RESUMEN
Patients with temporomandibular disorder (TMD) report poor sleep quality on the Pittsburgh Sleep Quality Index (PSQI). However, polysomnographic (PSG) studies show meagre evidence of sleep disturbance on standard physiological measures. The present aim was to analyse self-reported sleep quality in TMD as a function of myofascial pain, PSG parameters and depressive symptomatology. PSQI scores from 124 women with myofascial TMD and 46 matched controls were hierarchically regressed onto TMD presence, ratings of pain intensity and pain-related disability, in-laboratory PSG variables and depressive symptoms (Symptoms Checklist-90). Relative to controls, TMD cases had higher PSQI scores, representing poorer subjective sleep and more depressive symptoms (both P < 0·001). Higher PSQI scores were strongly predicted by more depressive symptoms (P < 0·001, R2 = 26%). Of 19 PSG variables, two had modest contributions to higher PSQI scores: longer rapid eye movement latency in TMD cases (P = 0·01, R2 = 3%) and more awakenings in all participants (P = 0·03, R2 = 2%). After accounting for these factors, TMD presence and pain ratings were not significantly related to PSQI scores. These results show that reported poor sleep quality in TMD is better explained by depressive symptoms than by PSG-assessed sleep disturbances or myofascial pain. As TMD cases lacked typical PSG features of clinical depression, the results suggest a negative cognitive bias in TMD and caution against interpreting self-report sleep measures as accurate indicators of PSG sleep disturbance. Future investigations should take account of depressive symptomatology when interpreting reports of poor sleep.
Asunto(s)
Depresión/complicaciones , Depresión/psicología , Síndromes del Dolor Miofascial/complicaciones , Polisomnografía , Autoinforme , Trastornos del Sueño-Vigilia/fisiopatología , Trastornos del Sueño-Vigilia/psicología , Trastornos de la Articulación Temporomandibular/complicaciones , Adulto , Análisis de Varianza , Electromiografía , Femenino , Humanos , Persona de Mediana Edad , Síndromes del Dolor Miofascial/fisiopatología , Síndromes del Dolor Miofascial/psicología , Dimensión del Dolor , Estudios Retrospectivos , Trastornos de la Articulación Temporomandibular/fisiopatología , Trastornos de la Articulación Temporomandibular/psicología , Factores de TiempoRESUMEN
Sleep bruxism (SB), primarily involving rhythmic grinding of the teeth during sleep, has been advanced as a causal or maintenance factor for a variety of oro-facial problems, including temporomandibular disorders (TMD). As laboratory polysomnographic (PSG) assessment is extremely expensive and time-consuming, most research testing this belief has relied on patient self-report of SB. The current case-control study examined the accuracy of those self-reports relative to laboratory-based PSG assessment of SB in a large sample of women suffering from chronic myofascial TMD (n = 124) and a demographically matched control group without TMD (n = 46). A clinical research coordinator administered a structured questionnaire to assess self-reported SB. Participants then spent two consecutive nights in a sleep laboratory. Audiovisual and electromyographic data from the second night were scored to assess whether participants met criteria for the presence of 2 or more (2+) rhythmic masticatory muscle activity episodes accompanied by grinding sounds, moderate SB, or severe SB, using previously validated research scoring standards. Contingency tables were constructed to assess positive and negative predictive values, sensitivity and specificity, and 95% confidence intervals surrounding the point estimates. Results showed that self-report significantly predicted 2+ grinding sounds during sleep for TMD cases. However, self-reported SB failed to significantly predict the presence or absence of either moderate or severe SB as assessed by PSG, for both cases and controls. These data show that self-report of tooth grinding awareness is highly unlikely to be a valid indicator of true SB. Studies relying on self-report to assess SB must be viewed with extreme caution.
Asunto(s)
Bruxismo del Sueño/diagnóstico , Síndrome de la Disfunción de Articulación Temporomandibular/complicaciones , Estudios de Casos y Controles , Femenino , Humanos , Polisomnografía/métodos , Reproducibilidad de los Resultados , Autoinforme , Sensibilidad y Especificidad , Bruxismo del Sueño/complicacionesRESUMEN
Patients with temporomandibular muscle and joint disorder (TMJD) increasingly seek and receive treatment for their pain with botulinum toxin (BoNTA; botulinum toxin A). Used intramuscularly in therapeutic doses, it produces localised paresis. Such paresis creates risk of reduced bone mineral density, or 'disuse osteopenia'. Animal studies have frequently used BoNTA as a model of paralysis to induce bone changes within short periods. Osteopenic effects can be enduring in animals but have yet to be studied in humans. This is the first study in humans to examine bone-related consequences of BoNTA injections in the masticatory muscles, comparing oral and maxillofacial radiologists' ratings of trabecular bone patterns in the condyles of patients with TMJD exposed to multiple masticatory muscle injection sessions with BoNTA to a sample of patients with TMJD unexposed to masticatory muscle injections with BoNTA. Cone-beam computed tomography (CBCT)-derived images of bilateral condyles were evaluated in seven patients with TMJD receiving 2+ recent BoNTA treatment sessions for facial pain and nine demographically matched patients with TMJD not receiving BoNTA treatment. Two oral and maxillofacial radiologists evaluated CBCT images for evidence of trabecular changes consistent with osteopenia. Both evaluators noted decreased density in all participants exposed to BoNTA and in none of the unexposed participants (P < 0.001). No other abnormalities associated with reduced loading were detected. These findings need replication in a larger sample and over a longer time period, to ensure safety of patients with TMJD receiving multiple BoNTA injections for their pain.
Asunto(s)
Densidad Ósea/efectos de los fármacos , Enfermedades Óseas Metabólicas/inducido químicamente , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Toxinas Botulínicas Tipo A/efectos adversos , Dolor Facial/tratamiento farmacológico , Fármacos Neuromusculares/efectos adversos , Síndrome de la Disfunción de Articulación Temporomandibular/tratamiento farmacológico , Adulto , Toxinas Botulínicas Tipo A/administración & dosificación , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Inyecciones Intramusculares , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/efectos de los fármacos , Músculos Masticadores/fisiopatología , Fármacos Neuromusculares/administración & dosificación , Satisfacción del Paciente , Proyectos Piloto , Calidad de Vida , Resultado del TratamientoRESUMEN
Despite theoretical speculation and strong clinical belief, recent research using laboratory polysomnographic (PSG) recording has provided new evidence that frequency of sleep bruxism (SB) masseter muscle events, including grinding or clenching of the teeth during sleep, is not increased for women with chronic myofascial temporomandibular disorder (TMD). The current case-control study compares a large sample of women suffering from chronic myofascial TMD (n = 124) with a demographically matched control group without TMD (n = 46) on sleep background electromyography (EMG) during a laboratory PSG study. Background EMG activity was measured as EMG root mean square (RMS) from the right masseter muscle after lights out. Sleep background EMG activity was defined as EMG RMS remaining after activity attributable to SB, other orofacial activity, other oromotor activity and movement artefacts were removed. Results indicated that median background EMG during these non-SB event periods was significantly higher (P < 0·01) for women with myofascial TMD (median = 3·31 µV and mean = 4·98 µV) than for control women (median = 2·83 µV and mean = 3·88 µV) with median activity in 72% of cases exceeding control activity. Moreover, for TMD cases, background EMG was positively associated and SB event-related EMG was negatively associated with pain intensity ratings (0-10 numerical scale) on post-sleep waking. These data provide the foundation for a new focus on small, but persistent, elevations in sleep EMG activity over the course of the night as a mechanism of pain induction or maintenance.
Asunto(s)
Electromiografía , Dolor Facial/fisiopatología , Músculos Masticadores/fisiopatología , Procesamiento de Señales Asistido por Computador , Bruxismo del Sueño/fisiopatología , Trastornos de la Articulación Temporomandibular/fisiopatología , Estudios de Casos y Controles , Dolor Facial/etiología , Femenino , Humanos , Persona de Mediana Edad , Monitoreo Fisiológico , Contracción Muscular , Dimensión del Dolor , Autoinforme , Bruxismo del Sueño/complicaciones , Sueño REM , Trastornos de la Articulación Temporomandibular/complicaciones , Factores de Tiempo , VigiliaRESUMEN
OBJECTIVE: The purpose of this study was to describe the utility of oral chemiluminescent lighting (FDA-cleared ViziLite) as an adjunct to standard visual examination (SVE) to enhance visualization of mucosal lesions, particularly those "clinically suspicious" for oral pre-cancer or cancer. Subjects were considered at risk for oral cancer or pre-cancer if they have no a priori knowledge of the presence or absence of an oral lesion at the time of examination. METHODOLOGY: Five-hundred and one consecutive consenting subjects, over 40 years of age and with a positive tobacco history, received a standard visual examination with conventional incandescent lighting, followed by chemiluminescent lighting. All lesions were recorded, and for lesions detected by both screening modalities, comparisons were made of the subjective parameters of lesion brightness, sharpness, surface texture, and relative size. RESULTS: A total of 410 epithelial lesions were detected in 270 subjects by standard visual examination, of which 127 were clinically "suspicious" for oral cancer and pre-cancer. Ninety-eight lesions were also visualized by chemiluminescent lighting as "aceto-white" (CL+), in addition to six lesions not previously seen by standard visual examination. Seventy-seven of the CL+ lesions (78.5%) were clinically suspicious; all "suspicious" lesions with an ulcerative component and ulcerated lesions consistent with trauma were CL+. Leukoplakias were significantly more likely to be CL+ than erythroplakias (p < 0.01). Overall, those lesions illuminated by chemiluminescent lighting appeared brighter, sharper, and smaller compared to incandescent illumination. CONCLUSION: The results of this study suggest that oral chemiluminescent lighting, when used as a screening adjunct following the standard visual oral examination, provides additional visual information. Leukoplakias may be more readily visualized by chemiluminescence. Studies are underway to explore the clinical significance and predictive value of oral chemiluminescent lighting.
Asunto(s)
Luminiscencia , Neoplasias de la Boca/diagnóstico , Lesiones Precancerosas/diagnóstico , Adulto , Anciano , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tabaquismo/complicacionesRESUMEN
We describe a case of a soft tissue neoplasm in the infraorbital region of a 31-year-old African-American man that met histologic and immunohistochemical criteria for solitary fibrous tumor. This uncommon spindle cell neoplasm was first described in the pleura, but it has since been reported in many other soft tissue locations. The lesion was locally aggressive and successfully treated by local excision. Solitary fibrous tumor can be locally destructive and can occur in a wide variety of tissues or organs; this is the seventh published case of solitary fibrous tumor in the orofacial region.
Asunto(s)
Neoplasias Faciales/patología , Mesotelioma/patología , Neoplasias de los Tejidos Blandos/patología , Adulto , Mejilla/patología , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , MasculinoRESUMEN
OBJECTIVE: Some patients diagnosed with chronic fatigue syndrome (CFS) have symptoms commonly observed in Sjögren's syndrome (SS), particularly xerophthalmia and xerostomia, leading to speculation that some patients with CFS might have primary SS or that the 2 disorders share common pathophysiological features. We investigated the prevalence of symptoms of mucosal dryness, salivary gland pathology, lacrimal hyposecretion, and autoantibodies (antinuclear antibody, SSA/SSB) among patients diagnosed with CFS. METHODS: Twenty-five subjects with CFS and 18 healthy control subjects were interviewed and examined, had a Schirmer test and fluorescein tear dilution, and underwent minor salivary gland (MSG) biopsy. Antibody to nuclear antigen as well as anti-La (SSA) and anti-Ro (SSB) antibody were available for subjects with CFS. Pathologists unaware of the subject group assignment examined labial salivary gland biopsy specimens and calculated a standard MSG score for each specimen. RESULTS: Mucosal dryness was reported by 13/25 (52%) subjects with CFS, of which 8 (32%) also had MSG score, low Schirmer test value, and symptoms consistent with primary SS (p = 0.05). No control subject met diagnostic criteria for primary SS. MSG focus scores < or =1 were common among both groups (CFS 14/25; controls 15/18). MSG results without pathological alteration were rare, seen in only one control and no CFS patients. Low Schirmer values were found in 10/25 (40%) CFS patients and 1/18 (6%) control (p = 0.01). CONCLUSION: A subset of patients with CFS may have primary SS.
Asunto(s)
Síndrome de Fatiga Crónica/diagnóstico , Síndrome de Sjögren/diagnóstico , Adulto , Biopsia , Diagnóstico Diferencial , Síndrome de Fatiga Crónica/complicaciones , Síndrome de Fatiga Crónica/fisiopatología , Femenino , Humanos , Aparato Lagrimal/metabolismo , Masculino , Persona de Mediana Edad , Glándulas Salivales Menores/patología , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/fisiopatología , Encuestas y CuestionariosAsunto(s)
Atención Dental para Enfermos Crónicos , Enfermedades de las Válvulas Cardíacas , Profilaxis Antibiótica , Anticoagulantes/uso terapéutico , Endocarditis Bacteriana/prevención & control , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/fisiopatología , Enfermedades de las Válvulas Cardíacas/terapia , Prótesis Valvulares Cardíacas , Humanos , Hemorragia Bucal/prevención & control , Medición de RiesgoRESUMEN
Pemphigus vulgaris most often begins in the mouth but is often overlooked in the differential diagnosis of chronic, multiple oral ulcerations and erosions. Accurate diagnosis requires perilesional biopsy including intact epithelium, submitted for hematoxylin and eosin as well as direct immunofluorescence staining. Early and aggressive treatment with moderate to high dose prednisone in combination with steroid sparing drugs such as azathioprine and mycophenolate allow complete remission in most patients.
Asunto(s)
Mucosa Bucal/patología , Úlceras Bucales/diagnóstico , Úlceras Bucales/terapia , Pénfigo/diagnóstico , Enfermedad Crónica , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Úlceras Bucales/patología , Pénfigo/patología , Pénfigo/terapiaRESUMEN
Oral disease is frequently associated with HIV. While nearly all oral disorders associated with HIV infection also occur in other conditions characterized by immunosuppression, no other condition is associated with as wide and significant a spectrum of oral disease as is HIV infection. Many HIV-associated oral disorders occur early in HIV infection, not infrequently as the presenting sign or symptom. Thus, early detection of associated oral disease should, in many cases, result in earlier diagnosis of HIV infection. Likewise, awareness of the variety of oral disorders which can develop throughout the course of HIV infection, and coordination of health care services between physician and dentist, should improve overall health and comfort of the patient. This paper reviews the clinical, diagnostic and therapeutic aspects of HIV-associated oral disorders.
Asunto(s)
Infecciones por VIH/complicaciones , Enfermedades de la Boca/virología , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/virología , Humanos , Huésped Inmunocomprometido , Enfermedades de la Boca/terapia , Neoplasias de la Boca/terapia , Neoplasias de la Boca/virología , Micosis/tratamiento farmacológico , Micosis/virología , Virosis/tratamiento farmacológico , Virosis/virologíaRESUMEN
Cutaneous T-cell lymphoma rarely involves the oral cavity. Only 14 detailed cases of oral cutaneous T-cell lymphoma have been described in the English-language literature; this report describes eight additional cases observed among 824 patients evaluated at our cutaneous T-cell lymphoma center since 1968. Oral involvement occurs late in the course of cutaneous T-cell lymphoma and usually is associated with poor prognosis; most patients die of disease complications within 3 years of the diagnosis of oral involvement.
Asunto(s)
Linfoma de Células T/patología , Neoplasias de la Boca/secundario , Neoplasias Cutáneas/patología , Anciano , Antígenos de Neoplasias , Relación CD4-CD8 , Femenino , Humanos , Linfoma de Células T/complicaciones , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/complicaciones , Micosis Fungoide/complicaciones , Síndrome de Sézary/complicaciones , Neoplasias Cutáneas/complicacionesRESUMEN
Oral symptoms of multiple myeloma are common. A patient with refractory multiple myeloma is described because of this unusual orofacial manifestations, including severe intraoral hemorrhage, a massive, erosive maxillofacial lesion with extension into the cranial fossa, and rapid growth of a large intraoral mass.
Asunto(s)
Neoplasias de Cabeza y Cuello , Neoplasias Maxilares/patología , Mieloma Múltiple/patología , Hemorragia Bucal/terapia , Plasmacitoma/patología , Diagnóstico Diferencial , Técnicas Hemostáticas , Humanos , Masculino , Neoplasias Maxilares/complicaciones , Neoplasias Maxilares/terapia , Persona de Mediana Edad , Mieloma Múltiple/complicaciones , Mieloma Múltiple/terapia , Hemorragia Bucal/etiología , Plasmacitoma/diagnóstico , Plasmacitoma/terapiaRESUMEN
Oral lesions commonly seen by primary care physicians represent manifestations of local or systemic disease of infectious, immunogenic, malignant, or traumatic etiology. The patient's history will readily show whether the lesions are acute or chronic, single or multiple, primary or recurrent--classifications that greatly simplify the differential diagnosis.