Initial assessment of the psycho-emotional state of patients with temporomandibular disorders: A pilot study.

BACKGROUND: Temporomandibular disorders (TMD) are a group of conditions that affect the function of the masticatory muscles, temporomandibular joints and surrounding structures. OBJECTIVES: The objective of the preliminary investigation was to develop an initial questionnaire for emotional assessment, pre-designed for TMD patients, and provide guidance for further management through referral to psychological and/or psychiatric counseling. Additionally, we aimed to compare the results of tests carried out in TMD patients with those of healthy subjects. MATERIAL AND METHODS: The study involved 260 patients who reported for dental treatment. The TMD study group (Group 1, n = 130) consisted of patients diagnosed with TMD, and the control group (Group 2, n = 130) had TMD diagnostically excluded. The questionnaire included 30 questions about the emotional state of the patients in the past 4 weeks. RESULTS: The mean scores were 37.715 points for Group 1 (median (Me) = 35.5, standard deviation (SD) = 12.58 and 24.938 points for Group 2 (Me = 24, SD = 7.95) (p < 0.001). CONCLUSIONS: The research suggests that the developed questionnaire is useful for an initial assessment of the psycho-emotional state of TMD patients. Furthermore, the results emphasize a greater need for psychological counseling in TMD patients compared to their healthy counterparts.

Impact of the COVID-19 pandemic on patients' anxiety levels related to dental appointments in Poland.

BACKGROUND: The reasons for the fear of coronavirus disease 2019 (COVID-19) infection are the ease of the transmission of the virus, the severe course of the disease and possible complications, as well as treatment difficulties. The dental office is a place of increased risk. Despite the applied epidemiological protection measures and the hygienic regimen, a dental visit may cause anxiety and generate stress. OBJECTIVES: The aim of the study was to determine the level of fear of coronavirus infection in dental patients during the COVID-19 pandemic, taking into account the patients' age, gender and education, the number of people in the household, and the reason for the appointment. In addition, the patients assessed the epidemiological comfort provided during their visit to the dental clinic. MATERIAL AND METHODS: The survey was conducted among 100 adults who visited the University Dental Clinic (UKS) in Cracow, Poland, for dental treatment. The patients completed 2 questionnaires: "Assessment of the level of anxiety associated with COVID-19"; and "Impact of the COVID-19 pandemic on the need of dental treatment and the level of epidemiological safety of patients". The results were statistically analyzed and interpreted. RESULTS: The level of anxiety assessed with the questionnaire was moderate, and there were no statistically significant differences with regard to the age, gender and education of the respondents or the number of people in the same household. The main reason for reporting to the clinic was the desire to start and continue treatment. Most of the respondents believed that wearing a mask and measuring the temperature protect against infection, but 27% assessed the security measures as insufficient. Nearly half feared impeded access to dental services, and more than half were afraid of increased costs of treatment. CONCLUSIONS: Despite the safety measures taken in place, patients felt anxious about dental appointments during the COVID-19 pandemic.

The significance of masticatory muscle's relaxation in the treatment of the temporomandibular disorders - Review article.

Temporomandibular disorder (TMD) is a disease of multifactorial etiology and a complex of symptoms, related to disorders of the masticatory muscles, temporomandibular joints and the surrounding orofacial structures. One of the main problems in the course of TMD disorders is the systematic increase in the tension of the masticatory muscles (masseter muscles, temporalis and medial and lateral pterygoid muscles), what is the cause of many damages and the development of pathological conditions in the stomatognathic system. The article discusses the differences in the structure of the masticatory and skeletal muscles, as well as the different nature and isoforms of myosin, which determines the much faster generation of contraction in the masticatory muscles and consequently easier generation of excessive, harmful tensions in the masticatory muscles. The article describes the causes of increased tension in the masticatory muscles and methods of their relaxation used in the basic and supportive treatment of temporomandibular disorders. The use of occlusal splints, physiotherapeutic procedures and TMD treatment with botulinum toxin type A were characterized. A role of psychological support and the methods used for patients with TMD were emphasized.

Differential diagnosis of temporomandibular disorders - a review of the literature.

Pain in the masticatory muscles or temporomandibular joints may in some cases be a symptom of other afflictions occurring in this region. The aim of the study was to present the differential diagnosis of temporomandibular disorders (TMD) and other diseases in the craniofacial area, based on review of the literature. Using the key words: "differential diagnosis of TMD", "pain of non-dental origin" and "chronic orofacial pain", PUBMED and Scopus databases were systematically searched for articles in English from 2005 to 2020. Additionally, the PUBMED database was supplementarily reviewed using the keywords "Lyme disease orofacial symptoms" for the English-language articles published in the years 1996-2020. Out of 445 publications from PUBMED and Scopus databases as well as other sources, 57 articles describing the pathogenesis and characteristic symptoms of diseases that may cause pain similar to that occurring in TMD as well as diagnostic methods used in differential diagnosis of TMD were selected for analysis. Dental and jawbones-related conditions, ear and maxillary sinus diseases, as well as ailments of neuropathic and vascular origin, were taken into account. Neoplastic processes taking place in this region and less often occurring diseases caused by viruses, bacteria and parasites were also described. Conclusions. Correct diagnosis of temporomandibular disorders is based on medical history and thorough physical examination, as well as results of additional tests. Pain localized in the head and neck structures may have diverse, sometimes complex aetiology, and may require multidisciplinary treatment. Observation of the patient's behaviour and - in selected cases - the results of additional laboratory tests, also play a significant role.

Risk factors for the development of temporomandibular disorders related to the work environment - a literature review and own experience.

This article characterizes the etiology of temporomandibular disorder with particular emphasis on emotional factors that have a major impact on the development of these dysfunctions and the most common their symptoms. They mainly affect people in the third and fourth decade of life and women predominate among this group of patients. The article analyzes the current literature (Pub Med Database, Scopus and EMBASE) in relation to the conditions in the work environment, which often constitute important causes of emotional tensions, constant state of mental tension and susceptibility to the effects of stressors, which have an impact on the state of functioning of the musculoskeletal system of the masticatory system. Despite the high frequency of temporomandibular disorders, unfortunately only a few studies describe the influence of harmful factors related to the work environment, and own experience (information from the patient's interview) and data from the literature indicate a significant share of these factors in the development of temporomandibular disorder. The relationships and anatomical connections affecting the influence of stressors on the functioning of masticatory muscles and temporomandibular joints are also discussed. In conclusion, it should be stated that the work environment and the emotional tensions generated in it constitute a serious sociological problem and increase the risk of developing and intensify the symptoms of TMD.

Physiotherapeutic rehabilitation of adolescent patients with temporomandibular disorders.

TMD is a group of pathological changes including increased tension in the masticatory muscles, pain in the muscles and/or the temporomandibular joints, abnormal range of the mandibular movement or the presence of acoustic symptoms in the joints in the form of clicking or poping. The aim of the project was to compare the effectiveness of two methods of physiotherapeutic rehabilitation, used in adolescent patients with temporomandibular disorders. MATERIAL AND METHODS: The material consisted of 68 patients, aged 14 to 17, of both sexes, generally healthy, who came to the Dental Prosthetics Department for treatment due to pain in the masticatory muscles. Dental examination and diagnostics revealed Ia in all cases in accordance with RDC/TMD protocol. Manual therapy was performed in group I (34 people) and kinesitherapy with massage was performed in group II (34 people). Patients were allocated randomly to both groups. Contraindications were considered for both methods. RESULTS: Within the first study, mean values of pain intensity between group I and group II were not significantly different (6.12 and 6.24 respectively). Within the second study significantly lower VAS scores in both groups have been revealed (0.92 and 0.74 respectively). Results of the first and second study differed significantly in both groups. Similar results were obtained for the maximum abduction of the mandible. CONCLUSIONS: The results of the conducted studies indicate a beneficial effect of the assessed physiotherapeutic procedures in terms of functional rehabilitation of adolescent patients with temporomandibular disorders.

The Influence of Preventive Activities on Stress Perception among Dentistry Students in the Period of the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic resulted in the strengthening of the earlier stressors and the appearance of new pandemic-related stressors. Many students of dentistry fit the profile of a group who are particularly susceptible to stress related to the pandemic. Thus, it was necessary to implement preventive activities, reducing their stress perception. This was understood as a means of significantly influencing the student's well-being, thus improving the quality of education. Therefore, the aim of the study was to assess the impacts of implemented preventive activities on stress perception among students of dentistry during the pandemic, as well as their influence on this assessment of the selected students' personal experiences regarding the pandemic. METHODS: The study was performed one year after the outbreak of the pandemic on students of dentistry at Jagiellonian University Medical College, Krakow, Poland. It consisted of the completion of a self-designed, voluntary, anonymous, online questionnaire. The respondent's task was to assess the influences of implemented preventive activities on stress perception using a five-point scale. The activities were divided into external (national, global) and internal (institutional). The material was statistically analysed for all students, including pre-clinical and clinical groups. Additionally, the impact of the selected students' personal experiences regarding the COVID-19 pandemic on the assessment was studied. RESULTS: All preventive activities (in total) significantly reduced stress perception (p ≤ 0.001), but the intensity of their impacts (mean rank) was different. The most highly assessed activities were all external preventive activities, with the greatest intensity belonging to the prospect of receiving vaccination against SARS-CoV-2. The remaining external activities were the prospect of developing an effective COVID-19 treatment and the increase in knowledge about SARS-CoV-2. The internal activities were assessed and ascribed lower positions, with the exception of the theoretical classes held online. This activity was placed slightly lower than the highest-rated activity, the prospect of receiving vaccination. CONCLUSIONS: The studied preventive activities reduced stress perception with different levels of intensity. The highest-ranked activities were external activities. One exception was the theoretical classes held online, an internal activity. Due to the lower impact of the internal activities and the ability to modify them by the educators, there is a need to strengthen their effectiveness. The possibility of monitoring and tailoring some preventive activities to the students' needs was the practical aspect of the conducted study. Students' personal experiences related to the COVID-19 pandemic influenced their assessment of the preventive activities, in some cases significantly.

Influence of Ultrasound Examination on Diagnosis and Treatment of Temporomandibular Disorders.

BACKGROUND: Disorders of the masticatory muscles and temporomandibular joints as well as the surrounding craniofacial structures are called temporomandibular disorders. These are dental diseases affecting an increasing number of people with a multifactorial etiology. Noninvasive ultrasonography imaging of temporomandibular joints was performed to obtain more detailed information on joint pathologies. MATERIAL AND METHODS: The aim of the study was to assess the influence of ultrasound examinations of the temporomandibular joints on the diagnosis and treatment planning in patients with temporomandibular disorders. The study included 110 patients examined with the use of the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire, axis I and II, after which the initial treatment plan was created. All patients underwent an ultrasound examination of the temporomandibular joints. RESULTS: The results reveal numerous morphological changes within the joint structures in all treatment groups. Comparative statistical analyses of symptoms were performed between study groups. CONCLUSIONS: The number of pathologies in the myofascial pain group was much higher than expected and required introduction of additional treatment procedures. Further studies confirming these results and the effectiveness of ultrasound diagnostic of temporomandibular disorders are recommended.

Temporomandibular disorders and their impact on the development of the overloading changes within temporomandibular joints.

TMD is a disease within the masticatory system that increases its reach among the society every year in the third and fourth decade of life. The etiology of TMD is complex and it is often difficult to establish the cause in a specific case. The a i m of the study was to determine the impact of TMD on pathomorphological changes within the temporomandibular joints, evaluated in USG examinations and evaluation the assessment of differences in the number of pathological changes between various forms of TMD. MATERIAL AND METHODS: The study material included a group of 386 patients, both sexes, aged 20 to 46 years, who came for prosthetic treatment due to symptoms of TMD. Ultrasound examination of the temporomandibular joints supplemented the clinical diagnosis of TMD in all the subjects. Axis I of the DC/TMD were used. RESULTS: Group I included 116 women and 89 men, group II consisted of 102 women and 79 men. Pathological morphological changes in the temporomandibular joints were found in all the examined patients. The changes in soft tissue structures were significantly increased in group II, but numerous pathomorphological changes were also present in the group of patients with the muscle form of TMD. CONCLUSION: The results of the conducted studies with the use of USG temporomandibular joints revealed numerous pathomorphological changes within the temporomandibular joints. This indicates the usefulness of the USG examination in additional diagnostic tests in the group of patients with TMD.

Analysis of the Hardness of Soft Relining Materials for Removable Dentures.

The main functional feature of elastomeric soft linings materials is the ability to discharge loads in the tissues of the mucosa. As a result, there are fewer injuries to the mucosa and chewing ability increases. In addition, these prostheses are more comfortable in the patient's opinion. To obtain the equal distribution of forces on the muco-bone basis and to reduce the traumatizing effect of the denture plate for patients using full dentures, soft lining materials can be used. AIM OF THE STUDY: the aim of the work was a comparative laboratory study of ten materials used for soft lining of acrylic complete dentures. METHODOLOGY: Materials based on acrylates (Vertex Soft, Villacryl Soft, Flexacryl Soft) and on silicones (Sofreliner Tough Medium, Sofreliner Tough Medium, Ufi Gel SC, GC Reline Soft, Elite Soft Relining, Molloplast) were compared. Laboratory tests include tests of changes in Shore'a A hardness of soft lining material. The tests were conducted taking into account 90 day term aging in the distilled water environment based on the methodology presented in the European Standard ISO 10139-2. RESULTS: For most silicone materials, only small changes in hardness were found in the range of 0.7 (Ufi Gel SC) to 3.3 (Sofreliner Tough Medium) on the Shore A scale. The exception was GC Reline Soft, for which a marked increase in hardness was noted. All materials based on acrylates were characterized by successive increase in hardness over time. However, in the case of the Vertex Soft material, the increase in hardness was relatively small (5.5 ShA).

Frequency of occurrence of the pain form of the temporomandibular disorders and gender distribution.

Temporomandibular disorders includes abnormalities of the masticatory muscles, temporomandibular joints and the surrounding structures. The aim of the study was to carry out a retrospective assessment of the frequency of the pain form of TMD based on the analysis of medical records of patients treated at the Prosthodontic Department at Jagiellonian University in Kraków. MATERIAL AND METHODS: The study included the results of a medical history and a clinical examination of patients, who came for consultation at the Prosthodontics Department at Jagiellonian University in Krakow, due to pain of the masticatory muscles or/and TMJ and painless symptom of TMD like limitation of the jaw movements and joints' sounds. Out of all the analyzed results of the examination of treated patients, a group of patients with a painless and painful TMD was selected. RESULTS: The study involved the results of a detailed specialized functional examination of 334 patients (210 women and 124 men), ranging in age from 41 to 68 years. Analysis of the results of clinical examinations conducted in all patients revealed that 161 had the painless form - SG (99 women and 62 men) and 173 patients had the pain form of the TMD - CG (111 women and 62 men). In the CG 104 patients reported mostly pain in the masticatory muscles, while the remaining (69 patients) had a history of pain in one or simultaneously two TMJs. CONCLUSION: The analysis of the patients forms allows to conclude that more than half of patients seeking help are patients with the painful form of the TMD and these abnormalities occur more frequently in women than in men.

Psychoemotional disturbance in adult patients with temporomandibular disorders Research article.

Temporomandibular disorders (TMD) encompass a diverse group of abnormalities in the functioning of the masticatory muscles, temporomandibular joints, and surrounding structures within the facial skull. One of the important etiological factors, contributing to the development of TMD are psychoemotional disorders, which include: depression, dysthymia, personality disorders, panic attacks as well as states and anxiety neuroses.The aim of the study was to carry out a retrospective evaluation of the occurrence of psychoemotional disorders reported in the application form of medical interview of patients treated at the Consulting Room of Temporomandibular Disorders in Dental Institute (University Dental Clinic) for TMD. The research material consisted of a subjective survey according to the protocol of the RDC/TMD questionnaire, axis II, of the 360 patients (224 women, 136 men), aged 19 to 43 who came to the University Dental Clinic in Krakow due to TMD management. Result: The results of the conducted studies indicate the common occurrence of emotional disorders in the group of patients treated for TMD, both in the group of muscular and joint form of dysfunctions. The most often the patients selected: loss of sexual interest or pleasure, crying easily, feeling lonely, indifference to every- thing and feeling of worthlessness. These aspects show a significant influence of emotional factors on TMD. Conclusion: The results of the conducted research indicate a significant frequencies of psychological and emotional disturbances reported in a survey among patients with TMD.

Dental environmental stress during the COVID­19 pandemic at the Jagiellonian University Medical College, Kraków, Poland.

OBJECTIVES: The burden of stress experienced by dentistry students has been the subject of numerous studies aimed at defining the strongest stressors, and at reducing their intensity to improve the conditions and, consequently, the quality of education. Such studies have never been performed in the conditions of a pandemic caused by a new, unknown coronavirus. Therefore, the objective of the study was to identify the sources of their stress in the course of the studies, with reference to the COVID­19 pandemic. MATERIAL AND METHODS: A total of 334 dentistry students of the Institute of Dentistry at the Jagiellonian University Medical College were invited to take part in the study. They represented a range from the first to the fifth year of studies in the 2019/2020 academic year. The tool employed in the study was the Dental Environmental Stress (DES) questionnaire and 11 supplementary questions related to the pandemic. The study was carried out on June 1-25, 2020. RESULTS: The participation rate was 72%. Academic work presented the highest level of stress. A comparison of the overall levels of stress in particular domains as well as questions included in the DES survey revealed significant differences between students of individual years of studies in the 2019/2020 academic year. The strongest positive relationships between the supplementary questions and the DES domains appeared in the area of clinical factors. These concerned returning to clinical classes and contact with patients with regard to SARS-CoV-2 (rs = 0.50, p < 0.001), contact with patients in connection with SARS-CoV-2 (rs = 0.47, p < 0.001), and a lack of practical classes with patients in connection with the COVID­19 pandemic (rs = 0.42, p < 0.001). CONCLUSIONS: Dentistry students were subjected to stress resulting from a conflict between the perceived risk of returning to clinical classes and contact with patients due to SARS-CoV-2, and disruptions in the course of clinical education, which they perceived negatively. Int J Occup Med Environ Health. 2021;34(2):211-22.

The effect of root canal rinsing protocol on the push-out bond strength to the dentin cementation of the fiber post.

B a c k g r o u n d: Studies on the effect of root canal rinsing protocols on fiber post bonding to dentin are inconclusive. This study reports investigation of this topic. O b j e c t i v e s: to determine effects of irrigation protocol by means of a push-out test on the strength of adhesion between the post and dentin in an in vitro study. Materials and Method: Thirty human single-rooted teeth were prepared using hand instruments and the step-back technique, filled with gutta-percha, sealed with AH Plus (Dentsply), and divided into three groups: A: rinsed with NaCl; B: rinsed with 2% chlorhexidine (CHX); C: not rinsed before cementation of posts. The fiber posts were set using RelyX and Built-it. The tooth roots were sliced and the push-out test was performed. The area of contact between the post and dentin was calculated and the destroying force was established. The results were statistically analyzed. R e s u l t s: The mean adhesive strength was 10.69 MPa in group A, 16.33 MPa in group B, and 16.72 MPa in C. The adhesive strength in group B and C was statistically significantly higher than in group A (p = 0.0016, ANOVA). Conclusion: Rinsing root canals with CHX seems to be the most effective method prior to setting a fiber post.

Diagnostic of Temporomandibular Disorders and Other Facial Pain Conditions-Narrative Review and Personal Experience.

Temporomandibular disorders are complex dysfunctions of masticatory muscles and temporomandibular joints. Their symptoms affect more than 40% of the population and their prevalence is rising. It is important to establish a unified protocol for this specialistic examination. This review describes the authors' own longstanding experiences and the discrepancies in the current literature regarding this topic as well as a detailed procedure of diagnosing temporomandibular disorders including the leading but often underrated role of a medical interview. We presented optimal physical examination methods as well as specific situations in which additional diagnostic and imaging tools may be useful. The emphasis was put on the importance of differential diagnosis between temporomandibular disorders and other diseases presenting with similar symptoms.

The mechanism of beneficial effect of radiofrequency therapy on masticatory muscles in temporomandibular disorders - a literature review.

Temporomandibular disorders (TMD) is one of the most common problem in contemporary dentistry. It is a term covering dysfunction of the masticatory muscles and the temporomandibular joints. Patients are suffering from severe pain, followed by limited mandibular opening and sounds in the temporomandibular joints during jaw movement. TMD influences the quality of life because the symptoms can become chronic and difficult to manage. Radiofrequency waves (RF) are electromagnetic waves with low energy and high frequency. They provide pain relief without causing significant damage to the nervous tissue. The RF therapy is commonly used for physiotherapeutic treatment of skeletal muscle relaxation, as a supportive therapy. The rehabilitation effect of these waves is based on diathermy by means of high-voltage quick alternating current. RF has also found application in physical therapy, as a therapeutic tool for various types of chronic pain syndromes. The aim of this literature review is to show the beneficial effect of radiofrequency waves on the pain of the masticatory muscles in the course of TMD.

The Application of Intra-Articulr Injections for Management of the Consequences of Disc Displacement without Reduction.

The aim of the study was to make a comparative studies on the effectiveness of platelet rich plasma (PRP) and hyaluronic acid (HA) in intra-articular injections to the temporomandibular joints-in double blind studies application-based on the analysis of selected clinical parameters of functional efficiency and the mean value of joint's pain intensity before and after management. The study enrolled a group of 100 patients, aged 21 to 43 years, of both sexes, who came for the prosthodontic treatment. All patients had II b group of disorder according to the Research Diagnostic Criteria/Temporomandibular Disorder, and were consecutively, alternately assigned to the groups, 50 patients in each. Study group PRP was treated with intra-articular injection of platelet rich plasma and study group HA had injection with hyaluronic acid. The examination was double-blind, so that the injecting physician and the patient were not informed what kind of medicinal substance they received in the joint injection. The final selected clinical parameters did not differ statistically significantly between the groups, what means that both administered substances were effective in the repair of intra-articular structures. The results of research showed that the use of PRP and HA in intraarticular joint's injections positively affects in selected clinical parameters and decrease of the pain in temporomandibular joints in the case of disc displacement without reduction.

Evaluation of C-Reactive Protein Level in Patients with Pain Form of Temporomandibular Joint Dysfunction.

Temporomandibular joint dysfunction is a functional disorder concerned with the abnormal functioning of the muscles of the stomatognathic system and temporomandibular joints involved in the dynamic movements of the jaw and surrounding structures. The aim of the study was to compare the level of C-reactive protein in patients with pain and painless forms of temporomandibular joint dysfunction. Materials and methods. The study group consisted of 72 patients who reported to the prosthetic treatment because of temporomandibular joint dysfunction. The study group included 36 patients with pain form of dysfunction, and the control group included 36 patients with painless form of disorder. Each patient underwent specialized examination of functional disorders in order to diagnose the type of dysfunction and was commissioned to carry out a study of the blood test concerned with evaluation of the C-reactive protein (CRP) level in the same analytical laboratory. The results of the investigation were subjected to statistical analysis. The research obtained approval from the Ethics Committee of the Jagiellonian University (KBET/125/L/2013). Level of Evidence for primary research was established as type V. Results. The mean values of C-reactive protein levels in both groups were in the normal range and did not differ statistically significantly, which indicates the fact that the pain form of the temporomandibular joint disorders is not associated with inflammation of the soft tissues of the joint. Conclusion. Painful form of the temporomandibular joint dysfunctions is not connected with the inflammation of joints.

Clinical crown lengthening - a case report.

Maintaining healthy parodontium during teeth restoration procedures is an indispensable condition for obtain- ing regular functionning and esthetics. Thus, the knowledge of correct anatomy and the influence of filling and complement on paradontium tissue is vital. Difficulty in maintaining appropriate gingival biological width (GBW) is a frequent problem encountered in this type of reconstruction. Preservation of unchanged biological width conditions predictible treatment result and, what is more, lack of inflammatory lesions in marginal parodontium. The ideal situation for parodontium is localizing the filling/complement border supragingivaly, which is at least 3 mm from alveolar process edge. In the case, when the above conditions are impossible to fulfil, elongation of clinical crown is a metod of choice. The effect is possible to achieve by surgical treatment or combined orthodontic - surgical treatment. Surgical treatment is faster and preferred procedure for indirect reconstruction, where achieving high clinical crown is necessary. Three clinical cases of performing method of surgical clinical crown elongation were presented in the article. Performing the described procedure enables correct tooth crown reconstruction and, what is most important, keeping individual toothing.