Effect of low-level LASER therapy versus CAD/CAM Michigan splint on patients with Temporomandibular Muscle Disorders: a randomized clinical trial / Efeito da terapia LASER de baixa potência versus placa de Michigan CAD/CAM em pacientes com Distúrbios Temporomandibulares musculares: um ensaio clínico randomizado

Objective: This study aimed to evaluate the efficacy and sustainability of using low level LASER therapy and CAD/CAM Michigan splint on improving the range of mandibular movements, muscle activity and reducing the pain. Material and Methods: 56 female patients were randomly divided into two groups. Group A: Patients received applications of low-level LASER therapy using semiconductor InGaAsp diode LASER type 940 nm with continuous mode of operation, applied for 180 sec per session for 12 sessions. Group B: Patients received Michigan splint of 2 mm thickness constructed on their upper teeth, the splint was 3D digitally printed. Electromyography was used to evaluate muscle activity, visual analogue scale was used to evaluate the pain intensity, ARCUS digma facebow was used to evaluate range of mandibular movements, and maximum mouth opening was taken using a millimeter ruler. They were measured before the beginning of the treatment, and at three and six month follow-up periods. Results: The results revealed that both low-level LASER therapy and Michigan splint reduce the myofascial pain, improved the range of the mandibular movements, and the muscles activity, but the effect of the low-level LASER therapy was more profound and sustainable. After 6 months from the beginning of the treatment, changes in masseter muscle activity (P= 0.001; effect size= 1.757), pain intensity (P= 0.003; effect size= 3), and range of mandibular movement (P= 0.001, effect size= 1.729) differed significantly between the two groups. Conclusions: Low-level LASER therapy had a better and more sustainable effect on reducing the pain intensity and improving the muscle activity as well as the mandibular movement when compared to Michigan splint (AU)

Objetivo: Este estudo teve como objetivo avaliar a eficácia e a durabilidade do uso da terapia LASER de baixa potência e da placa de Michigan CAD/CAM na melhora da amplitude dos movimentos mandibulares, atividade muscular e redução da dor. Material e Métodos: 56 pacientes do sexo feminino foram divididos aleatoriamente em dois grupos. Grupo A: os pacientes receberam aplicações de terapia LASER de baixa potência utilizando diodo semicondutor InGaAsp LASER tipo 940 nm em modo contínuo de operação, aplicado por 180 segundos por sessão durante 12 sessões. Grupo B: os pacientes receberam a placa de Michigan com uma espessura de 2 mm confeccionada sobre a arcada superior, a placa foi impressa digitalmente em 3D. A eletromiografia foi utilizada para avaliar a atividade muscular, a escala visual analógica foi utilizada para avaliar a intensidade da dor, o arco facial ARCUS digma foi utilizado para determinar a amplitude dos movimentos mandibulares e a abertura máxima da boca foi medida com uma régua milimétrica. Todas as medidas foram realizadas antes do início do tratamento e nos períodos de acompanhamento de três e seis meses. Resultados: Os resultados revelaram que tanto a terapia LASER de baixa potência como a placa de Michigan reduziram a dor miofascial, aumentaram a amplitude dos movimentos mandibulares e melhoraram a atividade muscular, mas o efeito da terapia LASER de baixa potência foi mais profundo e duradouro. Após 6 meses do início do tratamento, as alterações na atividade do músculo masseter (P= 0. 001; tamanho do efeito= 1,757), intensidade da dor (P= 0,003; tamanho do efeito= 3), e amplitude de movimento mandibular (P= 0,001, tamanho do efeito= 1,729) diferiram significativamente entre os dois grupos. Conclusão: A terapia com LASER de baixa potência teve um efeito melhor e mais duradouro na redução da intensidade da dor e na melhora da atividade muscular, bem como do movimento mandibular, quando comparada à placa de Michigan(AU)

Relación entre contactos mediotrusivos con la articulación temporomandibular y la oclusión / Relationship between mediotrusive contacs, the temporomandibular joint and occlusion

Los contactos mediotrusivos son aquellos contactos oclusales que se encuentran entre las vertientes in- ternas de las cúspides linguales maxilares y las inter- nas de las cúspides bucales mandibulares del lado de no trabajo durante los movimientos de lateralidad. Estos contactos mediotrusivos podría desencadenar trastornos temporomandibulares, afectando la oclu- sión y la articulación temporomandibular. El objetivo de este estudio es analizar las caracterís- ticas y la relación entre los contactos mediotrusivos con la articulación temporomandibular y la oclusión en pacientes que consultan al Servicio de Oclusión y ATM del Hospital Odontológico de la Facultad de Odontología de la Universidad Nacional del Nordeste (AU)

Mediotrusive contacts are those occlusal contacts that are found between the internal slopes of the maxillary lingual cusps and the internal slopes of the mandibular buccal cusps on the non-working side during laterality movements. These mediotrusive contacts could trigger temporomandibular disorders affecting occlusion and temporomandibular joint. The objective of this study was to analyze the characteristics and relationship of mediotrusive contacts with occlusion and the temporomandibular joint, in patients who consult the Occlusion and TMJ Service of the Dental Hospital of the Faculty of Dentistry of the National University of the Northeast (AU)

Osteoartrosis de ATM: recuperar la función / TMJ Osteoarthrosis: recover function

Objetivo: evaluar la rehabilitación funcional de la ATM en pacientes con osteoartrosis, con abordaje neuromuscular. La osteoartrosis se caracteriza por la degeneración del cartílago articular y la cortical ósea, que conduce a dolor e inmovilidad. Se incluyó a 8 mujeres entre 20 y 42 años de edad con dolor en la región orofacial, signos de oclusión disfuncional e imágenes compatibles con trastornos degenerativos en ATM. Clínicamente se evaluó el dolor y la oclusión y, mediante tecnología electrónica, se obtuvieron datos objetivos de los movimientos de apertura-cierre y lateralidades, la velocidad de apertura-cierre mandibulares y de los ruidos articulares. Las mediciones fueron realizadas al inicio y al finalizar el tratamiento de estabilización mandibular con una ortosis neuromuscular. Para determinar la significación estadística se utilizaron el Student`s test de comparaciones múltiples y el análisis de varianza, ANOVA, de un factor. Las diferencias entre medias se consideraron significativas con p <0.05. Los resultados demostraron ausencia de dolor en el 100% de los casos al primer mes de tratamiento. Se incrementaron la apertura bucal (6,73 mm promedio), ambas lateralidades (P=0.0023), velocidad en apertura y en cierre (no estadísticamente significativo). Después de estabilizar la mandíbula se redujo la frecuencia de los ruidos. En conclusión, la oclusión dental disfuncional es el principal factor etiológico de la artrosis de la ATM. El establecimiento de una oclusión fisiológica produce la descompresión de la ATM, aumenta el rango de los movimientos mandibulares y disminuye significativamente el dolor (AU)

Objective: to evaluate the functional rehabilitation of the TMJ in patients with osteoarthritis, with a neuromuscular approach. Osteoarthrosis is characterized by degeneration of articular cartilage and bone cortex, which leads to pain and immobility. Eight women between 20 and 42 years of age with pain in the orofacial region, signs of dysfunctional occlusion, and images consistent with degenerative TMJ disorders were included. Clinically, pain and occlusion were evaluated and, using electronic technology, objective data were obtained on the opening-closing movements and lateralities, the opening-closing speed of the jaws and joint noises. Measurements were made before and at the end of the mandibular stabilization treatment with a neuromuscular orthosis. To determine the statistical significance, the Student`s multiple comparisons test and the analysis of variance, ANOVA, of one factor were used. The differences between means were considered significant with p <0.05. The results showed absence of pain pain in 100% of cases in the first month of treatment. Mouth opening (6.73 mm average), both lateralities (P = 0.0023), opening and closing speed (not statistically significant) were increased. After stabilizing the jaw the noise frequency value was reduced. In conclusion, dysfunctional dental occlusion is the main etiologic factor of TMJ osteoarthritis. Establishing a physiological occlusion causes TMJ decompression, increases the range of mandibular movements, and significantly decreases pain (AU)

Alternativas de tratamiento para pacientes jóvenes con pérdida de estructura dentaria. Parte 2: caso clínico / Treatment alternatives for young patients with loss of dental structure. Part 2: a clinical case

El objetivo de este artículo es presentar una alternativa de tratamiento rehabilitador para pacientes jóvenes con gran pérdida de estructura dental, vinculada a lesiones de origen no bacteriano. Se presenta el caso clínico de un paciente de sexo masculino, de 39 años de edad, que acudió a la Cátedra de Odontología Integral Adultos de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA) relatando síntomas compatibles con hipersensibilidad dentaria y fatiga de los músculos masticadores. Al mismo tiempo, manifestó disconformidad con el aspecto estético de su sonrisa. Teniendo en cuenta la gran pérdida de sustancia en sus piezas dentarias producida por hábitos parafuncionales (bruxismo), se realizó una rehabilitación oral adhesiva con cerámicas utilizando el protocolo de abordaje terapéutico sugerido por la Cátedra. En pacientes que presentan severos desgastes (AU)

Análise de diferentes tarefas para normalização do sinal elétrico do músculo orbicular da boca pela contração voluntária máxima: estudo piloto / Analysis of different tasks to normalize the electrical signal of the orbicularis oris muscle by maximum voluntary contraction: pilot study

RESUMO Objetivo pesquisar a atividade elétrica do músculo orbicular da boca em quatro diferentes tarefas isométricas e indicar a mais apropriada para utilização como referência na normalização do sinal elétrico do músculo orbicular da boca pela contração voluntária máxima. Métodos participaram do estudo 22 indivíduos, sendo dez do sexo masculino e 12 do feminino, com idades entre 20 e 33 anos. A atividade elétrica das porções superior e inferior do músculo orbicular da boca foi registrada durante a realização das seguintes tarefas isométricas: protrusão labial com fechamento, protrusão labial sem fechamento, contrarresistência com a placa de resistência labial e preensão de lábios. A ordem de realização das tarefas foi randomizada entre os participantes. Os dados foram comparados entre as tarefas, para cada seguimento labial. Resultados no segmento marginal superior, a tarefa com maior média e mediana de amplitude foi preensão labial, embora sem diferença significativa entre tarefas. O menor coeficiente de variação foi obtido na tarefa de contrarresistência com a placa de resistência labial. No segmento marginal inferior, a tarefa com maior média e mediana de amplitude foi protrusão labial com fechamento, que também teve o menor coeficiente de variação e diferença significativa entre as tarefas protrusão labial com fechamento e preensão, sendo os maiores valores obtidos na primeira. Conclusão indica-se como referência para a normalização do sinal elétrico do músculo orbicular da boca, pela contração voluntária máxima, a tarefa de protrusão labial com fechamento.

ABSTRACT Purpose To verify the electrical activity of the orbicularis oris in four different isometric tasks and to indicate the most appropriate task for use as a reference in the normalization of the electrical signal of the orbicularis oris muscle by maximum voluntary contraction. Methods Twenty-two individuals participated in the study, of which 10 were male and 12 were female, with ages ranging from 20 to 33 years. The electrical activity of the upper and lower parts of orbicularis oris muscle was recorded during the following isometric tasks: lip protrusion with bilabial closure; lip protrusion without bilabial closure; the counter resistance using the plate of labial resistance and lips prehension. The order of the tasks was randomized among participants. Data were compared between tasks for each lip part. Results in the upper marginal segment, the task with the highest mean and median amplitude was lip prehension, although there was no significant difference between tasks. The lowest coefficient of variation was obtained in the counter resistance task with the plate of labial resistance. In the lower marginal segment, the task with the highest mean and median amplitude was labial protrusion with lips closure, which also had the lowest coefficient of variation. In this segment, there was a significant difference between labial protrusion with lips closure and prehension, with the highest values obtained in the first task. Conclusion lip protrusion with bilabial closure is suggested as reference for the normalization of the electrical signal of the orbicularis oris muscle, by maximum voluntary contraction.

Temporomandibular joint function 10-15 years after mandibular setback surgery and six weeks of intermaxillary fixation

Abstract Intermaxillary fixation (IMF) is a classic method for immobilization of the mandible after mandibular fractures and corrective surgery. However, it has been suggested that IMF may be a risk for developing temporomandibular joint (TMJ)-related symptoms, especially when applied for longer periods. Objective: To evaluate the clinical function of TMJs and masticatory muscles 10-15 years after mandibular setback surgery and subsequent six weeks of IMF. The patients' self-reported TMJ and masticatory muscle symptoms were also addressed. Methodology: Thirty-six patients (24 women and 12 men) treated with intraoral vertical ramus osteotomies and subsequent six weeks of IMF, underwent a clinical examination of TMJs and masticatory muscles 10-15 years after surgery and completed a five-item structured questionnaire reporting subjective TMJ-related symptoms. Mean age by the time of clinical examination was 34.1 years (range 27.2-59.8 years). The clinical outcome was registered according to the Helkimo clinical dysfunction index. Descriptive and bivariate statistics were performed and level of significance was set to 5%. Results: Mean maximum unassisted mouth opening 10-15 years after surgery was 50.1 mm, (range 38-70 mm, SE 1.2), statistically significantly greater in men compared to women (p=0.004). Mean Helkimo dysfunction group was 1.5 (range 1-3, SE 0.10). Eighty-one percent experienced pain on palpation in either the masseter muscle, temporal muscle or both, and 31% experienced pain when moving the mandible in one or more directions. Thirty-one percent reported pain from palpating the TMJs. In the questionnaire, none reported to have pain during chewing or mouth opening on a weekly or daily basis, but 22% reported difficulties with maximum opening of the mouth. Conclusion: Ten to fifteen years after mandibular setback surgery the patient's mandibular range of movement is good. Despite clinically recognizable symptoms, few patients reported having TMJ- or masticatory muscle-related symptoms in their daily life.

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

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

Influence of the presence of Temporomandibular Disorders on postural balance in the elderly

ABSTRACT Purpose To investigate the influence of the presence of Temporomandibular Disorders (TMD) on postural balance in elderly individuals. Methods The study sample consisted of 150 elderly: 103 women (67.7±5.0 years) and 47 men (69.3±5.5 years). Evaluation of the presence and severity of TMD included an anamnesis questionnaire, an evaluation of the temporomandibular joint (TMJ), and a muscular examination, which allowed the division of the elderly into 2 groups: G1 (experimental, n=95), with TMD; G2 (control, n=55), without TMD. Postural balance was assessed by means of the one-leg stance test (OLST) on a force platform (BIOMEC400), thus permitting the following measurements: center of foot pressure (COP); mean sway velocity (MV) and frequency (MF) of COP in both the anteroposterior (VAP and FAP) and medial/lateral (VML and FML) directions. The statistical analysis of data was performed using independent t-test, Variance Analysis, and Chi Square test (α=5%). Results Presence of TMD was observed in 63.3% of the individuals (Group 2), with different degrees of severity (mild: 42.7%, moderate: 14.7%, severe: 6%). Significantly higher TMD was observed for women (73.8%) compared with men (40.4%) (p=0.0002). No significant difference was found in between the groups for all balance parameters, e.g., presence and severity of TMD, presence of pain to palpation of TMJ and of masticatory and cervical muscles. Conclusion The presence and severity of TMD, in addition to the presence of pain to palpation of TMJ and masticatory and cervical muscles did not alter the variables related to postural balance in this population.

Sinais e sintomas de desordem temporomandibular em mulheres e homens / Signs and symptoms of temporomandibular disorders in women and men

RESUMO Introdução: Mulheres são mais susceptíveis às desordens temporomandibulares (DTM), contudo, estudos que tenham comparado os gêneros em amostras brasileiras são raros. Objetivo: Analisar a proporção de homens e mulheres, bem como a associação entre o gênero e as variáveis idade, duração do problema e sintomas de DTM em pacientes admitidos para tratamento em uma clínica universitária. Métodos: Foram coletados e analisados dados de entrevista e avaliação de mil protocolos de pacientes com diagnóstico de DTM, divididos em 2 grupos, masculino (n=177) e feminino (n=823). Foi realizada a análise exploratória a partir de tabelas de contingência e teste do χ2. Posteriormente, foi utilizado o modelo de regressão logística e calculadas as odds ratio brutas (OR) referentes às comparações avaliadas. Resultados: Na amostra prevaleceu o gênero feminino e as médias de idade e de duração da DTM foram semelhantes entre os grupos, predominando a faixa etária de adultos jovens (19 a 40 anos). Os valores de OR evidenciaram associação entre o gênero feminino e os sinais/sintomas dor na articulação temporomandibular (ATM), dor nos músculos faciais, pescoço e ombros, cefaleia, fadiga nos músculos mastigatórios, sintoma otológico e disfonia, tendo sido a chance das mulheres os apresentassem duas vezes maior do que os homens. Conclusão: Na amostra de pacientes brasileiros com DTM foi maior o número de mulheres e essas apresentaram maior prevalência de sintomas dolorosos, seguidos pelos otológicos e queixas de disfonia. A prevalência de ruído articular foi semelhante nos grupos estudados.

ABSTRACT Introduction: Women are more likely to present temporomandibular disorders (TMD); however, studies comparing genders in Brazilian samples are rare. Purpose: To analyze the proportion of men and women, as well as the association between gender and age, problem duration, and TMD symptoms in patients admitted to an university clinic for treatment. Methods: Interview and assessment data of protocols from 1,000 patients diagnosed with TMD were collected and analyzed and then divided into two groups, male (n = 177) and female (n = 823). The exploratory analysis was based on contingency tables and χ2 test was carried out. Subsequently, the logistic regression model was used and the odds ratios (OR) concerning the evaluated comparisons were calculated. Results: Females were more prevalent in the sample, and mean ages and TMD duration were similar between the groups, with higher occurrence in young adults (19 to 40 years old). The OR values showed an association between the female gender and the signs/symptoms of pain in the temporomandibular joint, pain in the facial muscles, neck and shoulders, headache, fatigue in the muscles of mastication, otologic symptoms, and dysphonia. Women had two times higher chances of presenting these symptoms than men. Conclusion: In the sample of Brazilian patients with TMD, the number of women who presented a higher prevalence of painful symptoms was greater, followed by otologic symptoms and complaints of dysphonia. The prevalence of joint noise was similar in both studied groups.

Avaliação do limiar de dor a pressão (LDP) e fadiga mastigatória em indivíduos submetidos à cirurgia bariátrica: análise da inatividade mastigatória / Evaluation of pressure pain threshold (PPT) and masticatory fatigue in patients undergoing bariatric surgery: analysis of masticatory inactivity

O objetivo deste estudo foi avaliar o limiar de dor a pressão (LDP) e a percepção de dor orofacial através do teste de fadiga mastigatória após um período de inatividade da mastigação. Estudo caracterizado como de coorte, prospectivo e observacional. Composto por 30 indivíduos obesos mórbidos, divididos em dois grupos. Experimental (GE) (n=15) que foram submetidos a cirurgia bariátrica e Controle (GC) (n=15) que se apresentavam na fase pré cirúrgica. O Limiar de Dor a Pressão e a Escala de Análise Visual (EAV) foram adotados como testes para compor a avaliação de fadiga mastigatória. Os dados foram registrados em dois tempos distintos para ambos os grupos, com um intervalo de 37 dias entre as coletas. No entanto, apenas o GE foi submetido a inatividade mastigatória. Empregou-se o teste de Shapiro-Wilk para avaliar a normalidade dos dados e adotou-se ANOVA mista de medidas repetidas (dados paramétricos) e o teste de Friedman (dados não paramétricos) para identificar diferenças intragrupos e para comparar os valores de LDP observados antes e depois da cirurgia bariátrica foram empregados o teste t de Student para amostras pareadas (dados paramétricos) e o teste de Wilcoxon pareado (dados não paramétricos) considerando-se uma probabilidade de erro do tipo I () de 0,05. Para o GE, os níveis do LDP apresentaram uma redução significativa e a percepção de dor aumentou durante o teste de fadiga mastigatória quando avaliado após o período de inatividade da mastigação. Outro dado observado foi a não recuperação dos níveis do LDP e EAV após a o teste de fadiga, no qual os níveis não retornaram aos registros iniciais como no período pré cirúrgico. Diante dos dados avaliados no teste de fadiga mastigatória, o Limiar de Dor a Pressão apresentou reduções significativas, caracterizando o aumento da sensibilidade à palpação nos músculos avaliados, após o período de inatividade mastigatória de 37 dias. Ao passo que houve aumento na percepção de dor orofacial dos pacientes obesos mórbidos no mesmo período de avaliação.(AU)

The aim of this study was to evaluate the pressure pain threshold (PPT) and the perception of orofacial pain through masticatory fatigue test after a period of inactivity of mastication. Study characterized as a cohort, prospective, observational. Composed of 30 morbid obese subjects, separated into two groups: Experimental (EG) (n = 15) were submitted to bariatric surgery and Control (CG) (n = 15) pre surgical procedure. The Pressure Pain Threshold and Visual Analysis Scale (VAS) have been adopted as testing to compose the evaluation of masticatory fatigue. Data were recorded at two different times for both groups, with an interval of 37 days between the analyses. However only the EG was subjected to masticatory inactivity. The Shapiro-Wilk test was employed to assess the normality of the data and adopted mixed repeated measures ANOVA (parametric data) and the Friedman test (nonparametric data) to identify intergroup differences and to compare the PPT values observed before and after bariatric surgery were used the Student t test for paired samples (parametric data) and Wilcoxon test (nonparametric data) considering a probability of error type I () of 0.05. For EG, the PPT levels showed a significant reduction and the perception of pain increased during the masticatory fatigue test when evaluated after a period of inactivity of mastication. Another fact observed was the non-recovery of the PPT and VAS levels after the fatigue test, in which the levels did not return to the original records as the surgical pre surgical procedure. According the data evaluated in the masticatory fatigue test, the pain threshold to pressure showed significant reductions, featuring increased tenderness to palpation in the muscles evaluated after masticatory inactivity period of 37 days. Whereas there was an increase in the perception of orofacial pain of morbidly obese patients in the same period of evaluation.(AU)

Parafunctional habits are associated cumulatively to painful temporomandibular disorders in adolescents

Abstract This cross-sectional study was designed to evaluate the effect of sleep bruxism, awake bruxism and parafunctional habits, both separately and cumulatively, on the likelihood of adolescents to present painful TMD. The study was conducted on a sample of 1,094 adolescents (aged 12-14). The presence of painful TMD was assessed using the Research Diagnostic Criteria for Temporomandibular Disorders, Axis I. Data on sleep bruxism, awake bruxism and parafunctional habits (nail/pen/pencil/lip/cheek biting, resting one's head on one's hand, and gum chewing) were researched by self-report. After adjusting for potential demographic confounders using logistic regression, each of the predictor variables (sleep bruxism, awake bruxism and parafunctional habits) was significantly associated with painful TMD. In addition, the odds for painful TMD were higher in the concomitant presence of two (OR=4.6, [95%CI=2.06, 10.37]) or three predictor (OR=13.7, [95%CI=5.72, 32.96]) variables. These findings indicate that the presence of concomitant muscle activities during sleep and awake bruxism and parafunctional habits increases the likelihood almost linearly of adolescents to present painful TMD.

Complicaciones postoperatorias asociadas a la cirugía del tercer molar inferior retenido / Postoperative complications associated with impacted lower third molar surgery

Antecedentes: La cirugía del tercer molar inferior retenido es unprocedimiento de rutina en la práctica de la cirugía bucal. Varias complicaciones surgen como resultado de esta intervención quirúrgica. Entre las más frecuentes se encuentran: dolor, infl amación, trismo, hemorragia, equimosis, alveolitis, infección, parestesia y dificultad para comer. Objetivos: El propósito de este estudio fue evaluar la incidencia de complicaciones postoperatorias en la cirugía del tercer molar inferior retenido en pacientes de la Unidad Académica deOdontología de la Universidad Autónoma de Nayarit a fin de tenerlas en cuenta y tomar las respectivas precauciones, ya sea para tratar de evitarlas en lo sucesivo o bien, para reconocerlas y darles tratamiento. No se incluye dolor, infl amación ni trismo. Material y métodos: Este estudio fue longitudinal y prospectivo de siete días consecutivos y de 30 días en total en 38 pacientes entre 16 y 38 años de edad. Se evaluaron las complicaciones postoperatorias relacionadas con la cirugía del tercer molar inferior. Resultados: Participaron 38 pacientes; 29 del género femenino (76.3 por ciento) y 9 del masculino (23.7 por ciento) de entre 16 y 38 años, con un promedio de edad de 23.16 ± 5.2 años. La complicación más frecuente fue la difi cultad para masticar seguida de equimosis...

Background: Impacted lower third molar surgery is a routine pro-cedure in the practice of oral surgery. However, there are various complications associated with the extraction of impacted mandibular third molars, the most common being pain, swelling, trismus, hemor-rhaging, ecchymosis, dry socket, infection, paresthesia, and diffi culty with chewing. Objectives: The aim of this study was to evaluate the incidence of postoperative complications following impacted lower third molar surgery in patients at the Academic Unit of Dentistry of the Autonomous University of Nayarit, so as to ensure these are taken into account and that the respective precautions are taken, either by attempting to avoid them in the future or to recognize and treat them. Pain, infl ammation and trismus are not analyzed in this paper. Material and methods: A longitudinal prospective study of 38 patients between the ages of 16 and 38 years old (with an average age 23.1) was carried out over seven consecutive days, with follow up examination performed at 15 and 30 days. The postoperative complications associated with lower third molar surgery were assessed. Results: 38 patients took part; 29 females (76.3%) and 9 males (23.7%) between the ages of 16 and 38 years, with a mean age of 23.16 ± 5.2 years old. The most common complication was diffi culty with chewing followed by ecchymosis...

Deep pain sensitivity is correlated with oral-health-related quality of life but not with prosthetic factors in complete denture wearers

ABSTRACT Low pressure Pain Threshold (PPT) is considered a risk factor for Temporomandibular Disorders (TMD) and is influenced by psychological variables. Objectives To correlate deep pain sensitivity of masticatory muscles with prosthetic factors and Oral-Health-Related Quality of Life (OHRQoL) in completely edentulous subjects. Material and Methods A total of 29 complete denture wearers were recruited. The variables were: a) Pressure Pain Threshold (PPT) of the masseter and temporalis; b) retention, stability, and tooth wear of dentures; c) Vertical Dimension of Occlusion (VDO); d) Oral Health Impact Profile (OHIP) adapted to orofacial pain. The Kolmogorov-Smirnov test, the Pearson Product-Moment correlation coefficient, the Spearman Rank correlation coefficient, the Point-Biserial correlation coefficient, and the Bonferroni correction (α=1%) were applied to the data. Results The mean age (standard deviation) of the participants was of 70.1 years (9.5) and 82% of them were females. There were no significant correlations with prosthetic factors, but significant negative correlations were found between the OHIP and the PPT of the anterior temporalis (r=-0.50, 95% CI-0.73 to 0.17, p=0.005). Discussion The deep pain sensitivity of masticatory muscles in complete dentures wearers is associated with OHRQoL, but not with prosthetic factors.

Controle motor oral e funções orofaciais em indivíduos com deformidade dentofacial / Oral motor control and orofacial functions in individuals with dentofacial deformity

Objetivo Verificar se há relação entre o controle motor oral e as funções orofaciais em indivíduos com deformidade dentofacial (DDF). Métodos Participaram 16 indivíduos entre 18 e 40 anos, média de 28,37 anos, sendo sete indivíduos padrão II (três mulheres e quatro homens) e nove, padrão III (cinco mulheres e quatro homens). Foi realizada avaliação da diadococinesia (DDC) das emissões /pa/, /ta/, /ka/ e /pataka/. As funções de mastigação, deglutição e fala foram analisadas por consenso entre três fonoaudiólogas especialistas na área, a partir da filmagem, utilizando o protocolo MBGR. A correlação entre os resultados da DDC e das funções orofaciais foi obtida por meio do teste de Spearman. Resultados Foi observada correlação positiva entre os parâmetros de instabilidade da DDC na emissão do “pa” e “ka” e a função de mastigação. Houve correlação positiva entre deglutição e DDC para a emissão do “pa” no que se refere à instabilidade das emissões e, quanto à velocidade, houve correlação negativa para a média da taxa da DDC e correlação positiva para a média do período da DDC na emissão do “pa”. Quanto à fala, houve correlação negativa para a emissão do “pa”, para parâmetro de instabilidade. Conclusão O controle motor oral mostrou-se relacionado à gravidade da alteração das funções de mastigação e deglutição, no que se refere aos parâmetros instabilidade e velocidade da DDC. .

Purpose To determine the correlation between oral motor control and orofacial functions in individuals with dentofacial deformity (DFD). Methods Sixteen individuals from 18 to 40 years, (average 28.37 years) participated. Seven individuals were class II (three women and four men) and nine were class III (five women and four men). They were evaluated for diadochokinesis (DDK) using the emissions /pa/, /ta/, /ka/ and /pataka/. The chewing, swallowing, and speech functions were filmed and analyzed by three speech specialists, using the MBGR protocol. The correlation results between DDK and the orofacial functions were obtained through the Spearman test. Results A positive correlation was observed between the DDK instability parameters in issuing the “pa” and “ka” and the chewing function. There was a positive correlation between swallowing and DDK for “pa” emission regarding the instability. As for the speed, there was a negative correlation for the DDK mean rate and a positive correlation for the average DDK period at “pa” emission. As for the speech, there was a negative correlation for “pa” emission for the instability parameter. Conclusion The oral motor control was related to the severity of the change in chewing and swallowing functions regarding the DDK speed and instability paramenters. .

TMD and chronic pain: A current view

This review aims at presenting a current view on the physiopathologic mechanisms associated with temporomandibular disorders (TMDs). While joint pain is characterized by a well-defined inflammatory process mediated by tumor necrosis factor-α and interleukin, chronic muscle pain presents with enigmatic physiopathologic mechanisms, being considered a functional pain syndrome similar to fibromyalgia, irritable bowel syndrome, interstitial cystitis and chronic fatigue syndrome. Central sensitization is the common factor unifying these conditions, and may be influenced by the autonomic nervous system and genetic polymorphisms. Thus, TMDs symptoms should be understood as a complex response which might get worse or improve depending on an individual's adaptation.

Esta revisão teve como objetivo apresentar uma visão atualizada dos mecanismos fisiopatológicos relacionados às disfunções temporomandibulares (DTMs). Enquanto a dor articular é caracterizada por um processo inflamatório bem descrito - mediado pelo fator de necrose tumoral alfa (TNF-α) e interleucinas -, a dor muscular crônica apresenta mecanismos fisiopatológicos mais obscuros, sendo considerada uma síndrome dolorosa funcional, assim como a fibromialgia, a síndrome do intestino irritável, a cistite intersticial e a síndrome da fadiga crônica. A sensibilização central é o processo comum, unificador, dessas condições, podendo sofrer influência do sistema nervoso autonômico e de polimorfismos genéticos. Portanto, os sintomas das DTMs devem ser entendidos como uma resposta complexa, podendo ser amplificados ou atenuados em função da adaptação individual.

Signs and symptoms of Temporomandibular Disorders in the elderly / Sinais e sintomas dos Transtornos Temporomandibulares em Idosos

Purpose: This study investigated the prevalence of Temporomandibular Disorders (TMD) in the elderly and its association with palpation of the temporomandibular joint (TMJ), masticatory and cervical muscles as well as the presence of headache and joint noises. Methods: The sample consisted of 200 elderly of both genders (mean age: 69.2±5.7 years). The clinical evaluation of TMD signs and symptoms was divided into three stages: an anamnestic questionnaire, a TMJ evaluation, and a muscular examination. The results were analyzed through descriptive statistics as well as using χ2 and the tendency tests. Results: The presence of TMD was observed in 61% of the sample (mild: 43.5%, moderate: 13%, severe: 4.5%). A significantly greater prevalence of TMD was found for females (72.4%) compared with that for men (41.1%) (p<0.0001). Additionally, a significant association among TMD severity and palpation of the TMJ (p=0.0168), of masticatory muscles (p<0.0001), and of cervical muscles (p<0.0001) was verified. Also, there was a significant association between the frequency of headaches and the presence of TMD (p=0.0001). The association between the presence of joint noises and sensitivity to TMJ palpation was not significant. Conclusion: The elderly presented high TMD prevalence, mostly in females, with mild severity and related to TMJ and masticatory/cervical muscles palpation. Thus, the accomplishment of a detailed clinical examination to investigate the presence of such disorders is essential and it must not be neglected during the treatment of elderly patients. .

Objetivo: O objetivo deste estudo foi investigar a prevalência de Transtornos Temporomandibulares (DTM) em idosos e sua associação com a palpação da articulação temporomandibular (ATM), dos músculos mastigatórios e cervicais, bem como com a presença de dores de cabeça e ruídos articulares. Métodos: A amostra foi composta por 200 idosos, de ambos os gêneros (média de idade: 69,2±5,7 anos). A avaliação clínica dos sinais e sintomas foi dividida em três etapas: aplicação de questionário anamnésico, avaliação da ATM e exame muscular. Os resultados foram avaliados por meio de estatística descritiva, teste do χ2 e teste de tendência. Resultados: A presença de DTM foi observada em 61% da amostra (leve: 43,5%, moderada: 13%, intensa/grave: 4,5%). Verificou-se prevalência significantemente maior de DTM para as mulheres (72,4%) em comparação aos homens (41,1%) (p<0,0001). Houve associação significante entre a severidade da DTM e a presença de dor à palpação da ATM (p=0,0168), dos músculos mastigatórios (p<0,0001) e cervicais (p<0,0001). Observou-se associação significante entre a frequência de dores de cabeça e a presença de DTM (p=0,0001). Não houve associação significante entre a presença de ruídos articulares e a sensibilidade à palpação da ATM. Conclusão: Os idosos apresentaram alta prevalência de DTM, em sua maioria no gênero feminino, de grau leve, relacionada à palpação na ATM e nos músculos mastigatórios e cervicais. Assim, é essencial a realização de um completo exame clínico para investigar a presença desses transtornos, especialmente durante o tratamento de idosos. .

Is there an association between anxiety/depression and temporomandibular disorders in college students?

Objective: Considering the high incidence of Temporomandibular Disorders (TMD) in the population aged 15-30 years and the fact that students are exposed to stressful psychosocial factors, the purposes of this study were: to verify clinical symptoms and jaw functionality in college students with TMD according to the anxiety/depression (A/D) level and to evaluate the correlation between A/D and functionality, maximum mouth opening (MMO) and pain and muscle activity. Material and Methods: Nineteen students with TMD diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders underwent two assessments during an academic semester. The evaluations were based on questionnaires (MFIQ - Mandibular Function Impairment Questionnaire; HADS - Hospital Anxiety and Depression Scale), clinical measurements (MMO without pain, MMO and assisted MMO; palpation of joint and masticatory muscles), and electromyography. The HADS scores obtained in the two assessments were used to classify all data as either "high" or "low" A/D. Data normality, differences and correlations were tested with the Shapiro-Wilk test, Student's t-test (or the Wilcoxon test), and Spearman test, respectively. The alpha level was set at 0.05. Results: None of the clinical variables were significantly different when comparing low and high A/D data. In low A/D there was a significant correlation between HADS score and: MFIQ (P=0.005, r=0.61), and MMO without pain (P=0.01, r=-0.55). Conclusions: Variation in A/D level did not change clinical symptoms or jaw functionality in college students with TMD. Apparently, there is a correlation between TMJ functionality and A/D level, which should be further investigated, taking into account the source of the TMD and including subjects with greater functional limitation. .