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Background: the escalating influx of patients with temporomandibular disorders and the challenges associated with accurate diagnosis by non-specialized dental practitioners underscore the integration of artificial intelligence into the diagnostic process of temporomandibular disorders (TMD) as a potential solution to mitigate diagnostic disparities associated with this condition., Objectives: In this study, we evaluated a machine-learning model for classifying TMDs based on the International Classification of Orofacial Pain, using structured data., Methodology: Model construction was performed by the exploration of a dataset comprising patient records from the repository of the Multidisciplinary Orofacial Pain Center (CEMDOR) affiliated with the Federal University of Santa Catarina. Diagnoses of TMD were categorized following the principles established by the International Classification of Orofacial Pain (ICOP-1). Two independent experiments were conducted using the decision tree technique to classify muscular or articular conditions. Both experiments uniformly adopted identical metrics to assess the developed model's performance and efficacy., Results: The classification model for joint pain showed a relevant potential for general practitioners, presenting 84% accuracy and f1-score of 0.85. Thus, myofascial pain was classified with 78% accuracy and an f1-score of 0.76. Both models used from 2 to 5 clinical variables to classify orofacial pain., Conclusion: The use of decision tree-based machine learning holds significant support potential for TMD classification.

Studies on low-level visual information underlying pain categorization have led to inconsistent findings. Some show an advantage for low spatial frequency information (SFs) and others a preponderance of mid SFs. This study aims to clarify this gap in knowledge since these results have different theoretical and practical implications, such as how far away an observer can be in order to categorize pain. This study addresses this question by using two complementary methods: a data-driven method without a priori expectations about the most useful SFs for pain recognition and a more ecological method that simulates the distance of stimuli presentation. We reveal a broad range of important SFs for pain recognition starting from low to relatively high SFs and showed that performance is optimal in a short to medium distance (1.2-4.8 m) but declines significantly when mid SFs are no longer available. This study reconciles previous results that show an advantage of LSFs over HSFs when using arbitrary cutoffs, but above all reveal the prominent role of mid-SFs for pain recognition across two complementary experimental tasks., (© 2021. The Author(s).)

Background: The main objective of this paper is to analyze the prevalence of each of the different clinical subtypes of temporomandibular disorders (TMD) in a sample of patients with this pathology. In addition, a second objective was to analyze their distribution according to gender., Material and Methods: To this end, the results of 1603 patients who went to the Unit of Temporomandibular Disorders in the Córdoba Healthcare District because they suffered from this pathology were analyzed. In order to diagnose them, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were applied, analyzing the different Axis I subtypes (myopathy, discopathy and arthropathy) and obtaining the combined Axis I for each patient and the relation of all these variables according to gender. The null-hypothesis test confirmed the lack of connection between the gender variable and the different subtypes in the clinical analysis, and between the former and the combined Axis I of the RDC/TMD., Results: The prevalence was high for the muscle disorders subtype in general, showing an 88.7% prevalence, while the presence of discopathies or arthropathies was much lower. Among discopathies, the most frequent ones were disc displacements with reduction, with 39.7% and 42.8% for the left and right temporomandibular joints (TMJ), respectively, while the prevalence of arthropathies was 26.3% for the right TMJ and 32.9% for the left TMJ. The bivariate analysis on the connection with gender reveals a p≥ 0.05 value for the muscle and arthralgia subtypes., Conclusions: The patients seen at the TMD Unit where mostly middle-aged women whose main clinical axis subtype was the muscle disorder subtype. For their part, both discopathies and arthropathies, although present, are much less prevalent.

Objectives. The aim of this study was to establish the reliability of the "chewing" subscale of the OPS-NVI, a novel tool designed to estimate presence and severity of orofacial pain in nonverbal patients. Methods. The OPS-NVI consists of 16 items for observed behavior, classified into four categories and a subjective estimate of pain. Two observers used the OPS-NVI for 237 video clips of people with dementia in Dutch nursing homes during their meal to observe their behavior and to estimate the intensity of orofacial pain. Six weeks later, the same observers rated the video clips a second time. Results. Bottom and ceiling effects for some items were found. This resulted in exclusion of these items from the statistical analyses. The categories which included the remaining items (n = 6) showed reliability varying between fair-to-good and excellent (interobserver reliability, ICC: 0.40-0.47; intraobserver reliability, ICC: 0.40-0.92). Conclusions. The "chewing" subscale of the OPS-NVI showed a fair-to-good to excellent interobserver and intraobserver reliability in this dementia population. This study contributes to the validation process of the OPS-NVI as a whole and stresses the need for further assessment of the reliability of the OPS-NVI with subjects that might already show signs of orofacial pain.

Diagnosis and treatment of facial pain is a problem for physicians of different specialties (neurologists, dentists, surgeons, oculists, otolaryngologists and psychiatrists). A classification of this pathology is far from ideal and an interdisciplinary comprehensive approach is needed. Current approaches to etiotropic, symptomatic and pathogenetic treatment of patients with most frequent variants of orofacial pain are presented.

Background: Temporomandibular disorder (TMD) patients might present a number of concurrent clinical diagnoses that may be clustered according to their similarity. Profiling patients' clinical presentations can be useful for better understanding the behavior of TMD and for providing appropriate treatment planning. The aim of this study was to simultaneously classify symptomatic patients diagnosed with a variety of subtypes of TMD into homogenous groups based on their clinical presentation and occurrence of comorbidities., Methods: Clinical records of 357 consecutive TMD patients seeking treatment in a private specialized clinic were included in the study sample. Patients presenting multiple subtypes of TMD diagnosed simultaneously were categorized according to the AAOP criteria. Descriptive statistics and two-step cluster analysis were used to characterize the clinical presentation of these patients based on the primary and secondary clinical diagnoses., Results: The most common diagnoses were localized masticatory muscle pain (n = 125) and disc displacement without reduction (n = 104). Comorbidity was identified in 288 patients. The automatic selection of an optimal number of clusters included 100% of cases, generating an initial 6-cluster solution and a final 4-cluster solution. The interpretation of within-group ranking of the importance of variables in the clustering solutions resulted in the following characterization of clusters: chronic facial pain (n = 36), acute muscle pain (n = 125), acute articular pain (n = 75) and chronic articular impairment (n = 121)., Conclusion: Subgroups of acute and chronic TMD patients seeking treatment can be identified using clustering methods to provide a better understanding of the clinical presentation of TMD when multiple diagnosis are present. Classifying patients into identifiable symptomatic profiles would help clinicians to estimate how common a disorder is within a population of TMD patients and understand the probability of certain pattern of clinical complaints.

There are currently four main pain classification systems relevant to orofacial pain (OFP): the International Association for the Study of Pain, International Classification of Headache Disorders, the American Academy of Orofacial Pain and the Research Diagnostic Criteria for Temporomandibular Disorders. Of the four, the Research Diagnostic Criteria for Temporomandibular Disorders is the most biopsychosocial system, with the remaining three focusing more on the biomedical aspects. Unsurprisingly, clinical scientists and clinicians have both reported perceived deficiencies in the published systems and have proposed further modified classifications and nomenclature for OFP. Establishing a standardized biopsychosocial classification of OFP is essential for ensuring continuity for patient care since it creates a standardized language with which to communicate healthcare information, thus enabling improved and more specific (epidemiological) research and patient care. Despite ongoing attempts, an accepted overarching classification of OFP is still a work in progress. There is an urgent need for a robust classification system for OFP. This review aims to highlight the recent debate and continued struggle to attain a consensus on a classification of OFP and highlight some recent developments that assist differential diagnosis of these conditions.

The aim of this research was to evaluate, within a controlled clinical study, the effects of a Delaire-type facemask or a modified Jasper Jumper (JJ) used in the treatment of children with Class III malocclusions due to maxillary retrognathia on temporomandibular disorders (TMDs). Forty-six patients with Class III malocclusions referred for orthodontic treatment were divided into two groups, a test and a control. The test group comprised 33 randomly chosen patients (15 females, 18 males) aged 8-11 years. The control group included 13 patients (eight females, five males) with similar features. TMD assessment was performed before and after treatment using a two-axis questionnaire, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMDs). Qualitative data were evaluated using chi-square and McNemar tests. No statistically significant differences related to the presence of TMD were observed pre- or post-treatment (P > 0.05). The most commonly encountered diagnosis was arthralgia in the JJ group both before and after treatment. Evaluation of joint and muscle regions showed decreased symptoms, apart from the diagnosed discomforts, in the JJ group (P < 0.05). Reduced symptoms were observed in the Delaire group; however, this reduction was not statistically significant. An increase, not considered to be statistically significant, was observed in the control group. The Delaire-type facemask and modified JJ used in the early phase of Class III malocclusion treatment did not result in TMD.

The authors compared the pain intensity and difficulty experienced in performing activities of daily living (ADL) among 237 patients with orofacial pain. The patients underwent comprehensive examinations and recorded their subjective symptoms on a form (five items for pain intensity and six for ADL-related difficulty). On the basis of the primary diagnosis, the patients were divided into the temporomandibular joint dysfunction (TMJ), myofascial pain (MP), neuropathic pain (NP), and fibromyalgia (FM) groups. The intensity of pain in the jaw/face, tightness in the jaw/face, pain in the neck, and toothache significantly differed among the groups (p < 0.01, Kruskal-Wallis test). Compared to other patients, the FM and NP groups reported greater pain intensity, whereas those in the TMJ group reported lesser pain intensity. The ADL-related difficulty was not significantly different among the groups. Thus, compared to pain due to joint-related disorders, myalgic and neuropathic pain seem to be of higher intensity.

The aim of this work was to describe the prevalence of signs and symptoms of temporomandibular disorders (TMD) in children of the State of Puebla, Mexico. A descriptive observational study was performed. After calculating sample size, children who met the following selection criteria were included: registered at an official elementary school, either sex, ages between 8 and 12 years, who accept to participate in the study and whose parents have signed the informed consent forms. The Research Diagnostic Criteria for Temporomandibular Disorders were used by calibrated researchers (Kappa 90) under the same conditions. Descriptive statistics were applied by using SPSSv15 software. The study included 235 children, 129 (54.9%) female and 106 (45.1%) male, of average age 9.31 + 1.2 years. Prevalence of signs and symptoms was 33.2%, and predominately muscular (82%), 48.1% showed signs of muscular pain and 19.1% joint pain. 63.4% showed signs of alteration in the mouth opening pattern, 39.1% presented joint sounds on opening or closing the mouth and 20.4% on mandibular excursions. The high prevalence of signs and symptoms related to temporomandibular disorders, in particular in children with mixed dentition, shows the importance of TMD evaluation during this period, when morphological changes associated to growth and craniofacial development prevail.

The aim of this study was to observe the prevalence of diagnostic groups of temporomandibular disorders (TMD) in patients who were referred or sought treatment for TMD and/or orofacial pain in a private clinic. The clinical records of 357 patients were evaluated and selected based on inclusion/exclusion criteria; the mean age was 32 years. A clinical examination was performed and the diagnosis was based on the American Academy of Orofacial Pain criteria. Results showed that 86.8% of patients were women and 93.3% of the patients presented more than one diagnosis. The most frequent chief complaint (n = 216, chi2 = 30.68, p = 0.001) and total diagnosis realized (n = 748, chi2 = 14.14, p = 0.001) were muscle related. We concluded that women seek treatment for dysfunction/disorders of orofacial structures more than men do; patients seeking specialized treatment have more than one diagnosis and muscle dysfunction is more prevalent than intra-articular disorders.

Unlabelled: This study examined the associations between acculturation and orofacial pain and healthcare among Hispanic adults. Understanding the effects of acculturation on Hispanic oral health may improve understanding of oral health disparities in the United States. Data were collected from 911 Hispanic adults reporting tooth pain and painful oral sores who were part of a larger study of South Florida residents conducted using random-digit dialing methodology. The survey was conducted in Spanish or English by bilingual interviewers per the choice of each respondent. Greater use of the Spanish language was associated with disparities in healthcare visits for orofacial pain, not having a usual dentist, having greater pain, increased difficulty eating and sleeping, and more depression. Respondents' and their parents' nativity (families that had been in the United States longer) and those identifying more closely to Hispanic culture were also predictive of several of the outcomes. Gender, financial status, and age, independent of acculturation, were also associated with orofacial pain, accessing health care, and pain-related loss of functioning among Hispanics. The data support the hypothesis that Hispanics with less acculturation are less able to access needed oral health care. This study highlights the need for outreach programs targeting recent Hispanic immigrants focusing on oral health care., Perspective: This study found that lower levels of acculturation, particularly less frequent use of English, were associated with greater oral pain and depression for Hispanics adults. This emphasizes the need to provide Hispanic patients with information in Spanish and the importance of having bilingual materials and staff in dental clinics.

The use of androgenic anabolic steroids (AAS) has increased significantly among athletes in Brazil and other countries. These drugs alter the physiological behavior of bone and muscles, also affecting these structures in masticatory system. This paper aims to evaluate bone and dental changes in users of AAS, as well as the incidence of temporomandibular dysfunction (TMD), compared to athletes not using AAS. Eight athletes were equally divided in two groups, AAS users and non-users. The groups were evaluated using Helkimo index, McNamara cephalometric tracing and cast analysis. The AAS users presented more intense TMD signs and symptoms (Di total value, P = 0.096, Mann-Whitney test), increased cephalometric measures (Co-A, P = 0.020, Mann-Whitney test) and Angle Class II malocclusion, compared to the non-users. These results suggested that the use of AAS alters masticatory structures and increases the incidence of TMD.

Based on specific, objective, and reproducible criteria, a classification scheme for trigeminal neuralgia (TN) and related facial pain syndromes is proposed. Such a classification scheme is based on information provided in the patient's history and incorporates seven diagnostic criteria, as follows. 1) and 2) Trigeminal neuralgia Types 1 and 2 (TN1 and TN2) refer to idiopathic, spontaneous facial pain that is either predominantly episodic (as in TN1) or constant (as in TN2) in nature. 3) Trigeminal neuropathic pain results from unintentional injury to the trigeminal nerve from trauma or surgery. 4) Trigeminal deafferentation pain results from intentional injury to the nerve by peripheral nerve ablation, gangliolysis, or rhizotomy in an attempt to treat either TN or other related facial pain. 5) Symptomatic TN results from multiple sclerosis. 6) Postherpetic TN follows a cutaneous herpes zoster outbreak in the trigeminal distribution. 7) The category of atypical facial pain is reserved for facial pain secondary to a somatoform pain disorder and requires psychological testing for diagnostic confirmation. The purpose of a classification scheme like this is to advocate a more rigorous, standardized natural history and outcome studies for TN and related facial pain syndromes.

There are few reports analyzing the effects of exercise on patients with temporomandibular disorders. This paper presents a case study examining whether there were additional benefits from performing neuromuscular control home exercises (NMCHE) in a patient with temporomandibular disorder who was already receiving conventional treatment. A woman, 41 years of age, completed a health status questionnaire called the TMJ Scale prior to being accepted. She completed additional TMJ Scales after receiving conventional treatment and again after conventional treatment was combined with neuromuscular control home exercises. Based on the TMJ Scale's best subscore indicator of the presence or absence of a temporomandibular disorder, the patient did not derive benefit from conventional treatment without exercise. However, she received a large benefit from the addition of NMCHE. It was concluded that exercises for patients with temporomandibular disorders may be beneficial to those who do not improve with conventional treatment alone.

We will describe the differential diagnosis of primary and secondary facial pains and present illustrative case studies. The diagnosis of facial pain needs a multidisciplinary approach if the clinical presentation is not pathognomic. While patients with acute facial pain urgently need treatment, those with chronic facial pain need at priority a correct diagnosis.

A multidisciplinary pain centre study of 120 consecutive chronic orofacial pain patients assessed pain description and intensity ratings, gender differences, prevalence of concurrent conditions, and interinstrument relationships of the McGill Pain Questionnaire and visual analogue scale. Pain words chosen by patients to describe conditions were predominantly sensory words, and patients with concurrent conditions often listed words indicating a substantial affective component. Results showed pain intensity ratings of chronic orofacial pain conditions have similar or higher pain ratings when compared with other medical chronic pain conditions such as back pain, cancer pain and arthritis. There was a significantly higher female: male ratio (88:32) with gender playing an important but poorly understood causal role. The most frequent condition diagnosed was atypical facial pain (n = 40), followed by temporomandibular disorder (n = 32), atypical odontalgia (n = 29) and pathology of the orofacial region (n = 19). Temporomandibular disorder was present in 75 of the 120 subjects, as the sole pain complaint (n = 32) or as an associated secondary condition (n = 43), indicating concurrent pain conditions exist and may be related. There were significantly higher total pain scores of the McGill Pain Questionnaire in patients with multiple conditions compared with patients with a single condition. The visual analogue scale showed a significant correlation to the number of words chosen index of the McGill Pain Questionnaire for orofacial pain.

To communicate, understand, and prescribe treatment, it is essential that some consensually validated criteria be used to describe groups of patients who share a set of relevant attributes. Several classification systems have been developed to described relatively homogeneous subgroups of chronic pain patients. These systems have been based on theoretical perspectives of chronic pain syndromes tied to physical pathology. Alternative systems based on a priori psychological categories or empirically derived classifications also have been proposed. Some of the strengths and weaknesses of deductive and inductive approaches to classification are described, and the advantages of polydiagnostic and multiaxial approaches are described as alternatives to the traditional classification. Research on an empirically derived multiaxial classification for chronic pain is described and related to chronic orofacial pain.