Comparative analysis of temporomandibular joint morphology in degenerative joint disease: A cone-beam CT study in patients with and without arthralgia.

This cross-sectional study aimed to compare, by using Cone-Beam Computed Tomography (CBCT), temporomandibular joint (TMJ) morphology among patients with degenerative joint disease (DJD) with or without arthralgia, as well as a control group. METHODS: Thirty-one patients and their respective CBCT TMJ exams were assessed. These individuals were selected from an Orofacial Pain Service and classified into three groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): group 1 (10 patients with TMJ DJD and arthralgia), group 2 (11 patients with TMJ DJD without pain), and group 3 (the control group, consisting of 10 healthy individuals without any signs or symptoms of TMD). A second examiner, who was calibrated and blinded for the patient's diagnosis, evaluated the CBCT images. RESULTS: Group 1 showed a statistically significant association with the variables of erosion (p = 0.003) and osteophyte (p = 0.04) on the condyle surface, as well as concentric condyle position with reduced joint space (p = 0.01). The Kappa concordance index between the clinical diagnosis of DC/TMD and CBCT images was k = 0.134 (p ≤ 0.001). CONCLUSION: The presence of erosion, osteophyte, and concentric condyle position with reduced joint space was statistically associated with DJD and ongoing TMJ joint pain.

Telediagnosis as an effective tool for assessment temporomandibular disorders.

BACKGROUND: The use of communication technologies has allowed a substantial improvement in telediagnosis. OBJECTIVES: To evaluate the feasibility and diagnostic agreement of synchronous teleconsultation compared to physical standard examination for temporomandibular disorders (TMD) and orofacial pain. METHODS: Sixty-one patients (50 women, 11 men) with a mean age of 46.07 years referred to the Orofacial Pain Ambulatory Service (SAMDOF -UFPR) were evaluated remotely. They were then examined in person by another evaluator, blinded for the first evaluation. Data on the experience and level of satisfaction with the teleconsultation were also collected. RESULTS: For each type and subtype of TMD, diagnostic agreement values, sensitivity, specificity, positive predictive values and negative predictive values were calculated with a 95% confidence interval. 'Almost perfect' agreement was found for Myalgia (k = 0.915), Arthralgia (k = 0.863), disc displacement without reduction without limited opening (k = 0.955) and no TMD (k = 1.00). 'Substantial' agreement for the subtypes headache attributed to TMD (k = 0.761), disc displacement without reduction with limited opening (k = 0.659) and subluxation (k = 7.82). The diagnoses of local myalgia (k = 0.573), myofascial pain with referral (k = 0.524) and disc displacement with reduction (k = 0.563) obtained 'moderate' agreement. Degenerative joint disease (k = 0.170) and disc displacement with reduction with intermittent locking (k = 0.000) obtained 'weak' and 'no agreement', respectively. More than 90% of the participants were satisfied and reported no discomfort during the assessment, agreeing to participate in another teleconsultation. CONCLUSION: Synchronous teleconsultation proved to be feasible and presented adequate diagnostic agreement for the main painful TMDs, especially for the diagnosis of myalgia and arthralgia. This format was also well accepted among patients.

Childhood and Adolescents Sleep Bruxism Treatment: A Systematic Review.

Introduction Sleep Bruxism (SB) is a common condition in childhood that can cause multiple consequences such as abnormal tooth wear, tensional headaches, masticatory muscle pain, or fatigue. The literature reports some interventions, however the treatment for SB in children is not well-established. Objectives A systematic review was performed to investigate the effectiveness of the treatments described for SB in children and adolescents: pharmacological and psychological treatments; behavioral guidelines; and dental approaches. Materials and methods Randomized clinical trials comparing different SB treatments with a control group were searched in the electronic databases PubMed, Scopus, Web of Science, Cochrane Library, and VHL until August 04, 2021. Two independent reviewers selected the studies, extracted the data, and assessed the risk of bias. After a two-phase selection process, 07 articles were selected. The methodology of the selected studies was analyzed using the Cochrane Risk of Bias Tool. The criteria used to qualify the studies were based on randomization, allocation, blinding of participants and evaluators, and analysis of results. Results The signs and symptoms of SB were reduced with pharmacotherapy (hydroxyzine/diazepam) and medicinal extracts ( M. Officinalis ), but with occlusal splints and physiotherapy, this improvement was not statistically significant when compared to control groups. Conclusion Some evidence of the efficacy of pharmacotherapy (hydroxyzine/diazepam) and medicinal extracts ( M. Officinalis ) was found. However, this systematic review is not enough to establish a protocol for the treatment of SB. Besides, the individualized management of SB in this population should be considered, emphasizing the management of risk factors.

Probable awake bruxism - prevalence and associated factors: a cross-sectional study.

INTRODUCTION: Bruxism is defined as a repetitive activity of masticatory muscles, characterized by the clenching or grinding of the teeth, which can occur during wakefulness (awake bruxism) or during sleep (sleep bruxism). OBJECTIVES: The objectives of the present study were to determine the prevalence of awake bruxism and its associated factors. METHODS: Sample was composed by 50 participants of both genders, aged between 18 and 60 years, submitted to a clinical examination - to observe the presence of tooth wear, marks on the mucosa, or masseter muscles hypertrophy - and self-applied questionnaires, which evaluated the presence of TMD signs and symptoms, oral behaviors, lifestyles, anxiety level and sleep quality. RESULTS: The prevalence of awake bruxism was 48%. Its presence was statistically and significantly associated with the presence of signs and symptoms of TMD (p= 0.002), poor sleep quality (p = 0.032), buccal mucosa indentations (p < 0.001) and tongue (p = 0.011). Age, gender, social characteristics, habits (such as coffee ingestion, smoking, alcoholism and physical activity) and tooth wear were variables that had no significant association with awake bruxism. CONCLUSIONS: It was concluded that awake bruxism shows a high prevalence and a positive association with signs and symptoms of TMD and worst sleep quality. In addition, awake bruxism is more likely to occur in individuals who have buccal mucosa indentation and who present high rates of oral habits and oral behaviors.

Interexaminer reliability for tomographic findings in temporomandibular joint degenerative disease and its agreement with clinical diagnosis: a blinded controlled cross sectional study.

OBJECTIVES: The aim of this study was to evaluate the interexaminer reliability for tomographic findings in degenerative temporomandibular joint disease and its agreement with clinical diagnosis. METHODS: Women aged 18 and 60 years were invited to participate in this research. All participants were evaluated by a single experienced examiner according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Group 1 was comprised of TMJs with Degenerative Joint Disease (DJD). Group 2 was comprised of healthy TMJs, without any signs and/or symptoms of TMD. All CBCT images were evaluated by 2 calibrated examiners for the image evaluation criteria but blinded for the clinical diagnosis. RESULTS: From the 194 women evaluated, 41 were included, with a mean age of 35.23 (± 14.06) years. Group 1 was comprised of 26 TMJs with DJD and group 2 of 36 asymptomatic TMJs. The interexaminer reliability was κ = 0.706 (p < 0.000), while agreement between clinical and tomographic findings were κ = 0.301 (p = 0.01) and κ = 0.273 (p = 0.02) for each examiner. The use of CBCT as a diagnostic test had shown sensitivity and specificity values of 61.5% and 75%, respectively. CONCLUSIONS: The interexaminer reliability for tomographic findings was strong. However, the agreement between clinical and tomographic findings was reasonable, for both examiners.

Probable awake bruxism - prevalence and associated factors: a cross-sectional study

ABSTRACT Introduction: Bruxism is defined as a repetitive activity of masticatory muscles, characterized by the clenching or grinding of the teeth, which can occur during wakefulness (awake bruxism) or during sleep (sleep bruxism). Objectives: The objectives of the present study were to determine the prevalence of awake bruxism and its associated factors. Methods: Sample was composed by 50 participants of both genders, aged between 18 and 60 years, submitted to a clinical examination - to observe the presence of tooth wear, marks on the mucosa, or masseter muscles hypertrophy - and self-applied questionnaires, which evaluated the presence of TMD signs and symptoms, oral behaviors, lifestyles, anxiety level and sleep quality. Results: The prevalence of awake bruxism was 48%. Its presence was statistically and significantly associated with the presence of signs and symptoms of TMD (p=0.002), poor sleep quality (p=0.032), buccal mucosa indentations (p<0.001) and tongue (p=0.011). Age, gender, social characteristics, habits (such as coffee ingestion, smoking, alcoholism and physical activity) and tooth wear were variables that had no significant association with awake bruxism. Conclusions: It was concluded that awake bruxism shows a high prevalence and a positive association with signs and symptoms of TMD and worst sleep quality. In addition, awake bruxism is more likely to occur in individuals who have buccal mucosa indentation and who present high rates of oral habits and oral behaviors.

RESUMO Introdução: O bruxismo é definido como a atividade repetitiva dos músculos mastigatórios, e pode ocorrer durante o período acordado (bruxismo em vigília) ou durante o sono (bruxismo do sono). Objetivo: O presente estudo teve como objetivo avaliar a prevalência de bruxismo em vigília e seus fatores associados. Métodos: A amostra foi composta por 50 participantes, de ambos os sexos, com idades de 18 a 60 anos, avaliados por meio de minucioso exame clínico - para observar se havia presença de sinais como desgaste dentário, indentações na mucosa, hipertrofia do músculo masseter - e de questionários autoaplicáveis que visaram avaliar a presença de sinais e sintomas de disfunção temporomandibular (DTM), os comportamentos orais e hábitos de vida, o nível de ansiedade e a qualidade de sono dos participantes. Resultados: A prevalência de bruxismo em vigília foi de 48%. Sua presença foi associada, estatística e significativamente, com a presença de sinais e sintomas de DTM (p=0,002), má qualidade do sono (p=0,032), e indentações na mucosa jugal (p<0,001) e língua (p=0,011). Por outro lado, a idade, sexo, características sociais, hábitos (como ingestão de café, fumo, álcool e prática de atividade física), e o desgaste dentário foram variáveis que não tiveram associação com o bruxismo em vigília. Conclusão: Diante disso, conclui-se que o bruxismo em vigília possui uma prevalência significativa e uma associação positiva com DTM e qualidade do sono. Além disso, o bruxismo em vigília apresenta maior probabilidade de acontecer em indivíduos com indentação de mucosa jugal e com alta prevalência de hábitos e comportamentos orais.

Audiological Evaluation of Patients With Somatosensory Tinnitus Attributed to Temporomandibular Disorders.

Purpose Tinnitus and temporomandibular disorders have already been associated in the literature, but despite many studies, it is still an intriguing discussion point. This study aimed to evaluate the prevalence of hearing loss among somatosensory tinnitus patients with temporomandibular disorders and to assess the influence of tinnitus on patients' quality of life. Method An otolaryngologist examined 585 patients in order to detect and evaluate the presence of tinnitus. Subjects were evaluated using the Portuguese version of the Research Diagnostic Criteria for Temporomandibular Disorders. An analysis of the somatic component of tinnitus was performed. Tinnitus was rated according to its onset (at least 6 months) and intensity with a visual analog scale. The sample was composed of 100 patients with somatosensory tinnitus divided into two groups: Group 1 (with temporomandibular disorder, n = 85) and Group 2 (without temporomandibular disorder, n = 15). The audiological evaluation was composed of pure-tone audiometry, high-frequency audiometry, tympanometry, and transient-evoked otoacoustic emissions. The impact of tinnitus on quality of life was assessed by the Tinnitus Handicap Inventory adapted and validated to Portuguese language. Results Pure-tone audiometry did not differ with statistical significance between groups (p = .29), neither did the high-frequency audiometry results (p = .74). Tinnitus Handicap Inventory scores also did not show any differences between Groups 1 and 2 (p = .67). Conclusions Subjects with somatosensory tinnitus, who also have temporomandibular disorders, do not seem to have hearing impairment. Also, they do not have a higher quality of life handicap when compared to those without tinnitus and temporomandibular disorder.

Prevalence of Temporomandibular Disorders and Anxiety State Levels in Ballet Dancers A Cross-Sectional Study.

This study evaluated the prevalence of temporomandibular disorders (TMDs) in ballet dancers and explored their association with levels of anxiety. Participants were 51 male and female ballet dancers with a mean age of 31.5 ± 12.6 years. The diagnosis of TMDs was made in accordance with Research Diagnostic Criteria for Temporomandibular Joint Disorders (RDC/TMD). All subjects completed the state part of an anxiety questionnaire (STAI). Data were gathered and analyzed using the R statistical software (version: 3.4.0.) with level of significance set at 5%. The prevalence of all TMDs in the sample was 78%; that is, of the 51 participants, 39 had at least one positive diagnosis. The two most prevalence diagnoses were disk displacement with reduction and arthralgia. Individuals with TMD had a mean anxiety score of 42.55 ± 9.92 on the STAI, whereas for those without TMD it was 44.27 ± 11.89, with no statistically significant difference (p = 0.53). It is concluded that the general prevalence of TMDs in ballet dancer is higher than in the population at large. Disk displacement with reduction and arthralgia are the most common TMDs, and the presence of TMDs does not seem to affect anxiety state levels in this population.

Diagnostic validity of CT to assess degenerative temporomandibular joint disease: a systematic review.

OBJECTIVES: The aim of this systematic review was to answer the focus question: "In subjects with degenerative joint disease (DJD) of the temporomandibular joint (TMJ), what is the diagnostic validity of CT or cone-beam CT (CBCT) compared with clinical protocols"? METHODS: DJD should be assessed through clinical diagnosis according to RDC/TMD or DC/TMD. Search strategies were specifically developed to the following electronic databases: Cochrane, Latin American And Caribbean Health Sciences (LILACS), PubMed (including Medline), Scopus and Web of Science. Furthermore, partial grey literature search through Google Scholar, OpenGrey and ProQuest was performed. The risk of bias was evaluated using the second version of Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). RESULTS: The databases search revealed 454 records. After applying the eligibility criteria, four studies were included in this review. All studies were methodologically acceptable, although none of the them fulfilled all criteria of risk of bias according to QUADAS-2. Despite there were some high values for sensitivity and specificity, they were not homogeneous between studies. Regarding specificity outcomes, there were three studies with poor values and only one considered as excellent. CONCLUSIONS: CBCT could be a good image to evaluate DJD progression over time, but should not be used as a screening tool in healthy individuals.

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.

Quality of life in chronic trigeminal neuralgia patients / Qualidade de vida em pacientes com neuralgia trigeminal crônica

ABSTRACTBACKGROUND AND OBJECTIVES:Trigeminal neuralgia is a debilitating painful condition found in some patients. It is classified as neuropathic episodic pain, reported as “electric shock”, “burning” and/or “tingling”. This study aimed at evaluating the impact of trigeminal neuralgia on quality of life and its association with pain duration.METHODS:Participated in the study 20 patients above 40 years of age, who were divided in two groups. Group I was was comprised of 10 trigeminal neuralgia patients and group II of healthy painless patients. All patients have filled a visual analog scale about pain severity and the Oral Health Impact Profile questionnaire about quality of life. Group I patients were also asked about time of pain onset. Data were recorded and submitted to statistical analysis (Spearman correlation and Mann-Whitney tests).RESULTS:Trigeminal neuralgia significantly and negatively impacts quality of life (p≤0.01). However, neither pain intensity nor pain duration seem to be associated with this result.CONCLUSION:Trigeminal neuralgia negatively impacts quality of life regardless of pain intensity.

RESUMOJUSTIFICATIVA E OBJETIVOS:A neuralgia trigeminal é uma condição dolorosa debilitante encontrada em alguns pacientes. É classificada como uma dor neuropática episódica, reportada como “choque elétrico”, “queimação” e/ou “formigamento”. O objetivo deste estudo foi avaliar o impacto da neuralgia trigeminal na qualidade de vida e sua associação com o tempo de dor.MÉTODOS:Foram avaliados 20 pacientes, acima de 40 anos, divididos em 2 grupos. O grupo I foi formado por 10 pacientes com neuralgia trigeminal e o grupo II por 10 pacientes saudáveis, sem dor. Todos os pacientes preencheram uma escala analógica visual sobre a gravidade da dor e o questionário Oral Health Impact Profile sobre qualidade de vida. Os pacientes do grupo I também foram questionados sobre o tempo de início da dor. Os dados foram registrados e submetidos a análise estatística (testes de correlação de Spearman e de Mann-Whitney).RESULTADOS:A presença da neuralgia trigeminal tem impacto significativo e negativo na qualidade de vida (p≤0,01). No entanto, nem a intensidade da dor, nem o tempo de dor parecem estar associados a esse resultado.CONCLUSÃO:A neuralgia trigeminal exerce um impacto negativo na qualidade de vida, não importando a intensidade da dor.

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

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.