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.

Comparative study of arthrocentesis with concentric-needle cannula with classic concentric needle: A randomized single-blind controlled clinical trial.

This study aimed to assess and compare the efficacy of two distinct single-puncture techniques in temporomandibular joint (TMJ) arthrocentesis for managing disk displacement without reduction (DDwoR). Sixty patients with DDwoR were randomly and blindly assigned to two treatment groups (n = 30 each): group 1 - TMJ arthrocentesis with the classic concentric needle; and group 2 - TMJ arthrocentesis with the concentric needle-cannula system. The following variables were recorded and compared across the groups: patient's pain perception (visual analog scale - VAS, 0-10); maximal interincisal distance (MID, mm); facial edema (FE, presence or absence); and operation duration (OP, minutes). Patients in group 2 presented significantly lower values of VAS score and presence of FE (p < 0.05) when examining the data at 24 and 48 h after the arthrocentesis. They also showed an increase in MID values (p = 0.024) after 6 months. With regard to OP, no significant difference was observed between the groups. Performing a single-puncture TMJ arthrocentesis using a concentric needle-cannula system significantly reduced the patients' pain perception, and mitigated the presence of facial edema during the immediate postoperative period (at 24 and 48 h). Furthermore, it resulted in a notable increase in the MID after 6 months.

Prediction of duloxetine efficacy in addition to self-management in painful temporomandibular disorders: A randomised, placebo-controlled clinical trial.

BACKGROUND: Conditioned pain modulation (CPM) is a potential predictor of treatment response that has not been studied in temporomandibular disorders (TMD). OBJECTIVES: We conducted a randomised, double-blind, placebo-controlled trial (RCT) of duloxetine in addition to self-management (SM) strategies to investigate its efficacy to reduce pain intensity in painful TMD patients. Moreover, we investigated whether baseline CPM would predict the duloxetine efficacy to reduce TMD pain intensity. METHODS: Eighty participants were randomised to duloxetine 60 mg or placebo for 12 weeks. The primary outcomes were the change in the pain intensity from baseline to week-12 and CPM-sequential paradigm at baseline. Safety, physical and emotional functioning outcomes were also evaluated. RESULTS: Of 80 participants randomised, 78 were included in intention-to-treat analysis. Pain intensity decreased for SM-duloxetine and SM-placebo but did not differ between groups (p = .82). A more efficient CPM was associated with a greater pain intensity reduction regardless of the treatment group (p = .035). Physical and emotional functioning did not differ between groups, but adverse events (p = .014), sleep impairment (p = .003) and catastrophizing symptoms (p = .001) were more prevalent in SM-duloxetine group. CONCLUSION: This study failed to provide evidence of a beneficial effect of adding duloxetine to SM strategies for treatment of painful TMD. Nonetheless, this RCT has shown the feasibility of applying pain modulation assessment to predict short-term treatment response in painful TMD patients, which confirms previous finds that CPM evaluation may serve a step forward in individualising pain treatment.

Subtypes of temporomandibular disorders in patients diagnosed with otalgia: observational study / Subtipos de desordem temporomandibular em pacientes diagnosticados com otalgia: estudo observacional

ABSTRACT BACKGROUND AND OBJECTIVES: Temporomandibular disorder (TMD) has complex symptoms that involve the orofacial region, such as otalgia. Considering the difficult differential diagnoses for associating otological symptoms with TMD. The aim of this study was to verify the diagnosis of TMD in patients with otalgia. METHODS: This is a cross-sectional and descriptive study, where 75 patients diagnosed with otalgia were evaluated. The European Academy of Craniomandibular Disorders's (EACD) screening questionnaire was initially applied, and those who answered affirmatively to at least one question were evaluated by the Research Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), with a final sample of 50 patients. Data were tabulated and ANOVA verified whether there was a statistical difference between TMD subtypes classified by DC/TMD, considering confidence intervals with 95% significance. RESULTS: The mean age of the participants was 39.9±14.1 years, with a predominance of females (76%) (p<0.0001). Among those diagnosed with TMD, females also predominated, with a higher percentage in all evaluated subtypes, with emphasis on arthralgia (82%) and myofascial pain with limited opening (81.8%), followed by myofascial pain (74%) and disc displacement with reduction (72.7%). When observing the distribution of TMD subtypes between genders, there was a predominance of myofascial pain in males (75%) and females (68%), but no statistical significance was observed in this variable and in the others studied. CONCLUSION: Patients with otalgia had one or more TMD subtypes, and the myofascial subtype TMD was the most prevalent among study participants.

RESUMO JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibular (DTM) possui sintomas complexos que envolvem a região orofacial, como a otalgia. Considerando os difíceis diagnósticos diferenciais para associar sintomas otológicos com DTM. O objetivo deste estudo foi verificar o diagnóstico de DTM em pacientes com otalgia. MÉTODOS: Este é um estudo transversal e descritivo, com uma avaliação de 75 pacientes diagnosticados com otalgia. O questionário de triagem da Academia Europeia de Disfunções Craniomandibulares (EACD) foi aplicado inicialmente, e aqueles que responderam afirmativamente a pelo menos uma questão foram avaliados pelo Critério Diagnóstico de Pesquisa para Disfunções Temporomandibulares (DC/TMD), com amostra final de 50 pacientes. Os dados foram tabulados e por meio da ANOVA foi verificado se havia diferença estatística entre os subtipos de DTM classificados pelo DC/TMD, considerando intervalos de confiança com 95% de significância. RESULTADOS: A idade média dos participantes foi de 39,9±14,1 anos. Além disso, predominou-se o sexo feminino (76%) (p<0,0001), com maior percentual em todos os subtipos avaliados, destacando-se a artralgia (82%) e a dor miofascial com limitação de abertura (81,8%), seguida da dor miofascial (74%) e deslocamento de disco com redução (72,7%). Quando observada a distribuição dos subtipos de DTM entre os sexos, notou-se predominância de dor miofascial no sexo masculino (75%) e feminino (68%), mas não foi observada significância estatística nessa variável e nas demais estudadas. CONCLUSÃO: Os pacientes com otalgia manifestaram mais de um dos subtipos de DTM, sendo o subtipo de dor miofascial o mais prevalente entre os participantes do estudo.

Peripheral muscle oxygenation and symptoms of stress in adolescents with and without temporomandibular disorder.

OBJECTIVE: To compare peripheral muscle oxygenation levels and the prevalence of psychological stress in adolescents with and without temporomandibular disorder (TMD). METHODS: A cross-sectional study was performed with adolescents submitted into two groups: those diagnosed with TMD (DG) and control (CG). Muscle oxygenation was measured by near-infrared spectroscopy in the masseter and upper trapezius muscles. Symptoms of stress were assessed by Lipp's Stress Symptom Inventory for Adults or Child Stress Scale. A Student t-test was used for intergroup comparisons and association between categorical variables by chi-square test, phi coefficient of correlation, odds ratio, and two-way ANOVA. RESULTS: Fifty-three adolescents were evaluated and a significant reduction was observed in the oxyhemoglobin level in the masseter muscle at rest (p = 0.04) and contraction (p = 0.02). A greater total hemoglobin level was found in the upper trapezius muscle at rest in DG (p = 0.03), with a significant difference in the tissue saturation index during contraction (p = 0.05) intergroup. Individuals in the DG were 4.523 times more likely to exhibit signs and symptoms of stress than in CG. CONCLUSION: Adolescents from DG showed reduced masseter oxyhemoglobin values at rest and during contraction and showed more signs and symptoms of stress than healthy controls. In the upper trapezius, DG showed higher values of total circulating hemoglobin, essential for greater blood flow and efficient maximum voluntary contraction. CLINICAL RELEVANCE: Changes in tissue oxygenation and stress in adolescents with TMD prompted the earlier treatment of this population to prevent disease progression into adulthood.

Algunas consideraciones sobre el tratamiento precoz en pacientes con bruxismo / Some considerations on the early treatment in patients with bruxism

El bruxismo es una disfunción neuromuscular considerada hoy día una parafunción, ya sea consciente (bruxismo en vigilia) o inconsciente (bruxismo del sueño). Debido al posible daño que puede ocasionar en las estructuras del aparato estomatognático, el tratamiento precoz resulta muy importante, de ahí la necesidad de un diagnóstico temprano para aplicar medidas preventivas y curativas. Teniendo en cuenta lo anterior, se realizó el presente estudio con el objetivo de fundamentar diferentes aspectos concernientes al tema en cuestión.

Bruxism is a neuromuscular dysfunction considered a parafunction nowadays, either conscious (awake bruxism) or unconscious (sleep bruxism). The early treatment is very important due to the possible damage that can cause in the structures of the stomatognathic system, hence the necessity of an early diagnosis to apply preventive and healing measures. Taking into acount the above-mentioned, the present study was carried out aimed at supporting different aspects concerning the topic in question.

Terapias físicas en pacientes con trastornos de la articulación temporomandibular / Physical therapies in patients with temporomandibular joint disorders

RESUMEN Introducción: Se denomina trastorno temporomandibular al conjunto de condiciones musculoesqueléticas que afectan la articulación temporomandibular, los músculos de la masticación y las estructuras anatómicas adyacentes. Objetivo: Evaluar la efectividad de las terapias físicas en pacientes con trastornos de la articulación temporomandibular. Métodos: Se efectuó una intervención terapéutica en la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, desde junio de 2016 hasta febrero de 2020. La muestra quedó conformada por 264 pacientes distribuidos en 4 grupos con 66 integrantes cada uno, a quienes se les aplicaron diferentes terapias físicas, tales como ultrasonido, laserterapia, magnetoterapia y técnica de estimulación eléctrica transcutánea, respectivamente. Se analizaron las siguientes variables: edad, grado de trastorno de la articulación temporomandibular y efectividad terapéutica. Se empleó el porcentaje como medida de resumen y el estadígrafo de Ji al cuadrado con un nivel de significación de 0,05. Resultados: Predominó el sexo femenino en todas las terapias aplicadas con más de 75,0 % y el grupo etario de 40 - 49 años. Al finalizar el tratamiento se observó que en los grupos donde se empleó ultrasonido, láser y magneto, la respuesta fue efectiva en más de 90,0 % de los pacientes, con primacía del primero (96,6 %); sin embargo, en el grupo donde se utilizó la técnica de estimulación eléctrica transcutánea solo se logró en 89,4 % de los afectados. Conclusiones: La ultrasonoterapia fue más efectiva en pacientes con trastornos de la articulación temporomandibular.

ABSTRACT Introduction: A temporomandibular disorder is a group of musculoskeletal conditions that affect the temporomandibular joint, the mastication muscles and the adjacent anatomical structures. Objective: To evaluate the effectiveness of the physical therapies in patients with temporomandibular joint disorders. Methods: A therapeutic intervention was carried out in Mártires del Moncada Teaching Provincial Stomatological Clinic from Santiago de Cuba, from June, 2016 to February, 2020. The sample was formed by 264 patients distributed in 4 groups with 66 members each one, to whom different physical therapies were applied, such as ultrasound, laser therapy, magnetotherapy and technique of transcutaneous electric stimulation, respectively. The following variables were analyzed: age, grade of dysfunction of the temporomandibular joint and therapeutic effectiveness. The percentage as summary measure and the chi-squared test were used with a significance level of 0.05. Results: There was a prevalence of the female sex in all the therapies applied with more than 75.0 % and the 40 - 49 age group. When concluding the treatment it was observed that in the groups where ultrasound, laser and magneto was used, the response was effective in more than 90.0 % of the patients, with primacy of the first one (96.6 %); however, in the group where the technique of transcutaneous electric stimulation was used it was just achieved in 89.4 % of the affected patients. Conclusions: The ultrasonotherapy was more effective in patients with temporomandibular joint disorders.

Desplazamiento Posterior Bilateral del Disco de la Articulación Temporomandibular: evidencia en Resonancia Magnética / Bilateral Posterior Displacement of the Temporomandibular Joint Disc: evidence on Magnetic Resonance Imaging

El desplazamiento del disco articular (DA) constituye una artropatía intracapsular en la que el disco se desplaza de su relación funcional con el cóndilo mandibular y la porción articular del hueso temporal. El desplazamiento del disco puede ser antero-medial, anterior, antero-lateral, lateral, medial o posterior, siendo este último uno de los menos frecuentes. El presente reporte tuvo como objetivo describir las manifestaciones clínicas y evaluación imagenológica mediante resonancia magnética (RM) de un desplazamiento posterior del disco (DPD) en la articulación temporomandibular (ATM). Presentación del caso: paciente masculino, de 35 años de edad quien a la exploración clínica, refirió dolor a la palpación lateral y posterior en la ATM izquierda, se observó desvío mandibular hacia el lado derecho, dificultad para realizar movimientos de lateralidad y limitación de la apertura oral. Intraoralmente, se evidenció mordida cruzada en zona canina derecha y facetas de desgaste en caninos superiores e incisivos inferiores. En imágenes sagitales de RM a boca cerrada se verificó en ambas articulaciones, el aplanamiento del DA, la localización de la banda anterior sobre la vertiente anterior de la cabeza de la mandíbula, de manera que el resto del disco estaba extendido hacia la vertiente posterior, ocupando parte de la zona retrodiscal; en el plano coronal la posición del DA estaba íntimamente relacionada con los polos lateral y medial de la cabeza de la mandíbula. Las características imagenológicas fueron sugestivas de DPD. El DPD es una artropatía poco frecuente de la ATM, siendo que las imágenes por RM muestran con precisión la relación DA-cóndilo, lo que posibilita su diagnóstico y permite al clínico tomar las decisiones idóneas para la atención del paciente.

The displacement of the articular disc (AD) constitutes an intracapsular arthropathy in which the disc is displaced from its functional relationship with the mandibular condyle and the articular portion of the temporal bone. It is frequently medial, anteromedial, or anterolateral, with posterior displacement being rare. The objective of this report was to describe the clinical manifestations and magnetic resonance imaging (MRI) of a disc posterior displacement (PDD) in the temporomandibular joint (TMJ). Case presentation: a 35-year-old male patient who reported on clinical examination, pain on lateral and posterior palpation in the left TMJ; mandibular deviation to the right side, difficulty in making lateral movements, and limitation of mouth opening were observed. Intraorally, cross bite was observed in the right canine area and wear facets in the upper canines and lower incisors. In closed mouth MRI sagittal views, the flattening of the DA, the location of the anterior band on the anterior aspect of the mandibular head, was verified in both joints, so that the rest of the disc was extended towards the posterior aspect, occupying part from the retrodiscal zone; in the coronal plane the position of the DA was closely related to the lateral and medial poles of condyle. Imaging characteristics were suggestive of PDD. Conclusions: PDD is a rare arthropathy of the TMJ, since MRI images accurately show the DA-condyle relationship, which enables its diagnosis and allows the clinician to make the best decisions for patient care.

Occurrence and severity of neck disability in individuals with different types of temporomandibular disorder.

BACKGROUND: Healthcare professionals need to know the degree of disability and severity of their patients to determine actions and therapy needed to minimize potential harm, improve their patient condition, and maximize clinical outcomes. OBJECTIVES: To evaluate the occurrence and severity of neck disability in individuals with muscular, joint, and mixed temporomandibular disorder (TMD). MATERIALS AND METHODS: Cross-sectional study with individuals divided into four groups: muscular TMD (n=20), joint TMD (n=20), mixed TMD (n=20) and control (n=20). For diagnosis and classification of TMD, it was used the Research Diagnostic Criteria (RDC) and to assess the severity of neck dysfunction the Neck Disability Index (NDI). RESULTS: Moderate neck disability was frequent in all individuals with TMD; high scores of neck disability index were evidenced in the mixed and joint TMD groups; there was a moderate positive correlation between the severity of neck disability and TMD severity (r=0.7; CI=0.32-0.78; p<0.03). CONCLUSION: The gravity of neck disability and the severity of TMD are directly proportional in the group of individuals with mixed TMD.

Treatment of Masticatory Muscle Pain with Acupuncture: Is It Necessary to Associate with Occlusal Splints?

Background: Temporomandibular disorders (TMDs) are treated by different modalities including splints, physiotherapy, and acupuncture. Although all of these offer evidencebased benefits to the patients, avoiding overtreatment is of paramount importance. Objectives: To assess the effectiveness of muscle pain treatment with acupuncture combined with or without occlusal splints. Methods: Recruited patients were allocated to G1 (acupuncture) and G2 (acupuncture and occlusal splint) groups and treated in four consecutive weekly sessions (P1, P2, P3, and P4). The reported pain (RP) and the pressure pain threshold (PPT) of the masseter and temporalis muscles were assessed before and after each session. Results: RP decreased after each session in G1, except at P4. In G2, the RP decreased only after the first session, and the PPT did not vary. Conclusion: The assessed treatments did not influence the PPT levels of the masseter and anterior temporalis muscles in patients with temporomandibular disorders. Our findings suggest that occlusal splints may not be mandatory along with the acupuncture treatment.

Association of sleep quality and psychological aspects with reports of bruxism and TMD in Brazilian dentists during the COVID-19 pandemic

Abstract Dentists are exposed to contamination by SARS-CoV-2 due to dental interventions, leading to a state of alert and potential risk of negative impact in mental health and sleep quality, associated with Temporomandibular Disorder (TMD) and bruxism. Objective: to evaluate the psychosocial status, sleep quality, symptoms of TMD, and bruxism in Brazilian dentists (DSs) during the COVID-19 pandemic. Methodology: The sample (n=641 DSs) was divided into three groups (quarantined DSs; DSs in outpatient care; and frontline professionals), which answered an electronic form containing the TMD Pain Screening Questionnaire (Diagnostic Criteria for Temporomandibular Disorders - DC/TMD), the Pittsburgh Sleep Quality Index (PSQI), the Depression, Anxiety and Stress Scale (DASS-21), and the sleep and awake bruxism questionnaire. ANOVA test and Mann Whitney post-test were used, with Bonferroni adjustment (p<0.016) and a 95% confidence level. Results: Probable TMD was found in 24.3% (n=156) of the participants, while possible sleep and awake bruxism were diagnosed in 58% (n=372) and 53.8% (n=345) of them, respectively. Among all variables evaluated, only symptoms of depression were significantly greater in the quarantined DSs group when compared to those who were working at the clinical care (p=0.002). Working DSs were significantly less likely (OR=0.630, p=0.001) to have depressive symptoms. Those who were not worried or less worried about the pandemic were less likely to experience stress (OR=0.360), anxiety (OR=0.255), and poor sleep quality (OR=0.256). Sleep had a strong positive and moderate correlation with psychological factors on frontline workers and DSs in outpatient care, respectively. Conclusion: The results suggest confinement may have a more negative impact on the life of DSs than the act of being actively working. The concern about Covid-19 and poor sleep quality was significantly prevalent and may negatively affect the quality of life of DSs. Thus, further research on the topic is needed.

Efectividad de la magnetoterapia en pacientes con trastornos de la articulación temporomandibular / Effectiveness of magnetotherapy in patients with temporomandibular joint disorders

Introducción: Los trastornos temporomandibulares constituyen un conjunto de condiciones musculoesqueléticas que afectan la articulación temporomandibular, los músculos de la masticación y las estructuras anatómicas adyacentes. Objetivo: Evaluar la efectividad de la magnetoterapia en pacientes con trastornos de la articulación temporomandibular. Métodos: Se realizó una intervención terapéutica en la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, desde junio de 2016 hasta febrero de 2019. La muestra quedó constituida por 132 pacientes distribuidos en 2 grupos: A (de estudio) y B (de control), quienes recibieron tratamientos con magneto (N=66) y convencional, respectivamente. Se analizaron variables, tales como sexo, edad, grado de trastorno de la articulación temporomandibular y efectividad terapéutica. Se empleó el porcentaje como medida de resumen y el estadígrafo de Ji al cuadrado con un nivel de significación de 0,05. Resultados: Predominaron el sexo femenino (69,7 %) y el grupo etario de 40 - 49 años (51,5 %). Al finalizar el tratamiento se observó que en el grupo A la respuesta fue efectiva en más de 90,0 % de los pacientes; sin embargo, en el grupo B solo se logró en un poco más de 70,0 %. Conclusiones: La magnetoterapia resultó efectiva en pacientes con trastornos de la articulación temporomandibular.

Introduction: The temporomandibular disorders constitute a group of musculo skeletal conditions that affect the temporomandibular joint, the masticatory muscles and the adjacent anatomical structures. Objective: To evaluate the effectiveness of the magnetotherapy in patients with temporomandibular joint disorders. Method: A therapeutic intervention was carried out in Mártires del Moncada Teaching Provincial Stomatologic Clinic in Santiago de Cuba, from June, 2016 to February, 2019. The sample was constituted by 132 patients distributed in 2 groups: A (study) and B (control) who received treatments with magneto (N=66) and conventional, respectively. Some variables were analyzed, such as sex, age, degree of the temporomandibular joint disorder and therapeutic effectiveness. The percentage as summary measure and the chi-square test with a significance level of 0.05 were used. Results: There was a prevalence of the female sex (69.7 %) and the 40 - 49 age group (51.5 %). When concluding the treatment it was observed that in group A the response was effective in more than 90.0 % of the patients; however, in group B it was achieved just in a little more than 70.0 %. Conclusions: The magnetotherapy was effective in patients with temporomandibular joint disorders.

Disfunção temporomandibular e sua relação com a ortodontia / Temporomandibular dysfunction and its relationship with orthodontics

Outrora, a má oclusão dentária era considerada o principal fator etiológico da disfunção temporomandibular (DTM) e muitos profissionais da odontologia foram persuadidos por esse paradigma a realizarem tratamentos visando às alterações oclusais, como o tratamento ortodôntico, para prevenir e tratar DTM. Uma revisão de literatura foi realizada com o propósito de apresentar, fundamentado nas evidências científicas, se a terapêutica ortodôntica pode prevenir, tratar ou causar DTM. Disfunção temporomandibular, sua sintomatologia, diagnóstico, etiologia e tratamento foram definidos. Foram utilizados os descritores cruzados: disfunção temporomandibular, tratamento ortodôntico e tratamento, nos sites de pesquisa Biblioteca Virtual em Saúde (BVS Odontologia) e Google Acadêmico. Critérios de inclusão: idioma português, publicação entre 2003 e 2020, disponibilidade do texto completo e versar sobre o tema da DTM e sua relação com a ortodontia. Foram selecionados dezoito artigos dos sites de pesquisa, que os encaminharam para as bases de dados BBO, LILACS, FAB e SciELO. Pela análise da literatura, conclui-se que não há evidências científicas de que o tratamento ortodôntico pode prevenir, causar ou tratar disfunção temporomandibular, sendo, portanto, contraindicada a terapêutica ortodôntica no tratamento ou prevenção da DTM

In the past, dental malocclusion was considered the main etiological factor of temporomandibular joint disorder (TMJ) and many dental professionals were persuaded by this paradigm to carry out treatments aimed at occlusal changes, such as orthodontic treatment, to prevent and treat TMJ disorders. A literature review was carried out with the purpose of presenting, based on scientific evidence, whether orthodontic therapy can prevent, treat or cause TMD. Temporomandibular dysfunction, its symptoms, diagnosis, etiology and treatment were defined. Cross-descriptors were used: temporomandibular disorder, orthodontic treatment and treatment, on the Virtual Health Library (VHL Dentistry) and Google Scholar research sites. Inclusion criteria: Portuguese language, publication between 2003 and 2020, availability of the full text and addressing the theme of TMD and its relationship with orthodontics. Eighteen articles were selected from the research sites, which forwarded them to the BBO, LILACS, FAB and SciELO databases. By analyzing the literature, it is concluded that there is no scientific evidence that orthodontic treatment can prevent, induce or treat temporomandibular disorders, and therefore orthodontic therapy is contraindicated in the treatment or prevention of TMJ disorders

Association between severity of the temporomandibular disorder, neck pain, and mandibular function impairment / Associação entre severidade da disfunção temporomandibular, cervicalgia e limitação funcional da mandíbula

ABSTRACT Purpose: to investigate the possible association between the severity of the temporomandibular disorder, cervical pain, and mandibular function impairment. Methods: is a cross-sectional, descriptive study, conducted with 32 individuals with temporomandibular disorder, categorized by degree of severity, according to the Fonseca Index. Using the diagnosis criteria for temporomandibular disorder, the likely etiological factors for the disorder were established, as well as the intensity of the functional disability, resulting from cervical pain and of the mandibular impairment. The data obtained were statistically treated, adopting the significance level of 5%. Results: the mean age was 33.8 years, 90.6% being females. As for the degree of disorder, 56.3% presented severe TMD, followed by 28.1% showing a moderate one. The myogenic etiology was present in 93.7% of the patients. Cervical pain was present in 90.6% of them, of which, 59.4% presented a mild disability, and 25%, a moderate one. Considering the mandibular function, 46.9% of the patients presented a low, 40.6%, a moderate, and 12.5%, a severe impairment. There was a statistically significant association between cervical pain and mandibular function (p = 0.011). However, although there was an increase in cervical disability and in mandibular impairment as the severity of the TMD also increased, these associations were not statistically significant (p = 0.178 and p = 0.102, respectively). Conclusion: it can be stated that there is a higher prevalence of severe TMD and of myogenic origin, and that cervical pain influences, directly, the mandibular function, which is not necessarily related to the severity of the temporomandibular alteration. Likewise, such severity does not present a relationship to mandibular function impairment either.

RESUMO Objetivo: investigar possível associação entre severidade da disfunção temporomandibular, cervicalgia e limitação funcional mandibular. Métodos: estudo seccional descritivo, em 32 indivíduos com disfunção temporomandibular, categorizados de acordo com o grau de severidade segundo o Índice de Fonseca. Utilizando-se o Critérios Diagnósticos de Pesquisa em Disfunção Temporomandibular, estabeleceram-se prováveis fatores etiológicos da disfunção e a intensidade de incapacidade funcional cervical e mandibular, avaliados pelo Índice de Incapacidade Relacionada à Dor no Pescoço e Questionário de Limitação Funcional Mandibular respectivamente. Os dados obtidos foram tratados estatisticamente, adotando-se nível de significância de 5%. Resultados: a média de idade foi de 33,8 anos, sendo 90,6% pertencentes ao gênero feminino. Quanto à severidade da disfunção, 56,3% possuíam o tipo severo, sendo moderada em 28,1%. Em 93,7%, verificou-se etiologia miogênica. A cervicalgia esteve presente em 90,6% dos pacientes, dos quais 59,4% apresentaram incapacidade leve e 25% moderada. Quanto à função mandibular, houve baixa limitação em 46,9%, moderada em 40,6%, tendo sido severa em 12,5%. Houve associação estatisticamente significante entre a cervicalgia e a função mandibular (p=0,011). Contudo, embora tenha havido aumento na incapacidade cervical e na limitação mandibular com o aumento da severidade da disfunção temporomandibular, estas associações não foram estatisticamente significantes (p=0,178 e p=0,102, respectivamente). Conclusão: é possível afirmar que há maior prevalência de disfunção temporomandibular de intensidade severa e de origem miogênica, e que a cervicalgia influencia diretamente a função mandibular, não estando necessariamente relacionada à severidade da disfunção temporomandibular. Da mesma forma, esta última também não apresenta relação direta com a limitação da função mandibular.

Effects of the hyaluronic acid infiltration in the treatment of internal temporomandibular joint disorders / Efeitos da infiltração de ácido hialurônico no tratamento das desordens internas da articulação temporomandibular

ABSTRACT BACKGROUND AND OBJECTIVES: The primary protocol for the control of temporomandibular disorders prioritizes reversible and less invasive measures. However, conservative treatment is sometimes ineffective. Therefore, the use of hyaluronic acid has been suggested as a therapeutic alternative to verify the effectiveness of the hyaluronic acid in patients who are not responsive to the most conservative treatments, helping them in the control of pain. This article aims to perform a literature review on the efficacy of this substance in the treatment of internal changes of the temporomandibular joint. CONTENTS: The search strategy used the Pubmed portal and the Web of Science database for the last 10 years. We included articles in English that evaluated the efficacy of the hyaluronic acid in the intra-articular disorders of temporomandibular joint, and excluded articles from literature review, clinical case reports, theses, and dissertations. Fifteen studies, classified as randomized clinical trials, prospective and retrospective studies, case-control, pilot study, and systematic reviews were selected. The hyaluronic acid is of fundamental importance in the function and lubrication of joint tissues due to its high molecular weight. When degenerative and inflammatory changes are present, their concentration and molecular weight are diminished, and the injection of this acid raises these levels, which can generate pain relief. CONCLUSION: Intra-articular therapy with hyaluronic acid is effective in the reduction of symptomatologic levels and the functional restoration of the temporomandibular joint.

RESUMO JUSTIFICATIVA E OBJETIVOS: O protocolo primário de controle das disfunções temporomandibulares prioriza as medidas reversíveis e menos invasivas. Entretanto, o tratamento conservador mostra-se, algumas vezes, ineficaz, e como alternativa terapêutica, tem sido sugerido o uso de ácido hialurônico para com isso, verificar a sua efetividade em pacientes não responsivos aos tratamentos mais conservadores e poder ajudá-los no controle da dor. O objetivo deste estudo foi rever na literatura a eficácia dessa substância no tratamento das alterações internas da articulação temporomandibular. CONTEÚDO: A estratégia de busca utilizou o portal eletrônico Pubmed e a base de dados Web of Science, nos últimos 10 anos. Foram incluídos artigos em inglês que avaliaram a eficácia do ácido hialurônico nas desordens intra-articulares da articulação temporomandibular, e excluídos artigos de revisão de literatura, relatos de casos clínicos, teses e dissertações. Foram selecionados 15 estudos, classificados como ensaios clínicos randomizados, estudos prospectivos e retrospectivos, caso-controle, estudo piloto e revisões sistemáticas. O ácido hialurônico tem importância fundamental na função e lubrificação dos tecidos articulares, devido ao seu alto peso molecular. Quando alterações degenerativas e inflamatórias estão presentes, sua concentração e peso molecular estão diminuídos, e a injeção desse ácido eleva esses níveis, o que pode gerar alívio da dor. CONCLUSÃO: A terapia intra-articular com ácido hialurônico é efetiva na diminuição dos níveis sintomatológicos e no restabelecimento funcional da articulação temporomandibular.

O impacto da dor crônica por disfunção temporomandibular nas atividades laborais / Chronic temporomandibular disorder pain impact on work activities

Objetivo: Avaliar se a disfunção temporomandibular (DTM) crônica esteve associada ao absenteísmo laboral. Métodos: O estudo foi realizado com dados secundários de um ensaio clínico randomizado conduzido em um centro de referência terciária. Foram selecionados os pacientes que apresentaram diagnóstico de DTM segundo o Research Diagnostic Criteria/Temporomandibular Disorders (RDC/TMD), e que exerciam atividade profissional. O grau de dor crônica foi relacionado com o absenteísmo laboral relatado. Resultados: Dos 106 pacientes selecionados, a maioria registrou níveis altos de intensidade da dor e baixos de interferência na capacidade de trabalhar. Entretanto, quanto maior a classificação do grau de dor crônica, mais dias de falta ao trabalho foram relatados (p<0,001). Houve ainda uma correlação positiva de média a forte entre ausência do trabalho, a interferência nas atividades diárias e a mudança na capacidade laboral. Conclusão: A dor crônica por DTM esteve associada ao absenteísmo laboral, e os pacientes com maior grau de dor crônica relataram mais dias de ausência ao trabalho.

Purpose: Evaluate if TMD chronic pain had been associated to work absenteeism. Methods: A study using secondary data obtained from a randomized clinical trial of patients seeking for TMD treatment at a tertiary center. Worker patients with TMD according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were selected. Mean degree of chronic pain severity was compared with number of days of work absenteeism. Results: Of 106 selected patients, majority reported high levels of pain intensity and low disability. However, the greater pain severity degree, the greater the number of days of sick leave reported (p<0,001). There was also a positive correlation between work absenteeism, disability and daily activities impairment. Conclusion: TMD chronic pain has been associated to work absenteeism, and patients with severe degree of chronic pain reported more days of sick leave.

Evaluation of integral electromyographic values and median power frequency values in women with myogenous temporomandibular disorder and asymptomatic controls.

BACKGROUND: Surface electromyography (EMG) has been used as a reliable tool for the evaluation of electrical muscle activity. OBJECTIVE: The purpose of this study was to evaluate the EMG indices of the masticatory muscles (masseter, anterior temporalis and suprahyoid) in women with temporomandibular disorder (TMD) and asymptomatic controls in the time domain, by the integrated EMG signal (IEMG) and in the frequency domain, using the median power frequency (MPF). METHODS: An observational, cross-sectional study was conducted involving 30 asymptomatic women as the control (mean age: 25.85 ± 2.57 years) and 74 women with myogenous TMD (mean age: 26.54 ± 2.45 years) diagnosed using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Three EMG readings were taken during maximum voluntary clenching (MVC) of the molars on parafilm for five seconds with a three-minute rest interval between readings. The mixed-model analysis of variance test followed by the Bonferroni correction or the Student-t test was used for the analyses, with the level of significance set to 5% (p < 0.05). RESULTS: IEMG values were significantly higher in the masseter muscles than the anterior temporalis muscles in the control group (p < 0.01). IEMG values were significantly higher in the masseter muscles of the control group than the group with myogenous TMD (p < 0.05). MPF values of the suprahyoid muscles were significantly higher in the myogenous TMD group than the control group. CONCLUSIONS: These significant findings show that women with myogenous TMD have reduction of electrical activity of their masseter muscles and increased firing rate of the motor units of the suprahyoid muscles. These findings may help the treatment of myogenous TMD in women.

Pain threshold, sleep quality and anxiety levels in individuals with temporomandibular disorders / Limiar de dor, qualidade do sono e níveis de ansiedade em indivíduos com disfunção temporomandibular

ABSTRACT Purpose: to evaluate the pressure pain threshold, sleep quality and anxiety levels of individuals with different types of chronic temporomandibular disorders (TMD). Methods: a controlled, observational and cross-sectional study. TMD diagnosis followed the Research Diagnostic Criteria and the volunteers were divided into three groups: A-Muscular Disorder (n = 15), B- Articular Disorder (n = 10) and C- Control Group (n = 15). Evaluation was performed using the Pittsburg Sleep Quality Index, Visual Analog Scale, Algometry and Hospital Anxiety and Depression Scale. The significance level for all tests was 5%. Results: lower threshold of pain was seen in the masticatory and cervical musculature within groups A and B. However, when TMD groups were compared to the control group, only a statistically significant difference in the pain threshold of the masticatory muscle and the trapezius muscle was found. Groups A and B presented poor sleep quality, showing a statistical difference when compared to the control group. Additionally, it was observed that patients in the groups with TMD presented anxiety, while those in the control group, did not present it. Conclusion: individuals presented with TMD show lower levels of pain threshold, sleep quality and anxiety, as compared to healthy subjects. These results do not depend on the type of disorder presented.

RESUMO Objetivo: avaliar o limiar de dor, qualidade do sono e níveis de ansiedade em iindivíduos com diferentes tipos de disfunções temporomandibulares. Métodos: estudo controlado, observacional transversal. Foi utilizado o Research Diagnostic Criteria e os voluntários foram divididos em três grupos: Grupo A-disfunção muscular (n=15), Grupo B-disfunção articular (n=10) e Grupo C- controle (n=15). Foi utilizado o Pittsburg Sleep Quality Index (PSQI), Escala Visual Analógica da Dor (EVA), Algometria e Hospital Anxiety and Depression Scale - HADS). O nível de significância para todos os testes foi de 5%. Resultados: menor limiar de dor da musculatura mastigatória e cervical nos grupos A e B, mas quando comparados ao grupo controle só houve diferença estatística na algometria da musculatura mastigatória e do trapézio (p<0,05). Os grupos A e B apresentaram qualidade do sono pobre, mostrando diferença estatística com o grupo controle (p<0,05). Apenas os grupos A e B apresentaram ansiedade. Entre os grupos A e B não houve diferença estatística em relação ao limiar de dor, qualidade do sono e ansiedade. Conclusão: menores níveis de limiar de dor e redução da qualidade do sono e ansiedade ocorreram em indivíduos com Disfunção temporomandibular quando comparado aos sadios. Esses resultados independem do tipo de disfunção apresentada.

Inflammatory mediators related to arthrogenic temporomandibular dysfunctions / Mediadores inflamatórios relacionados às disfunções temporomandibulares artrogênicas

ABSTRACT BACKGROUND AND OBJECTIVES: Inflammatory disorders of the temporomandibular joint present a high prevalence in the population. The knowledge about inflammatory mediators, such as histamine, serotonin, kinins, eicosanoids, platelet-activating factor, nitric oxide, tumor necrosis factor and interleukins, may contrib-goupute to a better understanding of these disorders. The objective of this study was to review the literature on the major inflammatory mediators involved in temporomandibular arthralgia. CONTENTS: A search was made in the LILACS, Pubmed/Medline, Scielo and Science direct databases, crossing the following descriptors in the English and Portuguese language: inflammation, temporomandibular joint, inflammatory mediators, inflammation, temporomandibular joint and inflammatory mediators. Articles of literature review, systematic review, meta-analysis and randomized clinical trials, as well as books with compatible themes, published between September 1990 and June 2017 were included. Clinical reports, open label studies, animal model studies, were excluded. CONCLUSION: The knowledge of the inflammatory process, with the different mediators and mechanisms, can contrib-goupute to a better understanding, allowing the selection of the best therapy to be used clinically in cases of arthrogenic temporomandibular joint disorders.

RESUMO JUSTIFICATIVA E OBJETIVOS: As desordens inflamatórias da articulação temporomandibular apresentam alta prevalência na população. O conhecimento sobre os mediadores inflamatórios, tais como histamina, serotonina, cininas, eicosanoides, fator de ativação plaquetária, óxido nítrico, fator de necrose tumoral e interleucinas, pode contribuir para melhor entendimento dessas desordens. O presente trabalho objetivou revisar a literatura a respeito dos principais mediadores inflamatórios envolvidos nas artralgias temporomandibulares. CONTEÚDO: Foi realizada uma busca nas bases de dados LILACS, Pubmed/Medline, Scielo e Science direct, cruzando-se os seguintes descritores em língua inglesa e portuguesa: inflammation, temporomandibular joint, inflammatory mediators, inflamação, articulação temporomandibular e mediadores inflamatórios. Foram incluídos artigos de revisão de literatura, revisão sistemática, meta-análise e estudos clínicos randomizados, bem como livros com temática compatível, publicados no período de setembro de 1990 a junho de 2017. Foram excluídos casos clínicos, estudos abertos «open-label¼ e estudos em modelos animais. CONCLUSÃO: O conhecimento do processo inflamatório, com os diferentes mediadores e mecanismos, pode contribuir para um melhor entendimento do mesmo, possibilitando a seleção da melhor terapêutica para ser empregada clinicamente nos casos de artralgias temporomandibulares.