Custo-Efetividade de Diferentes Tratamentos Minimamente Invasivos Para Disfunção Temporomandibular de Origem Articular sob a Perspectiva do Sistema Público de Saúde Brasileiro.

OBJECTIVE: This study aimed to evaluate the cost-effectiveness (CE) of minimally invasive interventions for pain associated with articular temporomandibular dysfunction from the Brazilian Public Health System (SUS) perspective. METHODS: This is a CE study with a 1-year time horizon. Effectiveness data were extracted from a network meta-analysis, and 2 treatments with moderate levels of evidence certainty were evaluated: arthrocentesis (ARTRO) plus intra-articular corticosteroid (CO) injection and ARTRO plus intra-articular injection of sodium hyaluronate (SH). For CE analysis, the costs of 2 types of SH (low and high molecular weight) and 4 COs (betamethasone [B], dexamethasone acetate [D], methylprednisolone sodium succinate [M], or triamcinolone hexacetonide [T]) were considered. Modeling was conducted using TreeAge Pro Healthcare software, with the construction of a decision tree representing a hypothetical cohort of adults with articular temporomandibular dysfunction. Deterministic and probabilistic sensitivity analyses were performed. In addition, an acceptability curve was developed. RESULTS: The total costs per joint for ARTRO plus low- and high-molecular-weight SH and ARTRO plus COs B, D, M, and T were, respectively, R$583.32, R$763.85, R$164.39, R$133.93, R$138.57, and R$159.86. ARTRO plus dexamethasone acetate was considered cost-effective, with lower cost and higher net monetary benefit than other technologies. In all sensitivity analysis scenarios, it remained cost-effective. It also showed greater acceptability. CONCLUSION: ARTRO plus dexamethasone acetate was considered the cost-effective technology, exhibiting higher net monetary benefit and higher acceptability from the SUS perspective.

Prevalence of temporomandibular joint dysfunction in patients with ankylosing spondylitis and comparison of the findings with healthy controls

SUMMARY OBJECTIVE: This study aimed to assess the prevalence of temporomandibular dysfunction in ankylosing spondylitis patients and healthy controls, examining the relationship between temporomandibular dysfunction and disease activity in ankylosing spondylitis patients, as well as associations with psychosocial factors. METHODS: The study included 113 ankylosing spondylitis patients and 110 healthy individuals aged 18-75. Temporomandibular dysfunction presence was evaluated using Diagnostic Criteria for Temporomandibular Disorders Axis I. Disease activity was assessed with the Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index, and Bath Ankylosing Spondylitis Functional Index. RESULTS: Among healthy individuals, 60.9% did not receive a temporomandibular dysfunction diagnosis, while 39.1% received at least one diagnosis. In contrast, 69.9% of the 113 ankylosing spondylitis patients received at least one temporomandibular dysfunction diagnosis, and only 30.1% were not included in any diagnosis group (p<0.001). Joint (p=0.001) and pain disorders (p=0.008) were significantly more common in the ankylosing spondylitis group than in the healthy controls. Significant associations emerged between Bath Ankylosing Spondylitis Disease Activity Index (p<0.001) and Bath Ankylosing Spondylitis Functional Index (p=0.005) scores and pain disorders. CONCLUSION: Temporomandibular dysfunction is more prevalent in ankylosing spondylitis patients than in healthy individuals, linked to increased joint issues and pain associated with disease activity. ClinicalTrials.gov ID: NCT05839925.

Auriculotemporal neuralgia overlapped with chronic orofacial myofascial pain: A case report of a challenging diagnosis.

AIM: Auriculotemporal neuralgia (AN) is a rare condition characterized by severe, stabbing, unilateral pain inadequately described in the literature. Often coexisting with other conditions sharing the same innervation, and this overlap complicates clinical interpretation, leading to diagnostic errors and inappropriate therapeutic choices. The absence of AN in headache and facial pain diagnostic criteria hampers access to crucial information for diagnostic reasoning.Thus, we aimed to report a case of AN overlapped with another orofacial pain condition. METHOD AND RESULT: We present a case of overlap between chronic orofacial myofascial pain (MP) and AN, where conservative MP treatment did not provide the patient with complete pain relief. After diagnosing AN, a single anesthetic block induced complete pain remission over a 2-year follow-up. CONCLUSION: These findings support reintroducing AN into diagnostic criteria, aiding clinicians in diagnostic reasoning, and preventing unnecessary interventions.

PAINe: An Artificial Intelligence-based Virtual Assistant to Aid in the Differentiation of Pain of Odontogenic versus Temporomandibular Origin.

INTRODUCTION: Pain associated with temporomandibular dysfunction (TMD) is often confused with odontogenic pain, which is a challenge in endodontic diagnosis. Validated screening questionnaires can aid in the identification and differentiation of the source of pain. Therefore, this study aimed to develop a virtual assistant based on artificial intelligence using natural language processing techniques to automate the initial screening of patients with tooth pain. METHODS: The PAINe chatbot was developed in Python (Python Software Foundation, Beaverton, OR) language using the PyCharm (JetBrains, Prague, Czech Republic) environment and the openai library to integrate the ChatGPT 4 API (OpenAI, San Francisco, CA) and the Streamlit library (Snowflake Inc, San Francisco, CA) for interface construction. The validated TMD Pain Screener questionnaire and 1 question regarding the current pain intensity were integrated into the chatbot to perform the differential diagnosis of TMD in patients with tooth pain. The accuracy of the responses was evaluated in 50 random scenarios to compare the chatbot with the validated questionnaire. The kappa coefficient was calculated to assess the agreement level between the chatbot responses and the validated questionnaire. RESULTS: The chatbot achieved an accuracy rate of 86% and a substantial level of agreement (κ = 0.70). Most responses were clear and provided adequate information about the diagnosis. CONCLUSIONS: The implementation of a virtual assistant using natural language processing based on large language models for initial differential diagnosis screening of patients with tooth pain demonstrated substantial agreement between validated questionnaires and the chatbot. This approach emerges as a practical and efficient option for screening these patients.

Can treatment with chondroitin and glucosamine sulphate prevent changes in the articular disc caused by temporomandibular joint osteoarthritis?

BACKGROUND: Chondroitin and glucosamine sulphates (CGS) are considered structure-modifying drugs and have been studied in the prevention, delay or reversal of structural morphological changes in joints caused by osteoarthritis. OBJECTIVE: The aim of the present study was to investigate the action of CGS on the progression of chemically induced osteoarthritis in the temporomandibular joint (TMJ) of rabbits by evaluating the serum levels of tumour necrosis factor (TNF-α) and collagen in the articular discs. MATERIALS AND METHODS: A sample of 36 male rabbits was divided into three groups: control (CG), osteoarthritis (OG) and treatment (TG). The disease was induced by intra-articular injection of sodium monoiodoacetate (10 mg/mL) in the OG and TG groups bilaterally. After 10 days, the TG animals received subcutaneous injection of chondroitin sulphates and glucosamine (7.5 mg/kg) and the OG and CG received saline solution (50 µL). Euthanasia times were subdivided into 40 and 100 days. Collagen quantification was performed by biochemical and histological analysis and for the quantification of serum levels of TNF-α, an enzyme immunoassay was used. RESULTS: The TG showed an increase in the collagen area of the articular disc when compared to the CG and the OG. The increase collagen concentration in the discs did not show a statistically significant difference between the groups. Post-treatment TNF-α levels were significantly lower in TG compared to OG. CONCLUSIONS: The results indicate that CGS treatment delayed the degeneration of the collagen in the TMJ articular disc and reduced serum TNF-α levels, indicating a preventive effect on OA progression.

Intra-articular and intraosseous approach to temporomandibular joint-targeted injections: a cadaveric investigation.

PURPOSE: Temporomandibular joint osteoarthritis (TMJ-OA) management is complex, and several conservative and minimally invasive protocols have been proposed. Intra-articular injections of medications directed at OA have been performed, but in some cases, these medications do not directly contact the tissue lesion sites. Here, we propose a new real-time ultrasound-guided technique to inject medications directly into the subchondral bone. METHODS: Ultrasound image screening was carried out with the point-of-care Clarius L15 device. Then, with the patient's mouth closed, a stainless-steel cannula with a concentric trocar was US-guided using an in-plane approach until the perforating tip of the internal trocar touched the lateral pole of the mandibular condyle. Then, the trocar was inserted through the medullary bone, where a posterior injection was made. RESULTS: The technique's precision was confirmed by capturing an iodine contrast solution that imaged the medullary condyle of fresh anatomical specimens processed by computed tomography. CONCLUSION: The proposed technique was effective in accessing the mandibular condyle subchondral bone in the inferior TMJ space for the simultaneously intra-articular (IA) and intra-osseous (IO) in-plane US-guided injections. Thus, its implementation may represent an important advance in early TMJ-OA treatment. This may be a promising approach, especially in OA cases in which the cortical bone is still preserved.

Corticosteroids for the Treatment of Internal Temporomandibular Joint Disorders: A Systematic Review and Network Meta-Analysis.

Background: We evaluated the comparative effectiveness of all intra-articular injection corticosteroids for treating internal temporomandibular joint (TMJ) disorders. Methods: We searched MEDLINE, CENTRAL, EMBASE, SCOPUS, and LILACS through December 2023. We included randomized clinical trials (RCTs) enrolling patients with symptomatic internal disorders of the TMJ comparing any type of intra-articular corticosteroid therapy against another or to another minimally invasive therapy. The outcomes of interest were pain, range of mandibular motion (RoM), quality of life (QoL) and adverse effects at 1, 3, 6, and 12 months. We assessed the risk of bias using the Cochrane Collaboration's tool. We conducted a frequentist network meta-analysis and assessed the certainty of the evidence (CoE) using GRADE. Results: We included 20 RCTs enrolling 810 participants, which assessed five corticosteroids alone or combined with arthrocentesis or hyaluronic acid. Based on moderate CoE, betamethasone is among the most effective corticosteroids for reducing pain at one (mean difference compared to arthrocentesis [MD], -3.80; 95% confidence interval [CI], -4.55 to -3.05) and three months (MD, -2.74; 95%CI, -3.42 to -2.06), and arthrocentesis plus dexamethasone at six months (MD, -0.80; 95%CI, -1.57 to -0.03). There was no convincing evidence that any intervention was better than arthrocentesis for improving the RoM and QoL at any follow-up time. Methylprednisolone may be more harmful than arthrocentesis for adverse effects. Discussion: Betamethasone and arthrocentesis plus dexamethasone are the most effective in managing pain in the short and medium term compared to arthrocentesis (moderate CoE). Decisions about their use should consider other factors, such as costs, feasibility, and acceptability. Future research should consider QoL as an outcome and assess participants at longer follow-up periods.

Efficacy of High-intensity laser therapy in patients with temporomandibular joint disorders: A systematic review and meta-analysis.

This study aimed to assess the effects of High-intensity laser therapy (HILT) on individuals suffering from temporomandibular joint disorders (TMDs). A search was conducted across six electronic databases for randomized controlled trials (RCTs) focusing on HILT for TMDs: PubMed, Scopus, Web of Science, ScienceDirect, EBSCOhost, Cochrane Library, the PEDro database and Google Scholar (last updated on July 18, 2024). Eligible studies were chosen by independent reviewers, and their quality was assessed with the Cochrane risk of bias tool (RoB). The main outcome was pain intensity (VAS), with secondary outcomes including mouth opening (mm), disability (JFLS-20), and quality of life (OHIP-14). A meta-analysis was conducted to assess the pooled effect by calculating mean differences (MD) for these variables (95% confidence level). The heterogeneity of the meta-analyses was explored using the I2 statistic. Three studies met the selection criteria and were included in the meta-analysis. The main RoB was the blinding of participant and treaters. Statistically significant differences (p < 0.05) in favor of HILT were observed for VAS and maximum mouth opening. The pooled effect showed an MD of -14.8 mm (95% CI:-27.1,-2.5) for pain intensity and 3.7 mm (95% CI:0.9,6.5) for mouth opening, changes that were assessed as clinically important. According to GRADE, the evidence was rated as important, and the certainty was moderate due to the heterogeneity between studies. A sensitivity analysis was not performed to address heterogeneity, primarily due to the limited availability of RCTs. HILT has been found effective in short-term pain relief and improvement of jaw opening in TMDs, potentially enhancing quality of life by facilitating activities such as chewing, jaw mobility, and communication. However, further research is needed to confirm its long-term effectiveness. Combining HILT with interventions such as occlusal splints or therapeutic exercises could potentially enhance its effects, leveraging the existing evidence supporting these treatments. It is important to note that the high RoB associated with the lack of blinding of participants and treaters may influence data collection, compromising the internal validity of findings in some studies.

Cóndilo mandibular bífido bilateral. Reporte de un caso / Bilateral bifid mandíbular condyle. A case report

Objetivo: El cóndilo mandibular bífido es una alteración morfológica de la articulación temporomandibular en la que el cóndilo presenta un surco en la superficie superior que genera dos cabezas condilares. Esta alteración puede ser unilateral o bilateral. La mayoría de los cóndilos mandibulares bífidos se detectan mediante radiografías panorámicas, sin embargo, la tomografía computarizada Cone Beam de articulación temporomandibular es considerado el examen de elección para el diagnóstico de esta alteración. El propósito de este trabajo es presentar un caso de cóndilo mandibular bífido bilateral detectado incidentalmente mediante una tomografía computarizada Cone Beam solicitada por un diagnóstico presuntivo de osteoartritis. Caso clínico: Una paciente de 22 años sin antecedentes de traumatismos cráneo faciales solicita una tomografía computarizada Cone Beam de articulaciones temporomandibulares por diagnóstico presuntivo de osteoartritis. En la exploración del volumen se encontraron cóndilos mandibulares bífidos con dos cabezas condilares, medial y lateral de forma bilateral, siendo más acentuado en el cóndilo derecho.(AU)

Aim: The bifid mandibular condyle is a morphological alteration of the temporomandibular joint in which the condyle has a groove on its upper surface that generates two condylar heads. This alteration can be unilateral or bilateral. Most bifid mandibular condyles are detected by panoramic radiographs, however, Cone Beam computed tomography of the temporomandibular joint is considered the test of choice for the diagnosis of this alteration. The purpose of this work is to present a case of bilateral bifid mandibular condyle, incidentally detected by Cone Beam computed tomography requested for a presumptive diagnosis of osteoarthritis. Clinical case: A 22-year old female patient with no history of craniofacial trauma requests a Cone Beam computed tomography of the temporomandibular joints due to a presumptive diagnosis of osteoarthritis. In the volume exploration, bifid mandibular condyles were found with two condylar heads, medial and lateral bilaterally, being more accentuated in the right condyle.(AU)

Estudo das diferentes formas de tratamento para disfunções temporomandibulares / Study of different treatment modalities for Temporomandibular Disorders / Estudio de diferentes formas de tratamiento para Trastornos Temporomandibulares

Introdução:Disfunções temporomandibularessão um termo coletivopara uma série de sinais e sintomas clínicos que envolvem os músculos mastigatórios, a articulação temporomandibular e estruturas associadas. O tratamento de pacientes deverá envolver uma equipe multidisciplinareparaquehajauma intervenção eficaz notratamento da disfunção é necessário que os profissionais envolvidos atuem emconjuntoetenhamplenoconhecimento das funções estomatognáticas.Objetivo:revisar aliteratura sobreas formas terapêuticas das disfunções temporomandibulares e sua eficácia.Metodologia:Trata-se de um estudosobre o panorama atual das terapêuticas utilizadas para o tratamento de disfunções temporomandibulares.Para compor o presente trabalho foi consultado o banco de dados da PubMed utilizando as palavras-chave "temporomandibular disorder" e "therapy" associados ao operador booleano AND. Os critérios de inclusão foram os artigos publicados, limitando-se ao período de 2020 a 2024 no idioma inglês. A busca computou um total de 545 artigos, dos quais foram excluídos os artigos que desviavam do tema proposto, artigos que abordavam técnicas com pouco embasamento científico e os artigos que não estavam disponíveis por completo.Resultados:os achados na literatura corroboram com a escolhaem primeiro plano de um tratamentoconservador, reversível e não invasivo. Dentre as opções destacam-se orientações de autocuidado, confecção de placa oclusal, terapias manuais, exercícios musculares, biofeedback e manejo farmacológico em casos de sintomas somáticos. A toxina botulínica tem sido sugerida para tratamento em casos de disfunções temporomandibularesmusculares, no entanto, com baixa evidência científicaquanto aos efeitos adversos. Técnicas cirúrgicas são indicadas em casos de não resolução com terapias conservadoras.Conclusões:Apesar dagrande diversidade nos protocolos,o tratamento conservador demonstra resolução do problema na maioria dos casos de disfunções temporomandibularese aquelestratamentos que combinam várias técnicasevidenciam melhores resultados do que tratamentos isolados (AU).

Introduction: Temporomandibular disorders are a collectiveterm for a range of clinical signs and symptoms involving the masticatory muscles, the temporomandibular joint, and associated structures. Treating patients with disorder temporomandibularshould involve a multidisciplinary team, and for effective intervention in dysfunction treatment, it is necessary for the involved professionals to work together and have a comprehensive understanding of stomatognathic functions. Objective: review the literature on therapeutic modalities for temporomandibular disorders and their effectiveness. Methodology:This is a study on the current landscape of therapies used for the treatment of temporomandibular disorders. To compose this work, the PubMed database was consulted using the keywords "temporomandibular disorder" and "therapy" associated with the boolean operator AND. Inclusion criteria were articles published in English from 2020 to 2024. The search yielded a total of 545 articles, from which articles deviating from the proposed theme, articles discussing techniques with little scientific basis, and articles not fully available were excluded. Results:Literature findings support the prioritization of conservative, reversible, and non-invasive treatment. Among the options, self-care guidance, occlusal splint fabrication, manual therapies, muscle exercises, biofeedback, and pharmacological management for somatic symptoms stand out. Botulinum toxin has been suggested for treatment in cases of muscular disordertemporomandibular, however, with low scientific evidence regarding adverse effects. Surgical techniques are indicated in cases where conservative therapies fail to resolve the issue. Conclusions:Despite the diversity in protocols, conservative treatment demonstrates resolution of the problem in most cases of disorder temporomandibular,and treatments combining multiple techniques show better results than isolated treatments (AU).

Introducción:Las disfunciones temporomandibulares son un término colectivopara una serie de signos y síntomas clínicos que afectan a los músculos masticatorios, la articulación temporomandibular y estructuras asociadas. El tratamiento de pacientes con disfunciones temporomandibularesdebe involucrar a un equipo multidisciplinario para una intervención efectiva, requiriendo que los profesionales actúen conjuntamente y conozcan bien las funciones estomatognáticas. Objetivo:revisar la literatura sobre las terapias paradisfunciones temporomandibularesy su eficacia. Metodología:Estudio comparativo de las terapias actuales para disfunciones temporomandibulares, utilizando la base de datos PubMed con las palabrasclaves "temporomandibular disorder" y "therapy" y el operador booleano AND, limitado a 2020-2024 en inglés. La búsqueda obtuvo un total de 545 artículos de los cuales fueron excluidos los que no abordaban el tema propuesto. Resultados:Los hallazgos respaldan un tratamiento conservador, reversible y no invasivo, destacando el autocuidado, placas oclusales, terapias manuales, ejercicios, biofeedback y manejo farmacológico. La toxina botulínica se sugiere para disfunciones temporomandibulares musculares, pero con poca evidencia científica de sus efectos adversos. Las técnicas quirúrgicas se reservan para casos sin resolución.Conclusiones: A pesar de la diversidad de protocolos, el tratamiento conservador resolveula mayoría de los casos de disfunciones temporomandibulares, y los tratamientos combinados muestran mejores resultados que los aislados (AU).

Hypervigilance to pain and sleep quality are confounding variables in the infrared thermography examination of the temporomandibular joint and temporal and masseter muscles.

OBJECTIVES: Verify whether hypervigilance to pain (HP) and sleep quality (SQ) are confounding variables in the infrared thermography (IT) examination of the temporomandibular joint and temporal and masseter muscles. METHODS: A cross-sectional and analytical study was conducted, collecting HP and SQ data from 80 participants without temporomandibular disorders (TMD), performing their IT and another 40 participants with TMD. For the selection of participants with and without TMD, the TMD Pain Screener questionnaire and axis I of the Diagnostic Criteria for Temporomandibular Disorders were applied. SQ was verified using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. For the HP assessment the Pain Vigilance and Awareness Questionnaire (PVAQ) was applied. And the IT was performed through a FLIR infrared sensor camera, model T650 Infrared. RESULTS: No significant correlations were found between SQ and the temperatures of the areas of interest (P > .05), and regarding HP, a statistically significant positive correlation was found with the dimensionless (ρ = 0.289) and non-dimensionless (ρ = 0.223) asymmetries of temporal muscle temperatures. In the temperature comparisons between the participants without TMD and the participants with TMD, significant differences were found (P < .05), also when the group without TMD was controlled according to both HP and SQ (P < .05), with higher temperatures found in the TMD group. CONCLUSIONS: HP and SQ can be considered confounding variables in IT examination of the temporomandibular region.

Influence of examiner calibration on clinical and MRI diagnosis of temporomandibular joint disc displacement: a systematic review and meta-analysis.

OBJECTIVES: This study aimed to verify the accuracy of clinical protocols for the diagnosis of disc displacement (DD) compared with MRI, considering examiners' calibration. METHODS: PubMed, Cochrane (Central), Scopus, Web of Science, LILACS, Embase, Science Direct, Google Scholar, and DANS EASY Archive databases were searched. Two reviewers independently screened and selected the studies. A meta-analysis was conducted using the R Statistical software. Results are shown using sensitivity and specificity, and 95% confidence intervals. RESULTS: Of the 20 studies included in the systematic review, only three were classified as low risk of bias. Seventeen studies were included in the meta-analysis. Compared to MRI, clinical protocols showed overall sensitivity and specificity of 0.75 (0.63-0.83) and 0.73 (0.59-0.84) for DD diagnosis, respectively. For DD with reduction, sensitivity was 0.64 (0.48-0.77) and specificity was 0.72 (0.48-0.87). For DD without reduction, sensitivity was 0.58 (0.39-0.74) and specificity 0.93 (0.83-0.97). Only 8 studies reported examiner calibration when performing clinical and/or MRI evaluation; nevertheless, calibration showed a tendency to improve the diagnosis of DD. CONCLUSION: The sensitivity and specificity of clinical protocols in the diagnosis of DD are slightly below the recommended values, as well as the studies lack calibration of clinical and MRI examiners. Examiner calibration seems to improve the diagnosis of DD.

Ultrasonographic characteristics of myogenous temporomandibular disorders: A scoping review.

OBJECTIVE: To identify the available evidence on the ultrasonographic characteristics of masticatory muscles in subjects with myogenous TMD, as well as the potential use of ultrasonography as a diagnostic and treatment assessment outcomes tool. METHOD: An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: 'ultrasonography', 'ultrasound', 'masseter', 'temporal', 'masticatory muscles', 'temporomandibular disorders', 'temporomandibular joint disorders'. Full-text articles were obtained from the records after applying the inclusion/exclusion criteria. RESULTS: Thirteen articles were included for analysis: one comparative cross-sectional study, five case-control studies, six clinical trials and one randomised clinical trial. Main ultrasonographic characteristic assessed were local cross-sectional dimension and intramuscular ultrasonographic appearance. Retrieved studies reported the use ultrasonography for diagnosis or treatment assessment purposes showing heterogeneous results. For diagnosis purposes, the results of local cross-sectional dimension are not consistent; therefore, its diagnostic value for myogenous TMD diagnosis is weak. However, more homogeneous results were observed for intramuscular ultrasonographic appearance showing a higher prevalence of type-II pattern in myogenous TMD subjects than non-TMD subjects. On the other hand, for treatment assessment purposes, muscles were observed thinner after treatment compared to pre-treatment. Also, results of intramuscular ultrasonographic appearance show disappearance or reduction of anechoic areas, higher prevalence of type-II pattern and significant distinction of echogenic bands were observed after treating TMD subjects. CONCLUSION: Ultrasonography cannot be considered as a diagnostic instrument, but maybe as a complementary tool for treatment assessment of myogenous TMD subjects, even though future research is required to confirm its utility.

[Magnetic resonance arthrography with physiological saline solution in the diagnosis of temporomandibular joint disc perforation. Case report]. / Artrografía mediante resonancia magnética con solución fisiológica en el diagnóstico de la perforación del disco de la articulación temporomandibular. Reporte de caso.

Partial or total perforation of the articular disc is mainly observed in the final stage of temporomandibular disorder. Magnetic resonance imaging (MRI) is considered the gold standard for the diagnosis of joint pathologies; MRI arthrography consists of the infiltration of a contrast medium into a joint, being Gadolinium chelates the most employed medium, however, possible harmful effects have been associated with its use. The aim of this work was to evaluate a case of perforation of the articular disc of the temporomandibular joint by MRI arthrography using physiological solution (NaCl 0.9%) as contrast medium. MR images were obtained with a STIR (Short Tau Inversion Recovery) weighted pulse sequence in the sagittal and coronal planes at maximum mouth opening, after the injection of the physiological solution in the superior articular space. The communication of both articular spaces was identified, observing a greater filling in the inferior articular space, as well as the latero-medial displacement of the disc segments. Arthrography with physiological solution allowed the precise diagnosis of the perforation, which made it possible to guide the treatment plan, reducing diagnostic and surgical times, also considering the reduction of complications and adverse effects related to other contrast media, added to the benefit of the reduction of the cost of the exam.

Muscle oxygenation and pain in different types of temporomandibular disorders.

OBJECTIVES: Studies exploring variations in peripheral muscle oxygenation and pressure pain thresholds (PPT) of masticatory muscles in individuals with Temporomandibular Disorders (TMDs) are limited. The purpose of this study was to compare variations in peripheral oxygenation of the masseter muscle; PPT of the masseter and temporal muscles and correlate peripheral muscle oxygenation and PPT of the masseter muscle in individuals with different types of TMDs. MATERIALS AND METHODS: Cross-sectional study involving 116 participants classified into three groups: muscle group (MG, n = 32), joint group (JG, n = 30) and muscle-joint group (MJG, n = 54). Individuals aged 26.97 ± 6.93, 68.97% female, 31,03% males were included. All participants were evaluated using the Diagnostic Criteria for Temporomandibular Disorders, Near-infrared spectroscopy (NIRS) for peripheral muscle oxygenation and pressure algometer for PPT. RESULTS: There was no difference in masseter muscle oxygenation among groups. In the masseter muscle, a weakly positive correlation was observed between PPT and variation in tissue saturation index in the MG (rho = 0.365) and JG (rho = 0.317). In addition, the MJG expressed lower PPT (p = 0.004) than JG, demonstrating that MJG had more pain in this muscle. CONCLUSIONS: MJG have lower PPT in the masseter muscle. Although the PPT is dependent on the type of TMDs, the correlation between PPT and oxygenation is weak. All TMDs groups evaluated (MG, JG, MJG) showed hemodynamic similarities of the masseter muscle. CLINICAL RELEVANCE: Understanding pain thresholds and the hemodynamic behavior of the masticatory muscles contributes to a more assertive physiotherapeutic assessment in TMDs, serving as a basis for careful and individualized interventions.

Frequência de sintomas de disfunção temporomandibular e hábitos parafuncionais associados ao estresse em estudantes universitários / Frequency of temporomandibular dysfunction symptoms and parafunctional habits associated with stress in university students / Frecuencia de los síntomas de trastornos temporomandibulares y de hábitos parafuncionales asociados al estrés en estudiantes universitarios

As disfunções temporomandibulares são uma série de alterações que afetam os músculos mastigatórios, a articulação temporomandibular e as estruturas associadas. Sua etiologia é multifatorial e inclui fatores como hábitos parafuncionais desencadeados ou intensificados por condições psicológicas como o estresse emocional. Este artigo tem como objetivo investigar a frequência de sintomas de disfunções temporomandibulares e de hábitos parafuncionais e sua associação com estresse percebido em estudantes de uma universidade pública da cidade de Salvador. Os dados primários foram coletados por meio de um questionário sociodemográfico, do questionário anamnésico de Fonseca, da Lista de Verificação dos Comportamentos Orais e da Escala de estresse Percebido. Os dados foram analisados de forma descritiva e a análise estatística realizada por meio do teste qui-quadrado de Pearson e do teste exato de Fisher. Participaram do estudo 149 estudantes de Fisioterapia. A frequência de sintomas de disfunções temporomandibulares foi elevada (83,9%), como também uma maior prática de hábitos parafuncionais (55%). Observou-se associação positiva entre os hábitos parafuncionais e os sintomas temporomandibulares. Um alto nível de estresse foi encontrado em 92,8% dos estudantes com a presença de disfunção e em 71% dos alunos com maior prática de hábitos parafuncionais, sendo ambas as associações estatisticamente significativas. Assim, as frequências de sintomas de disfunções temporomandibulares e de hábitos parafuncionais foram elevadas e estão associadas ao estresse percebido em estudantes universitários. Sugere-se a realização de estudos com amostras mais robustas que busquem estabelecer relações de causalidade entre as variáveis estudadas.

Temporomandibular disorders constitute a series of changes that affect the masticatory muscles, the temporomandibular joint, and their associated structures. Its multifactorial etiology includes factors such as parafunctional habits triggered or intensified by psychological conditions such as emotional stress. The purpose is to investigate the frequency of symptoms of temporomandibular disorders and parafunctional habits and their association with perceived stress in students at a public university in the municipality of Salvador. Primary data collected by a sociodemographic questionnaire, the Fonseca anamnestic questionnaire, the Oral Behaviors Checklist, and the Perceived Stress Scale. Data were descriptively analyzed, and a statistical analysis was performed using the Pearson's chi-squared and Fisher's exact tests. Overall, 149 physical therapy students participated in this study. They showed a high frequency of temporomandibular disorder symptoms (83.9%) and more frequent parafunctional habits (55.0%). This study found a positive association between parafunctional habits and temporomandibular symptoms. It also observed a high level of stress in 92.8% of students with the dysfunction and in 71.0% of students with more common practice of parafunctional habits, statistically significant associations. This study found a high frequency of temporomandibular disorder and parafunctional habit symptoms, which are associated with perceived stress in college students. It is suggested to carry out studies with more robust samples that seek to establish causal relationships between the studied variables.

Los trastornos temporomandibulares son una serie de cambios que afectan a los músculos masticatorios, la articulación temporomandibular y estructuras asociadas. Su etiología es multifactorial e incluye factores como hábitos parafuncionales desencadenados o intensificados por condiciones psicológicas como el estrés emocional. el objetivo es determinar la frecuencia de los síntomas de trastornos temporomandibulares y de hábitos parafuncionales y su asociación con el estrés percibido en estudiantes de una universidad pública de la ciudad de Salvador (Brasil). Los datos primarios se recolectaron de un cuestionario sociodemográfico, del cuestionario anamnésico de Fonseca, de la Lista de Comportamientos Orales y de la Escala de Estrés Percibido. Los datos se analizaron de forma descriptiva, y el análisis estadístico se realizó mediante la prueba de chi-cuadrado de Pearson y la prueba exacta de Fisher. Participaron en el estudio 149 estudiantes de fisioterapia. La frecuencia de los síntomas de trastornos temporomandibulares fue alta (83,9%), así como una mayor práctica de hábitos parafuncionales (55,0%). Se observó una asociación positiva entre hábitos parafuncionales y síntomas temporomandibulares. Se encontró un alto nivel de estrés en el 92,8% de los estudiantes con presencia de disfunción y en el 71,0% de los estudiantes con mayor práctica de hábitos parafuncionales, y ambas asociaciones fueron estadísticamente significativas. La frecuencia de los síntomas de trastornos temporomandibulares y de los hábitos parafuncionales fue alta, y estuvo asociada con el estrés percibido en estudiantes universitarios. Se sugiere realizar estudios con muestras más robustas para establecer relaciones causales entre las variables estudiadas.

Oromandibular dystonia as a cause of temporomandibular disorder (Case report) / Distonia oromandibular como causa de disfunção temporomandibular (Relato de caso)

Temporomandibular disorders (TMD) can have multiple etiologies, including oromandibular dystonia (OMD). However, in a few cases, the OMD can evolve from cervical dystonia (CD), leading to severe bone degeneration. The purpose of this case report of a 64-year-old woman presenting to the Outpatient Neurology Clinic of the Federal University of Bahia is to illustrate the development of oromandibular dystonia with temporomandibular joint (TMJ) dysfunction after 10 years of cervical dystonia. Clinical examination showed bone degeneration of the mandibular ramus and right TMJ click, a prevalent sound in patients with temporomandibular disorders when they open their mouths or chew. After onabotulinum toxin type A injections in the right lateral pterygoid muscle, the patient improved in swallowing and pain. This case highlights the importance of close follow-up of cervical dystonia patients to identify new dystonic muscles. In our patient, lateral pterygoid muscle involvement was followed by several comorbidities, such as dysphagia and jawbone abnormalities.

Os distúrbios temporomandibulares (DTM) podem ter múltiplas etiologias, incluindo a distonia oromandibular (DO). No entanto, em raros casos, a DO pode evoluir a partir da distonia cervical (DC) e raramente pode levar a degeneração óssea. O objetivo deste relato de caso de uma mulher de 64 anos atendida no Ambulatório de Neurologia da universidade Federal da Bahia é ilustrar o desenvolvimento de distonia oromandibular com disfunção da articulação temporomandibular (ATM) após 10 anos de distonia cervical. O exame clínico mostrou degeneração óssea do ramo mandibular e clique na ATM direita, um som prevalente em pacientes com distúrbios temporomandibulares quando abrem a boca ou mastigam. Após injeções de toxina botulínica tipo A no músculo pterigoideo lateral direito, a paciente apresentou melhora na deglutição e na dor. Este caso destaca a importância do acompanhamento próximo de pacientes com distonia cervical para identificar novos músculos distônicos. Em nossa paciente, o envolvimento do músculo pterigoide lateral foi seguido por várias comorbidades, como disfagia e anormalidades ósseas da mandíbula.

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.

Customized spacers in provisional treatment of temporomandibular joint ankylosis: a case report.

Ankylosis of the temporomandibular joint (TMJ) is a condition in which the mandibular condyle fuses with the mandibular fossa through fibrous or bone tissue. It is a debilitating pathology that interferes with chewing, speaking, and oral hygiene. Currently, alloplastic reconstruction is considered the gold standard for treating severely compromised TMJs, such as in ankylosis. The article describes a patient with a history of facial trauma, with bilateral ankylosis of the TMJs, inability to open his mouth, and poor dental condition. Due to a long period of immobilization of approximately 40 years, the initial treatment plan was to remove the ankylosis bilaterally and install customized PMMA (polymethylmethacrylate) spacers. The patient gained mouth opening and improved chewing quality with one year of customized spacer use prior to definitive alloplastic replacement with stock-type TMJ prostheses. Customized joint spacers are a provisional treatment option when definitive alloplastic reconstruction is not indicated. Spacers provide the patient with progressive jaw function and mobility gains.