Sinais e sintomas de disfunção temporomandibular em adolescentes e sua associação com o nível socioeconômico familiar e outras variáveis

Justificativa e Objetivos: A adolescência é caracterizada por intensas mudanças físicas, emocionais e sociais, o que pode propiciar a presença de fatores etiológicos e perpetuantes importantes da disfunção temporomandibular (DTM). Assim, o objetivo deste estudo foi avaliar a presença de DTM na adolescência e sua associação com aspectos socioeconômicos e outras variáveis. Métodos: Compuseram a amostra 200 adolescentes de 10 a 19 anos provenientes das clínicas do Curso de Odontologia da Universidade de Araraquara ­ UNIARA e de escolas públicas e particulares do município. O Critério de Classificação Econômica Brasil (ABEP) foi utilizado para a identificação da classe social do adolescente. Para diagnóstico da DTM e da intensidade da dor à palpação usou-se o Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). O número de problemas psicoemocionais, as áreas de dor extrafacial e o número de hábitos parafuncionais foram verificados por um questionário estruturado de autorrelato. Resultados: Houve associação positiva entre as classes D/E e a presença de DTM dolorosa (p= 0,007, OR=24,8; 95%IC=2,28-269,79), principalmente com disfunções musculares (p=0,003, OR=32,0; 95%IC=2,83-362,01). Os fatores que se expressaram significativamente maiores na presença de DTM dolorosa foram: intensidade de dor à palpação (p=0,000), quantidade de áreas de dor extrafacial (p=0,025) e número de hábitos parafuncionais (p=0,000). A Classe D/E relatou mais áreas de dor que as demais (p=0,049). Conclusão: O nível socioeconômico se associou significativamente à presença de DTM dolorosa, especialmente de origem muscular. O único fator que se expressou significativamente maior nas classes sociais mais baixas foi o número de áreas dolorosas extrafaciais.

Parafunctional habits and its association with the level of physical activity in adolescents / Hábitos parafuncionais e sua associação com o nível de atividade física em adolescentes

ABSTRACT BACKGROUND AND OBJECTIVES: Physical activities are considered beneficial to reduce daily stress. If not eliminated, stress is able to promote large increases in muscle tension, hypertension, asthma, heart arrhythmia and the development of parafunctions. Then, the aim of this study is to evaluate the association between the presence of parafunctional habits and the practice of physical activity in adolescence. METHODS: The sample comprised of 200 adolescents, boys and girls, from 10 to 19 years old, recruited from the clinics of the Dentistry Course of the University of Araraquara or from public and private schools from the city. The presence of parafunctional oral habits, daytime teeth clenching, and sleep bruxism was obtained through a self-report questionnaire (yes/no). The individuals answered a questionnaire to identify the practice of physical activity according to the instrument adopted in the National School Health Survey (PeNSE - 2012). For the associations, subjects were divided according to the practice of physical activity into active (>300 minutes of activity in the week) or inactive (≤300 minutes of activity in the week). RESULTS: It was observed that boys practiced more physical activity and for a longer period when compared to girls. However, the practice of exercises did not present a significant association with the presence, quantity or type of the oral parafunction (p>0.05). CONCLUSION: The level of physical activity is not associated with oral parafunction nor with extrafacial pain areas.

RESUMO JUSTIFICATIVA E OBJETIVOS: A prática de atividades físicas é considerada uma forma benéfica de redução de estresse diário. Quando não eliminado, o estresse é capaz de promover grande aumento de tensão muscular, hipertensão, asma, arritmias cardíacas e desenvolvimento de parafunções. Assim, o objetivo deste estudo foi avaliar a associação entre a presença de hábitos parafuncionais e a prática de atividade física na adolescência. MÉTODOS: A amostra foi composta por 200 adolescentes, de ambos os sexos, com idade entre 10 e 19 anos, recrutados das clínicas do Curso de Odontologia da Universidade de Araraquara ou de escolas públicas e particulares do município. A presença de hábitos parafuncionais orais, apertamento diurno e de bruxismo do sono foram rastreados por meio de um questionário de autorrelato (sim/não). Os indivíduos responderam a um questionário para a identificação da prática de atividade física de acordo com o instrumento adotado na Pesquisa Nacional de Saúde do Escolar (PeNSE - 2012). Para o estudo de associação, os indivíduos foram divididos em relação à prática de atividade física em ativos (>300 minutos de atividade na semana) e inativos (≤300 minutos de atividade na semana). RESULTADOS: Observou-se que os meninos praticavam mais atividade física e por mais tempo quando comparado às meninas, entretanto, a prática de exercícios não apresentou associação significativa com a presença, quantidade ou o tipo de hábito parafuncional, e nem com a presença de dor extrafacial (p>0,05). CONCLUSÃO: O nível de atividade física não se associou à parafunção oral nem com pontos de dor extrafacial.

Predictability and success rate of short implants

In oral rehabilitation with dental implants, severely resorbed alveolar ridges are a challenging problem due to the reduced height of the residual bone. Continuous search for minimally invasive procedures has resulted in the conception of reduced-length dental implants, decreasing the necessary amount of bone for implantation, thereby reducing the need of bone-grafts. Given the growing demand in the field of implant dentistry and the continuous development of surgical techniques, this study aimed to review the current literature on the predictability and success rate of short implants. Relevant articles published in the PubMed database between the years of 2004 and 2014 were selected using the following key-words: short dental implants, extra-short implants, survival rate, implant, mandible, maxilla, prognosis, implant survival, implant length. Based on the literature review, we concluded that short implants showed high predictability and high success rate in the short term, therefore they are one of the current options for the rehabilitation of atrophic alveolar ridges. Further longitudinal studies are necessary to define more reliably parameters for their proper use, ensuring the achievement of high success rates and survival rates with the use of this type of implant.o assess the attitude and practice of dental professionals towards using of advance radiographic technique.

Effectiveness of acupuncture for temporomandibular disorders and associated symptoms / Eficiência da acupuntura no tratamento das disfunções temporomandibulares e sintomas associados

ABSTRACT BACKGROUND AND OBJECTIVES: Temporomandibular disorder is defined as a set of clinical problems involving masticatory muscles, temporomandibular joint and associated structures. For having multifactorial etiology, several treatments are proposed and successfully used. However, most recommended therapies are those reversible and noninvasive, which should be the first choice to treat temporomandibular disorders. This study aimed at discussing acupuncture to treat temporomandibular disorders and associated symptoms. CONTENTS: This is a review of 34 articles published between 1983 and 2015. Since acupuncture aims at returning balance to body and harmony between physical and psychical parts by stimulating specific points, it may be considered therapy of choice to treat temporomandibular disorders. In TMD patients, evidences have shown efficacy in increasing temporomandibular joint movement amplitude, accelerating serotonin, encephalin and endorphin release, thus favoring masticatory muscles relaxation and pain relief. According to recent articles, most commonly used points for this purpose are: ST6, ST7, SJ21, SJ17, SI18, Taiyaing and Yintang (face and head) and LI4 (extrafacial). CONCLUSION: Acupuncture is as effective to control facial pain as conventional Western therapies. It is considered useful, of low cost and provides better quality of life to patients treated with this technique.

RESUMO JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibular é definida como um conjunto de problemas clínicos que envolvem os músculos mastigatórios, a articulação temporomandibular e estruturas associadas. Por serem de causa multifatorial, diversas modalidades de tratamento são propostas e utilizadas com êxito. Contudo, as terapias mais recomendadas são as reversíveis e não invasivas, as quais devem ser a primeira opção de escolha no tratamento das disfunções temporomandibulares. O objetivo deste estudo foi discorrer sobre o uso da acupuntura no tratamento da disfunção temporomandibular e sintomas associados. CONTEÚDO: Compuseram essa revisão 34 artigos, publicados entre os anos de 1983 e 2015. Uma vez que a acupuntura busca devolver o equilíbrio do organismo e harmonia entre as partes física e psíquica por meio de estímulos em pontos específicos, pode ser considerada uma terapia de eleição para o tratamento da disfunção temporomandibular. Em pacientes com disfunção temporomandibular evidências demonstraram eficácia no aumento da amplitude de movimento da articulação temporomandibular, acelerando a liberação de serotonina, encefalina e endorfina, e favorecendo assim o relaxamento dos músculos mastigatórios e a redução da dor. Segundo os artigos recentes, os pontos mais comumente empregados para esse fim são: E6, E7, TA21, TA17, ID18, Taiyaing e Yintang (face e cabeça) e IG4 (extrafacial). CONCLUSÃO: A acupuntura tem se mostrado tão eficiente no controle de dores faciais quanto as terapias ocidentais convencionais. É uma terapia considerada útil, de baixo custo e que proporciona uma melhor qualidade de vida aos pacientes tratados com essa técnica.

Ear acupuncture associated to home self-care in the treatment of chronic temporomandibular disorders in women. Case reports / Acupuntura auricular associada aos autocuidados caseiros no tratamento das disfunções temporomandibulares crônicas em mulheres. Relato de casos

ABSTRACT BACKGROUND AND OBJECTIVES: This study aimed at describing, in a case series, the effect of ear acupuncture associated or not to education and home self-care techniques in the treatment of chronic temporomandibular disorders in women. CASE REPORT: Nine patients with chronic painful temporomandibular disorder, aged between 22 and 45 years of age (mean of 32.11 years) were evaluated with the clinical chart of temporomandibular disorders and orofacial pain of the Occlusion II discipline, Universidade de Araraquara, with the Research Diagnostic Criteria for Temporomandibular Disorders and by a pain diary with visual analog scales delivered once a week in reference (first week) and after each treatment session (ear acupuncture and/or counseling). During the three weeks of treatment, patients were oriented to control temporomandibular disorders, being that six patients, in addition to self-care, have also received ear acupuncture in recommended points to treat temporomandibular disorders and associated symptoms (protocol: Shen-men, neurovegetative system, kidneys, temporomandibular disorders and anxiety triad). Ear acupuncture associated to education and home self-care has shown the best results in symptoms remission/improvement after 3 weeks of treatment as compared to the group receiving just self-care orientations. CONCLUSION: Ear acupuncture associated to education and home self-care techniques has shown better results to control pain of patients with temporomandibular disorder.

RESUMO JUSTIFICATIVA E OBJETIVOS: O objetivo desse estudo foi descrever, em uma série de casos, o efeito da acupuntura auricular associada ou não às técnicas de educação e autocuidados caseiros, no tratamento das disfunções temporomandibulares crônicas em mulheres. RELATO DOS CASOS: Nove pacientes com disfunção temporomandibular crônica dolorosa, com idade entre 22 e 45 anos (média de 32,11 anos) foram avaliadas por meio da ficha clínica de disfunções temporomandibulares e dor orofacial da Disciplina de Oclusão II da Universidade de Araraquara, pelo Research Diagnostic Criteria for Temporomandibular Disorders e por um diário de dor com escalas analógicas visuais, entregues semanalmente na referência (primeira semana) e após cada sessão de tratamento (acupuntura auricular e/ou aconselhamento). Durante as três semanas de tratamento, as pacientes receberam instruções para controle das disfunções temporomandibulares, sendo que seis pacientes receberam, além dos autocuidados, acupuntura auricular nos pontos recomendados para o tratamento das disfunções temporomandibulares e sintomas associados (protocolo: Shen-men, sistema neurovegetativo, rim, disfunções temporomandibulares e tríade da ansiedade). A acupuntura auricular associada à educação e autocuidados caseiros apresentou os melhores resultados na remissão/diminuição dos sintomas após 3 semanas de tratamento quando comparada ao grupo que recebeu apenas as instruções de autocuidados. CONCLUSÃO: A acupuntura auricular associada à educação e às técnicas de autocuidados caseiros demonstrou melhores resultados no controle da dor dos pacientes com disfunção temporomandibular.

Are there evidences of correlation between temporomandibular dysfunction and orthodontic treatment?

Aim: The aim of this study was verifying, through literature review, whether there are evidences of correlation between temporomandibular dysfunctions and the orthodontic treatment. Material and Methods: Papers published from 1981 to 2015 were excluded and 41 articles and 06 books composed this review. Results: It is known that temporomandibular dysfunctions is a general term that represents signals and symptoms involving masticatory muscles, the temporomandibular joint and associated structures, and it is the main cause of pain from non-dental origin in the orofacial region, including head, face and other structures. Its etiology is multifactorial involving a large number of direct and indirect causes. Among them, the occlusion was already considered one of the main etiological factors for temporomandibular dysfunction. From epidemiological studies, it is known that signals and symptoms of temporomandibular dysfunction occur in healthy people, they are common in children and adolescents and tend to increase with age, particularly after adolescence, from 13 to 45 years old. The hypothesis for causality between orthodontics and temporomandibular dysfunction has led to legal problems for dentists and orthodontists. For these reasons, the interest on the relation among occlusal factors, orthodontic treatments and temporomandibular dysfunction has growth and several studies were carried out. Conclusions: We conclude that until this moment, it is not possible affirm that the orthodontic treatment could prevent, cure or cause temporomandibular dysfunction.

Parafunctional habits are associated cumulatively to painful temporomandibular disorders in adolescents.

This cross-sectional study was designed to evaluate the effect of sleep bruxism, awake bruxism and parafunctional habits, both separately and cumulatively, on the likelihood of adolescents to present painful TMD. The study was conducted on a sample of 1,094 adolescents (aged 12-14). The presence of painful TMD was assessed using the Research Diagnostic Criteria for Temporomandibular Disorders, Axis I. Data on sleep bruxism, awake bruxism and parafunctional habits (nail/pen/pencil/lip/cheek biting, resting one's head on one's hand, and gum chewing) were researched by self-report. After adjusting for potential demographic confounders using logistic regression, each of the predictor variables (sleep bruxism, awake bruxism and parafunctional habits) was significantly associated with painful TMD. In addition, the odds for painful TMD were higher in the concomitant presence of two (OR=4.6, [95%CI=2.06, 10.37]) or three predictor (OR=13.7, [95%CI=5.72, 32.96]) variables. These findings indicate that the presence of concomitant muscle activities during sleep and awake bruxism and parafunctional habits increases the likelihood almost linearly of adolescents to present painful TMD.

Parafunctional habits are associated cumulatively to painful temporomandibular disorders in adolescents

Abstract This cross-sectional study was designed to evaluate the effect of sleep bruxism, awake bruxism and parafunctional habits, both separately and cumulatively, on the likelihood of adolescents to present painful TMD. The study was conducted on a sample of 1,094 adolescents (aged 12-14). The presence of painful TMD was assessed using the Research Diagnostic Criteria for Temporomandibular Disorders, Axis I. Data on sleep bruxism, awake bruxism and parafunctional habits (nail/pen/pencil/lip/cheek biting, resting one's head on one's hand, and gum chewing) were researched by self-report. After adjusting for potential demographic confounders using logistic regression, each of the predictor variables (sleep bruxism, awake bruxism and parafunctional habits) was significantly associated with painful TMD. In addition, the odds for painful TMD were higher in the concomitant presence of two (OR=4.6, [95%CI=2.06, 10.37]) or three predictor (OR=13.7, [95%CI=5.72, 32.96]) variables. These findings indicate that the presence of concomitant muscle activities during sleep and awake bruxism and parafunctional habits increases the likelihood almost linearly of adolescents to present painful TMD.

Temporomandibular Disorders in a Young Adolescent Brazilian Population: Epidemiologic Characterization and Associated Factors.

AIMS: To carry out an epidemiologic characterization of the most common subtypes of temporomandibular disorders (TMD) and to identify associated factors in a Brazilian sample of young adolescents. METHODS: From a population of public schoolchildren (12 to 14 years of age), 3,117 students were randomly invited to participate in this study. TMD was assessed according to the Research Diagnostic Criteria for TMD (RDC/TMD) Axis I, in addition to some questions of the Axis II history questionnaire. The associated factors, ie, difficulty with concentration/attention, anger, sadness, anxiety, headache complaints, oral parafunctions, diurnal jaw clenching, tooth grinding at night, and parents not living together, were assessed based on the responses of the adolescents and their parents to structured questions. For the statistical analyses, descriptive statistics, chi-square tests, odds ratio, and logistic regression models were used, adopting a 95% confidence interval and 5% level of significance. RESULTS: The sample consisted of 1,307 individuals (response rate of 41.9%), 56.8% (n = 742) girls. Overall, 397 (30.4%) adolescents presented with TMD, of whom 330 (25.2%) had painful TMD diagnoses. The majority of these had painful TMD of muscular origin (13.1%) and comprised chronic cases (14.9%). Girls presented higher frequencies of TMD overall, painful TMD, painful combined TMD, and chronic painful TMD diagnoses The final multivariate logistic regression model revealed that headache complaints (odds ratio 2.87; confidence intervals 2.21-3.72), oral parafunctions (2.08; 1.26-3.44), tooth grinding at night (2.05; 1.56-2.70), diurnal jaw clenching (1.96; 1.50-2.55), and parents not living together (1.38; 1.07-1.80) were the factors significantly associated with a TMD (overall) diagnosis. CONCLUSION: About 25% of the adolescents evaluated presented painful TMD, and the majority of these comprised muscular and chronic cases. Some factors, such as reports of headache complaints, oral parafunctions, tooth grinding at night, and parents not living together, were associated with this condition among young Brazilian adolescents. Special attention should be given to these factors among adolescents with TMD.

Temporomandibular disorders among Brazilian adolescents: reliability and validity of a screening questionnaire.

UNLABELLED: Temporomandibular disorders (TMD) screeners assume significant item overlap with the screening questionnaire proposed by the American Academy of Orofacial Pain (AAOP). OBJECTIVE: To test the reliability and validity of the Portuguese version of AAOP questions for TMD screening among adolescents. MATERIAL AND METHODS: Diagnoses from Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I were used as reference standard. Reliability was evaluated by internal consistency (KR-20) and inter-item correlation. Validity was tested by sensitivity, specificity, predictive values, accuracy and receiver operating characteristic (ROC) curves, the relationship between the true-positive rate (sensitivity) and the false-positive rate (specificity). Test-retest reliability of AAOP questions and intra-examiner reproducibility of RDC/TMD Axis I were tested with kappa statistics. RESULTS: The sample consisted of 1307 Brazilian adolescents (56.8% girls; n=742), with mean age of 12.72 years (12.69 F/12.75 M). According to RDC/TMD, 397 [30.4% (32.7% F/27.3% M)] of adolescents presented TMD, of which 330 [25.2% (27.6% F/22.2% M)] were painful TMD. Because of low consistency, items #8 and #10 of the AAOP questionnaire were excluded. Remaining items (of the long questionnaire version) showed good consistency and validity for three positive responses or more. After logistic regression, items #4, #6, #7 and #9 also showed satisfactory consistency and validity for two or more positive responses (short questionnaire version). Both versions demonstrated excellent specificity (about 90%), but higher sensitivity for detecting painful TMD (78.2%). Better reproducibility was obtained for the short version (k=0.840). CONCLUSIONS: The Portuguese version of AAOP questions showed both good reliability and validity for the screening of TMD among adolescents, especially painful TMD, according to RDC/TMD.

Temporomandibular disorders among Brazilian adolescents: reliability and validity of a screening questionnaire

Temporomandibular disorders (TMD) screeners assume significant item overlap with the screening questionnaire proposed by the American Academy of Orofacial Pain (AAOP). Objective: To test the reliability and validity of the Portuguese version of AAOP questions for TMD screening among adolescents. Material and Methods: Diagnoses from Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I were used as reference standard. Reliability was evaluated by internal consistency (KR-20) and inter-item correlation. Validity was tested by sensitivity, specificity, predictive values, accuracy and receiver operating characteristic (ROC) curves, the relationship between the true-positive rate (sensitivity) and the false-positive rate (specificity). Test-retest reliability of AAOP questions and intra-examiner reproducibility of RDC/TMD Axis I were tested with kappa statistics. Results: The sample consisted of 1307 Brazilian adolescents (56.8% girls; n=742), with mean age of 12.72 years (12.69 F/12.75 M). According to RDC/TMD, 397 [30.4% (32.7% F/27.3% M)] of adolescents presented TMD, of which 330 [25.2% (27.6% F/22.2% M)] were painful TMD. Because of low consistency, items #8 and #10 of the AAOP questionnaire were excluded. Remaining items (of the long questionnaire version) showed good consistency and validity for three positive responses or more. After logistic regression, items #4, #6, #7 and #9 also showed satisfactory consistency and validity for two or more positive responses (short questionnaire version). Both versions demonstrated excellent specificity (about 90%), but higher sensitivity for detecting painful TMD (78.2%). Better reproducibility was obtained for the short version (k=0.840). Conclusions: The Portuguese version of AAOP questions showed both good reliability and validity for the screening of TMD among adolescents, especially painful TMD, according to RDC/TMD. .