Oromandibular dystonia as a cause of temporomandibular disorder (Case report) / Distonia oromandibular como causa de disfunção temporomandibular (Relato de caso)

Temporomandibular disorders (TMD) can have multiple etiologies, including oromandibular dystonia (OMD). However, in a few cases, the OMD can evolve from cervical dystonia (CD), leading to severe bone degeneration. The purpose of this case report of a 64-year-old woman presenting to the Outpatient Neurology Clinic of the Federal University of Bahia is to illustrate the development of oromandibular dystonia with temporomandibular joint (TMJ) dysfunction after 10 years of cervical dystonia. Clinical examination showed bone degeneration of the mandibular ramus and right TMJ click, a prevalent sound in patients with temporomandibular disorders when they open their mouths or chew. After onabotulinum toxin type A injections in the right lateral pterygoid muscle, the patient improved in swallowing and pain. This case highlights the importance of close follow-up of cervical dystonia patients to identify new dystonic muscles. In our patient, lateral pterygoid muscle involvement was followed by several comorbidities, such as dysphagia and jawbone abnormalities.

Os distúrbios temporomandibulares (DTM) podem ter múltiplas etiologias, incluindo a distonia oromandibular (DO). No entanto, em raros casos, a DO pode evoluir a partir da distonia cervical (DC) e raramente pode levar a degeneração óssea. O objetivo deste relato de caso de uma mulher de 64 anos atendida no Ambulatório de Neurologia da universidade Federal da Bahia é ilustrar o desenvolvimento de distonia oromandibular com disfunção da articulação temporomandibular (ATM) após 10 anos de distonia cervical. O exame clínico mostrou degeneração óssea do ramo mandibular e clique na ATM direita, um som prevalente em pacientes com distúrbios temporomandibulares quando abrem a boca ou mastigam. Após injeções de toxina botulínica tipo A no músculo pterigoideo lateral direito, a paciente apresentou melhora na deglutição e na dor. Este caso destaca a importância do acompanhamento próximo de pacientes com distonia cervical para identificar novos músculos distônicos. Em nossa paciente, o envolvimento do músculo pterigoide lateral foi seguido por várias comorbidades, como disfagia e anormalidades ósseas da mandíbula.

Logistic regression analysis of clinical features and condylar bone changes in patients with temporomandib-ular disorders / 实用口腔医学杂志

Objective:To investigate the relationship between CBCT imaging changes of condyle and clinical features,and related risk factors in patients with temporomandibular disorders(TMD).Methods:453 patients with TMD were enrolled and underwent CBCT scan for bilateral temporomandibular joints(TMJ),3D reconstruction of the TMJs was analyzed.Logistic regression analysis was performed to investigate the relationship between condylar bone changes and TMD clinical features.Results:Patients＜18 years old were more likely to have condylar bone changes than the adults.The symptoms of pain and restricted mouth opening were more likely to be detected in the condylar bone change group(n=133)than in the normal condylar bone group(n=320).The incidence of brux-ism in the normal condylar bone group was higher than that in the condylar bone change group.Univariate logistic regression analysis showed that only bruxism(OR=0.550),pain(OR=1.844)and mouth restriction(OR=2.024)were included in the regression equa-tion.Multivariate logistic regression analysis showed that,due to the protective effect of bruxism,the OR value of pain decreased from 1.844 to 1.791,and the OR value of mouth restriction decreased from 2.024 to 1.847.Conclusion:The condylar bone change in TMD patients more likely occur in puberty or patients with pain and restricted mouth opening.Bruxism may be a protective factor in the occurrence of condylar bone changes in TMD patients.

Research progress on the application of botulinum toxin type A in the treatment of myogenous temporomandibular disorders / 口腔疾病防治

@#Myogenous temporomandibular disorder (M-TMD) is one of the main subtypes of temporomandibular disorder (TMD) and typically manifests as masticatory myofascial pain; the incidence of TMD has been increasing annually in recent years. Botulinum toxin type A (BTX-A) is a potent neurotoxin produced by Clostridium botulinum. BTX-A inhibits the release of acetylcholine from the presynaptic membrane, thereby blocking neuromuscular junction signaling. The noncosmetic application of BTX-A in the oral and maxillofacial regions is a prominent research topic. In recent years, an increasing number of studies have focused on the application of BTX-A in the treatment of M-TMD. The results of a literature review revealed that an appropriate dose (10-50 U unilaterally) of BTX-A administered in a single injection into the masticatory muscles can effectively treat myalgia over a period of 3-6 months. Common adverse effects, such as masticatory weakness and facial paralysis, are transient and can be avoided by standardized injection techniques. However, there is a lack of standardized guidelines for injection techniques in clinical practice.

Disc repositioning surgery combined with orthodontic treatment of patients with temporomandibular disorders and facial asymmetry: a case report and literature review / 口腔疾病防治

Objective@#To investigate the clinical efficacy of disc repositioning surgery combined with orthodontic treatment in patients with temporomandibular disorder and facial asymmetry.@*Methods@#One patient who underwent disc repositioning surgery combined with orthodontic treatment for temporomandibular joint disorder and facial asymmetry was reported. Preoperatively, the patient had a skewed shape of the opening, mild pressure pain in the right preauricular region with left mandibular deviation, and a mismatch between the width of the upper and lower dental arches. In the arthrosurgery department, bilateral temporomandibular disc replacement and anchorage were performed through a transauricular incision, and an auxiliary splint was worn to stabilize the jaw position for 6 months. In the orthopedic department, maxillary skeletal expansion was used in combination with the multiloop edgewise archwire technique to reconstruct the occlusion after 16 months of orthodontic treatment.@*Results@#The deviation was corrected by wearing an occlusal splint for six months after joint repositioning and anchoring; moreover, the pain symptoms disappeared, and the cone beam CT examination showed that the bilateral temporomandibular joint space was uniformly enlarged, the lower alveolar ridge midline deviated to the right, the posterior regions of the teeth were bilaterally inverted, and the anterior region and the posterior region of the left side were open. The orthodontic treatment matched the width of the upper and lower dental arches and established the cuspal molar neutrality relationship and the normal overjet coverage of the anterior teeth; additionally, the mandibular position was not obviously skewed. A review of the results of the related literature shows that abnormal occlusal relationships, such as mismatched arch width and skewed occlusal plane, can cause adaptive mandibular deviation, which can lead to the occurrence of TMD. Temporomandibular joint disc anchorage with splint treatment can effectively improve maxillofacial deformity in young TMD patients. After the establishment of a stable, physiologically functional disc-condylar relationship, orthodontic treatment is required to remove the interfering factors to rebuild the occlusion, and long-term postoperative review and follow-up are needed.@*Conclusion@#In patients with TMD and mandibular accommodative deviation due to occlusal anomalies, establishing a normal disc-condylar relationship and eliminating occlusal interference through disc repositioning surgery combined with orthodontic treatment can effectively improve facial shape and establish a stable jaw position.

Factors associated with voice-related quality of life among patients with temporomandibular disorders

Abstract Research would be important for obtaining a better understanding of voice complaints among patients with temporomandibular disorders (TMD). Objective The identification of predictors of voice disorders associated with TMD pain was made according to Diagnostic Criteria for TMD (DC/TMD) Axis I. Methodology Functional limitations were measured using the Jaw Functional Limitation Scales for mastication (JFLS-M), jaw mobility (JFLS-JM), and verbal and emotional expression (JFLS-VEE). Patients also completed the Hospital Anxiety and Depression Scale (HADS). The primary outcome was social-emotional and physical functioning as indicated by scores on the Voice-Related Quality of Life (V-RQOL) questionnaire. Multiple linear regression was used to model the relationship between the domains on the V-RQOL questionnaire and scores on the HADS and JFLS after adjusting for age, gender, DC/TMD diagnosis, pain intensity, and time since pain onset. Results The HADS-D (B=-1.15; 95% CI, -1.718 to -0.587; p<.001) and JFLS-VEE (B=-0.22; 95% CI, -0.40 to -0.06; p=.008) were significant predictors of scores on the V-RQOL questionnaire. Conclusion Higher scores on depression measures and limitations in verbal and emotional expression could exacerbate voice problems among TMD pain patients. Future research should promote multidisciplinary treatments for TMD pain-related voice disorders.

Signos y Síntomas en 3557 Pacientes con Trastornos Temporomandibulares

Los trastornos temporomandibulares (TTM) tienen una alta frecuencia en la población y pueden presentar síntomas en la región de la cabeza, el oído y la región cervical. Este estudio evalúa la presencia de signos y síntomas en la región de la cabeza y el cuello, incluyendo: cefalea, trastornos del oído, y de la columna vertebral, en una población de 3557 pacientes con TTM. Para este estudio los datos consistieron en los registros de 3557 pacientes consecutivos de TTM referidos a una clínica privada de trastornos temporomandibulares y dolor craneofacial, en Santiago de Chile entre 1998 y 2019. El examen y los registros fueron efectuados por uno los autores (RW), en un programa computacional previamente diseñado. Los resultados fueron analizaron utilizando la distribución de la frecuencia de los datos para evaluar la prevalencia. En esta serie 72.67 % correspondieron a pacientes de sexo femenino. Los síntomas más prevalentes reportados por los 3557 pacientes estudiados fueron rigidez en el cuello 65,25 %, cefaleas 61,01 % y dolor lumbar 57,16 %. Los síntomas relacionados con el oído fueron: mareos en el 46,70 %, dolor de oídos en 32,64 % y tinnitus en el 33,60 % de los pacientes. La asimetría facial estuvo presente en el 74.08 % de los 3557 pacientes. Se observó desviación mandibular en apertura bucal, en el 74.44 % de los 3557 pacientes. Se presentó dolor a la palpación muscular en un alto porcentaje de los pacientes, en los músculos temporales, maseteros, esternocleidomastoideo y trapecio, Este estudio nos permite describir la frecuencia de los signos y síntomas que presentan los pacientes con TTM en una amplia casuística.

Temporomandibular disorders (TMD) are frequently associated with other conditions in the head, ear and neck region, including cervical spine disorders and headache. This study evaluates the presence of signs and symptoms in the head and neck region, including headache, ear disorders, cervical and spine disorders, on a population of 3557 patients with TMD. For this study data consisted of the records of 3557 consecutive TMD patients referred to a temporomandibular disorder and craniofacial pain private clinic in Santiago, Chile between 1998 and 2019. The examination and recordings were made by all the authors. The results were analyzed using the distribution of frequency of the data to asses prevalence. The most prevalent symptoms reported by the 3557 subjects were neck stiffness 65.25 %, headaches 61.01 % and low back pain 57.16 %, the most frequent ear symptom was dizziness 46.70 %. The present study analize the frecuency of signs and symptons presented in a big casuistic of patients with TMD.

Bruxismo y su asociación con la disfunción temporomandibular en niños. Revisión de literatura / Bruxism and its association with temporomandibular disorders in children. Literature review

Resumen Introducción: El bruxismo está definido como una actividad oral motora que consiste en el apretamiento o rechinamiento involuntario (rítmico o espasmódico no funcional) de los dientes, con una prevalencia de 5,9% a 49,6% en niños. Lo que podría contribuir a problemas clínicos asociados con la articulación temporomandibular. La asociación entre la disfunción temporomandibular (DTM) y el bruxismo en niños aún no está totalmente establecida. Objetivo: El objetivo de esta revisión de literatura es recopilar información actualizada de estudios que hayan abordado la asociación entre el bruxismo y la disfunción temporomandibular en niños de 3 a 12 años. Metodología: Se realizó una búsqueda en las bases de datos de Scopus, Pubmed y Scielo usando los descriptores "Niño", "Niños", "Preescolar", "Bruxismo", "Bruxismo del sueño", "Disfunción Temporomandibular"; y, "Síndrome de la Disfunción de Articulación Temporomandibular". Fueron incluidos artículos publicados en los últimos 15 años en idiomas español, inglés y portugués. Fueron incluidos estudios transversales, de cohorte, casos controles y ensayos clínicos aleatorizados. Resultados: Se evaluaron 242 artículos, de los cuales solo 11 fueron incluidos de acuerdo a los criterios de inclusión. Entre los estudios incluidos, dos de ellos no encontraron asociación entre DTM y bruxismo, tres encontraron una tendencia o probable asociación y seis encontraron una asociación positiva. Conclusiones: Existen estudios que relatan asociación entre el bruxismo y las disfunciones temporomandibulares en niños de 3 a 12 años, relacionando la presencia de signos y síntomas de la DTM con el bruxismo, pudiendo ser este último, un factor de riesgo para la presencia de DTM.

ABSTRACT Introduction: Bruxism is defined as an oral motor activity that consists of involuntary clenching or grinding (non-functional rhythmic or spasmodic) of the teeth, with a prevalence rate ranging from 5.9% to 49.6% in children, which could contribute to clinical problems associated with the temporomandibular joint. The association between bruxism in children and temporomandibular dysfunction (TMD) is not yet fully established. Objective: The objective of this literature review is to collect up-to-date information on studies that have addressed the association between bruxism and temporomandibular dysfunction in children ranging 3 - 12 years of age. Methods: A search was performed in the Scopus, PubMed and SciELO databases using the descriptors "Child", "Children", "Child, Preschool", "Bruxism", "Sleep Bruxism", "Temporomandibular Dysfunction" and "Temporomandibular Joint Dysfunction Syndrome." Articles published in the last 15 years in the Spanish, English and Portuguese languages were included. Results: A total of seventy-two articles were assessed. Only 11 articles were included according to the inclusion criteria. Among the included studies, two of them found no association between TMD and bruxism, three found a trend or probable association, and six found a positive association. Conclusion: There are studies that report an association between bruxism and temporomandibular dysfunctions in children ranging 3 - 12 years old, relating the presence of signs and symptoms of TMD with bruxism.

Histological effect of platelet-rich plasma on temporomandibular joint osteoarthritis: systematic review in animal models

SUMMARY: The aim of this systematic review was to assess the histological effects of platelet-rich plasma (PRP) on temporomandibular joint osteoarthritis (TMJ-OA) in animal models. A systematic search was performed using PubMed, WoS, EMBASE, Science Direct and SCOPUS databases. The inclusion criteria were experimental studies in animal models that evaluated the use of PRP as a treatment for TMJ-OA with or without arthrocentesis/arthroscopy. Comparison was made to a healthy control group or to other treatment. The variables evaluated were the histological effects of the treatments, characteristics of the primary articles, characteristics of the sample studied and the risk of bias. The systematic search identified 120 studies. Eventually 5 studies were included in the analysis. Four of the studies showed a statistically significant repair in joint tissues and improvement of cartilage thickness in animals treated with PRP. The global risk of bias was unclear. The results of this systematic review suggest that PRP treatment in TMJ-OA has benefits at the histological level in cartilage, articular disc and articular bone tissue in animal models. However, due to the low number of studies and the risk of bias, further research is needed to recommend its use.

El objetivo de esta revisión sistemática fue evaluar los efectos histológicos del plasma rico en plaquetas (PRP) en la osteoartritis de la articulación temporomandibular (ATM-OA) en modelos animales. Se realizó una búsqueda sistemática en las bases de datos PubMed, WoS, EMBASE, Science Direct y SCOPUS. Los criterios de inclusión fueron estudios experimentales en modelos animales que evaluaran el uso de PRP como tratamiento para la ATM-OA con o sin artrocentesis/ artroscopia. La comparación se realizó con un grupo de control sano o con otro tratamiento. Las variables evaluadas fueron los efectos histológicos de los tratamientos, las características de los artículos primarios, las características de la muestra estudiada y el riesgo de sesgo. La búsqueda sistemática identificó 120 estudios. Finalmente se incluyeron 5 estudios en el análisis. Cuatro de los estudios mostraron una reparación estadísticamente significativa en los tejidos articulares y una mejora del grosor del cartílago en los animales tratados con PRP. El riesgo global de sesgo fue incierto. Los resultados de esta revisión sistemática sugieren que el tratamiento con PRP en la ATM-OA tiene beneficios a nivel histológico en el cartílago, el disco articular y el tejido óseo articular en modelos animales. Sin embargo, debido al escaso número de estudios y al riesgo de sesgo, se necesitan investigaciones adicionales para recomendar su uso.

Observaciones sobre trastornos temporomandibulares: prioridades de investigación y atención: ¿cómo avanzará Chile? / Remarks on "temporomandibular disorders: priorities for research and care": how will Chile advance?

Los trastornos temporomandibulares son complejos trastornos multisistémicos para los que, lamentablemente, siguen prevaleciendo los enfoques tradicionales odontocéntricos comunes de la investigación y la atención. Un comité designado por las Academias Nacionales de Ciencias, Ingeniería y Medicina de los Estados Unidos de América resumió importantes recomendaciones relativas a la urgente necesidad de transformar, desde el modelo predominantemente biomédico, la investigación, la educación/formación profesional y la atención al paciente para los trastornos temporomandibulares en el modelo biopsicosocial que es estándar en el resto de la medicina del dolor. La publicación del informe del estudio de consenso identifica once recomendaciones de corto y largo plazo respecto a brechas y oportunidades orientadas a la situación en Estados Unidos, que son igualmente aplicables a la situación en Chile. Las primeras cuatro recomendaciones se centran en la investigación básica y traslacional, la investigación en salud pública y el fortalecimiento de la investigación clínica. Las tres recomendaciones siguientes se refieren a la evaluación de riesgos, el diagnóstico y la difusión de guías de práctica clínica y métricas asistenciales para mejorar la atención de los pacientes y ampliar su acceso. Las recomendaciones octavas a décima proponen centros de excelencia para el tratamiento de los trastornos temporomandibulares y el dolor orofacial, la mejora de la formación en los centros profesionales y la ampliación de la formación continua especializada para los profesionales sanitarios. La undécima recomendación se centra en la educación de los pacientes y la reducción del estigma. Este artículo destaca las recomendaciones publicadas y aborda lo que debiesen considerar los profesionales chilenos, como primer paso hacia un gran esfuerzo por cambiar los paradigmas de investigación, tratamiento y educación sobre los trastornos temporomandibulares para los próximos años.

Temporomandibular disorders (TMDs) are complex multi-system disorders for which common traditional dental-centric approaches to research and care unfortunately continue to prevail. A committee appointed by the National Academies of Sciences, Engineering and Medicine (NAM) of the United States of America summarized important recommendations regarding the urgent need to transform, from the predominantly biomedical model, the research, professional education/training, and patient care for TMDs into the biopsychosocial model that is standard in the rest of pain medicine. The release of the Consensus Study Report identifies eleven short-term and long-term recommendations regarding gaps and opportunities oriented towards the situation in the US, which are equally applicable to the situation in Chile. The first four recommendations focus on basic and translational research, public health research and strengthening clinical research. The next three recommendations concern risk assessment, diagnostics, and dissemination of clinical practice guidelines and care metrics to improve patient care and expand its access. Recommendations eight to ten propose Centers of Excellence for Temporomandibular Disorders and Orofacial Pain Treatment, improving professional school education, and expanding specialized continuing education for healthcare providers. The eleventh recommendation focuses on patient education and stigma reduction. This article highlights the published recommendations and addresses what should be considered by Chilean professionals, as a first step of a major effort to shift TMD research, treatment, and education paradigms for the years to come.

Research progress in effect of chewing-side preference on temporomandibular joint and its relationship with temporo-mandibular disorders / 浙江大学学报·医学版

Chewing-side preference is one of the risk factors for temporomandibular disorders (TMD), and people with chewing-side preference is more prone to have short and displaced condyles, increased articular eminence inclination and glenoid fossa depth. The proportion of TMD patients with chewing-side preference is often higher than that of the normal subjects. Clinical studies have shown a strong correlation between chewing-side preference and TMD symptoms and signs; and animal studies have shown that chewing-side preference can affect the growth, development, damage and repair of the mandible. After long-term unilateral mastication, changes in the stress within the joint cause the imbalance of temporomandibular joint (TMJ) structural reconstruction, the transformation and even destruction of the fiber structure of masticatory muscle, resulting in uncoordinated movement of bilateral muscles. The joint neurogenic diseases caused by the increase of neuropeptide substance P and calcitonin-gene-related-peptide (CGRP) released locally by TMJ may be the mechanism of TMD. This article reviews the research progress of the influence of chewing-side preference on the structure of TMJ, the relationship between chewing-side preference and TMD, and the related mechanisms.

Magnetic resonance imaging texture analysis of the temporomandibular joint for changes in the articular disc in individuals with migraine headache / Análise de textura por ressonância magnética da articulação temporomanbibular com alterações no disco articular em individuos com cefaleia migranea

Objective: the aim of this study was to analyse the performance of the technique of texture analysis (TA) with magnetic resonance imaging (MRI) scans of temporomandibular joints (TMJs) as a tool for identification of possible changes in individuals with migraine headache (MH) by relating the findings to the presence of internal derangements. Material and Methods: thirty MRI scans of the TMJ were selected for study, of which 15 were from individuals without MH or any other type of headache (control group) and 15 from those diagnosed with migraine. T2-weighted MRI scans of the articular joints taken in closed-mouth position were used for TA. The co-occurrence matrix was used to calculate the texture parameters. Fisher's exact test was used to compare the groups for gender, disc function and disc position, whereas Mann-Whitney's test was used for other parameters. The relationship of TA with disc position and function was assessed by using logistic regression adjusted for side and group. Results: the results indicated that the MRI texture analysis of articular discs in individuals with migraine headache has the potential to determine the behaviour of disc derangements, in which high values of contrast, low values of entropy and their correlation can correspond to displacements and tendency for non-reduction of the disc in these individuals. Conclusion: the TA of articular discs in individuals with MH has the potential to determine the behaviour of disc derangements based on high values of contrast and low values of entropy (AU)

Objetivo: o objetivo deste estudo foi analisar o desempenho da técnica de análise de textura (AT) em exames de ressonância magnética (RM) das articulações temporomandibulares (ATM) como ferramenta para identificação de possíveis alterações em indivíduos com cefaléia migrânea (CM) relacionando os achados com a presença de desarranjos internos. Material e Métodos: trinta exames de RM das ATM foram selecionados para estudo, sendo 15 de indivíduos sem cefaleia migrânea ou qualquer outro tipo de cefaléia (grupo controle) e 15 diagnosticados com CM. As imagens de RM ponderadas em T2 das articulações realizadas na posição de boca fechada foram usadas para AT. A matriz de co-ocorrência foi usada para calcular os parâmetros de textura. O teste exato de Fisher foi usado para comparar os grupos quanto ao sexo, função do disco e posição do disco, enquanto o teste de Mann-Whitney foi usado para os demais parâmetros. A relação da AT com a posição e função do disco foi avaliada por meio de regressão logística ajustada para lado e grupo. Resultados: a AT por RM dos discos articulares em indivíduos com cefaleia migrânea tem o potencial de determinar o comportamento dos desarranjos discais, em que altos valores de contraste, baixos valores de entropia e sua correlação podem corresponder a deslocamentos e tendência a não redução do disco nesses indivíduos. Conclusão: a análise de textura dos discos articulares em indivíduos com CM tem potencial para determinar o comportamento dos desarranjos do disco com base em altos valores de contraste e baixos valores de entropia. (AU)

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)

Fibromialgia e disfunção temporomandibular: uma revisão de escopo / Fibromyalgia and temporomandibular disorder: a scoping review

A fibromialgia é uma síndrome complexa com alterações nociplásticas, caracterizadas por hiperalgesia e alodinia, frequentemente acompanhada pela presença de dor orofacial. Estudos têm demonstrado alta prevalência de disfunção temporomandibular (DTM) em pacientes fibromiálgicos, como fator etiológico ou agravante. O objetivo desta revisão de literatura foi identificar os mecanismos modulatórios comuns à fibromialgia e à DTM, e identificar diferentes modalidades de tratamento para os pacientes fibromiálgicos. Foram utilizados 69 artigos dos últimos 5 anos, além de 4 artigos conceituais anteriores a este período. Identificou-se que os principais fármacos utilizados para os sintomas de fibromialgia são pregabalina, amitriptilina, antidepressivos duais, tramadol, baixas doses de naltrexona e canabinoides. A associação de fármacos pode ser útil para aumentar a eficácia do tratamento e reduzir as doses dos mesmos. Por outro lado, novas terapias não farmacológicas, como as técnicas modulatórias não-invasivas, surgem como opções promissoras, promovendo alterações neuroplásticas importantes no tratamento. Conclusão: Há diversas opções terapêuticas farmacológicas e não-farmacológicas disponíveis no tratamento do paciente fibromiálgico para o especialista em DTM. Portanto, a combinação de diferentes abordagens pode auxiliar na obtenção de um protocolo individualizado, adequado às necessidades do paciente.

Fibromyalgia is a complex syndrome with nociplastic changes, characterized by hyperalgesia and allodynia, often accompanied by the presence of orofacial pain. Studies have shown a high prevalence of temporomandibular disorders (TMD) in fibromyalgia patients, as an etiological or aggravating factor. The aim of this review was to identify the modulatory mechanisms common to fibromyalgia and TMD, and to identify different treatment modalities for fibromyalgia patients. 69 articles from the last five years were included, in addition to 4 conceptual articles prior to this date. The main drugs used for fibromyalgia symptoms are pregabalin, amitriptyline, dual antidepressants, tramadol, low-dose naltrexone and cannabinoids. The combination of drugs may be useful in improving treatment efficacy and for reducing the drug's dose. On the other hand, new non-pharmacological therapies, such as non-invasive modulatory techniques, appear as promising options for treatment, promoting important neuroplastic alterations. Conclusion: Several pharmacological and non-pharmacological therapeutic alternatives are available for specialists in TMD. Therefore, combining therapy approaches can help create individualized protocols that are more effective at meeting the demands of fibromyalgia patients.

Bruxism an issue between the myths and fact / Bruxismo, un problema entre los mitos y los hechos

Abstract Is our goal in this paper to discuss the current concepts about bruxism, a topic that has been a matter of discussion on the dental field for many years. Recent International efforts have been made to challenge bruxism old definitions; this has derivate to a consensus and an actual new concept that defines bruxism as a behavior instead of a disorder. As a behavior, it is explained in this review how it can have negative health consequences, can be innocuous and how new research support that bruxism can even be a protective factor. Different etiological factors are reviewed in this paper as well the influence of external and internal mechanism related to medications, emotional stress, systemic factors, and potential pharmacological pathways. Moreover, it is briefly summarized the role of oral appliances on sleep bruxism. Finally, clinical considerations and recommendation for the dental professional regarding sings that should be notice during the exam are part of this overview.

Resumen Es nuestro objetivo en este artículo discutir los conceptos actuales sobre el bruxismo, un tema que ha sido motivo de discusión en el campo odontológico durante muchos años. Se han hecho esfuerzos internacionales recientes para desafiar las viejas definiciones de bruxismo; esto ha derivado en un consenso y en la actualidad un nuevo concepto que define al bruxismo como un comportamiento en lugar de un trastorno. Como conducta, se explica en esta revisión cómo puede tener consecuencias negativas para la salud, puede ser inocuo y cómo nuevas investigaciones avalan que el bruxismo puede incluso ser un factor protector. En este artículo se exponen diferentes factores etiológicos, así como la influencia de mecanismos externos e internos relacionados como: medicamentos, estrés emocional, factores sistémicos y posibles vías farmacológicas. Además, se resume brevemente el papel de los aparatos orales en el bruxismo del sueño. Finalmente, se presentan consideraciones clínicas y la recomendación para el profesional en odontología con respecto a los signos que deben ser observados durante el examen clínico son parte de esta revisión.

Bruxismo de la vigilia por autoreporte y factores asociados en estudiantes universitarios de educación física

El bruxismo es una actividad parafuncional de los músculos masticatorios con alta prevalencia en la población general. Asimismo, se ha descrito como un fenómeno frecuente en estudiantes universitarios de algunas disciplinas. En este sentido, el presente trabajo analizó la autopercepción y algunos factores asociados al bruxismo de la vigilia en estudiantes universitarios de educación física (ISEF-UdelaR). Se presenta un estudio observacional, descriptivo, transversal, en una muestra de 178 jóvenes universitarios. Para la recolección de los datos se utilizó un cuestionario de autoreporte. El 67,9% de los participantes conocían el bruxismo y el 33% lo reportaron (el 21% y 13%, representado por mujeres y hombres respectivamente). Asimismo, seis de cada diez voluntarios que reportaron bruxismo también reportaron ansiedad y tres de cada diez voluntarios con reporte de bruxismo reportan estrés. En suma, el bruxismo "probable" de vigilia es altamente prevalente en estudiantes de educación física y el factor más asociado al bruxismo de la vigilia es la ansiedad.

O bruxismo é uma atividade parafuncional dos músculos mastigatórios com alta prevalencia na população em geral. Assim mesmo, vem sendo descrito como um fenômemo frequente em estudantes universitários de algumas disciplinas. Neste sentido, o trabalho atual analisou a autopercepção e alguns fatores associados ao bruxismo da vigília em estudantes universitários de educação física (ISEF-UdelaR). Trata-se de um estudo observacional, descritivo, transversal, com uma amostra de 178 jovens universitários. Os dados foram coletados através de um questionário de auto-relato. Os 67,9% dos participantes conheciam o bruxismo e 33% lhe relataram (21% e 13% representado por mulheres e homens, respectivamente). Assim mesmo, seis de cada dez voluntários que relataram bruxismo, também relataram ansiedade e três dos dez voluntários que relataram bruxismo, relataram estresse. Então, o bruxismo "provável" da vigília é altamente prevalente em estudantes de educação física e o principal fator associado ao bruxismo da vigília seria a ansiedade.

Vulnerabilidad al estrés en adolescentes de instituciones deportivas / Vulnerability to stress in teenagers in sports institutions

Fundamento: Los trastornos temporomandibulares tienen origen multifactorial y el factor psicológico ocupa un papel importante en su desencadenamiento. Objetivo: Determinar la vulnerabilidad al estrés en adolescentes de instituciones deportivas. Metodología: Se realizó un estudio observacional descriptivo de corte transversal, en la EIDE provincial de Sancti Spíritus "Lino Salabarría Pupo" entre octubre de 2020 y marzo de 2021. Se seleccionaron 70 escolares de décimo, onceno y duodécimo grados mediante muestreo aleatorio simple. Se midió la variable: rango de vulnerabilidad al estrés. Se utilizaron métodos del nivel teórico, empírico y estadístico. Resultados: El 51.4 %.de los estudiantes fueron clasificados con vulnerabilidad al estrés, el 40 % no vulnerables, el 8.6 % seriamente vulnerables y ninguno extremadamente vulnerables. Conclusiones: Existe un predominio de adolescentes de instituciones deportivas con vulnerabilidad al estrés.

Background: Temporomandibular disorders have a multifactorial origin and the psychological factor plays an important role in their triggering. Objective: To determine the vulnerability to stress in teenagers from sports institutions. Methodology: A cross-sectional descriptive observational study was conducted at the Sancti Spíritus provincial EIDE "Lino Salabarría Pupo" between October 2020 and March 2021. Seventy schoolchildren from tenth, eleventh and twelfth grades were selected by simple random sampling. The variable range of vulnerability to stress was measured. Theoretical, empirical and statistical methods were used. Results: 51.4 % of the students were classified with vulnerability to stress, 40 % not vulnerable, 8.6 % seriously vulnerable and none extremely vulnerable. Conclusions: There is a predominance of teenagers from sports institutions with vulnerability to stress.

Efectividad del Bionator de California en la disminución del grado de severidad de los trastornos temporomandibulares / Effectiveness of the California Bionator in reducing the degree of severity of temporomandibular disorders

RESUMEN Fundamento: Existen modalidades de tratamiento para los trastornos temporomandibulares, una de ellas es la Ortopedia funcional de los maxilares. Objetivo: Evaluar la efectividad del Bionator de California en la disminución del grado de severidad de los trastornos temporomandibulares. Metodología: Se realizó estudio experimental, abierto, controlado y aleatorizado en el servicio de Prótesis Estomatológica de la Clínica Estomatológica de Fomento en el período de septiembre de 2019 a septiembre de 2021. Se seleccionaron 60 pacientes con trastornos temporomandibulares que cumplieron los criterios de selección, mediante asignación aleatoria se establecieron los grupos: Estudio (tratado con Bionator de California) y control (tratado con férula neuromiorrelajante). Se utilizaron métodos del nivel teórico, empírico y estadístico. La variable de respuesta principal fue: Efectividad del Bionator de California en el grado de severidad del trastorno temporomandibular. Resultados: Al inicio del estudio predominó la severidad moderada de trastornos temporomandibulares en ambos grupos, pero a los 6 meses de tratamiento predominaron los asintomáticos (66.7 %) en el grupo estudio y 36.7 % en el grupo control, con diferencia estadísticamente significativa entre ambos grupos. Conclusiones: El tratamiento con el Bionator de California fue efectivo porque se logró disminuir el grado de severidad de los trastornos temporomandibulares.

ABSTRACT Background: There are treatment modalities for temporomandibular disorders, one of them is functional orthopedics of the jaws. Objective: To evaluate the effectiveness of the California Bionator in reducing the degree of severity of temporomandibular disorders. Methodology: An experimental, open, controlled and randomized study was carried out in the Dental Prosthesis service at Fomento Dental Clinic from September 2019 to September 2021. 60 patients with temporomandibular disorders who met the selection criteria were selected. The groups were established by random assignment: Study (treated with Bionator from California) and control (treated with a neuromyorelaxant splint). Method theoretical, empirical and statistical levels were used. The main response variable was: Effectiveness of the California Bionator in the degree of severity of the temporomandibular disorder. Results: At the beginning of the study moderate severity of temporomandibular disorders prevailed in both groups, but after 6 months of treatment asymptomatic predominated (66.7%) in the study group and 36.7% in the control group, with a statistically significant difference between both groups. Conclusions: The treatment with the California Bionator was effective because the degree of severity of temporomandibular disorders was reduced.

Principios físicos y avances recientes de la termografía infrarroja en odontología

RESUMEN Introducción: El calor resultante de los procesos metabólicos celulares puede medirse mediante termografía infrarroja, especialmente en células con alto consumo de energía como las musculoesqueléticas. En odontología, los cambios térmicos pueden indicar anomalías o trastornos musculares. Se realizó una búsqueda de información científica en las bases de datos PubMed, SciELO, Redalyc, entre otras, de 2015 a 2020, en inglés y español. Objetivo: Describir los principios físicos y los avances más recientes de la termografía infrarroja en odontología, relacionados con trastornos temporomandibulares, el dolor pediátrico, aplicaciones en implantología y endodoncia. Desarrollo: Se encontraron varias aplicaciones de la termografía en odontología: i) trastornos temporomandibulares, ii) en el diagnóstico del lupus eritematoso, iii) en implantología, iv) endodoncia y v) dolor en odontopediatría. Sobre i) y ii) en la literatura consultada se obtuvieron resultados que respaldaban la eficacia de la termografía infrarroja como un examen diagnóstico complementario, sobre todo en mujeres. Respecto a iii) y iv) la termografía infrarroja mostró ser efectiva como método para evaluar los cambios térmicos en procedimientos como la preparación de la zona del implante y en la técnica de condensación vertical. Finalmente, en v), la TIR parece útil para la detección el nivel de dolor en niños. Conclusión: La termografía infrarroja es una herramienta diagnóstica con potencial de detección de anomalías que inducen cambios térmicos, además de ser un excelente método para detectar las altas temperaturas en diversos procedimientos odontológicos, que sin el debido cuidado puede llevar al fracaso del tratamiento.

ABSTRACT Introduction: The heat resulting from cellular metabolic processes can be measured by infrared thermography, especially in cells with high energy consumption such as musculoskeletal cells. In dentistry, thermal changes can indicate muscle abnormalities or disorders. A search for scientific information was carried out in databases PubMed, SciELO, Redalyc, among others, from 2015 to 2020, in English and Spanish. Objective: To describe the physical principles and the most recent advances of infrared thermography in dentistry, related to temporomandibular disorders; pediatric pain; applications in implantology and endodontics. Development: Several applications of thermography were found in dentistry: i) temporomandibular disorders, ii) in the diagnosis of lupus erythematosus, iii) in implantology, iv) endodontics and v) pain in pediatric dentistry. Regarding i) and ii) in the consulted literature, results were obtained that supported the efficacy of Infrared Thermography as a complementary diagnostic test, especially in women. Regarding iii) and iv) Infrared Thermography proved to be effective as a method to evaluate thermal changes in procedures such as the preparation of the implant area and in the vertical condensation technique. Finally, in v), the Infrared Thermography seems useful for detecting the level of pain in children. Conclusion: Infrared thermography is a diagnostic tool with the potential to detect anomalies that induce thermal changes, as well as being an excellent method to detect high temperatures in various dental procedures that, without due care, can lead to treatment failure.

Translation and Validation of the Malay Version of Oral Health Impact Profile for Temporomandibular Disorders

ABSTRACT@#Most prior oral health-related quality of life (OHRQoL) research concerning temporomandibular disorders (TMDs) had utilised generic OHRQoL measures. This study aimed to translate and validate the Malay version of Oral Health Impact Profile for TMDs (OHIP-TMDs), a TMDs-specific OHRQoL tool, for use in Malay literate populations. The translation and cross-cultural adaptation of the OHIP-TMDs into the Malay language were implemented according to the international guidelines. A convenience sample of 243 subjects completed the Malay OHIP-TMDs (OHIP-TMDs-M) as well as the Malay Short Oral Health Impact Profile (S-OHIP-M), Global Oral Health ratings (GOH-M) and Fonseca Anamnestic Index (FAI-M). The OHIP-TMDs-M was re-administered to a subset of 40 subjects after two weeks for test-retest reliability. Concurrent, convergent and discriminative validity were assessed using Spearman’s rank correlation, Kruskal Wallis and Mann-Whitney U tests with significance level set at p < 0.05. The OHIP-TMDs-M was found to have excellent internal consistency (Cronbach’s alpha = 0.98) and test-retest reliability (intraclass correlation coefficient = 0.99, p < 0.001). A strong and positive correlation with S-OHIP-M (rs = 0.74) was observed, and OHIP-TMDs-M scores differed significantly between subjects with disparate GOH-M ratings (p < 0.001). Furthermore, the OHIP-TMDs-M was able to discriminate between subjects with and without TMDs. The OHIP-TMDs-M was found to have excellent reliability and good validity. It is a promising tool for assessing TMDs-specific OHRQoL in Malay literate populations.

Análisis morfológico del cóndilo mandibular por tomografía computarizada de haz cónico en relación al sexo en población mexicana / Morphological analysis of the mandibular condyle by cone beam computed tomography in relation to sex in a Mexican population

RESUMEN: La articulación temporomandibular es una estructura doble y simétrica, con una compleja gama de movimientos. La morfología condilar puede variar dependiendo al sexo, edad, entre otros factores. Se analizaron 100 tomografías computarizadas de haz cónico (50 hombres y 50 mujeres) divididos en 4 grupos. Se identificó diferencias significativas entre las formas aplanadas vs ovaladas del cóndilo y a su vez se encontró diferencia entre los lados derechos vs izquierdo entre hombres y mujeres. La tomografía computada de haz cónico es un método económico y accesible mediante la exposición a bajas dosis de radiación se obtienen imágenes de alta resolución de los tejidos duros de la ATM. El análisis de la tomografía computarizada de haz cónico tiene una precisión aceptable para el diagnóstico de anomalías óseas de la ATM, componentes articulares, integridad del hueso cortical y anomalías óseas subcorticales.

SUMMARY: The temporomandibular joint is a double and symmetrical structure, whit a complex range of movements. Condylar morphology can vary depending on sex, age, among other factors. 100 cone beam computed tomography scans (50 men and 50 women) divided into 4 groups were analyzed. Significant differences were identified between the flattened vs oval forms on the condyle and, in turn a difference was found between the right vs left sides between men and women. Cone beam computed tomography analysis has acceptable accuracy for the diagnosis of TMJ bone abnormalities, articular components, cortical bone integrity and subcortical bone abnormalities.