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de-las-Penas C.F.,Rey Juan Carlos University | de-las-Penas C.F.,University of Aalborg | Svensson P.,University of Aarhus | Svensson P.,Karolinska Institutet | Svensson P.,Scandinavian Center for Orofacial Neurosciences
Current Rheumatology Reviews | Year: 2016

Temporomandibular disorders (TMD) have been discussed for more than 70 years without reaching consensus on causes, etiological factors, pathophysiology, or rationale management. Indeed, TMD pain remains an enigma and a diagnostic and management challenge for many clinicians. Perhaps the many and often conflicting views on TMD pain by different health care providers are routed in professional traditions, personal beliefs, experience, and clinical training. This review aims to provide an updated and critical discussion on what is known and supported by scientific evidence about myofascial TMD pain and which gaps there still may be in our understanding of this condition. It has not been the intention to make a systematic review on all aspects of TMD but rather to point out some of the more recent (and important) pieces of information that may help us to better appreciate TMD pain as a complex and multifaceted pain disorder manifested in the craniofacial system. © 2016 Bentham Science Publishers. Source


Stuginski-Barbosa J.,University of Sao Paulo | Porporatti A.L.,University of Sao Paulo | Costa Y.M.,University of Sao Paulo | Svensson P.,University of Aarhus | And 3 more authors.
Sleep and Breathing | Year: 2016

Purpose: The aim of this study was to determine an appropriate cutoff value and the number of nights of sleep with the portable single-channel EMG device (GrindCare) necessary for a valid sleep bruxism (SB) diagnosis. Methods: Twenty consecutive post-graduate students and staff at Bauru School of Dentistry composed the sample. Each participant underwent the GrindCare for five consecutive nights and the polysomnography (PSG). The discrimination between bruxers and non-bruxers was based only on the PSG analysis. Data about electromyography per hour with GrindCare (EMG/h) and PSG (bursts/h) were scored. Results: There were positive correlations between the two devices for EMG/h and bursts/h in three and five consecutive nights. Bland-Altman analysis of the EMG bursts/h showed positive agreement between the methods. The receiver operating characteristic (ROC) analyses also showed that using a minimum of 18 EMG/h for three nights and 19 EMG/h for five nights in GrindCare as cutoffs resulted in a 90 % specificity and positive likelihood ratio equal to 5. Conclusions: GrindCare is able to discriminate SB diagnosed by PSG and gold standard criteria, when used for three or five consecutive nights, and it may be a valid choice in clinical practice for SB assessment. © 2015, Springer-Verlag Berlin Heidelberg. Source


Schaldemose E.L.,Aarhus University Hospital | Horjales-Araujo E.,Aarhus University Hospital | Demontis D.,University of Aarhus | Borglum A.D.,University of Aarhus | And 3 more authors.
Molecular Pain | Year: 2014

Background: Recent studies have suggested an association between genotypes affecting the expression of the serotonin transporter and thermal pain perception and the thermal grill. The aim of this study was to investigate differences in thermal and mechanical pain perception and the thermal grill in two groups of healthy volunteers according to their genotype, associated with either high (n = 40) or low (n = 40) expression of the serotonin transporter and according to gender. Cold and warm detection and pain thresholds, pressure pain threshold and cold, warm and pain sensations to single or alternating stimuli with cold (20°C) and warm (40°C) temperatures (known as the thermal grill) were determined. In addition, intensity of ongoing pain and area and intensity of pinprick hyperalgesia in the secondary hyperalgesic area following topical application of capsaicin and vehicle control (ethanol) were determined. Results: No significant differences in detection and pain thresholds for cold and warm temperatures, presence of paradoxical heat sensation, pressure pain threshold and pain responses to suprathreshold thermal stimuli were observed. There was also no difference in capsaicin-evoked ongoing pain and secondary hyperalgesia between the two genotype groups (p >0.4), also when subdivided by gender (p >0.17). In addition, there were no significant differences in the perception of the thermal grill between the two genotypes (p >0.5), also when subdivided by gender. Conclusions: Genotypes associated with high or low expression of the serotonin transporter were not associated with thermal pain thresholds, pressure pain threshold, pain after capsaicin application or responses to the thermal grill. © 2014 applies to the data made available in this article, unless otherwise stated. Source


Takeuchi T.,Hokkaido University | Arima T.,Hokkaido University | Ernberg M.,Karolinska Institutet | Ernberg M.,Scandinavian Center for Orofacial Neurosciences | And 5 more authors.
Headache | Year: 2015

Background The traditional view contends bruxism, such as tooth grinding/clenching, is part of the etiology of temporomandibular disorders (TMD) including some subtypes of headaches. The purpose of this study is to investigate if a low-level but long-lasting tooth-clenching task initiates TMD symptoms/signs. Methods Eighteen healthy participants (mean age ± SD, 24.0 ± 4.3 years) performed and repeated an experimental 2-hour tooth-clenching task at 10% maximal voluntary occlusal bite force at incisors (11.1 ± 4.6 N) for three consecutive days (Days 1-3). Pain and cardiovascular parameters were estimated during the experiment. Results The task evoked pain in the masseter/temporalis muscles and temporomandibular joint after 40.0 ± 18.0 minutes with a peak intensity of 1.6 ± 0.4 on 0-10 numerical rating scale (NRS) after 105.0 ± 5.0 minutes (Day 1). On Day 2 and Day 3, pain had disappeared but the tasks, again, evoked pain with similar intensities. The onset and peak levels of pain were not different between the experimental days (P = .977). However, the area under the curve of pain NRS in the masseter on Day 2 and Day 3 were smaller than that on Day 1 (P = .006). Cardiovascular parameters changed during the task but not during the days. Conclusions Prolonged, low-level tooth clenching evoked short-lived pain like TMD. This intervention study proposes that tooth clenching alone is insufficient to initiate longer lasting and self-perpetuating symptoms of TMD, which may require other risk factors. © 2015 American Headache Society. Source


Skyt I.,University of Aarhus | Dagsdottir L.,University of Aarhus | Dagsdottir L.,Scandinavian Center for Orofacial Neurosciences | Vase L.,University of Aarhus | And 9 more authors.
Journal of Pain | Year: 2015

Anecdotally, orofacial pain patients sometimes report that the painful face area feels "swollen." Because there are no clinical signs of swelling, such illusions may represent perceptual distortions. In this study, we examine whether nociceptive stimulation can lead to perceptual distortion of the face in a way similar to that of local anesthesia. Sixteen healthy participants received injections of.4 mL hypertonic saline to induce short-term nociceptive stimulation,.4 mL mepivacaine (local anesthetic) to transiently block nerve transduction, and.4 mL isotonic saline as a control condition. Injections were administered in both the infraorbital and the mental nerve regions. Perceptual distortions were conceptualized as perceived changes in magnitude of the injected areas and the lips, and they were measured using 1) a verbal subjective rating scale and 2) a warping procedure. Prior to the study, participants filled in several psychological questionnaires. This study shows that both nociceptive stimulation (P <.05) and transient blocking of nerve transduction (P <.05) can lead to perceptual distortion of the face. A test-retest experiment including 9 new healthy subjects supported the results. Perceptual distortions were positively correlated with the psychological variable of dissociation in several conditions (P <.05). Perceptual distortions may therefore be influenced by somatosensory changes and psychological mechanisms. Perspective Knowledge of the factors that influence the perception of the face is important to understand the possible implications of perceptual distortions in orofacial pain disorders (and possibly other chronic pain states). Such information may ultimately open up new avenues of treatment for persistent orofacial pain. © 2015 American Pain Society. Source

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