Effect of Occlusal Splints on Posture Balance in Patients with Temporomandibular Joint Disorder: A Prospective Study.

AIM AND OBJECTIVE: Force platforms are widely used to evaluate the relationship between bodily posture and jaw positions. The aim and objective of this clinical prospective study was to evaluate the effect of occlusal splints on bodily posture using force platforms. MATERIALS AND METHODS: Forty-seven female patients with temporomandibular disorders (TMD) underwent a clinical and postural examination before and during an occlusal treatment with an upper splint. Six postural stabilometric examinations were performed under different visual conditions. Postural stability was assessed using a force platform (SATEL). Subjects were evaluated in static and dynamic conditions, with open and closed eyes, at baseline, at 1 week, and at 3 months. Changes in stabilometric parameters (sway area and sway length) were assessed and compared. RESULTS: In static and dynamic positions, the sway surface area decreased significantly after the occlusal guard placement with closed eyes (p-value, 0.012). Likewise, the sway surface area decreased significantly in the dynamic lateral position with closed eyes (p-value, 0.018) and in anteroposterior dynamic position with open eyes (p-value, 0.031). The mean sway length decreased significantly after the placement of the occlusal guard when participants were in the lateral position with open eyes (p-value, 0.025) and in the anteroposterior position with open eyes (p-value, 0.014). On a 3-month assessment, the mean surface and mean length decreased significantly after the placement of the occlusal guard for practically all the static and dynamic positions. CONCLUSION: The sway surface area and sway length decreased significantly with the use of occlusal splints Clinical significance: In female patients with TMD, the use of an occlusal splint is associated with a postural improvement evaluated by posturo-stabilometric tests.

Signos y síntomas asociados a trastornos temporomandibulares en niños y adolescentes. Cali, Colombia / Signsand symptoms associatesof temporomandibular disorders in children and adolescents. Cali, Colombia

Los trastornos temporomandibulares (TTM) en pacientes pediátricos se han estudiado poco. La necesidad de realizar un diagnóstico oportuno hace que exista mayor interés por parte de los investigadores para orientar a los odontólogos. El objetivo del presente estudio fue identificar la presencia de trastornos temporomandibularesregistrados en las historiasclínicas de pacientesatendidos en la Escuelade Odontopediatría de la Universidad del Valle(Cali, Colombia).Se realizó un estudio observacional descriptivo y transversalpara evaluar presencia de trastornos temporomandibulares en pacientes, en edades entrecuatro y14 años, que asistieron a lasclínicasde dicha escuela durante 2013 y 2016. Se revisaron 712 historias; 56% de sexo masculino y 44% de sexo femenino. Los signos y síntomas asociados con losTTMmás frecuentes fueron el clic bilateral (36,4%), la desviación y deflexión mandibular (27,1%) y el dolor a la palpación (24,0%), mientras quela subluxación (1,6%) y el chasquido articular en apertura (0,8%) fueron los de menor presencia.Se concluyó que los trastornos de la articulación temporomandibular (ATM)cada vez son mayores.Es importante, por tanto, realizar investigaciones que involucren los factores de riesgo y/o desencadenantes, la intervención oportuna y el manejo multidisciplinario de esta alteración.

Temporomandibular joint disordersin children and adolescents have been studied infrequently. The need for a timely diagnosis makesit more interesting for researchers to perform studies that advise dentists. The objective of the study was to identify the frequency of mandibular disorders in the clinical records of children and adolescents treated at the Pediatric Dentistry Clinic of the Universidad Del Valle. A descriptive and cross-sectional observational study was carried out to evaluate the prevalence of temporomandibular disorders in patients inaged 4 to 14 years attending in the Pediatric Dentistry Clinics of the University of Valle (Cali-Colombia) during January 2013 and June 2016. 712 stories were reviewed; 397 (56%) were boys and 315 (44%) girls. 129 reports of the presence of some type of TMJ level, compatible with 18.11% of the sample studied. The most prevalent signs were bilateral click (36.4%), mandibular deviation and deflection (27.1%) and pain on palpation (24.0%). In contrast, subluxation (1.6%) and the jump in ATM at opening (0.8%) were the minors. It is concluded thatdisorders increasing daily, it is necessary to carry out investigations involving risk factors and / or triggers, timely or early intervention and the multidisciplinary management that this affectation requires.

A efetividade de dois tratamentos para disfunção temporomandibular muscular: estudo piloto / The effectiveness of two treatments for muscle temporomandibular dysfunction: pilot study

Objetivo: comparar a eficácia de dois protocolos de tratamento para disfunção temporomandibular (DTM) de origem muscular. Sujeitos e método: Estudantes da Faculdade Especializada na Área de Saúde do Rio Grande do Sul foram selecionados por meio de questionário, para avaliar a presença de sinais e sintomas de DTM e diagnóstico de DTM muscular pelos Critérios de Diagnóstico para Transtornos da Pesquisa Temporomandibular. Dez estudantes compuseram a amostra, divididos em dois grupos, de acordo com o protocolo de tratamento: G1 ­ hipertermia induzida, exercícios mandibulares e massagem; e G2 ­ agulhamento seco, hipertermia induzida, exercícios mandibulares e massagem. Os alunos foram instruídos a realizar o protocolo do tratamento G1 todos os dias em casa e na instituição de ensino por três sessões, que ocorreram a cada cinquenta dias. O agulhamento seco foi realizado no G2 apenas nas segunda e terceira sessões de tratamento. Para avaliar a efetividade dos dois tratamentos antes e após cada sessão, avaliaram-se: abertura bucal (AB), por meio de régua milimetrada; dor, pela escala visual analógica; força de mordida (FM), usando um medidor de força digital; e qualidade de vida, avaliada imediatamente antes do início do tratamento e depois do término do tratamento. Resultados: a dor mostrou diferença estatística significativa no G2 após a segunda sessão (p=0,020) e a terceira sessão (p=0,047). Os demais resultados mostram que não houve diferença estatisticamente significativa entre os grupos (p>0,05). Conclusão: considera-se que neste estudo piloto ambos os tratamentos foram eficazes para DTM muscular, uma vez que todos os pacientes apresentaram melhora dos sintomas. Não houve diferença estatisticamente significativa entre os tratamentos, exceto a dor pós-procedimento, causada pela técnica do agulhamento seco. (AU)

Objective: the present study aims to compare the efficacy of two treatment protocols for temporomandibular dysfunction (TMD) of muscular origin. Subjects and method: students of the Faculdade Especializada na área de Saúde do Rio Grande do Sul, that were selected through the questionnaire to evaluate the presence of TMD signs and symptoms and diagnosis of muscular TMD from the Diagnostic Criteria for Temporomandibular Research Disorders. Ten students composed the sample, divided into two groups according to the treatment protocol: hyperthermia induced by G1, mandibular exercises and massage; G2 ‒ dry needling, induced hyperthermia, mandibular and massage exercises. Students were instructed to complete the G1 treatment protocol every day at home and at the educational institution for three sessions that occurred every fifty days. Dry needling was performed in G2 only in the second and third treatment sessions. To evaluate the effectiveness of the two treatments before and after each session, we evaluated: mouth opening (AB), through a millimeter ruler; visual analogue scale; bite force (FM) using a digital force gauge and quality of life was assessed immediately prior to initiation of treatment and after termination of treatment. Results: pain obtained a statistically significant difference in G2 after the second session (p=0.020) and the third session (p=0.047). The other results show that there was no statistically significant difference between the groups (p>0.05). Conclusion: it is considered that in this pilot study both treatments were effective for muscular TMD, since all the patients presented improvement of the symptoms. There was no statistically significant difference between treatments, except for post- -procedure pain, caused by the dry needling technique. (AU)

Value of cone-beam computed tomography in the process of diagnosis and management of disorders of the temporomandibular joint.

The objective of this study was to assess the value of cone-beam computed tomographic (CT) images in the primary diagnosis and management of 128 outpatients with disorders of the temporomandibular joint (TMJ). Before a diagnosis was made and treatment planned, the history was taken, physical examination made, and the orthopantomogram studied. After assessment of the cone-beam CT, the oral and maxillofacial surgeon (specialist or resident) was allowed to revise the provisional primary diagnosis and management. The degree of certainty was rated by the clinician before and after the cone-beam CT had been assessed. The primary diagnosis was changed in 32 patients (25%), additional diagnostic procedures were changed in 57 (45%), and the treatment was changed in 15 (12%) (in 4 the treatment was changed to a (minimally) invasive procedure). A total of 74 patients (58%) had their diagnosis and management changed after the cone-beam CT had been assessed. Changes in diagnosis and management were clinically relevant in 9/32 and 9/61 patients, respectively. The clinician's certainty about the primary diagnosis increased after the cone-beam CT had been assessed in 57 patients. Logistic regression analysis showed that the odds in favour of changes in primary diagnosis and management increased when limited mandibular function was a primary symptom, the patient was taking medication for pain, and the articular eminence could not be assessed on OPT. Assessment of cone-beam CT led to changes in primary diagnosis and management in more than half the patients with disorders of the TMJ.