Zmiana stężenia CGRP w osoczu u pacjentów z dysfunkcją układu ruchowego narządu żucia leczonych szynami okluzyjnymi — badanie randomizowane

Introduction: Occlusal splint therapy is a well-known method for the treatment of TMD. Muscle stretching and pain relief are effects of occlusal appliance. The aim of this study was to evaluate the plasma level of CGRP in patients with myofascial pain (RDC/TMD Ia) and myofascial pain with limited opening (RDC/TMD Ib) before and after muscle stretching with occlusal splint therapy.Material and methods: A randomised trial was performed including 35 subjects (males = 10, females = 25) in the experimental group and 30 subjects (males = 9, females = 21) in the control group. Blood samples were taken from the external jugular vein before and after 30 days of occlusal splint therapy. Plasma levels of CGRP were measured with a Radio Immunoassay Kit (Phoenix Pharmaceuticals Inc.) and Cobra Series Auto-Gamma Counting System.Results: The results of the study demonstrated that CGRP concentrations were significantly higher after occlusal splint than before splint therapy: CGRP2 = 17.02 pg/mL (SD = 5.85), CGRP1 = 13.78 pg/mL (SD = 5.12), in the experimental group (p < 0.05). In the control group, there were no statistically significant changes in CGRP levels: CGRP1 = 14.5 pg/mL (SD = 4.87) to CGRP2 = 13.5 pg/mL (SD = 4.63). In the experimental group, there was a statistically significant reduction in pain intensity, VAS1 = 5 (SD = 2.5) to VAS2 = 1 (SD = 1.04) after splint therapy (p < 0.05). In the control group, there were no statistically significant changes in pain intensity: VAS1 = 5 (SD = 2.3) to VAS2 = 4 (SD = 2.6), (p < 0.05).Conclusions: CGRP plays an important role in muscle blood flow, which is altered by changes in muscle length. Further investigation is needed to clarify the mechanism of muscle blood flow and the muscle healing process in patients with TMD.Wstęp: Szynoterapia jest popularną formą leczenia dysfunkcji układu ruchowego narządu żucia (DURNŻ). Głównymi jej efektami sązmiany napięcia mięśni oraz działanie przeciwbólowe. Celem pracy była ocena stężenia CGRP u pacjentów cierpiących z powodu bólu mięśniowo-powięziowego mięśni żucia (RDC/TMD Ia) oraz bólu mięśniowo-powięziowego z ograniczonym odwodzeniem żuchwy (RDC/TMD Ib) przed i po szynoterapii.Materiał i metody: Przeprowadzono randomizowane badanie kliniczne obejmujące 35 pacjentów z DURNŻ w grupie badanej: 10 mężczyzn oraz 25 kobiet oraz 30 pacjentów z DURNŻ w grupie kontrolnej: 9 mężczyzn i 21 kobiet. Materiał do badania pobierano z żyły szyjnej zewnętrznej przed oraz po 30 dniach szynoterapii. Do oceny stężenia CGRP zastosowano zestaw Radio Immunoassay Kit (firmyPhoenix Pharmaceuticals Inc.) oraz system Cobra Series Auto-Gamma Counting System.Wyniki: Uzyskane wyniki wskazują, że stężenia CGRP w badanej grupie był znacząco wyższy po niż przed szynoterapią: CGRP2 = 17,02pg/ml (SD = 5,85), CGRP1 = 13,78 pg/ml (SD = 5,12), (p < 0,05). W grupie kontrolnej nie odnotowano istotnych statystycznie zmian: przed i po szynoterapi: CGRP1 = 14.5 pg/ml (SD = 4,87), CGRP2 = 13,5 pg/ml (SD = 4,63). W grupie badanej zauważono statystycznie istotną redukcję natężenia bólu, VAS1 = 5 (SD = 2.5), VAS2 = 1 (SD = 1,04) (p < 0,05). W grupie kontrolnej nie wystąpiły istotne statystycznie zmiany w natężeniu bólu: VAS1 = 5 (SD = 2,3), VAS2 = 4 (SD = 2,6), (p < 0,05).Wnioski: Podsumowując, CGRP odgrywa istotną rolę w regulacji przepływu krwi przez mięśnie żucia. Perfuzja krwi przez tkankę mięśniową zmienia się wraz z długością mięśnia podczas szynoterapii. Niezbędne są dalsze badania, które wyjaśnią mechanizm regulacji przepływu krwi przez mięśnie żucia oraz gojenia tkanki mięśniowej, u pacjentów z DURNŻ

Venopunkcja żyły odłokciowej jako alternatywne podejście dla oceny stężenia CGRP w osoczu krwi u pacjentów z dysfunkcją układu ruchowego narządu żucia

Introduction: Calcitonin gene-related peptide is an important vasodilator. It plays an important role in the metabolism of chewing muscles. The aim of the study was to evaluate the plasma level of CGRP in patients with myofascial pain (RDC/TMD Ia) and myofascial pain with limited opening (RDC/TMD Ib) before and after occlusal splint therapy (Michigan splint). Material and methods: A randomised trial was performed including 39 patients (males = 3, females = 36). Blood samples were taken from the external jugular vein (JUG) and cubital vein (CUB) before and after 30 days of occlusal splint therapy. Plasma levels of CGRP were measured with ELISA KIT for Human Calcitonin Gene Related Peptide (CGRP) 96T (USCNK Business Co. Ltd.). Results: The results of the study show that the plasma CGRP level was higher in the external jugular vein (JUG1 = 5.07pg/mL [SD = 1.99]) than in cubital vein (CUB1 = 4.3 pg/mL [SD = 1.6]). After 30 days of the occlusal splint therapy the levels in both veins increased: JUG2 = 6.07 pg/mL (SD = 2.19), and CUB2 = 4.9 pg/mL (SD = 1.4). The CGRP plasma level increase was statistically significant only in the external jugular vein (JUG) (p < 0.05). Statistically significant pain intensity reduction was observed: VAS1 = 5.4 (SD = 2.08) decreased to VAS2 = 1.7 (SD = 2.07) after splint therapy (p < 0.05). Conclusions: Venepuncture of an external jugular vein is more precise, than venepuncture of a cubital vein in evaluating CGRP plasma level changes in patients with TMD.Wstęp: Peptyd pochodny genu kalcytoniny jest ważną substancja naczynio-rozkurczową. Odgrywa ważną role w metabolizmie mięśni żucia. Celem pracy była ocena stężenia osoczowego CGRP u pacjentów z bólem mięśniowo-powięziowym (RDC/TMD Ia) oraz z bólem mięśniowo-powięziowym z ograniczonym odwodzeniem (RDC/TMD Ib), przed i po terapii szyną okluzyjną (Szyna Michigan). Materiał i metody: Przeprowadzono badanie randomizowane, do którego włączono 39 pacjentów (mężczyźni = 3, kobiety = 36). Próbki krwi pobrano z żyły szyjnej zewnętrznej (JUG) oraz z żyły odłokciowej (CUB), przed leczeniem i po 30 dniach stosowania szyny okluzyjnej. Stężenie neuropeptydu CGRP oceniano za pomocą zestawu ELISA KIT for Human Calcitonin Gene Related Peptide (CGRP) 96T (USCNK Business Co. Ltd.). Wyniki: Stwierdzono, że stężenie neuropeptydu CGRP było wyższe w materiale pobranym z żyły szyjnej zewnętrznej JUG1 = 5,07pg/ ml (SD = 1,99), niż w materiale pobranym z żyły odłokciowej CUB1 = 4,3 pg/ml (SD = 1,6). Po 30 dniach terapii szyną okluzyjną średnie stężenie CGRP w obu grupach CUB i JUG wzrosły: JUG2 = 6,07 pg/ml (SD = 2,19) i CUB2 = 4,9 pg/ml (SD = 1,4). Wzrost stężenia CGRP w osoczu krwi był istotny statystycznie jedynie w materiale pobranym z żyły szyjnej zewnętrznej (JUG) (p < 0,05). Zaobserwowano także istotną statystycznie redukcję natężenia dolegliwości bólowych w skali VAS: VAS1 = 5,4 (SD = 2,08) redukcja do VAS2 = 1,7 (SD = 2.07), po przeprowadzonej szynoterapii (p < 0,05). Wnioski: Wenopunkcja żyły szyjnej zewnętrznej dostarcza bardziej precyzyjnych pomiarów stężenia neuropeptydu CGRP w osoczu niż wenopunkcja żyły odłokciowej, u pacjentów z bólową postacią dysfunkcji narządu żucia

Clinical Study Myorelaxant Effect of Bee Venom Topical Skin Application in Patients with RDC/TMD Ia and RDC/TMD Ib: A Randomized, Double Blinded Study

The aim of the study was the evaluation of myorelaxant action of bee venom (BV) ointment compared to placebo. Parallel group, randomized double blinded trial was performed. Experimental group patients were applying BV for 14 days, locally over masseter muscles, during 3-minute massage. Placebo group patients used vaseline for massage. Muscle tension was measured twice (TON1 and TON2) in rest muscle tonus (RMT) and maximal muscle contraction (MMC) on both sides, right and left, with Easy Train Myo EMG (Schwa-medico, Version 3.1). Reduction of muscle tonus was statistically relevant in BV group and irrelevant in placebo group. VAS scale reduction was statistically relevant in both groups: BV and placebo. Physiotherapy is an effective method for myofascial pain treatment, but 0,0005% BV ointment gets better relief in muscle tension reduction and analgesic effect. This trial is registered with Clinicaltrials.gov NCT02101632

Platelet-Rich Plasma Intramuscular Injections — Antinociceptive Therapy in Myofascial Pain Within Masseter Muscles in Temporomandibular Disorders Patients: A Pilot Study

Background and Objective: The objective of this study was to explore the nociceptive effect of platelet-rich plasma (PRP) intramuscular injections in myofascial pain of masseter muscles in patients with TMD.Methods: Patients diagnosed with myofascial pain were assessed for eligibility for the study. Masticatory muscle disorder was diagnosed based on the Research Diagnostic Criteria for Temporomandibular Disorders (Ia and Ib). A total of 80 patients were enrolled in the study; 58 of them (21 male and 37 female, 29.4 ± 6.53 years old) met the inclusion criteria and were randomized to one of the two groups: Group I (n = 29) and Group II (n = 29). The first group received injections with PRP and the second group received injections with isotonic saline as the control group (0.9% NaCl). The Visual Analog Scale (VAS) was used to determine the pain intensity changes during follow-up visits in each group.Results: A significant improvement in pain intensity in VAS scale was observed, with 58% reduction in the experimental group and 10.38% in the control placebo group, 5 days after the injections (Day 5). The pain intensity reduction (VAS) 14 days after the injections (Day 14) in experimental group was 47.16 and 4.62% in control group, according to the baseline values (Day 0).Conclusions: Intramuscular injection of PRP was a successful method for reducing myofascial pain within masseter muscles in temporomandibular disorders patients. However, the use of PRP for the treatment of myofascial pain within masticatory muscles requires further, clinical trials evaluation.Clinical Trial Registration: Bioethical Commission at the Silesian Medical Chamber in Katowice, Poland 44/2017 as well as at ClinicalTrials.gov NCT03323567 (December 13, 2017)

Evaluation of effectiveness of a toothpaste containing tea tree oil and ethanolic extract of propolis on the improvement of oral health in patients using removable partial dentures

The aimof this studywas to evaluate the effect of toothpaste containing natural tea tree essential oil (TTO) and ethanolic extract of propolis (EEP), onmicroflora and selected indicators of oral health in patients using removable acrylic partial dentures. Fifty patients with varying conditions of hygiene were divided into two groups. The study group received the toothpaste with TTO and EEP, while the control group received the same toothpaste but without TTO and EEP. At the first visit, oral hygiene and hygiene of the prostheses were carried out. Control visits took place 7 and 28 days later and compared to baseline. Indexes like API (Approximal Plaque Index),mSBI (modified Sulcus Bleeding Index), OHI-s (simplified Oral Hygiene Index), and DPI (Denture Plaque Index) were assessed in three subsequent stages, and swabs were collected fromfloor of themouth area to assess themicrobiota. After 7 and 28 days of using the toothpaste with TTO and EEP, a statistically significant decrease of the examined indicator values were observed in the study group as compared to the values upon the initial visit. The number of isolated strains ofmicroorganisms in the study group was decreased ormaintained at the same level, whereas in the control group an increase in the number of isolated strains was observed. The observed stabilization of oralmicrobiota in patients fromthe study group confirms the beneficial activity of toothpaste containing EEP and TTO compared to the control group

Correlation between TMD and Cervical Spine Pain and Mobility: Is the Whole Body Balance TMJ Related?

Temporomandibular dysfunction (TMD) is considered to be associated with imbalance of the whole body. This study aimed to evaluate the influence of TMD therapy on cervical spine range of movement (ROM) and reduction of spinal pain. The study group consisted of 60 patients with TMD, cervical spine pain, and limited cervical spine range of movements. Subjects were interviewed by a questionnaire about symptoms of TMD and neck pain and had also masticatory motor system physically examined (according to RDC-TMD) and analysed by JMA ultrasound device. The cervical spine motion was analysed using an MCS device. Subjects were randomly admitted to two groups, treated and control. Patients from the treated group were treated with an occlusal splint. Patients from control group were ordered to self-control parafunctional habits. Subsequent examinations were planned in both groups 3 weeks and 3 months after treatment was introduced. The results of tests performed 3 months after the beginning of occlusal splint therapy showed a significant improvement in TMJ function (P>0.05), cervical spine ROM, and a reduction of spinal pain. The conclusion is that there is a significant association between TMD treatment and reduction of cervical spine pain, as far as improvement of cervical spine mobility

Comparison between Collagen and Lidocaine Intramuscular Injections in Terms of Their Efficiency in Decreasing Myofascial Pain within Masseter Muscles: A Randomized, Single-Blind Controlled Trial

Background and Objective. A novel option for myofascial pain (MFP) management and muscle regeneration is intramuscular collagen injections. The aim of the study was to evaluate the efficiency of intramuscular injections of collagen and lidocaine in decreasing MFP within masseter muscles. Methods. Myofascial pain within masseter muscles was diagnosed on the basis of the Diagnostic Criteria for Temporomandibular Disorders (II.1.A. 2 and 3). A total of 43 patients with diagnosed MFP within masseter muscles were enrolled to the study (17 male and 26 female, 40 ± 3.8 years old) and randomly divided into three groups. The first group received injections using 2 ml of collagen MD Muscle (Guna), the second group received 2 ml of 2% lidocaine without a vasoconstrictor, and the third group 2 ml of saline as a control (0.9% NaCl). All patients received repeated injections at one-week intervals (days 0 and 7). The visual analogue scale was used to determine pain intensity changes during each follow-up visit (days 0, 7, and 14) in each group. The masseter muscle activity was measured on each visit (days 0, 7, and 14) with surface electromyography (sEMG) (Neurobit Optima 4, Neurobit Systems). Results. We found that sEMG masseter muscle activity was significantly decreased in Group I (59.2%), less in Group II (39.3%), and least in Group III (14%). Pain intensity reduction was 53.75% in Group I, 25% in Group II, and 20.1% in Group III. Conclusions. The study confirmed that intramuscular injection of collagen is a more efficient method for reducing myofascial pain within masseter muscles than intramuscular injection of lidocaine

Functional Assessment of the Stomatognathic System, after the Treatment of Edentulous Patients, with Different Methods of Establishing the Centric Relation

The study compares subjective experiences of patients, wearing complete dentures. Two different methods of determining a centric relation were performed: the traditional method using wax occlusal rims and the Gerber method, based on gothic arch tracings. The success rate of establishing a centric relation in both methods was evaluated (rentgenodiagnostics). The influence of the method used to obtain the centric relation on patients’ stomatognathic system (condyle centralization, pain) was also evaluated. Better results were achieved in gothic arch tracing method. Before every prosthetic treatment of edentulous patients, a functional analysis of the TMJ is necessary. The lack of centric relation, in a long term adaptation patients, does not lead to TMD symptoms. This trial is registered with NCT03343015

Sleep Bruxism in Children: Etiology, Diagnosis, and Treatment—A Literature Review

(1) Background: Bruxism, a condition characterized by grinding and involuntary clenching of the teeth, is a risk factor for the development of masticatory dysfunction. It can occur together with sleep disturbances and may be associated with abnormal body movements, breathing difficulties, increased muscle activity, and heart rate disturbances. This disorder is becoming an important dental concern in children. (2) Methods: A literature review was carried out based on a search in PubMed and Google Scholar databases for articles on bruxism in children, published between 2014 and 2021. The etiology, diagnosis, and treatment of bruxism in children were of particular interest in the study. (3) Results: A total of 40 articles were included in the review. The analyzed studies indicated that the prevalence rates of bruxism in children vary widely from 13% to 49%. The etiology of bruxism is complex and incomprehensible, and the main diagnostic criteria for this condition in children are subjective observation, clinical history, and clinical examination. The recommended therapy for sleep bruxism in children is physiotherapy and psychotherapy. (4) Conclusions: Dentists and primary care physicians should correctly diagnose bruxism in children, educate parents, prevent potential consequences for oral health, and identify possible comorbidities. Appropriate clinical guidelines for the treatment and prophylaxis of bruxism in children should also be developed

Prevalence and Possible Etiological Factors of Molar-Incisor Hypomineralization (MIH) in Population of Silesian Children in Poland: A Pilot Retrospective Cohort Study

(1) Background: This pilot retrospective cohort research study regarded the frequency of the prevalence of molar-incisor hypomineralization (MIH) in a population of Silesian children in Poland. The evaluation of the potential environmental etiological factors was performed and the correlation between the environmental factors and MIH was analyzed. (2) Methods: A total of 613 children were randomly enrolled in the pilot study (9.0 years ± 1.9). A survey was carried out with mothers regarding the potential exposure to environmental etiological factors of MIH in their children. The patients’ clinical assessments were carried out in the dental unit. (3) Results: The frequency of prevalence of MIH in the population of Silesian children was established at the level of 6.2% (p < 0.05). MIH symptoms were significantly associated with otitis in early childhood (OR = 2.50), atopic dermatitis (OR = 5.69), and premature delivery before 38 weeks of pregnancy (OR = 2.88). (4) Conclusions: MIH was observed in 6.2% of the population of Silesian children, and there was a relationship between environmental risk factors such as otitis, atopic dermatitis, premature birth, and MIH expression. Therefore, further research is needed to determine the influence of pre-, peri-, postnatal, and prophylactic factors on the frequency and severity of MIH symptoms in children