Peripheral nerve blocks for acute trigeminal neuralgia involving maxillary and mandibular branches: a case report.

Trigeminal neuralgia (TN) is neuropathic pain that affects the trigeminal nerve branches. Facial pain experienced by patients with TN is typically intense and excruciating. The second and third branches (maxillary and mandibular) are commonly affected. This case report focuses on the potential treatment options for acute TN attacks involving these branches. The proposed approach involves extra-oral peripheral blocks using local anesthetics. Pain levels were measured using a visual numeric scale (VNS) with potential side effects and other relevant documented information. The patients showed responses from high pain levels to almost complete remission (from 8 to 2 and from 10 to 2 on the final VNS), with no significant side effects. This technique provides immediate pain relief and complements oral medications by offering comfort and confidence until the desired drug effect is achieved.

O estresse ocupacional na disfunção temporomandibular e a resolutividade das teleconsultorias em dor orofacial no Brasil / Occupational stress in temporomandibular dysfunctions and resolution of teleconsultings in orofacial pain in Brazil

As disfunções temporomandibulares (DTM) formam um grupo heterogêneo de condições musculoesqueléticas que atingem a face em suas estruturas mastigatórias, causando limitação funcional ou dor que compõe uma categoria das dores orofaciais. Elas têm etiologia multifatorial, além serem reconhecidas como um problema de saúde pública. Por sua vez, a teleconsultoria assíncrona em saúde visa ao esclarecimento de dúvidas remetidas por profissionais de saúde aos núcleos de telessaúde, contemplando, dentre vários aspectos, diagnósticos e procedimentos clínicos. Com o advento da pandemia da COVID-19, o serviço ganhou nova dimensão, com potencial para permanecer como relevante ferramenta pós-pandemia. O presente trabalho utilizou duas abordagens metodológicas. A primeira teve o objetivo de desenvolver uma revisão sistemática sobre as relações entre estresse no trabalho ­ uma categoria de estresse - e as DTM. As buscas foram realizadas nas bases de dados Pubmed, Scopus, Web of Science, Lilacs, Embase, Google Scholar e Opengrey. Foi elaborada uma análise da qualidade metodológica dos artigos originais e de suas medidas de associação. A segunda avaliou por um estudo transversal a resolutividade de teleconsultorias nacionais assíncronas em DTM/dor orofacial do Programa Telessaúde Brasil Redes. Utilizou-se o banco de dados secundários do Sistema de Monitoramento e Avaliação de Resultados do Telessaúde (SMART), do período de 2019 a 2020 (antes e durante a pandemia de COVID-19). A variável dicotômica "Se evitou encaminhamento para atenção secundária" foi considerada o desfecho, representando a resolutividade do programa de teleconsultorias, confrontada com covariáveis de sexo e profissão dos demandantes, além das categorias de suas demandas. Foram elaborados uma análise descritiva dos dados, por meio de frequência, e um modelo de regressão binomial negativa para estimar as razões de prevalência não ajustadas e ajustadas (RP) com o intervalo de confiança de 95%. Como resultados da revisão sistemática, 12 de 602 artigos originais foram selecionados. Metade encontrou uma associação entre estresse no trabalho e DTM; sons da ATM (um sinal de DTM) e o estresse no trabalho foram associados apenas em uma população de músicos. Apenas 3 dos estudos usaram ferramentas validadas tanto para estresse quanto para DTM. Já para o estudo transversal, foram avaliadas 2.629 teleconsultorias, sendo 1.982 referentes a 2019 (75,4%). Em 2019, 1.522 (76,8%) evitaram o encaminhamento para a atenção secundária e, em 2020, 373 (57,7%) o fizeram. Os cirurgiões-dentistas (33,1%) e médicos (55,1%) compuseram a maioria de demandantes, e as dúvidas odontológicos (39,6%) e "outras" (58%) foram as mais frequentes. Como conclusão, a revisão sistemática mostrou baixa evidência para a associação entre estresse no trabalho e DTM, dado o número limitado de artigos e várias deficiências metodológicas. O estudo transversal evidenciou o efeito da pandemia na distribuição das variáveis na amostra em 2020, assim como uma maior resolutividade para mulheres, dentistas e demandas associadas à odontologia no mesmo período.

Temporomandibular dysfunctions (TMD) comprise a heterogeneous group of musculoskeletal conditions that reach the face in their masticatory structures, causing functional limitation or pain that makes up a category of orofacial pain. They have multifactorial etiology and are a public health problem. In turn, asynchronous teleconsulting in health aims to clarify health problems referred by health professionals to telehealth, including, among various aspects, the diagnostic and clinical procedures. With the advent of the COVID-19 pandemic, the service gained a new dimension, potentially remaining a relevant post-pandemic tool. The present work used two methodological approaches. The first aimed to develop a systematic review on the relationship between work stress ­ a stress category ­ and TMD. Searches were performed in Pubmed, Scopus, Web of Science, Lilacs, Embase, Google Scholar, and Opengrey databases. In addition, an analysis of the original articles' methodological quality and their association measures was carried out. By a cross-sectional study, the second evaluated the resolution of asynchronous national dental teleconsultations of the Telessaúde Brasil Redes Program. The secondary database of the Telehealth Results Monitoring and Evaluation System (SMART, in the Portuguese acronym) from 2019 to 2020 (before and after the COVID-19 pandemic) was used. The dichotomous variable "If referral to secondary care was avoided" was considered the outcome, compared with sex and professional covariates of the users, in addition to categories of the claims. A descriptive data analysis was developed using frequency data and a negative binomial regression model to estimate the unadjusted and adjusted prevalence ratios (PR) with the corresponding 95% confidence interval. As a result of the systematic review, 12 of 602 original articles were selected. Half found an association between work stress and TMD; ATM sounds (a DTM signal) and stress at work were associated only in a population of musicians. In addition, only three studies used validated tools for both stress and TMD. As for the cross-sectional study, a total of 2,629 teleconsultations were evaluated, of which 1,982 refer to 2019 (75.4%). In 2019, 1,522 (76.8%) avoided referral to secondary care, and in 2020, 373 (57.7%) did so. Dentists (33.1%) and physicians (55.1%) made up the majority of claimants, and dental doubts (39.6%) and "others" (58%) were the most frequent. In conclusion, given the limited number of articles and several methodological deficiencies, the systematic review showed minimal certainty of the evidence for the association between work stress and TMD. The cross-sectional study showed the effect of the Pandemic on the distribution of variables in the sample in 2020, as well as a higher resolution for women, dentists, and doubts associated with dentistry in the same period.

Association between Stress at Work and Temporomandibular Disorders: A Systematic Review.

Temporomandibular disorders (TMD) have been traditionally associated with psychosocial factors; however, occupational stress as a factor related to TMD has not been adequately assessed in the literature. The aim was to investigate the association between stress at work and TMD on adult paid workers. An electronic search included PubMed, Scopus, Web of Science, Embase, and LILACS databases. Manual searches in the included articles' reference and gray literature were performed. There were no restrictions regarding language or publication period. The inclusion criteria comprised observational studies with paid workers of any category, of both sexes, above 18 years old, assessing occupational stress/stress or distress and TMD as diagnosis or isolated signs and symptoms. Methodological quality was evaluated using Joanna Briggs tools. We narratively assessed the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. We collected 12 studies. 50% reported a positive association between stress and TMD diagnostic across various job categories. On the other hand, TMJ sounds (a TMD sign) and work stress were associated only in a musicians' population. However, the shortage of eligible articles and the methodological limitations provided a very low certainty of the evidence; only 4 of the studies used validated tools for both stress and TMD (2 reporting positive association). The association between stress and TMD is inconclusive by the available data. In the future, we expect more robust epidemiologic studies addressing these relevant aspects.

Factors associated with toothache among Brazilian adults: a multilevel analysis.

The aim of this study was to evaluate the factors associated with toothache in the adult population of Minas Gerais, Brazil. Individual data from a population sample (age 35 to 44 years) were collected from a secondary database of the SB Minas survey. Sampling was carried out by clusters and with multiple drawing stages. The eligibility criteria were to reside in areas chosen for the research, be within the age group, and accept to participate in the research. The individual variables assessed by a questionnaire and dental exams were sex, income, race/skin color, root caries, periodontal condition, need for dental treatment, and last dental appointment. The contextual variables, assessed by municipal indexes, were Human Development Index (HDI), illiteracy, unemployment, half minimum wage, quarter minimum wage, oral health team coverage, access to individual health care, and supervised tooth brushing average. The dependent variable was toothache in the past six months. A descriptive analysis was made using the Statistical Package for the Social Sciences and Hierarchical Linear and Nonlinear Modeling Software was used to perform the multilevel analyses for individual and contextual levels. An association was found between toothache and low income (OR = 2.00; 95%CI = 1.32-3.13), dental caries (OR = 1.86; 95%CI = 1.22-2.86), periodontal condition, and living on a quarter of the minimum wage or less (OR = 1.03; 95%CI = 1.00-1.08). Clinical and social factors were associated with toothache, reinforcing the need to improve public polices in oral health focused on the adult population.

Factors associated with toothache among Brazilian adults: a multilevel analysis

Abstract The aim of this study was to evaluate the factors associated with toothache in the adult population of Minas Gerais, Brazil. Individual data from a population sample (age 35 to 44 years) were collected from a secondary database of the SB Minas survey. Sampling was carried out by clusters and with multiple drawing stages. The eligibility criteria were to reside in areas chosen for the research, be within the age group, and accept to participate in the research. The individual variables assessed by a questionnaire and dental exams were sex, income, race/skin color, root caries, periodontal condition, need for dental treatment, and last dental appointment. The contextual variables, assessed by municipal indexes, were Human Development Index (HDI), illiteracy, unemployment, half minimum wage, quarter minimum wage, oral health team coverage, access to individual health care, and supervised tooth brushing average. The dependent variable was toothache in the past six months. A descriptive analysis was made using the Statistical Package for the Social Sciences and Hierarchical Linear and Nonlinear Modeling Software was used to perform the multilevel analyses for individual and contextual levels. An association was found between toothache and low income (OR = 2.00; 95%CI = 1.32-3.13), dental caries (OR = 1.86; 95%CI = 1.22-2.86), periodontal condition, and living on a quarter of the minimum wage or less (OR = 1.03; 95%CI = 1.00-1.08). Clinical and social factors were associated with toothache, reinforcing the need to improve public polices in oral health focused on the adult population.

Estudo epidemiológico e translacional sobre dor na Odontologia / Epidemiological and translational study about pain in dentistry

A dor, definida como uma experiência sensorial e emocional desagradável associada a um dano tecidual real ou potencial pode receber diferentes denominações dependendo do local anatômico de onde se origina. A dor orofacial é reconhecida como "dor localizada acima do pescoço, na frente da linha das orelhas e abaixo da linha orbitomeatal, bem como dentro da cavidade oral". Ela inclui, dentre outras, a dor de origem dentária, a mais prevalente, e a disfunção temporomandibular (DTM), condição de dor ou disfunção musculoesquelética que atinge a face em suas estruturas mastigatórias. A dor dentária é muitas vezes incapacitante, sendo um problema de saúde pública. O presente trabalho objetivou a avaliação da dor dentária na população adulta de Minas Gerais (Brasil) (35 a 44 anos) e sua associação com fatores biológicos e sócioeconômicos, além de elaborar, como produto técnico, material de nível científico com base em pesquisa translacional para o dentista clínico geral sobre os tópicos relevantes na área de bruxismo e disfunção temporomandibular. Para avaliação da dor dentária foram utilizados dados secundários obtidos do levantamento epidemiológico SB Minas Gerais 2012. Como variável dependente estabeleceu-se a dor de dente reportada nos últimos 6 meses, e as covariáveis foram: domínio (capital, interior I e II), sexo, cor da pele ou raça, renda familiar, histórico de cárie de raiz, condição periodontal, necessidade de tratamento dentário e última consulta odontológica. Como um segundo nível, variáveis municipais foram abordadas: IDH, analfabetismo, desemprego, renda de até metade do salário mínimo, renda de até um quarto do salário mínimo, cobertura das equipes de saúde bucal, acesso ao serviço dentário individual e média de escovação supervisionada. A população avaliada compreendeu 1.182 indivíduos (n=1,182). Um modelo de regressão logística multinível foi usado para inferir associação, considerando ao final uma significância de 5%. Os dados foram analisados no programa IBM SPSS Software versão 22.0, e a análise multinível realizada no HLM 6.08. Como resultado, 21.1% da amostra relatou dor dentária nos últimos 6 meses, e houve associação entre dor dentária e nível baixo de renda individual, cárie de raiz, condição periodontal e necessidade de tratamento (p<0,05). O aumento de um ponto porcentual na taxa de indivíduos com renda até um quarto do salário mínimo aumentou em 3% a chance de dor dentária em adultos em MG. Concluiu-se que fatores sócio demográficos e econômicos relacionaram-se à dor de dente na população avaliada, o que reforça a necessidade de uma maior abordagem destes fatores a fim de auxiliar o enfrentamento deste importante problema de saúde pública. Como produto técnico, foram elaborados dois artigos de revisão translacional, que por sua vez intenciona transmitir de forma sintética e com linguagem acessível conhecimentos de áreas específicas da odontologia. Os temas abordados, prementes na área odontológica, foram a atualização e a adequada abordagem clínica de pacientes com bruxismo e/ou disfunções temporomandibulares. Concluiu-se que, exceto para uso de placas oclusais, não há evidência suficiente para se sustentar qualquer abordagem terapêutica no bruxismo. Também não há evidência para a sustentação de tratamentos oclusais invasivos para bruxismo ou DTM. Recomenda-se cautela no planejamento protético destes pacientes.

Pain, defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, receive different denominations depending on its origin. Orofacial pain is classified as orbitomeatal as well as pain within the oral cavity. It includes the most prevalente, toothache, and temporomandibular disorder (TMD), a musculoskeletal pain or dysfunction condition that affects the masticatory system. Toothache is often disabling and is also a public health problem. This study aimed the evaluation of toothache in adult population from the state of Minas Gerais (Brazil) (35 a 44 anos), and its association with biological and socioeconomic factors, besides the elaboration of scientific level material on relevant topics around bruxism and temporomandibular disorders by translational review, aiming the general practioner. Regarding toothache, secondary data from SB Minas Gerais 2012 epidemiological databank were collected. Dependent variable was pain felt in the last 6 months. As covariables: domains (capital, interior I and II); sex; race / skin color; familiar wage; root caries history; periodontal condition, dental need treatment, last dental appointment). As a second level, municipal variables were assessed: HDI, illiteracy, unemployment, up to half minimum wage, up to quarter minimum wage, health team coverage, access to individual dental service and supervisioned tooth brushing average. Assessed population comprehended 1.182 individuals (n=1,182). A multilevel logistic regression statistical model was used to infer association between different levels, considering 5% significance in the end. The data were processed in the IBM SPSS Software version 22.0 program and multilevel analysis was undertaken in HLM 6.08. As a result, 21.1% of the sample reported toothache in the last 6 months, and association was found between pain and higher income (this one as protective factor), root caries, periodontal condition and treatment need, at individual level (p <0.05). The one-percentage-point increase in group rated in "up to quarter minimum wage" increases pain risk by 3% for adults in MG. In conclusion, sociodemographic factors are related with toothache in Minas Gerais` adult population, which reinforces the need to adress those factors in order to better assist people upon toothache, an important public health problem. As a technical product, two translational review articles were formulated, synthesizing in plain language specific dental knowledge to general practioner. The topics discussed were the upgrade and the proper approach in clinical practice to patients with bruxism and / or temporomandibular disorders. As conclusions, except for oral appliances, there is no suficiente evidence to support any therapeutic method for bruxism. There is also no evidence to support invasive occlusal procedures for bruxismo or TMD. Caution on the prosthodontic planning for these patients are recommended, and they must be previously treated by noninvasive therapeutic resources.