Trastornos temporomandibulares en la infancia: bruxismo de sueño y compromiso de atm en artritis idiopática juvenil / Temporomandibular disorders in childhood: sleep bruxism and temporomandibular joint involvement in juvenile idiopathic arthritis

Los trastornos temporomandibulares (TTM) corresponden a un grupo de condiciones musculoesqueletales y neruromusculares que involucran las articulaciones temporomandibulares (ATM), los músculos masticatorios y todos los tejidos asociados. La etiología de los TTM es considerada multifactorial, siendo el bruxismo de sueño (BS) uno de muchos factores asociados con TTM dolorosos. Tanto los TTM como el BS se presentan en adultos y niños y actualmente es sabido que la etiopatogenia de ambos no difiere de acuerdo a la edad. Las ATM son articulaciones sinoviales que pueden verse afectadas por diversos TTM o por condiciones sistémicas como la artritis idiopática juvenil (AIJ). La ATM está involucrada en un 40% de los pacientes con AIJ, siendo subestimada debido a que clínica-mente se manifiesta con poco dolor. En el presente artículo se revisarán los conceptos de TTM y BS en niños, así como también la manifestación de la AIJ en el territorio orofacial, entregando una aproximación de su etiopatogenia, identificación y manejo.

Temporomandibular disorders (TMD) encompass a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joints (TMJ), the masticatory muscles, and all associated tissues. TMD's etiology is considered to be mul-tifactorial, were sleep bruxism (SB) is one of many causes of painful TMD. TMD and SB can present in adults and children and the etiology does not differ regarding age.TMJ are synovial joints that can be affected by many TMD as well as systemic conditions such as juvenile idiopathic arthritis (JIA). TMJ are involved in 40% of patients with JIA, which is usually underestimated because of its painless presentation.This article will review the concepts of TMD and SB in children, as well as JIA presentation in the orofacial region.

Oclusión terapéutica: desde las escuelas de oclusión a la odontología basada en evidencia / Therapeutic occlusion: from occlusal schools of thought to evidence-based dentistry

Tanto en la práctica clínica como en la academia, siempre está presente la interrogante de cuál es la mejor posición mandibular para organizar una oclusión terapéutica y satisfacer los requerimientos estéticos y funcionales de los pacientes. Esta pregunta se podría responder desde la perspectiva de las diferentes escuelas de oclusión, siguiendo sus técnicas y utilizando su aparatología. Sin embargo, debido a que no existe suficiente evidencia científica que sustente la superioridad de una escuela sobre la otra, es preciso hacer una revisión donde se expongan los principios en que se basan las distintas filosofías oclusales, los autores que les dieron origen, la época en que surgieron y la terminología que usaron -desde el siglo pasado hasta nuestros días-, contrastándolas con la literatura científica actual. Esta no es una tarea fácil, ya que los estudios disponibles acerca de oclusión presentan gran variabilidad en la definición operacional de los términos, haciendo difícil su comparación. Se sugiere para el futuro buscar una estandarización de las definiciones y técnicas de registro, con el objeto de generar evidencia científica confiable, conducente a la creación de protocolos de recomendación para la toma de decisiones clínicas predecibles desde el punto de vista oclusal.

Both in clinical practice and academia, there is always the question about what is the best mandibular position to organize a therapeutic occlusion that satisfies functional and aesthetic requirements from patients. This question could be answered from the point of view of different occlusion schools of thought, following their techniques and using their apparatuses. However, due to the lack of scientific evidence to support the pre-eminence of a particular school over the rest, it is necessary to go through the princip les that provide the foundations for the different occlusal philosophies: the authors who gave birth to each school of thought, the time in which they were formed and the terminology they used, from the early 20th century to present times and making a comparison with current scientific literature. This is not an easy task, given that available studies about occlusion feature a great variability in the operational definition of terms, making comparison difficult. The article suggests that it would be necessary for the future to look for a standardization of recording definitions and techniques. The aim is to generate reliable scientific evidence for the creation of protocols of recommendation for predictable decision-making from an occlusal point of view.

Perception of difficulties with vision-related activities of daily living among patients undergoing unilateral posterior capsulotomy.

OBJECTIVES: To assess the influence of Nd:YAG (neodymium: yttrium-aluminum- garnet) laser unilateral posterior capsulotomy on visual acuity and patients' perception of difficulties with vision-related activities of daily life. METHODS: We conducted an interventional survey that included 48 patients between 40 and 80 years of age with uni- or bilateral pseudophakia, posterior capsule opacification, and visual acuity

Perception of difficulties with vision-related activities of daily living among patients undergoing unilateral posterior capsulotomy

OBJECTIVES: To assess the influence of Nd:YAG (neodymium: yttrium-aluminum- garnet) laser unilateral posterior capsulotomy on visual acuity and patients' perception of difficulties with vision-related activities of daily life. METHODS: We conducted an interventional survey that included 48 patients between 40 and 80 years of age with uni- or bilateral pseudophakia, posterior capsule opacification, and visual acuity <0.30 (logMAR) in one eye who were seen at a Brazilian university hospital. All patients underwent posterior capsulotomy using an Nd:YAG laser. Before and after the intervention, patients were asked to complete a questionnaire that was developed in an exploratory study. RESULTS: Before posterior capsulotomy, the median visual acuity (logMAR) of the included patients was 0.52 (range 0.30-1.60). After posterior capsulotomy, the median visual acuity of the included patients improved to 0.10 (range 0.0-0.52). According to the subjects' perceptions, their ability to perform most of their daily life activities improved after the intervention (p<0.05). CONCLUSIONS: After patients underwent posterior capsulotomy with an Nd:YAG laser, a significant improvement in the visual acuity of the treated eye was observed. Additionally, subjects felt that they experienced less difficulty performing most of their vision-dependent activities of daily living.

Long-term visual outcomes in the Cataract-Free Zone Project in Brazil.

PURPOSE: To determine the long-term visual outcomes and causes of poor vision in the cataract population in Brazil treated in the Cataract-Free Zone Project. METHODS: Project A subjects (62 patients) were recruited in Taquaritinga, SP, 26 months after surgery. Project B subjects (34 patients) were recruited in São João da Boa Vista, SP, 43 months after surgery. All patients underwent visual screening and eye examination (examination 1). They were classified according to visual acuity in the operated eye and the causes of poor vision were diagnosed and referred for treatment. The results of these interventions were collected (examination 2) and analysed by Chi-square test. RESULTS: At examination 1 in project A, 47 of 62 patients (75.6%) had visual acuity < or = 20/100. The main causes of poor vision were refractive error (31.9%) and posterior capsule opacification (17.0%), with or without refractive error. At examination 1 in project B, 22 of 34 patients (64.7%) had visual acuity < or = 20/100. The main causes of poor vision were again posterior capsule opacification (50.0%) and refractive error (9.0%). After posterior capsulotomy with Nd:YAG laser and prescription of new corrective eyeglasses, visual acuity = 20/80 was obtained in 64.5% of patients in project A (OR = 0.18, CI = 0.07-0.41) and 70.5% of patients in project B (OR = 0.19, CI = 0.06-0.60) at examination 2. The causes of blindness in the remaining patients were identified. CONCLUSION: This type of project is effective in reducing blindness caused by cataracts in developing countries. However, long-term scheduled follow-up of operated patients is an effective means of avoiding consecutive blindness resulting from secondary cataracts and refractive changes.

Esporotricose: lesäo solitária palpebral: relato de um caso) / Sporothricosis: palpebral solitary lesion: a case report)

Os autores descrevem um caso de uma paciente portadora de esporotricose acometendo a pálpebra inferior, tratada com êxito pelo uso de iodeto de potássio. Säo feitas consideraçöes a respeito de diversos aspectos da doença.

Banco de óculos e laboratório óptico / Eye glasses bank and optic laboratory

Os autores relatam os resultados da criaçäo de um Banco de óculos e laboratório óptico com equipamento básico para montagem de óculos de baixo custo no Serviço Satélite de Oftalmologia da UNICAMP em Divinolândia, SP A óptica, inalgurada em 1988, atende a populaçäo clínica de Divinolândia, pobre em sua grande maioria. Até dezembro de 1993 foram confeccionados 4623 pares de óculos, doados ou vendidos pelo preço de US$7 a 10, com entrega média entre 2 horas a 4 dias após o exame. Propöe-se criaçäo de serviços semelhantes em Hospitais Públicos e universitários para fornecimento de óculos gratuitos ou a preço de custo às pessoas carentes.