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The global burden of orofacial pain (OFP), including temporomandibular disorders (TMDs), has never been estimated due to lacking disability weights (DWs). This is a significant limitation in the World Health Organization's goals for oral health. The present study presents DWs with directions for the development of corresponding health state descriptions. We used general population data on OFP and TMD (n > 180,000) with linked data on health-related quality of life from the Short Form Health Survey (SF-36; n > 110,000). From the SF-36 sum scores, a cumulative DW was mapped, and condition-specific DWs adjusted for common risk factors were calculated. Pain disability and related self-reported clinical characteristics were presented descriptively in a subsample of 300 individuals. In the study sample (n = 26,253, 49.9% women), participants with OFP reported significantly lower scores on the mental and physical components of the SF-36 when compared with pain-free individuals (P < 0.001), as did individuals with TMD as compared with those without TMD (P < 0.001). After adjusting for the presence of common health states, the mean DW was 0.024 (95% CI, 0.011 to 0.038) for OFP and 0.026 (95% CI, 0.016 to 0.038) for TMD. Individuals with higher pain disability reported higher pain intensity as well as increased pain catastrophizing and functional jaw limitations. Our findings demonstrate a feasible solution for estimating DW for OFP and TMD as an important step toward incorporation of these conditions into the Global Burden of Disease study and suggest a greater impact of pain than other common oral diseases. Further efforts are needed to develop lay descriptions and validate DW findings in other populations.

Background: Care should be neutral and equal, but normative beliefs may impact the interaction between patients and healthcare professionals in pain management.

Objectives: To explore how patients with jaw and neck pain perceive pain management and the interaction with healthcare professionals in relation to intersectionality, with a specific focus on gender.

Methods: Recruitment was performed at a specialist dentistry clinic in Sweden. Inclusion criteria were patients aged 18-70 years, reporting jaw and neck pain and understanding the Swedish language. Exclusion criteria were rheumatic disease, temporomandibular joint arthralgia or arthritis. Using purposive sampling, 16 patients (11 women) aged 19-56 were interviewed using individual semi-structured interviews. The analysis was performed using thematic analysis.

Results: The analysis resulted in the theme: 'Intersectional bias in healthcare - the inequity borne by the patients', with five subthemes that entailed different types of bias related to the participants' personal characteristics and their interaction with healthcare professionals. Health-related stigmata was one subtheme described among participants, resulting in labelling and burden in the encounter. Other subthemes also described bias in relation to biological differences among pain patients and patients not being taken seriously due to, for example, female gender and younger age. Two subthemes also described bias in relation to the healthcare professionals' gender and age.

Conclusion: Normative beliefs have a negative impact on the interaction between patients and healthcare professionals in pain management. Since patient-provider interaction should be neutral and equal, intersectional bias should be acknowledged to prevent health and care inequalities.Keywords: gender differences; healthcare disparities; intersectionality; neck pain; temporomandibular joint disorders.

BACKGROUND: Despite being one of the most common chronic pain conditions, painful temporomandibular disorders (TMDs) are still not included in the Global Burden of Disease (GBD) measures of health loss. A key obstacle is the absence of a lay description that can be used to derive a disability weight reflecting the severity relative to all other diseases' consequences measured in GBD. This study aims to propose lay descriptions of painful TMDs suitable for use within the GBD framework.

METHODS: The process was guided by experts from the Institute for Health Metrics and Evaluation (IHME), USA. A structured consensus process was conducted among international experts, clinicians, and patient representatives in three steps: terminology alignment, roundtable discussions during a workshop, and outcome synthesis. After aligning terminology through introductory lectures, five groups of 8-12 participants reviewed existing lay descriptions for other pain-related disorders. In addition, they discussed lay descriptions and severity states.

RESULTS: No existing descriptions adequately captured the characteristics of painful TMDs. After consensus discussions, the proposed lay description was "Pain in the jaw, face, cheeks, or around the ears, sometimes radiating to the temples or behind the eyes. The pain may be felt as dull, sharp, tense, or stiff, making chewing, talking, or opening the mouth difficult." Duration, intensity, and frequency were identified as important dimensions linked to severity.

CONCLUSIONS: The lay description provides direction on how painful TMDs can be quantified in GBD estimates. Future studies, including those that incorporate patients' perspectives, are essential to ensure alignment with lived experiences.

Background: Awake bruxism is a masticatory muscle activity reported by approximately one in four individuals in the general population. Bruxism can have various manifestations such as tooth clenching, grinding or bracing, with different possible clinical consequences, ranging from tooth wear and fractures of dental restorations to orofacial pain related to the musculoskeletal overload. However, no official guidelines exist on the management of awake bruxism. The aim of this systematic review was to review published literature on management of awake bruxism.

Methods: The review followed the PRISMA guidelines. After registration in Prospero (CRD42022351309), an electronic literature search was conducted in Medline, Embase, Scopus, LILACS, CINAHL, OpenGrey, Trip Medical, and Google on 30 August 2023 to identify articles on management of awake bruxism in participants aged 13 years and above. The electronic search was complemented with a hand search of reference lists. The review process was managed in Covidence. Two researchers independently screened titles, abstracts, and full-text articles according to the inclusion criteria which required the studies to be clinical studies involving teenagers or adults, written in English, and presented as randomized controlled trials, non-randomized controlled trials, reports or trials, or case series reports. Risk of bias was assessed using the Newcastle-Ottawa Scale, the Joanna Briggs Institute Critical Appraisal Checklist for case-series, or the RoB 2 scale, depending on study design.

Results: After screening of 4358 abstracts, 210 articles were assessed in full text and nine studies, with 165 participants, were included and summarized in a qualitative synthesis. The most common reason for exclusion was having the wrong study design. In addition, 30 articles were excluded because of not evaluating an awake bruxism population. In the included studies, most evaluated strategies fall within the broad category of cognitive behavioural therapy. The included studies, despite varying risks of bias, generally suggested positive effects of biofeedback, guided music listening, habit reversal, medication, reminder prompts, and counselling with self-management. Given the heterogeneity of included studies, meta-analysis was deemed not appropriate.

Conclusion: The available evidence is limited but still suggests benefits of a behavioural approach to managing the frequency and consequences of awake bruxism.

Background: Screening methods are crucial in enabling prevention and early intervention for individuals with temporomandibular disorders (TMDs) in the general population. Several screening instruments for TMDs have been published, making it challenging to choose the best-suited one for identifying patients with TMDs in daily practice.

Objective: To evaluate the diagnostic accuracy of available screening instruments for TMDs in the general adult population.

Method: The study’s protocol was registered in PROSPERO (CRD42024527919). PubMed/Medline, Web of Science, and Scopus were searched on April 12, 2024, supplemented by a hand search, to identify studies reporting diagnostic accuracy of screening instruments for TMDs in the general adult population. Two independent reviewers performed abstract screening, full-text assessment, risk-of-bias assessment (QUADAS-2), and data extraction.

Results: The search identified 3,608 studies. After abstract screening, 151 studies were reviewed in full text, and five studies on diagnostic accuracy with 2,556 participants were included. Two included studies reported reliability measures for the Short Form Fonseca Amnestic Index (SFAI) compared with other questionnaires. Three studies included in the meta-analysis evaluated the Fonseca Amnestic Index (FAI), its short form (SFAI), and Three Screening Questions for TMDs (3Q/TMD): they report sensitivity of 86% (FAI and SFAI) and 81% (3Q/TMD), and specificity of 92% (FAI), 96 % (SFAI), and 79% (3Q/TMD) respectively. All included studies had high risk of bias for the index test but low risk of bias for patient selection.

Conclusion: FAI, SFAI, and 3Q/TMD demonstrate high sensitivity and specificity, suggesting their suitability for screening for TMD in the general population.

Systemic dissemination of inflammation-related proteins has been linked to unhealthy ageing and increased mortality. Yet, the systemic inflammatory profile of periodontitis, a common oral inflammatory disease, remains poorly characterised. The aim of this study was to evaluate the existing evidence linking alterations in serum levels of inflammation-related proteins to periodontitis. This study was registered in Prospero (CRD42024597308). The inclusion criteria were original, English language studies of human participants ≥16 years that assessed serum biomarkers in individuals with periodontitis and periodontally healthy controls. PubMed, Scopus, and Web of Science were searched on October 13, 2024, and complemented with a hand search. Two independent reviewers performed abstract screening, full-text assessment, risk-of-bias assessment (modified Newcastle-Ottawa Scale), and extraction of summary data. A random-effects meta-analysis was performed to estimate the ratio of mean protein (RoM) level between periodontitis cases and controls. From 9120 screened records, 206 studies were included in the qualitative data synthesis, yielding 17953 participants (157 unique proteins) in total. Data from 144 studies (39 proteins) were included in the meta-analysis. In individuals with periodontitis compared with controls, analyses showed significantly (P<0.05) higher levels of C-C motif chemokine ligand 2 (CCL2); interleukin (IL)-1β, IL-6, IL-17, IL-17A and IL-18; leptin; matrix metalloproteinase 8 (MMP-8), myeloperoxidase (MPO); receptor activator of nuclear factor kappa-Β ligand (RANKL); and tumour necrosis factor α (TNF-α). Notably, CCL2, IL-1β, IL-6, IL-17, IL-17A, MMP-8, RANKL and TNF-α remained significantly elevated even in analyses restricted to systemically healthy participants, with additional significant associations observed for IL-12 and IL-33. Periodontitis is, independently of comorbidities, associated with systemic inflammation and with specific cytokines involved in metabolic and immune dysregulation, including inflammaging. These findings highlight the systemic impact of periodontitis and the importance of reducing the inflammatory burden to promote healthy aging and longevity.

Background: Psychosocial screening is a valuable part of the assessment of patients with orofacial pain, as psychosocial factors will affect prognosis and treatment outcomes. Paper-based questionnaires are predominately used to assess the degree of psychosocial comorbidity; however, digital alternatives for screening questionnaires may be more cost-effective and resource-saving if patients are receptive to using them.

Objective: To evaluate how patients perceive digital psychosocial screening in dentistry.

Method: Using a qualitative approach, individual semi-structured interviews were conducted with a purposive sample of adult patients with orofacial pain (n = 16) recruited from specialist dental clinics in Umeå and Gävle, Sweden. The interviews were transcribed verbatim and then analysed using Qualitative Content Analysis. Before the interviews, patients first completed the paper-based questionnaires and then the digital version.

Results: The analysis of patients' experiences resulted in an overarching theme: Patients appreciate a holistic approach, thus valuing psychosocial screening, and they particularly favour screening in a digital format. From this theme, two categories emerged:

1. Perceptions about health shape patients' expectations of dental care, and with deeper understanding of the value of psychosocial assessment, patients appreciate a holistic approach that includes psychosocial factors.
2. Digital screening is perceived by patients as a reliable, meaningful and environmentally sustainable method.

Conclusions: In general, the patients appreciated a holistic approach in dentistry and understood the value of psychosocial screening as part of this. From the patients' perspective, digital psychosocial screening was both acceptable and beneficial. The findings support the introduction of digital psychosocial screening into daily dental practice.