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.

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.

Avaliação da técnica de aperto de punho como interferente pré-analítico na dosagem do potássio / Evaluation of the wrist tightening technique as a pre-analytical interference in the potassium dosage

Objetivo: avaliar as alterações do potássio em relação a frequência de aperto de punho pelos participantes da pesquisa, buscando contribuir para um melhor entendimento sobre os aspectos quantitativos em relação ao uso da técnica de aperto de punho durante a flebotomia, para verificar com que frequência o aperto de punho poderá contribuir para a elevação do potássio. Método: Foram realizadas duas coletas sanguíneas de cada indivíduo. Em um primeiro momento, mantendo as mãos relaxadas durante flebotomia e, segundo, bombeando o punho durante o procedimento de flebotomia para avaliar as alterações do potássio em relação a frequência de aperto de punho. Resultados: De um modo geral, observa-se que houveram alterações em praticamente todas as dosagens e que indivíduos poderiam ter sido diagnosticados incorretamente com uma hipercalemia, podendo ser submetidos a tratamentos desnecessários. Conclusão: A técnica de aperto de punho durante a flebotomia deve ser evitada, pois uma significativa porcentagem dos casos apresentou uma elevação de potássio não condizente com o nível sérico de potássio normal do indivíduo.

Objective: To evaluate potassium alterations in relation to wrist grip frequency by the research participants, seeking to contribute to a better understanding of the quantitative aspects regarding the use of wrist grip technique during phlebotomy, to verify how often wrist may contribute to potassium elevation. Method: Two blood samples were collected from each individual. At first, keeping the hands relaxed during phlebotomy and secondly, pumping the fist clenching the phlebotomy procedure to evaluate potassium changes in relation to the frequency of wrist tightening. Results: In general, it was observed that there were changes in practically all dosages and that individuals could have been misdiagnosed with hyperkalemia and could be submitted to unnecessary treatments. Conclusion: The technique of wrist tightening during phlebotomy should be avoided, since a significant percentage of the cases presented a potassium elevation that does not correspond to the individual's normal serum potassium level.

Application of fist clenching method with shaking hands in venipuncture to elderly angular patients / 中国实用护理杂志

Objective To evaluate application of fist clenching method with shaking hands in venipuncture to elderly angular patients. Methods 360 elderly angular patients were randomly divided into group A and group B with 180 cases in each group. Group A used fist clenching method with shaking hands, group B adopted traditional fist clenching method in venipuncture. Pain degree and one-time success rate of two groups were compared. Results One-time success rate of group A in venipuncture was obviously higher than group B, while pain degree of group A was less than group B. Conclusions Fist clenching method with shaking hands to elderly angular patients can raise success rate in venipuncture, and reduce pain degree of patients.

Mouthguard for relief of repeated clenching stress to cervical restorations during exercises / 대한치과보존학회지

Mouthguards were used to protect boxers from lip lacerations and other soft tissue injuries in the late 19th century. Now they are used various parts of dental treatment, which are sports protective aid, bleaching tray, orthodontic retainer, implant insertion guide tray, splint and so on. Repeated dislodgement of Class V restoration due to habitual clenching stress should be restored with stress control. Mouthguard can be used as stress relief device. This case describes methods that can relieve occlusal force to teeth by using mouthguard. Satisfactory results can be obtained by using mouthguard for retention of repeated dislodgement Class V restorations. If patients suffered from repeated restorations of Class V due to clenching, mouthguard can be used additional device to relieve the occlusal stress in conservative dentistry.

Freqüência de relatos de parafunções nos subgrupos diagnósticos de DTM de acordo com os critérios diagnósticos para pesquisa em disfunções temporomandibulares (RDC/TMD) / Frequency of relates of parafunctions in the diagnostic subgroups of TMD according to research diagnostic criteria for temporomandibular disorders (RDC/TMD)

INTRODUÇÃO: as disfunções temporomandibulares (DTM) podem ser definidas como um conjunto de condições dolorosas e/ou disfuncionais, que envolvem os músculos da mastigação e/ou as articulações temporomandibulares (ATM). Um dos meios usados para o diagnóstico é o "Critério Diagnóstico para Pesquisa em Disfunções Temporomandibulares" (RDC/TMD). Hábitos parafuncionais são aqueles não relacionados à execução das funções normais do sistema estomatognático. O bruxismo é caracterizado por atividade parafuncional noturna involuntária dos músculos mastigatórios, enquanto o apertamento dentário é considerado uma parafunção diurna envolvendo esta musculatura, embora possa ocorrer também à noite. OBJETIVOS: o objetivo do presente estudo foi avaliar a freqüência do relato de parafunções orais diurna e/ou noturna em pacientes com DTM nos diferentes subgrupos diagnósticos do RDC/TMD. METODOLOGIA: foram utilizados dados provenientes de 217 pacientes que procuraram tratamento na Clínica de DTM e Dor Orofacial da Faculdade de Medicina de Petrópolis, sendo avaliados através do questionário e exame físico que compõem o RDC/TMD. RESULTADOS: dos 182 pacientes com DTM estudados, 76,9 por cento relataram algum tipo de parafunção, podendo ser diurna, noturna ou a associação de ambas. A parafunção diurna foi a mais freqüentemente relatada entre os subgrupos de DTM, sendo encontrada em 64,8 por cento dos casos contra 55,5 por cento dos casos com relato de bruxismo. O relato de ambas as parafunções foi constatado em 43,4 por cento dos pacientes com DTM. CONCLUSÕES: considerando cada subgrupo diagnóstico, os relatos de parafunções diurna e noturna foram mais freqüentes nos pacientes com dor miofascial.

INTRODUCTION: temporomandibular disorders (TMD) can be defined as a group of painful and/or dysfunctional conditions that involve masticatory muscles and/or the temporomandibular joints (TMJ). One of the methods used to the diagnostic is the "Research Diagnostic Criteria for Temporomandibular Disorders" (RDC/TMD). Parafunctional habits are those not related to the execution of normal functions of stomatognatic system. Bruxism is characterized by nocturnal involuntary parafunctional activity of masticatory muscles, while clenching is considered as a diurnal parafunction involving this musculature, although this may also occur at night. OBJECTIVE: the goal of the present study was to evaluate the frequency of relates of diurnal and/or nocturnal oral parafunctions in patients with TMD in different diagnostic subgroups of RDC/TMD. METHODOLOGY: it has been used data from 217 patients that seek for treatment at TMD and Orofacial Pain Clinic of Petropolis Medicine School, being evaluated through questionnaire and physical examination that compose RDC/TMD. RESULTS: from 182 TMD patients studied, 76.9 percent has related some kind of parafunction, that could be diurnal, nocturnal or both. Diurnal parafunction was the most frequent related among TMD subgroups, present in 64.8 percent of cases against 55.5 percent of cases with relates of bruxism. Relate of both parafunctions was verified in 43.4 percent of TMD patients. CONCLUSION: regarding each diagnostic subgroup, relates of diurnal and nocturnal parafunctions has been more frequent in patients of miofascial pain group.

Diagnosis and Management of Bruxism / 수면정신생리

Bruxism is defined as 'diurnal or nocturnal parafunctional activity including clenching, bracing, gnashing, and grinding of the teeth'. Bruxism and clenching are two of the most common contributing factors in patients with temporomandibular disorders and craniofacial pain disorders. Even though many studies report the high prevalence of bruxism, its cause is still not clear. Occlusal interference has been regarded as a major etiologic factor. Nowadays, psychological stress and sleeping disorders are generally regarded as major possible etiologic factors. More than likely, the cause is multifactoral and overlapping, which makes it difficult for the practitioner to apply comprehensive and effective management strategies. Although dentists and psychologists generally believe that effective treatment is best achieved with a better understanding of the etiology of a given disorder, for now treatment for this type of disorder must proceed without a clear understanding of etiology. To overcome this obstacle, evidence-based comprehensive management protocols based on accumulated scientific findings should be provided. In this presentation, epidemiology, etiology, and the characteristics of bruxism are reviewed. Diagnostic procedures and management strategies focused on occlusal appliances and behavioral approaches are also discussed.

Augmentation of eccentric strength of knee extensors with teeth clenching / 体力科学

Previous research has demonstrated that the concentric muscle strength of knee extension exerted at slow to medium angular velocities is increased by teeth clenching. This study evaluated the isokinetic eccentric strength of knee extensors at 4 angular velocities (60, 120, 180 and 240 degrees per second) with and without teeth clenching on the Cybex 6000 Extremity Testing and Rehabilitation System. Twelve healthy adult male (26.8±1.8 years) volunteered for the study. Peak torque per body weight and average power per body weight were analyzed. The results demonstrated that peak torque per body weight accompanied by teeth clenching was significantly increased at 60, 120, 180 and 240 deg/s by 9.5%, 8.2%, 8.2% and 9.8%, respectively (p<0.01) . Similarly average power per body weight during teeth clenching was significantly higher at 60, 120, 180 and 240 deg/s by 9.1%, 9.5%, 9.4% and 7.7%, respectively (p<0.05) . These findings suggest that teeth clenching is a factor that leads to augmented eccentric strength of knee extensors. Its effect appears to be independent of angular velocity.

Effect of teeth clenching on muscle strength during repeated isokinetic knee extensions / 体力科学

The purpose of this study was to investigate the effect of teeth clenching on isokinetic knee extension force during repeated voluntary contractions. We assessed isokinetic muscle strength in association with teeth clenching during 100 consecutive knee extensions at 60 degrees per second (deg/s) using a Cybex 6000 isokinetic dynamometer. In this study, 8 healthy male volunteers (28.4 ± 3.89 years) were asked to perform isokinetic contractions in an extended cycle of five contractions without teeth clenching followed by five contractions with the teeth clenching. The peak torque per body weight was statistically analyzed. In our results, the peak torque per body weight with teeth clenching were significantly greater than those without teeth clenching in the first 70 cycles; however, no significant differences were shown at 71-100 cycles. There was a significant negative correlation between the number of knee extensions and the difference in peak torque per body weight derived from with and without teeth clenching (r=-0.475, p<0.0001) . Our findings reveal that the effect of teeth clenching on the isokinetic muscle strength of knee extension is dependent on muscular fatigue, and that the improving effect of teeth clenching on isokinetic muscle strength declines with increasing muscular fatigue.

Effect of teeth clenching on force-velocity relationships in isokinetic knee extension / 体力科学

To investigate the effect of teeth clenching on isokinetic knee extension at various velocities, isokinetic muscle strength during knee extension was measured in association with teeth clenching at 30, 60, 150, 300 and 450 degrees per second (deg/s) using the Cybex 6000 isokinetic dynamometer. The volunteer subjects were 9 healthy males (26.2±0.97 years) . The peak torque per body weight and average power per body weight were statistically analyzed. Our results demonstrated that the peak torque per body weight with teeth clenching at 30, 60 and 150 deg/s significantly increased by 7.0%, 7.4% and 4.9%, respectively (p<0.05), but no significant differences were found at 300 and 450 deg/s. While the average power per body weight with teeth clenching at 30, 60 and 150 deg/s significantly increased by 6.5%, 6.1% and 6.9%, respectively (p<0.05), no sig-nificant differences were found at 300 and 450 deg/s. A significant negative correlation was shown between the isokinetic angular velocity and the difference in peak torque per body weight derived from with and without teeth clenching (r=-0.699; p<0.05) . These findings suggested that the effect of teeth clenching on isokinetic muscle strength of knee extension was dependent on the angular velocity, and at lower angular velocities teeth clenching had the effect of increasing the isokinetic muscle strength during knee extension.

THREE DIMENSIONAL FINITE ELEMENT STRESS ANALYSIS OF THE MANDIBULAR CONDYLE DURING UNILATERAL CLENCHING / 대한치과보철학회지

It has been held that excessive mechanical forces to the osseous and soft tissues of the TMJ result in joint dysfunction. Understanding the stress pattern on TMJ is very important in TMJ research. But, it is very difficult to measure directly the biomechanical stress distribution in the TMJ during functional movement was studied through animal experiment or mathematical model . It was observed and compared the stress distribution occuring in the working and balancing condyle when lower right canine, lower right first molar and lower right second molar were clenched by the three dimensional finite element analysis. Also, stress distribution in the working and balancing condyles were observed and compared when 20 forward and buccal bite forces were applied to the first molar The results were as follows : 1. Stress distribution in the condyles during unilateral clenching of the first molar, second molar, canine showed no difference. In the working condyle, tensile force was concentrated on the lateral aspect of the condylar articular surface and condylar neck. And compressive force was concentrated on the anteromedial and lateral aspect of condyle. In the balancing condyle, tensile and compressive force was concentrated on the lateral aspect of the condylar articular surface and stress transmission to the temporal bone was not observed. 2. When lateral force were applied to the first molar, tensile force were concentrated on the medial aspect of the condylar neck and condylar posterior surface in working and balancing condyle. Compressive force was concentrated on the anteromedial and lateral surface of condyle and stress transmission to the temporal bone was not observed. 3. During unilateral clenching, stress in the working condyle decreased as the occlusal load moved posteriorly while the stress in the balancing condyle increased when lateral forces were applied to the first molar, the incremental amount of stress was greater than vertical load. 4. During unilateral clenching, the average balancing/ working stress ratio was 2.52. There was a greater concentration of stress in the balancing condyle. The ratio increased at the occlusal load moved posteriorly and decreased considerably when lateral forces were applied to the first molar