Prospective study of the aesthetic effect of botulinum toxin a when injected into the muscles of facial expression

Botulinum neurotoxin A (BoNT-A) causes an anticholinergic effect on neuronal fibers, which control muscle contraction and autonomic disorders. Thus, it has been widely used in facial aesthetics, decreasing the action of motor muscles and consequent wrinkles. This preliminary study evaluated the effect of BoNT-A in 77 patients, the treatment satisfaction index was defined in percentage (from 0% to 100%). The evaluation was carried out on 15th, 30th, 60th, 90th, and 180th days after BoNT. The data were analyzed using the Friedman, Student t, Mann-Whitney test with t (alpha=0.05). The results showed that at 15th and 30th days the scores were similar in all muscles with high level of satisfaction and until 90th days the scores decreased significantly for Corrugator supercilii 79.38%, Occipitofrontalis 71.46%, Orbicularis oculi 70.43%; but the satisfaction was good. At 180 days, there was a drop in effectiveness in all treated muscles since the scores decreased significantly, showing low satisfaction by the participants. This study demonstrated that the BoNT-A had attested satisfaction effect by participants for up to 90th days, but at 180th days the satisfaction was low. In the comparative analyzes between women under 40 and over 40 years of age, there was no significant differences.

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.

Evaluation of pain intensity of the masticatory muscles after occlusal appliance and combined therapy: a 6-months follow-up pilot study

Masticatory muscle pain (MMP) is a common type of orofacial pain.Occlusal appliance (OA) is contemplated as a first-line conservative approach for chronic MMP, however, integrated biopsychosocial approaches such as counseling and self-care therapies (CSG) are also considered essential. Aim: This pilot study aimed to compare the use of a combined therapy (GSG + OA) and solely OA treatment on pain intensity related to chronic MMP over a 6-month follow-up. Methods:For this, 20 patients diagnosed with chronic MMP using the Diagnostic criteria for temporomandibular disorders (DC/TMD) were divided into 2 groups (n=10) and treated with OA or combined therapy (CoT; OA + CSG). Electromyographic muscle activity (EMG), visual analogue scale (VAS) and pressure pain threshold (PPT) were recorded at baseline, 1, 3 and 6 months after treatment. Data was collected and statistical analysis were applied at a significance level of 5%. Results:Results showed no significant differences at baseline among groups for any assessment. VAS showed that both treatments decreased subjective pain in volunteers over time, but no significant differences among both groups were observed at any evaluation time. For electromyography, CoT and OA presented no significant differences throughout the experiment neither on relaxed muscle position or maximum volunteer contraction. Finally, a significantly higher PPT for CoT was found for all muscles at the last assessment point (p<0.05). Conclusion: These findings suggest that both treatments are effective for the reduction of pain perception (VAS) in patients with chronic MMP. However, the addition of CSG to an OA therapy may be more beneficial for the improvement of tenderness on the same patients, at least in a long-term basis (> 3 months). Notwithstanding, a larger study should be performed to substantiate these findings

Atualidades sobre o tratamento das disfunções temporomandibulares / Updates on the management of temporomandibular disorders

O crescimento das situações estressantes, associado a outros fatores agravantes, tem tornado as Disfunções Temporomandibulares (DTM) foco de diversas pesquisas e intervenções clínicas. As incorreções oclusais, musculares e comportamentais podem alterar o sistema estomatognático, prejudicando a saúde periodontal, dental e dos demais tecidos bucais, e comprometendo os trabalhos clínicos já realizados. A compreensão dessa patologia deve ser de conhecimento do cirurgião-dentista, especialmente daquele que vai realizar reabilitações bucais implantossuportadas. O controle da DTM pode ser primordial para o sucesso do tratamento planejado. Condições diagnósticas e comportamentais do paciente podem orientar as propostas terapêuticas do profi ssional, e essa tem sido cada vez mais uma realidade para o controle das situações sintomáticas relacionadas às DTM. Fatores inerentes ao diagnóstico são relevantes na condução terapêutica, e somente através de procedimentos sistemáticos e bem estruturados é possível obter dados que assegurem organizar a intervenção necessária ao manejo das DTM. Neste artigo descrevemos alguns procedimentos adotados em nossa conduta clínica para o diagnóstico das DTM, ao mesmo tempo em que abordamos algumas modalidades de intervenção terapêutica, com uma visão voltada à terapia baseada em evidências.

The stressful situations associated with other aggravating factors has made Temporomandibular Disorders (TMD) the focus of several researches and clinical interventions. Occlusal, muscular and behavioral disturbance may alter the stomatognathic system, compromising periodontal, dental and other oral tissues health, as well as some clinical work already done. The understanding of this pathology should be relevant to the dentist, especially when it will be performed supported implant rehabilitations. Control of TMD may be critical to the success of planned treatment. Diagnostic conditions and behavioral understanding of the patient may guide the therapeutic proposals, and it has been an increasingly reality for the control of TMD symptomatic situations. Factors inherent to the diagnosis are relevant in the therapeutic conduction, and it is only through systematic and well structured procedures the data can be obtained to organize the necessary intervention for TMD management. In this article, we describe some of the procedures adopted in our clinical management for the diagnosis of TMD, while addressing some modalities of therapeutic intervention, with a vision focused on evidence-based therapy.

Chronicity factors of temporomandibular disorders: a critical review of the literature

Facial pain often persists long after any identifiable organic pathology has healed. Moreover, in a subgroup of patients with temporomandibular disorder (TMD), no treatment is effective. Knowledge of factors associated with persistent pain in TMD could help identify personalized treatment approaches. Therefore, we conducted a critical review of the literature for the period from January 2000 to December 2013 to identify factors related to TMD development and persistence. The literature findings showed that chronic TMD is marked by psychological distress (somatization and depression, affective distress, fear of pain, fear of movement, and catastrophizing) and characteristics of pain amplification (hyperalgesia and allodynia). Furthermore, these factors seem to interact in TMD development. In addition, our review demonstrates that upregulation of the serotonergic pathway, sleep problems, and gene polymorphisms influence the chronicity of TMD. We conclude that psychological distress and pain amplification contribute to chronic TMD development, and that interactions among these factors complicate pain management. These findings emphasize the importance of multidisciplinary assistance in TMD treatment.

Tratamento endodôntico na terceira idade / Endodontic treatment in elderly

A odontogeriatria é um ramo que cada vez mais vem tomando espaço na odontologia. Este segmento vem acompanhado de uma maior conscientização, tanto de profissionais quanto de pacientes, que passam a ter maiores preocupações com a saúde bucal, chegando à terceira idade com um maior número de dentes do que as gerações anteriores. Dessa forma, o cirurgião-dentista deve estar preparado para qualquer tipo de procedimento necessário para manter os seus pacientes com uma boa qualidade de saúde bucal. A endodontia, que em décadas passadas era muito pouco realizada em pacientes idosos, tem apresentado um crescente número de casos. Baseado nesse aumento de demanda, o presente trabalho realizou uma revisão da literatura quanto aos aspectos histológicos da polpa dental senil, do tratamento endodôntico propriamente dito e de aspectos sistêmicos que podem alterar o tratamento convencional, com o intuito de orientar o profissional que se dispõe a realizar estes procedimentos na prática diária.

Geriatric dentistry is in continuous diffusion in dentistry. It is followed by professionals conscious raising and by the patients preoccupations about oral health quality, keeping into their elderly which more teeth than the past generations. In this way the professional should be prepared to do any necessary procedure to patients keep their oral health quality. The endodontics, which few decades ago were rarely done in elderly is showing a considerable arouse in number of cases. Based on that increment on endodontics procedures the present paper reviewed the literature about the histological aspects of the elderly dental pulp, the endodontic procedure itself and some systemic aspects that may interfere anyhow in comparison with the conventional treatment, to guide the professional about these procedures in the daily practice.

Temporomandibular disorders in fibromyalgia: a critical view / Disfunção temporomandibular na fibromialgia: uma visão crítica

Temporomandibular disorders (TMD) and fibromyalgia (FM) are musculoskeletal syndromes that appear to be associated to each other. Various studies throughout the literature relate the signs and symptoms of TMD in patients with FM. The objective of this study was to analyze the literature regarding clinical association between FM and TMD. Even though these conditions present different etiologies, the pain modulating mechanisms are similar. Many studies in this field aim to elucidate questions which are still little understood. However, it has been observed that these syndromes are characterized by a reduction in pain threshold and in the attenuation capabilities of descending pain modulating systems. Moreover, there is a certain degree of comorbidities between these two pathologies, which share many clinical characteristics. Numerous patients with FM present various signs and symptoms of TMD, while only a small quantity of individuals with TMD is diagnosed with FM. Therefore, an adequate and precise evaluation of the stomatognathic system in patients with FM, which encompasses TMD diagnosis in therapeutic intervention, is paramount.

A disfunção temporomandibular (DTM) e a fibromialgia (FM) são síndromes musculo-esqueléticas que parecerem estar associadas. Vários estudos na literatura relatam sinais e sintomas da DTM em pacientes com FM. O objetivo deste trabalho foi analisar a literatura quanto à associação clínica entre fibromialgia e as disfunções temporomandibulares. Apesar de estes distúrbios possuírem etiologias diferentes, o mecanismo de modulação de dor é semelhante. Muitas pesquisas desenvolvidas nessa área buscam elucidar esta questão ainda pouco compreendida. Mas sugere-se que estas síndromes são caracterizadas por uma diminuição no limiar de dor e na capacidade de atenuação de sistemas descendente de modulação da dor. Além disso, há certo grau de comorbidade entre estas duas patologias, que compartilham muitas características clínicas. Muitos pacientes com FM apresentam vários sinais e sintomas de DTM, entretanto, uma pequena quantidade de indivíduos com DTM recebem um diagnóstico de FM. Portanto, é importante uma avaliação precisa e adequada do sistema estomatognático em pacientes com fibromialgia englobando o diagnóstico de disfunção temporomandibular na intervenção terapêutica

A Prótese parcial removível no contexto da odontologia atual / The issue of the removable partial denture in modern dentistry

O evidente declínio da perda dentária e a consolidação dos implantes têm intrigado pesquisadores sobre qual será o futuro dos procedimentos protéticos. Este assunto é de interesse para toda a comunidade odontológica, pois está diretamente relacionado tanto à necessidade e demanda por tratamento clínico, quanto ao ensino nas universidades. Assim, o presente artigo busca discutir a importância da Prótese Parcial Removível no contexto da Odontologia atual tendo em vista as mudanças ocorridas nas últimas décadas.

The decline of tooth loss and the established success of implant therapy have intrigued researchers about the future of Prosthodontics. This issue is of major importance for the Dentistry community, since it is directly related to need and demand for prosthetic treatment and teaching in dental schools. Therefore, this paper aims to discuss the importance of Removable Partial Denture in modern Dentistry based on the changes occurred in the past few decades.

Eficacia del proceso adhesivo en dentina escerótica: revisión de literatura / Effectiveness of sclerotic dentin adhesive process: literature review

The purpose of this review was to evaluate witch adhesive system and technique are the most suitable to be used at non carious cervical lesions with sclerotic dentine. The search was carried out in the electronic databases PubMed, Embase and Bireme/Medline, including studies published from 1990 to 2009. The inclusion criteria were: randomized clinical trials with sclerotic dentine treated with different types of adhesive systems and adhesive techniques, randomized in-vitro studies concerning to microtensile bond strength, contraction gap and dentine/adhesive interface evaluation. In total, 1807 papers were identified and only thirteen studies met the inclusion criteria, which showed high complex structure of sclerotic dentine, with high mineral content and sclerotic casts that obstruct the entrance of dentine tubules, reducing the dentin permeability and altering their adhesive properties. The hybrid layer formed at sclerotic dentin is smaller than at sound dentin and without resin tags and the use of high concentration of acids conditioners for longer periods or the remove of the superficial hipermineralyzed layer showed to be inefficient to increase the bond strength. It is also suggest that the use of self-etching adhesive systems has to be avoided at sclerotic dentine

La propuesta de esta revisión sistematizada fue evaluar cuál sistema adhesivo y cuál técnica son los más indicados para ser usados en lesiones cervicales no cariosas con dentina esclerótica. La búsqueda de los estudios fue realizada en las bases de datos electrónicas PubMed, Embase y Bireme/Medline, incluyendo estudios entre los años 1990 y 2009. Los criterios de inclusión fueron: ensayos clínicos randomizados utilizando dentina esclerótica tratada con diferentes tipos de sistemas e técnicas adhesivas, estudios randomizados in-vitro con respecto a resistencia adhesiva a la microtracción, gaps de contracción, y evaluación de la interface adhesiva utilizando microscopia electrónica de barrido o transmisión. Desde 1807 artículos identificados, trece estudios cumplieron los criterios de inclusión, los cuales describieron alta complejidad estructural de la dentina esclerótica, con alto contenido mineral y cast escleróticos que obstruían la entrada de los túbulos dentinarios, reduciendo la permeabilidad dentinária y alterando sus propiedades adhesivas. La capa hibrida formada fue reducida sin tags resinosos, siendo que la aplicación de acondicionadores ácidos en altas concentraciones o en periodos prolongados de tiempo, así como la remoción de la capa superficial de dentina esclerótica, fueron ineficientes para incrementar la resistencia adhesiva. Los resultados también sugieren que la utilización de sistemas adhesivos auto-acondicionantes en dentina esclerótica debe ser evitada

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.

Nutrição para idosos / Nutrition for the elderly

Este artigo tem por objetivo discutir a contribuição da nutrição na qualidade vida dos indivíduos idosos e de que forma ela pode influenciar para uma velhice mais saudável. Serão abordados os aspectos bioquímicos e fisiológicos do envelhecimento, os aspectos relacionados à saúde bucal e às necessidades nutricionais dos idosos, assim como serão evidenciadas as alterações fisiológicas que direta ou indiretamente afetam a sua alimentação.

The main of this article is to discuss the influence of nutrition in the orderly?s quality of life and whether it can implicate in oral health or to contribute for a healthier old age. Considerations on biochemical and physiologic aspects of the aging will be considered, associated with the senior?s nutritional needs, as well as it will be evidenced the physiologic changes that directly or indirectly affect elder food consumption.

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.

Prevalencia del elongamiento del proceso estiloide en UMA / The prevalence of elongated styloid process in UMA

El elongamiento y mineralización del proceso estiloide ha sido descrito en la literatura como un acontecimiento que puede ser asintomático o manifestarse como síndrome estiloestilohióideo o síndrome de Eagle. Este estado se caracteriza por un conjunto de señales y síntomas como el dolor facial leve, disconformidad en la deglución, limitaciones en los movimientos de la cabeza, cuello y abertura bucal, otalgia, cefalea y disfagia que pueden ser confundidas con el desorden temporomandibular. Uno de los principales recursos de diagnóstico para el elongamiento del proceso estiloide es la evaluación radiográfica. El propósito de este trabajo fue investigar en la población adulta totalmente desdentada la prevalencia del elongamiento del proceso estiloide. Los autores analizaron 233 radiografías panorámicas del servicio de tiraje de la FOP-UNICAMP en pacientes adultos, de ambos sexos. Fueron realizadas mediciones de las imágenes de los procesos estiloides y fueron consideradas elongadas las imágenes de los procesos estiloides mayores de 30 mm conforme a los estudios obtenidos en la revisión de la literatura. Las imágenes que no permitieron realizar las mediciones en forma segura fueron despreciadas. Los resultados fueron organizados en tablas y divididos según los factores de edad, sexo y lado predominante. Los datos permitieron observar que de las 233 radiografáis analizadas fue posible medir 341 procesos estiloides, siendo de estos, 50,1 por ciento(n=176) presentaron medida mayor de 30 mm. De estas imágenes 64 por ciento (n=113) fueron mujeres y 35 por ciento (n=63) hombres. Los valores promedios obtenidos fueron de 33, 5 mm para los individuos de sexo masculino y de 31,38 mm para los de sexo femenino. En relación con la edad, la mayor prevalencia fue comprendida entre 61 y 70 años con un porcentaje de 61,8 por ciento (nt=110) seguida de la franja etaria entre 51 y 60 años con un porcentaje de 53 por ciento (nt=341; nd=159; n=82) para el lado derecho y de 28,4 por ciento (nt=341; ne=182; n=97) para el lado izquierdo. Los autores concluyeron que existió una mayor prevalencia de proceso estiloide elongado en individuos de sexo femenino; no ocurrió predominio en cuanto al lado de presencia del proceso elongado, existió una mayor prevalencia de elongamiento del proceso estiloide en los individuos de edades entre 51 y 70 años y baja prevalencia entre los individuos con menos de 30 años

Prevalencia del elongamiento del proceso estiloide en una población adulta totalmente desdentada / Prevalence of styloid process elongation in a complete edentulous adult population

El elongamiento y mineralización del proceso estiloide ha sido descrito en la literatura como un acontecimiento que puede ser asintomático o manifestarse como Síndrome estilo-estilohioideo o Síndrome de Eagle. Este estado se caracteriza por un conjunto de señales y síntomas, como el dolor facial leve, molestia en la deglución, limitaciones en los movimientos de cabeza, cuello y la abertura bucal, otalgia, cefalea, disfagia y vértigo que pueden ser confundidos con desorden temporomandibular. Uno de los principales recursos diagnósticos para el elongamiento del proceso estiloide es la evaluación radiográfica. El propósito de este trabajo fue investigar en la población adulta totalmente desdentada, la prevalencia de elongamiento del proceso estiloide. En este trabajo los autores analizaron 233 radiografías panorámicas del servicio de examen de la FOP-UNICAMP en pacientes adultos de ambos sexos. Fueron realizadas mediciones de las imágenes de los procesos estiloides y se consideraron elongadas las imágenes de los procesos estiloides mayores de 30 milímetros. Las imágenes que no permitieron realizar las mediciones en forma segura fueron despreciadas. Los resultados fueron organizados en tablas y divididos según los factores de edad, sexo y lado predominante. Los datos permitieron observar que de las 233 radiografías, fue posible medir 341 procesos estiloides. Los autores concluyeron que existió una mayor prevalencia de proceso estiloide elongado en individuos de sexo femenino, no ocurrió predominio en cuanto al lado de presencia del proceso estiloide en individuos entre 51 y 70 años, y una baja prevalencia entre individuos con menos de 30 años

Avaliaçäo diária da dor na desordem temporomandibular: caso clínico / The diary assessment of pain in craniomandibular disorder: a clinical report

As Desordens Temporomandibulares (DTM) têm etiologia multifactorial e normalmente envolvem uma abordagem interdisciplinar para seu tratamento. Dor nas articulaçöes temporomandibulares, nos músculos da mastigaçäo e na cabeça, sons articulares e movimentos mandibulares inccordenados säo os sinais e sintomas mais frequentes. Devido aos diferentes métodos propostos no seu diagnóstico e tratamento, várias pesquisas têm sido feitas na tentativa de aprimorar o controle desta patogenia de alta prevalência na populaçäo. Uma das maiores dificuldades encontradas refere-se ao controle da dor e avaliaçäo da efetividade do tratamento durante as diferentes intervençöes terapêuticas. Neste trabalho, foi proposto o tratamento por abordagem interdisciplinar utilizado no Núcleo de Estudos da Dor (NED) da UNICAMP, a um paciente portador de DTM. A efectividade do tratamento foi acompanhada através da avaliaçäo diária de dor e desagradabilidade por meio de uma escala visual analógica (VAS), com acompanhamento de 251 dias após o tratamento. Esta escala possibilitou comparar as intensidades relativas da dor, uma experiência altamente individual e subjectiva, e favoreceu a avaliaçäo constante do tratamento proposto e sua efectividade, demonstrando ser um método eficaz quando correctamente utilizado

Complicaciones en las prótesis sobre implantes / Complications in implant-supported dentures

El propósito de esta revisión fue verificar las tasas de éxito y fallas, y las causas más frecuentes de complicaciones, tanto en las prótesis soportadas por implantes como en los implantes propiamente dichos. Se puede notar un mayor número de complicaciones en las fijaciones de los maxilares superiores, comparados con los inferiores. Las fracturas de la superestructura metálica y/o dientes artificiales, fractura o inclinación de los pilares, fractura de la estructura metálica y fractura de los clips retentivos (sobredentaduras) fueron los problemas más comunmente encontrados. Se verificó que pacientes desdentados presentando rebordes severamente reabsorbidos pueden conseguir un buen pronóstico con prótesis implantosoportadas, eliminando la inestabilidad de las prótesis. El grado de satisfacción de los pacientes fue alto, y la tasa de pérdida de los implantes fue baja. Los problemas periodontales de mayor incidencia fueron presencia de placa, infecciones y pequeñas bolsas en torno de las fijaciones. Se verificó que las prótesis sobre implantes oseointegrados presentan ventajas y desventajas, como cualquier otro modelo restaurador; sin embargo, al ser comparadas con las prótesis totales y removibles convencionales, pueden ofrecer mayor seguridad a los pacientes debido a su mayor estabilidad.