Revista Da Faculdade De Odontologia – de Paço Fundo – UPF. 28(1) 2023
Manejo das disfunções temporomandibulares. Parte I: tratamento conservador
Objetivo: Apresentar as modalidades de tratamentos conservadoras e minimamente invasivas mais usadas disponíveis no arsenal terapêutico das desordens temporomandibulares (DTM). Revisão da literatura: Os objetivos do tratamento invariavelmente incluem redução da dor, diminuição das atividades parafuncionais e restauração da função. Dentre as alternativas conservadoras e minimamente invasivas, podemos citar os dispositivos interoclusais, exercícios terapêuticos, eletrofototermoterapia, agulhamento seco e infiltração de anestésicos locais em pontos gatilho, injeção de sangue autógeno para controle da luxação mandibular, terapia cognitivo comportamental, toxina botulínica, viscossuplementação, controle farmacológico da dor aguda e crônica. As DTMs afetam uma proporção significativa da população. Somente após o fracasso das opções não invasivas é que devem ser iniciados tratamentos mais invasivos e irreversíveis. No entanto, algumas condições, como a anquilose e neoplasias, por exemplo, são essencialmente tratadas cirurgicamente e tentativas de tratamentos conservadores podem trazer piora na qualidade de vida ou risco de morte. Considerações finais: Uma abordagem de equipe multidisciplinar para o manejo é essencial no cuidado fundamental de todos os pacientes com DTM, para que o tratamento possa ser especificamente adaptado às necessidades individuais do paciente.
Palavras-chave: Desordem temporomandibular. Dor orofacial. Tratamento conservador.
BrJP 6 (1) • Jan-Mar 2023 • https://doi.org/10.5935/2595-0118.20230008-en
Diagnosis of temporomandibular dysfunction subtypes in a population seeking specialized care
Ludmila Maria Alves e Silva1, Luciana e Silva Nobre1, Luciane Lacerda Franco Rocha Rodrigues1, Lidia Audrey Rocha Valadas2, Thiago Bezerra Leite3, Antônio Sérgio Guimarães1.
1 São Leopoldo Mandic College of Dentistry, Laboratory of Neuroimmune Interface of Pain Research, Campinas, SP, Brazil, 2 University of Buenos Aires, College of Dentistry, Buenos Aires, Argentina, 3 Leão Sampaio University Center, Juazeiro do Norte, CE, Br
HIGHLIGHTS: The predominant type of TMD was joint/muscular. More frequent in female individuals. Individuals between the ages of 39 and 48 were more affected.
BACKGROUND AND OBJECTIVES: The goal of the present study was to assess the frequency of temporomandibular disorders (TMD) subtypes in individuals that search for specialized care, identifying the subtypes of TMD, muscular and/or articular, in addition to relating each subtype with variables such as gender and age. METHODS: In this context, after a screening, 270 individuals, aged between 18 and 70 years, were selected. All data were acquired using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) instrument. RESULTS: Among the 267 patients, 88.7% (n = 237) were female and 11.3% (n = 30) were male, with a mean age of 42±11.8 years. In this study, the predominance of joint/muscle TMD was evidenced (51.7%; n = 138), followed by only muscle TMD (47.5%; n = 127) and lastly, joint TMD (0.8%; n = 2). Important correlations (p>0.05) were not identified when comparing TMD subtypes with the variables gender and age, according to chi-square test. By relating the diagnosis to the TMD subtype, it was evidenced that bilateral myalgia was the most prevalent in muscle TMD (n = 100; 37.4%) and articular/muscular (n = 112; 41.9%). The other variables did not show significant statistics, neither moderate nor strong correlation. CONCLUSION: In this research, all TMD subtypes were found, with a clear predominance of joint/muscle type of TMD, followed by muscle only, especially in females aged between 39 and 48 years. Keywords: Diagnosis; Prevalence; Temporomandibular joint disorders.
ORIGINAL ARTICLE • BrJP 6 (1) • Jan-Mar 2023 • https://doi.org/10.5935/2595-0118.20230020-en
Frequency of symptoms of temporomandibular dysfunction in homeless people: cross-sectional study
Thiago Bezerra Leite1 , Lidia Audrey Rocha Valadas2, Luciane Lacerda Franco Rocha Rodrigues1, Antônio Sérgio Guimarães1. 1 São Leopoldo Mandic College of Dentistry, Laboratory of Neuroimmune Interface of Pain Research, Campinas, SP, Brazil . 2 University of Buenos Aires, College of Dentistry, Buenos Aires, Argentina
HIGHLIGHTS: Homeless report fewer symptoms of TMD. Pain in the temples was the most reported symptom. BACKGROUND AND OBJECTIVES: Homeless people live a reality of social vulnerability, poverty and exclusion and are considerably more affected by long-term pain (chronic pain) than the general population. The objective of this study was to evaluate the presence of symptoms of temporomandibular disorder (TMD) in homeless people who attended a reception center for this population (POP Center) in the city of Juazeiro do Norte-CE. METHODS: This is an observational, cross-sectional, descriptive-exploratory study, whit a quantitative approach and a convenience sample. For this, the TMD-Pain Screener was applied to measure TMD frequency in 100 individuals who were divided into two groups, group 1 (G1, n=50) composed of residents who were assisted by the center and group 2 (G2, n=50) individuals who worked in the center. The TMD Pain Screener instrument was used and the data were paired according to gender and age group. The Qui-square test was applied to verify associations between the variables, considering a level of significance of 5% (p≤0.05). RESULTS: It was observed that homeless people had fewer TMD symptoms than the control group and this difference was statistically significant (p=0,045). The symptom of pain in the lateral region of the head was the most commonly found, being reported by 20% of the homeless population and by 48% of the control group 48% (p=0.03). CONCLUSION: The homeless population presented TMD symptoms, which should be taken into account by the health authorities, however, in a smaller proportion than the control group, requiring further studies to identify these differences. Keywords:
Facial pain; Homeless persons; Temporomandibular joint disorders
The literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol in the PubMed, Cochrane Library, LILACS, EBSCO, Scielo, between 2012 and 2022. The methodological quality was assessed by using the Newcastle-Ottawa Study Quality Assessment Scale. Mean differences and 95% confidence intervals were calculated and combined in meta-analyses. A total of 1202 participants were included in this systematic review (690 with TMD; 512 without TMD), with 22 articles being included in the qualitative analysis. Only three studies enabled the comparative analysis of the results. Ten articles showed a high methodological quality and a low risk of bias, and twelve had a low methodological quality and an increased risk of bias. The meta-analysis showed that the differences between the intervention and control groups were not statistically significant for the percentage overlapping coefficient of the anterior temporal muscle, for the masseter, and for the torque coefficient. The parameters analyzed with the compound technique for chewing showed altered mandibular functions in individuals with TMD. With the EMG method, it was possible to suggest that TMD in adult individuals causes compensatory muscle behaviors, and several changes in the masticatory function were found.
Keywords: bite force; chewing; electromyography; mastication; masticatory efficiency; temporomandibular disorders.
Background: Clear aligners (CA) are used 22 h daily, creating a bite-block effect. This work aims to (i) analyze occlusal changes before the beginning of treatment, after the first set of CA and after the use of additional aligners; (ii) compare planned occlusal contacts with the ones obtained after the first set of CA; (iii) analyze the occlusal changes occurred after reaching the orthodontic goals after 3 months of using CA only at night; (iv) evaluate and characterize which tooth movements did not allow the treatment to be completed at the end of the first set of aligners, and finally (v) verify the possible relation between the changes in occlusal contact and areas and parameters such as case complexity and facial biotype.
Materials and methods: A quantitative, comparative, and observational longitudinal cohort study design was implemented to evaluate the clinical data and the complexity levels of cases receiving CA. A non-probabilistic and convenience sample of 82 individuals was recruited. The orthodontic malocclusion traits were classified as simple, moderate, or complex corrections based on the basis of the Align® recommendations with the Invisalign® evaluation tool. According to the Invisalign® criteria, patients need only one complex problem for their case to be classified as complex. Meshlab® v. 2022.02, ClinCheck® version Pro 6.0, My-Itero® version 126.96.36.1991 5d plus, and IBM® SPSS Statistics software (Statistical Program for Social Sciences), version 27.0 for Windows were the software® used.
Results: A statistically significant decrease in area and occlusal contacts number were observed from before the start of orthodontic treatment (T0) to the end of treatment (T1). The changes in the occlusal area (from T0 to T1) were statistically different between hyperdivergent (28.24 [15.51-40.91]) and hypodivergent (16.23 [8.11-24.97]) biotypes (p = 0.031). A significant difference between the hyperdivergent (4.0 [2.0-5.0]) and normodivergent (5.5 [4.0-8.0]) group was found in T1 for the anterior contacts (p = 0.044). Anterior contacts obtained were significantly higher than the planned (p = 0.037) Between T1 and T2 statistically significant increases of occlusal areas, posterior and total contacts were observed.
Conclusions: Occlusal contact and area were decreased, either at the end of the first set or after the use of additional aligners. Anterior occlusal contacts obtained were higher than planned as opposed to posterior occlusal contacts obtained. The hardest tooth movements to achieve to complete the treatment were distalization, rotation, and posterior extrusion. After completing orthodontic treatment (T1) to 3 months after (T2) using additional aligners only at night, posterior occlusal contacts were significantly increased, which could be due to the natural settling of the teeth in this period.
Keywords: clear aligners; facial biotype; masticatory function; occlusal area; occlusal contacts.
Braz Dent Sci 2023
Jan/Mar;26 (1): e3725 DOI: https://doi.org/10.4322/bds.2023.e3725
Relationship between myofascial pain and facial types: an observational study
Francisco Ferreira da SILVA1, Mayra Soares Ferreira BARROSO2, Antônio Sérgio GUIMARÃES1, Lidia Audrey Rocha VALADAS3, Luciane Lacerda Franco Rocha RODRIGUES1
1 – Faculdade de Odontologia São Leopoldo Mandic, Laboratório de Pesquisa da Interface Neuroimune da Dor. Campinas, SP, Brazil. 2 – Serviço de Otorrinolaringologia, Hospital Edmundo Vasconcelos. São Paulo, SP, Brazil. 3 – Universidad de Buenos Aires. Buenos Aires, Argentina.
ABSTRACT: Temporomandibular disorder (TMD) is a term that covers a number of clinical problems involving the masticatory muscles, TMJ and all associated structures leading to signs and symptoms such as jaw pain, otalgia, headaches and limitation of function. In this context, TMD has been related to facial type and there are three distinct facial types (euryprosopic, mesoprosopic, and leptoprosopic). Objective: The aim of this study was to investigate the correlation between myofascial pain and facial types classified by the RDC/TMD Axis I. Material and Methods: this study was composed of 64 women aged between 12 and 49 years, using data obtained from two institutions. We used the anthropometric methodology, which meets the criteria of simplicity and reliability. We also applied the Brugsh Facial Index. The individuals were classified as euryprosopic (51.56%), mesoprosopic (12.50%) and leptoprosopic (35.94%), without statistical significance among the groups (p=0,3492). Results: there is no statistical difference between the age groups (p=0.2976) and no association between facial type and age range. Conclusion: this study found that there was a correlation between myofascial pain and facial types, with the predominance of euryprosopic faced women aged between 20 and 29 years when compared with other facial types and other age groups. KEYWORDS: Temporomandibular joint dysfunction syndrome; Anthropometric methodology; Mandibular disorders; Myofascial pain; Orofacial pain.
Self-ligating brackets do not reduce discomfort or pain when compared to conventional orthodontic appliances in Class I patients: a clinical study
Objectives: To compare the intensity, location, and short-term impact of the periodontal discomfort/pain, as well as the related functional parameters of bite force and masticatory efficiency, between self-ligating and conventional orthodontic appliances.
Materials and methods: In 20 patients referred for orthodontic treatment, samples were collected from the gingival sulcus to evaluate the level of substance P using enzyme-linked immunosorbent assay. Orthodontic devices were randomly bonded, with self-ligating appliances on one side and conventional brackets on the contralateral side. Pain threshold (PT), maximal bite force (MBF), and masticatory efficiency (ME) were assessed using standard validated techniques at the beginning of the treatment and 24 hours post-orthodontic activation with an 0.016-inch nickel-titanium wire.
Results: There were no significant differences (P > .05) in the substance P levels, PT, MBF, and ME between the self-ligating and conventional orthodontic appliances.
Conclusions: There was no difference between conventional and self-ligating appliances in the parameters of pain: substance P and pressure. Functional aspects, such as pain, discomfort, and masticatory efficiency, should not be considered when making a therapeutic decision regarding the use of self-ligating vs conventional orthodontic appliances.
Keywords: Orthodontic appliances; Pain; Self-ligating brackets.
Studies in Health Sciences, Curitiba, v.3, n.3, p. 1333-1338, jul./sep., 2022
DOI: 10.54022/shsv3n3-005DOI: 10.54022/shsv3n3-005
Abordagem terapêutica para resolução imediata de travamento aberto da mandíbula. Abordagem terapêutica para resolução imediata de travamento aberto da mandíbula
Paulo Henrique Novo1, Roberto Gomes dos Santos1, Gabriela Pizão Werneck Moreira da Costa2, Tainá Pinheiro Bonfim2, Antônio Sérgio Guimarães1 Instituição: São Leopoldo Mandic 1, Universidade Federal Fluminense2
A luxação da Articulação Temporomandibular ( ATM ) ocorre quando o côndilo mandibular se desloca externamente à cavidade glenóide, permanecendo em uma condição de travamento, podendo ser classificado em relação à eminência articular,como anterior (forma mais comumente encontrada), medial, lateral, superior ou posterior (casos mais raros e normalmente associados a quadros de trauma). Esse travamento comumente leva a um decaimento mandibular que impede que o paciente feche a boca e, por isso, dá-se o nome de travamento aberto á essa forma de disfunção. Ela pode ser bilateral ou unilateral, sendo a última a mais comum. Além disso, pode ser classificada de acordo com sua frequência, em: habitual, recidivante ou recorrente. Os quadros de maior recidiva e recorrência estão mais atrelados a piores prognósticos e a necessidade de tratamentos mais invasivos e permanentes. Entretanto, seja para casos mais complexos ou menos habituais, os sintomas do travamento geralmente se repetem e ocasionam fortes dores, desconforto, distensão muscular, dificuldades de fala, alimentação e respiração, prejudicando assim todo o funcionamento do sistema estomatognático e implicando muitas vezes em quadros de urgência médica. Com o intuito de auxiliar no alívio imediato destes sintomas a abordagem de redução manual da mandíbula, possibilita um tratamento conservador eficaz dessa condição. A presente revisão tem o intuito de descrever esta técnica, seu mecanismo de resolução imediata e seus benefícios. Para tanto, foi realizada uma revisão da literatura, onde foram selecionados artigos identificados pelos descritores: Transtornos da Articulação Temporomandibular; Síndrome da Disfunção da Articulação Temporomanbibular (DeCS©), nas plataformas PubMed e BVS, com filtro de temporalidade de 2000 à 2020. Após leitura de títulos e resumos foram selecionados ao todo 11 artigos para leitura na íntegra.
DOI: DOI 10.5935/2595-0118.20220055-en
Fatores relacionados a indicação de cirurgia da articulação temporomandibular em uma operadora de saúde suplementar: estudo retrospectivo e transversal
1, Conceitualização, Investigação, Redação – Preparação do original
1, Conceitualização, Redação – Revisão e Edição, Validação 2, Redação – Revisão e Edição, Validação 1, Aquisição de financiamento, Redação – Revisão e Edição, Visualização 1Faculdade São Leopoldo Mandic, Curso de Odontologia, Laboratório de Dor Orofacial, Campinas, SP, Brasil. 2Universidade de Buenos Aires, Departamento de Odontologia Preventiva e Comunitária, Buenos Aires, Argentina.
JUSTIFICATIVA E OBJETIVOS: O número de cirurgias da articulação temporomandibular (ATM) vem crescendo nos últimos anos. O objetivo deste estudo foi avaliar os fatores relacionados à indicação de cirurgia da ATM.
MÉTODOS: Trata-se de um estudo observacional, quantitativo, retrospectivo e transversal. Foram analisadas 99 solicitações cirúrgicas para a realização da cirurgia de ATM, destinadas a uma
operadora de saúde suplementar. Foram coletadas informações sobre idade, sexo, queixa principal do paciente, alteração de movimento, resultados de ressonância magnética, teste diagnóstico
utilizado e terapia prévia realizada. Foram utilizados os testes T e Qui-quadrado (α=5%).
RESULTADOS: 85% dos pacientes avaliados eram do sexo feminino, e a média de idade entre as mulheres (27,07±6,33) foi menor quando comparada à dos homens (31,98±9,55) (p=0,03).
Quase metade dos pacientes não recebeu nenhuma abordagem terapêutica antes da indicação da cirurgia. Menos de 10% das solicitações descreveram a classificação de Wilkes. Dentre os sintomas considerados para a indicação da cirurgia, destaca-se a dor na região da ATM (63,64%). A limitação do clique e da abertura Fatores relacionados a indicação de cirurgia da articulação temporomandibular em uma operadora de saúde suplementar: estudo retrospectivo e transversal Related factors for indication of temporomandibular joint surgery in a supplementary health
operator: retrospective and cross-sectional study
• A dor foi o principal sintoma considerado para a indicação de cirurgia da ATM.
• A maioria dos fatores avaliados para a indicação de cirurgia da ATM não corresponde
às recomendações do Colégio Brasileiro de Cirurgia e Traumatologia Oral e Maxilo-facial.
• Poucos tratamentos conservadores foram previamente recomendados.
Apresentado em 06 de maio de 2022.
Aceito para publicação em 4 de novembro de 2022.
Conflito de interesses: não há – Fontes de fomento: não há
CONCLUSÃO: Os fatores relacionados às indicações de cirurgia da ATM pelos cirurgiões bucomaxilofaciais no presente estudo não condizem com as recomendações do Colégio Brasileiro
de Cirurgia e Traumatologia Bucomaxilofacial (CTBMF). Poucos tratamentos conservadores foram recomendados anteriormente, sendo que a maioria foi decidida sem a utilização de
nenhum critério diagnóstico.
Descritores: Cirurgia bucal, Diagnóstico, Síndrome da disfunção da articulação temporomandibular.
BACKGROUND AND OBJECTIVES: The number of temporomandibular joint (TMJ) surgeries has been growing in recent years. The objective of this study was to evaluate the factors measured for the indication of TMJ surgery. METHODS: This is an observational, quantitative, retrospective, cross-sectional study. A total of 99 surgical requests for TMJ surgery, assigned to a supplementary health operator, were analyzed. Information regarding age, gender, the patient’s main complaint, movement alteration, magnetic resonance results, diagnostic tests used, and previous therapy performed were collected. The T-test and the Chi-squared test were used (α=5%). RESULTS: 85% of patients were female, and the mean age among women (27.07±6.33) was lower when compared to men (31.98±9.55) (p=0.03). Almost half of the patients did not receive any therapeutic approach before the surgery indication. Less than 10% of the requests described the Wilkes classification. Among the symptoms considered for the indication of surgery. Pain report in the TMJ region (63.64%) stands out. The clicking and mouth-opening limitations were among the highest prevalence as 52.5% and 67.7%. respectively. CONCLUSION: The factors evaluated for the indication of TMJ surgery by oral and maxillofacial surgeons in the present study do not match the recommendations of the Colégio Brasileiro de Cirurgia e Traumatologia Bucomaxilofacial (CTBMF – Brazilian College of Oral and Maxillofacial Surgery and Traumatology). Few conservative treatments were previously recommended. Where the majority was decided without any diagnostic criteria. Keywords: Diagnosis. Surgery oral. Temporomandibular joint disorders.
Objective: This study aimed to develop and validate a questionnaire to detect signs of temporomandibular disorders (TMD), verifying whether the perception of signs observed by caregivers of non-verbal autistic children are the same as those observed by caregivers of verbal ones.
Methods: This is a cross-sectional, exploratory and analytical study. The sample consisted of forty individuals with Autism Spectrum Disorders (ASD), thirty non-verbal and ten verbal, besides their respective caregivers. For this, an experimental questionnaire was applied and compared to the European Academy of Orofacial Pain (EAOP) questionnaire, which is already validated and widely used throughout the world. All responses were compared using the chi-square test and the questionnaires were compared with the McNemar test, considering p < .05.
Results: When comparing the number of coincident responses to the questionnaire between caregivers and children, the mean was 8.2 ± 1.61 responses. After performing the binomial test, no statistically significant discrepancy was found between the results of the two tests adopted when the questionnaires were compared (Mc Nemar test, p > .05) CONCLUSION: The development of this questionnaire and its validation serve as a support for health professionals in the TMD area, for the detection of TMD in non-verbal autistic children, providing them and their caregivers, who are faced with several difficulties in their day-by-day, a facilitating instrument.
Keywords: autism spectrum disorder; pain; temporomandibular joint; termporomandibular disorders.
© 2022 Special Care Dentistry Association and Wiley Periodicals LLC.
Background: Temporomandibular disorder (TMD) pain is common among adolescents. The association between painful TMD and other comorbidities has been demonstrated. However, the difference between short-term (<6 months) and long-term (≥ 6 months) painful TMD is not yet clear.
Objective: The aim of this study was to assess the association between comorbidities and short- and long-term painful TMD among adolescents.
Methods: In this cross-sectional study, adolescents were recruited from Montreal (Canada), Nice (France) and Arceburgo (Brazil). Self-reported painful TMD, comorbidities, school absence and analgesic intake were assessed using reliable instruments. Multivariable logistic regression analyses were conducted to assess the study aims.
Results: The prevalence of short- and long-term painful TMD was estimated at 22.29% and 9.93% respectively. The number of comorbidities was associated with short- (OR = 1.71, 95%CI = 1.53-1.90) and long-term painful TMD (OR = 1.79, 95%CI = 1.55-2.08) compared to controls. Frequent headaches (ORshort-term = 4.39, 95%CI = 3.23-5.98, ORlong-term = 3.69, 95%CI = 2.45-5.57) and back pain (ORshort-term = 1.46, 95%CI = 1.06-2.03, ORlong-term = 1.69, 95%CI = 1.11-2.59) were associated with both painful TMD groups. Frequent neck pain (OR = 2.23, 95%CI = 1.53-3.26) and allergies were only associated with short-term painful TMD (OR = 1.54, 95%CI = 1.13-2.10). Frequent stomach pain was related to long-term (OR = 2.01, 95%CI = 1.35-3.26), and it was the only comorbidity significantly more frequent among the long than short-term TMD (OR = 1.82, 95%CI: 1.14-2.90). These analyses were adjusted by sex, age and city.
Conclusion: In this multi-centre study, both short- and long-term painful TMD are associated with frequent headaches and back pain, whereas frequent neck pain and allergies are related to only short-term and frequent stomach pain with long-term painful TMD.
Keywords: adolescents; comorbidities; epidemiology; oro-facial pain; pain; temporomandibular disorders.
© 2021 John Wiley & Sons Ltd.
Background: Total or partial calcification of the stylohyoid chain, elongation of the stylohyoid process of the temporal bone and/or calcification of the stylohyoid ligament are usually incidental radiographic findings. The purpose of this study was to evaluate the prevalence of morphological and structural changes within the stylohyoid chain in 4413 digital panoramic radiographs.
Material and methods: The images were evaluated for the presence or absence of changes in the stylohyoid chain by a specialist in dentofacial radiology and the information collected comprised gender, age, side, right and left measurements and classification of the chain side elongated or calcified stylohyoid process, as well as type and pattern of right or left calcification.
Results: 275 (6.2%) subjects presented alterations, mostly bilateral, in the stylohyoid chain, being 186 females (67.6%) and 89 males (32.4%), with a higher proportion elongation. Partial calcification was more prevalent than total calcification. The right side was most affected and the frequency of events increased with age.
Conclusions: The findings of the present study demonstrate that the commonest alterations in the stylohyoid chain are bilateral, mainly elongation, with a clear trend to increased prevalence with increasing age, presenting a low incidence. Noneless, the clinicians must be aware of these alterations in the routinely radiographic examination. Key words:Stylohyoid process, Stylohyoid ligament calcification, Stylohyoid chain, Eagle’s syndrome.
Copyright: © 2020 Medicina Oral S.L.
Conflict of interest statement
Conflicts of interest There are no personal or financial conflicts of interests in publishing this data, current and within the past five years, that might pose a potential, perceived or real conflict of interest.
Background: Painful temporomandibular disorder (TMD) is common among adolescents. Presence of painful comorbidities may worsen painful TMD and impact treatment effectiveness.
Objective: The aim of this study was to assess the association between painful TMD and comorbidities.
Methodology: In this cross-sectional study, adolescents were recruited in Montreal (Canada), Nice (France) and Arceburgo (Brazil). Reliable instruments were used to assess painful TMD and comorbidities. Multivariable logistic and linear regression analyses were conducted to assess the study aims.
Results: The prevalence of self-reported painful TMD was estimated at 31.6%; Arceburgo (31.6%), Montreal (23.4%) and Nice (31.8%). Painful TMD was more common among girls than boys (OR = 1.96). Painful TMD was associated with a higher number of comorbidities (OR = 1.77); Arceburgo (OR = 1.81), Montreal (OR = 1.80) and Nice (OR = 1.72). A stronger association was found between painful TMD and headaches (OR = 4.09) and a weaker one with stomach pain (OR = 1.40). Allergies were also related to painful TMD (OR = 1.43).
Conclusion: Painful TMD was associated with comorbidities. Headaches were consistently associated with painful TMD. Other associations were modified by sex and/or covariates related to the cities where participants were recruited.
Keywords: adolescents; comorbidities; epidemiology; oro-facial pain; pain; temporomandibular disorders.
© 2019 John Wiley & Sons Ltd.
Self-medication and pain catastrophizing in patients with myofascial pain: Are they related?
- DOI: 10.1111/odi.13131
A window to consolidate the “functional hypothesis of bruxism” through cardiovascular autonomic link
- DOI: 10.1111/odi.13077
Introduction: Orofacial pain and dysfunction include a broad range of disturbances among which pain and insomnia are some of the most common complaints. Sleep strengthens physiological and psychological resilience and is an absolute requirement for health. Insomnia is a common symptom or sleep disorder, yet data on its prevalence is sparse. Here we extracted data from the insomnia severity index which was part of the web-based interdisciplinary symptom evaluation (WISE) tool given to a large sample of patients seeking care at an orofacial pain unit for analyzing insomnia prevalence in this clinical population. Material and methods: Anonymized data were available from 952 patients who consulted the Orofacial Pain Unit at the Center of Dental Medicine, University of Zurich, Zurich, Switzerland between January 2017 and December 2018. Prevalence data for insomnia stratified by gender and 10 age groups (decades) were calculated. The distribution of four insomnia severity grades was determined, also stratified by age and gender. Results: 952 patients (290 men: 30.5%) with a mean age of 44.8 ± 17.4 years completed a WISE. Three hundred and fifty-two (37.0%) patients with a mean age of 45.8 ± 16.7 years positively responded to a screening question for insomnia and/or hypersomnia. Insomnia was severe in women from the 2nd to 8th decade, ranging from 4.3% (3rd decade) to 14.5% (6th decade), and moderately severe from the 2nd to 9th decade, ranging from 18.8% (6th decade) to 27.8% (2nd decade). In men, severe insomnia was present from the 3rd to 7th decade, ranging from 2.3% (7th decade) to 4.4% (4th decade) and moderately severe insomnia from the 3rd to 7th decade, ranging from 4.6% (7th decade) to 12.2% (5th decade). Conclusions: This is the first study reporting on insomnia in a large sample of patients seeking care at an orofacial pain unit. One in three patients reported some form of sleep disturbances, which for almost half of them was moderate to severe insomnia. The gender ratio was almost equal throughout adulthood, yet younger and older women were more frequently affected and experienced higher insomnia severity than men.
Keywords: dysfunction; epidemiology; insomnia; insomnia severity index; orofacial pain; prevalence; sleep; sleep questionaire.
Aims: To investigate whether an international consensus exists among TMD experts regarding indications, performance, follow-up, and effectiveness of jaw exercises.
Methods: A questionnaire with 31 statements regarding jaw exercises was constructed. Fourteen international experts with some geographic dispersion were asked to participate in this Delphi study, and all accepted. The experts were asked to respond to the statements according to a 5-item verbal Likert scale that ranged from “strongly agree” to “strongly disagree.” The experts could also leave free-text comments, which was encouraged. After the first round, the experts received a compilation of the other experts’ earlier responses. Some statements were then rephrased and divided to clarify the essence of the statement. Subsequently, the experts were then asked to answer the questionnaire (32 statements) again for the second round. Consensus was set to 80% agreement or disagreement.
Results: There is consensus among TMD experts that jaw exercises are effective and can be recommended to patients with myalgia in the jaw muscles, restricted mouth opening capacity due to hyperactivity in the jaw closing muscles, and disc displacement without reduction. The patients should always be instructed in an individualized jaw exercise program and also receive both verbal advice and written information about the treatment modality.
Conclusion: This Delphi study showed that there is an international consensus among TMD experts that jaw exercises are an effective treatment and can be recommended to patients with TMD pain and disturbed jaw function.
Background: The search for the ideal, healthy and reproducible position of the condyles is of utmost importance for dental diagnosis and treatment. Thus, the objective of this laboratory cross-sectional study was to verify the relationship between the posterior joint space and the mandibular lateral movements.
Material and methods: Dental casts from 15 women and 15 men with normal mastication, 28 natural teeth and no history of temporomandibular disorders or pain, were fabricated and mounted on a fully adjustable articulator. From the maximum intercuspal position, condylar displacement was evaluated and measured on the working and nonworking sides during mandibular lateral movement, both to the right and left sides.
Results: The correlation between the measures of interest was assessed with the Pearson correlation coefficient (α=.05). Condylar displacement on the working side and nonworking side condyle was 0.88±0.71 mm and 3.57±1.11 mm (right mandibular lateral movement); and 0.91±0.58 mm and 3.51±0.78mm (left mandibular lateral movement), respectively. No significant correlation in the condylar displacement between the working side condyles on the right and on the left sides was observed (r=.22; P=.248). The condylar poles of the articulator moved posteriorly, simulating the functional movements of the mandible during mastication. In all cases, condylar displacement during mandibular lateral movement both to the right and left occurred posteriorly on the working side condyle.
Conclusions: The condylar poles of the articulator moved posteriorly simulating the functional movements of the mandible during mastication. Moreover, left and right working condyles may require slightly different spaces to function, suggesting minor anatomical asymmetries. Key words:Mastication, dental occlusion, prosthodontics.
Conflict of interest statement
Conflict of interest statement: This research presents no conflict of interests and was carried on with no financial support other than the facilities of TMD and Orofacial Pain Clinic.
Aims: To investigate the possible relationship between the orthodontic treatment of Class II malocclusion and the development of temporomandibular disorders (TMD).
Methods: A total of 40 patients was evaluated at four time points: the day before the start of treatment employing bilateral Class II elastics (baseline), as well as at 24 hours, 1 week, and 1 month after the start of treatment. The development of TMD pain complaints in the orofacial region and changes in the range of mouth opening were assessed at these times. Shapiro-Wilk, McNemar, and Friedman tests with 5% significance level were used to analyze the data.
Results: The treatment produced pain of a transitory, moderate intensity, but there was no significant change from baseline after 1 month. There were no restrictions in the range of jaw motion or any evidence of limitations in mouth opening.
Conclusion: Orthodontic treatment with bilateral Class II elastics does not cause significant orofacial pain or undesirable changes in the range of mouth opening. Furthermore, this modality of orthodontic treatment was not responsible for inducing TMD.
Background and objectives: To determine the incidence of signs and symptoms of temporomandibular disorder in elective surgery patients who underwent orotracheal intubation.
Methods: This was a longitudinal controlled study with two groups. The study group included patients who underwent orotracheal intubation and a control group. We used the American Academy of Orofacial Pain questionnaire to assess the temporomandibular disorder signs and symptoms one-day postoperatively (T1), and the patients’ baseline status prior to surgery (T0) was also recorded. The same questionnaire was used after three months (T2). The mouth opening amplitude was measured at T1 and T2. We considered a p value of less than 0.05 to be significant.
Results: We included 71 patients, with 38 in the study group and 33 in the control. There was no significant difference between the groups in age (study group: 66.0 [52.5-72.0]; control group: 54.0 [47.0-68.0]; p=0.117) or in their belonging to the female gender (study group: 57.9%; control group: 63.6%; p=0.621). At T1, there were no statistically significant differences between the groups in the incidence of mouth opening limitation (study group: 23.7% vs.
Control group: 18.2%; p=0.570) or in the mouth opening amplitude (study group: 45.0 [40.0-47.0] vs.
Control group: 46.0 [40.0-51.0]; p=0.278). At T2 we obtained similar findings. There was no significant difference in the affirmative response to all the individual questions in the American Academy of Orofacial Pain questionnaire.
Conclusions: In our population, the incidence of signs and symptoms of temporomandibular disorder of muscular origin was not different between the groups.
Keywords: Anestesia geral; Dor orofacial; General anesthesia; Intubation; Intubação; Myofascial pain syndromes; Orofacial pain; Síndrome da dor miofascial; Temporomandibular joint disorders; Transtornos da articulação temporomandibular.
Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.
The aims of this longitudinal study were to perform a comprehensive clinical evaluation of temporomandibular joint (TMJ) and to investigate the association between the clinical and magnetic resonance imaging (MRI) findings in the TMJs of patients with juvenile idiopathic arthritis (JIA). Seventy-five patients with JIA participated in this study. All patients underwent a rheumatological examination performed by a paediatric rheumatologist, a TMJ examination performed by a single dentist and an MRI with contrast of the TMJs. These examinations were scheduled on the same date. The patients were examined again 1 year later. Twenty-eight (37.3 %) patients reported symptoms at the first evaluation and 11 (14.7 %) patients at the second evaluation. In relation to signs, 35 (46.7 %) of the patients presented at least one sign at the first evaluation and 29 (38.7 %) at the second. Intense contrast enhancement of TMJ was significantly associated with disease activity (p < 0.001) at the first evaluation and a trend to significance was observed at the second (p = 0.056), with poly/systemic subtypes (p = 0.028 and p = 0.049, respectively), with restricted mouth opening capacity (p = 0.013 and p = 0.001, respectively), with the presence of erosions at both evaluations (p = 0.0001 and p < 0.0001, respectively) and with altered condylar shape at the second evaluation (p = 0.0005). TMJ involvement is highly prevalent in JIA patients, with asymptomatic children presenting severe structural alterations of the TMJ. The TMJ should always be evaluated in JIA patients, even in the absence of signs and symptoms.
Keywords: Disease activity; Juvenile idiopathic arthritis; Magnetic resonance imaging; Temporomandibular joint.
Temporomandibular disorders (TMD) affecting the articular disc and/or the facial muscles are common among the population, recording a higher incidence in women age 20-40 years. The aim of this study was to investigate the correlation between facial types and muscle TMD in women. This study comprised 56 women age 18 to 49 years, seeking treatment for TMD at the School of Medicine, Federal University of São Paulo. All of the study individuals were diagnosed with muscle TMD, based on the Research Diagnostic Criteria (RDC). Facial type was determined using the Facial Brugsch Index and classified as euryprosopic (short and/or broad), mesoprosopic (average width) and leptoprosopic (long and/or narrow). The data were submitted to the Chi-square test and ANOVA-Tukey’s test to conduct the statistical analysis. The faces of 27 individuals were classified as euryprosopic (48%), 18 as mesoprosopic (32%), and 11 as leptoprosopic (20%). A statistically significant difference (Chi-square, p = 0.032) was found among the facial types, in that leptoprosopic facial types showed the lowest values for muscle TMD. A greater number (p = 0.0007) of cases of muscle TMD were observed in the 20 to 39 year-old subjects than in the subjects of other age segments. In conclusion, women with euryprosopic facial types could be more susceptible to muscle TMD. Further studies are needed to investigate this hypothesis.
Aim: Identify whether the degree of oral motor performance is related to the presence of teeth grinding and maximal bite force values in children with spastic cerebral palsy.
Methods: Ninety-five spastic cerebral palsy children with and without teeth grinding, according to caregivers’ reports, were submitted to a comprehensive oral motor performance evaluation during the feeding process using the Oral Motor Assessment Scale. Maximal bite force was measured using an electronic gnathodynamometer.
Results: The teeth grinding group (n = 42) was younger, used anticonvulsant drugs, and was more frequently classified within the subfunctional oral motor performance category. Teeth grinding subfunctional spastic cerebral palsy children presented lower values of maximal bite force. The functional groups showing the presence or absence of teeth grinding presented higher values of maximal bite force compared with the subfunctional groups.
Conclusion: In spastic cerebral palsy children, teeth grinding is associated with the worse oral motor performance.
Keywords: bruxism; cerebral palsy; maximal bite force; oral motor performance; spasticity.
© 2015 Special Care Dentistry Association and Wiley Periodicals, Inc.
Objective: To investigate the correlation between pain measurements performed using a visual analogue scale (VAS) and pressure pain threshold (PPT) in individuals with temporomandibular disorders who underwent conservative treatment.
Study design: This prospective study assessed 78 individuals diagnosed with myofascial pain, and the treatment consisted of counseling and self-care therapy sessions. Pain was assessed by means of a VAS and PPT at baseline (T0), after 15 to 30 days (T1), and after 75 to 90 days (T2). The participants were divided into two groups: “Compliant Group” and “Non-Compliant Group.” The data were analyzed by means of Spearman’s correlation test and Friedman’s analysis of variance by ranks.
Results: Correlations were not identified between the VAS and PPT values at time points-T0, T1, or T2-in any group.
Conclusion: Although, VAS and PPT represent subjective features, such as the perception of pain, the hypothesis that high pain intensity levels are equivalent to high pain sensitivity levels was not demonstrated.
Copyright © 2015 Elsevier Inc. All rights reserved.
Aim: To report on a patient with Eagle’s syndrome with a complete and very large ossification of the stylohyoid complex on the right side that to our best knowledge has never been published previously.
Background: Eagle’s syndrome is characterized by a set of symptoms that are caused by the irritation of the neurovascular and soft-tissues caused by an elongated styloid process or ossification of stylohyoid ligament.
Case description: Because of the high discomfort and pain degree as well as limitations of mandibular and head mobility and also the thickness of the ossifed stylohyoid chain, the patient was treated surgically by removing the hypertrophic segment.
Conclusion: These symptoms subsided completely after the surgical excision of the anomaly. The elongated styloid process on the left side was symptom free.
Clinical significance: Eagle’s syndrome symptoms are not specific and can mimic those of other disorders, the syndrome must be included in the differential diagnosis of patients with pain in the orofacial, pharyngeal and cervical area.
The aim of the present study was to assess the prevalence of symptoms of temporomandibular disorders (TMD) in patients with the relapsing-remitting form of multiple sclerosis (MS), the relationship between TMD and the severity of MS, and the presence of TMD symptoms in the evaluated groups. Sixty individuals were evaluated: 30 patients diagnosed with relapsing-remitting MS and 30 control individuals matched for gender and age range with no neurologic pathology. In order to investigate the TMD symptoms, the questionnaires of the EACD (European Academy of Craniomandibular Disorders) and the RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders), both validated for TMD research, were administered. To assess the extent of disability produced by MS, the Expanded Disability Status Scale (EDSS) was used. The prevalence of TMD symptoms in patients with MS was 56.7% versus 16.7% for the control group, with a statistically significant difference between the groups (p=0.0016). No correlation was found between the severity of MS and the prevalence of TMD symptoms (Fisher’s test, p=1.0).
Objectives: Evaluate the way the topics for the study of pain mechanisms in general, and Orofacial Pain (OFP) and temporomandibular disorders (TMDs) more specifically, are addressed in undergraduate courses curricula, and also to verify the existence of specialist OFP/TMD teachers in Brazilian dental schools.
Methods: Between July 2010 and January 2011, course Coordinators/Directors of all dental schools duly registered at the Ministry of Education were invited to answer a questionnaire on topics related to OFP/TMD teaching in their institutions.
Results: Fifty-three dental schools representatives answered the questionnaire. The study of pain mechanisms was found to cover an average of less than 10% of the courses’ total time. Pharmacology, Endodontics and Physiology were identified as the departments usually responsible for addressing pain mechanisms in dental courses. Psychosocial aspects were found to occupy a very small proportion in the syllabi, while most of the content referred to biological or somatic aspects. OFP/TMD is addressed by a specific department in only 28.4% of the participating dental schools, while in most cases (46.3%), OFP/TMD is under the responsibility of the Prosthodontics department. Only 38.5% of respondents indicated that they had a specialist OFP/TMD teacher in their Schools.
Conclusion: Among the Brazilian dental schools participating in the study, the teaching of OFP/TMD was found to be insufficient, segmented or with an extremely restricted focus. This initial assessment indicates that Curricular Guidelines for the study of OFP/TMD at undergraduate dental schools should be developed and implemented to facilitate their appropriate inclusion into the curricula and in specific pedagogical projects.
Introduction: Temporomandibular disorder (TMD) is a multifactorial disease. For this reason, it is difficult to obtain an accurate and correct diagnosis. In this context, conservative treatments, including therapeutic exercises classified as stretching, relaxation, coordination, strengthening and endurance, are oftentimes prescribed.
Objective: Thus, the aim of the present article was to conduct a literature review concerning the types of exercises available and the efficacy for the treatment of muscular TMD.
Methods: The review included researches carried out between 2000 and 2010, indexed on Web of Science, PubMed, LILACS and BBO. Moreover, the following keywords were used: Exercise, physical therapy, facial pain, myofascial pain syndrome, and temporomandibular joint dysfunction syndrome. Studies that did not consider the subject “TMD and exercises”, used post-surgery exercises and did not use validated criteria for the diagnosis of TMD (RDC/TMD) were not included.
Results: The results comprised seven articles which proved therapeutic exercises to be effective for the treatment of muscular TMD. However, these studies are seen as limited, since therapeutic exercises were not applied alone, but in association with other conservative procedures. In addition, they present some drawbacks such as: Small samples, lack of control group and no detailed exercise description which should have included intensity, repetition, frequency and duration.
Conclusion: Although therapeutic exercises are considered effective in the management of muscular TMD, the development of randomized clinical trials is necessary, since many existing studies are still based on the clinical experience of professionals.
Keywords: Exercise; Myofascial pain syndromes; Physical therapy modalities; Temporomandibular joint dysfunction syndrome.
Aims: To translate the Pictorial Representation of Illness and Self Measure (PRISM) instrument from German to Portuguese (Brazilian) and adapt it to the Brazilian cultural context, and then assess its reliability and validity in orofacial pain patients.
Methods: The PRISM was translated to Portuguese then back-translated to German. The translated PRISM was evaluated by a multidisciplinary committee and administered as a pre-test to 30 Portuguese-speaking orofacial pain patients. Psychometric properties were obtained after testing 116 orofacial pain patients. Validity was obtained through correlation analyses of scores obtained from PRISM and other psychometric tests, including the Numerical Pain Scale (NPS), Insomnia Severity Index (ISI), and Hospital Anxiety and Depression Scale (HAD).
Results: The adapted instrument showed high levels of reliability, proven by means of the test-retest procedure, and calculation of the Intraclass Correlation Coefficient (ICC = 0.991). Significant correlations were found between PRISM and the other tests. Correlation with NPS was moderate (-0.42), whereas correlations with ISI (-0.24), HAD-anxiety (-0.25), and HAD-depression (-0.22) were weak.
Conclusion: The cross-cultural adaptation process of PRISM was successful and the adapted version offers reliable and valid psychometric properties in the Brazilian context.
Objectives: The aim of this prospective longitudinal study was to evaluate the relationships between anxiety, depression, and temporomandibular disorders (TMD) in a sample of pre-university students submitted to a stressful event.
Study design: 153 students from a pre-university course (82 females and 71 males between 16 and 31 years old) were given a survey about TMD symptoms and a survey about anxiety and depression scale at the beginning and the end of the preparatory course (August 2009-T1, and November 2009-T2).
Results: Results were analyzed using a chi-square test and Odds Ratio (OR), significance level of α = 0.05. Statistical significance were found to depression rates in students with TMD (16% on T1 and 26% on T2, p = 0.001) as well as in general sample (12% on T1 and 22% on T2, p = 0.009), anxiety and TMD symptoms presented constant rates in both periods. Increased risk of having TMD were found in participants with anxiety (OR 2.6 in T2 and 5.6 in T1) and depression (2.0 in T2 and 3.3 in T1), but only anxiety reach statistical significance in both periods.
Conclusions: TMD symptoms were a fluctuating variable that exchange between some individuals of this study. Independently of the TMD, depression rates significant increased in the evaluated period. Finally, anxiety was the psychological symptom related to the increased risk of having TMD. Key words:Temporomandibular disorders, anxiety, depression, orofacial pain, hospital anxiety and depression scale.
Focal dermal hypoplasia (FDH), also known as Goltz-Gorlin syndrome, is an autosomal dominant disease affecting tissues derived from the ectoderm and mesoderm. Knowledge and early diagnosis of the craniofacial alterations commonly found in patients with FDH provide oral health care professionals with effective preventive and therapeutic tools. This article aims to review the craniofacial characteristics present in FDH and the main systemic manifestations that have implications for dental management, while presenting a new case of the syndrome with novel oral findings.
The aim of this study was to analyze the temporomandibular joint (TMJ) disc displacement and articular sounds incidence after orotracheal intubation. A prospective cohort study was conducted in the Hospital Universitário do Oeste do Paraná (HUOP), in Cascavel, Brazil. 100 patients (aged 14-74 years, mean 44 years), 34 male and 66 female, in need of surgical procedure with orotracheal intubation were evaluated. The anterior disc displacement with reduction incidence and the nonclassifiable sounds incidence by the Research Diagnostic Criteria Axis I was evaluated in all patients after orotracheal intubation. The patients was evaluated one day before and until two days after the procedure. Eight percent present with anterior disc displacement with reduction and 10% presented nonclassifiable sounds after the orotracheal intubation. There was no correlation of any kind regarding gender related influence in the incidence of disc dislocations (P = 0.2591) and TMJ sounds (P = 0.487). Although anterior disc dislocations and TMJ sounds after anesthetic with orotracheal intubation presented a low incidence (8%-10%), it is recommended that the evaluation of TMJ signs and symptoms be done before the anesthetic procedure to take care with susceptible patients manipulation.
Keywords: TMJ dislocations; TMJ disorders; TMJ sounds; disc displacement; orotracheal intubation; surgical procedure.
This study aimed to determine the frequency of temporomandibular disorder (TMD) signs in 68 individuals with cerebral palsy, aged between 3 and 23 years. TMD signs were evaluated according to the Research Diagnostic Criteria to assess temporomandibular joint sounds, lateral jaw deviation during opening and closing movements and limitation of maximum mouth opening (>40 mm). The frequency of TMD signs observed in the cerebral palsy group (46/68-67.6%) was higher than in the control group (17/68-25%). The clinical scenario of CP seems to make these individuals more prone to the development of TMD signs.
Treacher Collins syndrome usually affects bilateral and symmetric structures that include the orbits, mandible, and ears. The purpose of this report is to describe a clinical case of the syndrome, focusing on the anatomy of the temporomandibular joint, which was assessed using the computed tomography method. Clinical examination included evaluation of mandibular dynamics, investigation of temporomandibular dysfunction, and measurement of bite force. Significant morphological and functional alterations were observed but without significant documented clinical consequences.
The aim of this study was to assess the shape of the temporomandibular joint (TMJ) articular eminence and the articular disc configuration and position in patients with disc displacement. TMJ magnetic resonance images (MRI) of 14 patients with bilateral disc displacement without unilateral reduction were analyzed. Articular eminence morphology was characterized as box, sigmoid, flattened, or deformed. Articular disc configuration was divided into biconcave, biplanar, biconvex, hemiconvex or folded, and its position, as “a” (superior), “b” (anterosuperior), “c” (anterior) or “d” (anteroinferior). The images were divided and the sides with disc displacement with reduction (DDWR) and without reduction (DDWOR) were compared. Regarding articular eminence shape, the sigmoid form presented the greatest incidence, followed by the box form, in the DDWR side, although this was not statistically significant. In the DDWOR side, the flattened shape was the most frequent (p = 0.041). As to disc configuration, the biconcave shape was found in 79% of the DDWR cases (p = 0.001) and the folded type predominated in 43% of the DDWOR cases (p = 0.008). As to disc position, in the DDWR side, “b” (anterosuperior position) was the most frequent (p = 0.001), whereas in the DDWOR side, “d” (anteroinferior position) was the most often observed (p = 0.001). The side of the patient with altered disc configuration and smaller shape of TMJ articular eminence seems to be more likely to develop non-reducing disc displacement as compared to the contralateral side.
Cerebral palsy (CP) is one of the most frequent conditions encountered in the daily practice of dentists who treat special-needs patients and it seems that parafunctional oral habits are often present in such individuals. The aim of this study was to investigate the frequency of occurrence of parafunctional habits in individuals with CP. Sixty-five patients with CP were evaluated through a questionnaire and clinical observation, regarding the following habits: pacifier-sucking, finger-sucking, biting objects, tongue interposition, and bruxism. The results showed that nine (13.8%) patients presented with pacifier-sucking, four (6.1%) showed finger-sucking, 12 (18.4%) had the habit of biting objects, 27 (41.5%) presented with tongue interposition, and 24 (36.9%) had eccentric bruxism. The significance of the presence of oral parafunctional habits in individuals with CP, revealed in this study, justifies the need to establish protocols for adequate prevention and clinical intervention in order to minimize the deleterious consequences that may result from such habits.
The osteogenesis imperfecta congenita (OMIM 166210) type II phenotype can be caused by mutation in either the COL1A1 gene or the COL1A2 gene that encode the chains of type I procollagen, the major protein in bones. Patients can therefore present a combination of features, including multiple long bone fractures and deformities, growth deficiency, joint laxity, hearing loss, blue sclera, and dentinogenesis imperfecta. The purpose of this study is to describe a clinical case of this syndrome, focusing on the anatomy of the temporomandibular joint (TMJ) that was assessed using computed tomography (CT) method. Clinical examination included evaluation of mandibular dynamics and investigation of temporomandibular dysfunction (TMD).
Myotonic dystrophy is a multisystemic disease with varying symptomatology. The aim of this study was to compare the maximal bite force and handgrip force in patients with molecular diagnosis of myotonic dystrophy with those in a group of healthy individuals. It was hypothesized that these forces were reduced in the patients in comparison with the control subjects. The bite and handgrip forces of 37 patients with molecular diagnosis of myotonic dystrophy and 37 control subjects matched regarding age and gender were measured using an electronic dynamometer. The bite and handgrip forces were significantly lower in the myotonic dystrophy patient group when compared with the healthy controls (P < 0.0001). There were no significant force differences between genders, right- or left-hand side of mastication or hands in the myotonic dystrophy patient group whereas such differences were found among the controls. There were moderate but significant correlations between bite and handgrip force in both groups (r = 0.43-0.59; P < 0.01). It was concluded that there were considerable differences between the myotonic dystrophy group and the control subjects regarding both bite force and handgrip force. The weakness of the masticatory and hand muscles may have various negative consequences for oral function and dental health in patients with myotonic dystrophy.
Aims: Arthrogryposis multiplex congenita (AMC) is characterized by congenital contractures and joint deformities, but there are only a few reports of temporomandibular joint (TMJ) involvement. The objective of this investigation was to study the cause of limited mouth movement in this disease.
Materials and methods: Four individuals from a family affected by AMC over 5 generations were examined clinically and by magnetic resonance imaging (MRI) and 3-dimensional computerized tomography (3D-CT).
Results: The CT scans of the 4 individuals showed hyperplasia of the coronoid process protruding into the infratemporal fossa in 2 of them and cranially to the zygomatic arch in the other 2; the hyperplasia was associated with mechanical limitation of the mouth opening. The MRI showed a disc displacement with reduction in 1 patient and a disc displacement without reduction in another; disc displacement could not be evaluated because of the limited mouth opening in the other 2. The condyle-disc complex of these last 2 individuals could only rotate. The MRI on T2-weighted images showed disc hyposignal in all cases but no alterations in the masticatory muscle tissue. The pedigree of the family suggests an autosomal dominant form of inheritance.
Conclusions: The restriction of mouth opening in the 4 individuals affected by AMC was likely due to osseous dysplasia.
Objectives: To describe a case of mandibular condyle intrusion into the middle cranial fossa in a young child and to systematically review the literature pertaining to this condition.
Study design: The diagnostic procedures comprised clinical examination, health history, and both magnetic resonance imaging and computerized tomography. A systematic review of the literature from PubMed, Medline, and Web of Science databases from 1960 to 2005 was made and a total of 55 cases in 51 references were found, of which 36 were described in detail.
Conclusions: Prompt diagnosis of mandibular condyle intrusion into the middle cranial fossa is essential to minimize complications. Advanced imaging modalities of computed tomography and magnetic resonance imaging are indicated.
Introduction: Epidemiological studies have suggested an association between unilateral posterior crossbite (UPXB) and temporomandibular joint disc displacement. The purpose of this prospective study was to investigate articular disc positioning and its configuration in children with functional UPXB malocclusions and their counterparts with normal occlusions by using magnetic resonance imaging.
Methods: The study sample included 9 girls and 6 boys (mean age, 9.3 years; SD, 2.1) with complete UPXB involving 3 or more posterior teeth and functional shift from centric relation to intercuspal position (patient group). The control group consisted of 10 girls and 6 boys (mean age, 9.6 years; SD, 2.1) with normal occlusion. All participants had no signs or symptoms of temporomandibular disorder. Sagittal and frontal magnetic resonance images of the temporomandibular joint with the jaw in closed and open positions were made bilaterally. Three investigators independently interpreted the magnetic resonance images.
Results: No intergroup or intragroup differences regarding sex were found, and only 1 subject with articular derangement (disc displacement without reduction associated with disc distortion-folded disc) was found (patient group, same side of crossbite).
Conclusions: These findings suggest that temporomandibular joint derangements and functional UPXB are independent occurrences, or that the magnitude of such derangements is still not normally detected by magnetic resonance imaging in children in this age range. Another explanation for posterior crossbite not being reflected in disc displacement is the potential compensatory asymmetrical condyle growth or articular fossa remodeling that can hold the articular disc in position.
This prospective study investigated the influence of functional unilateral posterior crossbite on mastication movements. The study group included 16 patients (nine girls and seven boys) with functional unilateral posterior crossbite involving three or more posterior teeth. A control group comprised 15 individuals (nine girls and six boys) with normal occlusion and the mean age of both groups was 9.17 years. The mandibular masticatory movements were registered, using computer axiography, for 30 seconds during chewing to determine the preference side of chewing. The patterns of the first, third, and fifth chewing cycles were compared with the preference side to establish whether they would predict the chewing preference side. The extent of the maximal lateral and vertical displacements of the mandible during chewing were compared between study and control groups. This study found that overall the left side was the preferred mastication side in 43.7% of individuals in the study and 46.7% in the control group. There was no relationship between the side of the crossbite and the masticatory preference side (Mc Nemar test, P = .5). No correlation was present between the patterns of chewing movements in the first, third, or fifth cycles. Both study and control groups showed similar maximal lateral and vertical mandible displacement.
We describe here the temporomandibular joint and masticatory muscle abnormalities disclosed by computed tomography and magnetic resonance imaging in a 25-year-old man with centronuclear myopathy (a congenital myopathy) who presented with marked limitation of jaw movements. We found an intense and general fatty replacement of the masticatory muscles, and magnetic resonance imaging signals indicated articular fibrosis. We conclude that in centronuclear myopathy, the presence of weakness and hypomotility of the masticatory muscles can induce chronic abnormalities of the temporomandibular joint.