Experimental pain thresholds and psychosocial features across menstrual cycle in myofascial orofacial pain compared to healthy individuals: cross-sectional study / Limiares de dor experimental e características psicossociais ao longo do ciclo menstrual na dor miofascial orofacial em comparação com indivíduos saudáveis: estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: The hormonal impact on pain perception during the menstrual cycle is a major focus of study, and further elucidation in temporomandibular disorders (TMD) field is necessary. Thus, this cross-sectional study evaluated experimental pain thresholds, psychosocial features, and clinical pain report on TMD women across menstrual cycle versus healthy controls. METHODS: A total of 220 women's clinical files were screened, with 80 selected and divided into control group (healthy individuals, n=40) and TMD group (myofascial pain, n=40). Regarding the menstrual cycle phases, the files were divided into Pre-Luteal and Luteal. The Perceived Stress Scale (PSS), Pain Catastrophizing Scale (PCS), Mechanical Pain Threshold (MPT), Wind-up (WUR), Pressure Pain Threshold (PPT), Conditioned Pain Modulation (CPM) and Visual Analogue Scale (VAS) were analyzed at a 5% significance level, by Two-Way ANOVA test and post hoc Tukey test. RESULTS: PSS and PCS were significantly different between TMD and control group (p<0.001), regardless of menstrual cycle. Healthy individuals in the Luteal phase presented higher MPT values compared to the other phases (p<0.001). PPT showed significant difference across menstrual phases (p=0.022), but no differences in multiple comparisons. VAS values showed no difference between menstrual cycle phases (p=0.376). CONCLUSION: Finally, healthy individuals in the Luteal phase have higher MPT and PPT values on the orofacial region. Pain report in patients with TMD showed no difference throughout the menstrual cycle, showing that small alterations on experimental pain thresholds may not be clinically relevant. The presence of chronic pain seems to be more related to psychosocial features than hormonal fluctuations.

RESUMO JUSTIFICATIVA E OBJETIVOS: O impacto do ciclo menstrual na percepção da dor é um foco importante de estudo, sendo necessária uma maior elucidação na disfunção temporomandibular (DTM). Assim, este estudo transversal avaliou limiares de dor experimental, características psicossociais e relatos de dor em mulheres com DTM ao longo do ciclo menstrual, comparadas com controles saudáveis. MÉTODOS: 220 prontuários de mulheres foram analisados, sendo 80 selecionados para os grupos de controle (saudáveis, n=40) e DTM (dor miofascial, n=40). Nas fases do ciclo menstrual, as pacientes foram divididas nas categorias Pré-Luteal e Luteal. Os instrumentos Escala de Estresse Percebido (PSS), Escala de Pensamentos Catastróficos (PCS), Limiar de Dor Mecânica (MPT), Wind-up Ratio (WUR), Limiar de Dor à Pressão (PPT), Modulação Condicionada da Dor (CPM) e Escala analógica visual (EAV) foram analisados com nível de significância de 5%, pelos testes ANOVA de dois fatores e Tukey post hoc. RESULTADOS: As escalas PSS e PCS foram significativamente diferentes entre os grupos DTM e controle (p<0,001), independentemente do ciclo menstrual. Indivíduos saudáveis na fase luteal apresentaram MPT maior em comparação com outras fases (p,0,001). O PPT mostrou diferença significativa entre as fases menstruais (p=0,022), sem diferença nas comparações múltiplas. Os valores da EAV não apresentaram diferença entre as fases menstruais (p=376). CONCLUSÃO: Indivíduos saudáveis na fase luteal têm MPT e PPTl maior na região orofacial. Os relatos de dor em pacientes com DTM não mostraram diferença ao longo do ciclo menstrual, indicando que pequenas alterações nos limiares experimentais podem ser clinicamente relevantes. A presença de dor crônica parece estar mais relacionada com características psicossociais do que com flutuações hormonais.

Divergence between confidence and knowledge of endodontists regarding non-odontogenic pain

Abstract This study aimed to assess the self-reported levels of confidence and knowledge related to non-odontogenic pain among a group of Brazilian endodontists. Methodology A total of one hundred and forty-six endodontists affiliated with the Brazilian Society of Endodontics participated in the survey. The questionnaire, distributed via email or WhatsApp, contained inquiries designed to gauge self-perceived confidence and knowledge concerning non-odontogenic pain. The practitioners were categorized into four groups based on their self-reported familiarity with various orofacial pain types, classified as either sufficient or insufficient, and on their engagement in ongoing educational programs related to orofacial pain. Data were analyzed by Chi-Square Test and Fischer's exact test (p<0.05). Results Overall, self-reported confidence about non-odontogenic pain was high, especially for endodontists who considered their knowledge about orofacial pain sufficient, regardless of whether they had (71.1% - 97.8%) or not (35.7% - 96.4%) been continuously involved in education courses on orofacial pain. In general, self-reported knowledge about non-odontogenic pain was insufficient (0% - 42%), except in the question about how they would act in cases of pain that persists beyond the normal healing time after an endodontic procedure (70.6% - 81.9%). In general, endodontists are confident in their diagnosis and treatment of non-odontogenic pain. Nonetheless, this confidence did not correlate with a commensurate knowledge depth of. Thus, specialization courses in endodontics should highly consider training and qualifying these professionals in the diagnosis of non-odontogenic pain.

Primary headache and myofascial pain: a data based study / Cefaleia primária e dor miofascial: um estudo baseado em dados

Aim: This study aimed to evaluate the relationship be-tween the presence of primary headaches and myofascial pain in orofacial patients. Materials and methods: Six hundred and ninety-nine records of patients seeking treatment in a specialized orofacial pain clinic were assessed. The primary diagnostic categories of heada-che and myofascial pain were recorded. Data analyses were carried out by Pearson Chi-square and Logistic Regression, with a p-value of 0.05. Results: Average age of patients was 34.6 years. Females constituted 82.8% of the sample. A relationship between the presence of tension-type headache and myofascial pain was found (p=0.00); however, this relationship was not found for the presence of migraine and myofascial pain (p>0.05). Discussion: Tension-type headaches may be triggered or perpetuated by trigger points in orofacial structures. Conclusion: It can be concluded that trigger points in myofascial pain patients can play an important role in the genesis of tension-type headache.

Objetivo: Este estudo avaliou a relação entre a presença de cefaleia primária e dor miofascial em pacientes orofaciais. Materiais e métodos: Foram avaliados 699 prontuários de pacientes que buscavam atendimento em clínica especiali-zada em dor orofacial. As categorias diagnósticas primárias de cefaleia e dor miofascial foram registradas. A análise dos dados foi realizada pelo Qui-quadrado de Pearson e Regressão Logística, com valor de p=0,05. Resultados: A idade média dos pacientes foi de 34,6 anos. O sexo feminino constituiu 82,8% da amostra. Foi encontrada relação entre a presença de cefaleia do tipo tensional e dor miofascial (p = 0,00); en-tretanto, essa relação não foi encontrada para a presença de enxaqueca e dor miofascial (p> 0,05). Discussão: As cefaleias primárias do tipo tensionais podem ser desencadeadas ou perpetuadas por pontos-gatilhos nas estruturas orofaciais. Conclusão: Pode-se concluir que os pontos-gatilhos em pacientes com dor miofascial podem desempenhar um papel importante na gênese da cefaleia do tipo tensional.

Effects of acute mental stress on conditioned pain modulation in temporomandibular disorders patients and healthy individuals

Abstract Stress is a contributing factor to painful temporomandibular disorders (TMD). Nevertheless, the underpinnings of this relationship are not fully understood. Objective To investigate the effects of acute mental stress on conditioned pain modulation (CPM) in TMD patients compared with healthy individuals. Methodology Twenty women with chronic myofascial TMD diagnosed according to the RDC/TMD and 20 age-matched healthy women had the CPM assessed before and after a stressful task using the Paced Auditory Serial Addition Task (PASAT) in a single session. Subjective stress response was assessed with the aid of visual analog scale (VAS). Pressure pain threshold (PPT) on masseter muscle was the test stimulus (TS) and immersion of the participant's hand on hot water was the conditioning stimulus (CS) - CPM-sequential paradigm. Results Healthy individuals reported PASAT are more stressful when compared with TMD patients and the stress task did not affect the CPM in neither group. Nonetheless, a negative correlation was observed between change in CPM and change in TS from baseline to post-stress session, which indicates that the greater the increase in PPT after the stress task, the greater was the decrease in CPM magnitude. The correlation was strong for healthy controls (r=- 0.72, p<0.001) and moderate for TMD patients (r=- 0.44, p=0.047). Conclusions The correlation between the change in CPM and the TS change following the stress task may possibly indicate an overlapping pathway between stress-induced analgesia/hyperalgesia and descending pain inhibition.

Botulinum toxin type A and acupuncture for masticatory myofascial pain: a randomized clinical trial

Abstract BoNT-A has been widely used for TMD therapy. However, the potential benefits compared to dry needling techniques are not clear. Objective this study aimed to compare the immediate effects of botulinum toxin type A (BoNT-A) injections and Acupuncture in myofascial temporomandibular disorders (TMD) patients. Methodology 54 women were divided into three groups (n=18). AC patients received four sessions of traditional acupuncture, being one session/week during 20-min. BoNT-A patients were bilaterally injected with 30U and 10U in masseter and anterior temporal muscles, respectively. Moreover, a control group received saline solution (SS) in the same muscles. Self-perceived pain was assessed by visual analog scale, while pressure pain threshold (PPT) was verified by a digital algometer. Electromyographic evaluations (EMG) of anterior temporal and masseter muscles were also measured. All variables were assessed before and 1-month after therapies. The mixed-design two-way repeated measures ANOVA and Tukey's post-hoc tests were used for analysis, considering a=0.05. Results Self-perceived pain decreased in all groups after one month of therapy (P<.001). BoNT-A was not better than AC in pain reduction (P=0.05), but both therapies were more effective in reducing pain than SS (P<0.05). BoNT-A was the only treatment able to improve PPT values (P<0.05); however, a severe decrease of EMG activity was also found in this group, which is considered an adverse effect. Conclusion after one month of follow-up, all therapies reduced the self-perceived pain in myofascial TMD patients, but only BoNT-A enhanced PPT yet decreased EMG.

Oral behaviors, bruxism, malocclusion and painful temporomandibular joint clicking: is there an association?

Abstract The present cross-sectional case-control study aimed to determine if there is an association between specific oral behaviors, sleep bruxism (SB), awake bruxism (AB), and painful temporomandibular joint (TMJ) clicking. Ninety individuals were dived into three groups; Group 1 (n = 30): painful TMJ clicking; Group 2 (n = 30): painless TMJ clicking; and Group 3 (n = 30): control group. The following clinical data were studied: oral behaviors (unilateral chewing, gum chewing, nail biting, foreign objects biting, leaning with jaw against the hand, and sleeping in a position that pressures the jaw), SB, AB (including the frequency in 10 days, evaluated by ecological momentary assessment), and malocclusions investigated based on clinical inspections (anterior open bite, posterior cross-bite, abnormal overbite/overjet, occlusal guidance, mediotrusive and/or laterotrusive interferences, retruded contact position to maximum intercuspation slide, missing posterior teeth). All statistical tests (Kolmogorov-Smirnov, chi-square, and one-way ANOVA) were performed with a 5% significance level. Group 1 had the highest frequency of and a significant association with leaning with jaw in the hand, sleeping position that pressures the jaw, gum chewing, nail biting, and AB (p<0.05). Gum chewing, nail biting, and AB were associated with Group 2 only when compared to Group 3 (p<0.05). No significant difference among groups was found for other behaviors (unilateral chewing and foreign objects biting), SB, and all malocclusions (p>0.05). It can be concluded that patients with painful TMJ clicking had a higher frequency of and a significant association with some specific harmful behaviors and AB.

Association of sleep quality and psychological aspects with reports of bruxism and TMD in Brazilian dentists during the COVID-19 pandemic

Abstract Dentists are exposed to contamination by SARS-CoV-2 due to dental interventions, leading to a state of alert and potential risk of negative impact in mental health and sleep quality, associated with Temporomandibular Disorder (TMD) and bruxism. Objective: to evaluate the psychosocial status, sleep quality, symptoms of TMD, and bruxism in Brazilian dentists (DSs) during the COVID-19 pandemic. Methodology: The sample (n=641 DSs) was divided into three groups (quarantined DSs; DSs in outpatient care; and frontline professionals), which answered an electronic form containing the TMD Pain Screening Questionnaire (Diagnostic Criteria for Temporomandibular Disorders - DC/TMD), the Pittsburgh Sleep Quality Index (PSQI), the Depression, Anxiety and Stress Scale (DASS-21), and the sleep and awake bruxism questionnaire. ANOVA test and Mann Whitney post-test were used, with Bonferroni adjustment (p<0.016) and a 95% confidence level. Results: Probable TMD was found in 24.3% (n=156) of the participants, while possible sleep and awake bruxism were diagnosed in 58% (n=372) and 53.8% (n=345) of them, respectively. Among all variables evaluated, only symptoms of depression were significantly greater in the quarantined DSs group when compared to those who were working at the clinical care (p=0.002). Working DSs were significantly less likely (OR=0.630, p=0.001) to have depressive symptoms. Those who were not worried or less worried about the pandemic were less likely to experience stress (OR=0.360), anxiety (OR=0.255), and poor sleep quality (OR=0.256). Sleep had a strong positive and moderate correlation with psychological factors on frontline workers and DSs in outpatient care, respectively. Conclusion: The results suggest confinement may have a more negative impact on the life of DSs than the act of being actively working. The concern about Covid-19 and poor sleep quality was significantly prevalent and may negatively affect the quality of life of DSs. Thus, further research on the topic is needed.

The association of self-reported awake bruxism with anxiety, depression, pain threshold at pressure, pain vigilance, and quality of life in patients undergoing orthodontic treatment

Abstract This study aimed to evaluate whether the presence of awake bruxism was associated with temporomandibular dysfunction symptoms, pain threshold at pressure, pain vigilance, oral health-related quality of life (OHRQoL), and anxiety and depression symptoms in patients undergoing orthodontic treatment. Methodology This observational study followed patients who had started receiving orthodontic treatment for six months. The following variables were measured three times (at baseline, one month, and six months): pressure pain threshold (PPT) in the right and left masseter, anterior temporalis, and temporomandibular joint (TMJ), and right forearm; pain vigilance and awareness questionnaire; and shortened form of the oral health impact profile (OHIP-14). Anxiety and depression symptoms were measured using the Beck anxiety inventory and the Beck depression inventory, respectively. The patients were divided into two main groups according to the presence (n=56) and absence (n=58) of possible awake bruxism. The multi-way analysis of variance (ANOVA) was applied on the date (p=0.050). Results TMJ and/or muscle pain were not observed in both groups. Time, sex, age group, and awake bruxism did not affect the PPT in the masticatory muscles and pain vigilance (p>0.050). However, the primary effect of awake bruxism was observed when anxiety (ANOVA: F=8.61, p=0.004) and depression (ANOVA: F=6.48, p=0.012) levels were higher and the OHRQoL was lower (ANOVA: F=8.61, p=0.004). Conclusion The patients with self-reported awake bruxism undergoing an orthodontic treatment did not develop TMJ/masticatory muscle pain. The self-reported awake bruxism is associated with higher anxiety and depression levels and a poorer OHRQoL in patients during the orthodontic treatment.

Orofacial manifestations of chikungunya infection. Case report / Manifestações orofaciais após infecção por vírus da chikungunya. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: The chikungunya virus is a human pathogen responsible for a disease characterized by fever, headache, myalgia, skin rash and acute and persistent arthralgia. The purpose of this case report was to describe the orofacial manifestations of a patient infected with the chikungunya virus. CASE REPORT: A female patient was referred to the Universidade Federal de Juiz de Fora, MG dental clinic due to severe facial pain. Two weeks earlier, she had been diagnosed with chikungunya virus infection by ELISA. After the febrile period and skin rash, the patient presented severe pain in the shoulders, knees, and face, which make it difficult to move and perform daily activities. She was diagnosed with temporomandibular disorders (arthralgia and myofascial pain in the masseter muscle on the right side). The patient was counseled about diet free of pain, hot packs and massages in the painful region. She was already self-medicated with corticosteroids. In addition, she was instructed to seek a specialist for her body pain. The manifestations caused by infection were healed after 10 days of the beginning of the use of corticosteroids and counseling. CONCLUSION: To date, no reports have been published in the literature about the orofacial manifestation of chikungunya virus, which could serve as a basis to aid in diagnosis temporomandibular joint disorders secondary to chikungunya virus or resulting from possible psychological alteration due to constant generalized pain) and treatment. The detailed anamnesis provided information about a probable temporomandibular joint disorder secondary to Chikungunya virus infection, and it was remarkable as improvement of the systemic factors resulted in the remission of orofacial symptomatology.

RESUMO JUSTIFICATIVA E OBJETIVOS: O vírus chikungunya é um patógeno humano responsável por uma doença caracterizada por febre, dor de cabeça, mialgia, erupção cutânea e artralgia aguda e persistente. O objetivo deste relato de caso foi descrever as manifestações orofaciais de uma paciente infectada pelo vírus chikungunya. RELATO DO CASO: Paciente do sexo feminino foi encaminhada para a clínica odontológica da Universidade Federal de Juiz de Fora, MG, devido à dor orofacial grave. Duas semanas antes, ela havia sido diagnosticada com infecção por vírus chikungunya. Após período febril e erupção cutânea, a paciente apresentou dor intensa nos ombros, joelhos e face, que dificultava a movimentação e realização das atividades diárias. Foi diagnosticada com desordens temporomandibulares (artralgia e dor miofascial com referência do músculo masseter no lado direito). A paciente foi orientada sobre dieta livre de dor, compressas quentes e massagens na região dolorosa. Ela já se automedicava com corticosteróides. Foi instruída a procurar especialista para suas dores no corpo. As manifestações provocadas pela infecção foram curadas após 10 dias do início do uso de corticosteroides e aconselhamento. CONCLUSÃO: Até o momento, nenhum relato foi publicado na literatura sobre a manifestação orofacial do vírus chikungunya, que poderia servir de base para auxiliar no diagnóstico de disfunção temporomandibular secundária ao vírus chikungunya ou resultante de possível alteração psicológica por dor generalizada constante) e tratamento. A anamnese detalhada forneceu informações sobre uma provável disfunção temporomandibular secundária à infecção pelo vírus chikungunya e foi notável, pois a melhora dos fatores sistêmicos resultou na remissão do sintoma orofacial.

Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation

Abstract Disc displacement with reduction (DDWR) is one of the most common intra-articular disorders of the temporomandibular joint (TMJ). Factors related to the etiology, progression and treatment of such condition is still a subject of discussion. This literature review aimed to address etiology, development, related factors, diagnosis, natural course, and treatment of DDWR. A non-systematic search was conducted within PubMed, Scopus, SciELO, Medline, LILACS and Science Direct using the Medical Subjective Headings (MeSH) terms "temporomandibular disorders", "temporomandibular joint", "disc displacement" and "disc displacement with reduction". No time restriction was applied. Literature reviews, systematic reviews, meta-analysis and clinical trials were included. DDWR is usually asymptomatic and requires no treatment, since the TMJ structures adapt very well and painlessly to different disc positions. Yet, long-term studies have shown the favorable progression of this condition, with no pain and/or jaw locking occurring in most of the patients.

Short-term transcutaneous electrical nerve stimulation reduces pain and improves the masticatory muscle activity in temporomandibular disorder patients: a randomized controlled trial

Abstract Studies to assess the effects of therapies on pain and masticatory muscle function are scarce. Objective To investigate the short-term effect of transcutaneous electrical nerve stimulation (TENS) by examining pain intensity, pressure pain threshold (PPT) and electromyography (EMG) activity in patients with temporomandibular disorder (TMD). Material and Methods Forty patients with myofascial TMD were enrolled in this randomized placebo-controlled trial and were divided into two groups: active (n=20) and placebo (n=20) TENS. Outcome variables assessed at baseline (T0), immediately after (T2) and 48 hours after treatment (T1) were: pain intensity with the aid of a visual analogue scale (VAS); PPT of masticatory and cervical structures; EMG activity during mandibular rest position (MR), maximal voluntary contraction (MVC) and habitual chewing (HC). Two-way ANOVA for repeated measures was applied to the data and the significance level was set at 5%. Results There was a decrease in the VAS values at T1 and T2 when compared with T0 values in the active TENS group (p<0.050). The PPT between-group differences were significant at T1 assessment of the anterior temporalis and sternocleidomastoid (SCM) and T2 for the masseter and the SCM (p<0.050). A significant EMG activity reduction of the masseter and anterior temporalis was presented in the active TENS during MR at T1 assessment when compared with T0 (p<0.050). The EMG activity of the anterior temporalis was significantly higher in the active TENS during MVC at T1 and T2 when compared with placebo (p<0.050). The EMG activity of the masseter and anterior temporalis muscle was significantly higher in the active TENS during HC at T1 when compared with placebo (p<0.050). Conclusions The short-term therapeutic effects of TENS are superior to those of the placebo, because of reported facial pain, deep pain sensitivity and masticatory muscle EMG activity improvement.

Occlusal changes secondary to temporomandibular joint conditions: a critical review and implications for clinical practice

ABSTRACT The relationship between Temporomandibular Disorders (TMD) and malocclusion is an extremely critical issue in dentistry. Contrary to the old concept that malocclusion causes TMD, occlusal changes, especially those observed as sudden, may be secondary and reflect joint or muscle disorders due to the obvious connection between these structures and the dental occlusion. Objectives The aim of this article is to present the most commonly occlusal changes secondary to TMD. Methods The clinical presentation of these conditions is discussed. Details regarding diagnosis, treatment, and follow-up of patients presenting TMD prior or during treatment are also presented. Conclusions All plans for irreversible therapy should be preceded by a meticulous analysis of TMD signs and symptoms in such a way that patients are not submitted to irreversible treatment, based on an untrue occlusal relationship, secondary to articular and/or muscular disorders. When present, TMD symptoms must always be controlled to reestablish a “normal” occlusion and allow proper treatment strategy.

Is aerobic exercise useful to manage chronic pain? / Exercício aeróbico ajuda no tratamento da dor crônica?

ABSTRACT BACKGROUND AND OBJECTIVES: Several studies have shown the importance of biopsychosocial strategies, including pharmacological and non-pharmacological therapies, to decrease pain in orofacial pain patients. The involvement of pain modulation during aerobic exercise contributes to the use of such modality as part of rehabilitation programs for chronic pain patients. Studies have shown that aerobic exercise may increase the level of several neurotransmitters, such as serotonin, dopamine, acetylcholine and norepinephrine. The reality is that it activates endocannabinoid and endogenous opioid systems, involved in pain modulation. The effect of physical activity on pain perception is often called exercise-induced hypoalgesia. This study aimed at discussing the use of exercise-induced hypoalgesia as part of chronic pain management, including orofacial pain. CONTENTS: Comprehensive search on Pubmed, Medline, Web of Science and Scopus databases was carried out using the keywords: physical exercise, aerobic exercise, exercise-induced hypoalgesia, exercise-induced analgesia and orofacial pain/chronic orofacial pain. CONCLUSION: Exercise does not need to be of high-intensity to have an effect on pain management. Although there is evidence that some chronic pain patients may have the capacity to exercise at intensities and durations that appear to be required to elicit exercise-induced hypoalgesia in healthy subjects, the exercise tolerance of other unhealthy populations requires study. Additional research is needed to clarify and expand the understanding of the mechanisms responsible for exercise-induced hypoalgesia and how it can be used in chronic pain conditions such as chronic orofacial pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: Vários estudos têm demonstrado a importância de utilização de estratégias biopsicossociais, incluindo terapias farmacológicas e não farmacológicas, para reduzir a dor em pacientes com dor orofacial. O envolvimento da modulação da dor durante o exercício aeróbico contribui para o uso dessa modalidade como parte de programas de reabilitação para pacientes com dor crônica. Estudos demonstram que o exercício aeróbico pode aumentar o nível de vários neurotransmissores tais como serotonina, dopamina, acetilcolina e norepinefrina. A realidade é que ele ativa os sistemas endocanabinóide e opioide endógeno, envolvidos no sistema de modulação de dor. O efeito da atividade física na percepção da dor é comumente denominado hipoalgesia induzida por exercício. O objetivo deste estudo foi discutir o uso do fenômeno da hipoalgesia induzida por exercício como parte do tratamento da dor crônica, incluindo a dor orofacial. CONTEÚDO: Pesquisas abrangentes na base de dados Pubmed, Medline, Web of Science e Scopus foram realizadas utilizando as palavras-chave: exercício físico, exercício aeróbico, hipoalgesia induzida por exercício, analgesia induzida por exercício e dor orofacial/dor orofacial crônica. CONCLUSÃO: O exercício não precisa ser de alta intensidade para se obter efeito sobre o controle da dor. Embora alguns estudos comprovem que alguns pacientes com dor crônica tem a capacidade de se exercitarem em intensidades e durações de exercício que induzem a hipoalgesia induzida por exercício, a tolerância ao exercício e seus efeitos em populações de pacientes crônicos ainda exigem mais estudos e investigações para esclarecer e ampliar a compreensão do mecanismo da hipoalgesia induzida por exercício.

Deep pain sensitivity is correlated with oral-health-related quality of life but not with prosthetic factors in complete denture wearers

ABSTRACT Low pressure Pain Threshold (PPT) is considered a risk factor for Temporomandibular Disorders (TMD) and is influenced by psychological variables. Objectives To correlate deep pain sensitivity of masticatory muscles with prosthetic factors and Oral-Health-Related Quality of Life (OHRQoL) in completely edentulous subjects. Material and Methods A total of 29 complete denture wearers were recruited. The variables were: a) Pressure Pain Threshold (PPT) of the masseter and temporalis; b) retention, stability, and tooth wear of dentures; c) Vertical Dimension of Occlusion (VDO); d) Oral Health Impact Profile (OHIP) adapted to orofacial pain. The Kolmogorov-Smirnov test, the Pearson Product-Moment correlation coefficient, the Spearman Rank correlation coefficient, the Point-Biserial correlation coefficient, and the Bonferroni correction (α=1%) were applied to the data. Results The mean age (standard deviation) of the participants was of 70.1 years (9.5) and 82% of them were females. There were no significant correlations with prosthetic factors, but significant negative correlations were found between the OHIP and the PPT of the anterior temporalis (r=-0.50, 95% CI-0.73 to 0.17, p=0.005). Discussion The deep pain sensitivity of masticatory muscles in complete dentures wearers is associated with OHRQoL, but not with prosthetic factors.

Management of painful temporomandibular joint clicking with different intraoral devices and counseling: a controlled study

Objective The benefit of the use of some intraoral devices in arthrogenous temporomandibular disorders (TMD) patients is still unknown. This study assessed the effectiveness of the partial use of intraoral devices and counseling in the management of patients with disc displacement with reduction (DDWR) and arthralgia.Materials and Methods A total of 60 DDWR and arthralgia patients were randomly divided into three groups: group I (n=20) wore anterior repositioning occlusal splints (ARS); group II (n=20) wore the Nociceptive Trigeminal Inhibition Clenching Suppression System devices (NTI-tss); and group III (n=20) only received counseling for behavioral changes and self-care (the control group). The first two groups also received counseling. Follow-ups were performed after 2 weeks, 6 weeks and 3 months. In these sessions, patients were evaluated by means of a visual analogue scale, pressure pain threshold (PPT) of the temporomandibular joint (TMJ), maximum range of motion and TMJ sounds. Possible adverse effects were also recorded, such as discomfort while using the device and occlusal changes. The results were analyzed with ANOVA, Tukey’s and Fisher Exact Test, with a significance level of 5%.Results Groups I and II showed improvement in pain intensity at the first follow-up. This progress was recorded only after 3 months in Group III. Group II showed an increased in joint sounds frequency. The PPT values, mandibular range of motion and the number of occlusal contacts did not change significantly.Conclusion The simultaneous use of intraoral devices (partial time) plus behavioral modifications seems to produce a more rapid pain improvement in patients with painful DDWR. The use of NTI-tss could increase TMJ sounds. Although intraoral devices with additional counseling should be considered for the management of painful DDWR, dentists should be aware of the possible side effects of the intraoral device’s design.

Quality of life in chronic trigeminal neuralgia patients / Qualidade de vida em pacientes com neuralgia trigeminal crônica

ABSTRACTBACKGROUND AND OBJECTIVES:Trigeminal neuralgia is a debilitating painful condition found in some patients. It is classified as neuropathic episodic pain, reported as “electric shock”, “burning” and/or “tingling”. This study aimed at evaluating the impact of trigeminal neuralgia on quality of life and its association with pain duration.METHODS:Participated in the study 20 patients above 40 years of age, who were divided in two groups. Group I was was comprised of 10 trigeminal neuralgia patients and group II of healthy painless patients. All patients have filled a visual analog scale about pain severity and the Oral Health Impact Profile questionnaire about quality of life. Group I patients were also asked about time of pain onset. Data were recorded and submitted to statistical analysis (Spearman correlation and Mann-Whitney tests).RESULTS:Trigeminal neuralgia significantly and negatively impacts quality of life (p≤0.01). However, neither pain intensity nor pain duration seem to be associated with this result.CONCLUSION:Trigeminal neuralgia negatively impacts quality of life regardless of pain intensity.

RESUMOJUSTIFICATIVA E OBJETIVOS:A neuralgia trigeminal é uma condição dolorosa debilitante encontrada em alguns pacientes. É classificada como uma dor neuropática episódica, reportada como “choque elétrico”, “queimação” e/ou “formigamento”. O objetivo deste estudo foi avaliar o impacto da neuralgia trigeminal na qualidade de vida e sua associação com o tempo de dor.MÉTODOS:Foram avaliados 20 pacientes, acima de 40 anos, divididos em 2 grupos. O grupo I foi formado por 10 pacientes com neuralgia trigeminal e o grupo II por 10 pacientes saudáveis, sem dor. Todos os pacientes preencheram uma escala analógica visual sobre a gravidade da dor e o questionário Oral Health Impact Profile sobre qualidade de vida. Os pacientes do grupo I também foram questionados sobre o tempo de início da dor. Os dados foram registrados e submetidos a análise estatística (testes de correlação de Spearman e de Mann-Whitney).RESULTADOS:A presença da neuralgia trigeminal tem impacto significativo e negativo na qualidade de vida (p≤0,01). No entanto, nem a intensidade da dor, nem o tempo de dor parecem estar associados a esse resultado.CONCLUSÃO:A neuralgia trigeminal exerce um impacto negativo na qualidade de vida, não importando a intensidade da dor.

Ocorrência de disfunção temporomandibular em indivíduos com deformidade dentofacial / The occurrence of temporomandibular disorders in subjects presented with dentofacial deformities

Resumo:OBJETIVO:verificar a ocorrência de disfunção temporomandibular em indivíduos com deformidade dentofacial.MÉTODOS:foram avaliados 60 indivíduos de ambos os gêneros e idade entre 18 e 40 anos (média=27 anos), sendo formados dois grupos, um composto por 30 sujeitos com deformidade dentofacial, em tratamento ortodôntico pré-cirúrgico e um grupo controle constituído por 30 indivíduos com equilíbrio dentofacial, pareados segundo o gênero e a idade com o grupo deformidade. Para avaliação da articulação temporomandibular, foram aplicados o questionário anamnésico de disfunção temporomandibular e o Eixo 1 do Research Diagnostic Criteria for Temporomandibular Disorderspara verificar e classificar o grau e o tipo da disfunção temporomandibular, respectivamente.RESULTADOS:os resultados da aplicação do questionário demonstraram que o grupo com deformidade apresentou maior grau e escore da disfunção que o grupo controle (p<0,01). A partir do Research Diagnostic Criteria for Temporomandibular Disorders verificou-se maior ocorrência de diagnósticos de deslocamento de disco (p=0,02) e de artrite, artralgia e artrose (p<0,01) no grupo com deformidade em relação ao grupo controle.CONCLUSÃO:indivíduos com deformidade dentofacial apresentaram maior ocorrência de disfunção temporomandibular, quando comparados aos indivíduos com equilíbrio dentofacial, na amostra estudada.

Abstract:PURPOSE:to investigate the occurrence of temporomandibular dysfunction in subjects with dentofacial deformity.METHODS:60 subjects of both sexes and aged between 18 and 40 years (mean = 27 years) and formed two groups, one composed of 30 subjects with dentofacial deformity undergoing presurgical orthodontic treatment were evaluated and a control group consisted of 30 individuals with dentofacial balance, paired to dentofacial group, according to gender and age. Anamnestic questionnaire of temporomandibular dysfunction and Axis 1 of Research Diagnostic Criteria for Temporomandibular Disorders were applied, respectively, so as to verify and rate the degree and type of temporomandibular disorders.RESULTS:the results of the questionnaire demonstrated that dentofacial group presented a greater dysfunction degree and score than control group (p <0.01). From the Research Diagnostic Criteria for Temporomandibular Disorders, a greater occurrence of diagnoses involving disc displacement (p = 0.02) and arthritis, arthrosis and arthralgia (p <0.01) for dentofacial group, in relation to control group, was verified.CONCLUSION:individuals with dentofacial deformity had increased incidence of temporomandibular dysfunction, compared with individuals with dentofacial equilibrium, in the sample studied.

Primary headaches interfere with the efficacy of temporomandibular disorders management

OBJECTIVES: This cross-sectional study aimed to evaluate the influence of Primary Headache (PH) on efficacy of a Temporomandibular Disorders (TMD) conservative therapy and its association with the presence of self-reported parafunctional habits. SAMPLE AND METHODS: Sample was composed of 400 medical records, divided into four groups: I) Muscular TMD (n=64); II) Muscular TMD+PH (n=48); III) Muscular TMD+Articular TMD (n=173); IV) Muscular TMD+Articular TMD+PH (n=115). All groups had undergone a TMD therapy for three months with a stabilization appliance and counseling for habits and behavioral changes, with no specific headache management. Current pain intensity and existence or not of self-reported bruxism were assessed. Repeated measures ANOVA and Chi-Square test followed by Odds were used for statistical analysis, with a significance level of 5%. RESULTS: results of this study showed that: (1) A conservative therapy with stabilization appliance and counseling for habits and behavioral changes was effective in the TMD pain relief; (2) Groups with an additional diagnosis of PH had worsened the pain improvement significantly; and (3) no association between the presence of self-reported bruxism and PH was found. CONCLUSIONS: this study could elucidate the important effect that headache may have on the TMD management. .

Acupuncture therapeutic protocols for the management of temporomandibular disorders / Protocolos de acupuntura para o tratamento da disfunção temporomandibular

BACKGROUND AND OBJECTIVES: For most cases, temporomandibular disorders should be treated by a non-invasive, interdisciplinary and integrative process. In traditional Chinese medicine, acupuncture is an excellent tool aiming at treating and healing this disease. This study was a critical literature review to observe the efficacy of traditional Chinese acupuncture to treat muscular temporomandibular disorders and to identify primary acupoints. CONTENTS: Pubmed, LILACS, Scielo and Cochrane databases were queried to identify scientific articles relevant for the study. Articles were selected from January 2000 to May 2013. A total of 125 articles were found and 21 were included. Acupuncture treatment alone or as additional therapy, or even compared to other techniques, was superior and effective to improve pain and function of patients with temporomandibular disorders and most commonly used acupoints were IG4, E6, E7 and F3. CONCLUSION: This study has shown that acupuncture is a technique recommended by national and international literature to treat muscular temporomandibular disorders, promoting pain relief and/or total intensity, improvement of joint movements and oral function and decrease of masticatory muscles hyperactivity. .

JUSTIFICATIVA E OBJETIVOS: Na grande maioria dos casos, o tratamento das disfunções temporomandibulares deve ser um processo não invasivo, interdisciplinar e integrativo. Dentro da medicina tradicional chinesa, a acupuntura é uma ótima ferramenta que visa a terapia e cura dessas doenças. O objetivo deste estudo foi conduzir uma revisão crítica da literatura para verificar a eficácia da acupuntura tradicional chinesa no tratamento da disfunção temporomandibular do tipo muscular, bem como identificar os principais acupontos. CONTEÚDO: Foi realizada uma pesquisa nas bases de dados Pubmed, LILACS, Scielo e Cochrane para identificar artigos científicos relevantes para o estudo. Os artigos foram selecionados no período de janeiro de 2000 a maio de 2013. Encontrou-se um total de 125 artigos, sendo que 21 foram incluídos. O tratamento de acupuntura isolado ou como terapia complementar, ou ainda comparado com outras técnicas, se mostrou superior e eficiente na melhora da dor e da função de pacientes com disfunção temporomandibular, e os pontos de acupuntura mais citados foram IG4, E6, E7 e F3. CONCLUSÃO: Este estudo demonstrou que a acupuntura é uma técnica recomendada pela literatura nacional e internacional para o tratamento de disfunções temporomandibulares de origem muscular, promovendo alivio e/ou redução total da intensidade dolorosa, melhora nos movimentos mandibulares e na função oral e diminuição da hiperatividade muscular dos músculos da mastigação. .