Difference between revisions of "Conclusion of the ‘Normal Science’ section"

Chronic 'OP' conditions can be particularly challenging to diagnose and treat due to their complexity and limited understanding of the mechanisms underlying their etiology and pathogenesis.<ref>NASEM Temporomandibular Disorders: Priorities for Research and Care The National Academies Press, Washington, DC (2020), 10.17226/25652</ref><ref>B.J. Sessle. Chronic orofacial pain: models, mechanisms, and genetic and related environmental influences. Int J. Mol. Sci., 22 (2021), p. 7112, 10.3390/ijms22137112</ref> A frequent characteristic of 'OP' is the multifactorial nature of the pathology, which further complicates diagnosis. TMDs, for example, referred to variously as Temporo-Mandibular Disorders (TMDs), Cranio Facial Pain (CFP), and Temporo-Mandibular Joint Dysfunction (TMJ dysfunction) in Anglo-Saxon countries, sometimes present diagnostic challenges. The orofacial pain caused by TMDs often overlaps with symptoms and clinical signs similar to other painful disorders, which may be manifestations of other systemic neurological diseases. This clinical scenario can make differential diagnosis difficult, especially in the early stages of the disease.<ref>Sollecito T.P., Richardson R.M., Quinn P.D., Cohen G.S.: Intracranial schwannoma as atypical facial pain. Case report. Oral Surg Oral Med Oral Pathol. 1993;76:153-6</ref><ref>Shankland W.E.: Trigeminal neuralgia: typical or atypical? Cranio. 1993;11:108-12.</ref><ref>Graff-Radford S.B., Solberg W.K.: Is atypical odontalgia a psychological problem? Oral Surg Oral Med Oral Pathol. 1993;75:579-82.</ref><ref>Ruelle A., Datti R., Andrioli G.: Cerebellopontine angle osteoma causing trigeminal neuralgia: case report. Neurosurgery. 1994;35:1135-7.</ref> In a percentage of patients with functional disorders of the stomatognathic apparatus, some peripheral risk factors, i.e., occlusal, have been identified<ref>B.C. Cooper Temporomandibular disorders: a position paper of the International College of Cranio-Mandibular Orthopedics (ICCMO) Cranio, 29 (2011), pp. 237-244, 10.1179/crn.2011.034</ref><ref>M.S. Nguyen, T. Jagomägi, T. Nguyen, M.Saag, Ü. Voog-Oras Occlusal support and temporomandibular disorders among elderly Vietnamese Int J. Prosthodont, 30 (2017), pp. 465-470, 10.11607/ijp.5216</ref><ref>M.S. Nguyen, M. Saag, T. Jagomägi, Q.H.Nguyen, Ü. Voog-Oras The impact of occlusal support on temporomandibular disorders: a literature review Proc. Singap. Healthc., 31 (2021), pp. 1-12, 10.1177/2010105821102</ref><ref>T.R. Walton, D.M. Layton Mediotrusive occlusal contacts: best evidence consensus statement J. Prosthodont, 30 (S1) (2021), pp. 43-51, 10.1111/jopr.13328</ref><ref>A. Kucukguven, M.D. Demiryurek, I.Vargel Temporomandibular joint innervation: anatomical study and clinical implications Ann. Anat., 240 (2022), Article 151882, 10.1016/j.aanat.2021.151882</ref><ref>E. Tervahauta, L. Närhi, P. Pirttiniemi, K.Sipilä, R. Näpänkangas, M. Tolvanen, V.Vuollo, A.S. Silvola Prevalence of sagittal molar and canine relationships, asymmetries and midline shift in relation to temporomandibular disorders (TMD) in a Finnish adult population Acta Odontol. Scand., 80 (2022), pp. 1-11, 10.1080/00016357.2022.2036364</ref> as well as a series of central biopsychosocial risk factors concerning Central Nervous System dysfunctions.<ref>R.B. Fillingim, R. Ohrbach, J.D.Greenspan, C. Knott, R. Dubner, E. Bair, C. Baraian, G.D. Slade, W. Maixner Potential psychosocial risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA case-control study J. Pain., 12 (11 Suppl) (2011), pp. T46-T60, 10.1016/j.jpain.2011.08.007</ref><ref>G.D. Slade, R. Ohrbachm, J.D.Greenspan, R.B. Fillingim, E. Bair, A.E.Sanders, R. Dubner, L. Diatchenko, C.B.Meloto, S. Smith, W. Maixner Painful temporomandibular disorder: decade of discovery from OPPERA studies J. Dent. Res, 95 (10) (2016), pp. 1084-1092, 10.1177/0022034516653743</ref><ref>G.D. Slade, R. Ohrbach, J.D. Greenspan, R.B. Fillingim, E. Bair, A.E. Sanders, R.Dubner, L. Diatchenko, C.B. Meloto, S.Smith, W. Maixner Painful temporomandibular disorder: decade of discovery from OPPERA studies J. Dent. Res, 95 (2016), pp. 1084-1092, 10.1177/0022034516653743</ref> However, these studies have not provided new information on the main causes of TMDs and their implications for managing these patients<ref>P. Svensson, F. Exposto Commentary 2: further evidence for overlaps among chronic pain conditions-but no news about causal relationships J. Oral. Facial Pain. Headache, 34(Suppl) (2020), pp. s6-s8, 10.11607/ofph.2020.suppl.c2</ref> and consequently, a wide variety of mostly conservative treatments have been proposed<ref>C.S. Stohler, G.A. Zarb On the management of temporomandibular disorders: a plea for a low-tech, high-prudence therapeutic approach J. Orofac. Pain., 13 (1999), pp. 255-261</ref><ref>J. Feng, M. Luo, J. Ma, Y. Tian, X. Han, D.Bai The treatment modalities of masticatory muscle pain a network meta-analysis Med. (Baltim. ), 98 (2019), Article e17934, 10.1097/MD.0000000000017934</ref><ref>Z. Al-Ani Occlusion and temporomandibular disorders: a long-standing controversy in dentistry Prim. Dent. J., 9 (2020), pp. 43-48, 10.1177/2050168420911029</ref><ref>C. Penlington, C. Bowes, G. Taylor, A.A.Otemade, P. Waterhouse, J. Durham, R.Ohrbach Psychological therapies for temporomandibular disorders (TMDs) Cochrane Database Syst. Rev., Issue 8(2022), Article CD013515, 10.1002/14651858.CD013515.pub2</ref> but the lack of clinical evidence has allowed the role of occlusion in TMDs to be contested<ref>P. Alanen Occlusion and temporomandibular disorders (TMD): still unsolved question? J. Dent. Res, 81 (2002), pp. 518-519, 10.1177/154405910208100803</ref> although there is no scientific evidence contradicting a causal occlusal role in functional disorders.<ref>P. Kirveskari, T. Jamsa, P. Alanen Occlusal adjustment and the incidence of demand for temporomandibular disorder treatment J. Prosthet. Dent., 79 (1998), pp. 433-438, 10.1016/s0022-3913(98)70158-1</ref><ref>T. de Abreu, C. Bahia, T. Foscaldo, P.Senna, H. de Souza, R. Fischer, P.Kirveskari Effect of occlusal equilibration on masticatory muscle activity in females with sleep bruxism: a double-blind randomised controlled trial J. Sleep. Res., 14 (2023), Article e13879, 10.1111/jsr.13879</ref>