D. Manfredini | University of Padova (original) (raw)
Papers by D. Manfredini
Journal of Oral Rehabilitation, 2013
To date, there is no consensus about the definition and diagnostic grading of bruxism. A written ... more To date, there is no consensus about the definition and diagnostic grading of bruxism. A written consensus discussion was held among an international group of bruxism experts as to formulate a definition of bruxism and to suggest a grading system for its operationalisation. The expert group defined bruxism as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism has two distinct circadian manifestations: it can occur during sleep (indicated as sleep bruxism) or during wakefulness (indicated as awake bruxism). For the operationalisation of this definition, the expert group proposes a diagnostic grading system of 'possible', 'probable' and 'definite' sleep or awake bruxism. The proposed definition and grading system are suggested for clinical and research purposes in all relevant dental and medical domains.
Journal of Oral Rehabilitation, 2005
The aim of this work was to evaluate the accuracy and reliability of ultrasonography in the diagn... more The aim of this work was to evaluate the accuracy and reliability of ultrasonography in the diagnosis of temporomandibular joint (TMJ) disc position abnormalities compared with magnetic resonance imaging (MRI). Participants in this study were 41 consecutive patients with signs and symptoms of temporomandibular disorders. All 82 TMJs were evaluated to detect disc position abnormalities by means of ultrasonography and MRI, performed by blinded operators. The accuracy of ultrasonography was evaluated with respect to MRI. Ultrasonography demonstrated good accuracy in the evaluation of disc position, showing a sensitivity of 65AE8% and a specificity of 80AE4%, resulting in a positive likelihood ratio of 3AE35, a negative likelihood ratio of 0AE42, and a diagnostic odds ratio of 7AE97. The predictive positive and negatives values were respectively 77AE1% and 70AE2% and the overall agreement between the two radiological techniques was 73AE1%. Ultrasonography proved to be accurate in detecting normal disc position and the presence of abnormalities in disc-condyle relationship but not so useful for the distinction between disc displacement with and without reduction.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2003
Objective. The aim of this work was to evaluate the predictive value of clinical symptoms for mag... more Objective. The aim of this work was to evaluate the predictive value of clinical symptoms for magnetic resonance imaging (MRI) findings of temporomandibular joint (TMJ) effusion. Study design. Sixty-one patients with TMJ pain were assessed by means of a standardized clinical examination and MRI. A calibrated investigator evaluated the presence of 8 clinical indicators (predictors) of TMJ effusion (outcome variable). A logistic regression analysis was performed to detect significant associations between clinical symptoms and MRI findings of TMJ effusion. The accuracy of the final logit to predict effusion was compared with that derived from univariate analysis.
Stomatologija / issued by public institution "Odontologijos studija" ... [et al.], 2007
The importance of psychosocial factors in the etiopathogenesis of temporomandibular disorders (TM... more The importance of psychosocial factors in the etiopathogenesis of temporomandibular disorders (TMD) has led to the hypothesis that these disorders may be part of a wider group of somatoform disorders, the functional somatic syndromes (FSS). Types of studies reviewed. The present paper is an overview summarizing the current concepts on the TMD-FSS relationship. A non-systematic search in the Medline database identified peer-reviewed papers on the epidemiological and clinical characteristics of the complex groups of disorders labelled functional somatic syndromes, focusing on the common features to temporomandibular disorders patients. Literature data suggest that FSS and TMD share many etiopathogenetic and epidemiological features, both groups of disorders having a multifactorial etiopathogenesis and needing a multidisciplinary approach to diagnosis and treatment. Psychosocial characteristics of patients seem to have many similarities and the prevalence of Axis I psychiatric disorder...
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2005
Objective. The objective of the study was to compare findings from ultrasonography (US) of the te... more Objective. The objective of the study was to compare findings from ultrasonography (US) of the temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and temporomandibular disorders (TMD).
Journal of Oral Rehabilitation, 2005
The present work was an attempt to investigate for the existence of an association between anxiet... more The present work was an attempt to investigate for the existence of an association between anxiety psychopathology and bruxism. The presence of bruxism was investigated according to validated clinical criteria in 98 subjects, who also filled out a self-report questionnaire (PAS-SR) for the assessment of panic-agoraphobic spectrum. 34AE7% (n ¼ 34) of participants were diagnosed as bruxers. The prevalence of anxiety psychopathology was similar between bruxers and non-bruxers, but Mann-Whitney U-test revealed significant differences in total PAS-SR (P ¼ 0AE026) score, indicating that subclinical symptoms of the anxiety spectrum might differentiate bruxers from controls. In particular, significant differences emerged in scores of domains evaluating panic (P ¼ 0AE039), stress sensitivity (P ¼ 0AE006) and reassurance sensitivity symptoms (P ¼ 0AE005) of panic-agoraphobic spectrum. Support to the existence of an association between bruxism and certain psychopathological symptoms has been provided.
Australian Dental Journal, 2004
Background: The aim of this study was to investigate the existence of associations between bruxis... more Background: The aim of this study was to investigate the existence of associations between bruxism and psychic and occlusal factors. Methods: Participants in this study (n=85) were recruited from the Section . They were split into two groups, bruxers (n=34) and non-bruxers (n=51), on the basis of the presence of both clinical and anamnestical indicators of bruxism. All participants were administered two self-reported validated questionnaires to evaluate mood (MOODS-SR) and panic-agoraphobic (PAS-SR) spectra. A number of occlusal variables (deepbite, cross-bite, open-bite, mediotrusive and laterotrusive interferences, slide RCP-ICP, laterotrusive guides, canine and molar classes) were also recorded. Results: With regards to occlusal factors, the only association was revealed between bruxism mediotrusive interferences (p<0.05). As for psychiatric investigation, significant differences between bruxers and controls emerged for the presence of both depressive (p<0.01) and manic symptoms (p<0.01) in MOODS-SR, and for stress sensitivity (p<0.01), anxious expectation (p<0.05), and reassurance sensitivity symptoms (p<0.05) in PAS-SR. In particular, both mood (p<0.01) and panic-agoraphobic (p<0.05) spectra symptoms seem to differentiate bruxers from controls in males, while in females strong differences emerged for stress sensitivity symptoms (p<0.05). Conclusions: It can be confirmed that certain psychic traits are present in bruxers, while occlusal factors are not useful parameters to discern bruxers from non-bruxers.
Journal of Oral Rehabilitation, 2010
AIMS To estimate the criterion validity of the Research Diagnostic Criteria for Temporomandibular... more AIMS To estimate the criterion validity of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I TMD diagnoses. METHODS A combined total of 614 TMD community and clinic cases and 91 controls were examined at 3 study ...
International journal of oral and maxillofacial surgery, 2012
The aim of the study was to compare the effectiveness of five weekly two-needle arthrocentesis pl... more The aim of the study was to compare the effectiveness of five weekly two-needle arthrocentesis plus hyaluronic injections vs. the same protocol performed with a single-needle technique in patients with inflammatory-degenerative disorders of the temporomandibular joint (TMJ). 80 patients with TMJ osteoarthritis were randomly assigned to the two-needle or single-needle protocol and followed up for 6 months after treatment. Several outcome parameters, such as maximum pain at rest and maximum pain on chewing, subjective chewing efficiency, limitation in jaw function, jaw range of motion in mm, were recorded at baseline and multiple follow up assessments. Both treatment groups recorded significant improvement with respect to baseline levels in almost all outcome variables. The rate of improvement was not significantly different between the treatment protocols in any of the outcome variables (p-values between 0.143 and 0.970). No between-group differences emerged for the perceived subject...
International Journal of Oral and Maxillofacial Surgery, 2009
Nardini: Temporomandibular joint osteoarthritis: an open label trial of 76 patients treated with ... more Nardini: Temporomandibular joint osteoarthritis: an open label trial of 76 patients treated with arthrocentesis plus hyaluronic acid injections. Int.
Dental Cadmos, 2011
ABSTRACT Objectives The aim of this study was to define the most effective protocol for temporoma... more ABSTRACT Objectives The aim of this study was to define the most effective protocol for temporomandibular joint arthrocentesis through comparative efficacy analysis of three different treatment protocols involving joint lavage with or without the use of drugs to manage symptoms of intracapsular disorders.
Journal of Oral Rehabilitation, 2012
The aim of this investigation was to perform a review of the literature dealing with the issue of... more The aim of this investigation was to perform a review of the literature dealing with the issue of relationships between dental occlusion, body posture and temporomandibular disorders (TMD). A search of the available literature was performed to determine what the current evidence is regarding: (i) The physiology of the dental occlusion-body posture relationship, (ii) The relationship of these two topics with TMD and (iii) The validity of the available clinical and instrumental devices (surface electromyography, kinesiography and postural platforms) to measure the dental occlusion-body posture-TMD relationship. The available posturographic techniques and devices have not consistently found any association between body posture and dental occlusion. This outcome is most likely due to the many compensation mechanisms occurring within the neuromuscular system regulating body balance. Furthermore, the literature shows that TMD are not often related to specific occlusal conditions, and they also do not have any detectable relationships with head and body posture. The use of clinical and instrumental approaches for assessing body posture is not supported by the wide majority of the literature, mainly because of wide variations in the measurable variables of posture. In conclusion, there is no evidence for the existence of a predictable relationship between occlusal and postural features, and it is clear that the presence of TMD pain is not related with the existence of measurable occluso-postural abnormalities. Therefore, the use instruments and techniques aiming to measure purported occlusal, electromyographic, kinesiographic or posturographic abnormalities cannot be justified in the evidence-based TMD practice.
Journal of Oral Rehabilitation, 2011
The present investigations attempted to assess the diagnostic accuracy of commercially available ... more The present investigations attempted to assess the diagnostic accuracy of commercially available surface electromyography (sEMG) and kinesiography (KG) devices for myofascial pain of jaw muscles. Thirty-six (n = 36) consecutive patients with a research diagnostic criteria for temporomandibular disorders (RDC ⁄ TMD) axis I diagnosis of myofascial pain and an age-and sex-matched group of 36 TMD-free asymptomatic subjects underwent sEMG and KG assessments to compare EMG parameters of the masseter and temporalis muscles as well as the jaw range of motion and the interarch freeway space. EMG data at rest were not significantly different between myofascial pain patients and asymptomatic subjects, while the latter achieved significantly higher levels of EMG activity during clenching tasks. Symmetry of muscle activity at rest and during clenching tasks, KG parameters of jaw range of motion and the measurement of the interarch vertical freeway did not differ between groups. Receiver operating characteristics curve analysis showed that, except EMG parameters during clenching tasks, all the other outcome sEMG and KG measures did not reach acceptable levels of sensitivity and specificity, with a 30AE6-88AE9% percentage of false-positive results. Therefore, clinicians should not use sEMG and KG devices as diagnostic tools for individual patients who might have myofascial pain in the jaw muscles. Whether intended as a stand-alone measurement or as an adjunct to making clinical decisions, such instruments do not meet the standard of reliability and validity required for such usage.
Journal of Oral Rehabilitation, 2010
AIMS To estimate the criterion validity of the Research Diagnostic Criteria for Temporomandibular... more AIMS To estimate the criterion validity of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I TMD diagnoses. METHODS A combined total of 614 TMD community and clinic cases and 91 controls were examined at 3 study ...
Journal of Oral Rehabilitation, 2011
Journal of Oral Rehabilitation, 2013
To date, there is no consensus about the definition and diagnostic grading of bruxism. A written ... more To date, there is no consensus about the definition and diagnostic grading of bruxism. A written consensus discussion was held among an international group of bruxism experts as to formulate a definition of bruxism and to suggest a grading system for its operationalisation. The expert group defined bruxism as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism has two distinct circadian manifestations: it can occur during sleep (indicated as sleep bruxism) or during wakefulness (indicated as awake bruxism). For the operationalisation of this definition, the expert group proposes a diagnostic grading system of 'possible', 'probable' and 'definite' sleep or awake bruxism. The proposed definition and grading system are suggested for clinical and research purposes in all relevant dental and medical domains.
Journal of Oral Rehabilitation, 2012
The aim of the present investigation was to assess the psychological profile of a sample of patie... more The aim of the present investigation was to assess the psychological profile of a sample of patients with temporomandibular disorders (TMD) and to compare the psychometric scores between patients with pain of different diffusion, location, intensity and duration. One hundred and ten (N = 110) patients with painful TMD fulfilled three psychometric instruments. Pain features were assessed as categorical variables as concerns its diffusion, viz., diffuse or localised, duration, viz., more or <6 months, and location, viz., joint and/or muscles. Pain intensity was scored on a 0-100 Visual Analog Scale (VAS) rating. Patients with diffuse pain showed higher psychometric scores than patients with localised pain. No significant differences were detected between patients with pain lasting from more or equal than 6 months and those with pain lasting from <6 months as well as between patients with pain localised in the jaw muscles, joints or both, even if a trend for lower scores for patients with joint pain alone was observed. Pain intensity was significantly related with anxiety (ANX), depression (DEP) and somatisation(SOM) scores. In conclusion, pain diffusion and intensity were strongly related with high levels of SOM, ANX and DEP, while no differences in psychometric scores were detected between patients with pain of different duration and location.
Journal of Oral Rehabilitation, 2015
ABSTRACT The aim of this study was to compare clinical sleep bruxism (SB) diagnosis with an instr... more ABSTRACT The aim of this study was to compare clinical sleep bruxism (SB) diagnosis with an instrumental diagnosis obtained with a device providing electromyography/electrocardiography (EMG/ECG) recordings. Forty-five (N = 45) subjects (19 males and 26 females, mean age 28 ± 11 years) were selected among patients referring to the Gnathology Unit of the Dental School of the University of Torino. An expert clinician assessed the presence of SB based on the presence of one or more signs/symptoms (i.e. transient jaw muscle pain in the morning, muscle fatigue at awakening, presence of tooth wear, masseter hypertrophy). Furthermore, all participants underwent an instrumental recording at home with a portable device (Bruxoff(®) ; OT Bioelettronica, Torino, Italy) allowing a simultaneous recording of EMG signals from both the masseter muscles as well as heart frequency. Statistical procedures were performed with the software Statistical Package for the Social Science v. 20.0 (SPSS 20.0(®) ; IBM, Milan, Italy). Based on the EMG/ECG analysis, 26 subjects (11 males, 15 females, mean age 28 ± 10 years) were diagnosed as sleep bruxers, whilst 19 subjects (7 males, 12 females, mean age 30 ± 10 years) were diagnosed as non-bruxers. The correlation between the clinical and EMG/ECG SB diagnoses was low (ϕ value = 0·250), with a 62·2% agreement (28/45 subjects) between the two approaches (kappa = 0·248). Assuming instrumental EMG/ECG diagnosis as the standard of reference for definite SB diagnosis in this investigation, the false-positive and false-negative rates were unacceptable for all clinical signs/symptoms. In conclusion, findings from clinical assessment are not related with SB diagnosis performed with a portable EMG/ECG recorder. © 2015 John Wiley & Sons Ltd.
Journal of Oral Rehabilitation, 2013
To date, there is no consensus about the definition and diagnostic grading of bruxism. A written ... more To date, there is no consensus about the definition and diagnostic grading of bruxism. A written consensus discussion was held among an international group of bruxism experts as to formulate a definition of bruxism and to suggest a grading system for its operationalisation. The expert group defined bruxism as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism has two distinct circadian manifestations: it can occur during sleep (indicated as sleep bruxism) or during wakefulness (indicated as awake bruxism). For the operationalisation of this definition, the expert group proposes a diagnostic grading system of &amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;possible&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;, &amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;probable&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;definite&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; sleep or awake bruxism. The proposed definition and grading system are suggested for clinical and research purposes in all relevant dental and medical domains.
Journal of Oral Rehabilitation, 2005
The aim of this work was to evaluate the accuracy and reliability of ultrasonography in the diagn... more The aim of this work was to evaluate the accuracy and reliability of ultrasonography in the diagnosis of temporomandibular joint (TMJ) disc position abnormalities compared with magnetic resonance imaging (MRI). Participants in this study were 41 consecutive patients with signs and symptoms of temporomandibular disorders. All 82 TMJs were evaluated to detect disc position abnormalities by means of ultrasonography and MRI, performed by blinded operators. The accuracy of ultrasonography was evaluated with respect to MRI. Ultrasonography demonstrated good accuracy in the evaluation of disc position, showing a sensitivity of 65AE8% and a specificity of 80AE4%, resulting in a positive likelihood ratio of 3AE35, a negative likelihood ratio of 0AE42, and a diagnostic odds ratio of 7AE97. The predictive positive and negatives values were respectively 77AE1% and 70AE2% and the overall agreement between the two radiological techniques was 73AE1%. Ultrasonography proved to be accurate in detecting normal disc position and the presence of abnormalities in disc-condyle relationship but not so useful for the distinction between disc displacement with and without reduction.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2003
Objective. The aim of this work was to evaluate the predictive value of clinical symptoms for mag... more Objective. The aim of this work was to evaluate the predictive value of clinical symptoms for magnetic resonance imaging (MRI) findings of temporomandibular joint (TMJ) effusion. Study design. Sixty-one patients with TMJ pain were assessed by means of a standardized clinical examination and MRI. A calibrated investigator evaluated the presence of 8 clinical indicators (predictors) of TMJ effusion (outcome variable). A logistic regression analysis was performed to detect significant associations between clinical symptoms and MRI findings of TMJ effusion. The accuracy of the final logit to predict effusion was compared with that derived from univariate analysis.
Stomatologija / issued by public institution "Odontologijos studija" ... [et al.], 2007
The importance of psychosocial factors in the etiopathogenesis of temporomandibular disorders (TM... more The importance of psychosocial factors in the etiopathogenesis of temporomandibular disorders (TMD) has led to the hypothesis that these disorders may be part of a wider group of somatoform disorders, the functional somatic syndromes (FSS). Types of studies reviewed. The present paper is an overview summarizing the current concepts on the TMD-FSS relationship. A non-systematic search in the Medline database identified peer-reviewed papers on the epidemiological and clinical characteristics of the complex groups of disorders labelled functional somatic syndromes, focusing on the common features to temporomandibular disorders patients. Literature data suggest that FSS and TMD share many etiopathogenetic and epidemiological features, both groups of disorders having a multifactorial etiopathogenesis and needing a multidisciplinary approach to diagnosis and treatment. Psychosocial characteristics of patients seem to have many similarities and the prevalence of Axis I psychiatric disorder...
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2005
Objective. The objective of the study was to compare findings from ultrasonography (US) of the te... more Objective. The objective of the study was to compare findings from ultrasonography (US) of the temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and temporomandibular disorders (TMD).
Journal of Oral Rehabilitation, 2005
The present work was an attempt to investigate for the existence of an association between anxiet... more The present work was an attempt to investigate for the existence of an association between anxiety psychopathology and bruxism. The presence of bruxism was investigated according to validated clinical criteria in 98 subjects, who also filled out a self-report questionnaire (PAS-SR) for the assessment of panic-agoraphobic spectrum. 34AE7% (n ¼ 34) of participants were diagnosed as bruxers. The prevalence of anxiety psychopathology was similar between bruxers and non-bruxers, but Mann-Whitney U-test revealed significant differences in total PAS-SR (P ¼ 0AE026) score, indicating that subclinical symptoms of the anxiety spectrum might differentiate bruxers from controls. In particular, significant differences emerged in scores of domains evaluating panic (P ¼ 0AE039), stress sensitivity (P ¼ 0AE006) and reassurance sensitivity symptoms (P ¼ 0AE005) of panic-agoraphobic spectrum. Support to the existence of an association between bruxism and certain psychopathological symptoms has been provided.
Australian Dental Journal, 2004
Background: The aim of this study was to investigate the existence of associations between bruxis... more Background: The aim of this study was to investigate the existence of associations between bruxism and psychic and occlusal factors. Methods: Participants in this study (n=85) were recruited from the Section . They were split into two groups, bruxers (n=34) and non-bruxers (n=51), on the basis of the presence of both clinical and anamnestical indicators of bruxism. All participants were administered two self-reported validated questionnaires to evaluate mood (MOODS-SR) and panic-agoraphobic (PAS-SR) spectra. A number of occlusal variables (deepbite, cross-bite, open-bite, mediotrusive and laterotrusive interferences, slide RCP-ICP, laterotrusive guides, canine and molar classes) were also recorded. Results: With regards to occlusal factors, the only association was revealed between bruxism mediotrusive interferences (p<0.05). As for psychiatric investigation, significant differences between bruxers and controls emerged for the presence of both depressive (p<0.01) and manic symptoms (p<0.01) in MOODS-SR, and for stress sensitivity (p<0.01), anxious expectation (p<0.05), and reassurance sensitivity symptoms (p<0.05) in PAS-SR. In particular, both mood (p<0.01) and panic-agoraphobic (p<0.05) spectra symptoms seem to differentiate bruxers from controls in males, while in females strong differences emerged for stress sensitivity symptoms (p<0.05). Conclusions: It can be confirmed that certain psychic traits are present in bruxers, while occlusal factors are not useful parameters to discern bruxers from non-bruxers.
Journal of Oral Rehabilitation, 2010
AIMS To estimate the criterion validity of the Research Diagnostic Criteria for Temporomandibular... more AIMS To estimate the criterion validity of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I TMD diagnoses. METHODS A combined total of 614 TMD community and clinic cases and 91 controls were examined at 3 study ...
International journal of oral and maxillofacial surgery, 2012
The aim of the study was to compare the effectiveness of five weekly two-needle arthrocentesis pl... more The aim of the study was to compare the effectiveness of five weekly two-needle arthrocentesis plus hyaluronic injections vs. the same protocol performed with a single-needle technique in patients with inflammatory-degenerative disorders of the temporomandibular joint (TMJ). 80 patients with TMJ osteoarthritis were randomly assigned to the two-needle or single-needle protocol and followed up for 6 months after treatment. Several outcome parameters, such as maximum pain at rest and maximum pain on chewing, subjective chewing efficiency, limitation in jaw function, jaw range of motion in mm, were recorded at baseline and multiple follow up assessments. Both treatment groups recorded significant improvement with respect to baseline levels in almost all outcome variables. The rate of improvement was not significantly different between the treatment protocols in any of the outcome variables (p-values between 0.143 and 0.970). No between-group differences emerged for the perceived subject...
International Journal of Oral and Maxillofacial Surgery, 2009
Nardini: Temporomandibular joint osteoarthritis: an open label trial of 76 patients treated with ... more Nardini: Temporomandibular joint osteoarthritis: an open label trial of 76 patients treated with arthrocentesis plus hyaluronic acid injections. Int.
Dental Cadmos, 2011
ABSTRACT Objectives The aim of this study was to define the most effective protocol for temporoma... more ABSTRACT Objectives The aim of this study was to define the most effective protocol for temporomandibular joint arthrocentesis through comparative efficacy analysis of three different treatment protocols involving joint lavage with or without the use of drugs to manage symptoms of intracapsular disorders.
Journal of Oral Rehabilitation, 2012
The aim of this investigation was to perform a review of the literature dealing with the issue of... more The aim of this investigation was to perform a review of the literature dealing with the issue of relationships between dental occlusion, body posture and temporomandibular disorders (TMD). A search of the available literature was performed to determine what the current evidence is regarding: (i) The physiology of the dental occlusion-body posture relationship, (ii) The relationship of these two topics with TMD and (iii) The validity of the available clinical and instrumental devices (surface electromyography, kinesiography and postural platforms) to measure the dental occlusion-body posture-TMD relationship. The available posturographic techniques and devices have not consistently found any association between body posture and dental occlusion. This outcome is most likely due to the many compensation mechanisms occurring within the neuromuscular system regulating body balance. Furthermore, the literature shows that TMD are not often related to specific occlusal conditions, and they also do not have any detectable relationships with head and body posture. The use of clinical and instrumental approaches for assessing body posture is not supported by the wide majority of the literature, mainly because of wide variations in the measurable variables of posture. In conclusion, there is no evidence for the existence of a predictable relationship between occlusal and postural features, and it is clear that the presence of TMD pain is not related with the existence of measurable occluso-postural abnormalities. Therefore, the use instruments and techniques aiming to measure purported occlusal, electromyographic, kinesiographic or posturographic abnormalities cannot be justified in the evidence-based TMD practice.
Journal of Oral Rehabilitation, 2011
The present investigations attempted to assess the diagnostic accuracy of commercially available ... more The present investigations attempted to assess the diagnostic accuracy of commercially available surface electromyography (sEMG) and kinesiography (KG) devices for myofascial pain of jaw muscles. Thirty-six (n = 36) consecutive patients with a research diagnostic criteria for temporomandibular disorders (RDC ⁄ TMD) axis I diagnosis of myofascial pain and an age-and sex-matched group of 36 TMD-free asymptomatic subjects underwent sEMG and KG assessments to compare EMG parameters of the masseter and temporalis muscles as well as the jaw range of motion and the interarch freeway space. EMG data at rest were not significantly different between myofascial pain patients and asymptomatic subjects, while the latter achieved significantly higher levels of EMG activity during clenching tasks. Symmetry of muscle activity at rest and during clenching tasks, KG parameters of jaw range of motion and the measurement of the interarch vertical freeway did not differ between groups. Receiver operating characteristics curve analysis showed that, except EMG parameters during clenching tasks, all the other outcome sEMG and KG measures did not reach acceptable levels of sensitivity and specificity, with a 30AE6-88AE9% percentage of false-positive results. Therefore, clinicians should not use sEMG and KG devices as diagnostic tools for individual patients who might have myofascial pain in the jaw muscles. Whether intended as a stand-alone measurement or as an adjunct to making clinical decisions, such instruments do not meet the standard of reliability and validity required for such usage.
Journal of Oral Rehabilitation, 2010
AIMS To estimate the criterion validity of the Research Diagnostic Criteria for Temporomandibular... more AIMS To estimate the criterion validity of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I TMD diagnoses. METHODS A combined total of 614 TMD community and clinic cases and 91 controls were examined at 3 study ...
Journal of Oral Rehabilitation, 2011
Journal of Oral Rehabilitation, 2013
To date, there is no consensus about the definition and diagnostic grading of bruxism. A written ... more To date, there is no consensus about the definition and diagnostic grading of bruxism. A written consensus discussion was held among an international group of bruxism experts as to formulate a definition of bruxism and to suggest a grading system for its operationalisation. The expert group defined bruxism as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism has two distinct circadian manifestations: it can occur during sleep (indicated as sleep bruxism) or during wakefulness (indicated as awake bruxism). For the operationalisation of this definition, the expert group proposes a diagnostic grading system of 'possible', 'probable' and 'definite' sleep or awake bruxism. The proposed definition and grading system are suggested for clinical and research purposes in all relevant dental and medical domains.
Journal of Oral Rehabilitation, 2012
The aim of the present investigation was to assess the psychological profile of a sample of patie... more The aim of the present investigation was to assess the psychological profile of a sample of patients with temporomandibular disorders (TMD) and to compare the psychometric scores between patients with pain of different diffusion, location, intensity and duration. One hundred and ten (N = 110) patients with painful TMD fulfilled three psychometric instruments. Pain features were assessed as categorical variables as concerns its diffusion, viz., diffuse or localised, duration, viz., more or <6 months, and location, viz., joint and/or muscles. Pain intensity was scored on a 0-100 Visual Analog Scale (VAS) rating. Patients with diffuse pain showed higher psychometric scores than patients with localised pain. No significant differences were detected between patients with pain lasting from more or equal than 6 months and those with pain lasting from <6 months as well as between patients with pain localised in the jaw muscles, joints or both, even if a trend for lower scores for patients with joint pain alone was observed. Pain intensity was significantly related with anxiety (ANX), depression (DEP) and somatisation(SOM) scores. In conclusion, pain diffusion and intensity were strongly related with high levels of SOM, ANX and DEP, while no differences in psychometric scores were detected between patients with pain of different duration and location.
Journal of Oral Rehabilitation, 2015
ABSTRACT The aim of this study was to compare clinical sleep bruxism (SB) diagnosis with an instr... more ABSTRACT The aim of this study was to compare clinical sleep bruxism (SB) diagnosis with an instrumental diagnosis obtained with a device providing electromyography/electrocardiography (EMG/ECG) recordings. Forty-five (N = 45) subjects (19 males and 26 females, mean age 28 ± 11 years) were selected among patients referring to the Gnathology Unit of the Dental School of the University of Torino. An expert clinician assessed the presence of SB based on the presence of one or more signs/symptoms (i.e. transient jaw muscle pain in the morning, muscle fatigue at awakening, presence of tooth wear, masseter hypertrophy). Furthermore, all participants underwent an instrumental recording at home with a portable device (Bruxoff(®) ; OT Bioelettronica, Torino, Italy) allowing a simultaneous recording of EMG signals from both the masseter muscles as well as heart frequency. Statistical procedures were performed with the software Statistical Package for the Social Science v. 20.0 (SPSS 20.0(®) ; IBM, Milan, Italy). Based on the EMG/ECG analysis, 26 subjects (11 males, 15 females, mean age 28 ± 10 years) were diagnosed as sleep bruxers, whilst 19 subjects (7 males, 12 females, mean age 30 ± 10 years) were diagnosed as non-bruxers. The correlation between the clinical and EMG/ECG SB diagnoses was low (ϕ value = 0·250), with a 62·2% agreement (28/45 subjects) between the two approaches (kappa = 0·248). Assuming instrumental EMG/ECG diagnosis as the standard of reference for definite SB diagnosis in this investigation, the false-positive and false-negative rates were unacceptable for all clinical signs/symptoms. In conclusion, findings from clinical assessment are not related with SB diagnosis performed with a portable EMG/ECG recorder. © 2015 John Wiley & Sons Ltd.