Evidence of an effect by botulinum toxins is still lacking for most pain conditions. In the present randomized, placebo-controlled, crossover multicenter study, the efficacy of botulinum toxin type A (BTX-A) was investigated in patients with persistent myofascial temporomandibular disorders (TMD). Twenty-one patients with myofascial TMD without adequate pain relief after conventional treatment participated. A total of 50 U of BTX-A or isotonic saline (control) was randomly injected into 3 standardized sites of the painful masseter muscles. Follow-up was performed after 1 and 3 months, followed by a 1-month washout period, after which crossover occurred. Pain intensity at rest was the primary outcome measure, while physical and emotional function, global improvement, side effects, and clinical measures were additional outcome measures. There was no main difference between drugs (ANOVA; P=.163), but there was a significant time effect (P<.001), so BTX-A reduced mean (SD) percent change of pain intensity by 30 (33%) after 1 month and by 23 (30%) after 3 months compared to 11 (40%) and 4 (33%) for saline. The number of patients who received a 30% pain reduction was not significantly larger for BTX-A than after saline at any follow-up visit. The number needed to treat was 11 after 1 month and 7 after 3 months. There were no significant changes after treatment in any other outcome measures, with the exception of pain on palpation, which decreased 3 months after saline injection (P<.05). These results do not indicate a clinical relevant effect of BTX-A in patients with persistent myofascial TMD pain.

BackgroundStudies have indicated that the prevalence of symptoms and signs of temporomandibular disorders (TMD) are rare early in childhood, but become more prevalent in adolescents and adulthood. To our knowledge, no study has investigated the prevalence of TMD-diagnoses in children in the general population. The aim was thus to investigate the prevalence of TMD-diagnoses among children and adolescents in the general population using the Research Diagnostic Criteria for TMD (RDC/TMD).MethodsThe current cross-sectional study consisted of 456 children and adolescents, aged between 10 and 18, randomly enrolled from 10 boy’s- and 10 girl’s- schools in Jeddah. The participants first answered two validated questions about TMD-pain, followed by a clinical examination according to RDC/TMD.ResultsOne hundred twenty-four participants (27.2 %) were diagnosed with at least one TMD-diagnosis. Myofascial pain was the most common diagnosis (15 %) followed by disc displacement with reduction, arthralgia, myofascial pain with limited mouth opening and osteoarthrosis. Children diagnosed with myofascial pain more often reported orofacial pain, headache and tooth clenching (p < 0.05), whereas children with arthralgia more often reported orofacial pain and tooth grinding than those without a TMD-diagnosis (p < 0.05). Only 18 % of the subjects in the TMD group had sought a dentist or physician for their pain.ConclusionTMD was common among children and adolescents in Saudi Arabia. Self-reported orofacial pain and headache as well as bruxism were associated with a TMD-pain diagnosis and disc displacement. A surprisingly low percentage of children and adolescents sought treatment by a dentist or physician for their pains.

Saliva is often neglected as a body fluid of diagnostic or prognostic value, even though generally well accepted by the patients. This is due to lack of a standardized collection procedure. The aim of this study was to identify the ideal saliva collection technique and develop new sensitive methods to detect and analyse markers related to pain in healthy pain-free subjects. Plasma and five different saliva collection approached was evaluated during strictly controlled conditions. Levels of nerve growth factor (NGF), calcitonin gene-related peptide (CGRP) and brain derived neurotropic factor (BDNF) were determined using novel western blotting based technology. Glutamate and substance P (SP) was determined using commercial available methods. Several new isoforms were found for NGF, CGRP and BDNF in saliva. The isoform pattern showed significant variation in both expression and chemiluminescence levels between different collection methods. New sensitive methods to study pain related markers in saliva were developed in this study. Furthermore, we are first to demonstrate a correlation between the Glutamate concentration in stimulated whole saliva and blood. However, the fundamental conclusion drawn is the importance of consistency in the collection method.

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Determination of the variability in the salivary proteome is a prerequisite for the development of saliva as a diagnostic and prognostic tool in particular physiological states. In this context, it is important that technical variability induced by sample collection and processing is kept at minimum to be able to reproducibly assess variability in states of health and disease. In the current study, the proteome profile in unstimulated and stimulated whole, parotid and sublingual saliva was investigated using two-dimensional gel electrophoresis. Saliva samples were structurally collected from ten examined and characterized healthy individuals during the exactly same conditions. The results demonstrated that different collection methods provide clear differences in the snapshot of the salivary proteome and also in the relative amount of specific proteins. The variable nature of the salivary proteome suggests that different approaches may have to be adopted when studying its composition or its possible role as an indicator for particular physiological states. The results emphasize the importance of consistency when collecting saliva samples for proteomic analysis.

BackgroundTemporomandibular disorders (TMD) in children and adolescents is prevalent with pain as a common component, and has a comorbidity with psychosocial problems such as stress, depression, anxiety as well as somatic complaints. Therefore, the aim of the study was to investigate if psychosocial problems in children and adolescents are associated with TMD with pain (TMD-pain) and TMD without pain (TMD-painfree) when compared to children and adolescents without TMD.MethodsThis cross-sectional study consisted of 456 randomly selected children and adolescents, enrolled from 10 boy’s- and 10 girl’s- schools in Jeddah, between 10 and 18 years of age. On the examination day, prior to the clinical examination according to Research Diagnostic Criteria for TMD Axis I and II, the participants first answered two validated questions about TMD pain, and after that the Arabic version of the Youth Self Report scale. According to their clinical examination and diagnosis the participants were divided into three groups; non-TMD group, TMD-pain group, and TMD-painfree group.ResultsThe TMD-pain group presents a higher frequency of the internalizing problems anxiety, depression and somatic complaints than non-TMD group (p < 0.05). Regarding externalizing problems the only significant association found was for aggressive behavior in the TMD-pain group (p < 0.05). The TMD-pain group also shows a higher frequency of social problems than the non-TMD group. However, no such difference was found when compared to the TMD-painfree group. There was also a significant association with a higher frequency of thought problems in the TMD-pain group (p < 0.05). The children’s and adolescents’ physical activities were within border line clinical range for all three groups, whereas the social competence was within the normal range. There were no significant associations between any of the groups in this respect.ConclusionsTMD-pain in children and adolescents does not seem to affect the social activities. However, TMD-pain seem to have a strong association to emotional, behavior and somatic functioning, with higher frequencies of anxiety, depression, somatic problems, aggressive behavior and thought problems, than children and adolescents without TMD-pain. With respect to the biopsychosocial model the present study indicates that there are significant associations to psychosocial, somatic and behavioral comorbidities and TMD-pain in children and adolescents in the Middle East region.

These obtained results are probably because of joint pain, making it difficult to perform oral hygiene as well as the use of medication and general disease activity.

Symptoms and signs of temporomandibular disorders (TMD) in 46 patients were investigated and compared with those in 20 healthy individuals. Twenty-three patients had fibromyalgia (FM) and 23 had local myalgia (LM). Facial pain was assessed with a visual analogue scale, and a clinical examination was performed, including maximum voluntary mouth opening, temporomandibular joint sounds, tenderness to digital palpation in the masticatory muscles, pressure pain threshold and tolerance level of the superficial masseter muscle, intramuscular temperature, and maximum voluntary bite force. There was a difference in the number of tender muscles between the groups. Pressure pain threshold and tolerance levels were lower in the FM than in the LM group, whereas both showed lower values than a control group (C). The intramuscular temperature and maximum voluntary mouth opening were lower in the patient groups than in the C group. TMJ sounds showed a difference between all three groups. In conclusion, this study shows that FM patients frequently have TMD and indicates several differences between patients with FM and LM with regard to clinical variables.