BACKGROUND: The reduction in joint load is a potential beneficial factor in managing osteoarthritis of the temporomandibular joint (TMJ). This paper aims to compare the effectiveness of the intramuscular injection of botulinum toxin (BTX-A) as an adjunct to TMJ arthrocentesis plus viscosupplementation with arthrocentesis plus viscosupplementation alone in the management of TMJ osteoarthritis.
METHODS: A pilot clinical retrospective study examined TMJ osteoarthritis treatments. Patients were divided into two groups: Group A received BTX-A injections and arthrocentesis with viscosupplementation, while Group B received only arthrocentesis with viscosupplementation. The study assessed outcomes based on mouth opening (MO), pain at rest (PR), pain at mastication (PF), and masticatory efficiency (ME) at various time points (baseline (T0), 1 week (T1), 2 weeks (T2), 3 weeks (T3), and 4 weeks (T4)) up to 2 months after treatment.
RESULTS: The study included two groups, each with five patients. Group A received five weekly sessions of arthrocentesis plus viscosupplementation and a single BTX-A injection during the first arthrocentesis appointment. Group B underwent the five-session protocol of arthrocentesis plus viscosupplementation alone. MO, PF, PR, and ME improved quickly in T2 in both groups, but the improvement was of greater importance over the following weeks and lasted longer in Group A.
CONCLUSIONS: Arthrocentesis with viscosupplementation associated with BTX-A was found to be more effective than arthrocentesis alone in improving clinical outcomes. This suggests that patients with TMJ osteoarthritis and myofascial pain may benefit from reduced muscle tone and joint load.

OBJECTIVE: Few studies investigated the influence of oral parafunctional habits during the COVID-19 pandemic. Since some studies have demonstrated that signs and symptoms of temporomandibular disorder (TMD), as well as psychological alterations, increased during the COVID-19 pandemic lockdown, the aim of this study was to investigate whether social isolation is a situation that increases the prevalence of oral parafunctional habits.
METHODS: This was an observational case-control study. An online survey with questions about TMD symptoms (Diagnostic Criteria Symptom Questionnaire) and oral parafunctional habits (Oral Behaviours Checklist [OBC]) was administered to Brazilian residents at two different times (2020 and 2021). The participants were divided according to social isolation practices into study groups (GI: 2020, n = 507; GIII: 2021, n = 282) and control groups (GII: 2020, n = 98; GIV: 2021, n = 202).
RESULTS: In each group, we evaluated the association of the frequency of oral parafunctional habits with the symptoms of TMD, and we observed that individuals with a greater presence of painful TMD present a greater number of oral parafunctional habits. Despite the literature showing that individuals who practiced social isolation developed more oral parafunctional habits, when analysing the association of the OBC questions in Groups GI × GII and GIII × GIV, only \'sustained talking\' (p = .0022) and \'hold telephone between your hand and shoulders\' (p = .0124) showed a significant difference in GI × GII. Kendall\'s coefficient of concordance revealed that there was a very strong concordance (GI × GII 0.9515 (p = .0087) and GIII × GIV 0.9655 (p = .0074)) between the ranks of the analysed oral parafunctional habits in all groups.
CONCLUSIONS: We can state that Individuals who practiced social isolation did not present more oral parafunctional habits than individuals who did not.

Glossopharyngeal neuralgia due to vertebrobasilar dolichoectasia is a rare form of neuropathic pain, and presents diagnostic and therapeutic challenges. Clinical presentation: A 67-year-old man presented with severe burning pain in the left oral cavity, with no explanatory findings during dental and ear, nose, and throat evaluations. Temporomandibular joint examination revealed tenderness, and panoramic radiographs showed a noncontributory periapical radiolucency. Magnetic resonance imaging/magnetic resonance angiography revealed abnormally tortuous vertebral arteries compressing the glossopharyngeal nerves and the brainstem. Topical lidocaine reduced pain, confirming glossopharyngeal neuralgia. Carbamazepine was initially ineffective, but at 200 mg pain reduced from 90 to 20 on the visual analog scale. The patient requested and underwent microvascular decompression surgery, which eliminated his pain. Conclusion: When the vertebral artery compresses the glossopharyngeal nerve, the pain is more intense, attributed to its thicker vascular structure. Local anesthetic testing aids in identifying glossopharyngeal neuralgia. Dental practitioners must be skilled in diagnostics and possess anatomical knowledge for accurate evaluation and referral of throat and ear pain.

In this case report, the authors reviewed a rare case of a vestibular schwannoma manifesting as trigeminal neuralgia (TN). Intracranial tumors can have a variety of orofacial pain symptoms. Among benign cerebellopontine angle tumors, vestibular schwannoma is the most common cause of a TN-like manifestation. Although the most common symptoms of a vestibular schwannoma are hearing loss and vestibulopathy, the unique feature of this case was the manifestation of symptoms consistent with TN.
The patient had right-sided episodic facial pain that was short in duration and severe in intensity. The initial differential diagnoses included short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing and TN. As part of the routine evaluation, the patient was referred for brain magnetic resonance imaging, which revealed a right-sided vestibular schwannoma. The patient was prescribed 200 mg of gabapentin 3 times daily and was referred to neurosurgery for excision of the schwannoma. Surgical excision resulted in complete resolution of pain.
This case illustrates the importance of interdisciplinary treatment and how it can lead to an optimal outcome for a patient with complex orofacial pain symptoms.

Rhythmic masticatory muscle activity (RMMA) is a periodic muscle activity that characterises sleep bruxism (SB) events. These can occur as a single event, in pairs, or in clusters. Since RMMA episodes often occur in clusters and the relevance of this occurrence is unknown, we conducted a study to investigate the effect of RMMA clusters on sleep fragmentation and the severity of orofacial muscle pain. This study involved a secondary analysis using data from 184 adult subjects with orofacial muscle pain who underwent definitive polysomnography (PSG) for sleep bruxism diagnosis. Self-reported orofacial muscle pain (OFMP) was assessed using the numeric rating scale, and additional evaluation of side-to-side equivalence (symmetry) was described using a binary system. Among the 184 participants, 60.8% (n = 112) did not exhibit clusters and among the 72 participants with clusters, 36.1% (n = 26) and 63.9% (n = 46) were in the high and low RMMA frequency groups, respectively. The high SB group had significantly three times more phasic RMMA events than the noncluster group. A total of 89.67% (n = 165) of subjects reported orofacial muscle pain. While there was no difference in the severity of OFMP among groups, a significant decrease in symmetry between the severity of temporal muscle pain on the left and right sides was noted in the cluster group compared with the noncluster group. Clustering of RMMA events is associated with sleep fragmentation. The asymmetry of temporal muscle pain is related to the presence of RMMA clusters in sleep bruxism.

Chronic orofacial pain, by definition, is a pain that can anatomically extend anywhere between the area just under the orbitomeatal line, anterior to the pinnae, and above the neck. It occurs for 15 days or more per month, lasting four or more hours daily, for at least three months. Chronic orofacial pain, including persistent idiopathic facial pain syndrome, can significantly impact patients\' quality of life and pose challenges for effective management. This case report describes a successful transnasal approach in treating a patient with severe oral pain following a bone graft surgery by blocking the sphenopalatine ganglion. The block provided significant pain relief and improved the patient\'s daily functioning. This minimally invasive treatment option offers an alternative for managing chronic orofacial pain after dental procedures such as bone graft surgery.

Burning mouth syndrome (BMS) is a rare disorder primarily affecting the oral mucosa and characterized by a chronic burning sensation without specific oral mucosal lesions. This paper presents a case of a 54-year-old adult male patient who complained of chronic burning mouth pain. The clinical diagnosis was made after excluding various differentials, including oral candidiasis, hairy oral leukoplakia, gastroesophageal reflux disease, oral lichen planus, local infective processes, and nutritional deficiencies. Physical examination did not reveal specific signs or lesions related to BMS; however, considering the patient\'s signs, symptoms, and the exclusion of other possibilities, a possible diagnosis of BMS was considered. The patient was evaluated in an outpatient setting, and management was conducted in this setting to reduce patient costs. This presentation is considered rare, as the disorder predominantly affects postmenopausal females, and most proposed theories behind its pathophysiology revolve around estrogen-mediated modulation of pain receptors. Currently, diagnostic and management criteria for BMS may vary and continue to evolve. The management of this patient focuses on patient education and routine follow-up. This case report presents the management of this particular case, along with a review of other proposed management options.

This paper presents a clinical case study investigating the pattern of a saxophonist\'s embouchure as a possible origin of orofacial pain. The rehabilitation addressed the dental occlusion and a fracture in a metal ceramic bridge. To evaluate the undesirable loads on the upper teeth, two piezoresistive sensors were placed between the central incisors and the mouthpiece during the embouchure. A newly fixed metal ceramic prosthesis was placed from teeth 13 to 25, and two implants were placed in the premolar zone corresponding to teeth 14 and 15. After the oral rehabilitation, the embouchure force measurements showed that higher stability was promoted by the newly fixed metal-ceramic prosthesis. The musician executed a more symmetric loading of the central incisors (teeth 11 and 21). The functional demands of the saxophone player and consequent application of excessive pressure can significantly influence and modify the metal-ceramic position on the anterior zone teeth 21/22. The contribution of engineering (i.e., monitoring the applied forces on the musician\'s dental structures) was therefore crucial for the correct assessment and design of the treatment plan.

Chronic neuropathic dental pain has a poor prognosis with a low chance of significant spontaneous improvement. Local or oral therapies may be efficient, however short in terms of duration with potential side effects. Cryoneurolysis has been described to prevent acute postoperative pain or to treat some chronic pain conditions; however, application to dental orofacial pain has not been reported so far.
Following a positive diagnostic block on the corresponding alveolar nerve, neuroablation was performed using a cryoprobe on three patients suffering from persistent pain after a dental extraction and 1 after multiple tooth surgeries. The effect of treatment was assessed using a Pain Numeric Rating Scale (NRS) and determined by changes in medication dosage and quality of life at day 7 and 3 months. Two patients experienced more than 50% of pain relief at 3 months, 2 by 50%. One patient was able to wean off pregabalin medication, one decreased amitriptyline by 50%, and one decreased tapentadol by 50%. No direct complications were reported. All of them mentioned improvement in sleep and quality of life.
Cryoneurolysis on alveolar nerves is a safe and easy-to-use technique allowing prolonged neuropathic pain relief after dental surgery.

BACKGROUND: The orofacial pain syndromes (OFPs) are a heterogeneous group of syndromes characterized by painful attacks involving the orofacial structures. They may be summarily subdivided into two great categories: (1) orofacial pain mainly attributed to dental disorders such as dentoalveolar and myofascial orofacial pain or temporomandibular joint (TM) pain; (2) orofacial pain mainly attributed to non-dental pain as neuralgias, facial localization of primary headaches or idiopathic orofacial pain. The second group is uncommon, often described by single case reports, can often show overlapping symptoms with the first group, and represents a clinical challenge, carrying the risk of undervaluation and possibly invasive odontoiatric treatment. We aimed to describe a clinical pediatric series of non-dental orofacial pain and better to underline some topographic and clinical features associated with them. We retrospectively collected the data of children admitted to our headache centers (Bari, Palermo, Torino) from 2017 to 2021. Our inclusion criterion was the presence of non-dental orofacial pain following the topographic criteria of 3° International Classification of Headache Disorders (ICHD-3), and exclusion criteria included the pain syndromes attributed to the dental disorders and pain syndromes due to the secondary etiologies Results. Our sample comprised 43 subjects (23/20 M/F, in the range of ages 5-17). We classified them int: 23 primary headaches involving the facial territory during attacks, 2 facial trigeminal autonomic cephalalgias, 1 facial primary stabbing headache, 1 facial linear headache, 6 trochlear migraines, 1 orbital migraine 3 red ear syndrome and 6 atypical facial pain. All patients described debilitating pain for intensity (moderate/severe), 31 children had episodic attacks, and 12 had continuous pain. Almost all received drugs for acute treatment (less than 50% were satisfied), and some received non-pharmacological treatment associated with drug therapy Conclusion. Although rare OFP can occur in pediatric age, it can be debilitating if unrecognized and untreated, affecting the psychophysical well-being of young patients. We highlight the specific characteristics of the disorder for a more correct and earlier identification during the diagnostic process, already difficult in pediatric age, and to define the approach and possible treatment to prevent negative outcomes in adulthood.