Pain Patterns of the Temporomandibular Joint Dysfunction and Implications of Stress-Related Behaviors: A Pilot Study / Patrones de Dolor de la Disfunción de la Articulación Temporomandibular e Implicaciones de los Comportamientos Relacionados con el Estrés: Un Estudio Piloto

SUMMARY: Temporomandibular joint dysfunction interferes with the quality of life and activities of daily living among patients. The symptoms of temporomandibular dysfunction, including pain and clicking and popping sounds, are worsened during stressful events, and patients report increased pain around the temporomandibular joint. Stress-related behaviors, such as teeth clenching and teeth grinding, are commonly reported as increasing during stress. The prevalence of temporomandibular dysfunction and stress-related behaviors is reported differently in the literature. Stress in higher education is common. The purpose of this pilot study was to investigate the prevalence of temporomandibular joint dysfunction and stress-related behaviors among staff members at a local University. The study also sought to explore pain patterns described by people experiencing temporomandibular joint dysfunction and the relationship between stress-related behaviors and pain symptoms experienced. Further, the impact of stress on symptoms experienced by people with temporomandibular dysfunction was investigated in this pilot study.

La disfunción de la articulación temporomandibular interfiere con la calidad de vida y las actividades de la vida diaria entre los pacientes. Los síntomas de la disfunción temporomandibular, incluidos el dolor y los chasquidos, empeoran durante los eventos estresantes, y los pacientes informan un aumento del dolor alrededor de la articulación temporomandibular. Los comportamientos relacionados con el estrés, como apretar y rechinar los dientes, suelen aumentar durante el estrés. La prevalencia de la disfunción temporomandibular y los comportamientos relacionados con el estrés se informa de manera diferente en la literatura. El estrés en la educación superior es común. El propósito de este estudio piloto fue investigar la prevalencia de la disfunción de la articulación temporomandibular y los comportamientos relacionados con el estrés entre los miembros del personal de una universidad local. El objetivo del estudio además fue explorar los patrones de dolor descritos por personas que experimentan disfunción de la articulación temporomandibular y la relación entre los comportamientos relacionados con el estrés y los síntomas de dolor experimentados. Además, en este estudio piloto se investigó el impacto del estrés en los síntomas que experimentan las personas con disfunción temporomandibular.

The association of self-reported awake bruxism with anxiety, depression, pain threshold at pressure, pain vigilance, and quality of life in patients undergoing orthodontic treatment

Abstract This study aimed to evaluate whether the presence of awake bruxism was associated with temporomandibular dysfunction symptoms, pain threshold at pressure, pain vigilance, oral health-related quality of life (OHRQoL), and anxiety and depression symptoms in patients undergoing orthodontic treatment. Methodology This observational study followed patients who had started receiving orthodontic treatment for six months. The following variables were measured three times (at baseline, one month, and six months): pressure pain threshold (PPT) in the right and left masseter, anterior temporalis, and temporomandibular joint (TMJ), and right forearm; pain vigilance and awareness questionnaire; and shortened form of the oral health impact profile (OHIP-14). Anxiety and depression symptoms were measured using the Beck anxiety inventory and the Beck depression inventory, respectively. The patients were divided into two main groups according to the presence (n=56) and absence (n=58) of possible awake bruxism. The multi-way analysis of variance (ANOVA) was applied on the date (p=0.050). Results TMJ and/or muscle pain were not observed in both groups. Time, sex, age group, and awake bruxism did not affect the PPT in the masticatory muscles and pain vigilance (p>0.050). However, the primary effect of awake bruxism was observed when anxiety (ANOVA: F=8.61, p=0.004) and depression (ANOVA: F=6.48, p=0.012) levels were higher and the OHRQoL was lower (ANOVA: F=8.61, p=0.004). Conclusion The patients with self-reported awake bruxism undergoing an orthodontic treatment did not develop TMJ/masticatory muscle pain. The self-reported awake bruxism is associated with higher anxiety and depression levels and a poorer OHRQoL in patients during the orthodontic treatment.

Distribution of depression, somatization and pain-related impairment in patients with chronic temporomandibular disorders

Abstract Objective the aim of this study was to describe the frequency of psychosocial diagnoses in a large sample of patients attending a tertiary clinic for treatment of temporomandibular disorders (TMD). Material and Methods six hundred and ninety-one patients who sought treatment for pain-related TMD were selected. Chronic pain-related disability (Graded Chronic Pain Scale, GCPS), depression [Symptoms Checklist-90 (SCL-90) scale for depression, DEP] and somatization levels (SCL-90 scale for non-specific physical symptoms, SOM) were evaluated through the Research Diagnostic Criteria for TMD (RDC/TMD) Axis II psychosocial assessment; TMD diagnoses were based on the Axis I criteria. Results the majority of patients presented a low disability or no disability at all, with only a small portion of individuals showing a severely limiting, high disability pain-related impairment (4.3%). On the other hand, abnormal scores of depression and somatization were high, with almost half of the individuals having moderate-to-severe levels of depression and three-fourths presenting moderate-to-severe levels of somatization. The prevalence of high pain-related disability (GCPS grades III or IV), severe/moderate depression and somatization was 14.3%, 44% and 74.1% respectively. Gender differences in scores of SCL-DEP (p=0.031) and SCL-SOM (p=0.001) scales were signficant, with females presenting the highest percentage of abnormal values. Conclusion patients with TMD frequently present an emotional profile with low disability, high intensity pain-related impairment, and high to moderate levels of somatization and depression. Therefore, given the importance of psychosocial issues at the prognostic level, it is recommended that clinical trials on TMD treatment include an evaluation of patients' psychosocial profiles.

Impact of temporomandibular disorders on oral health-related quality of life of institutionalized elderly people / Impacto da disfunção temporomandibular na qualidade de vida relacionada à saúde bucal em idosos institucionalizados

Objective: to assess the characteristics associated withtemporomandibular disorders (TMD) and their impacton oral health-related quality of life (OHRQoL) of institutionalizedelderly people. Subjects and method: itwas a cross-sectional study performed in 30 private institutionsfor the elderly. The data collected included theTMD questionnaire and clinical evaluation assessed bythe Research Diagnostic Criteria/TemporomandibularDisorders (RDC/TMD), as well as the OHIP-49 questionnairefor OHRQoL. Results: twenty-four institutionsaccepted to participate in the study (n = 375 with 133fit for answering both questionnaires). Considering thecharacteristics, tinnitus was the most frequent symptomreported, while 98.5% of the research participants didnot present myofascial pain. Disc displacement wasobserved in 26.3%, while 93% of individuals did notpresent chronic pain. Severe depression was found in23.3% of the elderly with 24.1% presenting moderatelevels of non-specific physical symptoms, includingpain. Poisson regression analysis showed that the characteristicsreported were associated with a negativeimpact on OHRQoL. Conclusion: the domain-specificanalysis showed that all domains were affected negativelyby TMD characteristics and higher levels of depressionare associated with a negative impact on OHRQoL. (AU)

Objetivo: avaliar as características associadas às disfunções temporomandibulares (DTM) e seu impacto na qualidade de vida relacionada a saúde bucal (OHRQoL) em idosos institucionalizados. Sujeitos e método: este foi um estudo transversal, realizado em trinta instituições privadas de idosos. Os dados coletados incluíram um questionário e uma avaliação clínica de DTM por meio do instrumento Research Diagnostic Criteria/ Temporomandibular Disorders (RDC/TMD) e do questionário OHIP 49 para OHRQoL. Resultados: vinte e quatro instituições autorizaram a realização do estudo, (n = 375 com 133 idosos aptos a responder ambos os questionários). Dentre as características, o agravo mais frequentemente relatado foi a ocorrência de zumbido no ouvido, enquanto 98,5% dos participantes da pesquisa não apresentaram dor miofascial. Deslocamento de disco foi observado em 26,3%, enquanto 93% dos indivíduos não apresentaram dor crônica. Depressão severa foi encontrada em 23,3% dos idosos avaliados, com 24,1% apresentando grau moderado de sintomas físicos não específicos, incluindo dor. Análise da regressão de Poisson apresentou que as características relatadas estiveram associadas a impacto negativo na qualidade de vida relacionada à saúde bucal. Conclusão: realizando a análise por domínios, todos os domínios foram negativamente afetados pelas características da DTM, e os níveis maiores de depressão estão associados a um impacto negativo na OHRQoL. (AU)

Prevalência de sinais e sintomas de disfunção temporomandibular em estudantes pré-vestibulandos: associação de fatores emocionais, hábitos parafuncionais e impacto na qualidade de vida / Prevalence of signs and symptoms of temporomandibular disorders in college preparatory students: associations with emotional factors, parafunctional habits, and impact on quality of life

Resumo O objetivo deste estudo foi avaliar a prevalência de sinais e sintomas de disfunção temporomandibular (DTM), sua associação com gênero, hábitos parafuncionais, tensão emocional, ansiedade e depressão e, o seu impacto sobre a qualidade de vida relacionada com a saúde oral (QVRSO) em estudantes pré-vestibulandos de instituições públicas e privadas de João Pessoa/PB. A presença de sintomas de DTM foi determinada através de questionário anamnésico, contendo também questões relacionadas à presença de hábitos parafuncionais e tensão emocional. Um protocolo simplificado de avaliação clínica foi aplicado. Ansiedade e depressão foram determinadas através da escala Hospital Anxiety and Depression (HAD) e, a QVRSO avaliada por meio da versão resumida do Oral Health Impact Profile (OHIP-14). Foram realizados testes de Qui-quadrado, Exato de Fisher, Mann Whitney e Kruskal-Wallis. A presença de sinais e sintomas de DTM foi estatisticamente associada ao gênero feminino, hábitos parafuncionais, tensão emocional e ansiedade, e representou maior comprometimento da QVRSO. A elevada prevalência de sinais e sintomas de DTM entre os estudantes pré-vestibulandos sinaliza a necessidade de divulgação e esclarecimento de professores e alunos visando o diagnóstico precoce e a prevenção.

Abstract The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) signs and symptoms, its correlation with gender, parafunctional habits, emotional stress, anxiety, and depression and its impact on oral health-related quality of life (OHRQL) in college preparatory students at public and private institutions in João Pessoa, Paraíba (PB). The sample consisted of 303 students. Presence of TMD symptoms was determined by an anamnesis questionnaire containing questions related to the presence of parafunctional habits and emotional stress. A simplified clinical evaluation protocol was used. Anxiety and depression were determined with the Hospital Anxiety and Depression (HAD) scale and the OHRQL using the short version contained in the Oral Health Impact Profile (OHIP-14). The Chi-square, Fisher Exact, Mann Whitney, and Kruskal-Wallis tests were performed. Presence of signs and symptoms of TMD was statistically associated (p ≤ 0,05) with female gender, parafunctional habits, emotional stress, and anxiety, and represented greater impairment of the OHRQL. The physical pain domain was the most affected. The increased prevalence of signs and symptoms of TMD among college preparatory students indicates that there is a need for education and clarification among teachers and students to improve early diagnosis and to prevent the problem.

Is quality of life affected by temporomandibular disorders? / A disfunção temporomandibular afeta a qualidade de vida?

ABSTRACT Objective To determine the impact of temporomandibular disorders in quality of life. Methods A total of 102 volunteer patients (68 female) aged 19 to 86 years, who sought medical care in health clinics of the university and were evaluated in the period from September to December 2013. The subjects were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders, using a mechanical algometer (Palpeter®) with standardized pressure of 0.5 and 1.0kg, and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) questionnaire, to assess quality of life. The data were tabulated for statistical analysis and the variables were correlated with the clinical findings of the temporomandibular disorders and quality of life. Results Fifty percent of patients were positive for temporomandibular disorders and 39.2% classified as myofascial pain group. The temporomandibular disorder group was significantly associated with uncomfortable bite (p=0.0000), temporomandibular joint clicking (p=0.0001) and tooth clenching (p=0.0001). The Mann Whitney test used to analyze the SF-36 revealed that the domains of pain (mean score of 47.80%; p<0.0001) and mental health (62.67%; p<0.05) were strongly associated with temporomandibular disorders. Conclusion The quality of life of individuals with temporomandibular disorders was negatively affected by the presence of pain and mental health disorders.

RESUMO Objetivo Determinar o impacto das disfunções temporomandibulares na qualidade de vida. Métodos Foram incluídos 102 pacientes voluntários (68 mulheres) com idades entre 19 e 86 anos, que buscaram atendimento médico nas clínicas de saúde da universidade e foram avaliados no período de setembro a dezembro de 2013. Os pacientes foram examinados segundo os Critérios Diagnósticos para Pesquisa em Disfunções Temporomandibulares, usando um algômetro mecânico (Palpeter®) com pressão padronizada de 0,5 e 1,0kg e o questionário Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), para avaliação da qualidade de vida. Os dados foram tabulados para análise estatística, e as variáveis foram correlacionadas com os achados clínicos das disfunções temporomandibulares e da qualidade de vida. Resultados Metade dos pacientes foi positiva para disfunções temporomandibulares, sendo 39,2% deles classificados como grupo de dor miofascial. O grupo de disfunções temporomandibulares foi significativamente associado ao desconforto ao morder (p=0,0000), à crepitação da articulação temporomandibular (p=0,0001) e ao apertar dos dentes (p=0,0001). O teste de Mann-Whitney usado para analisar o SF-36 revelou que os domínios da dor (pontuação média de 47,80%; p<0,0001) e saúde mental (62,67%; p<0,05) estavam fortemente associados às disfunções temporomandibulares. Conclusão A qualidade de vida de indivíduos com disfunções temporomandibulares foi afetada negativamente pela presença da dor e de transtornos de saúde mental.

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.

Salivary stress biomarkers and anxiety symptoms in children with and without temporomandibular disorders

Abstract The etiology of temporomandibular disorders (TMD), which are considered as a heterogeneous group of psychophysiological disturbances, remains a controversial issue in clinical dentistry. This study aimed to evaluate whether the salivary alpha-amylase (sAA), cortisol levels, and anxiety symptoms differ between children with and without TMD. Initially, 316 young subjects were screened in public schools (nonreferred sample); 76 subjects aged 7-14 years were selected and comprised the TMD and control groups with 38 subjects each matched by sex, age, and the presence/absence of sleep bruxism. Four saliva samples were collected: upon waking, 30 min and 1 h after awakening (fasting), and at night (at 8 PM) on 2 alternate days to examine the diurnal profiles of cortisol and sAA. Anxiety symptoms were screened using the Multidimensional Anxiety Scale for Children (MASC-Brazilian version). Shapiro-Wilk test, Student's t-test/Mann-Whitney U test, and correlation tests were used for data analysis. No significant differences were observed in the salivary cortisol area under the curve (AUCG mean ± SD = 90.22 ± 63.36 × 94.21 ± 63.13 µg/dL/min) and sAA AUCG (mean ± SD = 2544.52 ± 2142.00 × 2054.03 ± 1046.89 U/mL/min) between the TMD and control groups, respectively (p > 0.05); however, the clinical groups differed in social anxiety domain (t = 3.759; CI = 2.609, 8.496), separation/panic (t = 2.243; CI = 0.309, 5.217), physical symptoms (U = 433.500), and MASC total score (t = −3.527; CI = −23.062, −6.412), with a power of the test >80% and large effect size (d = 0.80), with no significant correlation between the MASC total score, cortisol, and sAA levels. Although children with TMD scored higher in anxiety symptoms, no difference was observed in the salivary stress biomarkers between children with and without TMD.

Assessment of knowledge on temporomandibular disorders among Mexican dental educators / Evauación del conocimiento sobre trastornos temporomandibulares en docentes de odontología en México

Temporomandibular disorders (TMDs) is an umbrella term that embraces a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joints, muscles and all associated tissues. Because of the relatively high number of patients with TMDs in the population, instruction in this area of health care should be included on all dental curricula. Although levels of knowledge among dentists have been evaluated in several countries, they have not been in Mexico. This study evaluates the dental faculty's range of knowledge about TMD at five dental schools in Puebla, Mexico. Using an observational design, a survey was administered to 161 educators in order to assess their knowledge of TMD. Four domains were assessed, including: a) pathophysiology; b) psychophysiology; c) psychiatric disorders; and d) chronic pain. Overall knowledge of TMD was measured using a consensus of TMD experts' answers as a reference standard1The results show that educators' overall knowledge had 55% agreement with the reference standard. Individually, the psychophysiological domain was correctly recognized by 77.7% of the educators; correct responses on the other domains ranged from 38% to 56%. This study demonstrates the need to incorporate standardized TMDs instruction into the dental curricula at Mexican Universities, without which graduating dentists will lack the necessary knowledge or experience to diagnose and manage their TMD patients.

Los Trastornos Témporomandibulares (TTM) incluyen un grupo de condiciones musculoes que léticas y neuromusculares que afectan a la Articulación Temporomandibular (ATM), los músculos masticadores y otros tejidos asociados. Debido al número relativamente alto de pacientes con TTM en la población, la educación en esta área de la salud debe ser incluida en las currículas de las escuelas de odontología. A pesar de que el nivel de conocimiento sobre TTM ha sido evaluado en diversos países, esto no ha sido realizado en México, por lo que el objetivo del presente estudio fue evaluar el nivel de conocimiento sobre los TTM de los profesores de odontología en cinco universidades de Puebla, México. Bajo un diseño observacional, se administró una encuesta a 161 docentes de odontología para evaluar el nivel de conocimiento sobre los TTM. La encuesta incluyó cuatro dominios: a) patofisiología; b) psicofisiología; c) trastornos psiquiátricos y d) dolor crónico. Se usaron las respuestas otorgadas con un consenso de expertos como estándar de referencia1 para evaluar el nivel global de conocimiento sobre los TTM. Los resultados mostraron que los docentes tuvieron un nivel global de conocimiento del 55% de acuerdo al estándar de referencia. El dominio psicofisiológico indivi dualmente fue el mejor reconocido con el 77% de acuerdo con los expertos; las respuestas correctas en los otros dominios oscilaron entre el 38% y el 56%. El presente estudio demostró la necesidad de incorporar educación sobre los TTM estandarizada en la currícula de las escuelas o facultades de odontología en las universidades mexicanas. Hasta que esto suceda, las generaciones de odontólogos no tienen el conocimiento ni la experiencia necesarios para diagnosticar y manejar a los pacientes con Trastornos Temporomandibulares.

Niveles de ansiedad y su relación con los trastornos temporomandibulares / Anxiety levels and their relationship to temporomandibular disorders

El diagnóstico de los trastornos temporomandibulares es un tema muy controvertido dentro del campo de la salud, desde una perspectiva psicológica son muy escasas las referencias en este sentido, sobretodo las enfocadas a analizar los niveles de ansiedad en estos pacientes. En los últimos años se han realizado diferentes investigaciones que validan la inclusión de factores psicológicos como parte de la etiología del diagnóstico, dentro de los factorespsíquicos más asociados se presentan la ansiedad como rasgo y la ansiedad como estado. El propósito de este trabajo es presentar una revisión sobre la relación existente entre los niveles de ansiedad y los trastornos temporomandibulares.

The diagnosis of temporomandibulardisorders is very controversial within the fieldof health issue, from a psychological perspectiveare very few references in this regard,especially focused on analyzing anxiety levelsin these patients. In recent years there have beenvarious studies that validate the inclusionof psychological factors as part of the etiology,diagnosis, within the psychological factorsmost associated trait anxiety and state anxietyas presented. The purpose of this paper is topresent a review of the relationship betweenanxiety levels and temporomandibular disorders.

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.

Perceived coercion of noninstitutionalized elderly patients undergoing research for the diagnosis of temporomandibular joint dysfunction / Percepción de coerción en ancianos no institucionalizado sometidos a la investigación para diagnóstico de la disfunción temporomandibular / Avaliação da percepção de coerção em idosos não institucionalizados submetidos a pesquisa para diagnóstico da disfunção temporomandibular

OBJECTIVE: To evaluate perceived coercion (PC) of noninstitutionalized elderly patients undergoing research for the diagnosis of temporomandibular joint dysfunction. METHOD: A cross-sectional study conducted with 1,112 elderly individuals aged 60 or older, enrolled in the Family Health Programme of the municipality of Areia, State of Paraíba, Brazil, from January to June 2013. The data collection tool was the Perceived Cohesion Scale (PSC). RESULTS: The participants were predominantly women (62.5%) in the 60 to 69 age group (45.9%), illiterate (57.9% percent), married or in a common law marriage (54.1%), retired (83.6%), and receiving a monthly income under the minimum wage (72.0%). The average overall PC was 1.25+ 1.15 and Trend 1 (41,4%). There was a difference between the group of individuals who were literate, married and in a common law marriage and the members of the other groups. CONCLUSION: Results showed that the elderly patients were minimally coerced when deciding whether to participate in research for diagnosing temporomandibular joint dysfunction. They also revealed a significant association of PC with literacy and marital status. .

OBJETIVO: En este estudio se evaluó la percepción de coerción (PC) en personas de edad avanzada, no institucionalizadas sometidas a la investigación para el diagnóstico de los trastornos temporomandibulares. MÉTODO: Se hizo un estudio transversal con 1.112 ancianos de 60 años de edad o mayores, participantes del Programa de Salud de la Familia, en la ciudad de Areia, estado de Paraiba, Brasil, en el periodo de enero a junio del año de 2013. La recolección de datos se hizo con la escala de percepción de coerción. RESULTADOS: La mayoría de los pacientes eran mujeres (62,5%), de 60-69 años de edad (45,9%), casados o como pareja estable (57,9%), retirados (54,1%), analfabetos (83,6%) y con menos de un sueldo base menual (72,0%). El promedio general de PC fue de 1,25 ± 1,15 y Moda 1 (41,4%). Hubo diferencias de PC entre el grupo de analfabetos, casados o pareja estable en comparación con los demás. CONCLUSIÓN: Se observó el grupo de ancianos poco coaccionado para decidir participar en la investigación del diagnóstico de los trastornos temporomandibulares, con una asociación significativa de PC con la alfabetización y el estado civil. .

OBJETIVO: Neste estudo, avaliou-se a percepção de coerção (PC) em idosos não institucionalizados submetidos a pesquisa para diagnóstico da Disfunção Temporomandibular. MÉTODO: Realizou-se estudo transversal com 1.112 idosos, com idade igual ou superior a 60 anos, inscritos no Programa da Saúde da Família do município de Areia, Estado da Paraíba, Brasil, no período de janeiro a junho de 2013. Utilizou-se como instrumento de coleta a Escala de Percepção de Coerção. RESULTADOS: Houve predominância de pessoas do sexo feminino (62,5%), com faixa etária de 60 a 69 anos (45,9%) não alfabetizados (57,9%), casados ou em união estável (54,1%), aposentados (83,6%) e com renda mensal inferior a um salário mínimo (72,0%). A média geral de PC foi de 1,25+ 1,15 e Moda 1 (41,4%). Houve diferença da PC entre o grupo de alfabetizados, casados e em união estável versus os demais. CONCLUSÃO: Percebeu-se o grupo de idosos pouco coagido ao decidir quanto à sua participação na pesquisa para diagnóstico da Disfunção Temporomandibular, com associação significativa da PC com alfabetização e estado civil. .

Temporomandibular disorder and anxiety, quality of sleep, and quality of life in nursing professionals

To evaluate the association between temporomandibular disorder (TMD) and anxiety, quality of sleep, and quality of life in nursing professionals at theHospital de Clínicas de Uberlândiaof theUniversidade Federal de Uberlândia – HCU-UFU (Medical University Hospital of the Federal University of Uberlândia), four questionnaires were given to nursing professionals. The questionnaires were completed by 160 of these professionals. The Fonseca’s questionnaire was used to evaluate the presence and severity of TMD, the IDATE was used to evaluate anxiety, the SAQ was used to evaluate quality of sleep, and the SF-36 was used to evaluate quality of life. Forty-one nurses (25.6%) reported having no TMD (Fonseca’s questionnaire score ≤ 15), 66 (41.3%) had mild TMD (Fonseca’s questionnaire score 20–40), 39 (24.4%) had moderate TMD (Fonseca’s questionnaire score 45–65), and 14 (8.8%) had severe TMD (Fonseca’s questionnaire score ≥ 70). According to Fonseca’s questionnaire, the presence of TMD was associated with trait anxiety, but the TMD severity was associated with state anxiety classification (mild, moderate, severe). The SAQ score differed significantly from Fonseca classification. The Fonseca’s questionnaire score correlated negatively with the score of each dimension of the SF-36 (r = –0.419 to –0.183). We conclude that TMD is common among nursing professionals; its presence was associated with trait anxiety, and its severity was associated with state anxiety. Hence, the presence of TMD may reduce quality of sleep and quality of life.

Temporomandibular disorders and eating disorders: a literature review / As desordens temporomandibulares e os transtornos alimentares: uma revisão de literatura

INTRODUCTION: Temporomandibular disorders (TMD) and eating disorders (ED) affect function and parafunction of the oral cavity and have high rates of medical and psychological comorbidity. However, little is known about the possible associations between them, and few studies have investigated the existence of such associations. METHODS: A search was conducted on the SciELO, LILACS, and PubMed/MEDLINE databases to find relevant articles written in English and Portuguese. Only studies involving human beings were included, and there was no limit for year of publication. RESULTS AND CONCLUSIONS: There is evidence of the correlation between TMD and ED, but their comorbidity must be better understood. The presence of depressive symptoms is an aggravating factor that must also be taken into account during the diagnosis and treatment of those patients (AU)

INTRODUÇÃO: As disfunções temporomandibulares (DTM) e os transtornos alimentares (TA) envolvem a função e a parafunção da cavidade oral e apresentam altos índices de comorbidade médica e psicológica. No entanto, pouco se sabe sobre as possíveis associações entre essas entidades clínicas, e poucos artigos avaliaram a existência de uma relação elas. MÉTODOS: Uma busca foi realizada nas bases de dados SciELO, LILACS e PubMed/MEDLINE a fim de encontrar artigos relevantes escritos em inglês e português. Apenas estudos envolvendo seres humanos foram incluídos, e não foi estabelecido um limite para ano de publicação. RESULTADOS E CONCLUSÕES: Há evidências da correlação entre DTM e TA, mas essa comorbidade precisa ser melhor compreendida. A presença de sintomas depressivos é um fator agravante que também precisa ser levado em consideração durante o diagnóstico e tratamento desses pacientes (AU)

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. .

Painful temporomandibular disorders, self reported tinnitus, and depression are highly associated / Disfuncao temporomandibular dolorosa, auto-relato de zumbido e depressao estao fortemente associados

Objective The aim of this study was to investigate the association among painful temporomandibular disorders (TMD), self reported tinnitus, and levels of depression. Method The sample consisted of 224 individuals with ages ranges from 18 to 76 years. The Research Diagnostic Criteria for Temporomandibular Disorders Axis I were used to classify TMD and Axis II were used for self reported tinnitus, and to score the levels of depression. The odds ratio (OR) with 95% confidence interval (CI) was applied. Results The presence of painful TMD without tinnitus was significantly associated with moderate/severe levels of depression (OR=9.3, 95%; CI: 3.44-25.11). The concomitant presence of painful TMD and tinnitus self-report increased the magnitude of the association with moderate/severe levels of depression (OR=16.3, 95%; CI, 6.58-40.51). Conclusion Painful temporomandibular disorders, high levels of depression, and self reported tinnitus are deeply associated. However, this association does not imply a causal relationship. .

Objetivo Investigar a associação entre disfunção temporomandibular (DTM) dolorosa, auto-relato de zumbido e níveis de depressão. Método A amostra foi composta por 224 indivíduos com idades de 18 a 76 anos. O Research Diagnostic Criteria for Temporomandibular Disorders , eixo I, foi usado para classificar a DTM e o eixo II para obtenção do auto-relato de zumbido e dos níveis de depressão. Para a análise dos dados, foi aplicado o teste odds ratio (OR) com intervalo de confiança (IC) de 95%. Resultado Somente a presença de DTM dolorosa estava significativamente associada aos níveis de depressão moderado/severo (OR=9,3, 95%; IC: 3,44-25,11). A presença concomitante de DTM dolorosa e auto-relato de zumbido aumentaram a magnitude da associação com os níveis de depressão moderado/severo (OR=16,3; 95% IC: 6,58-40,51). Conclusão Disfunção temporomandibular dolorosa, altos níveis de depressão e auto-relato de zumbido estão fortemente associados. Entretanto, o desenho do estudo não permite estabelecer uma relação causal entre essas três entidades. .

Intervención psicológica en trastornos temporomandibulares: revisión narrativa / Psychological intervention in temporomandibular disorders: review

Los pacientes con trastornos temporomandibulares (TTM) presentan trastornos psicológicos y psiquiátricos frecuentemente. Estos pacientes frecuentemente muestran somatización, depresión, ansiedad, reacción al estrés y catastrofismo, lo que juega un rol en la predisposición, iniciación y perpetuación de los TTM y en la respuesta al tratamiento. Esta revisión presenta opciones terapéuticas que comprometen al eje psicológico de los pacientes con TTM, las cuales buscan principalmente reducir la ansiedad y la tensión emocional presentes, modificar las distintas percepciones del dolor y cómo afrontarlo. Existen diversas posibilidades, dentro de las cuales se encuentran: educación del paciente, identificación de las situaciones que incrementan esa tensión para evitarlas, enseñanza de técnicas de relajación como biofeedback, hipnosis y yoga. En cuanto al tratamiento psicológico, la que presenta mejor resultado para los TTM, es la terapia cognitiva conductual (TCC). La intervención psicológica adecuada y eficaz puede reducir el dolor de los TTM, disminuyendo la probabilidad de que el cuadro se haga más complejo. Dentro de las alternativas de tratamiento psicológico para los TTM, un tratamiento estándar conservador (educación, instrucción de autocuidado, evitación de movimientos dolorosos, dieta blanda), incluso el más breve, puede ser suficiente a corto plazo para la mayoría de los pacientes que presentan TTM, sobretodo en los casos de cuadros agudos. La adición de una TCC, por parte de un especialista, entrega habilidades de afrontamiento que se sumarán a la eficacia, especialmente en los casos crónicos, obteniendo mejores resultados a largo plazo.

Patients with temporomandibular disorders (TMD) frecuently present psychological and psychiatric problems. These patients often show increased somatization, depression, anxiety, stress reaction and catastrophism, wich plays a role in the predisposition, initiation and perpetuation of TMD and treatment response. This review presents thaerapeutic options that compromise the psychological axis of patients with TMD, wich primarily seek to reduce the anxiety and the emotional stress present, modify different perceptions of pain and coping. There are different posibilities, within wich are: patient education, identifying situations that increase the tension to avoid them, teaching relaxation techniques such as biofeedback, hipnosis and yoga. As for psychological treatment, the most common for chronic orofacial pain is cognitive behavioral therapy (CBT). The appropriate and effective psychological intervention can reduce TMD pain, decreasing the probability that the symptoms become more complex. Within psychological treatment options for TMD, conservative standard treatment (education, self-instruction, avoidance of painful movements, soft diet), even the shortest, may be sufficient in the short term for most patients with TMD, especially in cases of acute conditions. The addition of CBT, by a specialist, gives coping skills that will add to the effectiveness, especially in chronic cases, obtaining better results in the long term.