Non-invasive therapies for management of temporomandibular disorders: a systematic review

Introduction: As a multifactorial disease, temporomandibular disorders (TMD) require a complex therapeutic approach, being noninvasive therapies the first option for most patients. The aim of this study was to perform a systematic review to analyze the most common non-invasive therapies used for TMD management. Methods: The review was done by searching electronic databases to identify controlled clinical trials related to pharmacologic and non-invasive treatments. Of all potential articles found, 35 were included in this review. Results: Low-level laser therapy (LLLT), occlusal splints (OS) and oral exercises/ behavior education (OE/BE) were the most common therapies used. LLLT showed significant results in pain and movement improvement in most studies. OS was usually combined to other therapies and resulted in improvement of pain. OE/BE showed significant results when combined with ultrasound, LLLT, and manual therapy. Conclusions: Non-invasive treatments can provide pain relief and should be prescribed before surgical procedures. LLLT was the therapy with the higher number of studies showing positive results. Based in heterogeneity of treatment protocols, diagnostic and outcomes criteria used, new well-designed randomized controlled trials (RCT) are necessary. (AU)

Influence of photobiomodulation therapy on root development of rat molars with open apex and pulp necrosis

Abstract This study aimed to evaluate the role of photobiomodulation (PBM) in apexification and apexogenesis of necrotic rat molars with an open apex. Rat molars were exposed to the oral environment for 3 weeks. Canals were rinsed with 2.5% NaOCl and 17% EDTA, filled with antibiotic paste and sealed. After 7 days, canals were rinsed and divided into six groups (n=6): mineral trioxide aggregate (MTA); blood clot (BC); human dental pulp stem cells (hDPSC); MTA+PBM; BC+PBM; and hDPSC+PBM. In hDPSC groups, a 1% agarose gel scaffold was used. Two groups were not exposed: healthy tooth+PBM (n = 6), healthy tooth (n = 3); and one was exposed throughout the experiment: necrotic tooth (n = 3). In PBM groups, irradiation was performed with aluminum gallium indium phosphide (InGaAlP) diode laser for 30 days within 24-h intervals. After that, the specimens were processed for histological and immunohistochemical analyses. Necrotic tooth showed greater neutrophil infiltrate (p < 0.05). Necrotic tooth, healthy tooth, and healthy tooth+PBM groups showed absence of a thin layer of fibrous condensation in the periapical area. All the other groups stimulated the formation of a thicker layer of fibers (p < 0.05). All groups formed more mineralized tissue than necrotic tooth (p < 0.05). PBM associated with MTA, BC, or hDPSC formed more mineralized tissue (p < 0.05). MTA+PBM induced apexification (p < 0.05). Rabbit polyclonal anti-bone sialoprotein (BSP) antibody confirmed the histological findings of mineralized tissue formation, and hDPSC groups exhibited higher percentage of BSP-positive cells. It can be concluded that PBM improved apexification and favored apexogenesis in necrotic rat molars with an open apex.

Comparative effectiveness of photobiomodulation and manual therapy alone or combined in TMD patients: a randomized clinical trial

Abstract The effectiveness of photobiomodulation (PBM) and manual therapy (MT), alone or combined (CT), were evaluated in pain intensity, mandibular movements, psychosocial aspects, and anxiety symptoms of temporomandibular disorder (TMD) patients. Fifty-one TMD patients were randomly assigned to three groups: the PBM group (n = 18), which received PBM with 808 nm, 100 mW, 13.3 J/cm2, and 4 J per point; the MT group (n=16) for 21 minutes each session on masticatory muscles and temporomandibular joint TMJ; and the CT group (n = 17), applied during twelve sessions. Seven evaluations were performed in different moments using visual analogue scale (VAS), Research Diagnosis Criteria for Temporomandibular Disorders (RDC/TMD) Axis I and II, and Beck anxiety inventory (BAI). All groups demonstrated reductions in pain and improvement in jaw movements during treatment and at follow-up (< 0.001). The assessment of psychosocial aspects of TMD, comparing baseline and follow-up in all treatment groups, revealed that treatment did not promote modification in the intensity of chronic pain (p > 0.05). However, depression symptoms showed a reduction in PBM and CT groups (p≤0.05). All treatments promoted reduction in physical symptoms with and without pain and enhancement of jaw disabilities (p ≤ 0.05). MT promotes improvement in 5 functions, PBM in 2, and CT in 1 (p < 0.001). BAI analysis revealed that all treatments lead to a reduction in anxiety symptoms (p≤0.05). All protocols tested were able to promote pain relief, improve mandibular function, and reduce the negative psychosocial aspects and levels of anxiety in TMD patients. However, the combination of PBM and MT did not promote an increase in the effectiveness of both therapies alone.

Effect of different presentations of resveratrol on cell proliferation and epitelial thickness of the oral mucosa of wistar rats

Introduction: Grape is one of the most important fruit crops across the world and can be consumed in different ways. There has been a growing interest in the role of antioxidants such as resveratrol, which can be found in grape skin, in oral and dental tissues. Thus, the objective of this study was to analyze the effect of different presentations of resveratrol on cell proliferation and epithelial thickness of the oral mucosa of Wistar rats. Methods: Fifty male Wistar rats were randomly divided into five groups: water/control, red wine, grape juice, 12% alcoholic solution/ethanol and aqueous solution of resveratrol. Samples of palatal and tongue mucosa were collected for a histomorphometric analysis using hematoxylin-eosin staining and the argyrophilic nucleolar organizer region (AgNOR) technique for quantification of cell proliferation. Results: As to epithelial thickness, both the tongue and the palate showed a statistically significant difference between the control group and the other groups, with greater decrease in the resveratrol and the wine groups. In the suprabasal layer of both the tongue and the palate epithelium, red wine reduced the rate of cell proliferation, while ethanol increased it. In the basal layer of the tongue epithelium, there was a statistically significant difference between the control, the grape juice and the resveratrol groups and the ethanol group, with increased cell proliferation in the ethanol group. Conclusions: Wine does not interfere in the physiological renewal of the basal layer of the buccal epithelium and exerts a protective action by reducing the cell proliferation rate of the suprabasal layer (AU)

Conhecimentos e condutas para prevenção da endocardite infecciosa entre cirurgiões-dentistas e acadêmicos de odontologia / Prevention of infectious endocarditis knowledge and behaviors between dentists and dental students

A endocardite infecciosa é uma doença de difícil diagnóstico e tratamento, na qual a profilaxia antibiótica,especialmente em pacientes de risco, durante o tratamento odontológico exerce papel fundamental, apesarde muitas vezes ser negligenciada ou esquecida pelos profissionais no dia-a-dia.O objetivo desta pesquisa foi verificar os conhecimentos sobre endocardite infecciosa (EI) e as condutasclínicas para sua prevenção entre os cirurgiões-dentistas (CDs) de Anápolis e acadêmicos do 8º períododo Curso de Odontologia da UniEVANG ÉLICA. Cinqüenta CDs e cinqüenta acadêmicos responderam aoquestionário, composto por seis questões sobre as condições de risco, os procedimentos odontológicos derisco e prevenção da endocardite infecciosa. Os pacientes mais identificados como de risco para desenvolvimentode EI foram portadores de valvas cardíacas protéticas e endocardite bacteriana prévia. Já em relaçãoaos procedimentos odontológicos que necessitavam de profilaxia antibiótica, os mais citados foram extraçãodentária, raspagem e alisamento radicular e reimplantes de dentes avulsionados. A posologia 2g de Penicilina1h antes do procedimento como ideal para profilaxia da EI foi citada por apenas metade dos participantesdos dois grupos. Os dados obtidos na pesquisa ressaltam que o conhecimento dos CDs de Anápolis e dosacadêmicos é limitado em relação à endocardite infecciosa, sinalizando a necessidade de enfatizar maisdurante o ensino de graduação e realizar cursos de formação continuada sobre as condições de risco paradesenvolvimento da endocardite infecciosa e sua prevenção durante a prática odontológica.

The aim of this study was to verify the knowledge about infectious endocarditis (IE) and the clinics behaviorfor its prevention between Anapolis´ dentists and 8th period students of Dental Course of UniEVANGÉLICA.Fifty dentists and fifty students answered the questionnaire about risk patients and procedures for InfectiousEndocarditis and its prevention. Patients that are considered at risk of endocarditis for the groups were:prosthetic cardiac valve and previous IE. Regarding the dental procedures that need antibiotic therapy werementioned dental extractions, periodontal procedures and re-implants of avulsed teeth. The indicated prophylacticregimen of 2g amoxicillin 1h before the procedure was mentioned by half of both groups. The resultsobtained from this research shows that the dentists and students knowledge about IE is limited, meaning thatit is necessary to give more emphasis on the graduation and create courses about the risk conditions thatdevelop IE at the dental procedures and how to prevent it.