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.

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.

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.

Oral Behaviors and Parafunctions: Comparison of Temporomandibular Dysfunction Patients and Controls.

The aim of this study is to evaluate the frequency of oral behaviors in patients with temporomandibular disorders (TMD) and a control group without TMD.In this baseline case-control study, 260 controls and 260 subjects with TMD completed the oral behaviors checklist defined as a "self-report scale for identifying and quantifying the frequency of jaw overuse behavior" and underwent clinical examinations using the DC/TMJ international examination form (version May 12, 2013). Relationships of oral parafunctions' frequencies between groups were examined. The statistical analysis was performed with IBM SPSS Statistics 23 software.Age and gender distribution in the study groups did not reveal statistical differences (P > 0.05). Multivariate logistic regression analysis was conducted to establish system of independent oral behaviors for prognosis TMD. The stepwise regression analysis demonstrated that very frequent expression of holding, tightening, or tense muscles is associated with 10.83 times (P < 0.05) higher risk of TMD, grinding teeth together during waking hours with 4.94 times (P < 0.05) higher risk, and sustained talking with 2.64 times (P < 0.05) higher risk of TMD. By contrast, it was determined that 3 oral behaviors were less common in the TMD patients compared with the control group: clenching teeth together during waking hours, facing grimaces, and yawning (P < 0.05). The individuals with TMD reported a significantly higher frequency of 10 behaviors (P < 0.05), 3 of which may be regarded as independent risk factors for TMD. In addition, 3 oral behaviors were more frequently observed in the healthy subjects than in the TMD patients.

Assessment of the Relationship Between Clinicophysiologic and Magnetic Resonance Imaging Findings of the Temporomandibular Disorder Patients.

Temporomandibular joint disorders (TMJDs) are a complex group of disorders that comprise dysfunctions of the temporomandibular joint (TMJ). In this study, we analyzed the objective and subjective findings of the TMJD patients by using Helkimo anamnesis (Ai) and clinical dysfunction (Di) indices, and tried to document a relation between these findings and magnetic resonance imaging (MRI) results.Ninety-eight patients who were admitted to our clinic were included in the study. The clinical evaluation was performed by using Ai, an 8-question-survey based on the objective symptoms of patients; Di, concluded as the score of 5 objective measurements of physical examination. The morphology of the TMJ was evaluated by MRI, and the findings were analyzed and statistically compared with respect to the Di.The most commonly seen symptoms were noise during mandibular movement (58%), pain around the joint (42.5%), and pain with mandibular movements (40%). Seventeen patients (17.3%) were Di0, 47 (48%) were DiI, 24 (24.5%) were DiII, and 10 (10.2%) were DiIII. Thirty-seven patients (37.8%) had abnormal MRI findings, whereas 61 patients (62.2%) had normal MRI. The most commonly encountered pathology was anterior disc displacement with reduction, which was reported in 15 patients. Increased TMJ Di, which points a more progressed TMJD, was found to be significantly related with the pathological MRI findings (P < 0.05).MRI is especially effective in particularly those with high Di; therefore, the results of the study may give a prospect in which types of patients does MRI give a valuable data toward diagnosis, in which stages of the TMJD should we expect pathological findings, and thereby preventing unnecessary use of MRI in patients with symptoms of TMJD.

Tuberculose e suas manifestações na ATM: uma revisão de literatura / Tuberculosis and its manifestations in TMJ: a literature review

A disfunção temporomandibular tem caráter multifatorial e merece uma abordagem diferenciada tanto para seu diagnóstico quanto seu tratamento, sendo frequentemente recomendada a atuação de uma equipe multidisciplinar. Várias são as manifestações que podem acometer as articulações temporomandibulares decorrentes de patologias sistêmicas. Dentre estas, a tuberculose raramente as acomete, mas a ocorrência de manifestações extrapulmonares vem crescendo nos últimos anos. Estima-se que a tuberculose acometa 8.8 milhões de pessoas ao ano, levando 1.45 milhões destas ao óbito. O objetivo desta revisão foi levantar dados e informações para profissionais da área da saúde, em especial os Cirurgiões Dentistas,para um correto e precoce diagnóstico, uma vez que a detecção correta da patologia possibilita tratamento adequado e previne o surgimento de alterações graves na forma e função das articulaçõesenvolvidas.

Temporomandibular disorders are a multifactorial disease, that deserves a special approachfor its diagnosis and treatment, and a multidisciplinary team is suggested. Various systemic pathologies have a TMJ manifestation. Among these diseases, tuberculosis rarely has a temporomandibularjoint occurrence, but extra pulmonary manifestation is increasing in the last years.About 8,8 million people are affected by tuberculosis each year, and 1,45 million die because ofit. The objective of this review is collect data and information for health professional, in special Dentists, in order to clarify the relationship between TMD and tuberculosis, early diagnosis and correct treatment, once that the correct identification of this patology can provide adequate treatment and prevents for more severe complications.

Chondromatosis of the Temporomandibular Joint as a Consequence of Persistent Long-Lasting Joint Dysfunction: Late Diagnosis of a Rare Occurrence.

The authors present a rare patient of right synovial chondromatosis (SC) of the temporomandibular joint in which diagnosis was late and delay led to SC extension to the cranial base. Synovial chondromatosis is a rare benign disorder characterized by multiple cartilaginous free-floating nodules originated from the synovial membrane of large articular joints of the body. Differential diagnosis is with neoplasm and radical surgical removal is essential. The patient came to the authors' observation complaining about long-lasting temporomandibular joint dysfunction. The patient already underwent either functional or medical therapy in times without any improvement. Clinical examination showed limited mouth opening and swelling of the right preauricolar region with no signs of facial nerve palsy and without paresthesia or hearing loss. No history of recent trauma was recorded. Magnetic resonance imaging showed a mucous-like hyperintense mass with small hypointense spots inside. A preoperative computed tomography scan was performed and showed a mass extending from the superior aspect of the temporomandibular joint to the glenoid fossa, which was partially eroded. The patient underwent either open joint surgery or arthroscopy of the superior joint space and a large number of chondrocytes were removed. No complications were recorded postoperatively and the patient completely recovered after 6 months. Histology confirmed the diagnosis of synovial condromatosys of the right temporomandibular joint.

The incidence of osteoarthritic change on computed tomography of Korean temporomandibular disorder patients diagnosed by RDC/TMD; a retrospective study.

Objective Osteoarthritis (OA) of the temporomandibular joint (TMJ) is generally thought to be an age-related disease like those of other joints. This study aims to investigate the incidence of computed tomographic (CT) OA changes in Korean temporomandibular disorder (TMD) patients diagnosed by the Research Diagnostic Criteria for TMD (RDC/TMD). Materials and methods The clinical records and radiographs of 1038 TMD patients (297 men and 741 women with mean age 31.1 ± 17.4 and 34.0 ± 16.2, respectively) diagnosed based on RDC/TMD Axis I in 2010 were reviewed. Results The incidence rate of OA changes in TMD patients is estimated to 27.3%, and higher in women than in men (15.5% in men and 32.0% in women) by 2.3 odds (p < 0.001). It has no correlation with age, showing an almost flat incidence rate throughout the age from the 2nd decade and has no correlation as well with pain or disc displacement diagnosed according to RDC/TMD, while arthrosis/arthritis diagnosis based on RDC/TMD supplemented by plain radiographs shows high risk of OA changes on CT by 38.8 odds (p < 0.05). Conclusions These results imply that the OA changes in young Korean TMD patients are as common as in the old and have no correlation with clinical pain and noise. Considered with high prevalence of TMDs known in the young population, the overall/absolute OA changes in the TMJ can be even higher in the young than in the old population, not like in other joints.

Utilização da imagem da ressonância magnética no diagnóstico das alterações da ATM / Use of magnetic resonance imaging in the diagnosis of changes in TMJ

A disfunção temporomandibular (DTM) é uma condição comum, que afeta até 28% da população. A articulação temporomandibular (ATM) é uma articulação complexa, composta por uma série de estruturas teciduais ósseas e moles, e cada uma das quais podem estar implicada em funções fisiológicas específicas e em síndromes associadas a patologias clínicas. O conhecimento da aparência da imagem normal da ATM, a sua aparição no exame radiológico e técnicas intervencionistas são úteis para fornecer uma contribuição diagnóstica eficiente. Anormalidades da ATM não podem ser avaliadas de forma confiável apenas por exame clínico, mas com o uso da RM podemos descrever alterações articulares que não eram vistas em qualquer outro método de imagem, indicando ser este o melhor método diagnóstico. Este artigo teve o objetivo de evidenciar a importância do uso da RM para diagnóstico das alterações da ATM, exemplificando diversas condições descritas com seu auxílio...

Emporomandibular disorders (TMD) is a common condition that affects up to 28% of the population. Temporomandibular joint (TMJ) is a complex articulation which consists of bones and soft tissue structures, each of which may be implicated in specific physiological functions and in clinical syndromes associated pathologies. Knowledge of the appearance of the normal image of TMJ, its appearance in the radiological examination, and interventional techniques are useful to provide efficient diagnostic contribution. TMJ abnormalities can not be evaluated only reliably by clinical examination, but with the use of MRI we can describe articular changes that were not seen in any other imaging method, indicating that this is the best diagnostic method for this task. This article aims to highlight the importance of MRI for diagnosis of impaired TMJ exemplifying various conditions described in the rescue...

Concordancia entre las Evaluaciones de la Articulación Temporomandibular Realizadas con los CDI/TTM y con Imágenes de Resonancia Magnética / Concordance between the Evaluations of the Temporomandibular Joint Performed with the RDC/TMD and with Images of Magnetic Resonance

Los Criterios Diagnósticos para la Investigación de los Trastornos Temporomandibulares (CDI/TTM) ofrecen un sistema estandarizado para evaluar la Disfunción Temporomandibular (DTM). Sin embargo, la validez del diagnóstico clínico obtenido con estos criterios al compararlo con el diagnóstico obtenido de las imágenes de Resonancia Magnética (RM) es controversial. El objetivo fue determinar la concordancia que existe entre la evaluación clínica realizada con los CDI/TTM e imágenes de RM de la articulación temporomandibular (ATM), de pacientes atendidos en la Clínica Integral del Adulto, de la Escuela de Odontología de la Universidad del Valle, en Cali, Colombia. Se evaluó clínicamente a 36 individuos, con edades comprendidas entre 18 y 60 años, utilizando los CDI/TTM y se les realizaron exámenes de RM. Las variables estudiadas fueron sexo, edad, signos y síntomas de la ATM, Posición Normal del Disco (PND), Desplazamiento Discal con Recaptura (DDCR) y Desplazamiento Discal Sin Recaptura (DDSR). Los datos obtenidos fueron sometidos a pruebas estadísticas para determinar el índice Kappa y características operativas de la prueba clínica. El Índice Kappa fue 0,53, con una concordancia entre las evaluaciones clínicas e imagenológicas moderada. De la población estudiada, 91,6% fue del sexo femenino, con 31 años como promedio de edad. El signo hallado con mayor frecuencia fue el ruido articular (77%) y el síntoma más frecuente fue el dolor facial (69%). La sensibilidad de los CDI/TTM para determinar la PND fue 0,52 y la especificidad 0,87; la sensibilidad para el DDCR fue 0,8780 y la especificidad 0,709; la sensibilidad para el DDSR fue 0,5714 y la especificidad 0,948. La DTM se presentó con mayor frecuencia en las mujeres, con edad promedio de 31 años. Los CDI/TTM pueden considerarse confiables, especialmente para el DDCR; sin embargo, tratamientos invasivos, permanentes o quirúrgicos, requerirían confirmación con un diagnóstico imagenológico para evitar falsos positivos.

The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) offer a standardized system to clinically evaluate the most common subtypes of Temporomandibular Disorders (TMD). However, the validity of the clinical diagnose obtained with these criteria when compared with the diagnose obtained from the images of Magnetic Resonance (MR) is controversial. The objective of this study was to determine the concordance existing between the clinical evaluation obtained from the RDC/TMD and that obtained from MR images of the temporomandibular joint (TMJ) of patients attending the Clínica Integral del Adulto ­ Clínica de ATM, of the Escuela de Odontología of the Universidad del Valle, Cali, Colombia. A population of 36 patients of both sexes, with ages between 18 and 60 years, were clinically evaluated with the RDC/TMD and MR. The variables considered were sex, age, signs and symptoms of the TMJ, Normal Disc Position (NDP), Disc Displacement with Reduction (DD-R) and Disc Displacement without Reduction (DD-NR). The data obtained were submitted to statistical tests to determine the Kappa Index and operative characteristics of the clinical evaluation. The Kappa Index obtained was 0.53, which shows that the concordance between the clinical and the imagenological evaluations is moderate. Of the total population studied, 91.6% were females, with 31 years as average age. The most frequent sign found was the joint sound (77%) and the most frequent symptom was facial pain (69%). The sensitivity of the RDC/TMD to determine NDP was 0.52 and the specificity 0.87; the sensitivity for the DD-R was 0.8780 and the specificity 0.709; the sensitivity for the DD-NR was 0.5714 and the specificity 0.948. The TMD were found most frequent in women, with average age of 31 years. The RDC/TMD can be considered reliable, especially for the DD-R; however, invasive, permanent or surgical treatments would require confirmation with imagenological diagnoses to avoid false positives.

Specific and number of comorbidities are associated with increased levels of temporomandibular pain intensity and duration.

BACKGROUND: Temporomandibular pain disorder (TMD) is a common pain condition in the face. People with TMD report multiple pain comorbidities. The presence of fibromyalgia and migraine in people with TMD is associated with an increase in TMD pain intensity and duration. However, data on the relationship between increasing number of pain comorbidities and TMD pain are rare. The aims of this study were: firstly to evaluate the extent to which increasing number of comorbidities is associated with increasing TMD pain intensity and duration; and secondly to evaluate the extent to which the presence of specific comorbidities is associated with increasing TMD pain intensity and duration. METHODS: The sample included 180 people seeking TMD treatment at Boston and Montreal clinics. TMD was diagnosed using the Research Diagnostic Criteria for TMD. A Numerical Pain Rating Scale assessed TMD pain intensity and participants provided their TMD pain duration in a study questionnaire. The comorbidities of migraine, chronic fatigue syndrome, irritable bowel syndrome, interstitial cystitis and restless leg syndrome were diagnosed by 5 validated diagnostic questionnaires. The associations were analyzed by linear regression, controlling for confounders. RESULTS: There was a positive association between the number of comorbidities present and TMD pain intensity (p < 0.01) and between the number of comorbidities present and TMD pain duration (p < 0.01). Also, the presence of migraine was positively associated with TMD pain intensity (p < 0.01) and the presence of chronic fatigue syndrome was positively associated with TMD pain intensity (p < 0.05) and with TMD pain duration (p < 0.01). When TMD patients were separated into groups, these associations did not change for the myofascial pain group, whereas in the non-myofascial pain group, the relationship between number of comorbidities and TMD pain duration was the only one still present. CONCLUSION: This study shows that the number of comorbidities is positively associated with TMD pain duration and intensity. The presence of specific conditions, such as migraine and chronic fatigue syndrome, is associated with an increase in TMD intensity and duration.

Propriedades clinimétricas da variável eletromiográfica duty factor para desordem temporomandibular / Clinimetric properties of duty factor for temporomandibular disorder

Objetivo Avaliar a confiabilidade e responsividade do duty factor à dor provinda da desordem temporomandibular Métodos Participaram 20 voluntárias, com média de idade de 29 anos e 6 meses (±9,2), portadoras de desordem temporomandibular miogênica, segundo o critério diagnóstico para pesquisa em Desordem Temporomandibular (RDC/TMD). Foram coletados sinais eletromiográficos nas condições de repouso dos músculos mastigatórios, na presença de dor moderada a severa e na diminuição ou eliminação desta dor após aplicação de Estimulação Elétrica Nervosa Transcutânea durante 45 minutos. Os sinais eletromiográficos de repouso foram processados para obtenção dos valores do tempo de ativação muscular acima de 10% do valor da máxima força de apertamento dentário. A confiabilidade foi testada pelo coeficiente de correlação intraclasse em dados repetidos antes da analgesia. Também foi calculado o erro padrão de medida e mínima mudança detectável. A responsividade da variável foi analisada entre as coletas eletromiográficas realizadas antes e após a analgesia pelo tamanho de efeito e média de resposta padronizada. Resultados Duty factor apresentou valores de coeficiente de correlação intraclasse acima de 0,75 para todos os músculos. O erro padrão foi entre 4% e 8% e a mínima mudança detectável entre 5% e 12%. Na responsividade da variável para a dor, o tamanho de efeito obteve valores entre 0,2 e 0,5 e a média da resposta padronizada, valores acima de 0,8. Conclusão O duty factor apresentou confiabilidade excelente e responsividade à dor da desordem temporomandibular baixa para tamanho de efeito e excelente para média da resposta padronizada. .

Purpose To assess the reliability and responsiveness of the duty factor variable for assessing pain originating from temporomandibular disorders. Methods The sample comprised 20 female volunteers, mean age 29 years 6 months (± 9.2), with a diagnosis of myogenic temporomandibular dysfunction according to the Research Diagnostic Criteria for Temporomandibular Disorders. Electromyographic (EMG) signals were collected at three times: during mandibular rest; in the presence of moderate to severe pain; and when pain was reduced to mild or absent after 45 minutes of transcutaneous electrical nerve stimulation (TENS). Electromyographic signals during mandibular rest were processed to obtain values for muscle activation time greater than 10% of maximum bite force. Reliability was tested with intraclass correlation for repeated data before analgesia. Standard error of measurement (SEM) and minimum detectable change (MDC) were also computed to determine reliability. Responsiveness of duty factor was analyzed between EMG recordings, before and after analgesia, by calculating effect size (ES) and standardized response mean (SRM). Results Duty factor presented intraclass correlation coefficient above 0.75 for all muscles. Standard error of measurement ranged from 4% to 8% and minimum detectable change from 5% to 12%. Regarding the responsiveness of duty factor to pain, effect size values fell between 0.2 and 0.5 and SRM values were greater than 0.8. Conclusion Duty factor showed excellent reliability. However, responsiveness to TMD-related pain was low as expressed by effect size and excellent as expressed by standardized response mean. .

An osteochondroma of the mandibular condyle.

OBJECTIVE: Osteochondroma is rarely seen in the facial region, especially around the condyle. Here, we report a case of condylar osteochondroma, aiming to assist the diagnosis and treatment of the tumor. METHODS: A case of osteochondroma of the left mandibular condyle in a 49-year-old man was presented. Medical records with x-ray, computed tomographic scan, and bone scan of histologically proven osteochondroma of mandibular condyle were obtained. RESULTS: The patient underwent a surgical resection and had fewer functional changes as well as less dysfunction of the temporomandibular joint. CONCLUSIONS: The current study highlights the fact that, despite its rarity in the mandibular condyle, surgical resection is an effective treatment method. The decision, however, depends on how much swing of the mandible is required after surgery for correction of asymmetry and occlusion.