R. Ohrbach
SUNY: University at Buffalo, Oral Diagnostic Sciences, Faculty Member
-
Primary focus is pain research: large multi-site research teams and international collaborations, to investigate diagnostic systems, etiology, mechanisms, and treatment.edit
Research Interests:
Research Interests:
Psychology, Algorithms, Dentistry, Radiology, Biomedical Engineering, and 41 moreResearch Design, Psychometrics, Dental Research, Depression, Magnetic Resonance Imaging, Sound, Temporomandibular Joint, Adolescent, Comorbidity, Osteoarthritis, Italy, Humans, Consensus, Calibration, Female, Male, Young Adult, Translating, Mandible, Dislocations, Palpation, Differential Diagnosis, Arthritis, Aged, Prevalence, Middle Aged, Observer Variation, Adult, Sex Factors, Age Factors, Reproducibility of Results, Oral Rehabilitation, Clinical Competence, Orofacial pain, Sensitivity and Specificity, X ray Computed Tomography, Epidemiologic Studies, Genetic Markers, Neurosciences, Logistic Models, and Temporomandibular Joint Disorders
The dilemma of scientific knowledge versus clinical management of TMD is discussed by focus on five questions; (1) What is scientific evidence and how is it transmitted? (2) What important evidence is lacking in the field of TMD? (3) What... more
The dilemma of scientific knowledge versus clinical management of TMD is discussed by focus on five questions; (1) What is scientific evidence and how is it transmitted? (2) What important evidence is lacking in the field of TMD? (3) What clinical concepts have been challenged by the scientific evidence? (4) Why is there adherence to concepts that appear to conflict with the evidence? (5) How does the clinician provide patient care in the face of uncertainty while retaining scientific integrity? It is concluded that no fundamental reason for a dilemma between scientific evidence and clinical practice need exist provided that (1) clinical investigators use appropriate research protocols and report results in refereed scientific journals and (2) dentists are familiar with the requirements of sound scientific evidence, interpret this evidence and its clinical implications, and apply it to the care of TMD patients.
Research Interests:
Research Interests:
Research Interests:
ABSTRACT The authors tested the hypothesis that obstructive sleep apnea (OSA) signs/symptoms are associated with the occurrence of temporomandibular disorder (TMD), using the OPPERA prospective cohort study of adults aged 18 to 44 years... more
ABSTRACT The authors tested the hypothesis that obstructive sleep apnea (OSA) signs/symptoms are associated with the occurrence of temporomandibular disorder (TMD), using the OPPERA prospective cohort study of adults aged 18 to 44 years at enrollment (n = 2,604) and the OPPERA case-control study of chronic TMD (n = 1,716). In both the OPPERA cohort and case-control studies, TMD was examiner determined according to established research diagnostic criteria. People were considered to have high likelihood of OSA if they reported a history of sleep apnea or ≥ 2 hallmarks of OSA: loud snoring, daytime sleepiness, witnessed apnea, and hypertension. Cox proportional hazards regression estimated hazard ratios (HRs) and 95% confidence limits (CL) for first-onset TMD. Logistic regression estimated odds ratios (OR) and 95% CL for chronic TMD. In the cohort, 248 individuals developed first-onset TMD during the median 2.8-year follow-up. High likelihood of OSA was associated with greater incidence of first-onset TMD (adjusted HR = 1.73; 95% CL, 1.14, 2.62). In the case-control study, high likelihood of OSA was associated with higher odds of chronic TMD (adjusted OR = 3.63; 95% CL, 2.03, 6.52). Both studies supported a significant association of OSA symptoms and TMD, with prospective cohort evidence finding that OSA symptoms preceded first-onset TMD.
Research Interests:
A symposium was held in Toronto, 2008, in which research progress regarding the biobehavioural dimension of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was presented. An extended workshop was held in April... more
A symposium was held in Toronto, 2008, in which research progress regarding the biobehavioural dimension of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was presented. An extended workshop was held in April 2009 in which further recommendations were made from an expert panel, using the 2008 symposium material as a base. This paper is a summary of the 2008 symposium proceedings with elaborations based on further developments. Seven studies were conducted between 2001 and 2008, in which the following were investigated: (i) basic properties of Axis II instruments, (ii) reliability and criterion validity of Axis II instruments, (iii) expansion of predictors, (iv) metric equivalence of the depression and non-specific physical symptoms subscales in the RDC/TMD, (v) laboratory investigation of oral behaviours, (vi) field data collection of oral behaviours, and (vii) functional limitation of the jaw. Methods and results for each of these studies are described. Based on the results of these studies that have been published, as well as the direction of interim results from the few studies that await completion and publication, the biobehavioural domain of the RDC/TMD, as published in 1992, is reliable and valid. These results also provide strong evidence supporting the future growth of the biobehavioural domain as the RDC/TMD matures into subsequent protocols for both clinical and research applications.
Research Interests:
Research Interests:
Research Interests:
Papers in this issue investigate when and how putative risk factors influence development of first-onset, painful temporomandibular disorder (TMD). The results represent first findings from the Orofacial Pain: Prospective Evaluation and... more
Papers in this issue investigate when and how putative risk factors influence development of first-onset, painful temporomandibular disorder (TMD). The results represent first findings from the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) prospective cohort study that monitored 2,737 men and women aged 18 to 44 years recruited at 4 U.S. study sites. During a median 2.8-year follow-up period, 260 participants developed TMD. The average incidence rate of 4% per annum was influenced by a broad range of phenotypic risk factors including sociodemographic characteristics, health status, clinical orofacial factors, psychological functioning, pain sensitivity, and cardiac autonomic responses. A novel method of multivariable analysis used random forest models to simultaneously evaluate contributions of all 202 phenotypic variables. Variables from the health status domain made the greatest contribution to TMD incidence, followed closely by psychological and clinical orofacial domains. However, only a few measures of pain sensitivity and autonomic function contributed to TMD incidence, and their effects were modest. Meanwhile, age and study site were independent predictors of TMD incidence, even after controlling for other phenotypes. Separate analysis of 358 genes that regulate pain found several novel genetic associations with intermediate phenotypes that, themselves, are risk factors for TMD, suggesting new avenues to investigate biological pathways contributing to TMD. Collectively, the papers in this issue demonstrate that TMD is a complex disorder with multiple causes consistent with a biopsychosocial model of illness. It is a misnomer and no longer appropriate to regard TMD solely as a localized orofacial pain condition.
Research Interests:
Research Interests:
Research Interests:
Your browser version may not work well with NCBI's web applications. More information here... ...
Research Interests:
ABSTRACT To examine whether any signs and symptoms of temporomandibular disorders were significantly associated with masseter muscle activity levels during sleep. One hundred three healthy adult subjects (age range, 22 to 32 years)... more
ABSTRACT To examine whether any signs and symptoms of temporomandibular disorders were significantly associated with masseter muscle activity levels during sleep. One hundred three healthy adult subjects (age range, 22 to 32 years) participated in the study. They were asked to fill out questionnaires, undergo a calibrated clinical examination of their jaws and teeth, and perform 6 consecutive nightly masseter electromyographic (EMG) recordings with a portable EMG recording system in their home. The EMG data were considered dependent variables, while the questionnaire and examination data were considered independent variables. Multiple stepwise linear regression analysis was utilized to assess possible associations between these variables. Both gender and joint sound scores were significantly related to the duration of EMG activity. None of the other independent variables were found to be related to any of the muscle activity variables. The results suggest that both gender and clicking are significantly related to duration of masseter EMG activity during sleep.
Research Interests:
ABSTRACT
Research Interests:
Research Interests:
Dentistry, Magnetic Resonance Imaging, Temporomandibular Joint, Medicine, Oral and Maxillofacial Surgery, and 12 moreHumans, Female, Male, Dislocations, Middle Aged, Image Enhancement, Adult, Temporal Bone, Asymptomatic, Temporomandibular Joint Disorders, Elastic tissue, and Magnetic resonance image
ABSTRACT
Research Interests:
Research Interests:
Research Interests:
Dentistry, Magnetic Resonance Imaging, Temporomandibular Joint, Medicine, Logistic Regression, and 15 moreOral and Maxillofacial Surgery, Humans, Physical Rehabilitation, Female, Male, Patient Satisfaction, Dislocations, Displacement, Risk factors, Adult, Odds ratio, Retrospective Studies, Bruxism, Risk Factors, and Nuclear Magnetic Resonance Imaging
Research Interests:
We conducted this case-control study to determine the role of 2 neuropsychologic variables (sleep and depression) as possible risk indicators for the development of temporomandibular disorders (TMD). Neuropsychologic tests, traditional... more
We conducted this case-control study to determine the role of 2 neuropsychologic variables (sleep and depression) as possible risk indicators for the development of temporomandibular disorders (TMD). Neuropsychologic tests, traditional signs and symptoms of TMD, and social and economic variables were analyzed. Seventy-two predominantly muscle-related TMD patients (Research Diagnostic Criteria for TMD groups Ia, Ib, and IIIa) and 30 age- and sex-matched pain-free controls were included in the population. Overall, TMD patients had statistically significantly higher sleep and depression scores on the Sleep Assessment Questionnaire and on the Brazilian Portuguese version of the Beck Depression Inventory, with odds ratios of 5 and 1.6, respectively. These results remained unchanged even after controlling for 8 confounders in the logistic regression analysis. Spontaneous pain and pain on palpation (grade 2 or higher) were also statistically significantly worse in TMD patients. In the forward-step logistic regression analysis, we also found that the combination of our best TMD predictors (ie, sleep, cigarettes, alcohol) had a better predictive value (percent agreement = 78.69%) than when the variables were analyzed alone. Sleep and depression are considered important risk indicators for the development of TMD.
Research Interests:
Dentistry, Prosthodontics, Biomedical Engineering, Depression, Brazil, and 15 moreAdolescent, Humans, Female, Sleep disorders, Rio Grande do Sul, Risk factors, Middle Aged, Questionnaires, Temporomandibular joint disorder (TMJD or TMD), Adult, Risk Factors, Logistic Models, Predictive value of tests, Case Control Studies, and Neuropsychological Tests
Research Interests:
Temporomandibular disorder (TMD) is a musculoskeletal condition characterized by pain and reduced function in the temporomandibular joint and/or associated masticatory musculature. Prevalence in the United States is 5% and twice as high... more
Temporomandibular disorder (TMD) is a musculoskeletal condition characterized by pain and reduced function in the temporomandibular joint and/or associated masticatory musculature. Prevalence in the United States is 5% and twice as high among women as men. We conducted a discovery genome-wide association study (GWAS) of TMD in 10,153 participants (769 cases, 9,384 controls) of the US Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The most promising single-nucleotide polymorphisms (SNPs) were tested in meta-analysis of 4 independent cohorts. One replication cohort was from the United States, and the others were from Germany, Finland, and Brazil, totaling 1,911 TMD cases and 6,903 controls. A locus near the sarcoglycan alpha ( SGCA), rs4794106, was suggestive in the discovery analysis ( P = 2.6 × 106) and replicated (i.e., 1-tailed P = 0.016) in the Brazilian cohort. In the discovery cohort, sex-stratified analysis identified 2 additional genome-wide significant loci in ...
Research Interests:
In 2006, the OPPERA project (Orofacial Pain: Prospective Evaluation and Risk Assessment) set out to identify risk factors for development of painful temporomandibular disorder (TMD). A decade later, this review summarizes its key... more
In 2006, the OPPERA project (Orofacial Pain: Prospective Evaluation and Risk Assessment) set out to identify risk factors for development of painful temporomandibular disorder (TMD). A decade later, this review summarizes its key findings. At 4 US study sites, OPPERA recruited and examined 3,258 community-based TMD-free adults assessing genetic and phenotypic measures of biological, psychosocial, clinical, and health status characteristics. During follow-up, 4% of participants per annum developed clinically verified TMD, although that was a “symptom iceberg” when compared with the 19% annual rate of facial pain symptoms. The most influential predictors of clinical TMD were simple checklists of comorbid health conditions and nonpainful orofacial symptoms. Self-reports of jaw parafunction were markedly stronger predictors than corresponding examiner assessments. The strongest psychosocial predictor was frequency of somatic symptoms, although not somatic reactivity. Pressure pain thres...
Research Interests:
Objective: To determine TMD diagnostic group differences in TMJ disc mechanics due to the effects of normal (perpendicular) load. Method: In accordance with IRB oversight, fifty-two subjects (30 female; 22 male) participated. Research... more
Objective: To determine TMD diagnostic group differences in TMJ disc mechanics due to the effects of normal (perpendicular) load. Method: In accordance with IRB oversight, fifty-two subjects (30 female; 22 male) participated. Research Diagnostic Criteria-calibrated investigators classified subjects based on signs of disc displacement (DD) and pain (+DD/+Pain, n=18; +DD/-Pain, n=17; -DD/-Pain, n=17). 3-D craniomandibular geometries were produced for each subject and used in validated numerical models to calculate normal TMJ loads during biting on canine teeth. To test load effects on TMJ disc mechanics, ex vivo data were used in the development and validation of a biphasic finite element model (bFEM) of the TMJ disc. Given the scarcity of mechanical data from healthy human tissue, 187 freshly extracted pig TMJ discs were subjected to a 7.6 N static normal load, followed by cyclic movement. Physical data in the form of aspect ratio and velocity of stress-field translation, compressive...
The likelihood of development of degenerative joint disease (DJD) of the temporomandibular joint (TMJ) is related to the integrity of the TMJ disc. Predilection for mechanical failure of the TMJ disc may reflect inter-individual... more
The likelihood of development of degenerative joint disease (DJD) of the temporomandibular joint (TMJ) is related to the integrity of the TMJ disc. Predilection for mechanical failure of the TMJ disc may reflect inter-individual differences in TMJ loads. Nine females and eight males in each of normal TMJ disc position and bilateral disc displacement diagnostic groups consented to participate in our study. Disc position was determined by bilateral magnetic resonance images of the joints. Three-dimensional (3D) anatomical geometry of each subject was used in a validated computer-assisted numerical model to calculate ipsilateral and contralateral TMJ loads for a range of biting positions (incisor, canine, molar) and angles (1-13). Each TMJ load was a resultant vector at the anterosuperior-most mediolateral midpoint on the condyle and characterized in terms of magnitude and 3D orientation. Analysis of variance (ANOVA) was used to test for effects of biting position and angle on TMJ load...
Research Interests:
Research Interests:
Research Interests:
Mathematics, Dentistry, Medicine, Finite Element Analysis, Bite force, and 15 moreHumans, Computer Simulation, Female, Animals, Male, Dislocations, Behavioral Animal Models, Middle Aged, Mechanical Stress, Adult, Elastic Modulus, Craniofacial Orthodontics, Neck Muscles, Biomechanical Phenomena, and masseter muscle
Research Interests:
Psychology, Pain, Chronic Pain, Principal Component Analysis, Adolescent, and 15 moreHumans, Negative Affect, Female, Male, Mood Disorders, Aged, Middle Aged, Adult, Ethnic Group, Health surveys, Case Control Study, Prospective Study, Case Control Studies, Multicenter Studies as Topic, and Medical and Health Sciences
Research Interests:
Research Interests:
Temporomandibular Joint, Medicine, Humans, Female, Male, and 15 moreJaw, Clinical Sciences, Middle Aged, International Classification of Diseases, Adult, Diagnostic Accuracy, Sensitivity and Specificity, Regression Tree, Neurosciences, Temporomandibular Joint Disorders, Standard Reference Materials, Diagnostic Criteria, Reference standards, Headache disorders, and Diagnostic errors
Research Interests:
Research Interests:
The psychosocial and functional consequences of chronic pain disorders have been well documented as having significant effects on the experience of pain, presentation to health care providers, responsiveness to and participation in... more
The psychosocial and functional consequences of chronic pain disorders have been well documented as having significant effects on the experience of pain, presentation to health care providers, responsiveness to and participation in treatment, disability, and health-related quality of life. Thus, psychosocial and functional consequences have been incorporated as 1 of the 5 dimensions within the integrated Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION)-American Pain Society (APS) Pain Taxonomy (AAPT): 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors. In this article we review the rationale for a biopsychosocial perspective, on the basis of current evidence, and describe a set of key psychosocial and behavioral factors (eg, mo...