MRI changes and clinical characteristics in temporomandibular joints with displacement of the articular disk without reduction - a cross-sectional observational study.

OBJECTIVES: This study examined changes in magnetic resonance imaging (MRI) of temporomandibular joints (TMJ) with anterior displacement disk without reduction (DDwoR) and its correlation to clinical symptoms. METHODS: 190 individuals with DDwoR were evaluated according to Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and MRI. Pain's chronicity/intensity and limited mouth opening (locking) were correlated with: TMJ degeneration (MRI T1), effusion (T2), disc's shape and position (proton density). RESULTS: In 103 TMJ with DDwoR, hemiconvex shape (41.6%), sclerosis (45.6%) and mild effusion (47.6%) were the most prevalent findings. There was not association (p > .05) between: different DDwoR positions with pain's intensity/chronicity; effusion with locking. Disk deformation was associated with degeneration (p = .034) and pain's intensity (p = .006). Locking was associated with degeneration (p = .05). CONCLUSIONS: Condylar osteodegeneration is often related to DDwoR. Locking by DDwoR is associated with severe levels of chronic pain and articular disk deformation.

Comparison of two needles arthrocentesis versus double needle cannula arthrocentesis in the treatment of temporomandibular disc displacement.

OBJECTIVE: To compare clinical and imaging results of two needles arthrocentesis (TNA) versus double-needle cannula arthrocentesis (DNCA) in the treatment of temporomandibular joint disc displacement (DD). METHODS: Twenty patients with DD were randomly divided into two groups: TNA and DNCA. Clinical data (pain scores; maximal interincisal distance [MID], and protrusion and laterality movements) were evaluated before and 24 months after the arthrocentesis. Disc and condyle position and joint effusion (JE) were evaluated by magnetic resonance exams. RESULTS: Both groups presented improvement in the MID, including pain reduction, modifications in disc and condyle positions, and reduction of the presence of JE, without difference between groups (p > 0.05). The DNCA was performed significantly faster (p = 0.0001). CONCLUSION: Both TNA and DNCA are efficient in promoting improvement in the MID: reduction in pain, modifications in disc and condyle positions, and, in part, may account for less JE, without difference between techniques.

Relationship between symptoms and imagenological signs of degenerative temporomandibular joint disorders using the Research Diagnostic Criteria for Temporomandibular Disorders and cone-beam computed tomography / Relação entre sintomas e sinais imagenológicos das disfunções degenerativas da articulação temporomandibular com o Research Diagnostic Criteria for Temporomandibular Disorders e a tomografia computadorizada de feixe cônico

ABSTRACT BAKGROUND AND OBJECTIVES: Arthralgia is a common complaint among patients with temporomandibular osteodegeneration, however, for the accurate diagnosis of osteodegeneration, it is suggested the adoption of imaging tests associated with standardized clinical diagnosis protocols. The objective of this study was to evaluate patients with degenerative changes in the temporomandibular joint previously visualized by cone beam computed tomography, relating these changes with the clinical diagnoses and symptoms of temporomandibular disorders, in order to conclude which of the degenerative changes develop more painful symptomatology. METHODS: A cross-sectional observational descriptive study. Thirty-eight patients who had previously done the cone beam computed tomography exam were evaluated. Subjects were grouped according to clinical diagnosis of temporomandibular joint changes using the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire. The presence of pain was considered during lateral palpation; intra-articular palpation; excursive movements; and active mouth opening. RESULTS: Among the purely clinical diagnoses, only 10.5% were conclusive, classifying patients as suffering from osteoarthritis/osteoarthrosis. Painful joint symptoms were found in all groups, with no statistically significant difference. Similarly, the presence of degenerative disorders, including flattening, osteophytes, sclerosis, and erosion were found in similar proportions in all diagnosis groups. CONCLUSION: 89.5% of the degenerative changes were clinically underdiagnosed. There was a positive association between the presence of symptoms and the number of correct clinical diagnoses of osteoarthritis/osteoarthrosis obtained with the Research Diagnostic Criteria for Temporomandibular Disorders.

RESUMO JUSTIFICATIVA E OBJETIVOS: Entre os pacientes com osteodegeneração cortical temporomandibular, a artralgia é uma queixa comum, entretanto, para o diagnóstico preciso de osteodegeneração sugere-se a adoção de exames de imagem associados a protocolos de diagnóstico clínico padronizados. O objetivo deste estudo foi avaliar pacientes com alterações degenerativas da articulação temporomandibular previamente visualizados por tomografia computadorizada de feixe cônico, relacionando essas alterações com os diagnósticos e sintomas clínicos da disfunção temporomandibular, a fim de concluir quais das alterações degenerativas se associam ao sintoma álgico. MÉTODOS: Trata-se de um estudo observacional descritivo transversal. Foram avaliados 38 pacientes que já haviam realizado realizado a tomografia computadorizada de feixe cônico. Os indivíduos foram agrupados de acordo com o diagnóstico clínico de alterações na articulação temporomandibular, utilizando o questionário Research Diagnostic Criteria for Temporomandibular Disorders. A presença de dor foi considerada durante: palpação lateral; palpação intra-articular; movimentos excursivos; e abertura ativa da boca. RESULTADOS: Entre os diagnósticos puramente clínicos, apenas 10,5% foram conclusivos, classificando os pacientes como portadores de osteoartrite/osteoartrose. Sintomas articulares dolorosos foram encontrados em todos os grupos, sem diferença estatisticamente significante. Da mesma forma, a presença de distúrbios degenerativos, incluindo achatamento, osteófitos, esclerose e erosão, foi encontrada em proporções semelhantes em todos os grupos de diagnóstico. CONCLUSÃO: 89,5% das alterações degenerativas foram clinicamente subdiagnosticadas. Houve associação positiva entre a presença de sintomas e o número de diagnósticos clínicos corretos de osteoartrite/osteoartrose obtidos com o Research Diagnostic Criteria for Temporomandibular Disorders.

Effectiveness of Sequential Viscosupplementation in Temporomandibular Joint Internal Derangements and Symptomatology: A Case Series.

Viscosupplementation is a minimally invasive technique that replaces synovial fluid by intra-articular injection of hyaluronic acid (HA). Although effective in some joints, there is not conclusive evidence regarding temporomandibular disorders. This case series described the efficacy of a viscosupplementation protocol in intra-articular temporomandibular disorders. Ten patients with a diagnosis of disc displacement and/or osteoarthritis by Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were submitted to four monthly injections of low or medium molecular weight HA. Pain, mandibular function, image analysis by tomography and magnetic resonance, and quality of life were assessed at baseline and follow-ups (1 and 6 months). Pain, jaw range-of-motion, mandibular function, and quality of life improved at follow-up evaluations. Osteoarthritis changes decreased, and 20% of patients improved mandibular head excursion after treatment. Resolution of effusion and improvement in disc morphology were observed for most patients. This viscosupplementation protocol reduced pain and symptoms associated with internal derangement of temporomandibular joint, improved quality of life, and showed benefits from both low and medium molecular weight HA in alternate cycles.

Evaluation of depressive symptoms and qualit y of life in individuals with tinnitus and temporomandibular disorders / Avaliação da presença de sintomas depressivos e qualidade de vida de indivíduos portadores de zumbido e desordens temporomandibulares

Various etiologies are attributed to the development of subjective tinnitus, but their inter-relationship with the presence of temporomandibular disorders and depression is still poorly understood. To assess the presence of depressive symptoms in individuals with TMD and subjective tinnitus, assessing the impact on their quality of life. This is a cross-sectional observational descriptive study. We evaluated 44 patients in a public University. For TMD diagnosis as well as assessment of depressive symptoms, the RDC/TMD questionnaire was used. Otolaryngological assessment was conducted by means of pure tone, speech, and immitance audiometry. The "Tinnitus Handicap Inventory" questionnaire was also administered. 84% of the individuals with tinnitus had myofascial pain, with the masseter muscle being the most prevalent area of pain, and 16% exclusively had painful and/or degenerative TMJ changes. Among the patients with myofascial pain, 86,5% had depressive symptoms, while among those without myofascial pain, only 42,8% presented these symptoms. Eleven (11) patients (25%) reported slight impact of tinnitus on quality of life, 15 (34%) mild impact, 7 (16%) moderate, 7 (16%) severe, and 4 (9%) catastrophic impact. There was a positive association between the presence of myofascial pain and depressive symptoms (p=0,02), as the intensity of tinnitus increases and the severity of depressive symptoms (p<0,01).

Diversas etiologias são atribuídas ao desenvolvimento do zumbido subjetivo, contudo sua inter-relação com a presença das desordens temporomandibulares e depressão é ainda pouco compreendida. Avaliar a presença de sintomas depressivos em indivíduos portadores de DTM e zumbido subjetivo, avaliando o impacto da presença do zumbido na qualidade de vida dos mesmos. Tipo de estudo: trata-se de um estudo descritivo observacional transversal. Foram avaliados 44 pacientes do Serviço ATM da Faculdade de Odontologia da Universidade Federal de Juiz de Fora. Para diagnóstico das DTM assim como avaliação dos sintomas depressivos, foi utilizado o questionário do RDC/TMD. Foi realizada avaliação otorrinolaringológica, sendo feitas a audiometria tonal, vocal e imitanciometria. Também foi aplicado o questionário "Tinnitus Handicap Inventory". Dos 84% indivíduos com zumbido apresentaram dor miofascial, sendo o músculo masseter a região mais prevalente de dor, e 16% possuíram exclusivamente alterações álgicas e/ou degenerativas da ATM. Dentre os portadores de dor miofascial, 86,5% apresentaram sintomas depressivos, enquanto naqueles sem dor miofascial a presença destes sintomas estava presente em apenas 42,8%. 11 indivíduos (25%) relataram impacto do zumbido na qualidade de vida desprezível, 15 (34%) impacto leve, 7 (16%) moderado, 7 (16%) severo e 4 (9%) impacto catastrófico. Houve associação positiva entre a presença de sintomas depressivos e dor miofascial (p=0,02), assim como relação direta entre o aumento da intensidade do zumbido e a severidade dos sintomas depressivos (p<0,01).

Surgical treatment of projectile in the infratemporal fossa. Case report / Tratamento cirúrgico de um projétil na fossa infratemporal. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Gunshot wounds may have fatal results. Even when not causing major injuries to soft and hard tissues, there may be other severe problems. This study aimed at reporting the case of a projectile located in the left infratemporal fossa and at discussing treatment, risks and complications. CASE REPORT: Male patient, 18 years old, suffered a gunshot wound which has penetrated the face by the left zygomatic region, and was lodged in the homolateral infratemporal fossa. This has caused jaw function impairment and pain. Foreign body was surgically removed by preauricular access and patient was then submitted to physiotherapy. After treatment, temporomandibular joint function was reestablished and esthetic results were considered excellent without sequelae. CONCLUSION: Management of patients hit by projectiles is more complex when these are located in an area of difficult access and close to noble structures. Radiographic techniques obtained by means of different planes allow the accurate location of the object. There may be major deformity and functional incapacity, especially if the facial nerve is affected during bullet trauma or during surgery. Although there were no nervous injuries, functional impairment of orofacial structures was decisive to indicate the surgical procedure. Surgical removal of the projectile from the infratemporal fossa, combined with postoperative physiotherapy, has shown to be an effective treatment.

RESUMO JUSTIFICATIVA E OBJETIVOS: Ferimentos causados por arma de fogo podem ter resultados fatais. Mesmo que a bala não cause grandes lesões para os tecidos moles e duros, outros problemas graves podem ocorrer. O objetivo deste estudo foi relatar o caso de um projétil localizado na fossa infratemporal esquerda, discutir o tratamento cirúrgico, seus riscos e complicações. RELATO DO CASO: Paciente do gênero masculino, 18 anos, sofreu um ferimento por arma de fogo que penetrou na face pela região zigomática esquerda, alojando-se na fossa infratemporal homolateral. Esse ocasionou comprometimento da função mandibular e dor. O corpo estranho foi removido cirurgicamente por meio do acesso pré-auricular e o paciente foi posteriormente submetido a sessões de fisioterapia. Após o tratamento, foi reestabelecida a função da articulação temporomandibular, a dor desapareceu e os resultados estéticos foram considerados excelentes, sem sequelas. CONCLUSÃO: O manuseio dos pacientes acometidos por projétil torna-se mais complexo quando esse está localizado em uma área de difícil acesso e ao lado de estruturas nobres. Técnicas radiográficas, obtidas por meio de diferentes planos, permitem uma localização precisa do objeto. Grande deformidade e incapacidade funcional podem ocorrer, especialmente, se o nervo facial é afetado durante o trauma balístico ou durante o ato cirúrgico. Apesar de não haver lesões nervosas, o comprometimento funcional das estruturas orofaciais foi decisivo para indicar o procedimento cirúrgico. A remoção cirúrgica do projétil da fossa infratemporal combinado com a fisioterapia, pós-operatória, mostraram ser um tratamento eficaz.

Diagnosis of temporomandibular joint disorders: indication of imaging exams / Diagnóstico das disfunções da articulação temporomandibular: indicação dos exames por imagem

ABSTRACT INTRODUCTION: Knowledge of the different imaging tests and their appropriate indications is crucial to establish the diagnosis of temporomandibular disorders, especially in patients with overlapping signs and symptoms. OBJECTIVE: To present and assess the main diagnostic imaging tests for temporomandibular disorders and rationally discuss their indication criteria, advantages, and disadvantages. METHODS: Literature review in the Web of Knowledge, PubMed and SciELO databases, as well as manual search for relevant publications in reference lists of the selected articles. RESULTS: Computed tomography and magnetic resonance imaging were considered the gold standard assessments for the temporomandibular joint to evaluate hard and soft tissues, respectively. Each diagnostic method exhibited distinct sensitivity and specificity for the different subtypes of joint dysfunction. CONCLUSION: Selecting an evaluation examination based on its accuracy, safety, and clinical relevance is a rational decision that can help lead to an accurate diagnosis and an optimum treatment plan.

Resumo Introdução: O conhecimento dos distintos exames de imagem e sua correta indicação é fundamental para elaboração do diagnóstico das disfunções temporomandibulares, principalmente em pacientes com grande sobreposição de sinais e sintomas. Objetivo: Apresentar e avaliar os principais exames de diagnóstico por imagem das disfunções temporomandibulares, além de discutir racionalmente os seus critérios de indicação, vantagens e desvantagens. Método: Revisão da literatura nas bases de dados Web of Knowledge, PubMed e SciELO, além de busca manual por publicações relevantes nas listas de referências dos artigos selecionados. Resultado: Os exames de tomografia computadorizada e ressonância magnética foram considerados ''padrão-ouro'' para a avaliação dos tecidos duros e moles, respectivamente, da articulação temporomandibular. Cada método de diagnóstico pesquisado apresentou sensibilidade e especificidade distintas para os diferentes subtipos de disfunção da articulação. Conclusão: Considera-se como racional a indicação fundamentada na acurácia, segurança e relevância clínica do exame a ser solicitado, o que implica na adequada determinação do diagnóstico e do plano de tratamento.

Associação entre hipermobilidade articular sistêmica e desordens temporomandibulares: uma investigação clínico-radiográfica / Association between generalized joint hypermobility and temporomandibular dysfunction: a clinical and radiographic investigation

Objetivo: Verificar a associação de DTM em pacientes com HAS, por meio da análise de características clínicas e radiográficas, e suas principais condições clínicas de diagnóstico em indivíduos com DTM e hiperexcursão articular. Métodos: Avaliou-se uma amostra de 43 pacientes do gênero feminino, com idade entre 20 e 50 anos. Estes foram submetidos ao Critério Diagnóstico para Pesquisa em Disfunção Temporomandibular (RDC/TMD) eixo I (para diagnóstico do tipo de desordem temporomandibular), ao Teste de Beighton (para avaliação da presença de HAS) e à avaliação de exame radiográfico do tipo planigrafia (para classificação do tipo de excursão apresentada e para observação de alterações morfológicas na cabeça da mandíbula). Os dados foram submetidos a tratamento estatístico com os testes de Fisher e Qui quadrado (p< 0,05). Resultados: Foram encontradas associações estatisticamente significantes de HAS às seguintes condições: aplainamento em articulação temporomandibular direita (p<0,013) e esquerda (p<0,075); DTM muscular (p<0,037); e DTM mista (muscular e articular associadas) (p<0,082). Associações borderline foram identificadas para de HAS e osteófito em articulação temporomandibular direita (p<0,102) e esquerda (p<0,166); hiperexcursão em articulação temporomandibular esquerda (p<0,173). Conclusão: Por meio da análise foi possível concluir que existe uma associação entre a HAS e as DTMs do tipo muscular e mista. A alteração de excursão mais frequentemente observada foi a hiperexcursão. Quando avaliadas alterações morfológicas nos componentes ósseos das ATM, verificou-se que indivíduos com HAS possuem uma maior probabilidade de manifestar alterações degenerativas do tipo aplainamento e osteófito. Por fim, constatou-se uma elevada frequência de outras dores musculoesqueletais nos pacientes.(AU)

Aim: To analyze the clinical and radiographic features of systemic articular hypermobility in patients with temporomandibular dysfunction (TMD), as well as the main conditions of clinical diagnosis (muscle, bone, disc position) in individuals with TMD. Methods: This study evaluated 43 female patients, between 20 and 50 years of age, who were submitted to the Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD) axis I (to diagnose the type of temporomandibular disorder), the Beighton test (to assess the presence of Systemic Joint Hypermobility), and the evaluation of planigraphy-type radiographic examinations (to classify the type of excursion presented and to observe the morphological changes in the condyle). Data were analyzed statistically by applying the Fisher and chi square tests (p> 0.05). Results: Statistically significant associations were found regarding hypertension under the following conditions: smoothing of right (p <0.013) and left (p <0.75) temporomandibular joints; Muscle TMD (p <0.037); and mixed TMD (association of muscle and joint) (p <0.082). Borderline associations were identified for hypertension and osteophytes in the right (p <0.102) and left (p <0.166) temporomandibular joints, hyperexcursion in left temporomandibular joint (p <0.173), and osteophytes in the right (p <0.102) and left (p <0.166) temporomandibular joints. Conclusion: Through this sample, it could be concluded that there is an association between hypertension and both muscular and mixed TMDs. The most frequently observed change was hyperexcursion. When morphological changes in the bone components of the temporomandibular joints were evaluated, it was found that individuals with hypertension are more likely to express degenerative changes, especially smoothing and osteophytes. A high frequency of other musculoskeletal pain was also observed in these patients.(AU)

Frequência dos padrões faciais em portadores da desordem temporomandibular / Frequency of facial patterns in patients with temporomandibular disorders

O objetivo deste estudo foi investigar a frequência dos diferentes padrões faciais (padrão I, II, III, face longa e face curta) em indivíduos portadores das desordens temporomandibulares (DTMs), diagnosticados através do eixo I do RDC/TMD. Também foi proposto avaliar a existência de associação entre esses padrões e a relação oclusal maxilomandibular dos pacientes (classe), além de aferir alguns ângulos e proporções tegumentares dos mesmos, a fim de relacioná-los com as diferentes faces encontradas. A amostra foi constituída de 55 pacientes portadores de DTM que não haviam realizado tratamento ortodôntico, e nem passado por cirurgia na boca ou na face. Foram utilizadas fotografias extraoclusais frontais e de perfil dos pacientes para classificação do padrão facial, assim como fotografias intraoclusais para a classificação de Angle. Para obtenção do ângulo de convexidade facial, ângulo do terço inferior da face, proporção do terço inferior da face e da altura facial anterior médio sobre a altura facial anterior inferior (Afam/Afai) foram realizadas marcações pontuais nas fotografias extraoclusais, através do software Radiocef Studio 1,0. Com a amostra de 55 pacientes, foi possível concluir que o padrão facial mais frequente foi o I (61,8 %), seguido pelos padrões II (21,8%) e III (16,4%). Foi demonstrado não haver associação entre as DTMs apresentadas pelos pacientes e os diferentes padrões faciais, porém, houve uma tendência das relações oclusais das classes acompanharem o padrão. Por fim, observou-se que as medidas angulares e as proporções faciais, que esta pesquisa se propôs avaliar, diferiram, em sua maioria, dos valores sugeridos pela literatura...

The aim of this study was to investigate the frequency of different facial patterns (I, II, III, short, and long types) in subjects with temporomandibular disorders (TMD), diagnosed by RDC/TMD axis I. Also, to evaluate the association between these patterns and occlusal maxillomandibular relationships, still measuring some angles and proportions of the same soft tissue in order to relate them to the different facial types found. The sample consisted of 55 patients with TMD, which had not undergone orthodontic treatment neither any surgery in the mouth or face. The facial pattern was classified by extra-oral (frontal and profile). The Angle malocclusions were classified by intra-oral photos. The facial convexity, lower third facial angle, the ratio between the lower third face and the middle third face height over the antero-inferior facial third height (MFTH/LFTH) were obtained by markings over the extra-oral photos using the Radiocef Studio 1.0. With a sample of 55 patients it was possible to conclude that the facial pattern I was the most frequent (61.8%), followed by patterns II (21.8%) and III (16.4%). There was no association between TMD and different facial patterns. However, the occlusal relationships follow the pattern. Finally, it was observed that the angular measurements and facial proportions, evaluated here differed from most of the values suggested in the literature...

Diagnosis of temporomandibular joint disorders: indication of imaging exams.

INTRODUCTION: Knowledge of the different imaging tests and their appropriate indications is crucial to establish the diagnosis of temporomandibular disorders, especially in patients with overlapping signs and symptoms. OBJECTIVE: To present and assess the main diagnostic imaging tests for temporomandibular disorders and rationally discuss their indication criteria, advantages, and disadvantages. METHODS: Literature review in the Web of Knowledge, PubMed and SciELO databases, as well as manual search for relevant publications in reference lists of the selected articles. RESULTS: Computed tomography and magnetic resonance imaging were considered the gold standard assessments for the temporomandibular joint to evaluate hard and soft tissues, respectively. Each diagnostic method exhibited distinct sensitivity and specificity for the different subtypes of joint dysfunction. CONCLUSION: Selecting an evaluation examination based on its accuracy, safety, and clinical relevance is a rational decision that can help lead to an accurate diagnosis and an optimum treatment plan.

Magnetic Resonance Image Evaluation of Temporomandibular Joint Osteophytes: Influence of Clinical Factors and Artrogenics Changes.

This research aims to examine the presence of osteophyte in patients with arthrogenic temporomandibular disorders through magnetic resonance imaging (MRI); to investigate the influence of sex and clinical symptoms in its prevalence; and the position of the osteophytes in the condyle. The study was based on 100 MRI and on reports of patients, which corresponded to the evaluation of 200 joints. Patients of both sexes were aged from 18 to 82 years (average = 49.48) and were subjected to the aforementioned examination from January 2006 to March 2009. The assessment considered the type of disc displacement, the presence of effusion, bone marrow edema, condyle changes, joint noise and pain. The MRI machine used was the GE Signa HDX (General Electric, Milwaukee, WI), with T1 and T2-weighted, 1.5 T magnetic field, sagittal oblique (mouth closed, mouth open) and coronal (mouth closed) imaging, with spherical surface coil and an asymmetric matrix. All images were interpreted by an experienced radiologist. A total of 28% (n = 56) of the temporomandibular joints showed osteophytes on the anterior surface of the mandible. No relationship was found between sex and osteophytes. The authors found a statistically significant difference between osteophytes and disc displacement without reduction (P < 0.001). The presence of osteophytes suggested a possible cause and effect relationship between osteoarthritis and disc displacement without reduction; the osteophyte was always located in the anterior surface of condyle, regardless of the sex variable; no significant difference was found between osteophytes and the main complaints of the patient.

A Study of the Association Between Sleep Bruxism, Low Quality of Sleep, and Degenerative Changes of the Temporomandibular Joint.

The aim of this study was to evaluate the presence of degenerative bone changes of the temporomandibular joint (TMJ) in individuals suffering from sleep bruxism (SB), associating these characteristics with the quality of sleep. For this, we followed the International Classification of Sleep Disorders for the diagnosis of SB, in addition to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the classification of TMD and cone beam computed tomography. It was found that 97.7% of the individuals with bruxism had at least 1 RDC/TMD group III diagnosis, 75.6% of the subjects considered their sleep quality as poor, and the largest group (23%) had centric bruxism. There was no significant association between the pattern of sleep quality (P = 0.36), the type of SB (P = 0.277), and the presence of degenerative changes of the TMJ. Regardless of the quality of sleep and the type of bruxism presented, the prevalence of degenerative bone disorders was high (67%) among women with a mean age of 46 years and a clinical diagnosis of SB.

Ear Acupuncture Therapy for Masticatory Myofascial and Temporomandibular Pain: A Controlled Clinical Trial.

Ear acupuncture works by reducing painful sensations with analgesic effect through microsystem therapy and has been demonstrated to be as effective as conventional therapies in the control of facial pain. This clinical trial aimed to evaluate the adjuvant action of auricular acupuncture through an observation of the evolution of temporomandibular and masticatory myofascial symptoms in two groups defined by the therapies elected: auricular acupuncture associated with occlusal splint (study) and the use of the occlusal splint plate alone (control). We have selected 20 patients, who were randomly allocated into two groups of ten individuals. Symptoms were evaluated in five different moments, every seven days. We analyzed the orofacial muscle and joint palpation in order to measure the intensity of the experienced pain. Both groups showed a statistically significant decrease in muscle and joint symptoms (p < 0.05). However, comparisons between the groups showed an expressive and significant reduction of symptomatology in the study group (p < 0.05) already on the first week of therapy. According to the results, to the methodological criteria developed and statistical analysis applied, the conclusion is that auricular acupuncture therapy has synergistic action on conventional occlusal splint treatment. It was demonstrated to be effective in the reduction of symptoms in the short term.

Chronic myalgia centrally mediated / Mialgia crônica mediada centralmente

The clinical case report of a 50-year-old patient who presented to the Diagnostic and Guidance Service for Patients with Temporomandibular Disorders, at the School of Dentistry, Federal University of Juiz de Fora, with complaint of pain in the facial muscles in a continuous, throbbing manner that was paroxysmal at times, with severe intensity and of a chronic nature. After semiological interdisciplinary examination (dental, speech and physical therapy), the diagnosis suggestive of temporomandibular disorder was reached, characterized by centrally mediated chronic myalgia, associated with articular structures, parafunctional habits, malocclusion and emotional factors. Supportive dental treatment consisted of guidance throughout treatment and use of occlusal splints. After a three-and-a-half-month period of interdisciplinary therapy the patient was discharged with an 80% improvement in pain and increase in mouth opening amplitude. Episodes of pain were related only to moments of stress. The patient was instructed about the need for orthodontic treatment and psycho therapy.

O caso clínico reporta uma paciente de 50 anos que se apresentou ao Serviço de Diagnóstico e Orientação a Pacientes com Desordens Temporomandibulares da Faculdade de Odontologia da Universidade Federal de Juiz de Fora com queixa de dores nos músculos da face de modo contínuo, do tipo latejante, às vezes paroxístico, de intensidade severa e caráter crônico. Após exame semiológico interdisciplinar (odontológico, fonoaudiológico e fisioterapêutico), chegou-se ao diagnóstico sugestivo de desordem temporomandibular caracterizado por mialgia crônica mediada centralmente, associada às alterações articulares, hábitos parafuncionais, má oclusão e fatores emocionais. O tratamento odontológico de suporte constituiu-se de orientações ao longo do tratamento e uso da placa neuromiorrelaxante. Após um período de 3 meses e meio de terapia interdisciplinar a paciente recebeu alta com melhora de 80% das dores e aumento da amplitude de abertura bucal. Relacionou episódios de dor somente em momentos de estresse. Foi orientada sobre a necessidade de tratamento ortodôntico e psicoterapia.

Laser acupuncture in patients with temporomandibular dysfunction: a randomized controlled trial.

A prospective, double-blind, randomized, and placebo-controlled trial was conducted in patients with chronic temporomandibular disorder (TMD) to check the analgesic efficacy of infrared low-power GaAlAs diode laser applied to acupuncture points. Forty female subjects, ranging in age from 20 to 40 years, with diagnoses of chronic myofascial pain and arthralgia were randomly allocated to two groups: an experimental group (EG) who received the laser acupuncture as adjunct to reversible occlusal splint therapy and a control group (CG) who received a placebo laser associated with occlusal splint therapy. Both approaches were applied once a week for 3 months. Laser acupuncture was defined by the following parameters: 50-mW continuous radiation for 90 s to acupoints ST6, SI19, GB20, GB43, LI4, LR3, NT3, and EX-HN3; defining 4.5-J energy; 1250-W/cm(2) density point; and 112.5-J/cm(2) total density. The outcome measurements included a symptom evolution assessment carried out by checking spontaneous and palpation pain intensity, which was indicated on a visual analog scale (VAS). All evaluations were made by an assessor who was blind to the treatment. The symptom reduction was significant in both groups (EG: VAS = 0, n = 20; CG: VAS between 2 and 4, n = 18). The measurements showed significantly faster and lower pain intensity values in the EG (p ≤ 0.002), where there was a higher proportion of patients with remission of symptoms related to the action of laser acupuncture. For patients in whom conservative treatment was adopted, the laser acupuncture is a secure, noninvasive, and effective treatment modality because it improves the chronic pain associated with TMD and has no side effects.

Inter-relação entre alterações otológicas e DTM em paciente fibromiálgico: caso clínico / Relationship between otological symptoms and tmd in pacient with fibromyalgia: case report

Para a correta condução de um tratamento de DTM é necessário que o Cirurgião-Dentista tenha conhecimento sobre doenças relacionadas a quadros álgicos difusos, como a fibromialgia e a otalgia, para que com isso seja capaz de formular o diagnóstico diferencial e estabelecer a conduta terapêutica adequada. O presente artigo relata o caso clínico de uma paciente de 42 anos, portadora de fibromialgia, que procurou o Serviço ATM (FO/UFJF) com queixa principal de tontura intensa, otalgia e zumbido, associada a dores orofaciais. O diagnóstico foi sugestivo de desordem temporomandibular associada à fibromialgia, tendo como fatores relacionados hábitos parafuncionais (bruxismo, apertamento e hábitos posturais inadequados), estresse emocional, ansiedade e quadros depressivos. A proposta terapêutica adotada baseou-se no tratamento odontológico de suporte com uso da placa neuromiorrelaxante e manutenção da terapia medicamentosa que proporcionou diminuição e estabilidade da sintomatologia, mesmo após seis meses de acompanhamento.

For the correct conduct of a treatment of TMD is ímportant that the dentist has knowledge about diseases related about diffuse painful picture, such as ear pain and fibromyalgia, to be able to formulate a differential diagnosis and establish the appropriate therapeutic approach. This article reports a case of a patient 42 years old, with fibromyalgia, who sought the ATM Service (FO/UFJF) complaining of severe dizziness, ear pain and tinnitus associated with orofacial pain. The diagnosis was suggestive of temporomandibular disorders associated with fibromyalgia, and related factors such as parafunctional habits (bruxism, clenching and improper postural habitsl emotional stress, anxiety and depression. Therapeutic proposal adopted was based on the dental treatment with use of the support plate neuromiorrelaxante and drug therapy that provide compensation if reduction and stability of symptoms, even after six months of follow-up.

Correlação entre severidade da desordem temporomandibular e fatores psicossociais em pacientes com dor crônica / Correlation Between severity of temporomadibular disordens and psychosocial factoris in patients with chronic pain

A desordem temporomandibular (DTM) é considerada a mais frequente condição de dor orofacial crônica. Os fatores psicossociais têm sido implicados na predisposição, iniciação e perpetuação das DTM. Objetivou-se, com este estudo, estabelecer a correlação existente entre a severidade da DTM e os níveis de depressão e de sintomas físicos inespecíficos, a graduação da dor crônica e o número de grupos de diagnósticos clínicos. Foram avaliados 73 pacientes portadores de DTM crônica (F=66; M=7) que procuraram atendimento no Serviço - ATM da UFJF. As correlações entre os índices temporomandibulares e os aspectos psicológicos foram positivas para a maioria das avaliações. O índice muscular se correlacionou com significância estatística para a maioria dos aspectos psicológicos. Houve correlação positiva e estatisticamente significativa entre o número de grupos de diagnósticos do eixo I do RDC/TMD e os índices funcional e temporomandibular. Pode-se concluir que, mesmo que o paciente apresente sinais e sintomas de DTM de baixa intensidade, a permanência desses por um período prolongado acarreta manifestações de ordem psicológica.

Temporomandibular disorder (TMD) is considered the most common chronic orofacial pain condition. Psychosocial factors have been implicated in the predisposition, initiation and perpetuation of TMD. The objective of this study was to establish the correlation between TMD and the levels of depression and nonspecific physical symptoms, the degree of chronic pain and the number of groups of clinical diagnoses. 73 patients with chronic TMD (F = 66, M = 7) who sought treatment in service-ATM UFJF were evaluated. The correlations between the indexes temporomandibulares and psychological aspects were positive for most evaluations. The muscle index was correlated with statistical significance for most of the psychological aspects. There were positive and statistically significant correlation between the number of groups of axis I diagnoses of the RDC / TMD and functional and temporomandibular indexes. It can be concluded that even if the patient shows signs and symptoms of TMD low intensity, the permanence of these for a long time, leads to a psychological impairment.

Fatores psicológicos relacionados à sintomatologia crônica das desordens temporomandibulares - revisão de literatura / Related psycological factors in chronic temporomandibulardisorder - literature review

A dor é caracterizada como uma expressão multidimensional, envolvendo aspectos quantitativos, sensitivos e emocionais, e as dores orofaciais enquadram-se entre aquelas originadas das desordens temporomandibulares (DTM), frequentemente ligadas a sintomatologia crônica. Tais condições se associam a vários aspectos fisiopatológicos, psicológicos, sociais e culturais. Esta revisão de literatura tem o objetivo de referir os principais fatores psicológicos que afetam pacientes com DTM de sintomatologia crônica, enfatizando a importância na identificação de fatores emocionais. O diagnóstico depende de um exame clínico criterioso, com vistas a um diagnóstico precoce e identificação de fatores psicológicos do paciente com DTM crônica, os quais são contribuintes para o aparecimento ou perpetuação da desordem por meio do aumento da atividade muscular, presença de fatores cognitivos e comportamentais. Os aspectos psicológicos mais frequentes nesses indivíduos são a depressão e a ansiedade, motivo pelo qual necessitam de intervenção interdisciplinar em razão da natureza físico-psicológica, necessitando da psicologia para otimização do tratamento odontológico.