ETIOLOGY, DIAGNOSIS AND TREATMENT OF MUSCLE-ARTICULAR DYSFUNCTION OF THE TEMPOROMANDIBULAR JOINT IN ADOLESCENCE.

Etiologic and pathogenetic aspects cause the most contentious issue in the study of temporomandibular joint (TMJ) syndrome in childhood and adolescence. Some researchers have linked the emergence of this group of diseases with abnormal occlusion, others have more emphasis on the age characteristics of a growing organism, or rather on a number of morphological and psychomotor processes arising and ending at puberty and cause physiological abnormalities in the growing organism. The aim of the study was to improve the method of complex treatment of TMJ dysfunction in adolescence by exploring its development factors with early diagnosis methods. MATERIAL AND METHODS: We have examined by clinical and radiological methods 33 patients with TMJ syndrome disorder between the ages of 11 to 18 years, 20 of them (60.6%) girls and 13 (39.4%) boys. All examined patients complained of the presence of clicks in the joint when they open mouth widely, irregular movement of the lower jaw when opening the mouth, the periodic occurrence of unilateral pain in the joint and the ear, increasing when taking rigid and solid food, which allowed us to establish the diagnosis of the TMJ syndrome. A clinical study has focused on the survey of patients, and in some cases their parents, in order to study carefully the history of life and disease, and the patient's complaints. We have found out the factors predisposing to the disease: the presence of various bad habits, family history, trauma of the lower jaw and TMJ, errors in orthodontic treatment. RESULTS: The data obtained showed that 16 (48.5%) patients had a history revealed various factors that contribute to the TMJ syndrome. The presence of various bad habits was about 38%. In addition, 13 (39.4%) patients reported the presence of emotional stress. The presence of orthodontic pathology was determined in 26 (78.8%) patients, 7 (21.2%) patients had no dentofacial disorders was not determined. The most common symptom, occurring in 27 (81.8%) patients was clicking in the joint with one or two sides, as well as excessive excursion of articular heads, occurring in 17 (51.5%) patients. A distinctive feature of TMJ syndrome manifestations in children and adolescents is relatively rare, in contrast to adults, the appearance of symptoms: pain when opening the mouth wide detected only 7 (21.2%) patients; pain in the joints - 8 (24.2%) patients; pain in the masticatory muscles - 6 (18.2%) patients. CONCLUSIONS: Based on the above, the etiological factors of musculo-articular dysfunction of the TMJ in adolescence can be not only dental anomalies, but also the presence of bad habits, disproportions in the growth of the bone and muscular skeleton and hypokinetic states caused by psychophysiological responses to chronic stress. Accordingly, treatment of patients with this pathology should be comprehensive and include not only treatment of the dental system, but also be aimed at the uniform development of the musculoskeletal system in children and at eliminating bad habits and chronic stress factors.

Bruxismo y su asociación con la disfunción temporomandibular en niños. Revisión de literatura / Bruxism and its association with temporomandibular disorders in children. Literature review

Resumen Introducción: El bruxismo está definido como una actividad oral motora que consiste en el apretamiento o rechinamiento involuntario (rítmico o espasmódico no funcional) de los dientes, con una prevalencia de 5,9% a 49,6% en niños. Lo que podría contribuir a problemas clínicos asociados con la articulación temporomandibular. La asociación entre la disfunción temporomandibular (DTM) y el bruxismo en niños aún no está totalmente establecida. Objetivo: El objetivo de esta revisión de literatura es recopilar información actualizada de estudios que hayan abordado la asociación entre el bruxismo y la disfunción temporomandibular en niños de 3 a 12 años. Metodología: Se realizó una búsqueda en las bases de datos de Scopus, Pubmed y Scielo usando los descriptores "Niño", "Niños", "Preescolar", "Bruxismo", "Bruxismo del sueño", "Disfunción Temporomandibular"; y, "Síndrome de la Disfunción de Articulación Temporomandibular". Fueron incluidos artículos publicados en los últimos 15 años en idiomas español, inglés y portugués. Fueron incluidos estudios transversales, de cohorte, casos controles y ensayos clínicos aleatorizados. Resultados: Se evaluaron 242 artículos, de los cuales solo 11 fueron incluidos de acuerdo a los criterios de inclusión. Entre los estudios incluidos, dos de ellos no encontraron asociación entre DTM y bruxismo, tres encontraron una tendencia o probable asociación y seis encontraron una asociación positiva. Conclusiones: Existen estudios que relatan asociación entre el bruxismo y las disfunciones temporomandibulares en niños de 3 a 12 años, relacionando la presencia de signos y síntomas de la DTM con el bruxismo, pudiendo ser este último, un factor de riesgo para la presencia de DTM.

ABSTRACT Introduction: Bruxism is defined as an oral motor activity that consists of involuntary clenching or grinding (non-functional rhythmic or spasmodic) of the teeth, with a prevalence rate ranging from 5.9% to 49.6% in children, which could contribute to clinical problems associated with the temporomandibular joint. The association between bruxism in children and temporomandibular dysfunction (TMD) is not yet fully established. Objective: The objective of this literature review is to collect up-to-date information on studies that have addressed the association between bruxism and temporomandibular dysfunction in children ranging 3 - 12 years of age. Methods: A search was performed in the Scopus, PubMed and SciELO databases using the descriptors "Child", "Children", "Child, Preschool", "Bruxism", "Sleep Bruxism", "Temporomandibular Dysfunction" and "Temporomandibular Joint Dysfunction Syndrome." Articles published in the last 15 years in the Spanish, English and Portuguese languages were included. Results: A total of seventy-two articles were assessed. Only 11 articles were included according to the inclusion criteria. Among the included studies, two of them found no association between TMD and bruxism, three found a trend or probable association, and six found a positive association. Conclusion: There are studies that report an association between bruxism and temporomandibular dysfunctions in children ranging 3 - 12 years old, relating the presence of signs and symptoms of TMD with bruxism.

Carboxytherapy for the elimination of pain symptoms (or arthralgia) among the elderly persons with the pathology of the temporomandibular joint.

Temporomandibular arthralgia is difficult to treat, painful and often relapses. 48 patients (19 men and 29 women) aged 61-72 years, suffering from the syndrome of pain dysfunction of the temporomandibular joint, were under observation. In 1st (control) group of patients (18 people), NSAIDs indomethacin in tablet form of 25 mg 3 times a day were used for 9 days. In patients of the 2nd (main) group (30 people), the method of invasive carboxytherapy was used, consisting in subcutaneous injection of carbon dioxide with a volume of 3 ml of 5 procedures every other day. On the 3rd, 9th and 15th days of follow-up, invasive carboxytherapy was more effective than the use of a nonsteroidal anti-inflammatory agent by 8.9; 36,5 and 37%, respectively. The high efficiency of the method of invasive carboxytherapy for the elimination of pain symptoms in pain dysfunction was shown, which was 22,86% on day 3; 64,29% on day 9 and 68,16% on day 15 of observation. The method of invasive carboxytherapy can be used in the complex treatment of patients with pain dysfunction of the temporomandibular joint.

Validade e confiabilidade do Instrumento de Diagnóstico Epidemiológico da Disfunção Temporomandibular - IDE/DTM / Validity and reliability of the Temporomandibular Disorder Epidemiological Diagnostic Instrument - IDE/TMD

Introdução: A disfunção temporomandibular é um problema de saúde pública bastante subnotificado. Além disso, o seu diagnóstico é complexo e exige o uso de instrumentos válidos e confiáveis para uso em estudos epidemiológicos. Objetivo: Validar o instrumento de diagnóstico epidemiológico da DTM (IDE/DTM), com aplicabilidade para estudos epidemiológicos nacionais. Metodologia: Trata-se de um estudo de validação, foram avaliadas a validade da estrutura interna através da Análise Fatorial Exploratória (AFE), confiabilidade (consistência interna, interobservadores e intraobservador) e a validade convergente do IDE/DTM usando os Critérios de Diagnóstico para Disfunção Temporomandibular (DC/TMD) como padrão-ouro. A amostra foi composta por 221 voluntários, 120 na etapa de AFE, 50 para o teste-reteste e 101 na validade convergente. Resultados: A AFE revelou 3 dimensões (DTM Muscular, DTM Articular e Diagnóstico diferencial) com todos os itens com cargas fatoriais > 0.4, que explicaram 73,3% da variância total. Boa consistência interna com alfa de Cronbach= 0,775. A confiabilidade variou entre substancial e excelente, reprodutibilidade interobservadores (Kappa=0,74-1,00, ICC=0,91-0,97; p< 0,001) e intraobservador (Kappa= 0,75-0,94, ICC=0,80-0,98; p< 0,001). O escore total do IDE/DTM apresentou critérios de diagnósticos válidos e satisfatórios segundo o DC/TMD (Kappa= 0,906; p<0,001), com capacidade para diferenciar indivíduos sem e com DTM com ponto de corte de 4,9 (Sensibilidade=1,0; Especificidade= 1,0; AUR=1,0), DTM Mista com ponto de corte de 14 ou mais (Sensibilidade=0,8; Especificidade=1,0; AUR=0,987), e DTM Muscular (Sensibilidade=1,0; Especificidade= 0,88; VPP= 0,89; VPN= 1,0) ou DTM Articular (Sensibilidade=0,95; Especificidade= 0,87; VPP= 0,83; VPN=0,96) com ponto de corte entre 5-13,9 pontos, sendo o diagnóstico obtido a partir da maior pontuação em cada dimensão (Muscular ou Articular). Conclusão: O IDE/DTM é um instrumento de avaliação válido e confiável, com propriedades psicométricas adequadas e satisfatórias, capaz de diagnosticar pessoas com DTM e classificar o subtipo da condição (Muscular, Articular e Mista) (AU).

Introduction: Temporomandibular disorders (TMD) is a highly underreported health problem. In addition, its diagnosis is complex and requires the use of valid and reliable instruments for use in epidemiological studies. Objective: To validate the Epidemiological Diagnostic Instrument for TMD (EDI/TMD), with applicability for national epidemiological studies. Methodology: This is a validation study, internal structure validity through Exploratory Factor Analysis (EFA), reliability (internal consistency, interobserver and intraobserver), and convergent validity of the EDI/TMD were assessed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) as the gold standards. The sample was composed of 221 volunteers, 120 in the EFA stage, 50 for the test-retest, and 101 for convergent validity. Results: AFE showed three factors (Muscles TMD, Joint TMD, and Differential Diagnosis) with all items having factor loadings > 0.4, which explained 73.3% of the total variance. Good internal consistency with Cronbach's alpha= 0.775. Reliability ranged from substantial to excellent, reproducibility interobserver (Kappa=0.74-1.00, ICC=0.91-0.97; p< 0.001) and intraobserver (Kappa= 0.75-1.00, ICC=0.80-0.98; p< 0.001). The EDI/TMD total score showed valid and satisfactory diagnostic criteria according to the DC/TMD (Kappa= 0.906; p<0.001), with the ability to differentiate between individuals without and with TMD with a cut-off point of 4.9 (Sensitivity=1.0; Specificity=1.0; AUR=1.0); Mixed TMD with a cut-off point of 14 or more (Sensitivity=0.8; Specificity=1.0; AUR=0.987); and either Muscles TMD (Sensitivity=1.0; Specificity= 0.88; PPV= 0.89; NPV=1.0) or Joint TMD (Sensitivity=0.95; Specificity= 0.87; PPV= 0.83; NPV=0.96), with a cut-off point between 5-13.9, with the diagnosis obtained from the highest score in each factor (Muscles or Joint). Conclusion: The EDI/TMD is a valid and reliable assessment tool, with adequate and satisfactory psychometric properties, capable of diagnosing people with TMD and classifying the subtype of the condition (Muscles, Joint, and Mixed) (AU).

Posición condilar y espacio articular témporomandibular valorado con tomografía Cone beam / Condylar position and Temporomandibular Joint Space analysis with Cone-beam tomography

Resumen Objetivo. Comparar posición condilar y espacio articular en articulación témporo-mandibular, en pacientes con y sin disfunción témporo-mandibular mediante tomografía Cone Beam. Métodos. Criterios diagnósticos de investigación para trastornos témporo-mandibulares Eje II, n=50 pacientes ambos sexos, edad comprendida 18 - 27 años. Muestra aleatoria n= 50 pacientes equivalente a 100 articulaciones, se obtuvo: n=25 pacientes sin disfunción témporo-mandibular, considerados asintomáticos 25 con y sin disfunción témporo-mandibulares, considerados sintomáticos. Mediante tomografía Cone Beam de articulación témporo-mandibular boca abierta - boca cerrada se avaluó de forma manual los espacios interarticulares. Resultados. El espacio condilar anterior en pacientes con y sin disfunción témporo-mandibular no presentó diferencia significativa, p=0,30. La posición condilar tampoco mostró diferencia significativa p=0,58. En pacientes con y sin disfunción témporo-mandibular (sintomáticos) la posición central y posterior del cóndilo (35,2%), pacientes con y sin disfunción témporo-mandibular (asintomáticos) la posición anterior y central fue más significativa (37,0%); seguido de la posición posterior del cóndilo (26,1%). Conclusión. No existe diferencia significativa en la posición condilar y el espacio interarticular en pacientes sintomáticos y asintomáticos.

Abstract Aim. To compare the condylar position and joint space of the temporomandibular join in individuals with and without temporomandibular dysfunction, using cone beam computed tomography (CBCT). Methods. Research Diagnostic Criteria for Temporomandibular Disorders Axis II (n= 50) patients both sexes, age 18 - 27 years. Random sample (n=50) patients equivalent to 100 joints, obtaining: n-25 patients without temporomandibular dysfunction, considered asymptomatic and 25 patients with and without temporomandibular dysfunction, considered symptomatic. By tomography Cone Beam of open mouth temporomandibular joint - closed mouth was manually evaluated the interarticular spaces. Results. The anterior condylar position space and condylar position not significantly different in induvials with and without temporomandibular dysfunction temporomandibular disorders p=0,30 and p=0,58, respectively. Conclusions. There is no significant difference in the condylar position and intraarticular.

Prevalência e características da disfunção temporomandibular de pacientes de uma clínica escola de Odontologia / Prevalence and characteristics of temporomandibular dysfunction of patients in a Dentistry clinic-school

Objetivos: determinar a prevalência da disfunção temporomandibular (DTM) em pacientes de uma clínica escola de Odontologia, descrever o perfil epidemiológico da amostra analisada, caracterizar o grau dessas disfunções e identificar os sinais e sintomas orofaciais mais frequentes. Método: estudo epidemiológico, do tipo transversal, que avaliou pacientes da Clínica Escola de Odontologia da Universidade de Rio Verde, GO. A pesquisa foi realizada através de três questionários: Índice Anamnésico Simplificado de Fonseca (IASF), Questionário para Triagem para Dor Orofacial (QTDO), questionário sociodemográfico e econômico. Resultados: foram analisados 200 pacientes, dentre os quais 78,5% apresentaram algum grau de DTM, sendo o mais prevalente a DTM de leve intensidade, presente em 38% da amostra. Conclusão: nesse cenário, conclui- -se que a maioria dos participantes apresentou DTM, sendo que a intervenção multidisciplinar seria de suma relevância no tratamento, podendo oferecer uma abordagem mais completa e com melhores resultados.(AU)

Objectives: to determine the prevalence of TMD in patients at a dental school clinic, as well as describe its epidemiological profile for the evaluated sample, characterizing the degree of this dysfunction and identifying the most frequent orofacial signs and symptoms. Method: it is an epidemiological, cross-sectional study that evaluated patients at the School of Dentistry clinic, University of Rio Verde, GO, Brazil. The study was carried out using three questionnaires: Simplified Fonseca Anamnesis Index (SFAI), Orofacial Pain Screening Questionnaire (OPSQ), and the socio-demographic and economic questionnaire. Results: 200 patients were evaluated, among which 78.5% had some degree of TMD, the most prevalent being mild TMD, present in 38% of the sample. Conclusion: most participants had TMD, and multidisciplinary intervention would be of paramount importance in the treatment, being able to offer a more complete approach and with better results.(AU)

Prevalence of Temporomandibular Disorders and its Correlation with Stress and Salivary Cortisol Levels among Students

ABSTRACT Objective: To evaluate the prevalence of temporomandibular disorders (TMD) in students and to evaluate if any relationship existed between the stress levels, salivary cortisol levels, and TMD. Material and Methods: A total of 348 students, 187 female, and 161 male students, participated in this cross-sectional study. Students were evaluated based on the Research Diagnostic Criteria for TMD. The stress levels were evaluated using the Perceived Stress Scale. The students were divided into the control and TMD groups. Salivary cortisol levels in the salivary samples were analyzed. Results: The prevalence rate of TMDs was 30.7% in the study population. Of the female students, 61% had TMD compared with 46% of male students. Muscle disorders were the most predominant disorder in 14.2% of the students with TMD. The TMD group showed significantly higher salivary cortisol and stress levels than the control group. The TMD group also showed a moderate positive correlation between cortisol and stress levels (p=0.01). Conclusion: The study showed a strong association between salivary cortisol levels, stress, and temporomandibular disorders. Salivary cortisol could be used as a prognostic biomarker for stress while assessing the severity of TMJ problems in stressed individuals.

The effectiveness of stabilization appliance therapy among patients with myalgia.

BACKGROUND: The efficacy of stabilization appliance therapy for masticatory muscle pain is debated. Therefore, there are currently no clear usage standards. We analyzed patient factors influencing its efficacy and characterized masticatory muscle pain subtypes to determine appropriate therapy candidates. METHODS: This case series study recruited patients diagnosed with local myalgia or myofascial pain and used variables related to temporomandibular disorders in the analysis. We used temporary appliance to screen patients for sleep bruxism for 2 weeks. Afterwards, we initiated therapy with stabilization appliances. Efficacy was evaluated via tenderness intensity during muscle palpation and the treatment satisfaction score after 2 months of treatment. RESULTS: We analyzed 62 (91%) patients. Tenderness upon muscle palpation was mitigated in 27 patients. Mitigated tenderness odds ratios were 0.035 for myofascial pain, 0.804 for 15-item Patient Health Questionnaire scores, and 1.915 for facet length. Thirty-nine patients expressed satisfaction; satisfaction odds ratios were 0.855 for 9-item Patient Health Questionnaire scores, 1.606 for facet length, and 4.023 for awake bruxism awareness. CONCLUSIONS: Stabilization appliance therapy is most effective for patients with awake bruxism awareness, local myalgia, long facets, and no psychosocial risk factors.

Avaliação de um novo índice anamnésico para o diagnóstico da disfunção temporomandibular / Evaluation of a new anamnestic index for the diagnosis of temporomandibular disorder

Introdução: A Disfunção Temporomandibular (DTM) consiste em uma condição complexa, que possui etiologia multifatorial e apresenta uma sintomatologia variada, além de uma certa dificuldade no seu diagnóstico. Objetivo: O estudo tem como objetivo comparar os diagnósticos de um novo índice anamnésico para a DTM (NIA/DTM), elaborado e baseado por um protocolo clínico, e ainda avaliar a sua sensibilidade e especificidade. Métodos: O presente estudo consiste na avaliação de um novo índice anamnésico diagnóstico, composto por 12 itens acerca de sinais e sintomas da DTM, baseado no Critério Diagnóstico para Disfunção Temporomandibular (The Diagnostic Criteria For Temporomandibular Disorders - DC/TMD) ­ considerado padrão-ouro para o diagnóstico na DTM. A amostra do estudo foi composta por 50 indivíduos em situação de espera pelo atendimento no setor de DTM e Dor Orofacial do Departamento de Odontologia da UFRN, Natal ­ RN. Os instrumentos utilizados foram aplicados por um único examinador previamente treinado. Os dados foram organizados e analisados pelo programa SPSS, através do Qui-quadrado e Kappa para sensibilidade e especificidade, considerando como nível de significância 5%. Resultados: Os dados analisados demonstraram que o novo instrumento diagnóstico para a DTM obteve uma boa concordância com o DC/TMD e sensibilidade, mas pouco específico. Conclusão: Pôde-se concluir que o novo índice anamnésico para o diagnóstico da DTM (NIA/DTM), de fácil e prática aplicação clínica, demonstrou boa concordância com o padrão ouro em diagnóstico para a DTM (DC/TMD) em relação às classificações diagnósticas de mialgia e artralgia, evidenciando a necessidade de aperfeiçoamento do instrumento com enfoque diferenciado para as demais alterações (AU).

Introduction: Temporomandibular Dysfunction (TMD) consists of a complex condition, which has a multifactorial etiology and presents varied symptoms, in addition to a certain difficulty in its diagnosis. Objective: The study aims to compare the diagnoses of a new anamnesic instrument for TMD (NIA/TMD), based on a clinical protocol, and to evaluate its sensitivity and specificity. Methods: The present study consists of the evaluation of a new diagnostic instrument, consisting of 12 items about TMD signs and symptoms, based on the Diagnostic Criteria for Temporomandibular Disorders (DC / TMD) - considered standard-gold for TMD diagnosis. The study sample consisted of 50 individuals waiting for care in the TMD and Orofacial Pain sector of the Department of Dentistry at UFRN, Natal - RN. The instruments used were applied by a single examiner previously trained. The data were organized and analyzed by the SPSS program, using the Chi-square and Kappa for sensitivity and specificity, considering a significance level of 5%. Results: The analyzed data demonstrated that the new diagnostic tool for TMD obtained a good agreement with the DC / TMD and sensitivity, but little specific. Conclusion: It was concluded that the new anamnesic index for the diagnosis of TMD (NIA / TMD), which is easy and practical to apply clinically, demonstrated good agreement with the gold standard in diagnosis for TMD (DC / TMD) in relation to the classifications diagnoses of myalgia and arthralgia, highlighting the need to improve the instrument with a differentiated approach to other changes (AU).

Hyoid bone syndrome masquerading as temporomandibular joint dysfunction.

Hyoid bone syndrome is a type of cervicofacial pain that is caused by degeneration of the greater cornu of the hyoid at the attachment of the stylohyoid ligament. We report four patients who presented with deep-seated, dull, aching, temporomandibular (TMJ) pain that radiated from the greater cornu of the hyoid bone and did not respond to conservative management. Diagnostic tests included a local anaesthetic block and digital palpation of the greater cornu of the hyoid bone. All four patients responded well to methylprednisolone 40 mg/ml at the greater cornu of the hyoid bone, which resulted in complete resolution of their symptoms. No patients developed postoperative complications. Oral and maxillofacial surgeons involved in the treatment of orofacial pain should consider this less documented condition in their differential diagnosis when treating temporomandibular disorders.

Nondental orofacial pain in dental practices - diagnosis, therapy and self-assessment of German dentists and dental students.

BACKGROUND: Patients with non-dental orofacial pain syndromes will often primarily consult general dentists and other dental specialists. Early and correct diagnosis and therapy is crucial to prevent chronification. METHODS: We assessed the experience of dentists (general dentists and dental specialists; n = 533) and knowledge level of dental students (n = 130) on the diagnosis and treatment of non-dental orofacial pain. We used an anonymized survey containing 14 items with the four main themes (1) prescription patterns, (2) treatment strategies in non-dental orofacial pain, (3) interdisciplinary cooperation, and (4) self-assessment of knowledge as well as post-graduate education. RESULTS: Ninety-two percent of dental students stated that they feel either 'not at all' (56%) or only 'somewhat' (36%) prepared for the diagnosis or treatment of non-dental orofacial pain. Only 23% of the dentists reported 'good' or 'very good' confidence for the diagnosis of non-dental orofacial pain. NSAID were the analgesics of choice when the pain is unspecific (25%) or even neuralgic (10%). Dentists referred patients with non-dental orofacial pain mostly to ENT-physicians (59%), oral and maxillofacial surgeons (54%) or TMD specialists (51%). CONCLUSION: Interdisciplinary pain treatment seems to be well acknowledged, however, with a focus on referral within the community of dental specialists. Dental curricula and post-graduate trainings need to implement the diagnosis and treatment options of non-dental orofacial pain.

Efeito a curto prazo da laser acupuntura na dor, ansiedade e depressão de pacientes com disfunção temporomandibular: ensaio clínico randomizado / Short-term effect of laser acupuncture on pain, anxiety and depression in patients with temporomandibular disorders: randomized clinical trial

Objetivo: Avaliar o efeito a curto prazo da laser acupuntura na dor, ansiedade e depressão em pacientes com DTM. Métodos: Foi realizado um ensaio clínico randomizado cego com portadores de DTM, diagnosticados pelo Critério de Diagnóstico de DTM (RDC/TMD). 60 pacientes foram alocados de forma aleatória em quatro grupos distintos: aconselhamento (AC), placa Oclusal (PO), fisioterapia (FP) e laser acupuntura (LA) e foram avaliados no baseline, e com 1 mês após a terapia. Para avaliação da ansiedade foram utilizados HADS, BAI, e o IDATE. Para a depressão foi BDI e HADS. Para dor foi utilizada a EVA. Foi utilizado o teste Kruskal-Wallis com nível de confiança de 95% para análise entre grupos. O pós teste de Mann-Whitney, para verificar onde estava a diferença encontrada entre os grupos. E o teste de classificações assinadas por Wilcoxon, para análise entre os tempos analisados. Resultados: Ao longo do tempo houve redução na sintomatologia dolorosa nos grupos PL (p=0,001), FP (p= 0,014) e grupo LA ficou no limiar de significância (p= 0,08). Após 30 dias de terapia houve redução significativa entre os grupos FP versus AC (p=0,004) e FP versus LA (p=0,006). O grupo FP foi o único grupo que reduziu os sintomas de ansiedade pelo BAI (p=0,09) e pelo IDATE-E (p=0,042). Nos parâmetros depressivos houve diferença estatisticamente significativa ao longo do tempo pelo BDI nos grupos PO (p=0,044) e LA (p=0,009). Entre os grupos houve diferença estatisticamente significativa pelo BDI, entre PO versus LA (p=0,004), e FP versus LA (p=0,005). E pelo HADS, entre FP versus LA (p=0,012). Conclusão: Para pacientes com ansiedade e depressão, a laser acupuntura não é a terapia mais indicada para diminuição da sintomatologia dolorosa a curto prazo (AU).

Objective: To evaluate the short-term effect of laser acupuncture compared with counseling, occlusal plaque, and physiotherapy treatments on pain, anxiety, and depression in TMD patients. Methods: A randomized clinical trial was performed with patients with TMD, diagnosed by the TMD (RDC / TMD). 60 patients were randomly allocated to four distinct groups: counseling (AC), Occlusal Plaque (PO), physical therapy (PF) and laser acupuncture (LA) and were evaluated at baseline, and at 1 month after therapy. To evaluate anxiety, HADS, BAI, and STAI were used. For depression was BDI and HADS. For pain, VAS was used. The Kruskal-Wallis test with a 95% confidence level was used for intergroup analysis. The Mann-Whitney post-test, to verify where was the difference found between the groups. And the Wilcoxon signed rank test for analysis between the times analyzed. Results: Over time there was a reduction in pain symptoms in the PL (p = 0.001), PF (p = 0.014) and LA groups were at the significance threshold (p = 0.08). After 30 days of therapy there was a significant reduction between the PF versus AC (p = 0.004) and FP versus LA (p = 0.006) groups. The FP group was the only group that reduced anxiety symptoms by BAI (p = 0.09) and by STAI-E (p = 0.042). In depressive parameters there was a statistically significant difference over time by BDI in the PO (p = 0.044) and LA (p = 0.009) groups. Between groups there was a statistically significant difference by BDI, between PO versus LA (p = 0.004), and PF versus LA (p = 0.005). And by HADS, between FP versus LA (p = 0.012). Conclusion: For patients with anxiety and depression, laser acupuncture is not the most appropriate therapy to reduce pain symptoms in the short term (AU).

Predictors of Long-Term Temporomandibular Disorder Pain Intensity: An 8-Year Cohort Study.

AIMS: To investigate, in individuals with pain-related temporomandibular disorder (TMD), the association of long-term pain intensity with baseline health-related quality of life (HRQoL) and jaw functional limitation. METHODS: Of 513 cases with baseline pain-related TMD (masticatory muscle and/or temporomandibular joint [TMJ] pain), 273 were reevaluated after 8 years, and 258 of them had complete baseline data for Jaw Functional Limitation Scale (JFLS) scores and HRQoL measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the 12-item Short Form Health Survey and follow-up data for Characteristic Pain Intensity (CPI) from the Graded Chronic Pain Scale. Secondary analyses of existing data quantified the effects of primary (PCS, MCS) and secondary (JFLS) predictors on follow-up CPI by using multivariable linear regression. Sensitivity analyses considered differences between the included participants (n = 258) and those who were not included (n = 255) by using inverse probability weighting. Interactions of baseline predictors with age, sex, and baseline CPI were evaluated using multivariable linear regression. RESULTS: The score for baseline PCS, but not MCS or JFLS, was associated with follow-up CPI (P = .012). One standard deviation (SD = 9.0)-higher baseline PCS score predicted an overall 3.2-point-lower follow-up CPI (95% confidence interval -5.8 to -0.7) after adjusting for age, sex, MCS, JFLS, and baseline CPI scores. However, the effect of PCS score was not uniform: the association between PCS and follow-up CPI scores was statistically significant for participants with baseline CPI ≥ 51.3/100 and clinically significant for participants with baseline CPI ≥ 68.7/100. Adjustment for TMD treatments and sensitivity analyses had negligible effect. CONCLUSION: In participants with moderate to severe baseline TMD pain intensity, higher baseline physical HRQoL predicted lower TMD pain intensity at 8 years follow-up. PCS score could contribute to a multifactorial long-term TMD pain prediction model.

Temporomandibular dysfunction

BACKGROUND: Orofacial pain is a common presentation in the primary healthcare setting and temporomandibular dysfunction represents one of the major causes. Its aetiology is multifactorial, caused by both masticatory muscle dysfunction and derangement within the temporomandibular joint. OBJECTIVE: The aim of this article is to provide an overview of temporomandibular dysfunction, its management and referral considerations for general practioners. DISCUSSION: Temporomandibular joint dysfunction affects a large number of adults. Conservative management involving non-pharmacological and pharmacological therapies is effective in the majority of cases.

Assessment of Temporomandibular Joint Dysfunction in Patients with Stroke.

GOAL: The aim of this study was to assess temporomandibular joint dysfunction in patients with stroke. MATERIALS AND METHODS: Total of 100 participants, 50 healthy and 50 who had stroke, were recruited into this study. Digital caliper and algometer were used to assess temporomandibular joint range of motion and masticatory muscle pressure pain threshold. Labial commissure angle measurement was used for the assessment of facial paralysis severity. Fonseca questionnaire was used for temporomandibular joint dysfunction assessment and categorization. In addition, dominant mastication shift was measured by the question that asks the pre and poststroke dominant mastication side. FINDINGS: In intergroup comparison, significant decrease was found in all temporomandibular range of motion parameters in favor of stroke group (P < .05). Despite the fact that no significant difference was found between groups for the pain threshold in masticatory muscles except for middle part of the left temporalis muscle, values were higher in healthy group (P > .05). As a result of intergroup examination of labial commissure angle degree, Fonseca questionnaire score, it was found that labial commissure angle and Fonseca questionnaire scores were higher in stroke group (P < .05). Intragroup examination of patients with stroke showed that dominant mastication side shift was seen in patients with stroke (P < .05). CONCLUSION: It was concluded that, temporomandibular joint dysfunction prevalence was higher in stroke group compared with healthy group and use of modalities specific to temporomandibular joint dysfunction treatment would be beneficial.

Multimodal physiotherapy treatment based on a biobehavioral approach for patients with chronic cervico-craniofacial pain: a prospective case series.

The purpose of this prospective case series was to observe and describe changes in patients with chronic cervico-craniofacial pain of muscular origin treated with multimodal physiotherapy based on a biobehavioral approach. Nine patients diagnosed with chronic myofascial temporomandibular disorder and neck pain were treated with 6 sessions over the course of 2 weeks including: (1) orthopedic manual physiotherapy (joint mobilizations, neurodynamic mobilization, and dynamic soft tissue mobilizations); (2) therapeutic exercises (motor control and muscular endurance exercises); and (3) patient education. The outcome measures of craniofacial (CF-PDI) and neck disability (NDI), kinesiophobia (TSK-11) and catastrophizing (PCS), and range of cervical and mandibular motion (ROM) and posture were collected at baseline, and at 2 and 14 weeks post-baseline. Compared to baseline, statistically significant (p < 0.01) and clinically meaningful improvements that surpassed the minimal detectable change were observed at 14 weeks in CF-PDI (mean change, 8.11 points; 95% confidence interval (CI): 2.55 to 13.69; d = 1.38), in NDI (mean change, 5 cm; 95% CI: 1.74-8.25; d = 0.98), and in the TSK-11 (mean change, 6.55 cm; 95% CI: 2.79-10.32; d = 1.44). Clinically meaningful improvements in self-reported disability, psychological factors, ROM, and craniocervical posture were observed following a multimodal physiotherapy treatment based on a biobehavioral approach.

Short clinical examination for temporomandibular symptoms in general practice.

OBJECTIVE: The aims of the study are to assess the reliability of the short clinical examination, and to compare the information gained with a well-known and validated examination, the diagnostic criteria for temporomandibular disorders (DC/TMD). MATERIALS AND METHODS: The study comprises 52 consecutive, newly referred patients at their first visit and examination to an Orofacial Pain and TMD Clinic, 15 years and older, mean age 44 years. The patients first answered three screening questions for reported symptoms. The clinical examination was performed using both the short examination and the DC/TMD and the result was compared. Another group of 40 newly referred patients, with similar inclusion criteria, was examined twice according to the short clinical examination by two examiners, and the inter-examiner variation was studied. The protocol of the short clinical examination is described. RESULT: The overall agreement between the two methods was fairly good to excellent, as was the degree of agreement between repeated examinations and two examiners using the short clinical examination method. The sensitivity and specificity of the short examination for diagnoses were acceptable to high (with DC/TMD as the golden standard). CONCLUSIONS: The short clinical examination has acceptable reliability and, together with three screening questions, provides enough information about the jaw function to decide whether there is a dysfunction.

O impacto das disfunções temporomandibulares na qualidade de vida dos professores do ensino público de Pernambuco / The impact of temporomandibular disorders on the quality of life in the teachers at Pernambuco state public schools

Neste trabalho foi realizada uma avaliação do impacto da desordem temporomandibular (DTM) na qualidade de vida dos professores da rede pública estadual de Pernambuco, atendidos em um serviço especializado nesta patologia para os servidores estaduais, composta por uma amostra de 70 prontuários que continham uma ficha de avaliação própria do setor para avaliar DTM. Foi utilizada uma ficha de avaliação de DTM do próprio serviço que contemplava a identificação do paciente, avaliação da dor, história odontológica, sintomatologia referida e a influência desta sobre a qualidade de vida desses profissionais. Os resultados obtidos receberam tratamento estatístico através do teste Qui-quadrado de Pearson ou Exato de Fisher, e para avaliar a força da associação nos cruzamentos das variáveis foi utilizado o Odds Ratio (OR), com intervalo de confiança de 95,0% e margem de erro 5%. Foi utilizado o programa SPSS (Statistical Package for the Social Sciences) na versão 2.1. Observou-se que a intensidade de dor foi de 8,6% para dores leves, 55,7% para moderadas e 28,6% para intensas. Em relação ao comprometimento dos aspectos psicossociais comportamentais, houve um prejuízo no trabalho na ordem de 47,1%, e junto com outros itens avaliados apresentou um impacto na qualidade de vida leve (7,1%), médio (61,4%) e forte (31,4%). Concluiu-se que a DTM causa um significante impacto negativo na qualidade de vida dos professores, sendo, portanto, necessária a elaboração de estratégias de prevenção, diagnóstico e tratamento especializado para este agravo à saúde, proporcionando melhor estado de saúde física e mental para esta classe trabalhadora (AU).

This paper reports the impact of temporomandibular joint disorder (TMD) on public school teachers' quality of life, from Pernambuco, Brazil, treated in a specialized TMD public service. Seventy records containing an evaluated from to assess the TMD informations from this patients were used. The impact of TMD on quality of life was evaluated from issues that were closest to OHIP 14 questions. Chi-square and Fisher´s exact tests were used and, to cross categorical variables, the value of the odds ratio (OR) was obtained with a confidence interval of 95% and a 5% margin of error. SPSS 2.1 (Statistical Package for Social Sciences) were used. The pain intensity was 8.6% for mild pain, 55.7% for moderate pain, and 28.6% for severe pain. An impairment on working time occurred with 47.1% of the sample, and along with other items tested, showed a mild impact on quality of life (7.1%), medium (61,4%), and strong (34,4%). It was concluded that the TMD causes a significant negative impact on teachers' quality of life and it is required strategies for prevention, diagnosis and specialized treatment for this health problem, providing better physical and mental health for public school teachers (AU).

Efectividad de láser en el tratamiento de pacientes con síndrome dolor disfunción de la articulación temporomandibular / Eficácia do laser no tratamento de pacientes com síndrome da dor disfunção temporomandibular / Effectiveness of laser in the treatment of patients with pain syndrome temporomandibular joint dysfunction

Introducción: el síndrome de disfunción temporomandibular, es una alteración que comprende un conjunto de signos y síntomas relacionados con las estructuras del sistema estomatognático. Objetivo: determinar la efectividad del tratamiento conjunto de láser y terapia de apoyo medicamentosa, aplicadas a los pacientes con el síndrome dolor disfunción de la articulación temporomandibular. Método: se realizó una intervención terapéutica en 84 pacientes que asistieron a la consulta de prótesis de la Clínica Estomatológica "Julio Antonio Mella" de Guantánamo, en el período comprendido entre septiembre de 2014 al mismo mes de 2015. Se conformaron dos grupos terapéuticos: uno recibió láser y terapia de apoyo medicamentosa y, el otro, terapia de apoyo medicamentosa, cada grupo con 42 pacientes que fueron evaluados a los 5, 10 y 15 días. Se tomaron en cuenta variables generales y clínicas: edad, grado de severidad, comportamiento del dolor y criterios de evaluación. Resultados: la terapia combinada de láser y terapia medicamentosa resultó ser más efectivo que la terapia medicamentosa, al desaparecer la sintomatología en un período de tiempo menor. Conclusiones: se validó que el tratamiento combinado de láser y terapia de apoyo medicamentosa resultó más efectivo al desaparecer progresivamente la sintomatología en un periodo de tiempo menor, en relación a los que se les aplicó el tratamiento convencional y por tanto es factible su aplicación(AU)

Introduction: temporomandibular dysfunction syndrome is an alteration that includes a set of signs and symptoms related to the structures of the stomatognathic system. Objective: to determine the effectiveness of the joint treatment of laser and drug support therapy, applied to patients with pain syndrome temporomandibular joint dysfunction. Method: a therapeutic intervention was carried out in 84 patients who attended the prosthesis consultation of the "Julio Antonio Mella" Stomatology Clinic in Guantánamo, in the period from September 2014 to the same month of 2015. Two therapeutic groups were formed: one received laser and drug support therapy and, the other, drug support therapy, each group with 42 patients who were evaluated at 5, 10 and 15 days. General and clinical variables were taken into account: age, degree of severity, pain behavior and evaluation criteria. Results: the combination therapy of laser and drug therapy proved to be more effective than drug therapy, as the symptoms disappear in a shorter period of time. Conclusions: it was validated that the combined treatment of laser and drug support therapy was more effective as the symptomatology progressively disappeared in a shorter period of time, in relation to those that were treated with conventional treatment and therefore its application is feasible(AU)

Introdução: a síndrome de disfunção temporomandibular é uma alteração que inclui um conjunto de sinais e sintomas relacionados às estruturas do sistema estomatognático. Objetivo: determinar a eficácia do tratamento articular da terapia de suporte a laser e medicamentosa, aplicada a pacientes com disfunção temporomandibular da síndrome da dor. Método: intervenção terapêutica em 84 pacientes atendidos no ambulatório de prótese de Estomatologia "Julio Antonio Mella" Clinic Guantanamo no período de setembro de 2014 para 2015. mês foi realizada foram organizados dois grupos de tratamento: um receberam laser e terapia de suporte medicamentoso e, o outro, terapia de suporte medicamentoso, cada grupo com 42 pacientes que foram avaliados aos 5, 10 e 15 dias. Variáveis gerais e clínicas foram consideradas: idade, grau de severidade, comportamento de dor e critérios de avaliação. Resultados: a terapia combinada de laser e terapia medicamentosa mostrou-se mais eficaz que a terapia medicamentosa, pois os sintomas desaparecem em menor tempo. Conclusões: é validado que o laser de tratamento combinado e terapia de droga foi mais eficaz para apoiar sintomas em fases num curto período de tempo, em relação aos quais foram aplicados o tratamento convencional, e, portanto, a sua aplicação é viável(AU)

Disfunciones temporomandibulares y su relación con trastornos de ansiedad en niños: un caso clínico / Temporomandibular joint dysfunctions and their relationship with anxiety disorders in children: report of a clinical case

La presencia de desórdenes temporomandibulares (TTM) en el niño es un tema controversial. Algunos autores sostienen su ausencia en la población infantil; sin embargo, otros han observado signos y síntomas de TTM en poblaciones pediátricas. Nosotros creemos que tales desórdenes pasan inadvertidos con frecuencia por la falta de un examen clínico completo y minucioso que incluya el estudio de la ATM como parte del sistema estomatognático y como revisión rutinaria en la clínica odontopediátrica. Ante las reiteradas consultas que recibimos en la asignatura Odontología Niños de la FOLP, surgió la inquietud de profundizar en el tema y decidimos realizar un trabajo de investigación denominado : "Disfunciones temporomandibulares y su relación con trastornos de ansiedad en una población infantil". El objetivo general de este trabajo fue determinar los signos y síntomas de los TTM y su relación con los distintos niveles de trastornos emocionales en una población infantil, con el propósito de brindar información a odontólogos y odontopediatras acerca de la importancia de realizar un correcto examen clínico de la ATM que nos alerte sobre la posibilidad de aparición de TTM en niños, sin dejar de estar atentos a los miedos o los diferentes grados de ansiedad que los niños pueden desarrollar y que contribuyen en buen grado a agravar o desencadenar el cuadro.