Trastornos temporomandibulares en adolescentes con hábitos parafuncionales / Temporomandibular disorders in adolescents with parafunctional habits i: en

Introducción: Los trastornos temporomandibulares en adolescentes pueden ser ocasionados por hábitos parafuncionales, que probablemente dan lugar a diferentes manifestaciones en los componentes del sistema estomatognático. Objetivo: Caracterizar a los adolescentes con trastornos temporomandibulares y hábitos parafuncionales según variables epidemiológicas y clínicas. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 74 adolescentes (15-18 años de edad) del Instituto Preuniversitario Antonio Alomá Serrano, perteneciente al área de salud del Policlínico Docente José Martí en Santiago de Cuba, desde noviembre del 2021 hasta marzo del 2022. Resultados: Se halló que 88,1 % de los integrantes de la serie presentaron alteraciones leves, 11,9 %, moderadas y 20,3 % no tuvo ninguna. De los 59 pacientes con trastornos temporomandibulares, 74,6 % eran del sexo femenino, con prevalencia de las alteraciones leves (76,9 %). El hábito referido con más frecuencia fue la onicofagia (50,8 %), seguida de la queilofagia (47,5 %). De los adolescentes que presentaban bruxismo, 71,4 % mostró una disfunción moderada; sin embargo, en aquellos con disfunción leve predominó la práctica de la onicofagia (53,8 %). Conclusiones: La mayoría de los adolescentes con más de un hábito parafuncional presentaron trastornos temporomandibulares.

Introduction: Temporomandibular disorders in adolescents can be caused by parafunctional habits that probably lead to different manifestations in the stomatognathic system՚s components. Objective: To characterize the adolescents with temporomandibular disorders and parafunctional habits according to epidemiologic and clinical variables. Methods: An observational, descriptive and cross-sectional study of 74 adolescents (15-18 years) from Antonio Alomá Serrano Senior High School, belonging to the health area of José Martí University Polyclinic in Santiago de Cuba, was carried out from November, 2021 to March, 2022. Results: It was found that 88.1% of the members in the series presented light alterations, 11.9% presented moderate changes and 20.3% didn't have any changes. Of the 59 patients with temporomandibular disorders, 74.6% were women, with prevalence of the light alterations (76.9%). The habit referred with more frequency was nail biting (50.8%), followed by cheilophagia (47.5%). Of the adolescents that presented bruxism, 71.4% showed a moderate dysfunction; however, in those with light dysfunction the practice of nail biting prevailed (53.8%). Conclusions: Most of the adolescents with more than one parafunctional habit presented temporomandibular disorders.

Relación entre el grado de ansiedad (autoevaluación de ansiedad estado/rasgo [STAI]) y el grado de trastorno temporomandibular (índice anamnésico de Fonseca) en una población mexicana / Relationship between the degree of anxiety (state/trait anxiety self-assessment [STAI]) and the degree of temporomandibular disorder (Fonseca anamnestic index) in a Mexican population

Introducción: en la actualidad la ansiedad es uno de los síndromes clínicos más frecuentes y la relación directa con el trastorno temporomandibular (TTM) ha sido el punto de partida para diversos estudios, además del motivo de consulta más común para el clínico. Objetivos: evidenciar la relación existente entre el grado de ansiedad y el TTM. Material y métodos: se realizó un estudio descriptivo, transversal y observacional con una muestra de 220 individuos. Utilizando el cuestionario de autoevaluación de ansiedad estado/rasgo (STAI) para medir el grado de ansiedad y el cuestionario índice anamnésico de Fonseca (IAF) para medir el grado de TTM. Resultados: de las personas que participaron en el estudio, 36.8% presentan ansiedad leve, 27.7% ansiedad moderada, 21.8% ansiedad mínima y 13.6% ansiedad severa, siendo los hombres con mayor porcentaje de ansiedad moderada (33.7%) y las mujeres mayor tendencia a la ansiedad severa (16.4%). de los pacientes, 42.3% refieren no presentar ningún grado de disfunción; 30% disfunción leve, 18.6% disfunción moderada, y solo 8.6% disfunción grave. Conclusión: se encontró una relación directa, correlacionándose gradualmente a mayor nivel de ansiedad, mayor grado de TTM

Introduction: anxiety is currently one of the most frequent clinical syndromes and the direct relationship with temporomandibular disorder (TMD) has been the starting point for various studies as well as the most common reason for consultation for the clinician. Objectives: to demonstrate the relationship between the degree of anxiety and TMD. Material and methods: a descriptive, cross-sectional and observational study was carried out with a sample of 220 individuals. Using the state/trait anxiety self-assessment questionnaire (STAI) to measure the degree of anxiety and the Fonseca anamnestic index questionnaire (IAF) to measure the degree of TMD. Results: 36.8% of the people who participated in the study present mild anxiety, 27.7% moderate anxiety, 21.8% minimal anxiety and 13.6% severe anxiety, the men having a higher percentage of moderate anxiety (33.7%) and women greater tendency to severe anxiety (16.4%). 42.3% of patients report not presenting any degree of dysfunction; 30% mild dysfunction, 18.6% moderate dysfunction, and only 8.6% severe dysfunction. Conclusion: a direct relationship was found, gradually correlating to a higher level of anxiety, a higher degree of TMD (AU)

Influencia de la ansiedad en el desarrollo de los trastornos temporomandibulares

Introducción: Los trastornos temporomandibulares constituyen un problema de salud importante en Cuba, la causa es de carácter multifactorial, actualmente se sabe que los factores psicosociales juegan un papel importante, sobre todo en lo que se refiere a la adaptación al dolor y su recuperación. Objetivo: Identificar la relación entre los trastornos temporomandibulares y los distintos niveles de ansiedad en pacientes pertenecientes al Consultorio Médico de la Familia No. 10 del área Norte de la provincia de Sancti Spíritus, Cuba, durante el período enero de 2019 a enero de 2020. Método: Se realizó un estudio observacional analítico del tipo casos y controles. El universo fue de 109 pacientes. La muestra quedó integrada por 80 pacientes distribuidos en 40 casos y 40 controles. Las variables estudiadas fueron: edad, sexo, trastornos temporomandibulares, signos y síntomas, ansiedad. Los trastornos temporomandibulares se diagnosticaron a través del Índice de Helkimo y la ansiedad mediante la aplicación del Inventario de Ansiedad Rasgo-Estado (IDARE). Se aplicó la prueba de asociación estadística Ji-cuadrado. Resultados: Predominaron los pacientes del sexo femenino en un 55 % y el 51,25 % en el rango de edad de 40-59 años. Los signos y síntomas más frecuentes en pacientes con trastornos temporomandibulares fueron el dolor en la articulación temporomandibular y en músculos masticatorios para un 85 % y 80 %, respectivamente. La mayoría de los casos presentaron niveles altos de ansiedad como estado en un 52,5 %. Conclusiones: Los distintos niveles de ansiedad predispusieron al origen y mantenimiento de los trastornos temporomandibulares en los pacientes estudiados.

Introduction: The temporomandibular disorders constitute an important health problem in Cuba. Today, it´s well known that the psychosocial factors play an important role in it, especially, with regard to pain adaptation and recovery. Objective: Identification of the relationship between temporomandibular disorders and different levels of anxiety in patients belonging to the Family Medical Clinic No. 10 located at the Northern Area of the Sancti Spíritus province, Cuba, during the period January 2019 to January 2020. Method: An analytical observational study of case-control type was carried out. The population was comprised of 109 patients. The sample consisted of 80 patients distributed in 40 cases and 40 controls. The variables studied were at following: age, sex, temporomandibular disorders, signs and symptoms, anxiety. Temporomandibular disorders were diagnosed through the Helkimo Index and anxiety through the application of the State-Trait Anxiety Inventory (STAI). The Chi-squared statistical association test was applied. Results: Female patients were predominant (55%) and 51.25% were in the age range of 40-59 years. The most frequent signs and symptoms in patients with temporomandibular disorders were pain in the temporomandibular joints and in muscles of mastication for 85 % and 80 %, respectively. Most of the cases (52.5 %) presented high levels of anxiety. Conclusions: The different levels of anxiety predisposed to the origin and maintenance of temporomandibular disorders in all the patients studied.

Introdução: As disfunções temporomandibulares constituem um importante problema de saúde em Cuba, a causa é multifatorial, atualmente sabe-se que os fatores psicossociais desempenham um papel importante, principalmente no que diz respeito à adaptação à dor e sua recuperação. Objetivo: Identificar a relação entre as disfunções temporomandibulares e os diferentes níveis de ansiedade em pacientes pertencentes ao Consultório Médico de Família nº 10 da zona Norte da província de Sancti Spíritus, Cuba, durante o período de janeiro de 2019 a janeiro de 2020. Método: Foi realizado um estudo observacional analítico do tipo caso e controle. O universo foi de 109 pacientes. A amostra foi composta por 80 pacientes distribuídos em 40 casos e 40 controles. As variáveis estudadas foram: idade, sexo, disfunção temporomandibular, sinais e sintomas, ansiedade. As disfunções temporomandibulares foram diagnosticadas por meio do Índice de Helkimo e a ansiedade por meio da aplicação do Inventário de Ansiedade Trait-State (IDARE). Foi aplicado o teste de associação estatística Qui-quadrado. Resultados: Pacientes do sexo feminino predominaram em 55% e 51,25% na faixa etária de 40 a 59 anos. Os sinais e sintomas mais frequentes em pacientes com disfunção temporomandibular foram dor na articulação temporomandibular e nos músculos mastigatórios para 85% e 80%, respectivamente. A maioria dos casos apresentou níveis elevados de ansiedade como estado em 52,5%. Conclusões: Os diferentes níveis de ansiedade predispõem à origem e manutenção das disfunções temporomandibulares nos pacientes estudados.

Asociación entre disfunción cráneocervical y trastornos temporomandibulares en adultos jóvenes / Association between craniocervical dysfunction and temporomandibular disorders young adults

RESUMEN Objetivo: Determinar la asociación entre disfunción cráneocervical y Trastornos Temporomandibulares en adultos jóvenes. Material y Métodos: Se realizó un estudio observacional, transversal y retrospectivo en una muestra probabilística donde se evaluaron 180 adultos jóvenes entre 18 y 35 años, distribuidos en dos grupos con y sin trastorno temporomandibular según el Eje I del Índice de Criterios Diagnósticos para Trastornos Temporomandibulares. El primer grupo estuvo conformado por 87 estudiantes con diagnóstico de trastorno temporomandibular y el segundo por 93 estudiantes sin este diagnóstico. Posteriormente, se les realizó el Índice de Disfunción Cráneocervical y Movilidad Cervical para medir el grado de movimiento cervical y postura cráneocervical. Los datos fueron analizados mediante estadística descriptiva e inferencial utilizando la prueba de Chi-cuadrado (p=0,05). Resultados : Los trastornos temporomandibulares predominaron en el género femenino (69 %). El diagnóstico de dolor relacionado a trastorno temporomandibular predominó para mialgia y artralgia (38 %) y el grado de disfunción cráneocervical predominante fue leve (40,4 %). Los estudiantes con disfunción cráneocervical leve presentaron mialgia (83,3 %) y los estudiantes con disfunción cráneocervical severa presentaron ambos (mialgia y artralgia: 55,6 %). Los estudiantes sin trastorno temporomandibular presentaron disfunción cráneocervical leve (61,9 %) y los con trastorno temporomandibular presentaron disfunción cráneocervical moderada (27 %). Los estudiantes con disfunción cráneocervical presentaron trastorno temporomandibular en un 64,7 %. Conclusiones: En este estudio encontramos que existió una asociación entre disfunción cráneocervical y trastornos temporomandibulares en los adultos jóvenes evaluados.

ABSTRACT Introduction : The close anatomical and functional relationship involving the cranio-cervico-mandibular system has caused a high prevalence of signs and symptoms of craniocervical dysfunction in subjects with temporomandibular disorder, especially postural and pain problems. Objective: To determine the association between craniocervical dysfunction and Temporomandibular Disorders in young adults. Material and Methods: 180 young adults between 18 and 35 years old were evaluated, distributed in two groups with and without temporomandibular disorder according to Axis I of the Index of Diagnostic Criteria for Temporomandibular Disorders. The first group consisted of 87 students with a diagnosis of temporomandibular disorder and the second of 93 students without this diagnosis. Subsequently, the Craniocervical Dysfunction and Cervical Mobility Index was performed to measure the degree of cervical movement and craniocervical posture. The data were analyzed by descriptive and inferential statistics using the Chi-square test (p = 0.05). Results: Temporomandibular disorders predominated in the female gender (69%). The diagnosis of pain related to temporomandibular disorder predominated for myalgia and arthralgia (38%) and the predominant degree of craniocervical dysfunction was mild (40.4%). Students with mild craniocervical dysfunction presented myalgia (83.3%) and students with severe craniocervical dysfunction presented both (myalgia and arthralgia: 55.6%). Students without temporomandibular disorder had mild craniocervical dysfunction (61.9%) and those with temporomandibular disorder had moderate craniocervical dysfunction (27%). Students with craniocervical dysfunction presented temporomandibular disorder in 64.7%. Conclusions: In this study we found that there was an association between craniocervical dysfunction and temporomandibular disorders in the young adults evaluated.

Treatment of Serious Occlusal Instability Associated with Temporomandibular Disorders (TMDs) Through Implant and Dynamic Occlusal Schemes Rehabilitation. A Case Report

ABSTRACT: A case report of 35 years old male patient, partially edentulous with occlusal instability, Disc Displacement with Reduction (DDWR), Local Muscle Soreness (LMS) and Alteration of vertical dimension is presented. Rehabilitation was planned to achieve predictability of long-term treatment, providing static and dynamic occlusal stability. A therapeutic occlus ion with premature contact in the right premolar sector was planned. Implants and cemented/screwed crowns were used to obtain contacts in the molar area. The restoration of dynamic occlusal schemes was made by direct adhesive technique in the anterior sector and Curve of Spee (COS) compensation with temporary anchoring for molar inclusion was used. Patient presents objective and subjective improvements associated with the treatment performed. Temporomandibular disorder is stabilized and controlled by a specialist.

RESUMEN: Se presenta el caso clínico de un paciente masculino de 35 años, parcialmente desdentado con inestabilidad oclusal, Desplazamiento Discal con Reducción (DDWR), Dolor Muscular Local (LMS) y Alteración de la dimensión vertical. La rehabilitación se planificó para lograr la previsibilidad del tratamiento a largo plazo, proporcionando estabilidad oclusal estática y dinámica. Se planificó una oclusión terapéutica con contacto prematuro en el sector premolar derecho. Se utilizaron implantes y coronas cementadas / atornilladas para obtener contactos en la zona de los molares. La restauración de esquemas oclusales dinámicos se realizó mediante técnica de adhesivo directo en el sector anterior y se utilizó compensación de Curva de Spee (COS) con anclaje temporal para inclusión molar. El paciente presenta mejoras objetivas y subjetivas asociadas al tratamiento realizado. El trastorno temporomandibular es estabilizado y controlado por un especialista.

Prevalencia de trastornos temporomandibulares en pacientes psicógenos: presentación de caso clínico / Prevalence of temporomandibular disorders in psychogenic patients: clinical case presentation

Antecedentes: Los trastornos temporomandibulares (TTM), según estudios realizados a nivel mundial, son un problema muy frecuente, aproximadamente entre el 70 y 90% de la población general tiene al menos un signo clínico, mientras que entre el 5 y 13% muestran sintomatología clínicamente signifi cativa; los TTM son considerados una patología presente en la ajetreada sociedad industrial de la actualidad, son una enfermedad de la sociedad moderna. Laskin, en 1969, comenzó a defender la etiología de los TTM, otorgando especial relevancia al estrés y al estado psicológico. Más de 340 millones de personas sufren actualmente de algún tipo de depresión clínica, con base en datos reportados por la Organización Mundial de la Salud (OMS, 2008). Según estudios en el 2012 en la Universidad de Greifswald en Alemania, se ha propuesto que los síntomas de depresión y ansiedad deberían ser considerados como factores de riesgo en los TTM. Material y métodos: Se acudió al Servicio de Psicología de la Unidad de Medicina Familiar (UMF) Núm. 26, Monterrey (Mty), Nuevo León (NL), donde se buscaron y evaluaron, en conjunto con la licenciada en psicología, pacientes sin antecedentes de traumatismos o lesiones cervicales. Se les aplicó una encuesta, se elaboró una fi cha epidemiológica y la valoración clínica, se seleccionó un caso para su presentación. Resultados: La paciente acude después de haber realizado una terapia miorrelajante, refi riendo mejoría a la apertura oral. Conclusiones: Es necesario el trabajo interdisciplinario por parte del estomatólogo, cirujano maxilofacial y psicólogo en la atención de las personas con trastornos temporomandibulares y una fi sioterapia en casa que incluya estrategias de autocuidado, educación del paciente, modifi caciones del estilo de vida. El tratamiento que incluye enfoques odontológicos y psicológicos al mismo tiempo parece ser más efectivo y se obtienen mejores resultados. Los pacientes deberían estar conscientes de que los hábitos no cambian solos y son éstos los responsables de estos cambios de comportamiento. La corrección de un hábito puede lograrse haciendo al paciente conocedor de que ese hábito existe, cómo debe corregirlo y por qué debe hacerlo (AU)

Background: Temporomandibular disorders (TMD), according to worldwide studies, are a very frequent problem, approximately between 70-90% of the general population has at least one clinical sign. While between 5-13% show significant symptomatology clinically; TMD is a pathology considered present in the busy industrial society of today, the disease of modern society. Laskin in 1969 began to defend the etiology of the TMD, giving special importance to stress and psychological state. More than 340 million people currently suff er from some type of clinical depression, based on data reported by the World Health Organization (WHO 2008). According to studies in 2012, the University of Greifswald, in Germany, has proposed that the symptoms of depression and anxiety should be considered as risk factors in TMD. Material and methods: We went to the Psychology Service of the Family Medicine Unit (FMU) No. 26 in Monterrey, Nuevo Leon (NL). And in conjunction with the psychologist, were researched patients without a history of trauma or cervical injuries and were assessed. A survey was applied, an epidemiological record was drawn up, a clinical assessment was made and a case was selected for its presentation. Results: The patient comes to monthly checks after myorelaxing therapy, referring improvement to oral opening. Conclusions: The stomatologist, maxillofacial surgeon, and psychologist in the care of people with TMD require interdisciplinary work; included home physiotherapy with self-care strategies, patient education, and lifestyle modifi cations. Treatment with dental and psychological approaches at the same time seems to be more eff ective and obtains better results. Patients should be aware that habits do not change on their own and they are responsible for these behavioral changes. The correction of a habit can be achieved by making the patient aware that this habit exists, how he should correct it and why he should do it (AU)

Toxina Botulínica para el Tratamiento de los Desórdenes Temporomandibulares / Botulinum Toxin for the Treatment of Temporomandibular Disorders

RESUMEN: Los Trastornos Temporomandibulares (TTM) consisten en un conjunto de condiciones patológicas que afectan la articulación temporomandibular (ATM), los músculos de la masticación y las estructuras asociadas. Estudios epidemiológicos estiman que 40 % a 75 % de la población adulta presenta por lo menos un signo de TTM, como ruido articular y 33 % por lo menos un síntoma, como dolor facial o en la ATM. La toxina botulínica (BoNT) es una neurotoxina producida por la bacteria anaerobia Clostridium botulinum, solo la toxina A y B son utilizadas en la práctica clínica después de la aprobación de la Food and Drug Administration en 1989 y 2000; actualmente continúan siendo utilizadas para tratar varias condiciones de dolor, incluyendo la espasticidad muscular, distonia, dolor de cabeza y dolor miofascial. Las propuestas del mecanismo de acción fueron sugeridas a mediados de 1950 manifestando que esta neurotoxina posee alta afinidad con la sinapsis colinérgicas, ocasionando un bloqueo en la liberación de acetilcolina de esos terminales nerviosos, sin alterar la conducción neural de las señales eléctricas o en la síntesis de almacenamiento de acetilcolina. La inyección intramuscular en dosis y localización apropiada, provoca denervación química parcial y disminución de la contractura, sin ocasionar parálisis completa a lo que se le atribuye ser un innovador y eficaz método de tratamiento para el dolor crónico asociada con hiperactividad de los músculos masticatorios. La toxina botulínica tipo A es ser una alternativa para el control de la sintomatología dolorosa presente en los TTMs de etiología miogénica. Los autores recomiendan realizar un correcto diagnóstico, ya que la indicación de este tipo de tratamiento con diagnósticos incorrectos lleva a resultados inciertos.

ABSTRACT: Temporomandibular Disorders (TMD) is a term that was used to describe a set of pathological conditions that affect temporomandibular joint (TMJ), muscles of mastication and associated structures. Epidemiological studies estimates that 40 % to 75 % of the adult population has at least one sign of TMD, such as joint noise and 33 % presented some symptom such as facial or joint pain. Botulinum toxin is a neurotoxin produced by the anaerobic bacterium Clostridium botulinum. There are two types of toxin (A and B) used in clinical practice that were approved by Food and Drug Administration in 1989 and 2000. These medications are in use to treat various diseases including muscle spasticity, dystonia, headache and myofascial pain. The mechanisms of action were suggested in the mid-1950s, this neurotoxin seems to have an action at cholinergic synapses, causing a block in the release of acetylcholine from the nerve terminals without altering the neural conduction of the electrical signals. The synthesis and storage of acetylcholine were preserved. Intramuscular injection in appropriate doses and location causes partial chemical denervation and decreased contracture, without causing complete paralysis of muscles. Due to this features, it has been considered an innovative and effective method to treat chronic pain associated with hyperactivity of masticatory muscles. The botulinum toxin type A appears to be an alternative method for pain control present in TMDs that have myogenic etiology. The authors recommend a correct diagnosis, since the indication of this type of treatment associated with an incorrect diagnosis leads to uncertain outcomes, creating false conclusions.

Comportamiento clínico de la articulación temporomandibular durante la artritis, en los pacientes del Instituto de Seguridad y Servicios Sociales de Trabajadores del Estado, en Yucatán, México / Clinical evaluation of temporomandibular articulation in arthritis patients, from the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Yucatán, Mexico

Introducción: la artritis es una inflamación en las articulaciones que, produce una afectación músculo-esquelética a la articulación temporomandibular (ATM). Objetivo: evaluar el comportamiento clínico de la ATM y sus áreas aledañas, en pacientes con artritis, del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Yucatán, México del 2015 al 2016. Métodos: se realizó un estudio transversal. Se aplicó un cuestionario basado en el examen clínico, sentados en un ángulo de 90°; y en el artículo Diagnostic criteria for temporomandibular disorders. En estos casos, no se retiró la prótesis, las férulas u otra aparatología. Las mediciones se realizaron con los músculos masticatorios en posición de reposo. Se utilizó un estetoscopio en el área articular para escuchar posibles ruidos. Se empleó el análisis descriptivo con porcentajes y frecuencias. Resultados: se investigaron 100 pacientes (91 mujeres y 9 hombres), con alguna enfermedad reumática previamente diagnosticada. El resultado mostró: un 80% de artritis reumatoidea (AR); 12% de osteoartritis (OR); 5% artritis idiopática juvenil (AIJ); y 3% de espondilitis anquilosante (EA). En pacientes adultos, se recogió un 59% de prevalencia de alguna artritis. Los patrones obtenidos fueron: 69% de apertura con desviación corregida; 17% de dolor en apertura bucal; y 20% de dolor al realizar movimientos laterales y protrusivos. En el 52% de los casos, se escuchó ruido en la ATM al realizar movimientos de apertura y cierre de la mandíbula. El 39% presentó dolor a la palpación de los músculos temporal y masetero, tanto en el lado derecho como en el izquierdo; un 8% en el temporal, un 17% en el masetero y un 14% en ambos. Conclusiones: los pacientes con artritis, presentaron signos y/o síntomas de trastorno temporomandibular.

Introduction: arthritis is the inflammation of the musculoskeletal system, in which temporomandibular joints (TMJ) are involved. Objective: to evaluate the clinical behavior of the TMJ and its surrounding areas, in workers of the Institute of Security and Social Services of State Workers (ISSSTE), Yucatan, Mexico. 2015-2016. Methods: a cross sectional study was done. A questionnaire about diagnostic criteria for temporomandibular disorders, whith a 90 ° clinical examination on sitting position, was applied. Prostheses, splints or other appliances were not removed. Measurements were made on resting masticatory muscles. A stethoscope for listening joints cliks, and a descriptive analysis of frecuencies percentages, were used. Results: one hundred patients (91 women and 9 men) with arthritis were investigated. On the process some rheumatic disease appeared: 80% of rheumatoid arthritis (RA), 12% of osteoarthritis (OR), 5% of juvenile idiopathic arthritis (JIA); 3% of ankylosing spondylitis (AS). Old adults presented a 59% prevalence of some opening corrected standar deviation; 69% showed pain in oral opening; 17% were aching when performing lateral and protrusive movements; 20% to 52% had clicks in the TMJ; and 39% showed distress to the palpation of the temporal and masseter muscles, both on the right and left side: 8% only on temporalis, 17% on the masseter, and 14% on both. Conclusions: arthritis patients reported signs and / or symptoms of temporomandibular disorders.

Inyecciones Intraarticulares de Ácido Hialurónico como Alternativa a los Corticoesteroides enel Tratamiento de la Osteoartritis de la Articulación Témporomandibular: Estudio de Revisión Sistemática / Intraarticular Injections of Hyaluronic Acid as an Alternative to Corticosteroids in the Treatment of Osteoarthritis of the Temporomandibular Joint: Study of Systematic Review

El objetivo de este trabajo fue determinar la disminución del dolor y la mejora de la función en los procesos artrósicos de la ATM mediante el empleo de hialuronato de sodio o corticoides. Realización de una revisión sistemática conforme a la metodología PICO del Centro de Medicina Basada en la Evidencia de Oxford. Se formula una pregunta dirigida al objetivo fijado y se elabora una estrategia de búsqueda, empleando términos MeSH y palabras clave específicas derivados de la pregunta en la base de datos de MEDLINE de enero de 1985 hasta abril del 2016. Se consultan un total de 43 artículos, incluyendo finalmente 7 estudios clínicos controlados y aleatorizados que cumplían los criterios de inclusión y se realiza una evaluación crítica del nivel de evidencia. Se estudiaron trabajos que comparasen la eficacia del hialuronato de sodio con los corticoides en la inyección articular de las patologías artrósicas de la ATM. No se encontraron diferencias significativas en la realización de la inyección con hialuronato de sodio y corticoides. Es necesario realizar estudios con una muestra y un tiempo de seguimiento mayor. A largo plazo podría ser más eficaz el hialuronato de sodio debido a los posibles efectos adversos de los corticoides, sin embargo, no se han demostrado cambios óseos con ninguno de los tratamientos.

The aim of this study was to determine decreasing pain and improving function in TMJ osteoarthritic processes using sodium hyaluronate or corticosteroids. A systematic review was carried out based on the PICO methodology of the Centre for Evidence-Based Medicine in Oxford. A question is addressed to the fixed aim and a search strategy is developed using specific MeSH terms and key words which come from the question in the PubMed database from January 1985 to April 2016. A total of 43 articles are consulted, finally including 7 randomized controlled trials which met the inclusion criteria and a critical assessment of the level of evidence is performed. Works that compare the efficacy of sodium hyaluronate to corticosteroids in the osteoarthritic pathologies articular injection were studied. No significant differences were found when injecting the sodium hyaluronate and the corticosteroids. It is necessary to do studies with a broader sample and a longer follow-up. In the long term sodium hyaluronate could be more effective because of possible corticosteroids adverse effects; however, no bone change has been shown with either treatment.

Uso de férulas oclusales en pacientes con trastornos temporomandibulares / Use of occlusal splints in patients with temporomandibular disorders

Los trastornos temporomandibulares constituyen un conjunto de entidades clínicas que pueden afectar la musculatura masticatoria y las articulaciones temporomandibulares. A tales efectos se realizó una revisión bibliográfica donde se exponen algunos aspectos que incluyen: características clínicas, causas que lo originan, tratamiento con férulas oclusales, clasificación de estas, tipos, así como ventajas y desventajas en cuanto a su uso.

The temporomandibular disorders constitute a group of clinical entities that can affect the masticatory muscles and the temporomandibular joints. To such effects a literature review was carried out where some aspects are exposed that include: clinical features, causes that originate it, treatment with oclusal splints, their classification, types, as well as advantages and disadvantages concerning their uses.

Evaluación de la posición condilary del espacio articular en atm de individuos chilenos con trastornos temporomandibulares / Assessment of tmj condylar position and joint space in chilean individuals with temporomandibular disorders

La importancia de la relación cóndilo-fosa en la articulación temporomandibular (ATM) aún no es clara, sin embargo algunos autores asocian la posición no céntrica del cóndilo de la mandíbula en la fosa mandibular con trastorno temporomandibular (TTM). Además, otros autores sugieren que la evaluación del espacio articular es una herramienta diagnóstica para la evaluación de las alteraciones de ATM. El objetivo de este estudio fue evaluar la posición condilar y el espacio articular de ATM en individuos chilenos con TTM utilizando tomografía computarizada cone-beam. Fueron seleccionados 19 pacientes de la Unidad de Trastornos Cráneo Cervico Mandibulares-Universidad de Talca, con diagnóstico de TTM según el Research Diagnostic Criteria for Temporomandibular Disorders. Para la evaluación de la posición condilar se utilizó la técnica de Pullinger & Hollender y para la evaluación de los espacios articulares anterior (EAA), superior (EAS) y posterior (EAP) se utilizó la técnica de Ikeda & Kawamura. Un 39,47% de los cóndilos se presentaron en posición posterior, 34,21% en posición central y un 26,31% en posición anterior. Para cóndilos en posición central encontramos: EAA=1,57 mm; EAS=2,20 mm; EAP= 1,54 mm. Para cóndilos en posición posterior encontramos: EAA= 2,18 mm; EAS= 2,02 mm; EAP= 0,98 mm. Para cóndilos en posición anterior encontramos: EAA= 1,00 mm; EAS= 1,89 mm y EAP= 2,07 mm. Concluimos que individuos con diagnóstico de TTM presentan las regiones anatómicas predisponientes a las alteraciones articulares con espacios articulares disminuidos cuando comparados con sujetos asintomáticos. La posición posterior fue la más común en individuos con TTM, sin embargo hubo gran variabilidad en la posición condilar, por ello sugerimos que una posición no centralizada del cóndilo no está necesariamente asociada con la presencia de TTM. Concluimos además que en individuos con TTM los cóndilos ubicados en posición central y posterior presentan EAP disminuido en comparación con individuos sanos.

The importance of the condyle-fossa relationship in the temporomandibular joint (TMJ) is not yet fully clear, however, some authors associate the non-central position of the head of the mandible in the mandibular fossa with temporomandibular disorder (TMD). Furthermore, other authors suggest that assessment of joint space is a diagnostic tool for assessing the TMJ alterations. The aim of this study was to evaluate the TMJ condylar position and joint space in Chilean individuals with TMD using cone-beam computed tomography. We selected 19 patients of "Unidad de Trastornos Cráneo Cervico Mandibulares (UCRACEM) - Universidad de Talca, Chile", who had a diagnosis of TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders. The assessment of condylar position was performed using Pullinger & Hollender technique and to evaluate the anterior joint space (AJS), superior joint space (SJS) and posterior joint space (PJS) was used Ikeda & Kawamura technique. Posterior condylar position was found in 39.47% of condyles, central condylar position in 34.21% and anterior condylar position in 26.31%. To condyles in central position we found: AJS = 1.57 mm; SJS = 2.20 mm; PJS = 1.54 mm. To condyles in posterior position we found: AJS = 2.18 mm; SJS = 2.02 mm; PJS = 0.98 mm. To condyles in anterior position we found: AJS = 1.00 mm; SJS = 1.89 mm and PJS = 2.07 mm. We conclude that individuals diagnosed with TMD present anatomical regions predisposing to joint disorders with joint spaces diminished when compared with asymptomatic subjects. Furthermore, the posterior condylar position was the most common in individuals with TMD, however there was great variability in condylar position, therefore we suggest that a non-centralized position of the condyle is not necessarily associated with the presence of TMD. We further conclude that in individuals with TMD the condyles located in central and posterior position present EAP decreased compared with healthy individuals.

Morphological characteristics of the temporomandibular joint articular surfaces in patients with temporomandibular deisorders / Características morfológicas de las superficies articulares de la articulación temporomandibular de pacientes con trastornos temporomandibulares

The knowledge of the anatomical characteristics of the temporomandibular joint (TMJ) articular surfaces is essentital to enable physicians and dentists to recognize the morphological changes that occur in this articulation in patients with temporomandibular disorders (TMD). Several researchers associate the TMD with changes of TMJ articular surfaces. The careful identification of bone changes related to TMJ is critical, since these abnormalities are associated with signs and symptoms of TMD and the knowledge of TMD signs and symptoms is fundamental for correctly diagnosing and for adequate treatment planning. The aim of this study was to evaluate the morphological characteristics of the TMJ articular surfaces in patients with TMD diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). In addition, therelationship between increasing age-osteoarthrosis was evaluated. For the sample we selected 19 patients, 17 female and 2 male, referred to the "Unidad de Trastornos Cráneo Cérvico Mandibulares (UCRACEM) - Universidad de Talca, Chile". The imaging assessment was carried out by Cone-Beam Computed Tomography (CBCT). In the imaging analysis of the articular surfaces 11 joints (28.94 percent) showed normal morphology. The bone changes found were: sclerosis, flattening, erosion, osteoarthrosis, osteophytes, subcondral cysts. We found statistically significant difference between increasing age-osteoarthrosis (p=0.00). Considering our results we concluded that bone changes of the TMJ articular surfaces in patients with TMD are very common, with sclerosis as the most frequent finding. It was also possible to conclude that there was a significant association between increasing age-osteoarthrosis.

El conocimiento de las características anatómicas de las superficies articulares de la articulación temporomandibular (ATM) es fundamental para que clínicos y odontólogos reconozcan las alteraciones morfológicas que ocurren en la articulación de pacientes con trastornos temporomandibulares (TTM). Diversos investigadores asocian los TTMs con alteraciones en las superficies articulares de la ATM. La identificación de los cambios óseos relacionados con la ATM es crítica, ya que estos se asocian a signos y síntomas de TTM, y el conocimiento de estos es fundamental para el correcto diagnóstico y adecuada planificación de tratamiento. El objetivo fue analizar las características morfológicas de las superficies articulares de la ATM en pacientes con diagnóstico de TTM, diagnosticado de acuerdo a los Criterios Diagnósticos para Investigación de los Trastornos Temporomandibulares (CDI/TTM), junto con analizar la relación existente entre incremento de edad-osteoartrosis. Fueron seleccionados 19 pacientes, 17 mujeres y 2 hombres, de la Unidad de Trastornos Cráneo Cérvico Mandibulares (UCRACEM) - Universidad de Talca, Chile. La evaluación imagenológica se realizó mediante el examen de Tomografía Computarizada Cone-Beam (TCCB). En el análisis de las superficies articulares, 11 (28,94 por ciento) presentaron morfología normal. Los cambios óseos encontrados fueron: esclerosis, aplanamiento de la cabeza de la mandíbula, erosión, osteoartrosis, osteofitos y quiste subcondral. Hubo relación estadística significativa entre incremento de edad-osteoartrosis (p=0,00). Nuestros hallazgos nos permiten concluir que los cambios óseos en las caras articulares de la ATM en pacientes con TTM son frecuentes, y la esclerosis el hallazgo más común. También se encontró asociación entre incremento de edad y osteoartrosis.

Oclusión dental: ¿doctrina mecanicista o lógica morfofisiológica? / Dental occlusion: mechanistic doctrine or morphophysiological logical?

Las escuelas de oclusión han creado un constructo mecanicista que busca explicar, bajo un modelo reduccionista y determinista, una dinámica cráneo-cervical y estomatognática compleja. Estos modelos de oclusión le dedican más importancia a la morfología dental y sus geometrías interpretativas que a la morfofisiología estomatognática. La configuración musculo-esquelética cráneo-cervical tiene el poder ganado de influir concomitantemente en la ubicación espacial de la mandíbula e implícitamente en las relaciones interoclusales. La visión actual de la oclusión sigue basándose en observaciones empíricas de un siglo de antigüedad que carecen de soporte apropiado en el marco del nivel de evidencia. En la dimensión funcional los modelos de oclusión conservan los mismos vacíos que existían desde su estructuración en el siglo pasado, particularmente en sus representaciones espaciales estáticas, uniáxicas y anti-dinámicas que desestiman la individualidad de cada sujeto. Cada especialidad puede tener tantas razones como puntos de vista diferentes de "maloclusión" así como formas de tratarla.

Occlusion schools have created a mechanistic construct that seeks to explain, under a reductionist and deterministic model, a craneal-cervical and stomatognathic complex dynamic. These occlusion models dedicate more importance to dental morphology and its interpretative geometries than a stomatognathic morphophysiology. Craneocervical musculoskeletal configuration has the gained power to concomitantly influence the jaw location in the space and implicitly in the interocclusal relations. The current vision of the occlusion is based on empirical observations of almost a century that lack support in the level of evidence framework. In the functional dimension occlusion models maintain the same gaps that existed from its origins since the last century, particularly in its static, uniaxic and anti-dynamic spatial representations that dismiss the individuality of each subject. Each specialty can have as many reasons as different points of view about "malocclusion" as well as techniques to treat it.

Confiabilidad y validez de la SCL-90 en la evaluación de psicopatología en mujeres

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Abstract: Women are especially vulnerable to anxiety and depressive disorders, as shown in the international literature and, in our country, in the National Survey of Psychiatric Epidemiology. However, it is important not only to identify the disorders as such, but also to identify the symptoms, that though not becoming a disorder generate illnesses in women and can respond to psychopharmacological or psychotherapeutic interventions. The Symptom Check List (SCL 90) is a widely used instrument. In this study, three groups of women were assessed: one group of the community (as reference group), a second one, of women diagnosed as depressed in a third level psychiatric institution, and another group of women with a temporomandibular disorder (TMD). The main objective of this study was to identify the psychometric characteristics of the SCL-90. The alpha of Cronbach was determined (internal consistency) by each one of the 9 subscales. The validity was determined through the following criteria: Validity of the SCL-90 as a method to detect depressed women. A ROC curve was made, comparing the depressed women and the women of the community. Validity of the SCL-90 as a measurement of depression. We hypothesized a high correlation with Beck's depression scale and Hamilton's depression scale. Sensitivity to change: effect size. We hypothesized that the greater effect would be in the depression subscale. For construct validity we compare the psychopathological profiles of the three groups of women. We hypothesized the existence of a gradient: the highest ratings in depressed women, the lowest in women of the community, and intermediate ratings in women with TMD. A factorial analysis was also carried out. Women older than 18 years of age were included, who were literate and accepted to participate in this study. They had no cognitive deficit (mental retardation, dementia, psychosis, states of confusion) or any other problem that would impede that they answer the surveys. The three groups were made up as follows: Women with TMD: Women with clinical diagnosis of Temporomandibular Disorder who went to an ambulatory service of Maxilofacial Surgery of the ISSSTEP (Social Security Hospi tal for State Government Employees), who had not had treatment for TMD during the past six months and who did not have degenerative arthritic illness. No previous psychiatric diagnosis. Depressed women: Women attending to the National Psychiatric Institute who were diagnosed with Major Depressive Disorder and were prescribed anti-depressive treatment. Women of the community: Mothers of the students at the secondary school Pablo Cassals, a field of work of the Community Psychiatric Service of the Psychiatric Hospital Fray Bernardino Alvarez Results: The interview was carried out with 289 women, 131 were depressed women, 96, women of the community, and 62, women with TMD. The mean (standard deviation) age was simi lar in the three groups: 36 (10), 37.7 (5.5), 37.6 (11.9) respectively Of the women with depression, 64% had a stable partner, 100% of the women in the community, and 61% of the women with TMD. 69% of the women with depression were dedicated to keeping house, 34% of the women with TMD, and 74% of the women of the community. Internal consistency was determined through Cronbach's alfa. The results of this analysis show us a high consistency of the instrument's nine subscales. Except for the subscale of paranoid symptoms in the women of the community, the alpha coefficients of all subscales in the 3 groups were higher than 0.7. Another form of establishing the validity of the instrument is through the determination of the cut-off point for patient identification. Through the ROC curve, 1.5 points in the subscale of depression was taken, as the best score to minimize the number of false positive and false negative results. As a measurement of depression, it was observed that the correlations of the subscales with Hamilton's depression scale and Beck's depression inventory had the highest correlations with the subscale of depression. The correlations with Beck's Inventory are higher than with Hamilton's scale of depression. This information supports the convergent validity of the subscale of depression with conventional instruments for its assessment. Another way of determining the validity of an instrument is to establish sensitivity to change. The size of the effect was calculated dividing the average of the difference (before-after) over the basal standard deviation of depressed women who participated in the longitudinal study. The size of the effect was higher in Hamilton's scale of depression and second in the subscale of depression, which indicates that there is a specific answer to a specific anti-depressive intervention. According to what has been hypothesized (construct validity), the highest ratings corresponded to the depressed women; the lowest to the women of the community, and the intermediate to the women with TMD. The differences between groups were statistically significant in each of the nine subscales and in the total indexes. The group of the community was significantly different from those of the depressed women and the women with TMD. The difference between these last two groups was also significant. In an exploratory factorial analysis of the 90 reactives, 87 had factorial loads higher than .40 in a first factor that explained 46.77% of the total variance of the SCL 90. Although 13 more factors with Eigen values higher than 1 were identified, the variance explained by each of them was lower than 5%; according to this technique, only one general factor is the best explanation for the checklist. The two reactives with small factorial loads were: "Do you believe that others should be blamed for your problems?", "Do you hear voices that others don't hear?" and "Excesive eating". Although the checklist was developed for the assessment of a psychopathological profile, some authors have proposed that it should be used as a measurement of general psychopathology. In this study, the checklist was evaluated as a method of assessing a psychopathological profile as originally proposed by Derogatis, as a method of assessing general psychopathology (with the three total indicators), and as a specific method of assessing depression. The information that most solidly supports the validity of the List's subscales is the differences in the profile that were observed among the three groups. The points in all the subscales were higher for women with TMD than those for the women of the community, but lower than in depressed patients; this shows that the psychological state of women with TMD tends to be similar to that of women with psychiatric diagnosis of depression. In this regard, the advantage of using the List to measure a profile is evident, and not only to assess general psychopathology The Symptom Checklist proved to have the psychometric characteristics appropriate to be used as an instrument to assess a psychopathological profile, to identify patients with depression, and to measure the intensity of depression. As an instrument to measure change, it is sensitive to psychopharmacological interventions. Although the size of the effect observed in the depression subscale is lower than that observed with the Hamilton scale, it is notably higher than the one observed with Beck's Depression Inventory. With these psychometric characteristics, it is possible to use the List in any type of research, including those that assess anti-depressive interventions.