ABSTRACT
Objetivo: esclarecer a importância de interação diagnóstica, tratamento e desordens temporomandibulares. Revisão de literatura: a necessidade de conhecimento para avaliar o funcionamento do sistema estomatognático identificando possíveis desordens temporomandibulares e mialgias faciais é de suma importância. Por meio de anamnese e exame clínico detalhado, é possível selecionar e instituir um plano de tratamento. Tratar desordens temporomandibulares e mialgias faciais associadas às deformidades dentoesqueléticas depende de um diagnóstico correto e, principalmente, de um plano de tratamento adequado, pois, havendo equívoco, poderá resultar em um mau prognóstico. As modalidades de tratamento das desordens articulares incluem os tratamentos conservadores e os não conservadores. Presume-se que a grande maioria dos pacientes que buscam um tratamento cirúrgico baseiam-se nas recomendações dos ortodontistas, porém, nem sempre enfocam os aspectos esqueletais de uma má oclusão severa, o que pode não ser conduzido da maneira mais adequada para o reestabelecimento da funcionalidade facial. Considerações finais: condutas terapêuticas instituídas nas desordens temporomandibulares não orientadas, descartando hipóteses fatoriais diversas, podem comprometer um futuro tratamento ou agravar a situação patológica presente.(AU)
Objective: to clarify the importance of diagnostic interaction, treatment and temporomandibular disorders. Literature review: the need for knowledge in assessing the functioning of the stomatognathic system by identifying possible temporomandibular disorders and facial myalgias is of paramount importance. Through anamnesis and detailed clinical examination it is possible to select and institute a treatment plan. Treating temporomandibular disorders and facial myalgias associated with dento-skeletal deformities depends on a correct diagnosis and, above all, on an adequate treatment plan, since doing so may result in poor prognosis. The mode of treatment of joint disorders includes conservative and non-conservative treatments. It is presumed that the vast majority of patients seeking surgical treatment are based on the recommendations of orthodontists, but they do not always focus on the skeletal aspects of severe malocclusion, which may not be conducted in the most appropriate way for reestablishment of facial functionality. Final considerations: therapeutic behaviors instituted in non-oriented temporomandibular disorders, discarding several factorial hypotheses may compromise a future treatment or exacerbate the present pathological situation. (AU)
Subject(s)
Humans , Temporomandibular Joint Disorders/diagnosis , Temporomandibular Joint Disorders/therapy , Stomatognathic System/physiopathology , Facial Pain/diagnosis , Facial Pain/physiopathology , Facial Pain/therapy , Temporomandibular Joint Disorders/physiopathologyABSTRACT
Los puntos gatillo miofaciales (Pgs) son puntos hiperirritables en un músculo esquelético asociado a un nódulo palpable causado por una banda muscular tensa. Los Pgs miofaciales presentan dentro de sus signos y síntomas alteraciones motoras, sensoriales y autonómicas. En este artículo reportamos un caso en el que se presenta un fenómeno autónomo referido a partir de un punto gatillo miofacial y se plantean las vías neuroanatómicas involucradas en esta respuesta, analizando la hipótesis que las respuestas autónomas referidas asociadas al dolor pueden considerarse eventos neuropáticos del sistema nervioso autónomo.
Myofascial trigger points (MTP) are hyperirritable points in skeletal muscle associated with a palpable lump caused by a strained muscle band. MTP presented within signs and symptoms of motor, sensory and autonomic impairment. In this article we report a case in which an autonomous referred phenomena from a myofascial trigger point and raises the neuroanatomical pathways involved in this response, considering the hypothesis that self-related responses associated with neuropathic pain can be regarded as events of the autonomic nervous system. Clinical and experimental evidence discussed in this article indicates that myofascial trigger point pain is an autonomic phenomena associated, that can be systemic and localized, and must be considered in evaluating patients with these diagnosis.
Subject(s)
Humans , Adult , Female , Autonomic Nervous System , Pain Measurement/methods , Hyperemia , Myofascial Pain Syndromes , Temporal Muscle/physiopathology , Temporal Muscle/innervation , Palpation , Sympathetic Nervous SystemABSTRACT
Se reporta una fémina de 20 años, estudiante de tercer año de Medicina con síndrome dolor disfunción temporo-mandibular, cuyo motivo de consulta fue el dolor, relacionado con el lado no habitual de masticación y de dormir. Los datos fueron tomados de su historia clínica donde fue inicialmente tratada. Nos basamos en la exploración clínica de músculos, articulaciones temporo-mandibulares y oclusión, para detectar como posibles causas: el estrés y una interferencia oclusal grosera. Se realizó un tratamiento multicausal: acupuntura, exodoncia, relajación progresiva de Jackonson, charlas educativas, plegable informativo control de placa dentobacteriana e higiene bucal y remisión al psicólogo. Pudimos constatar que una lesión funcional puede causar síntomas tan variados como el daño articular. El diagnóstico es fundamentalmente clínico y por su sencillez debería incorporarse al protocolo de exploración habitual. Consideramos el estrés un factor predisponerte principal y a la vez desencadenante. El estomatólogo del futuro guiará al paciente hacia una vida plena, libre de preocupaciones que alteren su salud mental. Siempre será necesario incorporar al Psicólogo en el equipo multidisciplinario que tratará la afección.
A 20 year-old female, a third year student of Medicine with temporomandibular pain-dysfunction syndrome is reported whose consultation reason was pain, related with the non habitual mastication and sleeping side. Data were taken of her clinical history where it was initially treated. We base ourselves on the clinical exploration of muscles, temporomandibular articulations and occlusion, to detect as possible causes: stress and a coarse occlusal interference. A multicausal treatment was carried out: acupuncture, exodontia, Jackonson´s progressive relaxation, educational talk, informative folding, control of dentobacterial plaque, oral hygiene and remission to the psychologist. We could verify that a functional lesion can cause such varied symptoms as the articular damage. Diagnosis is clinical fundamentally and for its simplicity should incorporate to the habitual exploration protocol. We consider stress a principal predisposing and at the same time triggering factor. The future stomatologist will guide the patient towards a full life, free of preoccupations that alter their mental health. It will always be necessary to incorporate the Psychologist in the multidisciplinary team that will treat the affection.
Subject(s)
Humans , Adult , Female , Dental Occlusion, Centric , Oral Medicine , Stress, Physiological , Temporomandibular JointABSTRACT
Las Férulas oclusales han sido consideradas como instrumento terapéutico en la conducción de casos en pacientes con desórdenes Temporo-mandibulares. Este estudio se realizó partiendo de una muestra de 10 pacientes que asistieron al Servicio de Alteraciones Cráneo-Mandibulares de la Universidad Central de Venezuela, los cuales presentaban signos y síntomas de dolor miofacial. Luego de finalizar el tratamiento se consideró el registro de 2 controles post-operatorios con la finalidad de evaluar la efectividad de las Férulas Blandas en cuanto a relajación muscular y disminución del dolor como en las Férulas Duras.
The occlusal splints had been considered as therapeutic instrument in the manegement of TMD patients. The study was based in a sample of a 10 patients, who come to Cranio-Mandibular Alteration Service of the U.C.V. They presented signs and symptoms of myofacial pain. After the treatment is finished, we considered to record two post-operative controls to evaluate the efectivity of soft splints in muscle relaxation and decrease of pain as in the hard splints.
As réguas dos oclusales foram consideradas como o instrumento therapeuticna condução dos casos nos pacientes com Temporo-mandibulares disorders. Este estudo foi feito começar fora de uma amostra de 10 pacientes que atenderam ao serviço de alterações de Craneo-Mandibulares do Universidad de Central de Venezuela, que presented assina e sintomas da dor miofacial. Após ter finalizado o tratamento o registro de 2 postoperativeos controles com a finalidade foram considerados da avaliação eficácia das réguas macias até o relaxation muscular e diminution da dor como nas réguas duras.