Calidad del Sueño, Estrés Percibido y Desórdenes Temporomandibulares Dolorosos en Adultos Jóvenes de Dos Comunidades Mexicanas

RESUMEN: Una mala calidad del sueño y estrés, pueden ser la génesis de anomalías temporomandibulares que consisten en una familia heterogénea de desórdenes músculoesqueletales que representan la afección de dolor orofacial crónica más común. El objetivo de este trabajo fue relacionar la calidad del sueño, estrés percibido y desórdenes temporomandibulares dolorosos en adultos jóvenes de dos comunidades mexicanas (Puebla y Yucatán). Material y Métodos: estudio de tipo correlacional, analítico, prospectivo, de corte transversal. Se obtuvo consentimiento informado y voluntario por medio de firmas de 552 sujetos adultos jóvenes: 276 de Puebla (P), 53 % (n=147) mujeres, 47 % (n= 129) hombres, con un promedio de 28 años (± 4,5); y 276 sujetos de Yucatán (Y), 58 % (n=161) mujeres, 42 % (n= 115) hombres, con un promedio de 27 años (±4,9). Se les realizó entrevistas con base a tres cuestionarios: Índice de Calidad de Sueño de Pittsburg (ICSP), Escala de Estrés Percibido de Cohen (EEP) e Instrumento de Examinación de Desórdenes Temporomandibulares Doloroso de González (IEDTD). Para el análisis estadístico se utilizó estadística descriptiva (frecuencias y porcentajes), regresión logística y correlación de Pearson. Puebla presenta un porcentaje mayor de individuos con calidad de sueño pobre 83 %, comparado con Yucatán, 56 %. De la misma forma, Puebla muestra un porcentaje mayor de individuos con estrés alto, 82 %, comparado con Yucatán, 74 %. Por otro lado, Puebla presenta un porcentaje mayor de individuos con DTM dolorosos, 33 %, comparado con Yucatán, 11 %. Asimismo, existe una correlación moderada general entre el estrés percibido y la calidad del sueño en mujeres (0,335) y edades de 30 a 35 años (0,383) ambas con una significancia de p <0,001. La calidad de sueño pobre aumenta 4 veces la posibilidad de padecer un DTM doloroso. Vivir en Puebla aumenta hasta 3.1 veces la posibilidad de un DTM doloroso.

ABSTRACT: Por sleep quality and stress may be the génesis of temporomandibular disorders that consist of a heterogeneous family of musculoskeletal disorders that represent the most common chronic orofacial pain condition. The objective of the study was to relate sleep quality, perceived stress, and painful temporomandibular disorders in Young adults from two Mexican communities (Puebla and Yucatán). a correlational, analytical, prospective, cross- sectional study. Informed and voluntary consent was obtained through the signatures of 552 young adult subjects: 276 from Puebla (P), 53 % (n = 147) women, 47 % (n = 129) men, with an average of 28 years (± 4.5); and 276 subjects from Yucatán (Y), 58 % (n = 161) women, 42 % (n = 115) men, with an average age of 27 years (±4.9). Interviews were conducted based on three questionnaires: Pittsburg Sleep Quality Index (ICSP), Cohen's Perceived Stress Scale (EEP) and González's Painful Temporomandibular Disorders Examination Instrument (IEDTD). Descriptive statistics (frequencies and percentages), logistic regression and Pearson's correlation were used for statistical analysis. Puebla has a higher percentage of individuals with por sleep quality, 83 %, compared to Yucatán, 56 %. In the same way, Puebla shows a higher percentage of individuals with high stress, 82 %, compared to Yucatán, 74 %. On the other hand, Puebla has a higher percentage of individuals with painful TMD, 33 %, compared to Yucatán, 11 %. Likewise, there is a general moderate correlation between perceived stress and sleep quality in women (0.335) and ages 30 to 35 years (0.383), both with a significance of p <.001. Poor sleep quality increases the chance of painful TMD by 4 times. Living in Puebla increases the possibility of painful TMD up to 3.1 times.

Temporomandibular Disorders in Violinists of Alliance Violin Community Bandung

@#Introduction: Technique of playing violin requires violinist to adjust the instrument on their left shoulder while the mandible helps holding it. The outcome is continuous mechanical force to area of craniofacial and neck. This force can induce temporomandibular disorders (TMD). The aim of this research was to obtain the description of diagnosis of TMD in violinists of Alliance Violin Community Bandung. Methods: This was a descriptive research. The subjects for this research were (n=34) violinists who became the members of Alliance Violin Community Bandung. Purposive sampling was used as sampling technique for this research. The procedure used for this research was referred to Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Results: The result of this research was 30 (16 females and 14 males) violinists with age ranging from 15-30 years old of Alliance Violin Community Bandung were diagnosed with TMD (88.24%). The description of diagnosis of TMD in violinists of Alliance Violin Community Bandung was dominated by disc displacement with reduction with 23 cases (67.65%), arthralgia with 5 cases (14.71%), and myalgia with 4 cases (11.77%). Conclusion: TMD were common in violinists of Alliance Violin Community Bandung, thereby we could conclude that violinists had a high risk of suffering from TMD. The method that was used in this study, DC/TMD, provided more detailed diagnosis so the violinists can raise their awareness of TMD to optimize early medical diagnosis and treatment.

Management of internal derangement of temporomandibular joint disc displacement with reduction using two different lines of treatment / Manejo do desarranjo interno do deslocamento de disco temporomandibular com redução utilizando dois tipos diferentes de tratamento

Objetive: This study was to compare the effectiveness of arthrocentesis versus the insertion of anterior repositioning splint (ARS) in improving the mandibular range of motion (MRM) for patients with the temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). Methods: 36 patients diagnosed as ADDwR were recruited and divided randomly into two groups. The first group (G1) was treated by arthrocentesis, and the second (G2) was treated using ARS. All patients were reexamined after six months. Results: Except that for protrusive movement, there were significant differences between the two groups for the percentage changes of the MRM as measured by the amount of pain free opening, unassisted opening, maximum assisted opening, right lateral and left lateral movements (p < 0.05). Conclusion: Within the context of the current study, the non-invasive, lower cost ARS, provided better results in improving the MRM when managing ADDwR cases. (AU)

Objetivo: O presente estudo comparou a eficácia da Artrocentese em relação à inserção da Placa Reposicionadora Anterior (PRA) na melhoria da Amplitude de Movimento Mandibular (AMM) para pacientes que apresentam Deslocamento de Disco Anterior com Redução (DDAcR) da Articulação Temporomandibular (ATM). Método: 36 pacientes diagnosticados como DDAcR foram recrutados e divididos aleatoriamente em dois grupos. O primeiro grupo (G1) foi tratado através da Artrocentese e o segundo (G2), tratado com a PRA. Todos os pacientes foram reexaminados após seis meses. Resultados: Com exceção do movimento protrusivo, houve diferenças significativas entre os dois grupos para as mudanças percentuais das medidas de AMM pela quantidade de abertura sem dor, abertura sem assistência, abertura máxima com assistência, movimentos laterais direitos e laterais esquerdos (p < 0,05). Conclusão: Dentro do contexto do estudo atual, a PRA, não invasiva e de menor custo, proporcionou melhores resultados na melhoria da AMM no gerenciamento de casos de DDAcR (AU)

Catastrofização e atenção plena na disfunção temporomandibular: estudo correlacional / Catastrophization and mindfulness in temporomandibular disorder: correlational study

A catastrofização é um constructo multidimensional que apresenta três dimensões: magnificação, ruminação e desamparo, segundo a Escala de catastrofização da Dor (Pain Catastrophizing Scale - PCS), sendo um importante mediador da dor crônica pelo modelo de medo e evitação de Vlaeyen e Lipton e definindo a entrada no ciclo de cronificação da dor. Estudos que analisaram a relação entre catastrofização e mindfulness pela Five Facets Mindfulness Questionnaire (FFMQ), apontam essa intervenção como um possível mediador da catastrofização. Porém como essas facetas de mindfulness se associam com as subescalas da catastrofização ainda não foi estudado. O objetivo deste estudo observacional e transversal foi verificar como se dá a associação de mindfulness e catastrofização, principalmente como os níveis de mindfulness e suas facetas se relacionam com as subdimensões magnificação, ruminação e desamparo. O intuito do aprofundamento do conhecimento dessa relação é gerar subsídios para o desenvolvimento e aplicação de intervenções baseadas em mindfulness direcionadas para as subdimensões da catastrofização e ser assim mais diretivo e assertivo na abordagem, aprimorando a qualidade de vida da população com dor crônica com mais eficácia. Foram recrutadas mulheres entre 18 e 45 anos (N=52) que apresentavam Disfunção Temporomandibular crônica segundo critérios do Critério Diagnóstico para Desordens Temporomandibulares (Diagnostic Criteria for Temporomandibular Disorders - DC/TMD) e após a assinatura dos termos de consentimento livre e esclarecido foram aplicados os Questionários Sociodemográfico, Escala de Catastrofização da Dor (PCS) e Questionário das Cinco Facetas de Mindfulness (FFMQ). Apresentaram correlação significante e de forma inversa a subescala magnificação com as facetas não reagir e não julgar e com a pontuação total da FFMQ. A pontuação total da PCS apresentou correlação inversa com a faceta não reagir. As demais não apresentaram correlação. Na análise de regressão logística, foi constatado que a cada ponto obtido no domínio descrever positivo é esperado um aumento de 1,67 vezes na chance de ocorrência de desamparo e para cada comorbidade aumenta em 12,9 vezes a chance de apresentar desamparo. O presente estudo fornece a possível existência de associações entre as habilidades mensuradas enquanto facetas de mindfulness com as subdimensões da catastrofização, sendo necessário considerar essas relações na abordagem das intervenções baseadas em mindfulness para essa população. É possível que estratégias baseadas em mindfulness que desenvolvam o não julgar e o não reagir sejam benéficas para pessoas com dor crônica que apresentem catastrofização com altas pontuações na magnificação na redução do comportamento catastrófico. Da mesma forma, os resultados indicam que o uso de técnicas de mindfulness que aprimorem o descrever positivo pode ser prejudicial para os catastróficos com desamparo. Esse trabalho pode ajudar no estudo e desenvolvimento de intervenções baseadas em mindfulness que considerem essas relações tornando mais direcionada e eficaz a abordagem na população com dor crônica

Catastrophizing is a multidimensional construct that presents three dimensions: magnification, rumination and helplessness, according to the Pain Catastrophizing Scale - PCS, being an important mediator of chronic pain by the model of fear and avoidance by Vlaeyen and Lipton and defining the entry into the pain chronification cycle. Studies that analyzed the relationship between Catastrofization and Mindfulness using the Mindfulness Five Facets Questionnaire (FFMQ), point to this intervention as a possible mediator of catastrophization. However, how these facets of mindfulness are associated with the subscales of catastrophization has not yet been studied. The objective of this observational and cross-sectional study is to verify how the association of mindfulness and catastrophization occurs, especially as the levels of mindfulness and their facets are related to magnification, rumination and helplessness sub-dimensions. The aim of deepening the knowledge of this relationship is to generate subsidies for the development and application of treatment based on mindfulness directed at the sub-dimensions of catastrophization and thus be more directive and assertive in the approach, improving the quality of life of the population with chronic pain more effectively. Women between 18 and 45 years old (N = 52) who had chronic temporomandibular disorder were recruited according to the criteria of the Diagnostic Criteria for Temporomandibular Disorders (Diagnostic Criteria for Temporomandibular Disorders - DC / TMD) and after signing the free and informed consent terms, the Sociodemographic Questionnaires, Pain Catastrophization Scale (PCS) and the Five Facets of Mindfulness Questionnaire (FFMQ) were completed. The magnification subscale showed a significant and inverse correlation with the facets not reacting and not judging and with the total FFMQ score. Total evaluation of the PCS presented an inverse correlation with the facet not reacting. The others are not correlated. In the logistic regression analysis, it was found that for each point added in the domain describes positive, a 1.67-fold increase in the chance of helplessness is expected, and for each comorbidity the chance of having helplessness increases by 12.9 times. The present study offers the possible existence of associations between the skills measured as facets of mindfulness with the sub-dimensions of catastrophization, and it is necessary to consider these relationships when approaching mindfulness-based techniques for this population. It is possible that based on mindfulness that develop not judging and not reacting are beneficial for people with chronic pain who have catastrophization with high scores on magnification in reducing catastrophic behavior. Likewise, the results indicate that the use of mindfulness techniques that enhance the positive, can be harmful to catastrophic people with helplessness. This work can help in the study and development of enlightened mindfulness that considers these relationships making the approach in the population with chronic pain more targeted and effective

Effect of using Photobiomodulation, stabilization, and anterior repositioning splints on the pain level of subjects with temporomandibular joint disc displacement with reduction / Efeito do uso da terapia a laser de baixa potência, placas planas e placas reposicionadoras anterior, no nível de dor de indivíduos com deslocamento anterior do disco articular com redução

Objective: was to evaluate the effect of four conservative treatment modalities on the pain level of patients with temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). Material and methods:100 subjects (64 females and 36 males) were selected, divided into four groups, 25 patients of each. Subjects of Group I have been treated with behavioral therapy. Subjects of Group II had been treated with Photobiomodulation therapy (PBMT). Subjects of Group III had been treated by anterior repositioning splint (ARS). Subjects of Group IV had been treated by a stabilization splint. The pain was evaluated by visual analog score (VAS) from 0 to 10. Statistical analysis was done using one-way ANOVA test for comparison between groups. Within each group, a comparison between baseline and after treatment was done using paired t-test (p<0.05). Results: There was a statistical difference between the pain scores of the different groups after treatment (p≤0.05). Also, there were statistical differences between all groups (p≤0.05) except that between group II and group III (p˃0.05). Conclusion: The use of stabilization splint and ARS are effective non-invasive methods for reducing the pain level in the treatment of TMJ ADDwR cases.(AU)

Objetivo: avaliar o efeito de quatro modalidades de tratamento conservador no nível de dor de pacientes com deslocamento anterior do disco articular com redução. Material e Métodos: foram selecionados 100 indivíduos(64 mulheres e 36 homens), divididos em quatro grupos, 25 pacientes cada. Os indivíduos do Grupo I foram tratados com terapia comportamental. Os indivíduos do Grupo II foram tratados com terapia de fotobiomodulação. Os indivíduos do Grupo III foram tratados com placa de reposicionamento anterior. Os indivíduos do Grupo IV foram tratados com uma placa de estabilização. A dor foi avaliada pelo escala visual analógica (EVA) de 0 a 10. A análise estatística foi feita usando o teste ANOVA de uma via para comparação entre os grupos. Dentro de cada grupo, uma comparação entre a linha de base e após o tratamento foi feita usando o teste t pareado (p <0,05). Resultados: Houve diferença estatística entre os escores de dor dos diferentes grupos após o tratamento (p ≤ 0,05). Além disso, houve diferenças estatísticas entre todos os grupos (p ≤0,05), exceto entre o grupo II e o grupo III (p˃0,05). Conclusão: O uso de placa de estabilização e reposicionadora anterior são métodos não invasivos eficazes para reduzir o nível de dor no tratamento de casos de deslocamento anterior de disco articular sem redução.(AU)

Evaluation of difficult airway in paediatric population ranging from 5-12 years age group

Background: The aim of this study is to predict difficult airway on the basis of various airway assessment parameter in the paediatric population between 5-12 years age group. To assess the value of modified Mallampati test (MMT), upper-lip-bite test (ULBT), thyromental distance (TMD), ratio of height to thyromental distance (RHTMD) from which Cormack Lehane grade was derived to predict difficult airway i.e. difficult intubation in paediatric patients ranging from 5-12 years age. Material and Methods: 100 ASA grade I & II paediatric patients of either sex between the age group of 5-12 years posted for elective surgery under general anaesthesia requiring endotracheal intubation were included in the study. Modified Mallampati test, upper lip bite test, thyromental distance and ratio of height to thyromental distance of the patients were measured and recorded. All the distances were measured with the help of a flexible measuring tape so as to measure the distances accurately. Results: Modified Mallampati test has the highest sensitivity (75%) and specificity (92.05%) among all the other screening tests. It also has high positive predictive value (56.25%), negative predictive value (96.43%) and diagnostic accuracy (90%). Upper Lip Bite test has high specificity (79.55%) and negative predictive value (93.33%) with high diagnostic accuracy (77%). It has a sensitivity of 58.33% which is similar to the sensitivity of thyromental distance and ratio of height to thyromental distance. Thyromental distance has high specificity (65.90%) with high negative predictive value (92.06%). Conclusion: Modified Mallampati test is a useful bedside screening test for predicting difficult intubation in patients between 5-12 years age group. The Upper Lip bite test and thyromental distance has high specificity with high negative predictive value and diagnostic accuracy. The ratio of height to thyromental distance is least useful predictor of airway assessment.

A Study to Predict Difficult Intubation Using Simple Non-invasive test: A Prospective Observational Study

Background: Airway Management is prime importance to the anaesthesiologist of all the anaesthetic deaths 30 % to 40 % are attributed to the inability to manage a difficult airway. The various simple bedside predictors of difficult airway like Mallampati test, Upper lip bite test, Thyromental, Hyomental, Thyrosternal & Sternomental distances, mandibular length, Neck circumferences etc. are easy to perform with No extra cost or inconvenience to patients. Aim: To assess the predictability of Upper lip bite test, Hyomental distance, Thyromental distance, Thyrosternal distance & Mandibular length. Objective: 1) To find out the best predictor of difficult intubation amongst the Upper Lip Bite Test, Hyomental Distance, Thyromental Distance, Thyrosternal Distance & Mandibular Length on the basis of the test. Methods: This is a prospective observational study of 110 patients are randomly selected & age caring between 20 to 59 yrs both male and female are presented in anaesthesia of routine per anaesthetic check-up. After from mouth opening & mallampati test which are routinely done airway assessment included ULBT, HMD, TMD, TSD & ML will be done. Results: After analysing study state that the age (P = 0.031) were significant , & sex (P = 0.213) ASA (P = 0.091) were not significant with difficult intubation on the basis of Cormack lehane grading. All these factors were applicant on next set of 110 patients to found sensitivity & specificity to be ULBT ( SE = 50.00%, SP =100.00%), HMD (SE = 10.00%, SP = 97.00%), TSD (SE = 0.00%, SP = 97.00%), ML (SE = 20.00%, SP = 97.00%) & TMD (SE = 70.00%, SP = 85.00%) respectively. Conclusions: Thyromental distance is the most important sensitive factors predicting difficult intubation on the basis of cormack lehane grading in indian patients.

Concordancia entre los criterios diagnósticos RDC/TMD y su actualización DC/TMD, aplicados a la patología inflamatoria de la articulación temporomandibular / Agreement between Diagnostic Criteria RDC/TMD and its update DC/TMD, applied to the inflammatory pathology of the Temporomandibular Joint

RESUMEN: Objetivo: Evaluar el grado de concordancia entre las prevalencias de trastornos articulares inflamatorios (TAI) de las Articulaciones Temporomandibulares (ATM), obtenidas con los Criterios Diagnósticos de Investigación para Trastornos Temporomandibulares (RDC/TMD) y los Criterios Diagnósticos para Trastornos Temporomandibulares (DC/TMD). Materiales y métodos: 59 pacientes adultos chilenos fueron examinados según el Eje I de los RDC/TMD y el Eje I de los DC/TMD para determinar la prevalencia de TAI. Luego se compararon los resultados obtenidos de cada protocolo con el test Kappa de Cohen para evaluar la concordancia entre ambos. Resultados: La prevalencia de TAI para ambos criterios fue de 22%, con una concordancia casi perfecta (kappa=0,91). Al comparar las prevalencias de TAI por articulación, se obtuvo un grado de acuerdo sustancial (kappa=0,77) para la ATM derecha y un grado de acuerdo casi perfecto (kappa=0,94) para la ATM izquierda. Al comparar las prevalencias de TAI según género y edad se obtuvo una concordancia estadísticamente significativa en la mayoría de los casos. Conclusión: Hay concordancia estadísticamente significativa entre los datos obtenidos con los RDC/TMD y los DC/TMD, en el diagnóstico de trastornos articulares inflamatorios.

ABSTRACT: Aim: To assess the agreement between the prevalence of inflammatory joint disorders (IJD) obtained with Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Materials and methods: 59 Chilean adult patients were examined according to Axis I of the RDC/TMD and Axis I of the DC/TMD to determine prevalence of IJD. Then, the results obtained from each protocol were compared with Cohen's Kappa test to assess the agreement between them. Results: The prevalence of IJD for both criteria was 22%, with almost perfect agreement (kappa = 0.91). When comparing the prevalences of IJD per joint, a substantial agreement (kappa = 0.77) was obtained for the right TMJ and an almost perfect agreement (kappa = 0.94) for the left TMJ. When comparing the prevalences of IJD according to gender and age, a statistically significant agreement was obtained in the majority of cases. Conclusion: There is statistically significant agreement between the data obtained with the RDC/TMD and the DC/TMD, in the diagnosis of inflammatory joint disorders.

Advancements in temporomandibular joint total joint replacements (TMJR)

The goal of this paper is to review the advantages and disadvantages of the various treatment options of temporomandibular joint (TMJ) total joint replacement (TJR). TMJ articles published within the last 20 years were reviewed to collect the information on non-invasive and invasive TMD treatment methods. Recent technological advancements helped the evolution of treatment methods and offered significant value to TMD patients and surgeons. Considering the TMD levels, the therapeutic procedures can involve general health examiniations, physical therapy, medication, oral rehabilation or as an end stage clinical invention, temporomandibular joint replacement. In fact when intra-articular TMD is present, the effective treatment method appears to be TJR. However, concern for infection, material hypersensitivity, device longevity and screws loosening issues still exists. Further combined research utilizing the knowledge and expertise of, surgeons, material scientists, and bioengineers is needed for the development of improved TMD therapeutic treatment.

The associations between work-related factors and temporomandibular disorders among female full-time employees: findings from the Fourth Korea National Health and Nutrition Examination Survey IV (2007–2009)

BACKGROUND: The aim of this study was to investigate the association between work-related factors and temporomandibular disorders (TMD) among female full-time employees using representative data from a national population-based survey. METHODS: Data from the Fourth Korea National Health and Nutrition Examination Survey IV (2007–2009) were used to analyze 1,612 women. Complex samples logistic regression was applied for adjusting for general characteristics and work-related factors to examine the association between work-related factors and TMD. RESULTS: The prevalence of TMD was 12.8% in this study population. With respect to age, educational status, marital status, problem drinking, exercise, and stress, there were statistically significant differences in the prevalence of TMD. In logistic regression analyses on complex samples, based on 40 h or less per week, odds ratios (ORs) for respondents who worked 40–48 working hours, 49–60 working hours, and more than 60 h were 1.16 (95% confidence interval (CI) 0.69–1.94), 1.41 (95% CI 0.79–2.54), and 2.43 (95% CI 1.29–4.59), after adjusting for general characteristics, working schedule, employment status, and occupation. CONCLUSIONS: This study found that long working hours were significantly associated with TMD in Korean female full-time employees.

Stress Related Oral Disorders: An Update

Oral changes with psychosomatic etiology are still an insufficiently confirmed and investigated subgroup of psychosomatic diseases which have long been known in medicine. In their daily practice dentists frequently come across patients showing signs of stress and their oral manifestations in form of recurrent oral stomatitis, oral lichen planus and temporomandibular disorders. Recognition of such psychological or emotional disturbance benefits both the patient and clinician. Hence psychological management should be taken into consideration when treating patients with these psychosomatic disorders.

Association between psychological distress and occlusion among temporomandibular disorder patients – a clinical study.

Background: TMD is a multifactorial disorder significant research efforts have been invested in finding its etiologies and management to improve their quality of life. Objectives: To evaluate and compare digital occlusal parameters, depression, anxiety and serum cortisol level between temporomandibular disorder patients and control group. Material and methods: A sample size of 24 TMD patients and 24 apparently healthy age and sex matched controls were recruited in the study. The patients occlusion time and disclusion time was recorded using T-Scan III, the level of anxiety and depression was evaluated by using Hospital Anxiety and Depression scale questtionaire and serum cortisol was evaluated by collecting fasting blood sample, under aseptic conditions. Results: The incidence of premature contacts (occlusal interferences), clusion time and disclusion time was significantly longer in TMD group than in control subjects. The anxiety and depression scores were statistically significant in TMD group compared to control group, but no statistically significant difference was observed in serum cortisol levels. Conclusion: The present study demonstrated increase in the premature contacts i.e occlusal interferences were high with increase in clusion time, disclusion time, anxiety and depression scores in TMD group, where as no significant increase in serum cortisol levels was seen among TMD group even though their anxiety and depression levels were high. Hence, patients with temporomandibular disorders should always be evaluated for stress and anxiety along with the T- Scan evaluation of occlusal prematurities and correction of the same.

Prevalence of temporomandibular joint disorders in a mexican elderly group / Prevalencia de trastornos temporomandibulares en un grupo de adultos mayores mexicanos

Abstract: Aim: to determine frequency and distribution of temporomandibulardisorders (TMD) by age and sex in a group of elderly adults in Mexico City. Material and methods: One hundred and fifty-four older adults in Mexico City were examined in a cross-sectional study. Subjects who had big edentulous gaps (absence of two or more teeth) or those who were fully edentulous, as well as those who refused to participate, were excluded from the study. For the epidemiological survey, diagnostic criteria for Temporomandibular Disorders (DC/TMD), after standardization by a dentist (kappa=0.892), were considered. Results. A 33.1 percent had some type of TMD, being more common in people between 60 and 69 years old, variable with which it was related (Likelihood Ratio=21.553, p=0.006, X2 MH=08.389, p=0.021). A 14.3 percent reported some type of facial trauma history, behavior that also was statistically significant (X2 MH=13.566, p= 0.0001). Disorders that occurred most frequently were: disc displacement with reduction (62.8 percent) and disc displacement without reduction (9.8 percent). Conclusions. TMD occurred in one of every three subjects examined, showing a relationship with age and trauma history.

Resumen: Objetivo. determinar la frecuencia y distribución de los trastornos temporomandibulares (TTM) por edad y sexo en un grupo de adultos mayores de la Ciudad de México. Material y métodos. Estudio de corte transversal. Se examinaron 154 adultos mayores de la Ciudad de México. Fueron excluidos del estudio a todos aquellos que presentaron brechas edéntulas amplias (ausencia de dos ó más dientes) o edentulismo total, así como aquellos que no aceptaron participar en el estudio. Para la encuesta epidemiológica se tomaron en cuenta los Criterios Diagnósticos de los Trastornos Temporomandibulares (CD/TTM), previa estandarización de una Cirujana Dentista (kappa=0.892). Resultados. El 33.1 por ciento presentó algún tipo de TTM, siendo más frecuente en personas entre 60 y 69 años variable con la cual estuvo relacionada (Razón de verosimilitud=21,553, p=0,006, X2 MH=08,389, p=0,021). El 14,3 por ciento refirió algún tipo de antecedente traumático facial, comportamiento que también resultó ser estadísticamente significativo (X2 MH=13,566, p=0,0001). Los trastornos que se presentaron con mayor frecuencia fueron: el desplazamiento del disco con reducción (62,8 por ciento) y el desplazamiento del disco sin reducción (9,8 por ciento). Conclusiones. Los TTM se presentaron en uno de cada tres adultos mayores examinados, existiendo una relación con la edad y los antecedentes traumáticos.

Clinical Signs and Subjective Symptoms of Temporomandibular Disorders in Instrumentalists

PURPOSE: Most of the reports on instrumentalists' experiences of temporomandibular disorders (TMD) have been reported not by clinical examinations but by subjective questionnaires. The aim of this study was to investigate the clinical signs and subjective symptoms of TMD in a large number of instrumentalists objectively. MATERIALS AND METHODS: A total of 739 musicians from a diverse range of instrument groups completed a TMD questionnaire. Among those who reported at least one symptom of TMD, 71 volunteers underwent clinical examinations and radiography for diag-nosis. RESULTS: Overall, 453 participants (61.3%) reported having one or more symptoms of TMD. The most frequently reported symptom was a clicking or popping sound, followed by temporomandibular joint (TMJ) pain, muscle pain, crepitus, and mouth opening limitations. Compared with lower-string instrumentalists, a clicking or popping sound was about 1.8 and 2 times more frequent in woodwind and brass instrumentalists, respectively. TMJ pain was about 3.2, 2.8, and 3.2 times more frequent in upper-string, woodwind, and brass instrumentalists, respectively. Muscle pain was about 1.5 times more frequent in instrumentalists with an elevated arm position than in those with a neutral arm position. The most frequent diagnosis was myalgia or myofascial pain (MFP), followed by disc displacement with reduction. Myalgia or MFP was 4.6 times more frequent in those practicing for no less than 3.5 hours daily than in those practicing for less than 3.5 hours. CONCLUSION: The results indicate that playing instruments can play a contributory role in the development of TMD.

Clinical Signs and Subjective Symptoms of Temporomandibular Disorders in Instrumentalists

PURPOSE: Most of the reports on instrumentalists' experiences of temporomandibular disorders (TMD) have been reported not by clinical examinations but by subjective questionnaires. The aim of this study was to investigate the clinical signs and subjective symptoms of TMD in a large number of instrumentalists objectively. MATERIALS AND METHODS: A total of 739 musicians from a diverse range of instrument groups completed a TMD questionnaire. Among those who reported at least one symptom of TMD, 71 volunteers underwent clinical examinations and radiography for diag-nosis. RESULTS: Overall, 453 participants (61.3%) reported having one or more symptoms of TMD. The most frequently reported symptom was a clicking or popping sound, followed by temporomandibular joint (TMJ) pain, muscle pain, crepitus, and mouth opening limitations. Compared with lower-string instrumentalists, a clicking or popping sound was about 1.8 and 2 times more frequent in woodwind and brass instrumentalists, respectively. TMJ pain was about 3.2, 2.8, and 3.2 times more frequent in upper-string, woodwind, and brass instrumentalists, respectively. Muscle pain was about 1.5 times more frequent in instrumentalists with an elevated arm position than in those with a neutral arm position. The most frequent diagnosis was myalgia or myofascial pain (MFP), followed by disc displacement with reduction. Myalgia or MFP was 4.6 times more frequent in those practicing for no less than 3.5 hours daily than in those practicing for less than 3.5 hours. CONCLUSION: The results indicate that playing instruments can play a contributory role in the development of TMD.

Prevalencia de Trastornos Temporomandibulares según los CDI/TTM, en un Grupo de Adultos Mayores de Santiago, Chile / Prevalence of Temporomandibular Disorders According to RDC/TMD in Older People of Santiago, Chile

En la población chilena, los adultos mayores representan un 13% de la población total del país (2,2 millones), proyectándose para el 2020 un aumento del grupo de 60 años o más en un 45%. Todos los seres humanos sufren un proceso de envejecimiento y, los tejidos orales y periorales no escapan de este proceso. Las repercusiones sobre el sistema estomatognático, podrían manifestarse a través de sintomatología en alguno de sus componentes, compatible con un trastorno temporomandibular (TTM). El objetivo de este trabajo, fue determinar la prevalencia de TTM según los Criterios de Investigación Diagnóstica ó CDI/TTM (Eje I), en adultos mayores examinados en la Clínica Odontológica de la Facultad de Odontología de la Universidad de Chile (FOUCh), durante el año 2012 y establecer la relación entre ambos sexos. Este estudio determinó, que existe una alta prevalencia de TTM en la muestra de adultos mayores chilenos estudiados (47%), principalmente diagnósticos de tipo articular y sin una relación significativa entre ambos sexos.

In Chilean population, elders represent a 13% of the overall population (2.2 million), projected for 2020 an increase of 45%, from the group of 60 and over. All humans undergo a process of aging. Oral and perioral tissues do not escape from this process, whose impact on the condyle and articular disc could be observed, in the presence of symptoms consistent with temporomandibular disorders (TMD). The aim of this study was to determine the prevalence of TMD according to the Research Diagnostic Criteria or RDC/TMD (Axis I), in older adults examined at the Dental Clinic of the Faculty of Dentistry, University of Chile during 2012, and establish the relationship between the sexes. In conclusion, this study found that there is a high prevalence of TMD in Chilean elderly sample studied (47%), mainly articular diagnoses without a statistically significant relationship between the sexes.

Salivary cortisol response to electrical stimulation in TMD cases and its relation with pain catastrophizing / 实用口腔医学杂志

Objective:To analyse the salivary cortisol changes in patients with temporomandibular disorders(TMD)after electrical stimulation,and the relationship between cortisol and pain catastrophizing.Methods:1 1 TMD and 1 1 healthy subjects were evoked by electrical stimulation.The saliva samples were collested before test,50 s and 1 00 s of stimulation after test seperately.Salivary cortisol was analysed by ELISA kit.The pain catastrophizing scale(PCS)was answered by all the subjects before stimulation.Data were statis-tically analysed.Results:The salivary cortisol concentration in TMD patients was higher than that in the controls(P <0.05).After stimulation,it showed a downward trend.No interaction between time and groups.The total scores of PCS including three indexes(ru-mination,magnification,helpless)were positively correlated with salivary cortisol concentration.Conclusion:The unpredictable stress causes high level of cortisol.which is related to pain catastrophizing.

The dental occlusion as a suspected cause for TMDs:epidemiological and etiological considerations / 实用口腔医学杂志

The relationship between the dental occlusion and temporomandibular disorders (TMDs)has been one of the most controversial topics in the dental community.In a large epidemiological cross-sectional survey-the Study of Health in Pomerania (Germany)-associations between 1 5 occlusion-related variables and TMD signs or symptoms were found.In other investigations,additional occlusal variables were i-dentified.However,statistical associations do not prove causality.By using Hill's nine criteria of causation,it becomes apparent that the evi-dence of a causal relationship is weak.Only bruxism,loss of posterior support and unilateral posterior crossbite show some consistency across studies.On the other hand,several reported occlusal features appear to be the consequence of TMDs,not their cause.Above all,however, biological plausibility for an occlusal aetiology is often difficult to establish,because TMDs are much more common among women than men. Symptom improvement after insertion of an oral splint or after occlusal adjustment does not prove an occlusal aetiology either,because the a-melioration may be due to the change of the appliance-induced intermaxillary relationship.In addition,symptoms often abate even in the ab-sence of therapy.Although patients with a TMD history might have a specific risk for developing TMD signs,it appears more rewarding to fo-cus on non-occlusal features that are known to have a potential for the predisposition,initiation or perpetuation of TMDs.

Phylogenic Oto-stomatognathic Connection of the Mammalian Jaw: A Novel Hypothesis for Tensor Tympani Muscle and TMD-related Otologic Symptoms / 체질인류학회지

Otologic complaints, including otalgia, tinnitus, vertigo, and hearing loss, are known to be related to temporomandibular disorders (TMDs). There have been several hypotheses regarding the clinical correlation between otologic complaints and TMDs, based on clinical phenomena with corresponding symptoms, the close neurological relationship between otic and masticatory structures, and anatomical features of the tympanic cavity and jaw joint. Function of the tensor tympani muscle seems to be crucial to understanding TMD-related otologic symptoms. The tensor tympani inserts into the handle of the malleus and it modulates sound transduction in situations of excessive noise. This muscle is innervated by the trigeminal nerve, like the masticatory muscles. Voluntary eardrum movement by pathological tensor tympani contraction results in various otologic symptoms. Thus, co-contraction of the tensor tympani with the masticatory muscle could be a possible cause of TMD-related otologic symptoms. The tensor tympani is rather unrelated to the acoustic reflex, in which the stapedius is strongly involved. The tensor tympani seem to be controlled by proprioceptive information from the trigeminal sensory nucleus. The peripheral innervation pattern of the tensor tympani and masticatory muscles is also supposed to be interconnected. The middle ear structure, including the malleus, incus, and tensor tympani, of mammals had been adapted for acoustic function and lacks the masticatory role seen in non-mammalian jawed vertebrates. The tensor tympani in non-mammals is one of the masticatory muscles and plays a role in the modulation of sound transduction and mastication. After the functional differentiation of the mammalian middle ear, the nervous connection of the tensor tympani with other masticatory apparatus still remains. Through this oto-stomatognathic vestige, the tensor tympani seems to contract unnecessarily in some pathological conditions of the TMD in which the masticatory muscles contract excessively. We hypothesized that the phylogenic relationship between the tensor tympani and masticatory apparatus is a significant and logical reason for TMD-related otologic complaints.

Ultra-thin Rigid diagnostic and therapeutic arthroscopy during arthrocentesis: Development and preliminary clinical findings / 대한악안면성형재건외과학회지

Arthroscopy is useful to detect early changes in the temporomandibular joint (TMJ). Despite great advances in arthroscopy, many arthroscopic surgeries have now been replaced by arthrocentesis. We propose a simple diagnostic and therapeutic method having operative rigid ultra-thin arthroscopy with 16 gauge needle size combined with arthrocentesis.