscle pain (MM) group, joint pain (TMJ) group, and Mixed group. Variables of interest were specific demographics and psychometrics derived from the Symptom Checklist 90-Revised (SCL-90-R): three SI-related items, depression, anxiety, and Global Symptom Index score. Group comparisons were performed with χ² tests and t tests; the level of significance was set at α = .05.RESULTS:The mean (± standard deviation) age for the whole sample was 35.76 ± 12.6 years; 88.3% were women. The overall prevalence of SI items from the SCL-90-R was 8.4% for "thoughts of ending your life," 28.5% for "feeling hopeless about the future," and 20.5% for "having thoughts of death and dying." The overall prevalence of depression was 30.4% and overall prevalence of anxiety was 28.9%. Patients in the MM group reported the highest prevalence of SI. Patients in the MM group were significantly more likely to be depressed and anxious compared to patients in the TMJ (P < .0001) and Mixed groups (P < .0001).CONCLUSION:Elevated levels of SI, depression, and anxiety were reported in a chronic TMD population, especially in those with chronic muscle pain, compared to the general population. These findings emphasize the need for screening for suicidality and other comorbidities in TMD patients suffering from chronic pain.

The aim of the current study was to elucidate whether there is an association between selected risk factors and implant failure, as determined by patient-reported outcomes. A trained clinician administered a formal survey questionnaire to 415 patients who had received a total of 963 implants through the University of Kentucky College of Dentistry's implant training program. The questionnaire was designed to obtain information about potential risk factors that may affect implant failure. Patients were also asked to rate their satisfaction with the appearance and function of the implant, their surgical experience, and the levels of pain and mobility associated with the implant(s). Both patient-level and implant-level data were analyzed in this study. Multiple logistic regression analysis at the patient level indicated that the following variables did not contribute to the success or failure of the implants: sex, smoking status, diabetes, osteoporosis, and use of bisphosphonates. When the statistical analyses controlled for these variables, the odds of patient-reported implant failure increased with the patient's age (by 15% every 5 years). The results of implant-level analyses adjusted for smoking status, diabetes, and osteoporosis showed that the patient's age (odds of failure increased by 12% every 5 years) and no use of bisphosphonates (odds ratio, 9.22; 95% confidence interval, 1.849, 45.975) were significantly associated with poor implant outcome. Our findings suggest a possible association between implant failure and the patient's age and use of bisphosphonates.

Aims: To evaluate the impact of cigarette smoking on the sleep quality of patients with masticatory myofascial pain and to determine whether the association between smoking and impaired sleep is influenced by other factors such as demographic, psychological, and behavioral variables. Methods: Data from a retrospective case series of 529 patients diagnosed with masticatory myofascial pain according to group I of the Research Diagnostic Criteria for Temporomandibular Disorders were obtained. Patients completed a standardized pain questionnaire and psychometric tests. Differences between smokers and nonsmokers were evaluated using independent samples t tests and chi-square tests. Hierarchical linear multiple regression models were used to examine predictors of sleep disturbances. Results: Of the entire sample, 170 (32%) reported that they were smokers. Smokers reported higher pain severity and more sleep disturbances and psychological distress than nonsmokers. Cigarette smoking significantly predicted sleep disturbance (beta = 0.229, P < .001), but this relationship was attenuated after controlling for pain severity and psychological distress (beta = 0.122, P < .001). Conclusion: Cigarette smoking is associated with numerous adverse health outcomes, including pain severity, alterations in mood, and disrupted sleep, and seems to be a significant predictor of sleep quality in patients with masticatory myofascial pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely available as over-the-counter medications, despite their numerous side effects and drug interactions. The aim of this article is to increase awareness of the hypertensive potential of NSAIDs and their interference with antihypertensives. Patients with hypertension appear to be more susceptible than normotensive individuals to the blood pressure-increasing effect of NSAIDs. Most studies have found that short-term use of NSAIDs does not pose a major risk for hypertension or increase in cardiovascular disease in healthy individuals. The calcium channel blockers and beta-blockers seem to be least affected by the concomitant use of NSAIDs. A dentist must weigh the benefits and disadvantages of using NSAIDs in patients taking antihypertensive drugs. For those who may be at greater risk, such as patients with hypertension and the elderly, careful selection of the class of NSAID and close monitoring are appropriate measures, especially if long-term use is anticipated.

AIMSTo test the role of fatigue and its subtypes (general, physical, emotional, mental, and vigor) in mediating the relationship between psychological distress and pain interference.METHODSRetrospective, de-identified records were examined for 431 patients seeking treatment for persistent orofacial pain. Primary diagnoses of participants were muscle pain (29.8%), joint pain (26.0%), neuropathic pain (19.5%), and other (ie, fibromyalgia, centrally mediated myalgia, tendonitis, dental pain, cervical spine displacement, and no diagnosis; 24.7%). Mediation models were tested with distress as the independent variable, interference as the dependent variable, and fatigue or its subtypes as the mediators.RESULTSAfter controlling for pain duration and average levels of pain, total fatigue mediated the relationship between distress and interference. Fatigue subtypes partially mediated the relationship between distress and interference, but mediation was strongest with the composite fatigue variable. The results, however, should be interpreted cautiously, as data were collected at a single time point and do not imply causality.CONCLUSIONThese results suggest that interventions targeted specifically at fatigue symptoms may be helpful for reducing interference and improving quality of life in patients with persistent orofacial pain.

Aims: The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments. Methods: Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel’s recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project’s data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project—the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings. Results: The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive selfreport instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions. Conclusion: The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations. J Oral Facial Pain Headache 2014;28:6–27. doi: 10.11607/jop.1151

Despite evidence of autonomic disturbances in chronic multisymptom illnesses such as temporomandibular disorder (TMD) and fibromyalgia, additional work is needed to characterize the role of parasympathetic reactivity in these disorders. Given the high levels of comorbidity with psychiatric disorders characterized by stronger parasympathetic decline than controls in safe contexts (leading to higher arousal), it was hypothesized that individuals with TMD and fibromyalgia would respond similarly. In this preliminary investigation, 43 women with TMD (n = 17), TMD + fibromyalgia (n = 11), or neither (controls; n = 15) completed a baseline assessment of respiratory sinus arrhythmia (a measure of parasympathetic activity) followed by ongoing parasympathetic assessment during a questionnaire period. As predicted, patients showed greater parasympathetic decline during psychosocial assessment, suggesting an autonomic stance that supports defensive rather than engagement behaviors. Individual differences in parasympathetic reduction during the questionnaire period Were related to a variety of physical and psychosocial variables. Although this study has a number of key limitations, including a convenience sampling approach and small group sizes,, if replicated in larger samples, the findings would have important implications for the treatment of patients with these disorders.Perspective: Compared to controls, individuals with TMD or TMD and fibromyalgia demonstrated greater parasympathetic decline during psychosocial assessment, and individual differences in parasympathetic decline predicted negative patient outcomes. Such parasympathetic decline may demonstrate a tendency to readily perceive danger in safe environments. (C) 2015 by the American Pain Society

The University of Kentucky College of Dentistry (UKCD) established an implant training program that provides training in the use of a single implant system, evidence-based diagnostic and treatment protocols (standardized work practices), and a total quality management system (Implant Quality Assurance Program). The aim of this study was to assess the programmatic effectiveness of the UKCD implant training program by reporting the success and survival of implants placed, using patient-reported outcomes and comparing them to previously established benchmarks. A total of 415 patients (963 implants) were interviewed, approximately 50 percent of all qualified patients. The implant survival rate was 97 percent, and 88 percent of the implants were considered successful (as determined by patient-centric criteria). These outcomes were consistent with the program's previously established benchmarks of 90 percent. These results suggest that work standardization (in the form of specific treatment protocols) and the use of a formal, incremental learning system can result in positive patient outcomes. Clinical outcomes should be monitored in academic dental settings as part of clinical process improvement, and these outcomes can provide a means of assessing the effectiveness of the training program.