Overview of occlusal splints used in the treatment of temporomandibular disorders – a literature review

Temporomandibular joint (TMJ) disorders concern 12–90% of the human population and the number of patients is constantly rising [1]. The most common symptoms indicating disorders in TMJ functions are mandible movement disturbances, acoustic symptoms and pain. The last one – the most unpleasant – is the most common reason for patients' visits to dental surgeries. Splint therapy is an effective method for these abnormalities. Nowadays, there is a great variety of occlusal splints; however, the therapeutic values of some of them are often underestimated. The correct diagnosis of temporomandibular dysfunction enables the selection of appropriate occlusal splints for every patient. The aim of this article is to harmonize classification and present short descriptions of the most commonly used occlusal splints

The Assessment of the Maximum Heat Production and Cooling Effectiveness of Three Different Drill Types (Conical vs. Cylindrical vs. Horizontal) during Implant Bed Preparation—An In Vitro Study

The aim of this experimental study was to verify thermal diffusion differences, by measuring the maximum temperature achieved with different drill shapes. Synthetic bone blocks of type I density made from solid rigid polyurethane (PUR) foam were used to perform the drilling procedures. The experiment was conducted at three different rotation speeds: 800, 3000 and 5000 rpm. Conical drills (with and without an internal cooling hole) were compared with horizontal drills and disc drills. The temperature during drilling for implant bed preparation was estimated with the use of thermocouples and an infrared (IR) camera. The temperature during drilling with disc cutters for lateral basal implants did not exceed 33 ∘C and the temperature decreased in proportion to higher drill speed. The results indicate that the tested design is safe and will not cause bone overheating

The Usefulness of the Pressure Algometer in the Diagnosis and Treatment of Orofacial Pain Patients: A Systematic Review

Study Design. Data were obtained from PubMed, Dentistry and Oral Sciences Source, ProQuest, Scopus, Medline (EBSCO), and ScienceDirect databases. Literature search was performed from 1 December 2017 through 12 January 2018. The titles and abstracts from electronic search results were screened for keywords and evaluated by two observers, with the following inclusion criteria: published since 1997, written in English, and encompassing human research. Exclusion criteria were as follows: articles published earlier than 1997, not written in English, animal studies, studies with the use of medicaments, and articles examining receptor interactions. Objectives. The pressure pain threshold (PPT) may be an efficient approach to screen and evaluate orofacial pain. However, the results of previous PPT studies have varied greatly. The aim of this paper was to determine whether the PPT is an efficient approach for screening and evaluating orofacial pain. Methods. The search yielded 123 articles. After removal of duplicates and screening of abstracts, 32 articles were selected for further evaluation. The Cochrane Collaboration tool for assessing the risk of bias was used for the evaluation of the studies. Results. The studies covered a total of 4403 adult patients, aged 16-62, and 30 children. The studies investigated the reliability and validity of the PPT (measured by a pressure algometer) in TMD patients. The PPT was investigated in relation to headache, menstrual cycle, oral contraception, occlusal interference, and occlusal appliances. Generally, the risk of bias was low to unclear. Some structural limitations were inherent in the studies, such as small samples and short duration of the testing involved. Also, the analyzed studies lacked consistency in study design and patient management. Pressure increase values differed from 20 kPa/s to 50 kPa/s and from 0.5 kg/cm2/s to 2 kg/cm2/s. Descriptions of the PPT examination points also varied, from very precise and repeatable to a simple listing of anatomical points. The number of measurements varied from 1 to 5 at each visit. The intervals ranged from 5 seconds to 15 minutes. However, some studies confirmed that the pressure algometer is an effective tool for determining the source of orofacial pain. Conclusions. Based on the analyzed articles, the authors argue that the PPT is not an efficient approach for screening and evaluating orofacial pain. What is more, it should not be used as the only diagnostics tool for patients with orofacial pain. Importantly, however, additional factors should be considered in the future for the evaluation of the PPT, including body symmetry and posture, hormone levels and the menstrual phase in women, and the use of medications and its influence on the PPT. Further clinical trials should also be performed on the PPT, examining head and neck pain patients, with more precise study design and larger samples

Effectiveness of Platelet-Rich Plasma in the Treatment of Androgenic Alopecia Compared to Placebo and Topical Minoxidil: A Systematic Review

Platelet-rich plasma (PRP) has become an increasingly popular alternative or additional method in treating androgenic alopecia (AGA). AGA is a multifactorial disease, in which testosterone plays a significant role in influencing hair growth. The aim of this study was to evaluate the effectiveness of PRP treatment in AGA affecting men and women. The research was performed using the following databases: PubMed, Embase, and Cochrane Library. The effects were measured with a TrichoScan by comparing the initial and final hair density. A significant difference was observed between the areas of the scalp where PRP injections were made and those where saline was administered. Compared to conventional minoxidil 5% topical PRP, PRP is more effective in treating alopecia. A beneficial outcome of combined therapy with PRP and minoxidil 5% was observed. Therefore, PRP is not only an excellent alternative for patients in whom the minoxidil 5% topical monotherapy did not bring the expected effects or who experienced unacceptable side effects, but can also be used as a complementary therapy

Is Chlorhexidine in Dentistry an Ally or a Foe? A Narrative Review

Chlorhexidine has been one of the most effective and popular antiseptic substances used in medicine for decades. In dentistry, it has been used in endodontics, periodontology, surgery, and general dentistry. It is also widely used daily by patients in mouth rinses, gels, or toothpastes. Because of its multiple uses, we should follow all types of research reporting its potential adverse effects. This article aims to review the most up-to-date studies regarding chlorhexidine and its possible side effects, in the period of the SARS-CoV-2 pandemic, as the use of different antiseptic substances has rapidly increased

The Impact of SARS-CoV-2 Outbreak on the Polish Dental Community’s Standards of Care—A Six-Month Retrospective Survey-Based Study

Currently, SARS-CoV-2 is the primary pathogen worldwide, disrupting most of our everyday activities. The study aim was to evaluate its impact on the Polish dental community, standards of care, health, and welfare. Methods: A Google Forms survey was conducted among 303 dental practitioners. Results: Of respondents, 54.93% curbed the number of patients in the last six months, 34.21% declared no changes, and 10.86% reported an increase; whereas 70.7% of the respondents reported a treatment price increase within the same period (27.96% and 1.32% reported no changes and a decrease, respectively). Of the respondents, 15.5% did not close their businesses during the first wave of the pandemic. Most declared 1 or 2 month break, 30.7% and 34.7%, respectively. Some reported 3, 4, or 5 month breaks (15.84%, 1.32%, and 0.99%, respectively), and only two respondents (0.66%) did not admit patients at all. Headache episodes were more frequent among female dentists before the pandemic; after the pandemic, headache frequency increased among both sexes. Temporomandibular disorders (TMDs) were more frequent among women (p = 0.017). Conclusions: Most Polish dentists followed SARS-CoV-2 recommendations and restricted their practices to admitting only patients with pain or incomplete treatment. Decreased sleep parameters, head, back, and neck pain, were observed. This situation may affect dental health conditions in Polish society over time

Evaluation of the efficacy of manual soft tissue therapy and therapeutic exercises in patients with pain and limited mobility TMJ: a randomized control trial (RCT)

Abstract Summary The limited number of randomized controlled trials (RCTs) comparing the efficacy of soft tissue manual therapy and self-therapy interventions prompted the authors to focus on the analgesic and myorelaxant use of massage, post-isometric muscle relaxation (PIR) and therapeutic exercise in TMD patients. Objectives To evaluate the effectiveness of soft tissue therapy and therapeutic exercises in female patients with pain, increased masseter muscle tension and limited mandibular mobility. Material and methods The study was conducted on a group of 82 women (G1) with the Ib disorder diagnosed in DC/TMD (Ib—myofascial pain with restricted mobility). The control group (G2) consisted of 104 women without diagnosed TMDs (normal reference values for TMJ ROM and masseter muscle sEMG bioelectric activity). Diagnostic procedures were performed in both groups (sEMG of the masseter muscles at baseline and during exercise, measurement of TMJ mobility, assessment of pain intensity—NRS scale). The G1 group was randomly divided into 3 therapeutic groups in which the therapy was carried out for 10 days: therapeutic exercises (TE), manual therapy – massage and therapeutic exercises (MTM_TE), manual therapy – PIR and therapeutic exercises (MTPIR_TE). Each time after therapy, the intensity of pain and TMJ mobility were assessed. Sealed, opaque envelopes were used for randomization. After 5 and 10 days of therapy, bilateral sEMG signals of the masseter muscles were acquired. Results Massage, PIR and self-therapy led to a decrease in sEMG at rest as well as in exercise. After day 6 of therapy, the groups obtained a significant difference (p = 0.0001). Each of the proposed forms of therapy showed a minimal clinically significant difference (MID) in the sEMG parameter at the endpoint, with the most considerable difference in the MTM_TE group. The forms of MT used were effective in reducing the patients’ pain intensity; however, a significant difference between therapies occurred after 4 treatments (p = 0.0001). Analyzing the MID between methods, it was observed that self-therapy had an analgesic effect only after 8 treatments, while PIR after 3 and massage after 1 treatment. After day 7, the mean pain score in the MTM_TE group was 0.889 and in the TMPIR_TE group was 3.44 on the NRS scale. In terms of MMO, a significant difference was obtained between monotherapy and each form of TM, i.e. massage (p = 0.0001) and PIR (p = 0.0001). Analyzing mandibular lateral movements, the authors got a significant difference in the proposed MT forms, of which massage treatments exceeded the effectiveness of PIR. Conclusions Soft tissue manual therapy and therapeutic exercise are simple and safe interventions that can potentially benefit patients with myogenic TMDs, with massage showing better analgesic effects than PIR

Chronotype Profile, Stress, Depression Level, and Temporomandibular Symptoms in Students with Type D Personality

Background: Despite a growing interest in the types of human circadian activity, different chronotypes and personality-related issues have been rarely studied. It has already been emphasized that ‘stress personality’ is considered a risk factor for certain psychosomatic diseases and may be a temporomandibular disorders (TMDs) predictor. Therefore, an attempt has been made to analyze the chronotypes, stress levels, stress factors, and the occurrence of depression and TMDs in students with type D personalities. People with this personality trait tend to experience negative emotions more—depression, anxiety, anger, or hostility—yet may have a negative image of themselves and report somatic complaints. Aim: The aim of this study was to analyze the importance of the chronotype profile for the level of stress perceived, as well as for the occurrence of depression and TMDs in people with type D personalities. Material and Methods: The study has been conducted on a group of 220 physical therapy students. The study group G1 consisted of 110 participants with type D personalities, the control group G2 consisted of the same number of participants without the stress personality. All participants have been analyzed for the chronotype (MEQ), stress perception (PSS10), the occurrence of depression (Beck scale-BDI), the occurrence of TMDs symptoms and have completed the stress factor assessment questionnaire during the study, followed by DS14 questionnaire—a tool for assessing the prevalence of type D personality. Results: In students with type D personalities (G1), the definitely evening and evening chronotypes have been significantly more predominant than in the control group (G2). A significantly higher number of stressors and TMDs symptoms have been observed in the respondents from the G1 group than in the control group (p < 0.05). In the multivariate model, adjusted with the above-mentioned factors, an increased risk of the type D personality trait was found. Conclusion: The evening chronotype and type D personality may imply greater feelings of stress, greater depression, and more frequent symptoms of TMDs in young adults

Effect of physiotherapeutic procedures on the bioelectric activity of the masseter muscle and the range of motion of the temporomandibular joints in the female population with chronic pain: a randomized controlled trial

Summary Introduction Physical therapy (PT) methods applied in dentistry are increasingly discussed nowadays. Taking into account a rapidly growing number of temporomandibular disorders (TMDs) and orofacial pain patients, it is reasonable to determine which of the available physiotherapeutic (PT) methods are more effective than others, especially in terms of their possible analgesic and myorelaxant effects. Objective To assess manual and physical factors influencing pain reduction or elimination and increased muscle tension in patients with TMD; yet the influence of the applied forms of PT on the range of motion (ROM) of temporomandibular joints (TMJ). Material and methods A randomized, parallel-group, RCT, single-blind, equi-randomized (1:1) study was conducted in DC/TMD Group Ib patients (20–45 years of age). An experimental group (G1, n = 104) and a control group without TMD (G2, n = 104) were created according to CONSORT guidelines. Diagnostic measurements were performed in both groups (mass sEMG, temporomandibular joint range of motion-ROM, pain intensity - NRS). Group G1 was randomly divided (envelope method) into 4 therapeutic groups, in which therapy was carried out for 10 days: magnetostimulation (MS), magnetoledotherapy (MLE), magnetolaserotherapy (MLA), manual therapy (MT). Each time after the therapy, ROM and NRS measurements were performed, and after the 5th and 10th day sEMG. Results Statistically significant differences were found in the sEMG values of the masseter muscles, TMJ ROM and the pain intensity in G1 and G2 (p < 0.00). The largest decrease in sEMG (% MVC) of the masseter muscle occurred in the subgroup in which the manual therapy (MT) procedures were applied, p < 0.000. There was no clinically significant difference in and between other subgroups. There was a distinct mandible ROM increase noted in the MT group, with minimal changes in the MLA and MLE groups and no changes in the MS group. There was a clear increase in the lateral mobility of both right and left TMJ in the MT group. There were no differences in the course of the study in the MS group, and slight increases in the MLA and MLE groups. In the case of pain measurements, the greatest decrease in pain intensity was observed in the MT subgroup. Conclusions According to our results manual therapy is an effective form of treatment in patients with pain, increased masticatory muscle tension and limitation in mandible ROM. Dental physiotherapy should become an integral part of multimodal TMD patients’ treatment

The Influence of the COVID-19 Pandemic on the Stress Levels and Occurrence of Stomatoghnatic System Disorders (SSDs) among Physiotherapy Students in Poland

Background: This study is a quantitative analysis examining the impact of the COVID-19 pandemic on the occurrence of stress and stomatognathic system disorders (SSDs) among students of physiotherapy. Objective: To assess stress severity, strategies of coping with stress and the presence of type D personality among physiotherapy students including those with symptoms of stomatognathic system disorders. Material and Methods: The research was conducted from October to December 2020 on a sample of 188 students of physiotherapy. The data were collected using a survey form related to the occurrence of SS disorders symptoms and standardized psychological questionnaires, such as the Perceived Stress Scale (PSS)-10, Mini-Cope, and the type-D Scale (DS14), developed for the purpose of this study. Results: Women experiencing at least one of the SS disorder-related symptoms were characterized by a significantly higher level of stress and a type D personality (p &lt; 0.05). Among men, these differences were not statistically significant (p &gt; 0.05). On the basis of the strategies of coping with stress, i.e., positive self-reevaluation, discharging and blaming oneself, and taking psychoactive substances, it is possible to predict the intensity of stress during the pandemic in the group of the examined students. Among the reported symptoms of SS, headache was a significant predictor of stress, which was accompanied by an increase in the intensity of stress by nearly 0.2 measurement points. Students with higher levels of stress showed more symptoms of type D personality, and those with more severe symptoms of SS showed higher levels of stress. Conclusions: People prone to stress and having type D personality traits should be assessed for the presence of SS disorders