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      Myogenous temporomandibular disorders and salivary markers of oxidative stress—A cross‐sectional study

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          Abstract

          Background

          The clinical care of chronic pain requires personalised understanding of the mechanisms involved. Temporomandibular disorders (TMD) are the most common chronic orofacial pain conditions, and oxidative stress has been proposed to be implicated in their pathophysiology, especially in arthrogenous TMD. However, few studies have explored oxidative stress in myogenous TMD (TMDM).

          Objective

          The aims of this study were to compare the salivary oxidative stress profiles between individuals with TMDM and healthy controls, and to explore associations of these markers with clinical characteristics.

          Methodology

          Saliva samples were collected from 39 individuals with TMDM and 37 age and sex‐matched healthy volunteers. Psychological stress levels and clinical characteristics were assessed in all participants. The samples were analysed for total oxidant status (TOS), total antioxidative capacity (TAC) and superoxide dismutase activity (SODa). Comparisons between groups were performed using parametric and non‐parametric tests depending on data distribution.

          Results

          Psychological stress was higher in TMDM compared to controls ( P < .001). TAC levels were significantly higher ( P < .05) whereas TOS levels were significantly lower ( P < .05) in TMDM compared to controls. There were no differences in SODa levels between groups and no correlations were found between clinical characteristics and oxidative stress markers.

          Conclusion

          Individuals with TMDM showed higher levels of antioxidative markers, but lower levels of oxidative markers. These results can be explained in part by chronicity and adaptation to the disease and other factors, such as psychological stress. Longitudinal studies must be conducted to clarify the role of oxidative stress in TMDM.

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          Most cited references49

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          Oxidative Stress: Harms and Benefits for Human Health

          Oxidative stress is a phenomenon caused by an imbalance between production and accumulation of oxygen reactive species (ROS) in cells and tissues and the ability of a biological system to detoxify these reactive products. ROS can play, and in fact they do it, several physiological roles (i.e., cell signaling), and they are normally generated as by-products of oxygen metabolism; despite this, environmental stressors (i.e., UV, ionizing radiations, pollutants, and heavy metals) and xenobiotics (i.e., antiblastic drugs) contribute to greatly increase ROS production, therefore causing the imbalance that leads to cell and tissue damage (oxidative stress). Several antioxidants have been exploited in recent years for their actual or supposed beneficial effect against oxidative stress, such as vitamin E, flavonoids, and polyphenols. While we tend to describe oxidative stress just as harmful for human body, it is true as well that it is exploited as a therapeutic approach to treat clinical conditions such as cancer, with a certain degree of clinical success. In this review, we will describe the most recent findings in the oxidative stress field, highlighting both its bad and good sides for human health.
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            Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†.

            The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments. Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project-the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings. The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive self report instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions. The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations.
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              Clinical Relevance of Biomarkers of Oxidative Stress

              Abstract Significance: Oxidative stress is considered to be an important component of various diseases. A vast number of methods have been developed and used in virtually all diseases to measure the extent and nature of oxidative stress, ranging from oxidation of DNA to proteins, lipids, and free amino acids. Recent Advances: An increased understanding of the biology behind diseases and redox biology has led to more specific and sensitive tools to measure oxidative stress markers, which are very diverse and sometimes very low in abundance. Critical Issues: The literature is very heterogeneous. It is often difficult to draw general conclusions on the significance of oxidative stress biomarkers, as only in a limited proportion of diseases have a range of different biomarkers been used, and different biomarkers have been used to study different diseases. In addition, biomarkers are often measured using nonspecific methods, while specific methodologies are often too sophisticated or laborious for routine clinical use. Future Directions: Several markers of oxidative stress still represent a viable biomarker opportunity for clinical use. However, positive findings with currently used biomarkers still need to be validated in larger sample sizes and compared with current clinical standards to establish them as clinical diagnostics. It is important to realize that oxidative stress is a nuanced phenomenon that is difficult to characterize, and one biomarker is not necessarily better than others. The vast diversity in oxidative stress between diseases and conditions has to be taken into account when selecting the most appropriate biomarker. Antioxid. Redox Signal. 23, 1144–1170.
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                Author and article information

                Contributors
                victor.madariaga@alumni.uni-heidelberg.de
                Journal
                J Oral Rehabil
                J Oral Rehabil
                10.1111/(ISSN)1365-2842
                JOOR
                Journal of Oral Rehabilitation
                John Wiley and Sons Inc. (Hoboken )
                0305-182X
                1365-2842
                05 October 2020
                January 2021
                : 48
                : 1 ( doiID: 10.1111/joor.v48.1 )
                : 1-9
                Affiliations
                [ 1 ] Division of Oral Diagnostics and Rehabilitation Department of Dental Medicine Karolinska Institutet and Scandinavian Center for Orofacial Neurosciences (SCON) Huddinge Sweden
                [ 2 ] Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
                Author notes
                [*] [* ] Correspondence

                Víctor Ignacio Madariaga, Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet and Scandinavian Center for Orofacial Neurosciences (SCON), Alfred Nobel Allé 8, BOX 4064, SE14104 Huddinge, Sweden.

                Email: victor.madariaga@ 123456alumni.uni-heidelberg.de

                Author information
                https://orcid.org/0000-0002-3445-3097
                https://orcid.org/0000-0003-2352-8070
                https://orcid.org/0000-0002-6396-5104
                https://orcid.org/0000-0003-4152-5439
                Article
                JOOR13100
                10.1111/joor.13100
                7820944
                32979853
                27b358b0-677f-4d5b-a661-850117f6e42a
                © 2020 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 September 2020
                Page count
                Figures: 2, Tables: 2, Pages: 9, Words: 6446
                Funding
                Funded by: Vetenskapsrådet , open-funder-registry 10.13039/501100004359;
                Award ID: K2009‐52P‐20943‐03‐2
                Award ID: 2014‐2979
                Funded by: Stockholms Läns Landsting , open-funder-registry 10.13039/501100004348;
                Funded by: Karolinska Institutet , open-funder-registry 10.13039/501100004047;
                Funded by: Reumatikerförbundet
                Funded by: Sveriges Tandläkarförbund , open-funder-registry 10.13039/501100005300;
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                January 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.6 mode:remove_FC converted:22.01.2021

                Dentistry
                antioxidants,craniomandibular disorders,myalgia,myofascial pain syndromes,oxidative stress,saliva

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