Temporomandibular disorder in individuals with spinal cord injuries.

OBJECTIVE: This study evaluated Temporomandibular Disorder (TMD) in individuals with Spinal Cord Injuries (SCI) compared to individuals without physical disabilities. DESIGN: Cross-sectional. SETTING: International Fair of Technologies in Rehabilitation and Accessibility (REATECH) and School of Dentistry at the University of São Paulo (USP), Brazil. PARTICIPANTS: In total, 19 patients with SCI and 19 patients without SCI (36.9 ± 11.4 years old) were examined by a calibrated examiner. METHODS: using the following parameters: cervical spine mobility, palpation of muscle groups of the head and neck, functional manipulation of the lateral and medial pterygoids, and joint palpation (Diagnostic Criteria). The pattern and amplitude of mandibular movements were determined during screening using the Helkimo index. STATISTICAL ANALYSES: Student's t-test, chi-square, Fisher's exact and Shapiro-Wilk test were used. RESULTS: The groups did not differ in the presence of noise, pain, temporomandibular joint palpation, locking, dislocation, jaw pain, muscle sensitivity, or in pain, mobility of the cervical spine and functional manipulation. With respect to the jaw mobility index, the groups differed in range of movement (P = 0.020) and maximum right lateral movement (P = 0.007), with the worst values in the SCI group. The groups also differed in relation to lateral flexion in cervical mobility, in which the group without SCI presented better results (P = 0.046). CONCLUSION: The Spinal Cord Injuries group showed higher levels of TMD in terms of range of movement, lateral flexion, and maximum right lateral movement, than the individuals without physical disabilities, demonstrating a clinical significance between cervical and mandibular disability in this group.

Association between symptoms of depression and oral health conditions.

AIMS: To investigate the symptoms of depression and oral health status in Brazilian public healthcare system users. MATERIALS AND METHODS: Analysis of a cross-sectional study conducted with a sample of 776 individuals aged 15 years or older, in the urban areas of Recife (Brazil), obtained by multistage sampling. Committee on Ethics in Research with Human Beings (CAAE) 0538.0.172.172-11. Depression symptoms were verified by means of Axis II of the Research Diagnostic Criteria in Temporomandibular Disorder. For the socioeconomic level, the economic classification criteria of the Brazilian Association of Research Companies and clinical exam record charts were used to establish variables related to oral health conditions. RESULTS: The variables discomfort on occlusion (OR = 1.882 CI = 1.384-2.560), gingival bleeding (OR = 1.384 CI = 1.002-1.912), and self-perception of oral health (OR = 1.549 CI = 1.054-2.277), remained in the regression model. CONCLUSION: Discomfort on occlusion, self-perception of oral health, gingival bleeding, sex, and skin color were shown to be associated with the presence of depressive symptoms.

Patients with mucopolysaccharidosis have tendencies towards vertical facial growth.

PURPOSE: Studies addressing the changes in craniofacial morphology of patients with mucopolysaccharidosis (MPS) are important for a better understanding of the progression of this disease. The present objective was to identify major cephalometric abnormalities in these patients. MATERIALS AND METHODS: This was a cross-sectional case-and-control study. The sample was composed of 2 types of study subjects (patients with MPS and normal subjects). The outcome variables were numerous cephalometric elements that measure facial height, dental positioning, facial growth pattern, and mandibular and maxillary positioning. The Student t test was used to compare the mean angular and linear measurements of the case and control groups and the level of significance was set at a P value less than .05. The Bonferroni method was used for adjustment of the P value (P<.003 was deemed significant). RESULTS: The control group consisted of randomly selected subjects matched to the patients with MPS for the demographic variables of gender and age. Seventeen patients with MPS were evaluated (64.7% female). The mean age of the sample was 13.29 years. One patient had MPS I, 8 had MPS IV, and 8 had MPS VI. The results showed important differences between groups in angular measurements (angle formed by the line between the sella and nasion [SN] and the plane of the gonion and gnathion, angle formed by the intersection of the gnathion point and the SN line, angle formed by the intersection of the long axis of the lower incisor with the line between the nasion and the B point, angle formed by the intersection of the long axes of the upper and lower incisors, and angle formed by the Frankfort horizontal plane with the mandibular plane) and linear measurements (condyle to A point, condyle to gnathion, pro-nasal ( Pn) point to the line between the pogonion and upper incisor, and the nearest point of the anterior half of the soft palate to the posterior pharyngeal wall). The angle formed by the SN line with the plane between the gonion and the gnathion and the distance from the condyle to the A point showed meaningful differences after Bonferroni adjustment. CONCLUSION: Patients with MPS present a tendency toward vertical growth that results in a dolichocephalic facial pattern. In addition, a smaller nasopharyngeal space was observed, a factor that might be responsible for the mouth breathing observed in these patients.

Pulp sensibility test in elderly patients.

BACKGROUND: The ageing process transforms the histological composition of the dental pulp and may affect the response to pulp sensibility tests. OBJECTIVES: The aim of this study was to assess the influence of age on pulp response time and on pain intensity. MATERIAL AND METHODS: Fifty elderly patients and 50 young patients were selected. Different classes of teeth were evaluated. The pulp sensibility test was performed with a refrigerant spray. The pulp response time was measured in seconds and the pain intensity was assessed by visual analogue scale. RESULTS: The Spearman coefficient was calculated and detect a positive correlation between age and pulp response time for maxillary incisors, premolars, mandibular incisors, and mean (p < 0.05). On the contrary, there was a negative correlation between age and pain intensity for maxillary incisors, mandibular incisors, and mean (p < 0.05). Also, the results of elderly and young groups were compared by Mann-Whitney test. Significant difference was noted regarding the pulp response time for maxillary incisors, premolars, mandibular incisors, and mean (p < 0.05). Significant difference was detected regarding the pain intensity for mandibular incisors only (p < 0.05). CONCLUSIONS: Pulp response time increases when people get older while pain intensity decreases. There were variations among the classes of teeth.

Quality of life of patients undergoing surgery by videolaparoscopy for GERD treatment.

BACKGROUND: Gastroesophageal reflux disease is a chronic disease of high prevalence in Western countries, with negative effects on quality of life. Surgery is indicated for patients with intolerance to continuous medication, prolonged treatment or control, or in complicated forms of the disease. AIM: To evaluate the quality of life of patients undergoing surgery by videolaparoscopy for gastroesophageal reflux disease treatment. METHODS: Sample comprised 43 patients of both genders (mean age = 51.4 years). For quality of life evaluation was made using the questionnaire Gastroesophageal Reflux Disease Health Related Quality of Life, translated and validated into Portuguese. Data were analyzed by Epi Info version 3.5.1, using Duncan test and Pearson's correlation coefficient, with 5% for null hypothesis (p ≤ 0.05). RESULTS: Over 50% of participants showed good quality of life (scores <5 of the questionnaire), more than 90% indicated satisfaction with their health. A significant positive correlation between most variables related to heartburn and the time after surgery was observed (p ≤ 0.05). CONCLUSION: Patients presented good quality of life and high level of satisfaction with their postoperative condition.

Drug-induced gingival enlargement: biofilm control and surgical therapy with gallium-aluminum-arsenide (GaAlAs) diode laser-A 2-year follow-up.

Drug-induced gingival enlargement has been reported in patients treated with various types of anticonvulsant drugs, and is generally associated with the presence of plaque, gingival inflammation, and a genetic predisposition. Effective treatment includes daily oral hygiene and periodic professional prophylaxis. However, in some patients, surgical removal of the gingival tissue overgrowth becomes necessary. The patient in this case report was mentally impaired and had severe drug-induced gingival enlargement. This report describes the initial protocol, the gingivectomy, and a 2-year follow-up. A diode laser was used as an effective and safe method to remove the patient's overgrown gingival tissue.

The use of surgical diode laser in oral hemangioma: a case report.

OBJECTIVE: To review the literature regarding the use of surgical lasers in hemangioma treatment and to report a clinical case involving diode laser. BACKGROUND: Hemangiomas are benign vascular proliferations consisting of numerous capillary structures and are especially common on the tongue, lips, jugal mucous membrane, and gums. A number of treatment modalities have been proposed for hemangioma treatment. METHODS: The patient was referred for evaluation complaining of chewing difficulty because of swelling in the right area of the upper lip, with no previous trauma. The lesion was located in the internal right jugal mucous membrane, measured 4 x 4 cm(2), presented a bluish coloration, and was diagnosed as a hemangioma. The treatment selected was surgical removal using gallium arsenide (GaAs) diode laser at 980 nm wavelength, with 4.0 W of power. RESULTS: During surgery, complications including hemorrhage were not observed, and no scarring developed after surgery. CONCLUSIONS: The use of GaAs high-potency diode laser in the treatment of hemangioma reduced bleeding during surgery, with a consequent reduction in operating time, and promoted rapid postoperative hemostasis. It is safe for use on large lesions and easy to manage, and postoperative problems, including potential scarring, and discomfort are minimal.

Traumatic dental injuries in individuals with cerebral palsy.

BACKGROUND: Cerebral palsy (CP) is one of the most frequent conditions encountered in the daily practice of dentists who treat special-needs individuals and it seems that traumatic dental injuries are often present in these cases. The aim of this study was to investigate and describe the prevalence related to traumatic dental injury (TDI) in individuals with CP attending rehabilitation treatment at the Lar Escola Sao Francisco Rehabilitation Center in São Paulo, Brazil. MATERIAL AND METHODS: The sample included 100 individuals with a medical diagnosis of CP (SG) aged 1-15 years (mean 7 years 2 months +/-SD 3 years 4 months) and 100 non-disabled individuals (CG), aged 1-15 years (mean 7 years 5 months +/- SD 4 years 0 month), presenting the same socioeconomic level as SG. Data were collected through clinical examinations according to Andreasen criteria and interviews. RESULTS: According to the Gross Motor Function Classification, the SG presented 34.0% of individuals that walked with or without assistive mobility devices and 66.0% required a wheelchair for mobility. The TDI prevalence observed for CG was 32.0% (n = 32), with 20.0% (n = 20) for SG, showing no statistically significant difference (P = 0.053). For both groups, the teeth most affected were the maxillary central incisors. Crown fracture without pulp exposure was the most frequent type of injury (31.2%) in CG and enamel fracture (30.0%), in SG. The groups differed significantly regarding dental treatment received after TDI (P = 0.012), with CG presenting higher percentages of treated individuals CONCLUSIONS: The data suggest that the TDI prevalence in individuals presenting CP and attending rehabilitation treatment was similar compared with non-disabled individuals, but they received less treatment.

Occlusal characteristics in cerebral palsy patients.

PURPOSE: The purpose of this study was to evaluate the occlusal characteristics of 104 randomly selected, noninstitutionalized patients with a medical diagnosis of cerebral palsy (CP). METHODS: Patients were grouped according to the CP motor disorder and clinical patterns. Occlusal characteristics were collected by one examiner. Nonparametric statistical tests, including Fisher's exact test (P) and chi-square test were used. RESULTS: The results showed that Class II molars were statistically higher (P<.05) for spastic patients. Anterior open bite and an increased overjet were significant (P<.01) in spastic patients with clinical patterns of quadriplegia, double-hemiplegia, and diplegia. Double hemiplegia patients presented a higher incidence of open bite (64%) with an edge-to-edge overjet (45%). A deep overbite was presented in athetoid (50%) and ataxic (67%) patients. A high incidence of tooth wear was observed in the athetoid group (54%). CONCLUSION: Spastic patients presented a high incidence of open bite and Class II malocclusion. A low level of malocclusion was observed in the ataxic group compared to the other groups studied. Further studies would be useful to determine if neurological injuries can be the cause of changes of the craniofacial growth and development patterns resulting in malocclusion in cerebral palsy patients.

Use of cryotherapy to enhance mouth opening in patients with cerebral palsy.

This study was conducted to assess the effect of cryotherapy on masseter spasticity on mouth opening, which is required for oral hygiene and dental treatment. The inter-incisal distance was measured before cryotherapy in 24 patients with cerebral palsy who had spasticity of the tetraparesis type. Ice was then applied on the skin surface with sliding movements over the masseter, bilaterally for one minute. Inter-incisal distance was then measured again. The results showed a significant increase of the inter-incisal distance after the application of cold to the masseter. We conclude that the action of cryotherapy on the masseter muscle produced a temporary reduction of spasticity, facilitating access to the occlusal and palatal surfaces of the maxillary molars. This improved access can be useful during dental treatment as well as preventive dental care such as oral hygiene.

Risk factors for dental caries in children with cerebral palsy.

This study was conducted to examine the oral condition and the salivary and microbiological parameters associated with dental caries in 62 children with cerebral palsy, who came from households of low socioeconomic status (Study Group). This group had mixed (6 to 11 years old) and permanent (11 to 16 years old) dentition. Dental examinations were performed to measure dental caries, plaque index, salivary levels of mutans streptococci and lactobacilli, salivary flow rate, pH of stimulated saliva, and buffer capacity of saliva. A group of 67 non-handicapped children from similar socioeconomic backgrounds also were examined using these parameters (Control Group). Data were analyzed statistically by non-parametric tests and by correlation. The results showed that children with cerebral palsy who had permanent dentitions had a higher mean decayed, missing and filled surfaces index, as well as a higher plaque index for both sexes. Microbiological examination revealed higher levels of mutans streptococci among Study Group subjects with mixed dentition than in the Control Group. Also, lactobacillus counts were higher in the Study Group, regardless of sex or dentition. With respect to salivary flow rate, pH and buffering capacity, lower mean values were obtained for the Study Group.