Histomorphometric Changes of the Masseter Muscle of Rats After a Single Injection of Botulinum Toxin Type A.

BACKGROUND: It has been reported that botulinum toxin type A (BoNT-A) produces structural changes in masticatory muscles. However, not all histomorphometric parameters affected by BoNT-A parameters have been assessed. This study investigated the histomorphometric changes in the masseter muscle of rats after a single injection of BoNT-A. METHODS: Forty-four adult animals were randomly divided into control group (n = 22) and BoNT-A group (n = 22). Controls received a single dose of 0.14 mL/kg of saline in masseter muscles, and the BoNT-A group received a 7 U/Kg of BoNT-A. The groups received the same volume of injected substances. Animals were sacrificed on 7th (n = 5), 14th (n = 5), 21st (n = 5), 28th (n = 4) and 90th (n = 3) days post-treatment. Histological masseter tissue slides were obtained from hematoxylin-eosin treatment and analyzed in optical microscopy regarding muscle cross-sectional area, amount of connective tissue and quantity and diameter of myocytes. For statistical analysis, generalized linear models were used to compare the data (ANOVA). In all test, the significance level of 5% was set. RESULTS: BoNT-A values of cross-sectional area of the masseter muscle were significantly lower than controls (p < 0.01) throughout the study. Regarding myocytes quantity, BoNT-A subgroups presented higher values than controls (p < 0.0001) since the 14th day until the end of the study; however, the diameter of myocytes was smaller in all BoNT-A subgroups (p < 0.0001) in all assessment points. The amount of connective tissue was higher in BoNT-A subgroups (p < 0.0001) throughout the study. CONCLUSION: A single injection of BoNT-A altered the structure of masseter muscle of rats, regarding its histomorphometric parameters. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Influence of botulinum toxin A in pain perception and condyle-fossa relationship after the management of temporomandibular dysfunction: a randomized controlled clinical trial.

OBJECTIVES: To investigate the pain perception (PP) and condyle-fossa relationship (CFR) after botulinum toxin A (BoNTA) injection in the masseter muscles of painful muscular temporomandibular dysfunction (TMD) patients. MATERIALS AND METHODS: Fourteen women (aged 29.7 ± 5.4 years) diagnosed with myogenic TMD were randomized in the BoNTA-treated group (TG) and control group (CG). TG masseter muscles (n = 7) were bilaterally injected with 30 U. The CG (n = 7) were injected with saline injections. Condyle-fossa relationship (CFR) spaces were measured in sagittal (SP) and frontal planes (FP) of images of cone-beam computed tomography (CBCT) done before (T0) and after 30 days' interventions (T1). Visual analogue scale (VAS) measured the patients' TMD pain perception (PP). Data were compared by generalized linear models considering the results over time (α = .05). RESULTS: There were no statistical differences in CFR in the SP or FP for TG and CG over time (p ˃ .05), except for frontal lateral space CFR (p < .05). In both groups, the condyle was positioned medially after interventions. Frontal lateral space increased in TG for both, left and right sides, over time (p < .05), as well as PP decreased over time (p < .05) for TG and CG. CONCLUSIONS: The results depicted that there was no significant association with BoNTA injection in TMD masseter muscles in PP and CFR, except considering the frontal lateral space of CFR. CLINICAL RELEVANCE: BoNTA injection in the masseter muscles may not promote clinically significant shifts in the condyle-fossa relationships of muscular TMD patients.

Prospective study of the aesthetic effect of botulinum toxin a when injected into the muscles of facial expression

Botulinum neurotoxin A (BoNT-A) causes an anticholinergic effect on neuronal fibers, which control muscle contraction and autonomic disorders. Thus, it has been widely used in facial aesthetics, decreasing the action of motor muscles and consequent wrinkles. This preliminary study evaluated the effect of BoNT-A in 77 patients, the treatment satisfaction index was defined in percentage (from 0% to 100%). The evaluation was carried out on 15th, 30th, 60th, 90th, and 180th days after BoNT. The data were analyzed using the Friedman, Student t, Mann-Whitney test with t (alpha=0.05). The results showed that at 15th and 30th days the scores were similar in all muscles with high level of satisfaction and until 90th days the scores decreased significantly for Corrugator supercilii 79.38%, Occipitofrontalis 71.46%, Orbicularis oculi 70.43%; but the satisfaction was good. At 180 days, there was a drop in effectiveness in all treated muscles since the scores decreased significantly, showing low satisfaction by the participants. This study demonstrated that the BoNT-A had attested satisfaction effect by participants for up to 90th days, but at 180th days the satisfaction was low. In the comparative analyzes between women under 40 and over 40 years of age, there was no significant differences.

Botulinum toxin type A and acupuncture for masticatory myofascial pain: a randomized clinical trial

Abstract BoNT-A has been widely used for TMD therapy. However, the potential benefits compared to dry needling techniques are not clear. Objective this study aimed to compare the immediate effects of botulinum toxin type A (BoNT-A) injections and Acupuncture in myofascial temporomandibular disorders (TMD) patients. Methodology 54 women were divided into three groups (n=18). AC patients received four sessions of traditional acupuncture, being one session/week during 20-min. BoNT-A patients were bilaterally injected with 30U and 10U in masseter and anterior temporal muscles, respectively. Moreover, a control group received saline solution (SS) in the same muscles. Self-perceived pain was assessed by visual analog scale, while pressure pain threshold (PPT) was verified by a digital algometer. Electromyographic evaluations (EMG) of anterior temporal and masseter muscles were also measured. All variables were assessed before and 1-month after therapies. The mixed-design two-way repeated measures ANOVA and Tukey's post-hoc tests were used for analysis, considering a=0.05. Results Self-perceived pain decreased in all groups after one month of therapy (P<.001). BoNT-A was not better than AC in pain reduction (P=0.05), but both therapies were more effective in reducing pain than SS (P<0.05). BoNT-A was the only treatment able to improve PPT values (P<0.05); however, a severe decrease of EMG activity was also found in this group, which is considered an adverse effect. Conclusion after one month of follow-up, all therapies reduced the self-perceived pain in myofascial TMD patients, but only BoNT-A enhanced PPT yet decreased EMG.

Evaluation of pain intensity of the masticatory muscles after occlusal appliance and combined therapy: a 6-months follow-up pilot study

Masticatory muscle pain (MMP) is a common type of orofacial pain.Occlusal appliance (OA) is contemplated as a first-line conservative approach for chronic MMP, however, integrated biopsychosocial approaches such as counseling and self-care therapies (CSG) are also considered essential. Aim: This pilot study aimed to compare the use of a combined therapy (GSG + OA) and solely OA treatment on pain intensity related to chronic MMP over a 6-month follow-up. Methods:For this, 20 patients diagnosed with chronic MMP using the Diagnostic criteria for temporomandibular disorders (DC/TMD) were divided into 2 groups (n=10) and treated with OA or combined therapy (CoT; OA + CSG). Electromyographic muscle activity (EMG), visual analogue scale (VAS) and pressure pain threshold (PPT) were recorded at baseline, 1, 3 and 6 months after treatment. Data was collected and statistical analysis were applied at a significance level of 5%. Results:Results showed no significant differences at baseline among groups for any assessment. VAS showed that both treatments decreased subjective pain in volunteers over time, but no significant differences among both groups were observed at any evaluation time. For electromyography, CoT and OA presented no significant differences throughout the experiment neither on relaxed muscle position or maximum volunteer contraction. Finally, a significantly higher PPT for CoT was found for all muscles at the last assessment point (p<0.05). Conclusion: These findings suggest that both treatments are effective for the reduction of pain perception (VAS) in patients with chronic MMP. However, the addition of CSG to an OA therapy may be more beneficial for the improvement of tenderness on the same patients, at least in a long-term basis (> 3 months). Notwithstanding, a larger study should be performed to substantiate these findings

Atualidades sobre o tratamento das disfunções temporomandibulares / Updates on the management of temporomandibular disorders

O crescimento das situações estressantes, associado a outros fatores agravantes, tem tornado as Disfunções Temporomandibulares (DTM) foco de diversas pesquisas e intervenções clínicas. As incorreções oclusais, musculares e comportamentais podem alterar o sistema estomatognático, prejudicando a saúde periodontal, dental e dos demais tecidos bucais, e comprometendo os trabalhos clínicos já realizados. A compreensão dessa patologia deve ser de conhecimento do cirurgião-dentista, especialmente daquele que vai realizar reabilitações bucais implantossuportadas. O controle da DTM pode ser primordial para o sucesso do tratamento planejado. Condições diagnósticas e comportamentais do paciente podem orientar as propostas terapêuticas do profi ssional, e essa tem sido cada vez mais uma realidade para o controle das situações sintomáticas relacionadas às DTM. Fatores inerentes ao diagnóstico são relevantes na condução terapêutica, e somente através de procedimentos sistemáticos e bem estruturados é possível obter dados que assegurem organizar a intervenção necessária ao manejo das DTM. Neste artigo descrevemos alguns procedimentos adotados em nossa conduta clínica para o diagnóstico das DTM, ao mesmo tempo em que abordamos algumas modalidades de intervenção terapêutica, com uma visão voltada à terapia baseada em evidências.

The stressful situations associated with other aggravating factors has made Temporomandibular Disorders (TMD) the focus of several researches and clinical interventions. Occlusal, muscular and behavioral disturbance may alter the stomatognathic system, compromising periodontal, dental and other oral tissues health, as well as some clinical work already done. The understanding of this pathology should be relevant to the dentist, especially when it will be performed supported implant rehabilitations. Control of TMD may be critical to the success of planned treatment. Diagnostic conditions and behavioral understanding of the patient may guide the therapeutic proposals, and it has been an increasingly reality for the control of TMD symptomatic situations. Factors inherent to the diagnosis are relevant in the therapeutic conduction, and it is only through systematic and well structured procedures the data can be obtained to organize the necessary intervention for TMD management. In this article, we describe some of the procedures adopted in our clinical management for the diagnosis of TMD, while addressing some modalities of therapeutic intervention, with a vision focused on evidence-based therapy.

The Role of Prosthesis Spacer for Ocular Prostheses.

Eye defects can lead to emotional, psychological, and social changes, impacting negatively the quality of life of the patient. When these structures cannot be satisfactorily repaired by reconstructive surgery, the prosthetic rehabilitation is the better treatment option to restore lost ocular anatomy and promote the social integration of the individual. The aim of this clinical report is to report and discuss a case of ocular prosthesis confection eviscerated patient with opening limitation eyelid and shortening of the distance between palpebral commissure, to obtain a more natural and comfortable to the patient ocular rehabilitation.

Sleep quality and facial pain in fibromyalgia syndrome.

AIMS: This study aims to evaluate the sleep conditions in fibromyalgia syndrome and the influence of the temporomandibular disorders (TMDs) and fibromyalgia association in self-reported sleep quality. METHODOLOGY: Forty female patients with fibromyalgia (FMS) were compared with 40 healthy women [control group (CG)]. Three questionnaires were used (i.e. RDC/TMD to diagnose TMD and to determine pain intensity and disability and Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) to assess sleep conditions). Statistical analyses were performed using the Wilcoxon-Mann-Whitney test to ordinal variables, Student's t-test to obtain the quantitative total scores of PSQI and chronic pain classification, Spearman's rho to determine the correlation between facial pain and quality sleep, and Fisher's exact test for other variables. RESULTS: A moderate correlation between facial pain intensity and low sleep quality was found (rho = 0·56; P<0·0001); however, TMD and FMS association did not show worse sleep quality (P>0·05). Excessive daytime sleepiness was more prevalent in FMS (37·5%; P<0·0001) besides having the worst sleep quality (PSQI = 12·72) compared with CG (PSQI = 4·62). CONCLUSION: Fibromyalgia patients experience intense facial pain in addition to poor sleep and high disabilities. TMD and FMS association do not appear to worsen this condition; however, facial pain intensity was correlated with low sleep quality.

Temporomandibular disorders in fibromyalgia syndrome: a short-communication.

Fibromyalgia syndrome (FMS) is a chronic painful syndrome and the coexistence of a painful condition caused by Temporomandibular Disorders (TMD) and FMS has been frequently raised for several studies, however, more likely hypothesis is that a set of FMS characteristics may lead to the onset of TMD symptoms and they are not merely coexisting conditions. Therefore, our aim is presenting a review of literature about the relation between fibromyalgia and the signs and symptoms of temporomandibular disorders. For this purpose, a bibliographic search was performed of the period of 1990-2013, in the Medline, Pubmed, Lilacs and Scielo databases, using the keywords fibromyalgia, temporomandibular disorders and facial pain. Here we present a set of findings in the literature showing that fibromyalgia can lead to TMD symptoms. These studies demonstrated greater involvement of the stomatognathic system in FMS and myogenic disorders of masticatory system are the most commonly found in those patients. FMS appears to have a series of characteristics that constitute predisposing and triggering factors for TMD.

Chronicity factors of temporomandibular disorders: a critical review of the literature

Facial pain often persists long after any identifiable organic pathology has healed. Moreover, in a subgroup of patients with temporomandibular disorder (TMD), no treatment is effective. Knowledge of factors associated with persistent pain in TMD could help identify personalized treatment approaches. Therefore, we conducted a critical review of the literature for the period from January 2000 to December 2013 to identify factors related to TMD development and persistence. The literature findings showed that chronic TMD is marked by psychological distress (somatization and depression, affective distress, fear of pain, fear of movement, and catastrophizing) and characteristics of pain amplification (hyperalgesia and allodynia). Furthermore, these factors seem to interact in TMD development. In addition, our review demonstrates that upregulation of the serotonergic pathway, sleep problems, and gene polymorphisms influence the chronicity of TMD. We conclude that psychological distress and pain amplification contribute to chronic TMD development, and that interactions among these factors complicate pain management. These findings emphasize the importance of multidisciplinary assistance in TMD treatment.

Tratamento endodôntico na terceira idade / Endodontic treatment in elderly

A odontogeriatria é um ramo que cada vez mais vem tomando espaço na odontologia. Este segmento vem acompanhado de uma maior conscientização, tanto de profissionais quanto de pacientes, que passam a ter maiores preocupações com a saúde bucal, chegando à terceira idade com um maior número de dentes do que as gerações anteriores. Dessa forma, o cirurgião-dentista deve estar preparado para qualquer tipo de procedimento necessário para manter os seus pacientes com uma boa qualidade de saúde bucal. A endodontia, que em décadas passadas era muito pouco realizada em pacientes idosos, tem apresentado um crescente número de casos. Baseado nesse aumento de demanda, o presente trabalho realizou uma revisão da literatura quanto aos aspectos histológicos da polpa dental senil, do tratamento endodôntico propriamente dito e de aspectos sistêmicos que podem alterar o tratamento convencional, com o intuito de orientar o profissional que se dispõe a realizar estes procedimentos na prática diária.

Geriatric dentistry is in continuous diffusion in dentistry. It is followed by professionals conscious raising and by the patients preoccupations about oral health quality, keeping into their elderly which more teeth than the past generations. In this way the professional should be prepared to do any necessary procedure to patients keep their oral health quality. The endodontics, which few decades ago were rarely done in elderly is showing a considerable arouse in number of cases. Based on that increment on endodontics procedures the present paper reviewed the literature about the histological aspects of the elderly dental pulp, the endodontic procedure itself and some systemic aspects that may interfere anyhow in comparison with the conventional treatment, to guide the professional about these procedures in the daily practice.

Facial pain associated with fibromyalgia can be marked by abnormal neuromuscular control: a cross-sectional study.

BACKGROUND: Temporomandibular disorder (TMD) development in fibromyalgia syndrome (FMS) is not yet fully understood, but altered neuromuscular control in FMS may play a role in triggering TMD. OBJECTIVE: The purpose of this study was to verify the association between neuromuscular control and chronic facial pain in groups of patients with FMS and TMD. DESIGN: A cross-sectional study was conducted. METHODS: This study involved an analysis of facial pain and electromyographic activity of the masticatory muscles in patients with FMS (n=27) and TMD (n=28). All participants were evaluated according to Research Diagnostic Criteria for Temporomandibular Disorders and surface electromyography (SEMG). Myoelectric signal calculations were performed using the root mean square and median frequency of signals. RESULTS: The data revealed premature interruption of masticatory muscle contraction in both patient groups, but a significant correlation also was found between higher median frequency values and increased facial pain. This correlation probably was related to FMS because it was not found in patients with TMD only. Facial pain and increased SEMG activity during mandibular rest also were positively correlated. LIMITATIONS: Temporal conclusions cannot be drawn from the study. Also, the study lacked a comparison group of patients with FMS without TMD as well as a control group of individuals who were healthy. CONCLUSIONS: Altered neuromuscular control in masticatory muscles may be correlated with perceived facial pain in patients with FMS.

Features of temporomandibular disorders in fibromyalgia syndrome.

This study aimed to investigate the prevalence of clinical features of temporomandibular disorders (TMD) in patients with fibromyalgia. The test group (FMG) consisted of 40 women with fibromyalgia (FM) compared to the control group of 40 healthy subjects using the research diagnostic criteria for temporomandibular disorders (RDC/TMD). The variables were compared using Fisher's exact test and a Mann-Whitney test. Facial pain was reported by 85% of the FM group, and 77.5% were diagnosed with myofascial TMD. Muscle pain during jaw movements, daytime bruxism/clenching, and limited mouth opening were significantly higher in the test group. There was no difference between groups in: (1) joint noises; (2) sleep bruxism/clenching; and (3) excursive or non-excursive movements. Classic signs of TMD, such as joint noise and self-reporting of clenching at night, are not associated with fibromyalgia syndrome as demonstrated in the current study. However, the self-reported daytime parafunctions, muscle pain in jaw movements, and limited mouth opening are features of the patients in the current study. This study revealed specific muscle involvement of TMD is also presence in FM.

The effect of posterior tooth loss on the expression of type II collagen, IL-1ß and VEGF in the condylar cartilage of growing rats.

OBJECTIVE: The aim of this study was to evaluate the effect of unilateral and bilateral loss of posterior occlusal support on the expression of type II collagen, interleukin-1ß and VEGF in the condylar cartilage of growing rats. DESIGN: Thirty female Wistar rats (5 weeks old) were randomized into three groups: control, unilateral extraction of mandibular molar teeth, bilateral extraction of mandibular molar teeth. Animals were sacrificed 8 weeks after tooth extraction and the temporomandibular joints were prepared for immunohistochemical analysis. RESULTS: Bilateral molar extraction increased the expression of interleukin-1ß (P<0.01) and VEGF (P<0.01), while unilateral extraction increased the expression of interleukin-1ß (P<0.05) and type II collagen (P<0.01). The expression of VEGF was higher on the extracted than on the non-extracted side (P<0.01) after unilateral extraction. CONCLUSION: Loss of posterior occlusal support alters the expression of type II collagen, interleukin-1ß and VEGF in the condylar cartilage of rats. The expression pattern of these proteins is different when loss of occlusal support was bilateral or unilateral, including differences between extracted and non-extracted sides.

Temporomandibular disorders in fibromyalgia: a critical view / Disfunção temporomandibular na fibromialgia: uma visão crítica

Temporomandibular disorders (TMD) and fibromyalgia (FM) are musculoskeletal syndromes that appear to be associated to each other. Various studies throughout the literature relate the signs and symptoms of TMD in patients with FM. The objective of this study was to analyze the literature regarding clinical association between FM and TMD. Even though these conditions present different etiologies, the pain modulating mechanisms are similar. Many studies in this field aim to elucidate questions which are still little understood. However, it has been observed that these syndromes are characterized by a reduction in pain threshold and in the attenuation capabilities of descending pain modulating systems. Moreover, there is a certain degree of comorbidities between these two pathologies, which share many clinical characteristics. Numerous patients with FM present various signs and symptoms of TMD, while only a small quantity of individuals with TMD is diagnosed with FM. Therefore, an adequate and precise evaluation of the stomatognathic system in patients with FM, which encompasses TMD diagnosis in therapeutic intervention, is paramount.

A disfunção temporomandibular (DTM) e a fibromialgia (FM) são síndromes musculo-esqueléticas que parecerem estar associadas. Vários estudos na literatura relatam sinais e sintomas da DTM em pacientes com FM. O objetivo deste trabalho foi analisar a literatura quanto à associação clínica entre fibromialgia e as disfunções temporomandibulares. Apesar de estes distúrbios possuírem etiologias diferentes, o mecanismo de modulação de dor é semelhante. Muitas pesquisas desenvolvidas nessa área buscam elucidar esta questão ainda pouco compreendida. Mas sugere-se que estas síndromes são caracterizadas por uma diminuição no limiar de dor e na capacidade de atenuação de sistemas descendente de modulação da dor. Além disso, há certo grau de comorbidade entre estas duas patologias, que compartilham muitas características clínicas. Muitos pacientes com FM apresentam vários sinais e sintomas de DTM, entretanto, uma pequena quantidade de indivíduos com DTM recebem um diagnóstico de FM. Portanto, é importante uma avaliação precisa e adequada do sistema estomatognático em pacientes com fibromialgia englobando o diagnóstico de disfunção temporomandibular na intervenção terapêutica

A Prótese parcial removível no contexto da odontologia atual / The issue of the removable partial denture in modern dentistry

O evidente declínio da perda dentária e a consolidação dos implantes têm intrigado pesquisadores sobre qual será o futuro dos procedimentos protéticos. Este assunto é de interesse para toda a comunidade odontológica, pois está diretamente relacionado tanto à necessidade e demanda por tratamento clínico, quanto ao ensino nas universidades. Assim, o presente artigo busca discutir a importância da Prótese Parcial Removível no contexto da Odontologia atual tendo em vista as mudanças ocorridas nas últimas décadas.

The decline of tooth loss and the established success of implant therapy have intrigued researchers about the future of Prosthodontics. This issue is of major importance for the Dentistry community, since it is directly related to need and demand for prosthetic treatment and teaching in dental schools. Therefore, this paper aims to discuss the importance of Removable Partial Denture in modern Dentistry based on the changes occurred in the past few decades.

Eficacia del proceso adhesivo en dentina escerótica: revisión de literatura / Effectiveness of sclerotic dentin adhesive process: literature review

The purpose of this review was to evaluate witch adhesive system and technique are the most suitable to be used at non carious cervical lesions with sclerotic dentine. The search was carried out in the electronic databases PubMed, Embase and Bireme/Medline, including studies published from 1990 to 2009. The inclusion criteria were: randomized clinical trials with sclerotic dentine treated with different types of adhesive systems and adhesive techniques, randomized in-vitro studies concerning to microtensile bond strength, contraction gap and dentine/adhesive interface evaluation. In total, 1807 papers were identified and only thirteen studies met the inclusion criteria, which showed high complex structure of sclerotic dentine, with high mineral content and sclerotic casts that obstruct the entrance of dentine tubules, reducing the dentin permeability and altering their adhesive properties. The hybrid layer formed at sclerotic dentin is smaller than at sound dentin and without resin tags and the use of high concentration of acids conditioners for longer periods or the remove of the superficial hipermineralyzed layer showed to be inefficient to increase the bond strength. It is also suggest that the use of self-etching adhesive systems has to be avoided at sclerotic dentine

La propuesta de esta revisión sistematizada fue evaluar cuál sistema adhesivo y cuál técnica son los más indicados para ser usados en lesiones cervicales no cariosas con dentina esclerótica. La búsqueda de los estudios fue realizada en las bases de datos electrónicas PubMed, Embase y Bireme/Medline, incluyendo estudios entre los años 1990 y 2009. Los criterios de inclusión fueron: ensayos clínicos randomizados utilizando dentina esclerótica tratada con diferentes tipos de sistemas e técnicas adhesivas, estudios randomizados in-vitro con respecto a resistencia adhesiva a la microtracción, gaps de contracción, y evaluación de la interface adhesiva utilizando microscopia electrónica de barrido o transmisión. Desde 1807 artículos identificados, trece estudios cumplieron los criterios de inclusión, los cuales describieron alta complejidad estructural de la dentina esclerótica, con alto contenido mineral y cast escleróticos que obstruían la entrada de los túbulos dentinarios, reduciendo la permeabilidad dentinária y alterando sus propiedades adhesivas. La capa hibrida formada fue reducida sin tags resinosos, siendo que la aplicación de acondicionadores ácidos en altas concentraciones o en periodos prolongados de tiempo, así como la remoción de la capa superficial de dentina esclerótica, fueron ineficientes para incrementar la resistencia adhesiva. Los resultados también sugieren que la utilización de sistemas adhesivos auto-acondicionantes en dentina esclerótica debe ser evitada

Aging and the periodontium: [review]

The geriatric population has been growing fast over the last decades in Brazil and all over the world, changing demographics. Additionally, increased knowledge and the advances of modern dentistry have led the old population to retain more natural teeth, needing specialized dental services for a longer time. Changes in biochemical and physiological processes occur with aging in all body tissues, including the periodontium. The association between periodontal and systemic diseases has also been widely discussed, suggesting the need of a multidisciplinary care, especially in older adults, who are frequently affected by chronic systemic conditions and multiple drug therapy. These features lead to a highly complex management of the geriatric population, challenging the dental care providers. The aim of this study is to review the age-related changes and the consequences of other factors, such as systemic diseases and drugs, on the periodontium of aged patients.

Nutrição para idosos / Nutrition for the elderly

Este artigo tem por objetivo discutir a contribuição da nutrição na qualidade vida dos indivíduos idosos e de que forma ela pode influenciar para uma velhice mais saudável. Serão abordados os aspectos bioquímicos e fisiológicos do envelhecimento, os aspectos relacionados à saúde bucal e às necessidades nutricionais dos idosos, assim como serão evidenciadas as alterações fisiológicas que direta ou indiretamente afetam a sua alimentação.

The main of this article is to discuss the influence of nutrition in the orderly?s quality of life and whether it can implicate in oral health or to contribute for a healthier old age. Considerations on biochemical and physiologic aspects of the aging will be considered, associated with the senior?s nutritional needs, as well as it will be evidenced the physiologic changes that directly or indirectly affect elder food consumption.