Publications by authors named "Leonardo Rigoldi Bonjardim"

71 Publications

Effects of acute mental stress on conditioned pain modulation in temporomandibular disorders patients and healthy individuals.

J Appl Oral Sci 2021 4;29:e20200952. Epub 2021 Jun 4.

Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Prótese e Periodontia, Bauru, Brasil.

Background: Stress is a contributing factor to painful temporomandibular disorders (TMD). Nevertheless, the underpinnings of this relationship are not fully understood.

Objective: To investigate the effects of acute mental stress on conditioned pain modulation (CPM) in TMD patients compared with healthy individuals.

Methodology: Twenty women with chronic myofascial TMD diagnosed according to the RDC/TMD and 20 age-matched healthy women had the CPM assessed before and after a stressful task using the Paced Auditory Serial Addition Task (PASAT) in a single session. Subjective stress response was assessed with the aid of visual analog scale (VAS). Pressure pain threshold (PPT) on masseter muscle was the test stimulus (TS) and immersion of the participant's hand on hot water was the conditioning stimulus (CS) - CPM-sequential paradigm.

Results: Healthy individuals reported PASAT are more stressful when compared with TMD patients and the stress task did not affect the CPM in neither group. Nonetheless, a negative correlation was observed between change in CPM and change in TS from baseline to post-stress session, which indicates that the greater the increase in PPT after the stress task, the greater was the decrease in CPM magnitude. The correlation was strong for healthy controls (r=- 0.72, p<0.001) and moderate for TMD patients (r=- 0.44, p=0.047).

Conclusions: The correlation between the change in CPM and the TS change following the stress task may possibly indicate an overlapping pathway between stress-induced analgesia/hyperalgesia and descending pain inhibition.
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http://dx.doi.org/10.1590/1678-7757-2020-0952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232930PMC
June 2021

Multifocal Analysis of Acute Pain After Third Molar Removal.

Front Pharmacol 2021 15;12:643874. Epub 2021 Apr 15.

Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.

To analyze the pain modulation capacity profile in a Brazilian population, the relationship between opioid receptor () and Catechol-O-methyltransferase () 1polymorphisms and pain modulation capacity was determined through preoperative pain modulation tests and acute postoperative pain control evaluation, swelling, and trismus in 200 volunteers undergoing lower third molar removal. Psychologic and clinical parameters were measured. Patient DNA was sequenced for single nucleotide polymorphisms in and , and the salivary concentration of interleukin (IL)-2 (IL)-6, interferon (IFN)-γ and tumor necrosis factor (TNF)-α was evaluated. Primary outcomes were the influence of all predictors on the fluctuation of pain intensity using a visual analogue scale (VAS), and swelling and trismus on the 2nd and 7th postoperative days. Preoperative pain modulation capacity (CPM), pain catastrophizing scale (PCS), body mass index (BMI), and surgery duration and difficulty were evaluated. Salivary concentration of IFN-γ and IL-2 as well as the duration of surgery influenced the fluctuation of postoperative pain in the VAS, and in the sum of the differences in pain intensity test at 8, 48, and 96 h. BMI influenced swelling, while both BMI and haplotype influenced trismus on the 2nd postoperative day. Polymorphisms in , salivary concentrations of IL-2 and IFN-γ, BMI, and duration of surgery were predictors for pain fluctuation, swelling, and trismus on the 2nd day after lower third molar extraction. This therapy was effective in controlling inflammatory symptomatology after lower third molar extraction and ibuprofen was well tolerated by patients. www.ClinicalTrials.gov, identifier NCT03169127.
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http://dx.doi.org/10.3389/fphar.2021.643874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082138PMC
April 2021

Impact of rehabilitation with removable complete or partial dentures on masticatory efficiency and quality of life: A cross-sectional mapping study.

J Prosthet Dent 2021 Apr 16. Epub 2021 Apr 16.

Full Professor, Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil. Electronic address:

Statement Of Problem: Tooth loss directly affects mastication, cognitive function, and oral health-related quality of life (OHRQoL). Complete dentures (CDs) and removable partial dentures (RPDs) represent a common oral rehabilitation approach. However, studies addressing the impact of removable dentures on replacing missing teeth are lacking.

Purpose: The purpose of this clinical study was to evaluate whether the OHRQoL, the jaw function limitation (JFL), and the masticatory efficiency of CD and RPD wearers are similar to those of patients with natural teeth and to evaluate whether wearing removable dentures can predict an effect on the OHRQoL, JFL, and masticatory efficiency of their wearers.

Material And Methods: The Oral Health Impact Profile (OHIP-14) questionnaire and the JFL scale were used to measure OHRQoL and JFL. Masticatory efficiency was analyzed by using a subjective color-mixing index for the chewing gum bolus and shape index and an objective colorimetric analysis by using a software program ViewGum. Data were analyzed with Kruskal-Wallis and post hoc Dunn tests, followed by multiple linear regression (α=.05).

Results: The results from OHIP-14 evidenced that both denture groups presented a low impact on OHRQoL. JFL was higher for all denture wearers. For the subjective color-mixing analysis, the control and RPD groups presented better masticatory efficiency than CD wearers. Colorimetric analysis evidenced better masticatory efficiency for the control group, who differed from the CD and RPD groups. Wearing RPDs was a predictor of impaired JFL and OHRQoL, and the use of CDs was a predictor of impaired JFL and masticatory efficiency.

Conclusions: Despite being rehabilitated, CD and RPD wearers still had impaired OHRQoL, JFL, and masticatory efficiency. Also, the use of these prostheses can predict a negative effect on these 3 variables.
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http://dx.doi.org/10.1016/j.prosdent.2021.02.035DOI Listing
April 2021

Can Concomitant Masticatory Muscle Contraction Interfere with Temporomandibular Joint Arthralgia Evaluation?

J Oral Facial Pain Headache 2021 Winter;35(1):72-76

Aims: To investigate the effect of masticatory muscle contraction on the pressure pain threshold (PPT) of the lateral pole of the temporomandibular joint (TMJ) in patients with TMJ arthralgia and in asymptomatic individuals.

Methods: A total of 72 individuals divided into two groups (group 1: patients with unilateral TMJ arthralgia [n = 36]; group 2: control group, asymptomatic individuals [n = 36]) were compared. The PPT of the lateral pole of the TMJ with and without concomitant masticatory muscle contraction was determined using a digital algometer in both groups. Paired and independent Student t test were used to compare the data within and between groups, respectively. A 5% significance level was used for all tests.

Results: Higher TMJ PPT values with concomitant masticatory muscle contraction were found in both groups (P < .001). The amount of increase in PPT with contracted muscles was not significantly different between groups (P = .341), but the TMJ arthralgia group had significantly lower PPT values than the control group regardless of muscle contraction status (P < .001).

Conclusion: Concomitant masticatory muscle contraction significantly increased the PPT of the lateral pole of the TMJ in relation to relaxed muscles, regardless of the presence of arthralgia.
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http://dx.doi.org/10.11607/ofph.2759DOI Listing
March 2021

Effect of Genetic Polymorphisms on Pain Sensitivity in the Orofacial Region: A Systematic Review.

J Oral Facial Pain Headache 2020 Fall;34(4):353-363

Aims: To systematically review the literature to assess whether genetic polymorphisms affect orofacial pain sensitivity in healthy individuals and in patients with chronic orofacial pain disorders.

Methods: Electronic searches were conducted to identify observational studies and clinical trials investigating the association between genetic polymorphisms and orofacial pain sensitivity in healthy individuals and/or patients with chronic orofacial pain disorders. Searches were carried out in PubMed, Embase, and Scopus databases using Medical Subject Headings and free terms.

Results: Seven studies fulfilled the eligibility criteria: four analyzed healthy subjects, two included chronic orofacial pain patients, and one included samples of healthy subjects and patients with neuropathic pain. The results showed that genes associated with mechanical and thermal pain sensitivity were mostly related to opioid, catecholaminergic, inflammatory, and dopaminergic pathways.

Conclusion: Genetic polymorphisms related to opioid, catecholaminergic, inflammatory, and dopaminergic pathways were associated with sensitivity to thermal and pressure stimuli in the orofacial region. Therefore, genetic factors should be taken into account for an accurate interpretation of orofacial pain sensitivity. These results will allow for a better understanding of the etiopathogenesis of chronic pain affecting the orofacial region, and consequently for finding new therapeutic targets.
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http://dx.doi.org/10.11607/ofph.2641DOI Listing
December 2020

Clinical variables associated with the presence of articular pain in patients with temporomandibular joint clicking.

Clin Oral Investig 2021 Jun 12;25(6):3633-3640. Epub 2020 Nov 12.

Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, 17012-901, Brazil.

Objective: To study and estimate the impact of clinical, somatosensory, and psychosocial variables associated with the concomitant presence of temporomandibular joint (TMJ) pain in patients with TMJ clicking.

Materials And Methods: Ninety-three individuals composed the sample: patients with painful TMJ clicking (n = 47) and patients with painless TMJ clicking (n = 46). Four categories of data were evaluated: clinical features (gender, maximal interincisal distance (MID), side of complaint, age); bruxism (sleep bruxism (SB), awake bruxism (AB)); somatosensory (mechanical pain threshold (MPT), wind-up ratio (WUR), pressure pain threshold (PPT), conditioned pain modulation (CPM)); and psychosocial (Pittsburgh Sleep Quality Index (PSQI), pain vigilance and awareness questionnaire (PVAQ), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK/TMD), Oral Behaviors (OBs)).

Results: Female gender, AB, WUR, CPM, PSQI, PCS, and OBs significantly (p < 0.05) increased the chance of the concomitant presence of TMJ pain in patients with TMJ clicking. On the other hand, MID, MPT, and PPT significantly (p < 0.05) decreased this chance. The other variables had no association.

Conclusion: It can be concluded that being a woman, having AB, hyperalgesia in WUR, less efficient CPM, poor sleep quality, pain catastrophizing, and harmful OBs significantly increased the chance of the concomitant presence of TMJ pain in patients with TMJ clicking. In the opposite, high figures of MID, MPT, and PPT decreased the chance.

Clinical Relevance: Most patients with TMJ clicking usually postpone seeking treatment until the clicking truly disturbs or there is a concomitant presence of TMJ pain. Understanding the variables associated with this concomitance can be important in clinical practice.
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http://dx.doi.org/10.1007/s00784-020-03685-8DOI Listing
June 2021

Evaluation of pain intensity in patients treated with aligners and conventional fixed appliances: Randomized clinical trial.

Orthod Craniofac Res 2021 May 26;24(2):268-276. Epub 2020 Oct 26.

Department of Orthodontics, University of North Paraná (UNOPAR), Londrina, Brazil.

Objective: This randomized clinical trial aimed to compare the pain intensity in patients treated with orthodontic aligners and conventional fixed appliances.

Setting And Sample Population: This study was a randomized clinical trial. The sample comprised 39 patients randomly allocated into 2 groups: OA (orthodontic aligners, n = 20) and FA (Fixed Appliance, n = 19).

Material And Methods: The pain intensity was measured by the visual analogue scale (VAS) in the following periods: T0 (baseline), T1 (seven days after appliance placement) and seven days after each return on the first (T2), third (T3) and sixth (T4) months. The following variables were also investigated in the baseline: conditioned pain modulation, anxiety levels, hypervigilance and catastrophizing. The VAS measurements between groups were compared by the Mann-Whitney test. Comparisons between periods within each group were performed by the Friedman test. Data regarding catastrophizing and hypervigilance were compared by the t test. All tests were applied at a significance level of 5%, with 95% confidence interval.

Results: Both groups presented similar levels of anxiety, hypervigilance, catastrophizing and conditioned pain modulation. Both groups did not differ concerning the pain intensity in all periods. The intragroup evaluation revealed statistical differences between days in the FA group at all moments evaluated, for the OA group, similar findings between days were found for the T1 evaluation; however, at the 6-month period (T4), the pain levels varied over these days without statistical difference. Higher levels of pain were observed in the first seven days after appliance placement.

Conclusion: The pain intensity, usually mild, was not influenced by the appliance design, although different patterns of reported pain seem to occur between groups.
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http://dx.doi.org/10.1111/ocr.12431DOI Listing
May 2021

Pain complications of oral implants: Is that an issue?

J Oral Rehabil 2021 Feb 26;48(2):195-206. Epub 2020 Oct 26.

Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.

The use of oral implants as a form of replacing missing teeth in partial or total edentulous patients is considered the gold standard in oral rehabilitation. Although considered a history of success in contemporary dentistry, surgical complications may occur, as excessive bleeding, damage to the adjacent teeth and mandibular fractures. Persistent pain and abnormal somatosensory responses after the surgery ordinary healing time are also potential problems and may lead to the development of a condition named posttraumatic trigeminal neuropathic pain (PTNP). Though relatively rare, PTNP has a profound impact on patient's quality of life. Appropriated previous image techniques, effective anaesthetic procedures and caution during the surgical procedure and implant installation are recommended for the prevention of this condition. In case of the PTNP, different management modalities, including antidepressant and membrane stabilizer medications, as well as peripheral strategies, as the use of topical medication and the botulin toxin are presented and discussed.
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http://dx.doi.org/10.1111/joor.13112DOI Listing
February 2021

Somatosensory and psychosocial profile of patients with painful temporomandibular joint clicking.

J Oral Rehabil 2020 Nov 5;47(11):1346-1357. Epub 2020 Sep 5.

Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.

Background: Determining the somatosensory and psychosocial profile of patients with painful temporomandibular joint (TMJ) clicking can help to understand the pain mechanisms in cases of TMJ clicking.

Objective: To characterise the somatosensory and psychosocial profile of patients with painful TMJ clicking when compared to patients with painless TMJ clicking and healthy control group.

Methods: Somatosensory and psychosocial functions were assessed in 90 individuals: patients with painful TMJ clicking (n = 30); patients with painless TMJ clicking (n = 30); and healthy controls (n = 30). Somatosensory profile included: mechanical pain threshold (MPT); wind-up ratio (WUR); pressure pain threshold (PPT); and conditioned pain modulation (CPM). Psychosocial profile included some questionnaires: Pittsburgh Sleep Quality Index (PSQI); Pain Vigilance-Awareness Questionnaire (PVAQ); Pain Catastrophizing Scale (PCS); Tampa Scale for Kinesiophobia (TSK); Perceived Stress (PSS); and State-Trait Anxiety Inventory (STAI). All variables were compared among all groups.

Results: Higher values of MPT and WUR; lower PPT; less efficient CPM; and higher scores of PSQI, PVAQ, PCS, and TSK were found in patients with painful TMJ clicking when compared to the other two groups (P < .001). Patients with painless TMJ clicking showed lower PPT and higher scores of PVAQ and TKS than the healthy control group. PSS and STAI data had no differences.

Conclusion: Patients with painful TMJ clicking had abnormalities in the somatosensory profile, with a significant somatosensory gain of function (more sensitive) to mechanical pain tests and less efficient CPM. Poor sleep quality along with higher levels of hypervigilance, pain catastrophising, and kinesiophobia were features of psychosocial profile of these patients.
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http://dx.doi.org/10.1111/joor.13081DOI Listing
November 2020

Role of inflammatory and pain genes polymorphisms in temporomandibular disorder and pressure pain sensitivity.

Arch Oral Biol 2020 Oct 31;118:104854. Epub 2020 Jul 31.

Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Sao Paulo, Brazil.

Objective: The aim of this study was to assess the correlation of inflammatory and pain genes polymorphisms with the presence of temporomandibular disorder (TMD) patients and with pressure pain sensitivity.

Design: Data was collected from 268 consecutive subjects at Bauru School of Dentistry. Subjects aged younger than 20 years, with dental and neuropathic pain, sinusitis, cognitive and neurologic disorder were excluded. Included subjects were evaluated using the Research Diagnostic Criteria for Temporomandibular disorders and divided into two groups: TMD cases and healthy controls. Groups were submitted to pressure pain threshold (PPT) test for the temporomandibular joint, anterior temporalis and masseter muscles and genotyped for Val158Met, IL6-174, IL-1β-3954 and TNFA-308. Student's t-test and Pearson chi-square test were used to comparisons between groups. A linear multiple regression was used to evaluate the influence of genetics variables on the PPT and a bivariate analysis was used to assesses the influence of genetics variables on pain sensitivity below the PPT cut off of the structures in TMD group.

Results: TMD group showed significantly lower PPT values for all structures when compared with control group (p < 0.001). SNP IL6-174 predicted higher pain sensitivity in the temporomandibular joint (p < 0.005) and in anterior temporalis muscle (p < 0.044) and SNP Val158Met in the masseter muscle (p < 0.038); when TMD group was divided according to PPT cut-off values the SNP Val158Met influenced increase pain sensibility in the masseter muscle.

Conclusion: TNFA-308 was associated with TMD and SNP IL6-174 and SNP Val158Met influenced pain sensitivity of patients with TMD.
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http://dx.doi.org/10.1016/j.archoralbio.2020.104854DOI Listing
October 2020

Influence of self-reported physical activity and sleep quality on conditioned pain modulation in the orofacial region.

Clin Oral Investig 2021 Mar 9;25(3):1195-1202. Epub 2020 Jul 9.

Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo, Al. Octávio Pinheiro Brizolla 9-75 CEP Vila Universitária, Bauru, SP, 17012-901, Brazil.

Objectives: To evaluate the influence of self-reported physical activity and sleep quality on conditioned pain modulation (CPM) in the orofacial region.

Materials And Methods: Ninety healthy participants aged 18-50 years old were evenly distributed according to the level of physical activity into low, moderate, and high level. The classification of physical activity was based on modified criteria of the International Physical Activity Questionnaire (IPAQ), considering intensity, duration, and frequency of physical activity. The Pittsburgh Sleep Quality Index (PSQI) assessed sleep quality and the individuals were then classified as good or poor sleepers. CPM was assessed using the pressure pain threshold (PPT) of the anterior temporalis as test stimulus and hand immersion in hot water as conditioning stimulus. ANOVA was applied to the data and Tukey's posttest was applied when the main effects or interactions were significant (p < 0.050).

Results: There was no significant main effect of neither physical activity nor sleep quality on pain modulation. However, individuals who reported high level of physical activity and good quality of sleep had a greater pain modulation (- 0.60 ± 0.34) when compared with those who reported moderate (- 0.10 ± 0.25) and low level of physical activity (- 0.10 ± 0.52) and good sleep quality (p < 0.028).

Conclusions: Pain modulation seems to be more efficient in individuals who report a good sleep quality and a high level of physical activity.

Clinical Relevance: Conditioned pain modulation is highly variable in healthy people. Therefore, a multifactorial approach should be taken into consideration in the evaluation of the efficacy of endogenous analgesia.
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http://dx.doi.org/10.1007/s00784-020-03424-zDOI Listing
March 2021

The association of self-reported awake bruxism with anxiety, depression, pain threshold at pressure, pain vigilance, and quality of life in patients undergoing orthodontic treatment.

J Appl Oral Sci 2020 27;28:e20190407. Epub 2020 Mar 27.

Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Prótese e Periodontia, Bauru, São Paulo, Brasil.

Introduction: This study aimed to evaluate whether the presence of awake bruxism was associated with temporomandibular dysfunction symptoms, pain threshold at pressure, pain vigilance, oral health-related quality of life (OHRQoL), and anxiety and depression symptoms in patients undergoing orthodontic treatment.

Methodology: This observational study followed patients who had started receiving orthodontic treatment for six months. The following variables were measured three times (at baseline, one month, and six months): pressure pain threshold (PPT) in the right and left masseter, anterior temporalis, and temporomandibular joint (TMJ), and right forearm; pain vigilance and awareness questionnaire; and shortened form of the oral health impact profile (OHIP-14). Anxiety and depression symptoms were measured using the Beck anxiety inventory and the Beck depression inventory, respectively. The patients were divided into two main groups according to the presence (n=56) and absence (n=58) of possible awake bruxism. The multi-way analysis of variance (ANOVA) was applied on the date (p=0.050).

Results: TMJ and/or muscle pain were not observed in both groups. Time, sex, age group, and awake bruxism did not affect the PPT in the masticatory muscles and pain vigilance (p>0.050). However, the primary effect of awake bruxism was observed when anxiety (ANOVA: F=8.61, p=0.004) and depression (ANOVA: F=6.48, p=0.012) levels were higher and the OHRQoL was lower (ANOVA: F=8.61, p=0.004).

Conclusion: The patients with self-reported awake bruxism undergoing an orthodontic treatment did not develop TMJ/masticatory muscle pain. The self-reported awake bruxism is associated with higher anxiety and depression levels and a poorer OHRQoL in patients during the orthodontic treatment.
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http://dx.doi.org/10.1590/1678-2019-0407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105289PMC
April 2020

Correlation Between Physical and Psychosocial Findings in a Population of Temporomandibular Disorder Patients.

Int J Prosthodont 2020 Mar/Apr;33(2):155-159

Purpose: To assess the correlation between RDC/TMD Axis I and Axis II diagnoses and whether pain could mediate a possible correlation between these two variables.

Materials And Methods: Data of both RDC/TMD axes were collected from 737 consecutive patients who sought TMD advice at the University of Padova, Italy. A descriptive analysis was used to report the frequencies of Axis I and II diagnoses, and Spearman test was performed to assess the correlation between the axes. Subsequently, the sample was divided into two groups (painful vs nonpainful TMD). Frequencies were reported using descriptive analysis, and chi-square test was used to compare groups. The painful TMD group was then divided based on the level of pain-related impairment (low = Groups I and II; high = Groups III and IV). Then, frequencies of depression and somatization were reported using descriptive analysis for each disability group, and chi-square test was used to compare groups.

Results: No correlation levels were found between Axis I and any of the Axis II findings (Graded Chronic Pain Scale, depression, and somatization). The painful TMD group presented higher levels of depression and somatization (P < .05). Comparisons of depression and somatization frequencies between pain-impairment groups showed a significantly higher prevalence of abnormal scores for the severe pain-impairment group.

Conclusion: There is no correlation between specific Axis I and Axis II findings. The presence of pain, independent of the muscle or joint location, is correlated with Axis II findings, and higher levels of pain-related impairment are associated with the most severe scores of depression and somatization.
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http://dx.doi.org/10.11607/ijp.5847DOI Listing
February 2020

Evaluation of oral mechanical and gustatory sensitivities and salivary cotinine levels in adult smokers.

Acta Odontol Scand 2020 May 27;78(4):256-264. Epub 2019 Nov 27.

Department Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), Diadema, Brazil.

The aim was to examine oral mechanical and gustatory sensitivities in adult smokers and to estimate salivary levels of cotinine by tobacco consumption. A total of 54 adults (20-45 years old; 28 males/26 females) were divided into two sex-paired groups: smoker group ( = 27), tobacco consumers with no other chronic disease/use of chronic medication, and a control non-smoker non-exposed group with similar age ( = 27). 24 h-Recall was used to gather information about tobacco consumption, date of onset and duration of the habit. Oral mechanical evaluation comprised touch detection threshold (MDT) of upper and lower lips and tongue tip and two-point discrimination (TPD) assessments. Taste sensitivities for sweet, salty, sour and bitter were evaluated in four concentrations. Salivary cotinine was determined by high performance liquid chromatography. Statistical analysis comprised Mann-Whitney, Two-way ANOVA test and regression analysis. The mean smoking time was 13.6 years (mean 8.4 mg/day; 13 cigarettes/day). A sex-effect was observed on MDT of tongue tip (higher sensitivity in females), while group-effect was observed on TPD of lower lip, showing a smaller sensitivity among smokers ( < .05; moderate effect: Eta partial = 0.076). Although the total score of gustatory sensitivity did not differ between groups, smokers exhibited an irregular pattern of correctly identified tastants among the different concentrations of salty, sour and bitter. The predictive model showed that salivary cotinine was dependent on "nicotine consumption on the day before" ( = 49%). A difference in tactile sensitivity of the lower lip and qualitative changes in taste sensitivity were observed in smokers.
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http://dx.doi.org/10.1080/00016357.2019.1694978DOI Listing
May 2020

Botulinum toxin type A applications for masticatory myofascial pain and trigeminal neuralgia: what is the evidence regarding adverse effects?

Clin Oral Investig 2019 Sep 24;23(9):3411-3421. Epub 2019 Jul 24.

Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil.

Objectives: The objective of the study was to conduct a systematic review of literature assessing botulinum toxin type A (BoNT-A) safety and adverse effects in the treatment of myofascial pain (MFP) and trigeminal neuralgia (TN).

Materials And Methods: The search for articles by two specific researchers involved the PubMed, EMBASE, Web of Science, and Scopus databases. Specific terms were used, and no publication time and language restrictions were applied. Clinical trials that investigated the effects of BoNT-A among participants with myofascial pain in masticatory muscles or trigeminal neuralgia were considered eligible for this systematic review. Data for each study were extracted and analyzed according to a PICO-like structured reading.

Results: The search strategy provided 436 citations. After analysis, 16 citations were included, seven for MFP and nine for TN. In all studies, BoNT-A was well tolerated and improved pain. The most common adverse effects were temporary regional weakness, tenderness over the injection sites, and minor discomfort during chewing. Most studies reported a spontaneous resolution of adverse effect.

Conclusions: It can be concluded that BoNT-A treatment is well tolerated, since minor adverse effects were the most frequently reported; however, it is recommended that future studies aim to assess the safety and possible adverse effects of multiples applications or high doses of this treatment.

Clinical Relevance: BoNT-A has been increasingly diffused in dentistry, being used for the management of masticatory myofascial pain and trigeminal neuralgia. Nonetheless, there is no consensus about its efficacy and adverse effects that could occur when this treatment is applied.
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http://dx.doi.org/10.1007/s00784-019-03026-4DOI Listing
September 2019

Temporomandibular joint morphology does not influence the presence of arthralgia in patients with disk displacement with reduction: a magnetic resonance imaging-based study.

Oral Surg Oral Med Oral Pathol Oral Radiol 2020 Feb 4;129(2):149-157. Epub 2019 May 4.

Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.

Objective: The aim of this study was to compare, by using magnetic resonance imaging (MRI), temporomandibular joint (TMJ) morphology between patients with disk displacement with reduction (DDWR) with or without arthralgia and a control group and to identify which factors are associated with the concomitant presence of arthralgia in DDWR patients.

Study Design: In this investigation, 36 TMJ MRIs were divided into 3 groups. Group 1 (n = 12) comprised patients with DDWR and arthralgia; group 2 (n = 12) comprised patients with DDWR without arthralgia; and group 3 (n = 12) was the control group. Disk and mandibular condyle morphologies; articular eminence morphology and inclination; size of the mandibular fossa; joint space size; joint effusion; bone marrow of the mandibular condyle; and the relative signal intensity of retrodiscal tissue were evaluated.

Results: Fisher's exact test and 1-way analysis of variance (ANOVA) revealed no significant differences (P > .05) between groups for any variable. Logistic regression analysis showed that no anatomic variables were related to the concomitant presence of arthralgia in patients with DDWR (P > .05).

Conclusions: As evaluated on MRI scans, no significant differences in the anatomic characteristics of the TMJ were detected between DDWR patients with or without concomitant arthralgia and the control group. There were no factors associated with the concomitant presence of arthralgia in patients with DDWR.
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http://dx.doi.org/10.1016/j.oooo.2019.04.016DOI Listing
February 2020

Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation.

J Appl Oral Sci 2019 Feb 21;27:e20180433. Epub 2019 Feb 21.

Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Prótese, Grupo de Dor Orofacial de Bauru, Bauru, São Paulo, Brasil.

Disc displacement with reduction (DDWR) is one of the most common intra-articular disorders of the temporomandibular joint (TMJ). Factors related to the etiology, progression and treatment of such condition is still a subject of discussion. This literature review aimed to address etiology, development, related factors, diagnosis, natural course, and treatment of DDWR. A non-systematic search was conducted within PubMed, Scopus, SciELO, Medline, LILACS and Science Direct using the Medical Subjective Headings (MeSH) terms "temporomandibular disorders", "temporomandibular joint", "disc displacement" and "disc displacement with reduction". No time restriction was applied. Literature reviews, systematic reviews, meta-analysis and clinical trials were included. DDWR is usually asymptomatic and requires no treatment, since the TMJ structures adapt very well and painlessly to different disc positions. Yet, long-term studies have shown the favorable progression of this condition, with no pain and/or jaw locking occurring in most of the patients.
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http://dx.doi.org/10.1590/1678-7757-2018-0433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382319PMC
February 2019

Lifetime prediction of veneered versus monolithic lithium disilicate crowns loaded on marginal ridges.

Dent Mater 2019 03 25;35(3):511-522. Epub 2019 Jan 25.

Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil. Electronic address:

Objective: To evaluate the probability of survival of monolithic and porcelain veneered lithium disilicate crowns comprised by a conventional or modified core when loaded on marginal ridges.

Methods: Lithium disilicate molar crowns (n=30) were fabricated to be tested at mesial and distal marginal ridges and were divided as follows: (1) bilayered crowns with even-thickness 0.5mm framework (Bi-EV); (2) bilayered crowns with modified core design (Bi-M-lingual collar connected to proximal struts), and: (3) monolithic crowns (MON). After adhesively cemented onto composite-resin prepared replicas, mesial and distal marginal ridges of each crown (n=20) were individually cyclic loaded in water (30-300N) with a ceramic indenter at 2Hz until fracture. The 2-parameter Weibull was used to calculate the probability of survival (reliability) (90% 2-sided confidence bounds) at 1, 2, and 3 million cycles and mean life.

Results: The reliability at 1 and 2 million cycles was significantly higher for MON (47% and 19%) compared to Bi-EV (20% and 4%) and Bi-M (17% and 2%). No statistical difference was found between bilayered groups. Only the MON group presented crown survival (7%) at 3 million cycles. The mean life was highest for MON (1.73E+06), lowest for Bi-M (573,384) and intermediate for Bi-E (619,774). Fractographic analysis showed that the fracture originated at the occlusal surface. The highest reliability was found for MON crowns. The modified framework design did not improve the fatigue life of crowns.

Significance: Monolithic lithium disilicate crowns presented higher probability of survival and mean life than bilayered crowns with modified framework design when loaded at marginal ridges.
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http://dx.doi.org/10.1016/j.dental.2019.01.007DOI Listing
March 2019

Practice-Based Clinical Evaluation of Dental Implants Placed with Immediate or Delayed Loading Protocols: One-Year Follow-Up.

J Long Term Eff Med Implants 2019 ;29(2):141-149

Unigranrio University, School of Heath Sciences, Duque De Caxias, Rio De Janeiro; Department of Prosthodontics and Periodontology, University of Sao Paulo Bauru School of Dentistry, Bauru, SP, Brazil, 17.012-901.

We evaluate bone remodeling and prostheses survival of immediately provisionalized with occlusal loading and delayed loading (DL) single implants placed in the posterior region after 1-yr follow-up in dental practices. Included in the study are patients selected to receive one regular implant (4 × 10 mm) for single tooth replacement in healed ridge sockets in the mandible and maxilla. Implants are immediately loaded or delayed functionally loaded with metal ceramic crowns, depending on peak insertion torque value. All implants are clinically and radiographically evaluated at T1, immediately postoperatively; T2, 60 d; T3, 180 d; and T4, 360 d. Measurements between implant platform and top of alveolar bone crest at distal and mesial areas are performed using periapical radiographs. Data are statistically evaluated through two-way repeated measures of analysis of variance following post hoc comparisons using the Tukey test (p < 0.05). Ten specialists working in ten different practices treat 36 patients who receive one implant each with internal conical connection (hybrid implant system, 4 × 10 mm) (Emfils; Itu, Brazil). Results show that bone-level alterations in immediate (IM; 0.56 mm; confidence interval [CI]: ± 0.21 mm) and delayed (0.65 mm; CI: ± 0.19 mm) groups are not significantly different (p = 0.515) during the course of the 1-yr observation period. In both groups, statistically significant progressive bone-level remodeling occurs through the evaluated follow-up time points (p < 0.047). All prostheses are rated "alpha," presenting 100% success at 1-yr follow-up. The loading method does not influence bone-remodeling levels around IM or DL at the posterior region after 1-yr follow-up. No prostheses complications are reported.
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http://dx.doi.org/10.1615/JLongTermEffMedImplants.2019031911DOI Listing
October 2020

The Effect of CAD/CAM Crown Material and Cement Type on Retention to Implant Abutments.

J Prosthodont 2019 Feb 2;28(2):e552-e556. Epub 2018 Jul 2.

Department of Prosthodontics and Periodontology, University of Sao Paulo - Bauru School of Dentistry, Bauru, Brazil.

Purpose: To evaluate the pullout resistance of CAD/CAM implant-supported crowns cemented with provisional and definitive cements on Ti-base implant abutments.

Materials And Methods: Sixty crowns were milled for use in Ti-base implant abutments and divided (n = 15/group) according to material, as follows: (a) [Pr] Temporary acrylic resin; (b) [Co-Cr] Cobalt-Chromium alloy; (c) [Zr] polycrystalline zirconia; and (d) [Ti] titanium. The cementation was performed with RelyX Temp NE (RxT) cement or RelyX U200 self-etching resin cement, under a 50 N (5 kg) load for 10 minutes. Twenty-four hours after cementation, the crowns were subjected to the pullout test in a universal test machine, at a 1.0 mm/min crosshead speed. The tests were performed first without cement to evaluate frictional resistance (Baseline), then with provisional cement (RelyX Temp NE without cement again (Baseline After RxT), and finally with resin cement (U200). The results were analyzed by ANOVA and Tukey test (p < 0.05).

Results: Data evaluation as a function of cement type demonstrated the superiority of resin-based cements relative to provisional and baseline groups (p < 0.01). While Co-Cr crowns presented the highest pullout strength values, Pr showed the lowest values (data collapsed over cement) (p < 0.001). Retentiveness data as a function of both factors demonstrated similar pullout resistance between groups without cement (p < 0.001), except Zr baseline. Also, Co-Cr presented higher pullout strength compared to other materials.

Conclusions: Self-adhesive resin cement exhibited superior retention compared to temporary cement, regardless of crown material. Co-Cr and titanium presented higher levels of retention to Ti-base abutment after being cemented.
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http://dx.doi.org/10.1111/jopr.12927DOI Listing
February 2019

Experimental Psychological Stress on Quantitative Sensory Testing Response in Patients with Temporomandibular Disorders.

J Oral Facial Pain Headache Fall 2018;32(4):428–435. Epub 2018 May 15.

Aims: To assess the modulatory effects of experimental psychological stress on the somatosensory evaluation of myofascial temporomandibular disorder (TMD) patients.

Methods: A total of 20 women with myofascial TMD and 20 age-matched healthy women were assessed by means of a standardized battery of quantitative sensory testing. Cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), mechanical pain threshold (MPT), wind-up ratio (WUR), and pressure pain threshold (PPT) were performed on the facial skin overlying the masseter muscle. The variables were measured in three sessions: before (baseline) and immediately after the Paced Auditory Serial Addition Task (PASAT) (stress) and then after a washout period of 20 to 30 minutes (poststress). Mixed analysis of variance (ANOVA) was applied to the data, and the significance level was set at P = .050.

Results: A significant main effect of the experimental session on all thermal tests was found (ANOVA: F > 4.10, P < .017), where detection tests presented an increase in thresholds in the poststress session compared to baseline (CDT, P = .012; WDT, P = .040) and pain thresholds were reduced in the stress (CPT, P < .001; HPT, P = .001) and poststress sessions (CPT, P = .005; HPT, P = .006) compared to baseline. In addition, a significant main effect of the study group on all mechanical tests (MPT, WUR, and PPT) was found (ANOVA: F > 4.65, P < .037), where TMD patients were more sensitive than healthy volunteers.

Conclusion: Acute mental stress conditioning can modulate thermal sensitivity of the skin overlying the masseter in myofascial TMD patients and healthy volunteers. Therefore, psychological stress should be considered in order to perform an unbiased somatosensory assessment of TMD patients.
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http://dx.doi.org/10.11607/ofph.2046DOI Listing
February 2019

Headache Exacerbates Pain Characteristics in Temporomandibular Disorders.

J Oral Facial Pain Headache 2017 3;31(4):339–345. Epub 2017 Oct 3.

Aims: To evaluate the impact of headache in adults with masticatory myofascial pain (MMP) on the outcome variables clinical pain (ie, self-reported pain intensity and pressure pain sensitivity), sleep quality, and pain catastrophizing.

Methods: A total of 97 patients with MMP were diagnosed with co-existing headache (MMPH group, n = 50) or without headache (MMP group, n = 47) according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The outcome parameters were the Pittsburgh Sleep Quality Index (PSQI); the Catastrophizing Thoughts subscale of the Pain-Related Self-Statement Scale (PRSS-C); pressure pain thresholds (PPTs) of the masseter and anterior temporalis muscles; and self-reported facial pain intensity measured on a 0- to 10-cm visual analog scale (VAS). Student t test for independent samples (α = 1.2%) and factorial analysis of variance (ANOVA) (α = 5%) were used to analyze the data.

Results: The MMPH group showed significantly impaired sleep quality (mean ± standard deviation [SD] PSQI score 9.1 ± 3.5) compared with the MMP group (7.2 ± 3.4; P = .008). Subscale scores on the PRSS-C were significantly higher in the MMPH (2.1 ± 1.2) than in the MMP group (1.6 ± 1.4, uncorrected P = .048). Also, the PPTs (kgf/cm²) of the masseter and anterior temporalis muscles were significantly lower in the MMPH group (1.52 ± 0.53; 1.29 ± 0.43, respectively) than in the MMP group (2.09 ± 0.73; 1.70 ± 0.68, respectively; P < .001), with no differences in self-reported facial pain intensity. Factorial analyses further indicated that chronic migraine was associated with poorer sleep quality (P = .003) and that tension-type headache patients had lower PPTs in the anterior temporalis muscle (P = .041) in comparison with non-headache patients.

Conclusion: Co-existence of headache further exacerbates clinical characteristics in patients with painful TMD, which implies involvement of common mechanisms and pathways of vulnerability in these patients.
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http://dx.doi.org/10.11607/ofph.1746DOI Listing
October 2017

Effect of interocclusal appliance on bite force, sleep quality, salivary cortisol levels and signs and symptoms of temporomandibular dysfunction in adults with sleep bruxism.

Arch Oral Biol 2017 Oct 27;82:62-70. Epub 2017 May 27.

Department of Pharmaceutical Sciences-Universidade Federal de São Paulo (UNIFESP), Diadema, Brazil. Electronic address:

Objective: The purpose was to evaluate the effect interocclusal appliance therapy on bite force (BF), sleep quality and salivary cortisol levels in adults with SB diagnosed by polysomnography. As a secondary aim, signs and symptoms of temporomandibular dysfunction (TMD) were evaluated.

Design: Forty-three adults (19-30 y/o) were divided into two groups: experimental group (G), composed of 28 subjects with SB, and control group (G), without SB and TMD (n=15). G was treated with stabilization interocclusal splint and evaluated at time intervals: before (baseline), one month (T1) and two months (T2) after therapy began, to collect data related to BF, sleep quality (Pittsburgh Sleep Quality Index), salivary cortisol levels and TMD. G was also examined three times and received no therapy. Data were analysed by means of normality tests, t-test/Mann-Whitney and One-way ANOVA repeated measures (Tukey post-test). Two-way ANOVA test for repeated measures was applied to verify the effect time*group interaction on the variance of each dependent variable (α=0.05).

Results: G showed an increase in BF and a positive effect on muscular symptomatology, range of mandibular movements and sleep quality; in G these parameters did not differ. Cortisol concentration decreased between baseline and T1 in G (F=4.46; test power=62%; p=0.017). The variance observed for BF, TMD and sleep quality among time points was dependent on the group (moderate effect size: partial Eta square >0.16; test power >80%).

Conclusions: The results suggested that short-term interocclusal appliance therapy had a positive effect on BF, temporomandibular symptomatology, sleep quality and salivary cortisol levels in adults with SB.
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http://dx.doi.org/10.1016/j.archoralbio.2017.05.018DOI Listing
October 2017

Effects of Experimental Pain and Lidocaine on Mechanical Somatosensory Profile and Face Perception.

J Oral Facial Pain Headache 2017 Spring;31(2):115-123

Aims: To assess the effects of experimental muscle pain and topical lidocaine applied to the skin overlying the masseter muscle on the mechanical somatosensory profile and face perception of the masseter muscle in healthy participants.

Methods: A total of 28 healthy participants received a 45-minute application of a lidocaine or placebo patch to the skin overlying the masseter muscle followed by one injection of 0.2 mL sterile solution of monosodium glutamate. Measurements were taken four times during each session of quantitative sensory testing (QST) (T0 = baseline, T1 = 45 minutes after patch application, T2 = immediately after glutamate injection, and T3 = 25 minutes after the glutamate injection), and the following variables were measured: mechanical detection threshold (MDT), mechanical pain threshold (MPT), pressure pain threshold (PPT), pain report (pain on palpation, pain spreading on palpation, and pain intensity), pain drawing, and perceptual distortion. Multi-way within-subjects analysis of variance (ANOVA) was applied to the data.

Results: The highest MDTs were present at T2 (F = 49.28, P < .001), the lowest PPTs were present at T2 and T3 (F = 21.78, P < .001), and the largest magnitude and area of perceptual distortion were reported at T2 (F > 6.48, P < .001).

Conclusion: Short-lasting experimental muscle pain was capable of causing loss of tactile sensitivity as well as perceptual distortion of the face, regardless of preconditioning with a topical lidocaine patch. Short-term application of a lidocaine patch did not significantly affect the mechanical somatosensory profile.
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http://dx.doi.org/10.11607/ofph.1758DOI Listing
October 2017

Short-term transcutaneous electrical nerve stimulation reduces pain and improves the masticatory muscle activity in temporomandibular disorder patients: a randomized controlled trial.

J Appl Oral Sci 2017 Mar-Apr;25(2):112-120

Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ciências Biológicas, Seção de Fisiologia da Cabeça e da Face, Bauru, SP, Brasil.

Objective: To investigate the short-term effect of transcutaneous electrical nerve stimulation (TENS) by examining pain intensity, pressure pain threshold (PPT) and electromyography (EMG) activity in patients with temporomandibular disorder (TMD).

Material And Methods: Forty patients with myofascial TMD were enrolled in this randomized placebo-controlled trial and were divided into two groups: active (n=20) and placebo (n=20) TENS. Outcome variables assessed at baseline (T0), immediately after (T2) and 48 hours after treatment (T1) were: pain intensity with the aid of a visual analogue scale (VAS); PPT of masticatory and cervical structures; EMG activity during mandibular rest position (MR), maximal voluntary contraction (MVC) and habitual chewing (HC). Two-way ANOVA for repeated measures was applied to the data and the significance level was set at 5%.

Results: There was a decrease in the VAS values at T1 and T2 when compared with T0 values in the active TENS group (p<0.050). The PPT between-group differences were significant at T1 assessment of the anterior temporalis and sternocleidomastoid (SCM) and T2 for the masseter and the SCM (p<0.050). A significant EMG activity reduction of the masseter and anterior temporalis was presented in the active TENS during MR at T1 assessment when compared with T0 (p<0.050). The EMG activity of the anterior temporalis was significantly higher in the active TENS during MVC at T1 and T2 when compared with placebo (p<0.050). The EMG activity of the masseter and anterior temporalis muscle was significantly higher in the active TENS during HC at T1 when compared with placebo (p<0.050).

Conclusions: The short-term therapeutic effects of TENS are superior to those of the placebo, because of reported facial pain, deep pain sensitivity and masticatory muscle EMG activity improvement.
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http://dx.doi.org/10.1590/1678-77572016-0173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393531PMC
May 2017

Temporomandibular disorders and painful comorbidities: clinical association and underlying mechanisms.

Oral Surg Oral Med Oral Pathol Oral Radiol 2017 Mar 24;123(3):288-297. Epub 2016 Dec 24.

Section of Head and Face Physiology, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil; Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.

The association between temporomandibular disorders (TMDs) and headaches, cervical spine dysfunction, and fibromyalgia is not artefactual. The aim of this review is to describe the comorbid relationship between TMD and these three major painful conditions and to discuss the clinical implications and the underlying pain mechanisms involved in these relationships. Common neuronal pathways and central sensitization processes are acknowledged as the main factors for the association between TMD and primary headaches, although the establishment of cause-effect mechanisms requires further clarification and characterization. The biomechanical aspects are not the main factors involved in the comorbid relationship between TMD and cervical spine dysfunction, which can be better explained by the neuronal convergence of the trigeminal and cervical spine sensory pathways as well as by central sensitization processes. The association between TMD and fibromyalgia also has supporting evidence in the literature, and the proposed main mechanism underlying this relationship is the impairment of the descending pain inhibitory system. In this particular scenario, a cause-effect relationship is more likely to occur in one direction, that is, fibromyalgia as a risk factor for TMD. Therefore, clinical awareness of the association between TMD and painful comorbidities and the support of multidisciplinary approaches are required to recognize these related conditions.
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http://dx.doi.org/10.1016/j.oooo.2016.12.005DOI Listing
March 2017

Pain from Dental Implant Placement, Inflammatory Pulpitis Pain, and Neuropathic Pain Present Different Somatosensory Profiles.

J Oral Facial Pain Headache 2017 Winter;31(1):19-29

Aims: To address the two following questions: (1) What kind of somatosensory abnormalities may be characterized in patients receiving dental implants (IMP), in ongoing inflammatory dental pulpitis (IP) patients, and in neuropathic pain (atypical odontalgia [AO]) patients? and (2) What sort of sensory and neural changes may result from dental implant placement surgery and pulpectomy?

Methods: A total of 60 subjects were divided into three groups: the IMP (n = 20), IP (n = 20), and AO groups (n = 20). Quantitative sensory testing (QST) was performed preoperatively (baseline) for all three groups and postoperatively at 1 month and 3 months after dental implant placement or pulpectomy (in the IMP group and IP group, respectively). Statistical analyses were completed with one-way and two-way analysis of variance and z score transformations (α = 5%).

Results: The main findings of this study indicated that: (1) Elevations in mechanical detection threshold (MDT) and in current perception threshold (CPT) related to C-fiber activation, indicating a loss of function, were found at baseline in IP patients; (2) Somatosensory abnormalities such as allodynia, reduced MDT and mechanical pain threshold (MPT), and impaired pain modulation were found in AO patients; (3) No somatosensory alterations after implant placement were found in the IMP group; and (4) Somatosensory alterations in the form of reduction in the CPT related to C-fiber activation were reported 3 months after pulpectomy in the IP group.

Conclusion: This study showed that somatosensory abnormalities were evident in AO and IP patients, and somatosensory alterations were seen in IP patients even 3 months after pulpectomy. However, no somatosensory alterations were seen after implant placement.
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http://dx.doi.org/10.11607/ofph.1680DOI Listing
May 2017

Reliability of the nociceptive blink reflex evoked by electrical stimulation of the trigeminal nerve in humans.

Clin Oral Investig 2017 Nov 10;21(8):2453-2463. Epub 2017 Jan 10.

Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.

Objective: The nociceptive blink reflex (nBR) can be useful to investigate trigeminal nociceptive function. The aim of this study was to estimate the reliability of the nBR evoked by electrical stimulation of the three branches of the trigeminal nerve under the following conditions: over time (test-retest and intrarater reliability) and by two examiners (interrater reliability).

Materials And Methods: Twenty-one healthy participants were evaluated in two sessions (24 h apart). The nBR was elicited by a so-called "nociceptive-specific" electrode placed over the entry zone of the right supraorbital (V1R), infraorbital (V2R), mental (V3R), and left infraorbital (V2L) nerve. The outcomes were individual electrical sensory (I ) and pain thresholds (I ); root mean square (RMS), area-under-the-curve (AUC), and onset latencies of R2 responses (determined twice after a recalibration session); and stimulus-evoked pain on a 0-10 numerical rating scale. Intraclass correlation coefficients (ICCs) and Kappa statistics were computed (α = 5%).

Results: ICCs were fair to excellent in 82% of the psychophysical measures (fair 21%, good 31%, excellent 30%) and in 86% of V1R, V2R, and V2L nBR parameters, whereas 52% of V3R showed poor reliability. ICCs for intrarater reliability were fair to good in 70% of measurements (fair 20%, good 50%) and in 75% of interrater measurements after the recalibration (fair 55%, good 20%). All kappa values showed at least fair agreement and the majority of the nBR measures (93%) presented moderate to excellent reliability.

Conclusion: The nBR and its associated psychophysical measures can be considered a sufficiently reliable test.

Clinical Significance: The nBR can be recommended as an electrophysiological technique to assess trigeminal nociceptive function.
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http://dx.doi.org/10.1007/s00784-016-2042-6DOI Listing
November 2017

Is the Nociceptive Blink Reflex Associated with Psychological Factors in Healthy Participants?

J Oral Facial Pain Headache 2016 ;30(2):120-6

Aims: To evaluate the possible association between the nociceptive blink reflex (nBR) and various pain-related psychological measures: the Anxiety Sensitivity Index-3 (ASI-3), the Fear of Pain Questionnaire III (FPQ-III), the Pain Vigilance and Awareness Questionnaire (PVAQ), the Somatosensory Amplification Scale (SSAS), the Pain Catastrophizing Scale (PCS), and the Situational Pain Catastrophizing Scale (S-PCS).

Methods: The nBR was evaluated in 21 healthy participants. It was elicited by a nociceptive-specific electrode placed over the entry zone of the right supraorbital nerve, infraorbital nerve, and mental nerve, as well as the left infraorbital nerve. The outcomes were (1) nBR measurements: (a) individual electrical sensory threshold (I0) and pain threshold (IP); (b) root mean square (RMS), area under the curve (AUC), and onset latencies of R2 responses; (c) stimulus-evoked pain on a 0 to 10 numeric rating scale (NRS); and (2) the ASI-3, the FPQ-III, the PVAQ, the SSAS, the PCS, and the S-PCS. Pearson correlation coefficient was used to evaluate the association between the means of nBR measurements from all sites and the questionnaires The significance level was set up after a Bonferroni correction (adjusted α = .8%).

Results: There was no correlation for any pair of variables at the adjusted significance level (P > .008). There was only a single significant correlation at the standard significance level (P < .05), where the pain intensity (NRS) at 50% of IP presented a positive and small to moderate correlation with the PCS (r = 0.43, P = .04).

Conclusion: It appears that the nBR and its associated psychophysical measures are not associated with psychological factors in healthy participants.
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http://dx.doi.org/10.11607/ofph.1598DOI Listing
July 2016

Deep pain sensitivity is correlated with oral-health-related quality of life but not with prosthetic factors in complete denture wearers.

J Appl Oral Sci 2015 Nov-Dec;23(6):555-61

Departamento de Prótese, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brasil.

Low pressure Pain Threshold (PPT) is considered a risk factor for Temporomandibular Disorders (TMD) and is influenced by psychological variables. Objectives To correlate deep pain sensitivity of masticatory muscles with prosthetic factors and Oral-Health-Related Quality of Life (OHRQoL) in completely edentulous subjects. Material and Methods A total of 29 complete denture wearers were recruited. The variables were: a) Pressure Pain Threshold (PPT) of the masseter and temporalis; b) retention, stability, and tooth wear of dentures; c) Vertical Dimension of Occlusion (VDO); d) Oral Health Impact Profile (OHIP) adapted to orofacial pain. The Kolmogorov-Smirnov test, the Pearson Product-Moment correlation coefficient, the Spearman Rank correlation coefficient, the Point-Biserial correlation coefficient, and the Bonferroni correction (α=1%) were applied to the data. Results The mean age (standard deviation) of the participants was of 70.1 years (9.5) and 82% of them were females. There were no significant correlations with prosthetic factors, but significant negative correlations were found between the OHIP and the PPT of the anterior temporalis (r=-0.50, 95% CI-0.73 to 0.17, p=0.005). Discussion The deep pain sensitivity of masticatory muscles in complete dentures wearers is associated with OHRQoL, but not with prosthetic factors.
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http://dx.doi.org/10.1590/1678-775720150174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716693PMC
July 2016
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