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Background: Botulinum toxin Type A (BTX-A) is increasingly used in the management of myofascial pain; however, the evidence to support this treatment modality is still inconclusive.

Objective: To evaluate the change in days with functional jaw pain after one session of BTX-A or placebo injections into the masseter and temporalis muscles in subjects with jaw myalgia. The hypothesis was that BTX-A is effective in reducing the number of days with functional jaw pain. Methods: This was a randomised, double-blind, parallel group study in subjects with jaw myalgia. After randomisation, BTX-A or placebo injections were made in the masseter and temporalis muscles. The number of days with jaw pain on function was evaluated after 2 months. Adverse events were registered.

Results: Twenty-three subjects were randomly assigned to BTX-A and 22 to placebo. Between baseline and the 2-month follow-up, the number of days with jaw pain at function changed from a median (interquartile range) of 14 (4) to 10.5 (6) days in the BTX-A group and from 14.0 (1.5) to 14 (5) in the saline group (p < 0.585). Adverse events were mild and transient and similar in the two groups.

Conclusion: A single treatment of BTX-A injections in the masseter and temporalis muscles was not effective in treating jaw myalgia. However, an adequately powered study might provide sufficient support for efficacy.

Background: People with hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorders (HSDs) are at greater risk of developing temporomandibular disorders (TMDs), perhaps due to the general joint hypermobility. There is, however, no information on how oral health–related quality of life (OHRQoL) is affected in people with hEDS or HSD with TMD. The authors’ aim was to assess OHRQoL via the 14-item, short version Oral Health Impact Profile (OHIP-14), as well as associated risk factors in women with TMD symptoms and confirmed hEDS or HSD.

Methods: A digital questionnaire was sent to members of The Swedish National EDS Association who reported having a confirmed or suspected EDS or HSD diagnosis in the health care system from January through March 2022. Then, a sample of 133 women with confirmed hEDS or HSD and TMD symptoms was constructed, and information on the following variables was collected: TMD symptoms, age, general health, oral health–related factors, comorbid symptoms, and psychological factors. Linear regression analysis was conducted to investigate the association between these variables and the OHIP-14 summary score as the outcome.

Results: Most participants reported TMD pain symptoms (93.9%), temporomandibular joint clicking (89.5%), and crepitation (55.6%). The mean (SD) total OHIP-14 summary score was 21.0 (13.2). Oral function had the lowest impact (2.0 [2.4]) and orofacial pain had the highest impact on OHRQoL (3.9 [2.5]). Self-reported bruxism, poor general health, and comorbid symptoms were significantly associated with impaired OHRQoL.

Conclusions: Women with confirmed hEDS or HSD and TMD symptoms have a considerably impaired OHRQoL.

Practical Implications: The multidimensional phenomenon of OHRQoL in this group needs to be considered in management strategies.

Background: While equity in health care is the core of the Swedish health system, social inequalities in accessing health care, particularly regarding dental care, exist. There is however no information on how the Sámi population is affected. This study aimed to assess the prevalence and risk factors for refraining from seeking dental care among the Sámi in Sweden.

Methods: A Sámi sample was constructed from three pre-existing registers. Among the 9,249 invitations for individuals aged 18–84 years old, 3,779 answered the survey during February–May 2021. We first calculated frequencies and proportions of the independent variables in terms of socio-economic, socio-demographic, and cultural-related factors as well as the outcome, refraining from dental care. Then, we summarized the magnitude of the association between the independent variables and self-reported refrain from dental care with the prevalence difference (PD) using the 95% confidence interval (95% CI) for inferential purposes.

Results: Overall, 17.5% of the participants refrained from seeking dental care despite self-reported need in the last three months, with almost the same proportion between men and women. Among the socio-demographic factors, being in the 30–44 years group (PD = 8.0; 95% CI: 3.59, 12.48), in the 45–64 group (PD = 7.3; 95% CI: 2.96, 11.61) and in the 65–84 group (PD = 5.4; 95% CI: 0.92, 9.78) as well as being divorced/widow-er (PD = 6.7; 95% CI: 2.73, 10.70) and unmarried (PD = 3.1; 95% CI: 0.23, 6.04) were statistically significantly associated with refraining from seeking dental care. Among the socio-economic variables, those in the middle-income quintile (PD = 5.3; 95% CI: 1.28, 9.35), in the poor (PD = 8.1; 95% CI: 3.64, 12.51) and poorest (PD = 8.0 95% CI: 3.48, 12.50) quintiles, and especially those experiencing economic stress once (PD = 9.2; 95% CI: 2.93, 15.48) and several times (PD = 26.5; 95% CI: 19.50, 33.43), were strongly associated with refraining.

Conclusions: Approximately one in six of the Sámi participating in this study refrained from seeking dental care despite self-reported need in the last three months. Those who experienced economic difficulties were the most affected group. To achieve equity in dental health care in Sweden, policies removing economic barriers to access dental health care should be implemented.

Background: Generalized joint hypermobility as a characteristic feature of Ehlers–Danlos syndromes (EDS) is among the factors contributing to temporomandibular disorders (TMD).

Objective: To evaluate the prevalence of TMD symptoms and their risk factors among women born in Sweden or Finland who were 27- to 78-year-olds with diagnosed hypermobile EDS (hEDS).

Methods: A cohort of women with confirmed hEDS (n = 185) was constructed from the members of the National EDS Associations in both countries. Based on questionnaire data, frequency of independent variables in terms of socio-demographic, general health and oral health-related factors, comorbid symptoms and psychological distress for self-reported TMD symptoms as the dependent variables, were calculated first. Prevalence ratios (PR) and their 95% confidence interval (95% CI) were estimated for the association between independent and dependent variables.

Results: Nearly all participants reported TMD symptoms (98%) with TMD pain (95%), TMJ clicking (90%) and jaw fatigue (80%) as the most common symptoms and TMJ crepitation (63%) and luxation (44%) as the least common symptoms. Risk factors for TMD among 27- to 50-year-olds participants were Finland as a country of birth, living alone and self-reported worst pain in the body (not the joints). The respective risk factors among the 51- to 78-year-olds were Finland as a country of birth, family history of EDS, tinnitus and regularly taking contraceptives.

Conclusions: Among adult women with confirmed hEDS, socio-demographic and health-related factors and comorbid symptoms were significantly associated with TMD but with differences regarding age group. Therefore, management of TMD requires a multidisciplinary approach among the affected.

This narrative review aims to demonstrate and summarize the complex relationship between Ehlers-Danlos syndromes (EDS) and temporomandibular disorders (TMD) by reviewing the results of observational studies and case reports. EDS are a set of hereditary connective tissue disorders, where generalized joint hypermobility (GJH), especially in the hypermobile subtype (hEDS), is a key symptom. Mutations have been identified in genes that impact the production or assembly of collagen for all subtypes except hEDS. While the correlation between GJH and TMD has been analysed in various studies, fewer studies have examined TMD in patients with EDS, with most showing an increased prevalence of TMD. In case–control studies, an elevated prevalence of myalgia, arthralgia and disc-related disorders was found in individuals with EDS. Various therapeutic interventions have been reported within the literature in the form of case reports and observational studies, but there are no long-term clinical trials with results on the efficacy of different therapeutic approaches to date. This review demonstrates the high prevalence of different TMDs in different subtypes of EDS, but also shows that little is known about the success of treatment thus far. Further clinical research is necessary to provide adequate guidance on targeted treatment.

Background: Temporomandibular Disorder (TMD) pain attributed to myalgia is a common condition and patients should get advice on the best treatment option. 

Objectives: The aim was to evaluate the effect of two different exercise programs, or bite splint therapy, respectively, in patients with chronic frequent primary myofascial orofacial pain. 

Methods: The study was a randomized clinical trial including patients fulϐilling criteria of chronic frequent primary myofascial orofacial pain with a reported pain intensity of ≥ 4 on a numerical rating scale (0-10). Ninety subjects were randomized to either bite splint, home exercises, or a supervised exercise program. Two examiners blinded to the treatment modality examined the same subject at baseline and a 3-month follow-up. Non-parametric statistical methods were applied for the outcome of treatment in intended-to-treat analyses. A P-value <0.05 was considered statistically signiϐicant. 

Results: The pain severity index was signiϐicantly reduced (p < 0.001) in all treatment groups. Jaw opening capacity improved signiϐicantly (p < 0.05) for those randomized to bite splint and for those in the home exercise program. About 70% of the participants reported improvement in their TMD pain severity with no signiϐicant difference between treatments. Both exercise groups improved in jaw function at the 3-month follow-up compared to baseline. Those who had a bite splint reported significantly more improvement in their headaches compared to those in the exercise programs.

Conclusion: Jaw exercise programs and bite splint treatments had similar positive effects on TMD pain severity attributed to myalgia after 3 months.

The aim of this study was to assess the received TMD treatment modalities and the perceived outcome among the frequent types of EDS. A digital questionnaire was sent to the member of the National Swedish EDS Association during January-March 2022. The subsamples of hypermobile and classical EDS were constructed. Almost 90% reported TMD symptoms. Bite splint therapy, counselling, jaw training and occlusal adjustment were reported as the most common treatments with no statistically significant difference in terms of good effect between the two subsamples. Hypermobile and classical EDS might consider as an entity with regards to TMD.

Objectives: To investigate the prevalence of poor self-reported oral health and to identify socio-demographic, socio-economic and cultural-related risk factors associated with poor oral health among Sámi in Sweden.

Methods: A Sámi sample frame was constructed drawing from three pre-existing registers. All identified persons aged 18–84 were invited to participate in the study during February–May 2021. Among the 9249 invitations, 3779 answered the survey. The frequencies of the independent variables in terms of socio-economic, socio-demographic and cultural-related factors as well as the outcome, self-reported oral health, were calculated first. Prevalence ratios (PRs) and their 95% confidence interval (95% CI) were estimated to assess the relationship between the independent variables and the outcome.

Results: Overall, 32.5% of the participants reported a poor oral health with a higher prevalence among men compared to women. Among the socio-demographic factors, being old (PR: 1.99; 95% CI: 1.59–2.51), unmarried (PR: 1.17; 95% CI: 1.03–1.33) and divorced or widow-er (PR: 1.27; 95% CI: 1.09–1.46) were statistically associated to poor self-reported oral health. Among the socio-economic factors, a low education level (PR: 1.56; 95% CI: 1.29–1.89), belonging to the poorest quintile (PR: 1.63; 95% CI: 1.35–1.96), and experiencing difficulties to make ends meet several times during the last 12 months (PR: 1.74; 95% CI: 1.51–1.99) were statistically significant related to poor oral health.

Conclusions: The self-reported oral health among Sámi in Sweden appears to be worse than that of the general Swedish population. Several socio-economic and socio-demographic factors were found to be strongly associated with poor self-reported oral health. Targeted interventions addressing these social determinants are needed to reduce inequalities in oral health among the Sámi population.

Objectives: Pain referral on palpation has been suggested to be a clinical sign of central sensitization potentially associated with widespread pain conditions. Our aim was to evaluate if myofascial pain with referral is a better predictor for widespread pain when compared to no pain or local myofascial pain.

Materials and methods: Individuals at the Public Dental services in Västerbotten, Sweden, were randomly invited based on their answers to three screening questions for temporomandibular disorders (TMD). In total, 300 individuals (202 women, 20–69 yrs) were recruited, and examined according to the Diagnostic Criteria for TMD (DC/TMD) after completion of a body pain drawing. Widespread pain was considered present when seven or more pain sites were reported on the widespread pain index. A binary logistic regression model, adjusted for the effect of age and gender were used to evaluate the association between myofascial orofacial pain and widespread pain.

Results: Widespread pain was reported by 31.3% of the study sample. There was a 57.3% overlap with myofascial pain. Widespread pain was associated to myofascial orofacial pain with and myofascial orofacial pain (OR 4.83 95% CI 2.62–9.05 and OR 11.62 95% CI 5.18–27.88, respectively).

Conclusion: These findings reinforce the existing knowledge on the overlap between painful TMD and other chronic pain conditions.

Objective: To analyze the relationship between different sites of elicited pain to muscle palpation (PtP), and reported frequent pain in jaw-face and head.

Materials and methods: The analysis was based on an epidemiological sample of 1200 randomly selected individuals, of which 779 (65%) both completed a questionnaire and participated in a clinical examination. The questionnaire addressed the presence of pain in the jaw-face region and headache, respectively. Part of the clinical examination entailed palpation of the jaw, neck, shoulder, arm, thumb and calf muscles. Logistic regression was applied with pain and headache as dependent variables. A p-value < .05 determined statistical significance.

Results: Five percent of participants reported frequent pain in jaw-face, and 17% reported frequent headaches. In the regression analysis, frequent headaches were significantly associated with jaw muscle PtP (OR 2.1, CI 1.4–3.4), regional PtP (OR 4.5, CI 2.6–7.6), and generalized PtP (OR 6.1, CI 2.2–17.0). Jaw-face pain was significantly associated with regional PtP (OR 5.3, CI 2.2–13.0) and generalized PtP (OR 30.1, CI 9.3–97.0). The relationship between pain prevalence and PtP showed a dose-response pattern.

Conclusions: The study indicates that frequent jaw-face pain and headache are primarily associated with signs of regional and widespread hyperalgesia, which may be linked to the central sensitization mechanism. Signs of widespread hyperalgesia should be accounted for in the diagnostic algorithms when examining patients with pain in the jaw, face, and head regions.