Research Award Winners

Research grants underline the AAOP’s commitment to advancing the field of orofacial pain and ensuring that healthcare professionals are equipped with the latest knowledge and techniques.

View previous award recipients below

2021-2024

Emily Kahnert, DPT, CCTT

Telerehabilitation Effectiveness for Individuals with Temporomandibular Disorders (TMD)

INTRODUCTION:

Temporomandibular joint disorders (TMD) are the second most common musculoskeletal cause of pain and disability in the general population and can become chronic if left untreated. Physical therapy (PT) is an effective strategy to treat patients with TMD, but patients report difficulty accessing high quality specialty care. Remote delivery could increase access to care, but whether or to what extent telerehabilitation (TR) can effectively deliver care for this population is unknown. The objectives of this thesis were: 1. Determine PT diagnostic reliability for in-person (IP) and TR diagnosis of TMD; 2. Determine noninferiority of telerehabilitation for individuals with TMD as compared to in-person PT; and 3. Explore telerehabilitation feasibility and long-term outcomes.

METHODS: After ethical approval, 207 patients with TMD ages 18-69 chose telehealth (n=113) or in-person (n=94) PT according to their preference in this open-label prospective cohort noninferiority trial. Adaptations for telehealth included guiding patients to self-assess with verbal instructions and visual cues. Diagnosis by the PT was completed according to the brief Diagnostic Criteria for TMD and compared to Orofacial pain (OFP) specialist clinical diagnoses (reference standard) to calculate diagnostic agreement between PT and reference in each group for the primary diagnosis of masticatory myalgia using percent agreement and prevalence-adjusted bias-adjusted kappa (PABAK). Individualized PT treatment occurred over 6 weeks at which point the proportion of therapy responders in each group was compared and the lower limit of the 95% confidence interval for the difference between proportions was compared to a 10% noninferiority margin. Participants continued with PT until discharge and optionally completed a qualitative questionnaire to give feasibility data. Intervention mapping according to the Behavior Change Wheel and intervention evaluation according to the acceptability, practicability, effectiveness, affordability, side effects/safety, and equity (APEASE) criteria characterized feasibility.

RESULTS: 200 participants completed the PT evaluation (TR=106, IP=94). Both groups had 95% raw agreement and almost perfect diagnostic agreement between PT and reference diagnosis of masticatory myalgia (IP PABAK=0.89[0.76,0.97]; TR PABAK=0.91[0.79,0.97]). After 6 weeks, 89 participants completed outcome questionnaires in each group. The proportion of therapy responders in each group was TR = 73(62,82)% and IP=62(51,72)% with a small effect size for TR (h=0.30) and the difference between group proportions was 11(-2,25)%. Intervention mapping revealed that adjustments made for TR addressed barriers and intervention evaluation revealed that it satisfied each APEASE criterion for the 11 participants who gave qualitative feedback.

CONCLUSION: Telediagnosis of TMD by a PT was reliable and after 6 weeks of PT, TR was effective and noninferior to IP care according to quality-of-life improvement. Patients demonstrated willingness to engage in TR with higher numbers preferring remote care delivery. Clinically these results show that TR is a viable and desirable care option for this population to increase accessibility for patients with TMD.

OUTCOMES: Thesis defended, University of Minnesota – PhD Rehabilitation Sciences (8/14/24); 3 poster presentations (1. Telerehabilitation for Individuals with Temporomandibular Disorders (TMD): A Non-Inferiority Study. Poster presented at the Combined Sections Meeting of the American Physical Therapy Association 2/16/2024; 2. Virtual and In-Person Physical Therapy Temporomandibular Disorder Diagnosis is Reliable. Poster presented at the 102nd International Association for Dental, Oral, and Craniofacial Research General Session & Exhibition 3/14/2024; 3. Reliability of virtual and in-person physical therapy diagnosis of temporomandibular disorders. Poster presentation at the 33rd Store Kro Club Conference of the Society of Oral Physiology 5/25/2024); 2 oral presentations (1. Telehealth PT is Effective for Patients with TMD. Invited research presentation at the 48th Clinical and Scientific Meeting of the American Academy of Orofacial Pain 5/12/2024; 2. Telerehabilitation effectiveness for individuals with temporomandibular disorders. Oral presentation at the 33rd Store Kro Club Conference of the Society of Oral Physiology 5/25/2024).

CITATIONS: In the process of submitting papers for publication.

2021-2022

Dr. Linda Sangalli

Establishing the Effectiveness of BBTI vs. PSR on Sleep and Pain Parameters in Adults with Musculoskeletal Orofacial Pain

INTRODUCTION:

Brief behavioral interventions targeting pain (e.g., Physical Self-Regulation, PSR) or sleep (e.g., Brief Behavioral Intervention for Insomnia, BBTI) have been shown to be effective for the multidisciplinary management of chronic musculoskeletal orofacial pain (MSK-OFP). Yet, these interventions have usually been delivered in person, with little research on the effectiveness of these interventions when delivered via telehealth. Further, no research has directly compared one intervention to the other to determine if it is more effective to target pain (i.e., PSR) or sleep (i.e., BBTI) when treating MSK-OFP patients.

Testing this requires a fully powered randomized clinical trial (RCT). However, as no RCT of these brief behavioral telehealth interventions has ever been conducted for MSK-OFP, pilot data are needed to establish the feasibility of such a study. The aim of the current pilot study was to preliminary assess the effectiveness of telehealth behavioral interventions on pain and sleep outcomes in a cohort of orofacial pain patients, and to evaluate whether one intervention was more effective than the other in reducing pain intensity, insomnia symptomatology, and quality of life.

METHODS: Participants with chronic MSK-OFP (>3 months) who self-reported sleep disturbances were recruited from a tertiary university-affiliated OFP clinic between December 2021-June 2023, and randomized to either 3-sessions of PSR or BBTI. Participants completed pre- and post-intervention questionnaires via REDCap assessing primary outcomes of pain intensity (Numerical Rating Scale, NRS, 0-10), insomnia symptomatology (Insomnia Severity Index, 0-28), and quality of life (Short-Form Health Survey of Life, SF-12, 0-100); and secondary outcomes of sleep quality (RU Sated scale, 0-12), pain-related disability (Graded Chronic Pain Scale, GCPS), fatigue (Fatigue Assessment Scale, FAS, 10-50), and jaw function limitation (Jaw Function Limitation Scale, JFLS, 0-80). After each session, participants also completed 8-consecutive days of actigraphy monitoring and daily diaries each morning and evening. Difference in outcomes were compared at pre- and post-intervention with paired t-test, by combining the two groups together. Change in outcomes between the two groups were analyzed with mixed factor ANOVA.

RESULTS: Out of 23 eligible patients, 4 declined to participate, while 19 participants (89.5% females, 38.4±12 years old) were randomized either to PSR (N=11) or BBTI (N=8). Through the intervention, N=3 participants drop out. Telehealth behavioral interventions were effective in significantly reducing pain intensity (p=.044), insomnia symptoms (p=.002), quality of life (p=.013), fatigue (p=.022), sleep health (p=.001), and jaw limitation (p=.003). No statistically significant difference was observed between PSR and BBTI in any of the primary or secondary outcomes.

CONCLUSION: These pilot data revealed the feasibility and efficacy of brief behavioral intervention delivered over telehealth for patients with chronic MSK-OFP. A bigger sample size is needed to confirm these results.

OUTCOMES:  Thesis Defended, University of Kentucky – M.S. Orofacial Pain (2022), Poster presented at the IASP Annual Meeting in Toronto (2022), Presentation at AAOP Annual Scientific Session in Florida (2023)

2020-2022

Dr. Iryna Daline

TMD and Endodontic Odontalgia: Screening and Comorbidity Assessment (TOSCA)

INTRODUCTION:

Pain from temporomandibular disorders (TMDs) may mimic endodontic pain, but its prevalence in endodontic patients is unknown. This cross-sectional study investigated the prevalence of painful TMDs in patients presenting for endodontic treatment of a painful tooth. Contribution of TMD pain to the chief complaint and characteristics associated with TMD prevalence were also assessed.

Abstract 1:

INTRODUCTION:  Pain from temporomandibular disorders (TMDs) may mimic endodontic pain, but its prevalence in endodontic patients is unknown. This cross-sectional study investigated the prevalence of painful TMDs in patients presenting for endodontic treatment of a painful tooth. Contribution of TMD pain to the chief complaint and characteristics associated with TMD prevalence were also assessed.

METHODS: Patients reporting tooth pain in the 30 days before attending university clinics for nonsurgical root canal treatment or retreatment were enrolled. Before endodontic treatment, they completed questionnaires and a board-certified orofacial pain specialist/endodontic resident diagnosed TMD using published Diagnostic Criteria for TMD. Log-binomial regression models estimated prevalence ratios to quantify associations with patient characteristics.

RESULTS: Among 100 patients enrolled, prevalence of painful TMDs was 54%. In 26% of patients, TMD pain was unrelated to endodontic pain; in 20%, TMD contributed to their chief pain complaint; and in 8%, TMD was a sole aetiology for pain. TMD prevalence was associated with greater intensity, frequency and duration of the chief pain complaint; pain in more than one tooth; tenderness to tooth percussion and palpation; a diagnosis of symptomatic apical periodontitis; pain medication use; and psychological distress.

CONCLUSION: A majority of patients with tooth pain seeking endodontic treatment had painful TMDs; one quarter had TMD as a component or sole cause of their pain. TMD prevalence was associated with more severe symptoms and signs of tooth pain and with psychological factors. The high frequency of TMD comorbidity warrants consideration in management of endodontic patients with history of toothache.

Abstract 2:

INTRODUCTION:  This study assessed the accuracy of a TMD Pain Screener questionnaire in identifying patients with temporomandibular disorder (TMD) pain among those seeking endodontic treatment for tooth pain. It also investigated whether the screener accuracy could be improved by adding questions regarding putative predictors of TMD status.

METHODS: One hundred patients seeking endodontic treatment for tooth pain were enrolled. Participants completed the 6-question TMD Pain Screener before treatment. A board-certified orofacial pain specialist/endodontic resident conducted endodontic and TMD examinations using validated Diagnostic Criteria for TMD (DC/TMD). The sensitivity (Se), specificity (Sp), and positive/negative predictive values (PPVs/NPVs) were calculated for the 6-question and 3-question versions of the TMD Pain Screener. Logistic regression and receiver operating characteristic curve (AUROC) analyses were performed to determine the screening accuracy.

RESULTS: At the screening threshold of !3, TMD Pain Screener’s sensitivity was 0.85, specificity 0.52, PPV 0.68, and NPV 0.75 for the 6-question version and 0.64, 0.65, 0.69, and 0.61, respectively, for the 3-question version. The AUROC was 0.71 (95% CL: 0.61, 0.82) and 0.60 (95% CL: 0.48, 0.71) for full and short versions, respectively. Adding a rating of current pain intensity of the chief complaint to the screener improved the AUROC to 0.81 (95% CL: 0.72, 0.89) and 0.77 (95% CL: 0.67, 0.86) for full and short versions, respectively, signifying useful overall accuracy.

CONCLUSION: The 6-question TMD Pain Screener, combined with the patient’s rating of current pain intensity of the chief complaint, could be recommended for use in endodontic patients with tooth pain for detecting painful TMD.

OUTCOMES:

  • Thesis defended at the University of North Carolina in 2022 – Master’s Degree awarded;
  • 2 Peer-Reviewed Publications:
    • Journal of Oral Rehabilitation (2022) and
    • Journal of Endodontics (2023)
  • Third manuscript is in preparation for submission to the Journal of Endodontics
  • Abstract presented at 2 meetings:
    • the UNC ASOD Research Day 2022 and the presentation chosen as a finalist for the UNC ASOD Turner award;
    • the American Association of Endodontists 2022 meeting and the presentation received the AAE22 Resident Award for Top 10 Oral Research Presentations ($1,000)
  • Daline was an invited speaker to lecture:
    • at the AAA23 annual meeting (2 lectures),
    • at the Tar Heel Endodontic Association annual meeting (2023), and
    • at AAE Insight Track: Pain (2023)

where she presented the research project findings to over 1,000 endodontists receiving multiple accolades and increased recognition of the importance of TMD screening in endodontic settings by the endodontic community

  • Daline was invited to co-author chapters on non-odontogenic pain including findings from the TOSCA research in two very prestigious endodontic textbooks:
    • 3rd edition of Seltzer and Bender’s Dental Pulp
    • 7th edition of Principles and Practice of Endodontics.

CITATIONS:

  1. Daline IH, Slade GD, Fouad AF, Nixdorf DR, Tchivileva IE. Prevalence of painful temporomandibular disorders in endodontic patients with tooth pain. J Oral Rehabil. 2023 Jul;50(7):537-547. doi: 10.1111/joor.13457. Epub 2023 Apr 14. PMID: 37021602.
  2. Daline IH, Slade GD, Fouad AF, Nixdorf DR, Tchivileva IE. Diagnostic Accuracy of a Temporomandibular Disorder Pain Screener in Patients Seeking Endodontic Treatment for Tooth Pain. J Endod. 2024 Jan;50(1):55-63. doi: 10.1016/j.joen.2023.10.011. Epub 2023 Oct 29. PMID: 38379174.

 

2020 – 2021

Dr. Fernanda Yanez Regonesi

Diagnostic accuracy of a portable device (Bruxoff®) to measure sleep bruxism

 

INTRODUCTION:

Diagnosis of sleep bruxism (SB) challenges clinicians every day due to multiple forms of assessment tools available, including self-reported questionnaires, clinical examinations, portable devices and laboratory polysomnography (PSG). PSG has become the gold standard for evaluating SB, but it can be limited due to cost and restricted accessibility which often is characterized by long waiting times.

BACKGROUND: Diagnosis of sleep bruxism (SB) challenges clinicians every day due to multiple forms of assessment tools available, including self-reported questionnaires, clinical examinations, portable devices and laboratory polysomnography (PSG). PSG has become the gold standard for evaluating SB, but it can be limited due to cost and restricted accessibility which often is characterised by long waiting times. Hence, there is a need for the development of a reliable method that can assess SB in a simple and portable manner, which would offer acceptable sensitivity and specificity to evaluate SB.

OBJECTIVES: The objective of this study was to investigate reliability and validity of the Bruxoff® device for the diagnosis of SB compared to the PSG.

METHODS: Forty-nine subjects underwent one night of polysomnographic study with simultaneous recording with the Bruxoff® device. Rhythmic masticatory muscle ac- tivity (RMMA) index was scored according to published criteria. Pearson correlation, Bland–Altman plot and receiver operating characteristic (ROC) curve outcomes were used to quantify the agreement between both methods.

RESULTS: Receiver operating characteristic analysis showed an acceptable accuracy for the Bruxoff® with sensitivity of 83.3% and specificity of 72% when the cut-off was set at two events per hour. Pearson correlation analysis showed a nearly significant correlation between PSG and Bruxoff® for RMMA index (r = .282 p = .071) and for total SB episodes per night (r = .295 p = .058). Additionally, the Bland–Altman plot re- vealed a consistent and systematic difference in the measurement of events between devices.

CONCLUSION: The Bruxoff® device appears to be a promising diagnostic method for clinical use, but further study is needed.

OUTCOMES: Thesis defensed, University of Kentucky, MS (dentistry 2020), 1 peer reviewed publication, 2 poster submission for national conferences, 1 presentation at National conference AAOP (2022).

CITATION: Yanez-Regonesi F, Eisa E, Judge S, Carlson C, Okeson J, Moreno-Hay I. Diagnostic accuracy of a portable device (Bruxoff®) to measure sleep bruxism. J Oral Rehabil. 2023 Apr;50(4):258-266. doi: 10.1111/joor.13416. Epub 2023 Jan 25. PMID: 36648354

2019-2021

Dr. Beth Groenke

Diagnostic Accuracy of MRI to Detect Vertical Root Fractures in Extracted Endodontically Treated Teeth

INTRODUCTION:

Vertical root fracture (VRF) is known to occur in root canal treated teeth and results in tooth loss. VRFs are difficult to diagnose. Magnetic Resonance Imaging (MRI) has the potential to identify VRF due to beneficial partial volume averaging, without using ionizing radiation. This investigation aimed to compare the sensitivity and specificity of MRI versus cone-beam computed tomography (CBCT) in detecting VRF, using micro-computed tomography (microCT) as the reference standard. It also described the limits of MRI for detecting VRF.

METHODS: 115 extracted human tooth roots were root canal treated using common techniques. VRFs were induced in a proportion that resulted in 62 VRF samples and 53 non-fractured control samples. All samples were imaged in a phantom using MRI and CBCT. Axial images for MRI and CBCT were presented to three board-certified endodontists. Evaluators determined VRF status and a confidence assessment for that decision. 30% of images were resampled to calculate intra- and inter-rater reliability. For MRI, the most coronal slice with discernible VRF was measured on correlated microCT to determine the minimum VRF width (µm).

RESULTS: Sensitivity for MRI and CBCT were 0.66 (95%CI:0.53-0.78) and 0.58 (95%CI:0.45-0.70). Specificity was 0.72 (95%CI:0.58-0.83) and 0.87 (95%CI:0.75-0.95). Intra-rater reliability ranged from k=0.29-0.48 for MRI and k=0.30-0.44 for CBCT. Inter-rater reliability for MRI was k=0.37 and CBCT k=0.49. Median VRF width detected using MRI was 39µm (first quartile:20µm, third quartile: 58µm).

CONCLUSION: MRI demonstrated ability to repeatedly detect VRF as small as 20 µm. There was no significant difference between sensitivity nor specificity for MRI versus CBCT in detecting VRF, despite the early stage of MRI development

OUTCOMES: Thesis Defended, University of Minnesota – M.S. Dentistry (2020), 2 Peer-Reviewed Publications, Presentation at AAOP Annual Scientific Session (2022)

CITATIONS: Groenke, B. R., Idiyatullin, D., Gaalaas, L., Petersen, A., Chew, H. P., Law, A., Barsness, B., Royal, M., Ordinola-Zapata, R., Fok, A., Aregawi, W., & Nixdorf, D. R. (2022). Minimal Detectable Width of Tooth Fractures Using Magnetic Resonance Imaging and Method to Measure. Journal of endodontics, 48(11), 1414–1420.e1.

Groenke, B. R., Idiyatullin, D., Gaalaas, L., Petersen, A., Law, A., Barsness, B., Royal, M., Fok, A., & Nixdorf, D. R. (2023). Sensitivity and Specificity of MRI versus CBCT to Detect Vertical Root Fractures Using MicroCT as a Reference Standard. Journal of endodontics, 49(6), 703–709.

2019-2020

Dr. Flavia P. Kapos

“Social and Contextual Determinants of Chronic Pain in the US: Investigating the Roles of Neighborhood Characteristics and Healthcare Policy”
PhD Dissertation Title: “Social Determinants of Chronic Pain in the United States”

INTRODUCTION:

Social aspects of the biopsychosocial framework of pain have been under theorized and under researched. We proposed a theory-driven conceptual framework to expose multilevel intersectional systems of inequity and pathways through which they may shape pain over the life course and across generations.

METHODS & RESULTS: Using directed acyclic graph-informed regression in a nationally representative sample of US adults, we estimated large relative inequities in high-impact chronic pain (HICP) and number of site-specific pains, especially by family income and education. Inequities in low-impact chronic pain and site-specific pains were smaller. In intersectional decomposition analysis, adults in nearly all doubly marginalized positions of race/ethnicity and socioeconomic position (SEP) were estimated to have higher absolute HICP burden than non-Hispanic White adults with high SEP, and lower absolute HICP burden than expected based on the sum of SEP and race/ethnicity disparities alone.

CONCLUSIONS: Enhanced conceptualization, measurement, and analytic strategies for social determinants of pain may contribute to research and policy strategies towards population health equity.

OUTCOMES: PhD degree received Aug/2021, PhD Dissertation submitted to ProQuest in Sep/2021, Special Sworn Status (SSS) received from US Census Bureau RDC/Department of Commerce in Nov/2020 (maintenance of access has been renewed for subsequent restricted data projects as of April 2024), 1 peer review manuscript under review, 2 abstracts accepted at National (USASP 2020) and International (IASP 2020-2021) pain research conferences, 6 invited presentations at National and International meetings (i.e., Chile 2020, Portugal 2022, IASP Social Aspects of Pain SIG Inaugural Symposium 2022, IADR International Network for Orofacial Pain and Related Disorders Methodology [INfORM] Keynote 2023, virtual presentation at AAOP 2021 annual scientific meeting, and 2021 AAOP webinar series), as well as 3 podcast episodes (Brazil 2022, Quebec 2022, and AAOP 2023).

CITATIONS: [PhD Dissertation] Kapos FP et al. Social determinants of chronic pain in the United States. [Order No. 28714501]. University of Washington; 2021.

[USASP 2020 abstract] Kapos FP, Hajat A. A break in the gradient: relational social class and high-impact chronic pain. J Pain 2021;22:598. doi:10.1016/j.jpain.2021.03.081.

2016-2017

Dr. Marcia Rojas Ramirez

Psychological Variables Predicting Orofacial Pain Outcomes 2-7 years After an Initial Appointment

INTRODUCTION:

Chronic pain in the orofacial region negatively influences quality of life, not only because it interferes with fundamental activities like eating, speaking, and expressing emotions, but also because of the psychological challenges it presents for patients. Depression,1, 2 anxiety,3 and fatigue4 have been cross-sectionally associated to worse pain outcomes in chronic orofacial pain patients, but the ability of these psychological factors to longitudinally predict pain outcomes in orofacial pain populations has been understudied.

METHODS: The purpose of the proposed study is to test the role of depression, anxiety, and fatigue in predicting pain intensity, unpleasantness, interference, and disability following an initial pain evaluation. Patients who had an initial appointment at an orofacial pain center 2-7 years ago will be re-contacted and invited to participate in an online survey that includes a battery of psychological and pain measurements. Data from their initial visit (Time 1) will be extracted from their medical records and used as predictors for pain outcomes 2 to 7 years after initial appointment (Time 2). Based on research showing that depression, anxiety, and fatigue are greater in people with muscular and neuropathic pains than in those with joint pains,5-7 the project also aims to explore whether psychological variables are better predictors of pain outcomes for some orofacial pain conditions than for others. The longitudinal nature of the study will expand on the existing literature regarding the association of psychological contributors to chronic pain trajectories and the creation of latent variables will allow us to capture the multidimensional nature of depression, anxiety, and fatigue.

RESULTS: Of 1499 eligible participants that were invited to complete the online survey, 280 provided complete data. Of those, 27% were no longer having an orofacial pain complaint. The initially proposed model structure was modified due to misspecifications. The modified model exhibited adequate global fit indexes (χ2= 111.54 (47), .001, RMSEA = .07 (.053, .087), CFI =.971, SRMR=.495) and acceptable measures of reliability. None of the proposed predictors of the modified model had a direct effect on pain outcomes (p > .05) in the SEM analysis.

CONCLUSION: The findings suggest that neither fatigue nor psychological factors were significant predictors of orofacial pain outcomes. Approximately 75% of the participants continued to have an orofacial pain complaint. Future research should explore if these associations are sample-, diagnosis-, or gender-specific.

Degree Obtained: Capstone Defended, University of Kentucky – M.P.H (2017)

Poster Presentations:
*Rojas Ramírez, M.V., Boggero, I.A. (2019, May). Pain status predicts satisfaction with life in a sample of women with orofacial pain: Insights from a longitudinal study. Poster presentation at the 43nd Scientific Meeting. AAOP. San Diego, California.

Boggero, I.A., Rojas Ramírez, M.V., King, C.D. (2019, May). Fatigue subtypes predict pain interference differently in younger and older adults with chronic orofacial pain: A cross-sectional study. Poster presentation at the 43nd Scientific Meeting. AAOP. San Diego, California.

Rojas Ramírez, M.V., Boggero, I.A., Carlson, C.R. (2018, May). Using fatigue and pain interference to predict pain status 3-7 years later: Longitudinal insights in chronic orofacial pain populations. Poster presentation at the 42nd Scientific Meeting. AAOP. Chicago, Illinois. ***First place award in poster competition

CITATION: Rojas-Ramirez, Marcia Vanessa, “Using structural equation modeling to predict orofacial pain-related outcomes” (2017). Theses and Dissertations–Public Health (M.P.H. & Dr.P.H.). 171.


2014-2015

Dr. Yasmin Fadol

Immediate effect of ultrasound therapy on bilateral masseter myalgia: A Randomized single-blinded investigative trial

 

INTRODUCTION:

Dose-response data for therapeutic ultrasound treatment of jaw muscle pain are sparse, so the first aim was to determine a dose response relationship of therapeutic ultrasound among four doses: two intensities (0.4 W/cm2 and 0.8 W/cm2) and two duty cycles (50% and 100%).

METHODS: Twenty-eight adult females with bilateral myalgia were randomly allocated to the four intervention doses.  Therapeutic ultrasound was applied on the masseter for five minutes on each side sequentially. The following outcomes were measured before and immediately after each intervention:  Self-reported pain scores (SRPS), pressure pain threshold (PPT) for the masseter and the temporalis muscles, and intraoral temperature adjacent to the treated masseter.

RESULTS: SRPS showed neither significant interaction among the doses, nor significant main effects (all p>0.05).  PPT of the masseter showed a significant main effect of intensity (p= 0.006).  Intraoral temperature was significantly related to the duty cycle (p= 0.005).  A significant segmental effect of the PPT of the temporalis was found for intensity (p= 0.04). 

CONCLUSION: The use of 0.4 W/cm2 with a 100% duty cycle was immediately effective in increasing the PPT of painful masticatory muscles and showed an increase in intraoral temperature adjacent to the treated area.

OUTCOMES: Thesis Defended, Presented at AAOP Annual Scientific Session (2016)

CITATION: Yasmin Fadol, Yoly Gonzalez, Heidi C. Crow, W.d. Mccall Jr. Immediate Effect of Ultrasound on Bilateral Masseter Myalgia: A Randomized Dose-Response Clinical Trial. Journal of Oral & Facial Pain and Headache. 2022. 36(3&4);263-271.

2015-2016

Dr. Elana Y. Laks

Therapeutic Potential of Non-psychoactive Cannabinoids in Dental Pain

INTRODUCTION:

Despite advancements in dental pain management, one of the most common reasons for emergency dental care is orofacial pain. Our study aimed to determine the effects of non-psychoactive Cannabis constituents in the treatment of dental pain and related inflammation.

Despite advancements in dental pain management, one of the most common reasons for emergency dental care is orofacial pain. Our study aimed to determine the effects of non-psychoactive Cannabis constituents in the treatment of dental pain and related inflammation. We tested the therapeutic potential of two non-psychoactive Cannabis constituents, cannabidiol (CBD) and β-caryophyllene (β-CP), in a rodent model of orofacial pain associated with pulp exposure. Sham or left mandibular molar pulp exposures were performed on Sprague Dawley rats treated with either vehicle, the phytocannabinoid CBD (5 mg/kg i.p.) or the sesquiterpene β-CP (30 mg/kg i.p.) administered 1 h pre-exposure and on days 1, 3, 7, and 10 post-exposure. Orofacial mechanical allodynia was evaluated at baseline and post-pulp exposure. Trigeminal ganglia were harvested for histological evaluation at day 15. Pulp exposure was associated with significant orofacial sensitivity and neuroinflammation in the ipsilateral orofacial region and trigeminal ganglion. β-CP but not CBD produced a significant reduction in orofacial sensitivity. β-CP also significantly reduced the expression of the inflammatory markers AIF and CCL2, while CBD only decreased AIF expression. These data represent the first preclinical evidence that non-psychoactive cannabinoid-based pharmacotherapy may provide a therapeutic benefit for the treatment of orofacial pain associated with pulp exposure.

CITATION: Laks EY, Li H, Ward SJ. Non-Psychoactive Cannabinoid Modulation of Nociception and Inflammation Associated with a Rat Model of Pulpitis. Biomolecules. 2023 May 16;13(5):846. doi: 10.3390/biom13050846. PMID: 37238715; PMCID: PMC10216280.

2014 – 2015

Dr. Cynthia P. Diep

Acupuncture treatments for management of burning mouth syndrome (BMS) with a salivary biomarker pilot study

 

INTRODUCTION:

This study has two aims: 1st is to investigate the safety and efficacy of acupuncture in the treatment of patients with BMS; 2nd is to identify target proteins in patients’ saliva. These proteins could be used as biomarkers for simple, non-invasive detection of BMS.


METHODS: #1:Acupuncture treatments were administered once a week for five weeks to 11 BM patients. Their pain visual analog scale (VAS) were marked before and after acupuncture, along with their saliva sample collections. Patients also fill out a VAS-poor rest form describing their restfulness for the past 5 days before treatments.
#2:First, the liquid chromatography with tandem mass spectrometry was used to quantify about 1100 saliva proteins between BMS patients and healthy control subjects. Statistical analysis was followed to identify 50 significantly different proteins between BMS and healthy subjects. A panel of 3 biomarkers, alpha-enolase, IL-18, and kallikrein 13 were chosen for further validation by ELISA.

RESULTS: #1:Data demonstrated a pain reduction of a 33.74% at 3rd and 50.72% at 5th acupuncture treatments with no adverse reaction.
#2:Our study indicated the utility of alpha-enolase, IL-18 and kallikrein 13 as valuable biomarkers for detection of BMS. The saliva of BMS patients with acupuncture treatments has shown changes in these biomarkers.

CONCLUSION: Acupuncture could be an effective and safe modality for the treatment of recalcitrant BMS. It was confirmed with the changes of patients’ salivary biomarkers, which could be useful in objectively monitoring BMS treatment- therapies.

OUTCOMES:
1 Publication at Sage
2 poster presentations, 1 at AAOP 2015 meeting, 1 at Society of Acupuncture Research at UC San Francisco, Stanford 2017
Oral presentation at the Society of Acupuncture Research at UC San Francisco, Stanford 2017

CITATION: Ji EH, Diep C, Liu T, et al. Potential protein biomarkers for burning mouth syndrome discovered by quantitative proteomics. Molecular Pain. 2017;13. doi:10.1177/1744806916686796

 

2013-2014

Dr. Adam Donnell

High-Definition and Non-invasive Brain Modulation of Pain and Motor Dysfunction in Chronic TMD

 

INTRODUCTION:

Temporomandibular disorders (TMD) have a high prevalence and in many patients pain and masticatory dysfunction persist despite a range of treatments. Non-invasive brain neuromodulatory methods, namely transcranial direct current stimulation (tDCS), can provide relatively long-lasting pain relief in chronic pain patients.

OBJECTIVES: To define the neuromodulatory effect of five daily 2×2 motor cortex high-definition tDCS (HD-tDCS) sessions on clinical pain and motor measures in chronic TMD patients. It is predicted that M1 HD-tDCS will selectively modulate clinical measures, by showing greater analgesic after-effects compared to placebo, and active treatment will increase pain free jaw movement more than placebo.

METHODS: Twenty-four females with chronic myofascial TMD pain underwent five daily, 20-min sessions of active or sham 2 milliamps (mA) HD-tDCS. Measurable outcomes included pain-free mouth opening, visual analog scale (VAS), sectional sensory-discriminative pain measures tracked by a mobile application, short form of the McGill Pain Questionnaire, and the Positive and Negative Affect Schedule. Follow-up occurred at one-week and four-weeks post-treatment.

RESULTS: There were significant improvements for clinical pain and motor measurements in the active HD-tDCS group compared to the placebo group for: responders with pain relief above 50% in the VAS at four-week follow-up (P = 0.04); pain-free mouth opening at one-week follow-up (P < 0.01); and sectional pain area, intensity and their sum measures contralateral to putative M1 stimulation during the treatment week (P < 0.01). No changes in emotional values were shown between groups.

CONCLUSION: Putative M1 stimulation by HD-tDCS selectively improved meaningful clinical sensory-discriminative pain and motor measures during stimulation, and up to four-weeks post-treatment in chronic myofascial TMD pain patients.

We would like to thank our key 2024 research sponsors

Dr. Ghabi A Kaspo