Changes in understanding of painful temporomandibular disorders: the history of a transformation.

OBJECTIVE: The understanding the etiology of painful temporomandibular disorders (TMD) has evolved over the last eight decades. Evidence-based systematic research had questioned historical concepts and abandoned preconceived dogmas based purely on mechanically based etiologies, transforming TMD into a complex musculoskeletal chronic pain model. Unfortunately, many of these old ideas persist in undergraduate education and the dental community. Revisiting the historical development and the way the etiology of painful TMD has changed over the years may be helpful to understand the complexities of TMD as a group of chronic pain pathologies. METHOD AND MATERIALS: A literature search using the MeSH terms: "temporomandibular joint disorders," "TMD," "etiology," "causality," "history," and "evolution" using Medline and Scopus databases was conducted aiming to answer the focused question: "In what ways has etiologic understanding of temporomandibular disorders evolved?" A narrative review was performed with the selected studies, highlighting significant contributions that have transformed TMD from a purely mechanical-based phenomenon into a chronic pain biopsychosocial disease model.

Efficiency of the Ocluch©MAD in the treatment of patients with OSAS and its association with craniofacial morphology.

OBJECTIVE: This study uses polysomnography and the Epworth sleepiness scale to assess the efficiency of the Ocluch©MAD in patients with Obstructive sleep apnea-hypopnea syndrome (OSAS), on overall respiratory disturbance indices (RDI), supine respiratory disturbance index (SRDI), minimum oxygen saturation, microarousals, CT90 (or ID90), sleep efficacy and snoring. These data are associated with skeletal class and facial biotype in order to establish predictive parameters for its effectiveness according to craniofacial morphology. METHODS: 22 adult patients (between 38 and 60 years of age) of both sexes (7 women, 15 men) diagnosed with OSAS in the Hospital de Carabineros de Chile (HOSCAR) Neurology Unit were recruited and given the Ocluch© MAD in the hospital's dental clinic, for its use during a three-month period. Patients were assess at the beginning and in the end of this period. RESULTS: 87.5% of patients with mild OSAS achieved the success criterion and normalization; 71.5% of patients with moderate OSAS achieved the success criterion and 33.3% achieved normalization; 85.7% of patients with severe OSAS achieved the success criterion and 57.1% achieved normalization. All class I and mesofacial patients achieved normalization, but class II patients had the greatest proportional improvement. CONCLUSIONS: The Ocluch MAD is an efficient low-cost alternative that should be considered among the therapeutic arsenal for a multidisciplinary approach to treating this disease.