Brazilian Journal of Development, Curitiba, v.7, n.3, p.
30556-30567 mar 2021
Prevalência de sintomas das Disfunções Temporomandibulares nos pacientes atendidos no CEO de Palmares PE
Andrey Rennato de Araújo e Sousa, Karla Shangela da Silva Alves Cabral, Antônio Sérgio Guimarães DOI:10.34117/bjdv7n3
RESUMO O Termo DTM (Disfunção Temporomandibular) engloba uma série de desordens que envolvem os músculos da mastigação, as articulações temporomandibulares e estruturas associadas. O objetivo do presente trabalho foi verificar a prevalência de sintomas de DTM e rastreamento de dor em indivíduos encaminhados para atendimento no Centro de Especialidades Odontológicas do município de Palmares (PE). Tratou-se de um estudo transversal epidemiológico, analítico, descritivo, quantitativo, no qual os indivíduos foram submetidos aos questionários da Academia Europeia de Disfunção Crâniomandibular e TMD-PAIN SCREENER. Os resultados referentes ao questionário TMD – PAIN SCREENER evidenciaram que 80.8% dos entrevistados não apresentaram dor, 14,2% apresentaram dor passageira, 5,0% apresentaram dor persistente e a origem do ambulatório não influenciou significativamente as respostas. Os resultados referentes ao questionário de rastreamento de dor, mostraram que 14 % dos voluntários apresentaram dor, uma vez por semana ou mais, quando abriam amplamente a boca ou mastigavam, sendo a totalidade do sexo feminino, e sem significância estatística para a origem do ambulatório. Houve maior prevalência de sintomas de DTM no sexo feminino dentre as pessoas que foram encaminhadas para atendimento Odontológico no Centro de Especialidade Odontológicas (CEO) de Palmares. Conclui-se, portanto, que a frequência de sintomas para essa disfunção mostra a necessidade de um profissional especializado em DTM e Dor Orofacial para atendimento da população assistida por essa unidade de saúde.
Palavras-chave: Articulação temporomandibular, Síndrome da Disfunção da Articulação Temporomandibular, Dor facial.
J Young Pharm2020; 12(2):141-144
Symptoms of Temporomandibular Dysfunction in Patients Submitted to Bucco-Dental Surgery
Objectives: To verify the symptoms of temporomandibular disorders (TMD) in a sample of patients who made dental surgery, before and after the procedure. Methods: This is a clinical, longitudinal and quantitative study. The study population consisted of patients of both genders, aged between 16 to 60 years, selected in the surgery service. The participants answered two questionnaires to evaluate the presence of TMD symptoms, the TMD-Pain Screener questionnaire and the questionnaire of the European Academy of Craniomandibular Disorders (EACD). Results: 110 patients were evaluated, the most female (p <0.05). When questioned about which surgery was performed, the highest prevalence was of impacted third molars (37.3%), followed by third erupted molars (27.2%) and third molars included (18.2%). When evaluating the results of the TMD-Pain Screener questionnaire, there was statistical significance for all questions both in the pre- and post-operative periods. Regarding the EACD questionnaire there was no statistical significance for pain. When comparing the questionnaires at different times, there was no statistical difference in the EACD questionnaire and TMD-Pain Screener, only in relation to mouth opening and laterality movements (p = 0.04). Patients with and without TMD symptoms showed no statistical significance for any of the questionnaires. Conclusion: It was concluded that there was a high prevalence of painful TMD symptoms in patients who sought dental surgery. After the surgical procedure, there was a significant decrease in mandibular pain in the opening, protrusion and laterality movements. Thus, dental surgeries performed under adequate operative conditions do not affect TMD symptoms in patients.
Key words: Temporomandibular Joint, Facial Pain, Signs and Symptoms , Ambulatorial Surgery Procedures, Oral Surgery.
J Young Pharm2019;11(4):424-428
Prevalence of Temporomandibular Dysfunction Symptoms in Dental Surgeons
André Luiz Menezes Cidrão, Antônio Sérgio Guimarães
Introduction: Temporomandibular Disorders (TMD) are defined as a set of painful and/or dysfunctional conditions related to masticatory muscles, Temporomandibular Joint (TMJ) and associated structures. This study proposed to evaluate the prevalence of TMD symptoms in dentists from Fortaleza, one Brazilian city, relating the age group, gender and time of professional performance. Materials and Methods: This is a crosssectional, descriptive-analytical research. A total of 495 dentists were selected, of which 55.8% (n= 276) were females and 44.2% (n= 219) were males, with a professional working time up to 10 years (69.1%, n= 342), up to 30 years old (57.0%; n= 282). Results: When asked about the movements that interfered with weekly pain according to European Academy of Craniomandibular Disorders (EACD), the majority of the participants reported no pain (p<0.01), among the ones who answered yes, headache was the most prevalent (31%, n= 70), followed by pain in the temples, face, TMJ or mandible (17.3%; n= 39). In relation to participants who responded to have pain symptoms, headache was the most prevalent symptom. Regarding the search for treatment, the majority pointed to seek treatment with a neurologist. Despite several pain symptoms reported, most participants rated their own health with an average of 8.69±1.35. Conclusion: In spite of the several studies on the prevalence of TMD in the literature, there are still few studies evaluating the prevalence of TMD symptoms in dentists.
Key words: Temporomandibular Joint Disoders, Signs and Symtoms, Dentists.
Comorbid conditions associated with painful temporomandibular disorders in adolescents from Brazil, Canada and France: A cross-sectional study
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.
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.
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.
Differences in bite force between dolichofacial and brachyfacial individuals: Side of mastication, gender, weight and height
Purpose: Due to the bite force importance in functionality of the masticatory system, this study aimed to characterize it in dolichofacial and brachyfacial individuals.
Methods: A sample comprised by 190 patients was divided into two groups: 90 severe dolichofacial, and 100 severe brachyfacial individuals classified according to the VERT index and the face height ratio (Jarabak quotient). Bite force was measured by using an adjusted digital dynamometer and proper methodology.
Results: The sample met the parametric assumptions and presented statistical significance when right and left sides of dolichofacial and brachyfacial individuals were compared. However, within the same group, no differences between the left and right sides were found. Generally, bite force was higher for male, left masticator, age between 41-50 years, weighing over 100kg and between 1.81 and 1.90m tall.
Conclusions: Based on the results of this cross-sectional study, it was possible to conclude that the bite force in severe brachyfacial individuals was significantly higher than in severe dolichofacial individuals, being influenced by gender, weight and height.
OBJECTIVES: This study aimed at identifying the prevalence of suspected temporomandibular disorders in employees and students of a Brazilian university and at evaluating the influence of socio-demographic and clinical variables on this disorder.
METHODS: This study had a non-probabilistic sample of 575 volunteers who were evaluated by a questionnaire proposed by the American Academy of Orofacial Pain.
RESULTS: Suspected temporomandibular disorder was present in 60.87% of the population. By means of multiple logistic regression analysis, just clinical variables were associated to the presence of suspected temporomandibular disorder, such as headache, neck pain or teethache (OR=47.60), stiff, tight or regularly tired jaws (OR=13.37), mouth opening difficulty (OR=13.55) and pain around the ears, temples or cheeks (OR=4.61).
CONCLUSION: The questionnaire was effective as a pre-screening tool to identify symptoms, and results support the importance of clinical symptoms for the identification and follow up of patients with such disorders.
Relationship Between Orthodontics and Temporomandibular Disorders: A Prospective Study
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.
[Orotracheal intubation and temporomandibular disorder: a longitudinal controlled study]
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 [52.5-72]; control group: 54 [47-68]; 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 [40-47] vs.
Control group: 46 [40-51]; 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.
Biopsychosocial factors of Axis II of the Research Diagnostic Criteria for Temporomandibular Disorders in individuals with muscular temporomandibular disorder and migraine
OBJECTIVES: To relate biopsychosocial variables of Research Diagnostic Criteria for Temporomandibular Disorders to groups of patients with temporomandibular disorders, temporomandibular disorders and migraine and a control group.
METHODS: This is a cross-sectional observational study where 280 consecutive patients were evaluated and distributed in three groups group I (140 control individuals); group II (65 individuals with muscle temporomandibular disorders) and group III (75 individuals with migraine and muscle temporomandibular disorders). Exclusion criteria were individuals with clinical history of muscle inflammatory processes, muscle spasms, contractures and acute temporomandibular joint traumatic injury.
RESULTS: Group III individuals had association with severe depression (p<0.001), level 4 in pain severity (p=0.004), unspecific physical symptoms without severe pain (p<0.0001) and unspecific symptoms with severe pain (p<0.00001). There has been significant difference between females and males in group III (Z=2.59; p=0.001), with longer pain duration among females. The percentage of females in group III was significantly higher as compared to males (p=0.004).
CONCLUSION: The relationship between variables and the three groups has shown a higher number of individuals with more severe symptoms in group III. So, it is understood that migraine is a morbid condition often associated to temporo mandibular disorders, worsening symptoms referred by patients. There is the need for multidisciplinary evaluation of these individuals to optimize treatment and minimize morbidity, costs and the number of medical visits.
Evaluation of body painful areas in patients with muscular temporomandibular disorder: a retrospective study
OBJECTIVES: Among temporomandibular disorder classifications, masticatory muscles myofascial pain is the most frequent. Its multifactorial etiology makes its treatment difficult. Identifying other painful sites related to temporomandibular disorders may help controlling comorbidities and, as a consequence, improving their symptoms. This study aimed at evaluating the presence of body pain in temporomandibular location.
METHODS: We have evaluated 328 medical charts of the Dental Research Center São Leopoldo Mandic, with diagnosis of muscular temporomandibular disorder. Patients were evaluated by means of a body map to locate pain complaints.
RESULTS: From 328 analyzed medical charts, 180 (55%) had body pain (160 females, 20 males), and 148 (45%) had facial pain only (116 females, 32 males). Areas with most frequent pain reports were cervical, lumbar and shoulders.Females had more body pain (with pain n=160, without pain n=116, p≤0.001) as compared to males (with pain n=20, without pain n=32) with statistical difference.In most cases pain has affected both body sides (bilateral face 67%, bilateral body 92%).
CONCLUSION: Most patients with temporomandibular disorder had pain in body parts different from the face. Regions marked in human body drawings with more pain were cervical followed by lumbar and shoulders.
Teeth grinding, oral motor performance and maximal bite force in cerebral palsy children
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.
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.
Temporomandibular Disorder: Prevalence Among Hemophiliac Patients
The objective was to investigate the prevalence of temporomandibular dysfunction TMD – in severe and moderate hemophiliac A and B patients and healthy men as control group. Hemophilia complication is chronic arthropathy that results from repeated joint bleeding, leading to limited movement. Limitation of jaw movement is present in patients with TMD. Hemophiliac patients were recruited in the Hemophilia outpatient clinic at Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). The control group was composed of voluntary subjects recruited among medical and dental students of UNIFESP. Both groups were screened for TMD symptoms according to the European Academy of Craniomandibular Disorders questionnaire. The Research Diagnostic Criteria further evaluated those considered positive for TMD. The results showed a similar prevalence of TMD in the hemophiliac group compared to the control group (n= 38, n= 79; p= 0.7). There were no significant differences in severity of sign and symptoms between the groups. In conclusion, patients with hemophilia do not have a higher prevalence of temporomandibular disorders, indicating absence of hemorrhage in temporomandibular joint.
2014 Jul 1;15(4):500-5.
Complete ossification of the stylohyoid chain as cause of Eagle’s syndrome: a very rare case report
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.
Frequency and Location of Referred Pain in Patients with Temporomandibular Disorder
Based on the survey of records regarding the location and frequency of referred pain in patients with temporomandibular disorder when certain pre-established areas are palpated, we proposed an anatomical-topographical division of the head and neck to allow the standardization and reproducibility of locations of referred pain. Of the 835 charts reviewed, 419 (50.2%) patients had referred pain on palpation of the regions based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and palpation of the cervical regions, as often analyzed by the Cochran Q test. The concordance coefficient of Kendall examined the correlation between regions of referred pain concerning to palpated sites. The new regions were defined preauricular, facial lateral, temporoparietal, posterior head, posterior and lateral cervical, anterior cervical and calvaria. The region palpated that originated more referred pain was corresponding to the masseter muscle followed by the region of the sternocleidomastoid muscle, regardless of the side palpated. On palpation of the regions established by the RDC/TMD, the most frequent area of referred pain was the lateral facial region. On palpation of the neck, were the posterior and lateral cervical regions. The sites that originated more referred pain when palpated were the masseter, temporalis, sternocleidomastoid and trapezius muscles.
Prevalence of temporomandibular disorders symptoms in patients with multiple sclerosis
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).
The teaching of temporomandibular disorders and orofacial pain at undergraduate level in Brazilian dental schools
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.
Comfort evaluation of non occlusal intraoral appliance use during sleep in patients with muscular temporomandibular dysfunction
The aim of this study was the evaluation of the discomfort level during the utilization of non oclusal intraoral appliance during sleep in patients with muscular temporomandibular dysfunction; time of acceptance; and the effectiveness of non oclusal intraoral appliance related to the relief of pain symptoms. We evaluated 30 patients from Orofacial Pain and Temporomandibular Dysfunction Clinic (UNIFESP/EPM/HSP) with muscular temporamandibular dysfunction, 25 females and 5 males, between 19 to 60 years. We used a non-oclusal intraoral appliance, based on the model developed by Minagi et al. (2001). Patients was conducted to use the appliance during all sleeping period e to persist in use, even when there was any kind of discomfort, which would be natural during the adaptation period, for 30 consecutive days. After this period, the researcher interviewed all patients, answering specific questions designed for this study. The mean time for adaptation was 4 days. Of all patients, 23.33 percent had no difficulty in adapting the appliance, with immediate acceptance. The gradual reduction in the intensity of myofascial pain and discomfort, as well as improving the quality of life in 78.3 percent of the sample confirmed the effectiveness of non-oclusal palatal intraoral appliance without occlusal contact in relieving the painful symptoms of muscular TMD.
Therapeutic exercises for the control of temporomandibular disorders
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.
The jaw muscles are essential components in the stomatognatic system. Their complex architecture allows them to execute several motor tasks. One of the structural peculiarities is the presence of hybrid and neonatal fibers.We studied the differences of the fiber-type in masseter and temporalis muscles along the first to nineth decades in both genders. Seventy-four (74) samples were analyzed by immunohistochemistry. Slow and fast muscle fibers distribution was similar in both muscles in both genders. Hybrid fiber was observed in all decades, and its frequency decreased significantly (p<0.001) with aging in masseter. Neonatal myosin expression was observed in all decades, its expression was more frequent in masseter (p=0.01), and males in temporalis (p=0.025). Decrease of the cross sectional area of fast and slow fibers, and decrease of capillary density were detected with aging. These morpho-immunohistochemical alterations on masseter and temporalis muscles correlated to the decrease in bite force with aging
The approval rating through the use of an interocclusal device
Objective: The objective of this study was to assess the approval rating of patients with muscular and/or joint TMD during the use of an interocclusal device.
Methods:51 consenting patients were selected with muscular and/or joint TMD, according to the criteria of the Research Diagnostic Criteria protocol (RDC/TMD) and needing the use of an interocclusal device as part of a conservative treatment at the São Leopoldo Mandic Dental Research Center in Campinas, São Paulo, Brazil. The interocclusal device was installed using the protocol defined by the manufacturer for its use and adaptation. The satisfaction questionnaire was applied to the subjects of the research after 30 days using the interocclusal device.
Results: The results were 71% of the patients had felt comfortable using the device; 73% used the device all night long, but 27% removed it at some time during the night, and 5 of these patients removed it every night, thus they did not succeed in using this type of device; 88% used it daily; 70% achieved the greatest relief from the main complaint in the first 3 weeks; 61% did not notice any change in bite; 47% did not feel any kind of tooth sensitivity; 51% did not grind their teeth with the use of the device and 72% took one or two weeks to get used to the device.
Conclusion: The majority obtained a high level of rating approval during the use of an interocclusal device.
OBJECTIVES: Temporomandibular disorders (TMD) involve a set of craniofacial changes, which may involve temporomandibular joint (TMJ), jaw muscles and/or associated structures. Muscle TMD is the most frequent, and one of its subtypes is myofascial pain. Botulinum toxin type A (BoNT A), has been studied to control pain, including myofascial pain, and is related to pain relief mechanisms not only in neuromuscular junction receptors. This study aimed at evaluating articles addressing BoNT A to treat jaw muscles myofascial pain. CONTENTS Pubmed, LILACS and BVS databases were queried from 2000 to April 2012, crossing the following keywords botulinum toxin type A, myofascial pain syndromes, facial pain, temporomandibular joint disorder syndrome, trigger-points, bruxism, temporomandibular joint, masseter muscle and temporalis muscle. Inclusion criteria were randomized double blind or blind studies, with 10 or more participants, with randomized methodological aspects, relating the use of botulinum toxin for jaw muscles TMD myofascial pain, more specifically masseter and temporalis muscles, and limited to the English language. Six articles were found and included in this study.
CONCLUSION: BoNT A was not more effective to treat myofascial pain than established conventional treatments. Because there are many uncontrolled variables in the few related studies, more studies with judicious methodologies are needed to make feasible its use in patients refractory to pain and previously submitted to conservative treatments.
Temporomandibular Joint Magnetic Resonance Imaging Analysis in Adults with Steinert’s Myotonic Dystrophy
OBJECTIVES: aim was to analyze the characteristics of the temporomandibular joint (TMJ) in a group of adult patients suffering from Steinert’s muscular dystrophy (DM1). This study included 42 adult patients aged between 21 and 69 years (mean = 38.7619; SD = 12.74) who were diagnosed for DM1. Study was conducted using the MRI of right and left TMJ sagittal images taken in maximum intercuspidation position and maximum oral opening without pain, and the following were discussed a) the quality of the cortical bone in the mandibular fossa, tuberosity, and mandibular head; b) the relationship of mandibular headdiscjoint tuberosity in maximum intercuspidation position; c) the anatomical shape of the articular disc. All patients showed abnormalities in the shape and surface of the cortical bone in the mandibularfossa, tuberosity, and the mandibular head.
CONCLUSION:With regard to the relationship of the mandibular head in the mandibular fossa, 41% was found in the region 2B, 29% in 1B, 18% in 1A, 9% in 2C, and 3% in 2A of the TMJ. About 49% of the disc in maximum intercuspidation position was found on the mandibular head, 26% were anterior displaced, 14% had anterior dislocations, 38% had alterations in the form of disc, and 30% had preserved the anatomical shape. However, 98% of the discs showed hyposignal in T1 and T2. Using MRI, the decrease in the muscle activity in patients with DM1 was found to generate degenerative changes visible in the TMJ.
Risk factors for temporomandibular disorder and orofaciaI pain in childhood and adolescence
Signs and symptoms of temporomandibular disorders (TMD) can be detected at different ages of growth and development of the individual. When treating children and adolescents, it is important for the pedodontist to be able to perceive early signs of TMJ. Thus, as in any disease, the knowledge of the risk factors offers the support to the professional to establish strategies in an attempt to prevent or delay the onset of adverse clinical conditions. Based on the premise of promoting the health of the individual, the need to understand the different situations associated with TMD precedes even the knowledge of early identification of signs and symptoms of TMD may not represent the disease under development. The clinical use of comprehension of risk factors is basically anamnestic and does not require specific training that requires physical diagnosis. The literature has not satisfactorily documented the influences that these factors perhaps exert in children and adolescents, in each time period, and many inferences from research in adults have yet to be made.
OBJECTIVES: study objective was to evaluate the prevalence of referred dental pain (RDP) in a group of Brazilians subjects and identify possible partnerships with sex, age and the presence of periodontal or periapical lesions. A descriptive cross-sectional study was designed, 98 patients between 14 and 64 years old (59 women and 39 men), who consulted by dental pain were evaluated clinically and radiographically in order to determine the cause and partnership with periapical and periodontal lesions and its possible territories projection other than their origin.
CONCLUSION: The prevalence of RDP was 31.6 percent, higher in women (67.74 percent) though without statistical significance. The RDP was presented at a 45.16 percent together with periapical lesion and a 25.8 percent along with periodontal lesion. There was no relationship between age and RDP presence. The high prevalence of RDP found reinforces the need for a diagnosis of orofacial pain.
Profile of patients with temporomandibular joint disorder: main complaint, signs, symptoms, gender and age
Objective: This study investigated the most common features of the signs and symptoms of temporomandibular joint disorder and patient profile, including age and gender. The study was done at the First Master Level temporomandibular joint disorder and Orofacial Pain Clinic of São Leopoldo Mandic School of Dentistry, in Campinas, São Paulo, Brazil, to better familiarize general dental surgeons and experts with this disorder.
Methods:This cross-sectional, retrospective study collected data from the records of the first consecutive 200 patients seen at the abovementioned clinic. The collected data included gender, age, main complaints and duration of each complaint. If pain was the main complaint, the affected region and pain intensity were also included.
Results:Most (81%) patients were females with a mean age of 36.5 years, ranging from 9 to 82. Pain was the most common complaint referred by 86% of the sample. The complaint bruxism/clenching had the longest mean duration (82.9 months). Pain was most common in the parotideomasseteric region, referred by 53% of the cases.
Conclusion: Individuals seeking treatment for temporomandibular joint disorder are usually middle-aged females complaining of pain, especially in parotideomasseteric region.
Is orthodontic treatment a risk factor for temporomandibular disorders?
INTRODUCTION: The possibility that orthodontic treatment in childhood might be a risk factor for the development of temporomandibular disorders (TMD) later in life has been an issue of great controversy in dental literature.
OBJECTIVE: To determine a possible negative or positive correlation between orthodontic treatment and TMD by presenting the results and conclusions from a number of key-papers dealing with this subject. RESULTS AND
CONCLUSION: According to current knowledge, there is no scientific evidence to support that orthodontic treatment is a risk factor for the development of TMD. On the other hand, there is some evidence to support that a proper orthodontic treatment performed in childhood might have a positive effect upon the functional status of the masticatory system later in life.
Oral effects and also in the temporomandibular joint for the anticipatory phenomenon in patients with Steinert’s muscular dystrophy
ABSTRACT: The Steinert’s muscular dystrophy type 1 involves frequently the masticatory muscle causing muscular weakness and orofacial alterations; this entity is characterized by to present the anticipatory phenomenon where la offspring of a involved person develops the disease in an early way.
OBJECTIVE: The aim of present paper is to report 2 cases in mother and daughter diagnosed with the DM1 and to analyze the oral clinical features and the effects of anticipatory phenomenon of disease by stomatologic examination, measurement of masticatory strength and magnetic nuclear resonance of temporomandibular joint.
CONCLUSION: The clinical expression of this disease was earlier in the daughter than in the mother, which was related to a greater number of lost teeth and of degenerative changes en la TMJ associated with a lesser masticatory strength(AU)
Focal dermal hypoplasia: a case report and literature review
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.
Intrusion of the mandibular condyle into the middle cranial fossa: case report and review of the literature
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.
Correlation between pressure pain threshold and pain intensity in patients with temporomandibular disorders who are compliant or non-compliant with conservative treatment
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.
Are temporomandibular joint signs and symptoms associated with magnetic resonance imaging findings in juvenile idiopathic arthritis patients? A longitudinal study
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.
o alongamento do processo estilóide pode ser assintomático ou desencadear uma série de sintomas que incluem dor e desconforto, e tem sido descrita como síndrome de Eagle (SE). Esta condição pode ser um achado ocasional durante exames de rotina no consultó- rio odontológico. O Cirurgião-Dentista, que muitas vezes é o primeiro profissional a ter oportunidade de fazer o diagnóstico, deve ter conhecimento desta condição e prováveis . consequências para esclarecer o paciente e nortear a conduta a ser adotada. Portanto, o objetivo deste trabalho foi apresentar conceitos clínicos encontrados na literatura da SE e apresentação de caso clínico.
Correlação entre disfunção temporomandibular e fibromialgia
OBJETIVOS:A disfunção temporomandibular (DTM) é o termo genérico para um grande número de distúrbios funcionais do sistema da mastigação, da articulação temporomandibular (ATM) e de estruturas associadas. Fibromialgia (FM) é uma das doenças reumatológicas mais frequentes, cuja característica principal manifesta-se com dor musculoesquelética difusa e crônica. Pelo fato dessas duas condições apresentarem diversas semelhanças, tanto na prevalência quanto nas características clínicas; o objetivo desse estudo foi realizar uma análise e relatar a possível correlação entre ambas. CONTEÚDO: Realizou-se uma revisão da literatura de 1995 a 2008 nas bases de dados Web of Science, Pubmed, MedLine, LILASC e BBO, cruzando-se os descritores fibromialgia, fibrosite, síndrome da dor miofascial difusa, síndrome da disfunção da articulação temporomandibular (DTM), transtornos da articulação temporomandibular e transtornos crânio mandibulares. Os estudos mostraram que a dor muscular oriunda da DTM, embora seja considerada uma condição regional pode, em determinados indivíduos, coexistir com síndromes dolorosas sistêmicas, como a FM. No entanto, indivíduos com FM apresentam, em sua grande maioria, dolorimento na região de cabeça caracterizando um forte indício da presença de possível DTM. O que se observou é que grande parte dos indivíduos com FM apresentam DTM, porém o inverso não é verdadeiro.
CONCLUSÃO: Considerando-se o escasso conhecimento sobre a apresentação orofacial da FM, o tratamento da DTM para pacientes com FM deve ser conservador e direcionado aos possíveis fatores de risco
Anterior disc displacement and the superior head of lateral pterygoid muscle: a case-control study
Objective: The objective of this study was to assess the association between an increase in the proportion of the superior head of the lateral pterygoid muscle (SHLP) inserted into the temporomandibular joint (TMJ) disc and the presence of anterior disc displacement diagnosed by using MRI. We analyzed 75 images of patients with anterior displacement and 75 controls with normal relationship between the mandibular head and the articular tubercle also diagnosed by MRI. Levels of insertion were measured. Results: Descriptive and analytic statistics were calculated. Analyses of differences were made by Fischer’s exact test and also were calculated clinical significance (OR, CI = 95 percent). The average insertion of SHLP was 71.14 percent (SD 14.13) in controls and 67.80 percent (SD.16.23) in cases group. The only relationship that presented a significant association (OR 5.61) was found when comparing subjects with a percentage of inserting the disc into the SHLP at 50 percent with those who had higher levels of insertion (50 percent). Conclusion: Our results suggest that the highest percentage of insertion serves as a protective factor for anterior disc displacement, probably due to greater control of neuromuscular activity.
Superior head of the lateral pterygoid muscle inserting in asymptomatic temporomandibular joints
The constitution and shape of superior head of the lateral pterygoid muscle (SHLP) inserts remains a topic of interest in the literature. Objective: The purpose of this study was to analyze by magnetic resonance imaging (MRI) the temporomandibular joint (TMJ) of individuals without signs of temporomandibular dysfunction. One hundred seventy-eight MRI images of one hundred and three patients were utilized, and the surface and percentage of the SHLP insert into the articular disc and condilar process was determined. Results:In women, the average insertion into the disc was found to be between 5.75.5mm (SD 1.51.3), corresponding to 69.870.7 percent of the SHLP. In men, the average insertion into the disc was between 6.26.12mm (SD 1.81.9), or 68.974.2 percent. There were no differences in terms of the sex of the patients or the side of the joint. Conclusion:We found a significant percentage of SHLP fibers embedded in the disc of asymptomatic TMJs, and its role in theanterior disc displacement and the development of the temporomandibular dysfunction should be revised.
2009 Dec 8;1:71-3.
Temporomandibular joint sounds and disc dislocations incidence after orotracheal intubation
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.
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.
2012 Apr 1;4(2):e102-6.
Prospective study of a group of pre-university students evaluating anxiety and depression relationships with temporomandibular disorders
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.
Prevalence of the third head of the lateral pterygoid muscle: a magnetic resonance image study
The lateral pterygoid muscle (LPM) is important in the physiology and dysfunction of the temporomandibular joint (TMJ), which has described the presence of a third head in the lateral pterygoid muscle (THLPM). Aims: The purpose of this study was to evaluate the prevalence of THLPM and its relationship with the TMJ disc through magnetic resonance imaging (MRI). Methods: It was evaluated 178 MRI of the TMJ of healthy individuals, in images that presented THLPM, and these were defined and measured at the surface inserted into the disc. Results: The prevalence of THLPM was 20.22 percent (n = 36). Insertion of THLPM was made entirely on the TMJ disc, the average area of insertion was 4.14mm (SD 1.35) in women and 4.67 (SD 2.68) in men, but these differences were not significant. Conclusion: We concluded that the LPM has a complex structure, and that a THLPM could contribute in the development of TMJ disc function alterations and anterior disc displacement.
Mandibular condyle position in maximum mouth opening: a magnetic resonance imaging evaluation
Aims: The purpose of this study was to analyze the condylar position in the maximum mouth opening in a group of individuals with and without temporomandibular joint disorders (TMD) using corrected magnetic resonance imaging (MRI). Methods: It was analyzed the MRIs of 200 temporomandibular joint (TMJ) of 100 adults (25 males and 75 females). The images protocol of the MRIs were in corrected sagittal plane T1, with the patient kept at a maximum mouth opening without pain. All the images were obtained parallel to the Frankfurt plane. The images were split by two lines parallel to the upper base of the image which was obtained parallel to the Frankfurt plane, tangential to the articular tubercle and the condyle of each TMJ, and set along the discrepancy of the condylar position on both sides and the position with regard to the articular tubercle. Results:The discrepancy was 45 percent overall, the most common condylar position types were 5 and 6 on the right and left sides in both the male and female TMJ patients. In this regard, the highest mean values were found for the maximum mouth opening. Conclusion:Our results support the hypothesis that the condylar position is not directly related to the magnitude of the oral opening.
Autonomus referred phenomena by myofacial trigger point in temporalis muscle as a neuropathic response
Myofascial trigger points (MTP) are hyperirritable points in skeletal muscle associated with a palpable lump caused by a strained muscle band. MTP presented within signs and symptoms of motor, sensory and autonomic impairment. In this article we report a case in which an autonomous referred phenomena from a myofascial trigger point and raises the neuroanatomical pathways involved in this response, considering the hypothesis that self-related responses associated with neuropathic pain can be regarded as events of the autonomic nervous system. Clinical and experimental evidence discussed in this article indicates that myofascial trigger point pain is an autonomic phenomena associated, that can be systemic and localized, and must be considered in evaluating patients with these diagnosis.
Localization of referred pain in patients with craneocervical muscles trigger points
The pain for miofascial point triggers it can refer to distant territories. Was carried out a retrospective descriptive study of the referred pain presence starting from trigger miofascial points located in masseter, temporalis, trapeze and sternocleidomastoid (SCM) muscles in 50 patients. The masseter was the muscle that presented pain referred with more frequency (n=32; 64 percent), followed by the temporalis (n=18; 36 percent), then the SCM (n=17; 34 percent) and that of smaller frequency was the trapeze (n=2; 4 percent). The presence of two cases of contralateral reference of the masseter is commented and some mechanisms that explain these situations, described in the literature, they are discussed.
Are dental surgeons qualified and motivated to care for TDJ in children and adolescents?
Trabalho objetiva caracterizar, em uma população de cirurgiões-dentistas que atendem crianças e adolescentes, a formação para o cuidado das DTMs e o interesse despertado na graduação para o tema. Em um congresso de Odontopediatria, de 181 profissionais, 20% faziam diagnóstico de DTM raramente ou nunca, 62% ocasionalmente e 16% com freqüência. Embora o tema “DTM” desperte muito interesse para 44,19% dos sujeitos, somente 4,97% correlacionaram a motivação com a graduação, na qual a DTM foi abordada superficialmente (70,16%) ou nunca (15,46%). Quanto à DTM em crianças e adolescentes, o tema nunca foi discutido (54%) ou o foi superficialmente (38%). É relevante capacitar os cirurgiões-dentistas, na graduação, para o cuidado da DTM em todas as idades e, em especial, na infância, considerando o grande potencial preventivo de lesões mais graves.
Estudo comparativo do efeito da retenção a barra no ciclo mastigatório de pacientes usuários de overdenture
O presente trabalho objetivou analisar as alterações no ciclo mastigatório quanto a sua forma, largura máxima, comprimento máximo e área total, em pacientes usuários de prótese total convencional superior e overdentures mandibulares, tanto com a manutenção quanto com a remoção da barra de retenção. Foram selecionados nove pacientes, entre 35 e 58 anos e sem histórico de disfunção articular. Com a mastigação de pedaços de cenoura crua, padronizados em 1 cm³ os registros no plano frontal foram obtidos por meio do aparelho Arcus Digma (Kavo Dental GmbH & Co. KG, Alemanha). Quanto à forma, encontrou-se uma variação inter-individual grande, porém, uma similaridade marcante nos dois registros de um mesmo paciente. Em relação à largura, quatro pacientes apresentaram aumento dos valores quando dos registros com a barra e para a altura, cinco pacientes com a barra apresentaram aumento desta variável. Sete pacientes apresentaram aumento da área total dos ciclos com a barra. Na análise estatística com a aplicação do teste não paramétrico de Wilcoxon, adotando o nível de significância de 5%, não foram encontradas diferenças significantes para os registros com e sem a barra. Os resultados demostraram que existe um padrão individual do ciclo mastigatório e uma grande variação inter-individual do mesmo. Nos registros com a barra, de modo geral, os ciclos foram mais regulares, lisos e com melhor direcionamento do que nos registros sem a barra, sugerindo uma mastigação mais efetiva.
Evaluation of TMJ articular eminence morphology and disc patterns in patients with disc displacement in MRI
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.
Frequency of parafunctional oral habits in patients with cerebral palsy
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.
Influência do aparelho propulsor Twin Block no crescimento mandibular: revisão sistemática da literatura
OBJETIVO: avaliar a eficácia do aparelho ortopédico propulsor mandibular Twin Block quanto ao crescimento mandibular. METODOLOGIA: revisão sistemática da literatura a partir de 1970. RESULTADOS E CONCLUSÕES: a maioria dos autores afirmou que houve uma diminuição significativa do ângulo SNA com retroinclinação dos incisivos superiores, o ângulo SNB sofreu aumento com vestibularização dos incisivos inferiores, houve uma resposta tissular positiva nas estruturas da ATM durante o uso do propulsor. As alterações que ocorreram são uma combinação de modificações do côndilo, da fossa mandibular, do osso basal, além de alterações alvéolo-dentárias. Cada modificação estrutural dependeu de uma multiplicidade de fatores em cada indivíduo, como o padrão morfogenético, a idade, o gênero, o padrão funcional, o controle do aparelho e os
hábitos orofaciais, entre outros.
Functional unilateral posterior crossbite effects on mastication movements using axiography
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.
Frequency of temporomandibular disorder signs in individuals with cerebral palsy
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.
Dominant form of arthrogryposis multiplex congenita with limited mouth opening: a clinical and imaging study
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.
Bite force and handgrip force in patients with molecular diagnosis of myotonic dystrophy
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.
Temporomandibular joint disc position and configuration in children with functional unilateral posterior crossbite: a magnetic resonance imaging evaluation
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.
Radiological findings and dynamic aspects of stomatognathic structures in Treacher Collins syndrome: clinical case report
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.
Anatomic and dynamic aspects of stomatognathic structures in osteogenesis imperfecta: a case report
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).
Epub 2005 Nov 22.
[Characterization of patients in a temporomandibular dysfunction and orofacial pain outpatient clinic]
This study aims to describe the characteristics of patients at a temporomandibular dysfunction and orofacial pain outpatient clinic and to discuss the insertion of nursing care in this service. A questionnaire based on the steps of the Nursing Process was applied to a sample of 150 patients attended from May to August 2003. Patients from both genders and aged between 12 and 77 years old were sequentially admitted to the study. Population data revealed that a majority was female (85%); the predominant age was from 21 to 60 years old (76%); only 3% did not present any formal instruction. The nursing role introduced in this multidisciplinary clinic created conditions to assess demographic and epidemiologic data, identify user needs and develop self-care abilities and attitudes. The proposed model made is possible to organize data collection and promote research.
. 2000 Jul;90(1):118-21.
Temporomandibular joint involvement in a patient with centronuclear myopathy
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.