Análisis de las creencias limitantes a través del acompañamiento en Bioneuroemoción(R) de individuos con diagnóstico de bruxismo / Analysis of limiting beliefs through the accompainment in Bioneuroemotion(R) in individuals with a diagnosis of bruxism

El propósito de este trabajo cualtitativo fue aplicar el método de Bioneuroemoción en individuos que, estando en tratamiento por bruxismo, continuaban con dolor y sintomatología asociada. El análisis de las creencias limitantes en común de los individuos, las resonancias familiares y la emoción primaria desencadenada, permitieron obtener desde dónde percibían dichos individuos las situaciones de mayor estrés. Para ello, se consideró un diseño muestral centrado en un grupo de cinco pacientes que concurrían al Servicio de ATM (Articulación Temporomandibular) de un hospital odontológico de la Ciudad de Buenos Aires, donde estaban siendo tratados por bruxismo con placas miorrelajantes (AU)

Case Report: Digital analysis of occlusion with T-Scan Novus in occlusal splint treatment for a patient with bruxism.

Bruxism is a disease with a multifactorial etiology. Its clinical manifestations are most often an unaesthetic smile with abraded tooth surfaces, temporomandibular disorders and muscle hyperactivity. Here we present a case of bruxism where proper articulation of the occlusal splint was performed using the T-scan Novus system. A patient with bruxism underwent treatment with stabilization splint made by 3D printer technology. Intraoral scanning was performed using Trios Color (3Shape, 2014), and the digital design was achieved using the 3Shape Dental system design - splint studio. Formlabs Form 2 printer with biocompatible resin Dental LT Clear Resin was used for printing. The T-Scan Novus system with software attached to it, version 9.1, was used for digital examination of the occlusion. A 2.7 mm thick occlusal splint was developed, and the software adapted the occlusion with antagonists. After adjustment with T-Scan Novus, a reduction in disocclusion time of the patient was achieved, which is a desired result in the treatment of bruxism. The position of the joint components was proven radiologically. The treatment of bruxism with splint therapy continues to be the main method of treatment. Using digital technology allows for more accurate constructions and precise balancing of occlusal relationships.

Alternativas de tratamiento para pacientes jóvenes con pérdida de estructura dentaria. Parte 2: caso clínico / Treatment alternatives for young patients with loss of dental structure. Part 2: a clinical case

El objetivo de este artículo es presentar una alternativa de tratamiento rehabilitador para pacientes jóvenes con gran pérdida de estructura dental, vinculada a lesiones de origen no bacteriano. Se presenta el caso clínico de un paciente de sexo masculino, de 39 años de edad, que acudió a la Cátedra de Odontología Integral Adultos de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA) relatando síntomas compatibles con hipersensibilidad dentaria y fatiga de los músculos masticadores. Al mismo tiempo, manifestó disconformidad con el aspecto estético de su sonrisa. Teniendo en cuenta la gran pérdida de sustancia en sus piezas dentarias producida por hábitos parafuncionales (bruxismo), se realizó una rehabilitación oral adhesiva con cerámicas utilizando el protocolo de abordaje terapéutico sugerido por la Cátedra. En pacientes que presentan severos desgastes (AU)

Bruxismo en la infancia: ¿cómo tratar? / Bruxismo na infância: como tratar? / Bruxism in childhood: how to treat?

El bruxismo infantil es una condición definida por la acción de apretar o rechinar los dientes involuntariamente, siendo así de etiologia multifactorial. Cuando no es tratado tempranamente, puede causar daño al sistema estomatognático, causando cambios orofaciales. De esta forma, este artículo tiene como objetivo abordar las diferentes opciones de tratamiento para el bruxismo en niños. Esta es una revisión integradora realizada a través de las bases de datos SciELO y PubMed, la cual incluye un total de 14 artículos, respetando los criterios de inclusión y exclusión. En general, el tratamiento debe ser cumplido realizado de manera multidisciplinaria, incluyendo la incorporación del cirujano dentista, doctor, psicólogo, fisioterapeuta y logopeda para mejorar la calidad de vida del individuo. A través de la exclusión de los posibles factores que determinan la enfermedad, tiene como objetivo promover la reducción de la actividad parafuncional. Para lograr eso, podemos usar placas oclusales, medicamentos como analgésicos, antiinflamatorio, benzodiacepinas, relajantes musculares, además de las hierbas medicinales, así como también, terapia de masaje, criolipólisis, acupuntura, entre otros. Sin embargo, mas estudios son necesarios para probar la efectividad de estas terapias. Se puede concluir que hasta el momento presente, lo que se puede ofrecer es un tratamiento paliativo y multidisciplinario que permite la reducción de complicaciones patológicas, favoreciendo así, la salud del niño.

O bruxismo infantil é uma condição definida pela ação de apertar ou ranger os dentes de forma involuntária sendo de etiologia multifatorial. Quando não interferida precocemente pode gerar danos ao sistema estomatognático, ocasionando alterações orofaciais. Dessa forma, o presente artigo tem como objetivo abordar as diferentes opções de tratamento para o bruxismo em crianças. Trata-se de uma revisão integrativa realizada por meio das bases de dados SciELO e PubMed, foram incluídos um total de 14 artigos, respeitando os critérios de inclusão e exclusão. De forma geral, o tratamento deve ser realizado multidisciplinarmente, englobando a adição do cirurgião-dentista, médico, psicólogo, fisioterapeuta e fonoaudiólogo, com intuito de proporcionar melhora da qualidade de vida ao indivíduo. Através da exclusão dos possíveis fatores determinantes da doença, visa-se a promoção da redução da atividade parafuncional. Para isso, pode-se lançar mão de placas oclusais, medicamentos, como analgésicos, anti-inflamatórios, benzodiazepínicos, relaxantes musculares, além de fitoterápicos, bem como, massagem terapêutica, criolipólise, acupuntura, entre outros. Contudo, é necessário que mais estudos comprovem a eficácia dos referidos terapêuticos. Assim sendo, conclui-se que até o presente momento, o que se pode oferecer é um tratamento paliativo e multidisciplinar que possibilite a diminuição das complicações patológicas e desta forma favorecendo o estado de saúde da criança.

The bruxism in the childhood is a multifactorial condition defined by the act of involuntarily clenching or grinding the teeth. When not interfered early can cause damage to the stomatognathic system, causing orofacial changes. Thus, this article aims to address the different treatment options for bruxism in children, this is an integrative review conducted through the SciELO and PubMed databases, a total of 14 articles were included, respecting the inclusion and exclusion criteria. In general, the treatment should be performed in a multidisciplinary manner, including the addition of the dental surgeon, physician, psychologist, physiotherapist and speech therapist, in order to improve the quality of life of the individual. By excluding possible determinants of the disease, the aim is to promote the reduction of parafunctional activity. For this, it can use occlusal plaques, medications such as analgesics, anti-inflammatory drugs, benzodiazepines, muscle relaxants, as well as herbal medicines, as well as massage therapy, cryolipolysis, acupuncture, among others. However, further studies need to prove the effectiveness of such therapies. Therefore, it can be concluded that, until now, what can be offered is a palliative and multidisciplinary treatment thatenables the reduction of pathological complications and thus favoring the child's health status.

The association of self-reported awake bruxism with anxiety, depression, pain threshold at pressure, pain vigilance, and quality of life in patients undergoing orthodontic treatment

Abstract This study aimed to evaluate whether the presence of awake bruxism was associated with temporomandibular dysfunction symptoms, pain threshold at pressure, pain vigilance, oral health-related quality of life (OHRQoL), and anxiety and depression symptoms in patients undergoing orthodontic treatment. Methodology This observational study followed patients who had started receiving orthodontic treatment for six months. The following variables were measured three times (at baseline, one month, and six months): pressure pain threshold (PPT) in the right and left masseter, anterior temporalis, and temporomandibular joint (TMJ), and right forearm; pain vigilance and awareness questionnaire; and shortened form of the oral health impact profile (OHIP-14). Anxiety and depression symptoms were measured using the Beck anxiety inventory and the Beck depression inventory, respectively. The patients were divided into two main groups according to the presence (n=56) and absence (n=58) of possible awake bruxism. The multi-way analysis of variance (ANOVA) was applied on the date (p=0.050). Results TMJ and/or muscle pain were not observed in both groups. Time, sex, age group, and awake bruxism did not affect the PPT in the masticatory muscles and pain vigilance (p>0.050). However, the primary effect of awake bruxism was observed when anxiety (ANOVA: F=8.61, p=0.004) and depression (ANOVA: F=6.48, p=0.012) levels were higher and the OHRQoL was lower (ANOVA: F=8.61, p=0.004). Conclusion The patients with self-reported awake bruxism undergoing an orthodontic treatment did not develop TMJ/masticatory muscle pain. The self-reported awake bruxism is associated with higher anxiety and depression levels and a poorer OHRQoL in patients during the orthodontic treatment.

Which Treatment Is Effective for Bruxism: Occlusal Splints or Botulinum Toxin?

PURPOSE: The aim of the present study was to compare the efficacy of an occlusal splint and botulinum toxin for the treatment of bruxism. PATIENTS AND METHODS: Seventy-three patients with myofascial pain due to bruxism were included in the present study. The patients were allocated into 3 groups. Group A was treated with an occlusal splint, group B was treated with botulinum toxin injections, and group C was treated with an occlusal splint and botulinum toxin injections. The Temporomandibular Disorder Pain Screener, Graded Chronic Pain Scale, Oral Behavior Checklist, Jaw Function Limitation Scale, and visual analog scale (VAS) by palpation of the chewing muscles were administered to all patients before treatment and 6 months after treatment. RESULTS: The questionnaire and VAS scores decreased in all 3 groups (P < .0001). The VAS and questionnaire scores had decreased significantly in groups B and C compared with those in group A (mean VAS score: group A, 5 [range, 3 to 7]; group B, 1.9 ± 0.97; group C, 1.79 [range, 0 to 3]). CONCLUSIONS: Occlusal splints might not be necessary for patients treated with botulinum toxin injections.

Una clínica adecuada para el bruxismo / An appropriate clinic for bruxism

Este trabajo plantea una clínica para el bruxismo, luego de dar cuenta de las causas que lo constituyen desde su fisiología. El bruxismo es producido por el impedimento de descarga ­por diversos motivos singulares de cada padeciente­ de la energía agresiva que el cuerpo tiene para defenderse u atacar. Esta energía no es exclusivamente fisiológica, sino también emocional, por lo cual hacer gimnasia o deportes no resuelve la problemática; de todos modos, la clínica a emprender debe contemplar un trabajo en ambos aspectos. Se diferencia la agresividad ­energía vital necesaria para el vivir cotidiano­ de la violencia, tomando desarrollos de Winnicott, Perls y Lorenz. Si bien las causas que impiden su descarga son diversas, la sintomatología es común. Por eso no sirve un grupo de autoayuda que no contemple la clínica singular, siendo adecuado el recurso grupal como modalidad de trabajo. Se considera que la clínica adecuada para la cura del bruxismo debe incluir: la toma de conciencia y el cambio de modalidades conductuales habituales respecto a la agresividad ­a la vez que su posibilidad de historizarlos­, unidos a un trabajo que posibilite la descarga efectiva corporal y afectiva de las energías agresivas, realizado en una modalidad de trabajo grupal (AU)

This work proposes a clinic for bruxism, after accounting for the causes that constitute it from its physiology. Bruxism is produced by the impediment of discharge - for various reasons unique to each patient - of the aggressive energy that the body has either to defend itself or to attack. As this energy is not exclusively physiological but also emotional, doing gymnastics or sports does not solve the problem, at the same time that the clinic to undertake must contemplate working in both aspects. Aggressiveness -vital energy necessary for daily living- is differtent from violence, taking in account developments from Winnicott, Perls and Lorenz. Although the causes that prevent its discharge are diverse, they share the same symptomatology. That is why a self-help group that does not contemplate the singular clinic is not useful, being the group resource a suitable modality of work. The appropriate clinic for the cure of bruxism should take into account: the awareness and the change of habitual behavioral modalities in regard to aggression -as well as the possibility of historicizing them-, together with a work that enables the effective corporal and affective discharge of aggressive energies, carried out in a modality of group work (AU)

[Medicine 4.0: examples of applications of electronics, information technology and microsystems in modern medicine]. / « Médecine 4.0 ¼ - Exemples d'application de l'électronique, de la technologie de l'information et des microsystèmes dans la médecine moderne.

The electronic advances of the last hundred years have made enormous contributions to medical research and the development of new therapeutic methods. In recent years in particular, it has been demonstrated that intelligent sensors, with appropriate radio interfaces, will soon allow diagnostic and therapeutic processes in medicine to be linked to one another - this will enable the development of completely new forms of therapy [1]. This new "Medicine 4.0" was the subject of a first article in the series, which presented the progress achieved through the merging of microsensor technology, microelectronics, information and communication technologies, with a particular focus on the case of personalized chemotherapy. The purpose of this new article is to present more practical applications of these new therapeutic methods.

Occlusal Palliation of a Hematopoietic Stem Cell Transplant Patient.

Dental providers are integral to patients preparing for hematopoietic stem cell transplantation (HSCT) and for survivorship care. Following successful treatment, HSCT patients eventually return to the care of a general dentist, who must understand the importance of assessing and managing these individuals in collaboration with medical colleagues. This case report describes the dental therapy of a patient diagnosed with multiple myeloma who was experiencing teeth chipping in the anterior, clenching, and myofascial tension. The three-phase treatment plan was aimed at creating a relaxed, comfortable bite position, preventing further functional damage, and optimizing the patient's dental/medical health for her survival prognosis of 2 to 4 years.

Comparação dos dispositivos interoclusais rígido e resiliente no tratamento do bruxismo: revisão de literatura / Comparison of hard and soft interoclusal splints in the treatment for bruxism: literature review

O bruxismo é definido pelo ranger e/ou apertar dos dentes, que pode provocar sinais e sintomas orofaciais como desgaste dental e dor. O dispositivo interoclusal tem sido a primeira escolha para controle do bruxismo, por ser reversível e de baixo custo, entretanto questiona-se sobre qual o material de fabricação dos dispositivos seja mais eficaz. O objetivo deste trabalho foi revisar sobre os tipos de dispositivo interoclusal, rígido ou resiliente, no tratamento desse hábito parafuncional. Foi realizada uma pesquisa bibliográfica através de uma busca computadorizada nas bases de dados Pubmed, Medline, Lilacs e Cochrane com os descritores "treatment bruxism", "splint occlusal", "hard", "soft" que foram cruzados nos mecanismos de busca. Para a inclusão no estudo, os artigos selecionados foram submetidos a uma revisão e como critérios de inclusão deveriam discorrer sobre o bruxismo e/ou terapêuticas com dispositivos oclusais rígidos e/ou resilientes e redigidos na língua inglesa ou portuguesa. Foram analisados artigos publicados de 1984 até a atualidade, sendo que apenas 9 artigos comparavam a utilização dos diferentes materiais. Com base nas evidencias científicas pesquisadas, investigou-se a ação dos dispositivos rígidos e resilientes sobre atividade muscular, força oclusal, distribuição de tensões sobre as superfícies dentais, e sinais e sintomas associados ao bruxismo. Finalmente, notou-se que ambos os dispositivos são eficazes na redução dos sinais e sintomas associados ao bruxismo, entretanto o dispositivo rígido apresenta melhores resultados na redução da atividade muscular, e o dispositivo interoclusal resiliente mostra-se mais eficaz na redução da força oclusal, e distribuição das tensões sobre as estruturas dentais(AU)

Bruxism is defined as grinding and / or tightening of teeth, which can cause orofacial signs and symptoms such as tooth wear and pain. The interocclusal splint has been a first choice to control bruxism, because it is reversible and inexpensive, but it's not clear about the quality of the material of manufacture of the splint. The objective of this work was to review the types of interocclusal splint, hard or soft, to treat the parafunctional habits. A bibliographic search was realized through a computerized search in the databases Pubmed, Medline, Lilacs and Cochrane with the descriptions "bruxism of treatment", "occlusal splint", "hard", "soft". For this study, the articles selected was reviewed and the inclusion criteria was bruxism and / or therapeutics with hard and / or soft occlusal splints written in English or Portuguese. We had analyzed articles published from 1984 until now, and only 9 articles compared a use of different materials. Based on the scientific evidences researched, it was investigated the action of the hard and soft splint on the muscular activity, occlusal force, distribution of tensions on dental surfaces and signs and synonym of association with bruxism. Finally, it was observed that both splints are effective in reducing the signs and symptoms of bruxism; however, the hard splint has better results in reducing muscle activity, and the soft splint is more effective in reducing occlusal strength, and stresses distribution on dental structures(AU)

Quality of life and epidemiological profile of patients undergoing botulinum toxin treatment / Qualidade de vida e perfil epidemiológico de pacientes submetidos a tratamento com toxina botulínica

The botulinum toxin (BTX) is a therapeutic modality used in diverse range of diseases in neurology such as dystonia, tics and tremors and spasticity. The literature about the relation between the use of BTX and its impact in quality of life scales are conflicting, our study proposes to aid answering this question. We selected 110 patients between April 2014 and January 2015, from two tertiary hospitals (movement disorder outpatient clinic), which have been evaluated for age, gender, type of BTX applied, technic of application, adverse events, clinical syndrome and etiology. To evaluate quality of life we used the SF-36® scale. The most prevalent clinical syndromes were dystonia, spasticity and daytime bruxism. We applied the scale in 55 patients pre and post treatment to trace a clinical and epidemiological profile of patients treated with botulinum toxin, evaluating its impact on quality of life. Main etiologies were: idiopathic, stroke and peripheral facial palsy. SF-36® scale applied to 55 patients showed that 35 of them improved, with higher impact upon the mental health, vitality, physical functioning and body pain subsections. Incidence of adverse events (21,8%) was similar to the literature. Botulinum toxin application was associated with higher scores on SF-36®, therefore representing a good therapeutic option dystonia and spasticity. (AU)

A toxina botulínica (TB) é uma modalidade terapêutica utilizada em diversas condições em neurologia, dentre elas distonia, espasticidade, tremor e tique. A literatura médica é conflitante em estabelecer a relação entre o uso da TB e seu impacto nas escalas de qualidade de vida. O presente estudo se propõe a avaliar esta relação. Foram selecionados 110 pacientes, no período entre abril de 2014 e janeiro de 2015 provenientes do ambulatório de Distúrbios do Movimento de 2 hospitais terciários, que foram avaliados de acordo com a idade, gênero, tipo de TB aplicada, técnica de aplicação, eventos adversos, síndrome clínica e etiologia. Para avaliar a qualidade de vida foi utilizada a escala SF-36®. As síndromes mais prevalentes foram distonia, espasticidade e bruxismo diurno. Aplicamos a escala em 55 paciente pré e pós tratamento para traçar um perfil clínico e epidemiológico dos pacientes tratados com toxina botulínica, avaliando o seu impacto na qualidade de vida. As principais etiologias foram: idiopática, acidente vascular encefálico e paralisia facial periférica. A aplicação da escala SF-36® em 55 pacientes revelou que 35 deles apresentaram beneficio, com maior impacto na avaliação dos subitens: saúde mental, vitalidade, performance física e dor. A incidência de efeitos adversos foi de 21,8%, similar à literatura. A aplicação de toxina botulínica foi associada com maior pontuação na escala SF-36®, portanto trata-se de boa opção terapêutica nos casos de distonia e espasticidade. (AU)

Dental health of children with cerebral palsy.

Cerebral palsy (CP) is a common chronic motor disorder with associated cognitive, communicative, and seizure disorders. Children with CP have a higher risk of dental problems creating significant morbidity that can further affect their wellbeing and negatively impact their quality of life. Screening for dental disease should be part of the initial assessment of any child with CP. The objective of this article is to present an updated overview of dental health issues in children with CP and outline important preventative and practical strategies to the management of this common comorbidity. Providing adequate oral care requires adaptation of special dental skills to help families manage the ongoing health issues that may arise. As oral health is increasingly recognized as a foundation for general wellbeing, caregivers for CP patients should be considered an important component of the oral health team and must become knowledgeable and competent in home oral health practices.

Factors associated with clinical decision-making in relation to treatment need for temporomandibular disorders.

OBJECTIVE: The aim of this study was to analyze dentist's clinical decision-making related to treatment need for temporomandibular disorders (TMD) in an adult population. MATERIALS AND METHODS: The study population comprised 779 randomly selected 35, 50, 65 and 75 year old individuals living in the county of Västerbotten, Sweden. The participants filled out a questionnaire and were examined clinically according to a structured protocol. The four examiners (two men, two women) were experienced dentists and were calibrated before the start of the study. After examination they individually assessed the need of treatment owing to TMD. RESULTS: In total, 15% of the study population was considered to have a treatment need owing to TMD. The highest estimate was noted for 35 and 50 years old women and the lowest for 65 and 75 years old men. Overall, 21% of the women and 8% of the men were considered to have a treatment need owing to TMD, with statistically significant differences between men and women for the 35 and 50 years old groups. Inter-individual variations in dentists' decisions were observed. In a multivariate analysis, female gender, signs and symptoms of TMD pain, signs and symptoms of TMD dysfunction and smoking were associated with estimated treatment need. CONCLUSIONS: The prevalence of estimated treatment need owing to TMD was fairly high, but the dentists' clinical decision-making process showed large inter-individual variability. The observation calls for further research on the factors affecting the decision-making process in care providers.

Advanced restorative dentistry - a problem for the elderly? An ethical dilemma.

The type of dental restorations taken into old age may have an adverse effect on the quality of life of the elderly. Root caries and dry mouth increase in prevalence with age and may precipitate the breakdown of remaining natural and restored teeth. At present the availability of dental personnel and facilities in residential aged care facilities (RACFs) is limited, often non-existent, and the elderly living at home may be unable to easily gain access to dental care. Thus, the provision of appropriate and timely dental treatment may not occur, resulting in prolonged pain and suffering. It is important that, as our elderly population increasingly retain natural teeth into advanced old age, appropriate funds are made available to ensure their dental health is maintained. A lack of early intervention to arrest dental disease may result in life-threatening medical consequences in the elderly, such as ventilator assisted pneumonia or the need for a general anaesthetic and possible associated medical risks. Significant local disease, such as osteonecrosis, may also result from a lack of appropriate dental intervention. The necessity to remove questionable teeth prior to irradiation for neoplastic disease or bisphosphonate prescription for neoplastic disease or severe osteoporosis emphasizes the need for regular dental care. In contrast, extensive dental restorative treatment for younger people may have benefits, such as optimal dental aesthetics and oral function, but in older individuals careful consideration should be given to select the most appropriate treatment modality so that adverse situations can be avoided or their resolution simplified should they occur later when the individual is compromised or in a RACF. This may mean the use of conservative dental restorative materials and an avoidance of complex restorative options which may be difficult for the individual or RACF staff to maintain. Some years after receipt of their complex restorations they may be unable to cope with the operative demands and financial burden of resolving their deteriorating dental situation and so complex implant-born structures and precision removable prostheses should probably be avoided for those individuals contemplating entering a care situation. Therefore, the timing of the provision of complex dentistry poses an ethical dilemma.

Women of valor: post-traumatic stress disorder in the dental practice.

Dental professionals can intervene in head, neck and facial pain found in female patients who suffer from post-traumatic stress disorder (PTSD). There are three theories for why women are predisposed to pain: hormonal differences, nervous system rewiring and sympathetic issues. This article includes case studies of three patients who are representative of these theories. A rapid, nonintrusive intervention will also be described.

Effect of a rapid maxillary expansion on snoring and sleep in children: a pilot study.

AIM: The aim of this study was to assess the efficacy of the McNamara rapid palatal expansion device for the treatment of sleep disorders in children. METHODS: The sample enrolled 12 children aged 4-11 years. Children with snoring and bruxism whose parents did not agree to tonsil surgery were included in the study. During the initial evaluation, a questionnaire addressing sleep was administered, and plaster models were made for the construction of the McNamara rapid maxillary expansion device. The expansion period was 7-15 days, and the McNamara device was removed after 6-8 months. The same questionnaire was administered again after 30 days of use of the orthopedic appliance. The data were analyzed using the McNemar test, with the level of significance set to 5% (P<0.05). RESULTS: Significant improvements were found in tiredness upon waking (P=0.002), mood (P=0.008), lip seal (P=0.031), drooling during sleep (P=0.031), snoring (P=0.001), and bruxism (P=0.0062). CONCLUSION: The use of non-invasive methods, such as rapid maxillary expansion, can be an effective treatment for snoring and other undesirable sleep behaviors in children.

[Dento-facial orthopedics and kinesthetic therapy: partners in patient management]. / Orthopédie dento-faciale et kinésithérapie : partenaires pour la prise en charge des patients.

Orthodontic treatment alone, or combined with maxillo-facial surgery, can benefit from a kinesthetic therapy approach. This method of functional management, set in place as soon as the orthodontic diagnosis is made, will allow for a comprehensive therapeutic approach to patients, marked by a dialogue, between the different players involved in treatment, orthodontists and maxillofacial surgeons who intelligently work in concert.

Conservative temporomandibular disorder management: what DO I do? -- frequently asked questions.

UNLABELLED: There are many myths and fallacies surrounding the conservative or non-surgical management of patients with temporomandibular disorders (TMD).This paper is not a treatise on splint design and does not champion any one particular treatment philosophy. It is, however, produced as the outcome of many years of lecturing and talking to fellow practitioners and represents the most frequently asked questions and common misconceptions encountered by the authors, who have addressed the topics raised with the intention of helping to avoid pitfalls. The common symptoms encountered in general dental practice are pain, either from muscles or the temporomandibular joint (TMJ) itself, limitation or deviation of mandibular movement, and joint sounds, and the authors have attempted to separate fallacy and fact. When appropriate examples are given. There are general treatment guidelines but, while some methods apply to an individual, there is no panacea - individual patient treatment needs vary. CLINICAL RELEVANCE: It is important that all treatments delivered to a TMD patient should be evidenced-based and should always be in the patient's best interests. Many treatment modalities are proposed that do not fulfil these parameters and can lead to confusion in management. A reference and reading list will be given which will direct the reader to an evidence-based approach to treatment. Some treatment suggestions are founded on the extensive clinical experience of the authors. There will not always be evidence from a randomized, controlled clinical trial to substantiate support for a specific treatment, but the reader should be directed by what the majority of clinicians would undertake as a responsible approach.

Routines for interocclusal appliance therapy among general dental practitioners in a Swedish county.

The aims of this study were to investigate what kind of interocclusal appliances that were chosen among Swedish dentists when treating temporomandibular disorders (TMD), the clinical rationale for the treatment, the diagnoses that warranted the appliance treatment, the use of adjunct TMD treatments and prognostic considerations, and possible differences in these respects between children/adolescents and adults with TMD, and, finally, possible differences between private practitioners and general practitioners in the public dental service. During the 12-months-period April 2009-March 2010 all general dental practitioners in the county of Jönköping, Sweden, were asked to fill in a questionnaire when performing a TMD treatment with an interocclusal appliance. A total of 394 questionnaires were filled in and returned, 216 (55%) from dentists in public dental service and 178 (45%) from private practitioners. It was found that in 40% of the cases, no pre-treatment recording of the functional status in the masticatory system had been made. The commonest reasons for the treatment were bruxism, headache, and replacement of a previous appliance. Less than half of the appliances made were hard acrylic appliances. Some kind of adjunct therapy had been made in 22% of the cases treated in public dental service. The corresponding figure for those treated by private practitioners was 25%. Therapeutic jaw exercises was the commonest adjunct therapy followed by selective occlusal adjustment. In the vast majority of cases, the dentists judged the prognosis of the treatment to be good. It is concluded that a large number of appliances made to treat TMD were soft appliances, especially in public dental service. This reflects a possible overuse of soft appliances at the expense of hard acrylic appliances. Furthermore, in a large number of cases, the treatment was performed without any pre-treatment registrations, and adjunct therapies were rarely used. In all these respects,there is an improvement potential for the treatment of TMD in general dental practice.

Bruxism elicited by inferior alveolar nerve injury: a case report.

The aim of this case report is to describe the history of a patient who received an injury to the right inferior alveolar nerve after placement of a dental implant, with bruxism noted afterward. The symptoms were managed by the use of an occlusal appliance worn at night and occasionally during the day, associated with increased awareness of parafunction during the day to reduce muscle pain and fatigue. Paresthesia of the teeth, gingiva, and lower lip persisted but were reduced during appliance use.