Prevalence of signs and symptoms related to temporomandibular disorders and orofacial pain in patients indicated for orthognathic surgery: a meta-analysis.

OBJECTIVE: To evaluate the prevalence of signs and symptoms related to temporomandibular disorders (TMD) and orofacial pain in patients with indication for orthognathic surgery. METHODS: The search was carried out in seven electronic databases and gray literature. Studies that evaluated the frequency of signs and symptoms related to TMD and orofacial pain were included. The risk of bias was assessed using the Joanna Briggs Critical Appraisal tool. A meta-analysis of proportions with a random effect model was performed and the GRADE tool judged the certainty of evidence. RESULTS: After searching the databases, 1859 references were retrieved, 18 of which were selected for synthesis. The prevalence of individuals with at least one TMD symptom was 51% [CI95% = 44-58%], and 44% of the subjects had temporomandibular joint click/crepitus [CI95% = 37-52%]. Additionally, 28% exhibited symptoms related to muscle disorders [CI95% = 22-35%], 34% had disc displacement with or without reduction [CI95% = 25-44%], and 24% had inflammatory joint disorders [CI95% = 13-36%]. The prevalence of headache was 26% [CI95% = 8-51%]. The certainty of evidence was considered very low. CONCLUSION: Approximately 1 in 2 patients with dentofacial deformity presents some sign and symptom related to TMD. Myofascial pain and headache may be present in approximately a quarter of patients with dentofacial deformity. CLINICAL RELEVANCE: A multidisciplinary treatment is necessary for these patients, involving a professional with expertise in the management of TMD.

Prevalence of otological symptoms and parafunctional habits in patients with temporomandibular dysfunction / Prevalência de sintomas otológicos e hábitos parafuncionais em pacientes com disfunção temporomandibular

ABSTRACT Objective: to verify the relationship between otological symptoms and parafunctional habits in individuals with temporomandibular joint dysfunction. Methods: evaluations were based on the clinical records of 768 patients treated at a temporomandibular joint diagnostic center from 2010 to 2016. The inclusion criteria were completely filled out charts of adult patients (> 18 years of age) and the final sample comprised 516 clinical records. The presence/absence of parafunctional habits and otological symptoms (tinnitus, hearing impairment, dizziness, the sensation of plugged ears and imbalance) was recorded. Results: statistically significant associations were found between otological symptoms and both sex and the presence of parafunctional habits, as otological symptoms were more prevalent among women and individuals with at least one parafunctional habit. Conclusion: in the present sample, otological symptoms were positively associated with parafunctional habits in individuals with temporomandibular joint dysfunction.

RESUMO Objetivo: avaliar a prevalência de sintomas otológicos e hábitos parafuncionais em pacientes com Disfunção Temporomandibular. Métodos: foram analisados 768 prontuários clínicos de pacientes atendidos em um Centro de Diagnóstico da Articulação Tempormandibular do ano de 2010 a 2016, sendo o critério de inclusão os prontuários preenchidos de forma completa e de pacientes maiores de 18 anos. Foram excluídos 252 prontuários que não estavam preenchidos de maneira completa ou que o paciente tinha idade inferior a 18 anos, identificando uma amostra final de 516 prontuários. Foram anotados a presença ou não dos hábitos parafuncionais e de sintomas otológicos (zumbido, surdez, tontura, sensação de ouvido tampado e desequilíbrio). Resultados: houve diferença estatisticamente significante na prevalência de sintomas otológicos relacionados ao sexo e a presença de hábitos parafuncionais, sendo que a referência de sintomas otológicos foi mais prevalente nas mulheres e naqueles com a presença de pelo menos um hábito parafuncional. Conclusão: foi observada uma relação positiva entre os sintomas otológicos e os hábitos parafuncionais em pacientes com DTM's.

Diagnostic validity of methods for assessment of swallowing sounds: a systematic review / Validade diagnóstica dos métodos de avaliação dos sons de deglutição: uma revisão sistemática

Abstract Introduction: Oropharyngeal dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may lead to outcomes of aspiration pneumonia, ranging from hospitalization to death. This assessment proposes a non-invasive, acoustic-based method to differentiate between individuals with and without signals of penetration and aspiration. Objective: This systematic review evaluated the diagnostic validity of different methods for assessment of swallowing sounds, when compared to videofluroscopy swallowing study to detect oropharyngeal dysphagia. Methods: Articles in which the primary objective was to evaluate the accuracy of swallowing sounds were searched in five electronic databases with no language or time limitations. Accuracy measurements described in the studies were transformed to construct receiver operating characteristic curves and forest plots with the aid of Review Manager v. 5.2 (The Nordic Cochrane Centre, Copenhagen, Denmark). The methodology of the selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. Results: The final electronic search revealed 554 records, however only 3 studies met the inclusion criteria. The accuracy values (area under the curve) were 0.94 for microphone, 0.80 for doppler, and 0.60 for stethoscope. Conclusion: Based on limited evidence and low methodological quality because few studies were included, with a small sample size, from all index testes found for this systematic review, doppler showed excellent diagnostic accuracy for the discrimination of swallowing sounds, whereas microphone-reported good accuracy discrimination of swallowing sounds of dysphagic patients and stethoscope showed best screening test.

Resumo Introdução: A disfagia orofaríngea é uma comorbidade altamente prevalente em pacientes neurológicos e representa uma séria ameaça à saúde, pode levar a desfechos como pneumonia por aspiração, hospitalização e até morte. A avaliação propõe um método não invasivo, acústico, para diferenciar entre indivíduos com e sem sinais de penetração e aspiração. Objetivo: Esta revisão sistemática analisou a validade diagnóstica de diferentes métodos para avaliação dos sons de deglutição, quando comparados com a videofluoroscopia da deglutição para detectar disfagia orofaríngea. Método: Artigos nos quais o objetivo principal era avaliar a acurácia dos sons de deglutição foram pesquisados em cinco bancos de dados eletrônicos sem limitações de idioma ou tempo de publicação. As medidas de acurácia descritas nos estudos foram transformadas para construir curvas ROC (Receptor Operating Characteristic) e gráfico em floresta (forest plot) com o auxílio do software Review Manager v. 5.2 (The Nordic Cochrane Centre, Copenhagen, Dinamarca). A metodologia dos estudos selecionados foi avaliada com a ferramenta Avaliação da Qualidade de Estudos de Acurácia de Testes Diagnósticos-2. Resultados: A busca eletrônica final resultou na identificação de 554 artigos; no entanto, apenas três estudos preencheram os critérios de inclusão. Os valores de acurácia (área abaixo da curva) foram 0,94 para microfone, 0,80 para doppler e 0,60 para estetoscópio. Conclusão: Baseado nas evidências limitadas e da baixa qualidade metodológica, pois foram poucos os estudos incluídos, e com pequeno tamanho amostral, de todos os testes diagnósticos (index testes) encontrados para essa revisão sistemática o doppler mostrou excelente acurácia diagnóstica na discriminação dos sons de deglutição, o microfone demonstrou uma boa acurácia na discriminação dos sons de pacientes disfágicos e o estetoscópio revelou o melhor teste de triagem.

Relationship between Otological Symptoms and TMD.

BACKGROUND: Patients with any type of temporomandibular disorder (TMD) may have several symptoms in their temporomandibular joints, masticatory muscles and associated structures, and may have otological symptoms such as tinnitus, ear fullness, ear pain, hearing loss, hyperacusis, and vertigo, which may be due to the anatomical proximity between the temporomandibular joint, muscles innervated by the trigeminal nerve, and ear structures. Objective: This study found a prevalence of ear complaints described in the medical records of patients (n = 485) at the Center for Diagnosis and Treatment of the Temporomandibular Joint and Dental-Facial Functional Alterations at Tuiuti University of Paraná (CDATM/UTP), with TMD evaluated by the Research Diagnostic Criteria/Temporomandibular Disorders (RDC/ TMD). METHOD: After approval by the ethics committee were examined 485 medical records of patients of the CDATM/UTP, of both sexes a period of 2 years. The data analyzed were gender, age and the presence of reported otologic symptoms. The data were organized and subjected to statistical analysis using SPSS (IBM Statistic 20.0). RESULTS: The results showed a higher number of female patients between 41 and 50 years old. There was a prevalence of otological symptoms (tinnitus, deafness, dizziness, imbalance, and ear fullness) in 87% of TMD cases, regardless of sex and age. Tinnitus was the symptom with the highest prevalence (42%), followed by the ear fullness (39%). CONCLUSION: These data support the correlation between temporomandibular disorders and otological symptoms, even without being caused directly by the ear.

Diagnostic validity of methods for assessment of swallowing sounds: a systematic review.

INTRODUCTION: Oropharyngeal dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may lead to outcomes of aspiration pneumonia, ranging from hospitalization to death. This assessment proposes a non-invasive, acoustic-based method to differentiate between individuals with and without signals of penetration and aspiration. OBJECTIVE: This systematic review evaluated the diagnostic validity of different methods for assessment of swallowing sounds, when compared to videofluroscopy swallowing study to detect oropharyngeal dysphagia. METHODS: Articles in which the primary objective was to evaluate the accuracy of swallowing sounds were searched in five electronic databases with no language or time limitations. Accuracy measurements described in the studies were transformed to construct receiver operating characteristic curves and forest plots with the aid of Review Manager v. 5.2 (The Nordic Cochrane Centre, Copenhagen, Denmark). The methodology of the selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. RESULTS: The final electronic search revealed 554 records, however only 3 studies met the inclusion criteria. The accuracy values (area under the curve) were 0.94 for microphone, 0.80 for doppler, and 0.60 for stethoscope. CONCLUSION: Based on limited evidence and low methodological quality because few studies were included, with a small sample size, from all index testes found for this systematic review, doppler showed excellent diagnostic accuracy for the discrimination of swallowing sounds, whereas microphone-reported good accuracy discrimination of swallowing sounds of dysphagic patients and stethoscope showed best screening test.

Nível de conhecimento sobre o pronto atendimento ao traumatismo alvéolo dentário e aquisição de conhecimento por meio de leitura de panfleto educativo

Objetivo: o objetivo deste trabalho é verificar a eficiência do uso de um folheto educativo na melhora do nível de conhecimento sobre o pronto atendimento em casos de traumatismo alvéolo dentário (TAD) por educadores de crianças do ensino fundamental. Sujeitos e método: foi aplicado questionário a 164 docentes do ensino fundamental no município de Almirante Tamandaré, PR, para avaliação do nível de conhecimento sobre a assistência prestada no pronto atendimento a crianças em caso de TAD. Os professores responderam ao Questionário sobre o pronto atendimento ao traumatismo alvé- olo dentário (QTDA) em dois momentos, antes da leitura do folheto educativo (QTDA1) e depois (QTDA2). Resultado: observou-se que 43,20% dos docentes não tinha conhecimento sobre os procedimentos corretos a serem adotados numa situação de TAD. Após a leitura do panfleto educativo, a taxa de acertos aumentou cerca de 21,83%, ou seja, houve diferença estatisticamente significante (p≤0,001) entre os escores antes e depois da leitura do panfleto, o que reflete uma melhora no nível de conhecimento por parte dos respondentes. Conclusão: o folheto educativo mostrou-se eficiente na aquisição de conhecimento sobre o tema TAD, pois o folheto educativo resultou em um percentual significativamente positivo, sendo um método barato e prático, cuja leitura pode ser realizada quando conveniente.