Temporomandibular disorder: otologic implications and its relationship to sleep bruxism / Disfunção temporomandibular: implicações otológicas e sua relação com o bruxismo do sono

Abstract Introduction: Temporomandibular disorder is an umbrella term for various clinical problems affecting the muscles of mastication, temporomandibular joint and associated structures. This disorder has a multifactor etiology, with oral parafunctional habits considered an important co-factor. Among such habits, sleep bruxism is considered a causal agent involved in the initiation and/or perpetuation of temporomandibular disorder. That condition can result in pain otologic symptoms. Objective: The aim of the present study was to investigate the relationship between temporomandibular disorder and both otologic symptoms and bruxism. Methods: A total of 776 individuals aged 15 years or older from urban areas in the city of Recife (Brazil) registered at Family Health Units were examined. The diagnosis of temporomandibular disorder was determined using Axis I of the Research Diagnostic Criteria for temporomandibular disorders, addressing questions concerning myofascial pain and joint problems (disk displacement, arthralgia, osteoarthritis and osteoarthrosis). Four examiners had previously undergone training and calibration exercises for the administration of the instrument. Intra-examiner and inter-examiner agreement was determined using the Kappa statistic. Individuals with a diagnosis of at least one of these conditions were classified as having temporomandibular disorder. The diagnosis of otologic symptoms and bruxism was defined using the same instrument and a clinical exam. Results: Among the individuals with temporomandibular disorder, 58.2% had at least one otologic symptom and 52% exhibited bruxism. Statistically significant associations were found between the disorder and both otologic symptoms and bruxism (p < 0.01 for both conditions; OR = 2.12 and 2.3 respectively). Otologic symptoms and bruxism maintained statistical significance in the binary logistic regression analysis, which demonstrated a 1.7 fold and twofold greater chance of such individuals have temporomandibular disorder, respectively. Conclusion: The logistic regression analysis demonstrated strong associations between the disorder and both otologic symptoms and bruxism when analyzed simultaneously, independently of patient age and gender.

Resumo Introdução: A disfunção temporomandibular é um termo que engloba vários problemas clínicos que afetam os músculos da mastigação, a articulação temporomandibular e estruturas associadas. Esse distúrbio tem uma etiologia multifatorial, com hábitos parafuncionais orais considerados um importante cofator. Entre esses hábitos, o bruxismo do sono é considerado um agente causador envolvido no desenvolvimento e/ou na perpetuação de disfunção temporomandibular. Esse problema pode resultar em sintomas otológicos dolorosos. Objetivo: Investigar a relação entre disfunção temporomandibular e os sintomas otológicos e bruxismo. Método: Foram examinados 776 indivíduos com idade igual ou superior a 15 anos de áreas urbanas da cidade de Recife (Brasil) registrados nas Unidades de Saúde da Família. O diagnóstico da disfunção foi determinado utilizando o Eixo I dos Critérios de Diagnóstico de Pesquisa para Distúrbios Temporomandibulares, abordando questões relativas a dor miofascial e problemas articulares (luxação discal, artralgia, osteoartrite e osteoartrose). Quatro examinadores foram treinados para a administração do instrumento. A concordância intraexaminador e interexaminador foi determinada usando a estatística Kappa. Os indivíduos com diagnóstico de pelo menos uma dessas condições foram classificados como tendo disfunção temporomandibular. O diagnóstico de sintomas otológicos e bruxismo foi definido utilizando o mesmo instrumento de diagnóstico e exame clínico. Resultados: Entre os indivíduos com a disfunção, 58,2% apresentaram pelo menos um sintoma otológico e 52% apresentaram bruxismo. Foram encontradas associações estatisticamente significativas entre a disfunção temporomandibular e ambos os sintomas otológicos e bruxismo (p < 0,01 para ambos os problemas, OR = 2,12 e 2,3, respectivamente). Os sintomas otológicos e o bruxismo mantiveram significância estatística na análise de regressão logística binária, o que demonstrou uma probabilidade de 1,7 e 2 vezes maior chance de que esses indivíduos tenham disfunção temporomandibular, respectivamente. Conclusão: A análise de regressão logística demonstrou associações fortes entre disfunção temporomandibular e sintomas otológicos e bruxismo quando analisados simultaneamente, independentemente da idade e do sexo do paciente.

Flexible resins: an esthetic option for partially edentulous patients / Resinas flexíveis: uma opção estética para desdentados parciais

Flexible thermoplastic resins have been used as an alternative to partially edentulous patients for decades in the USA. However, they are neither popular nor widespread in Brazil. This material represents an excellent treatment option to solve clinical problems such as compromised esthetics caused by visible metal clasps, and fall fracture of dentures made of conventional resins. Additionally, there is little researching and no controlled clinical studies about the use of flexible resins in prosthodontics. For these reasons, this study presents a case report of a dissatisfied patient treated with a conventional removable partial denture, which was replaced by a modified metal framework without metal clasps in combination with flexible resin, and a literature review about this material focusing on the dental practitioner. The study also reports how these polymers can be used, their indications, and their clinical and laboratory considerations.

As resinas termoplásticas flexíveis têm sido uma alternativa para tratamento de pacientes parcialmente desdentados disponível há décadas nos EUA. No Brasil, no entanto, ainda são pouco utilizadas e conhecidas. Este material pode representar uma excelente opção de tratamento reabilitador, para solucionar problemas tais como o aparecimento de grampos metálicos com comprometimento da estética e fratura de próteses confeccionadas com resinas convencionais devido a quedas. Além disso, pesquisas acerca desse material são escassas e não há estudos clínicos de sua utilização na área de prótese dentária na literatura. Por essas razões, este estudo apresenta um caso clínico de uma paciente insatisfeita tratada com prótese removível convencional, a qual foi substituída por uma estrutura metálica modificada sem grampos em combinação com resina, e uma revisão da literatura, com o objetivo de elaborar um apanhado de informações para o clínico sobre estes materiais, além de apresentar como estes polímeros podem ser utilizados, as suas indicações em prótese parcial removível, suas considerações clínicas e laboratoriais.

Temporomandibular Disorders in a Sample Population of the Brazilian Northeast

Temporomandibular disorder (TMD) is a common condition. This study is part of a research group and it investigated the prevalence of TMD and myofascial pain and its association with gender, age and socioeconomic class. The sample comprised 100 subjects, aged 15 to 70, users of the Family Health Units' services, in the city of Recife, PE, Brazil. The TMD degree was evaluated using the Research Diagnostic Criteria for TMD and socioeconomic class by the Economic Classification Criteria Brazil. Categorical variables were analyzed by chi-square test for proportions and Fisher's exact test for 2x2 tables, and binary logistic analysis to track the relationship between the independent and dependent variables. According to the results, 42% of the subjects had TMD and 14% myofascial pain. No statistically significant association could be found between TMD and gender or socioeconomic class, but it was found to have statistically significant association with age, and myofascial pain was associated with socioeconomic class. Considering that the results of the present study should be confirmed by further studies and the fact that this was a pilot study, the prevalence must be analyzed with caution.

Disfunção temporomandibular (DTM) é uma condição comum. Este estudo é parte de um grupo de pesquisa e investigou a prevalência de DTM e dor miofascial e suas associações com sexo, idade e classe socioeconômica. A amostra foi composta por 100 indivíduos, com idades entre 15 e 70 anos, usuários das Unidades de Saúde da Família, na cidade de Recife, PE. O grau de DTM foi avaliado usando os Critérios de Diagnósticos Científicos em DTM, e classe socioeconômica com o Critério de Classificação Econômica Brasil. As variáveis categóricas foram analisadas pelo teste do qui-quadrado para proporções e teste exato de Fisher para tabelas 2x2, e a análise logística binária para traçar a relação entre as variáveis independentes e dependentes. De acordo com os resultados, 42% dos indivíduos tinham DTM e 14% dor miofascial. Não houve associação estatisticamente significativa entre DTM e sexo ou classe socioeconômica, mas houve associação estatisticamente significativa com a idade e a dor miofascial foi associada com a classe socioeconômica. Considerando-se que os resultados do presente estudo devam ser confirmados em outros estudos e por causa de sua natureza piloto, a prevalência deve ser analisada com cautela.

Chewing side, bite force symmetry, and occlusal contact area of subjects with different facial vertical patterns

Craniofacial dimensions influence oral functions; however, it is not known whether they are associated with function asymmetry. The objective of this study was to evaluate chewing side preference and lateral asymmetry of occlusal contact area and bite force of individuals with different craniofacial patterns. Seventy-eight dentate subjects were divided into 3 groups according to the VERT index as follows: (1) mesofacial, (2) brachyfacial and (3) dolichofacial. Chewing side preference was evaluated using jaw tracking equipment, occlusal contact area was measured by silicon registration of posterior teeth, and bite force was measured unilaterally on molar regions using 2.25 mm-thick sensors. Statistical analysis was performed using ANOVA on Ranks, Student's t-test, and Mann-Whitney tests at a 5 percent significance level. Mesofacial, brachyfacial, and dolichofacial subjects presented more occlusal contact area on the left side. Only dolichofacial subjects showed lateral asymmetry for bite force, presenting higher force on the left side. No statistically significant differences were found for chewing side preference among all groups. Within the limitations of this study, it can be concluded that craniofacial dimensions play a role in asymmetry of bite force. ClinicalTrials.gov ID: NCT01286363.

Effect of hyposalivation on mastication and mandibular movements during speech

The aim of this study was to evaluate whether patients with hyposalivation present damaged mastication or mandibular movements during speech. Forty subjects composed 2 groups: control and hyposalivation. Masticatory performance was assessed with a silicon-based artificial material and a 10-sieve method. Mandibular movements during speech were observed with a 3D jaw-tracking device. Data were analyzed with Student's t-test or the Mann-Whitney method (P < 0.05). The masticatory performance (mm) of control and hyposalivation were 4.40 ± 0.62 and 4.74 ± 1.34, respectively. Outcomes for speech movements (mm) were as follows: maximum vertical opening amplitude (10.8 ± 4.2; 9.9 ± 2.7) and displacements to the right (1.0 ± 0.8; 0.5 ± 0.6), left (1.8 ± 1.4; 2.3 ± 1.2), or anterior-posterior (2.8 ± 1.1; 2.9 ± 1.0) for control and hyposalivation, respectively. No statistical difference was found between groups for any variable. The results indicated that hyposalivation did not affect masticatory performance or mandibular movements during speech.

Occlusal force, electromyographic activity of masticatory muscles and mandibular flexure of subjects with different facial types

OBJECTIVE: The aim of this study was to evaluate whether vertical facial patterns influence maximal occlusal force (MOF), masticatory muscle electromyographic (EMG) activity, and medial mandibular flexure (MMF). MATERIAL AND METHODS: Seventy-eight dentate subjects were divided into 3 groups by Ricketts's analysis: brachyfacial, mesofacial and dolychofacial. Maximum occlusal force in the molar region was bilaterally measured with a force transducer. The electromyographic activities of the masseter and anterior temporal muscles were recorded during maximal voluntary clenching. Medial mandibular flexure was calculated by subtracting the intermolar distance of maximum opening or protrusion from the distance in the rest position. The data were analyzed using ANOVA followed by Tukey's HSD test. The significance level was set at 5 percent. RESULTS: Data on maximum occlusal force showed that shorter faces had higher occlusal forces (P<0.0001). Brachyfacial subjects presented higher levels of masseter electromyographic activity and medial mandibular flexure, followed by the mesofacial and dolychofacial groups. Additionally, dolychofacial subjects showed significantly lower electromyographic temporalis activities (P<0.05). CONCLUSION: Within the limitations of the study, it may be concluded that maximum occlusal force, masticatory muscle activity and medial mandibular flexure were influenced by the vertical facial pattern.

Prevalência de doenças pulpares e periapicais na Clínica de especialização em Endodontia da FOP/UPE / Prevalence of pulp and periapical diseases in the Clinic of Specialization in Endodontics at FOP / UPE

Este estudo teve como objetivo estudar o diagnóstico endodôntico realizado na Clínica de Especialização em Endodontia da Faculdade de Odontologia de Pernambuco- FOP/UPE, verificando a etiologia das alterações pulpares e periapicais, os testes semiotécnicos empregados para o diagnóstico, a prevalência de patologias pulpares e periapicais correlacionando-as ao gênero e observando o dente tratado, através da análise de 300 de pacientes atendidos nesta clínica. O estudo foi analisado por estatística descritiva, e aplicado o teste do qui-quadrado de Pearson com significância estatística de p <0,05, obtendo-se os seguintes resultados: em 81,3% diagnosticaram-se patologias pulpares, sendo necrose pulpar (69,3%) a mais freqüente. Em 18,7% diagnosticaram-se patologias periapicais, sendo periodontite apical (30,4%) a mais freqüente. Dos fatores etiológicos mais freqüentes, a cárie foi o mais citado (70%), seguido de fratura coronária (8.9% ) e trauma oclusal (1.1%). Dos testes semiotécnicos os mais utilizados foram o térmico (63,3%), o de percussão horizontal e vertical (30,1%) e o de cavidade (6,6%). Das patologias periapicais diagnosticadas a mais prevalente, no sexo masculino, foi o abscesso dentoalveolar crônico e ,no sexo feminino, a periodontite apical. Das pulpares, em ambos sexos, a necrose pulpar foi a mais prevalente. Quanto aos dentes os primeiros molares foram os mais acometidos.

This study aimed to evaluate the endodontic diagnosis conducted at Clinic of Specialization in Endodontics, Faculty of Dentistry of Pernambuco-FOP / UPE, verifying the aetiology of pulpal and periapical changes, semiotics tests used for diagnosis, the prevalence of pulpal and periapical diseases were correlated with gender and observing the treated tooth, through analysis of 300 patients seen in clinic. The study was analyzed by descriptive statistics, and applied the chi-square test with statistical significance of p <0.05, obtaining the following results: 81.3% were diagnosed pulp pathologies, and pulp necrosis ( 69.3%) was the most frequent. 18.7% were diagnosed periapical pathologies, and apical periodontitis (30.4%) was the more frequent. Among the most frequent etiological factors, caries was the most cited (70%), followed by crown fracture (8.9%) and occlusal trauma (1.1%). Among semiotics tests the most used were heat (63.3%), the horizontal and vertical percussion (30.1%) and cavity (6.6%). Among periapical pathologies diagnosed more prevalent in males was the chronic dentoalveolar abscess, and in females, the apical periodontitis. Of pulp, in both sexes, pulp necrosis was the most prevalent. As to the first molar teeth were the most affected.

Ocorrência da Hipersensibilidade Dentinária e Seus Fatores de Risco / The Occurence and Risk Factors of Dentin Hypersensitivity

O objetivo deste trabalho foi avaliar a ocorrência de casos de Hipersensibilidade Dentinária Cervical (HSDC) e seus fatores etiológicos entre os pacientes que procuram atendimento na Faculdade de Odontologia de Pernambuco (FOP-UPE). Um estudo analítico transversal foi realizado com 97 pacientes, 37 (38,14%) dos quais foram diagnosticados com a HSDC, a qual foi avaliada exercendo-se pressão leve com uma sonda clínica sobre a superfície exposta do dente e com jateamento de ar sobre a área com recessão gengival. A prevalência da HSDC é preocupante. Os indivíduos que utilizavam escovas mais abrasivas, aqueles que foram submetidos a tratamento periodontal nos últimos três meses e aqueles com refluxo gástrico apresentaram maior chance de apresentar HSDC. A ocorrência da HSDC foi elevada na população estudada, demonstrando que os cirurgiõesdentistas deveriam dar maior atenção para o diagnóstico desta condição. O consumo de bebidas e alimentos ácidos, escovação com escovas de dente com cerdas abrasivas, má higiene bucal, tratamento periodontal e problemas gastrointestinais são importantes fatores etiológicos associados a esta condição. Outros estudos de base populacional são necessários para avaliar a prevalência e os determinantes da HSDC.

The aim of the present study was to verify the occurrence of cervical hypersensitivity (CHS) in the dentin and risk factors among patients seeking care at the policlinic of the Faculty of Dentistry, University of Pernambuco (Brazil) and assess the treatment need. An analytical cross-sectional study was carried out involving 99 patients, 39 (39,39%) of whom were diagnosed with CHS, which was assessed by touching a clinical probe to the exposed surface of the tooth with light pressure and a one-second jet of air on the area with gingival recession. The prevalence of CHS is worrisome. Individuals who used more abrasive toothbrushes, those who underwent periodontal treatment in the previous three months and those with gastric reflux had a greater chance of exhibiting CHS. The occurrence of CHS was high in the population studied, demonstrating that dentists should give greater attention to the diagnosis of this condition. The consumption of acidic drinks and foods, brushing with toothbrushes with more abrasive bristles, poor oral hygiene, periodontal treatment and gastrointestinal problems are important etiological factors associated to this condition. Further population-based studies are needed to assess the prevalence and determinants of CHS.

Aging and the periodontium: [review]

The geriatric population has been growing fast over the last decades in Brazil and all over the world, changing demographics. Additionally, increased knowledge and the advances of modern dentistry have led the old population to retain more natural teeth, needing specialized dental services for a longer time. Changes in biochemical and physiological processes occur with aging in all body tissues, including the periodontium. The association between periodontal and systemic diseases has also been widely discussed, suggesting the need of a multidisciplinary care, especially in older adults, who are frequently affected by chronic systemic conditions and multiple drug therapy. These features lead to a highly complex management of the geriatric population, challenging the dental care providers. The aim of this study is to review the age-related changes and the consequences of other factors, such as systemic diseases and drugs, on the periodontium of aged patients.

Dental practice implications of systemic diseases affecting the elderly: a literature review

According to the 2000 Brazilian Census, elderly people are over 14 million habitants. In consonance with what occurs worldwide, the Brazilian population is growing older and the elderly are expected to be over 33 million by the year of 2025. Although geriatric dentistry has already been recognized as a dental specialty, there is a lack of specialists in this branch of dentistry, which means that general dentists and other dental specialists will be dealing more and more with these patients. Aged individuals are commonly affected by a number of systemic diseases that have an impact on their oral health, such as cardiovascular and cerebrovascular diseases, diabetes mellitus, oral cancer, osteoporosis, Alzheimer’s and Parkinson’s diseases. Dental professionals must be prepared to treat properly these special patients. Therefore, the aim of this review article is to instruct dentist about these highly prevalent diseases affecting the elderly, as well as discuss their oral manifestations and dental implications, in order to propose a safe and adequate oral health care for these patients. Here we will shortly describe the diseases’ etiology, main signs/symptoms and medical treatment and will discuss about how to proceed with dental treatment in patients suffering from these pathological conditions.