Mastication movements and sleep quality of patients with myofascial pain: occlusal device therapy improvements.

STATEMENT OF PROBLEM: Patients with myofascial pain experience impaired mastication, which might also interfere with their sleep quality. PURPOSE: The purpose of this study was to evaluate the jaw motion and sleep quality of patients with myofascial pain and the impact of a stabilization device therapy on both parameters. MATERIAL AND METHODS: Fifty women diagnosed with myofascial pain by the Research Diagnostic Criteria were enrolled. Pain levels (visual analog scale), jaw movements (kinesiography), and sleep quality (Epworth Sleepiness Scale; Pittsburgh Sleep Quality Index) were evaluated before (control) and after stabilization device use. Range of motion (maximum opening, right and left excursions, and protrusion) and masticatory movements during Optosil mastication (opening, closing, and total cycle time; opening and closing angles; and maximum velocity) also were evaluated. Repeated-measures analysis of variance in a generalized linear mixed models procedure was used for statistical analysis (α=.05). RESULTS: At baseline, participants with myofascial pain showed a reduced range of jaw motion and poorer sleep quality. Treatment with a stabilization device reduced pain (P<.001) and increased both mouth opening (P<.001) and anteroposterior movement (P=.01). Also, after treatment, the maximum opening (P<.001) and closing (P=.04) velocities during mastication increased, and improvements in sleep scores for the Pittsburgh Sleep Quality Index (P<.001) and Epworth Sleepiness Scale (P=.04) were found. CONCLUSION: Myofascial pain impairs jaw motion and quality of sleep; the reduction of pain after the use of a stabilization device improves the range of motion and sleep parameters.

Prosthetic improvement of pronounced buccally positioned zygomatic implants: a clinical report.

This report presents a prosthetic technique for the improvement of surgically positioned, buccally placed zygomatic implants with the use of custom abutments for improved retention screw position and an esthetic implant reconstruction. The patient presented four zygomatic implants with pronounced buccal inclination. The anterior implants were inclined toward the location where the anterior artificial teeth should be placed during rehabilitation. As the manufacturer does not provide angulated abutments, we attempted the waxing and overcasting of a prosthetic abutment, repositioning the access holes of the prosthetic screws to a more palatal position. This clinical report demonstrates that abutment customization could be an interesting way to relocate the access holes of the prosthetic screws in cases of zygomatic implants with pronounced buccal inclination.

The Use of Implants to Improve Removable Partial Denture Function.

The oral rehabilitation with conventional removable partial dentures in Kennedy class I patients allows continuous bone resorption, dislodgment of the prosthesis during the mastication caused by the resilience of the mucosa, and rotation of the prosthesis. Thus, the associations of distal implants become an attractive modality of treatment for these patients. This case report presented an association of removable partial dentures, milled crowns and osseointegrated implants to rehabilitate a partial edentulous patient. A removable partial denture associated with implants and metal-ceramic milled crowns can offer excellent esthetics, and will improve function and biomechanics, at a reduced cost.

Oral Appliance for the Treatment of Severe Obstructive Sleep Apnea in Edentulous Patient.

Oral appliances have attracted interest for the treatment of mild and moderate obstructive sleep apnea (OSA) and the mandibular repositioning device (MRD) or a tongue-retainer device (TRD) is usually indicated to increase the upper air space. Describes a combination of MRD (with 60 % maximum mandibular protrusion) and TRD to treat severe OSA. Polysomnography (PSG) and two questionnaires: the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI) evaluated the sleep pattern in two times (after and before the use of oral appliance). The initial PSG exam was compatible with diagnoses severe OSA and the Apnea-Hypopnea Index was 40.4, and 54 % oxygen saturation -spO(2). The ESS and PSQI scores were 11 and 6, respectively. After she began wearing the device she stopped snoring, her Apnea-Hypopnea Index decreased to 17.6, presented a sleep efficiency of 81.6 % and had a 77 % spO(2). The ESS and PSQI scores dropped to three. MRD in association with the tongue-retainer was effective in reducing the severity of the apnea for this edentulous patient.

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.

Determination of salivary glucose in healthy adults.

OBJECTIVES: Our aim in this study was to determine the concentration of salivary glucose in healthy individuals and to compare it with the capillary glycemia. STUDY DESIGN: Samples of unstimulated whole saliva were collected from 63 non-diabetic patients. The concentration of salivary glucose and capillary blood was measured in all of the patients. The salivary glucose was determined by enzymatic method and spectrophotometry. The data was then analyzed using the Spearman correlation test, considering values of p<0.05 to be significant. RESULTS: The whole sample consisted of 47.6% males and 52.4% women, with an average age of 37.5+/-15.7 years old. The average rates of unstimulated salivary flow were 0.41+/-0.21 ml/min among males and 0.31+/-0.15 ml/min among females. No significant difference was found based on these results (p=0.078). The average blood glucose among the males studied was 100.05+/-13.51 mg/dL, and among females, it was 99.5+/-13.9 mg/dL. The average salivary glucose for the whole sample was 5.97+/-1.87 mg/dL, with 5.91+/-2.19 mg/dL among males and 5.97+/-1.56 mg/dL among females, respectively, without presenting any significant differences (p=0.908). The concentration of salivary glucose did not present any statistically significant correlation with the capillary glycemia (p=0.732). CONCLUSIONS: The results suggest that the concentration of salivary glucose is not dependent on capillary glycemia and that the concentration of salivary glucose does not present significant differences between the measurements for males and females.

Short implants to support mandibular complete dentures - photoelastic analysis.

This study evaluated the stress behavior around short implants in edentulous atrophic mandibles. Six groups included implants with two diameters regular and wide (4 and 5 mm) and three lengths (5, 7 and 9 mm) as follows: Ci9 (9 x 4 mm), Ci7 (7 x 4 mm), Ci5 (5 x 4 mm), Wi9 (9 x 5 mm), Wi7 (7 x 5 mm) and Wi5 (5 x 5 mm). These groups were compared to the control group CG (11 x 4 mm). The analysis was performed with the photoelastic method (n = 6). Each model comprised 4 implants with the same length and diameter connected by a chromium-cobalt bar that simulates a fixed denture. A 0.15 kg force was applied at the end of the cantilever (15 mm), and the maximum shear stress was recorded around the distal and subsequent implants. The stress values were determined, and the quantitative data (Fringes®) were submitted to statistical analysis with one-way ANOVA and the Dunnett test (p < 0.05). It was observed that the reduction in implant length increased stress values with a significant difference (p < 0.05) between CG Ci7 and Ci5, while the increase in implant diameter reduced the stress values without any differences found between short and long implants. Implants with 5 and 7 mm with regular diameter increased stress levels while short implants with larger diameters experienced similar stress to that of longer implants.

Photoelastic analysis of fixed partial prosthesis crown height and implant length on distribution of stress in two dental implant systems.

The aim of this study was to evaluate by photoelastic analysis stress distribution on short and long implants of two dental implant systems with 2-unit implant-supported fixed partial prostheses of 8 mm and 13 mm heights. Sixteen photoelastic models were divided into 4 groups: I: long implant (5 × 11 mm) (Neodent), II: long implant (5 × 11 mm) (Bicon), III: short implant (5 × 6 mm) (Neodent), and IV: short implants (5 × 6 mm) (Bicon). The models were positioned in a circular polariscope associated with a cell load and static axial (0.5 Kgf) and nonaxial load (15°, 0.5 Kgf) were applied to each group for both prosthetic crown heights. Three-way ANOVA was used to compare the factors implant length, crown height, and implant system (α = 0.05). The results showed that implant length was a statistically significant factor for both axial and nonaxial loading. The 13 mm prosthetic crown did not result in statistically significant differences in stress distribution between the implant systems and implant lengths studied, regardless of load type (P > 0.05). It can be concluded that short implants showed higher stress levels than long implants. Implant system and length was not relevant factors when prosthetic crown height were increased.

Photoelastic analysis of all-on-four concept using different implants angulations for maxilla.

Conventional tilted implants are used in oral rehabilitation for heavily absorbed maxilla to avoid bone grafts; however, few research studies evaluate the biomechanical behavior when different angulations of the implants are used. The aim of this study was evaluate, trough photoelastic method, two different angulations and length of the cantilever in fixed implant-supported maxillary complete dentures. Two groups were evaluated: G15 (distal tilted implants 15°) and G35 (distal tilted implants 35°) n = 6. For each model, 2 distal tilted implants (3.5 x 15 mm long cylindrical cone) and 2 parallel tilted implants in the anterior region (3.5 x 10 mm) were installed. Photoelastic models were submitted to three vertical load tests: in the end of cantilever, in the last pillar and in the all pillars at the same time. We obtained the shear stress by Fringes software and found values for total, cervical and apical stress. The quantitative analysis was performed using the Student tests and Mann-Whitney test; p ≥ 0.05. There is no difference between G15 and G35 for total stress regardless of load type. Analyzing the apical region, G35 reduced strain values considering the distal loads (in the cantilever p = 0.03 and in the last pillar p = 0.02), without increasing the stress level in the cervical region. Considering the load in all pillars, G35 showed higher stress concentration in the cervical region (p = 0.04). For distal loads, G15 showed increase of tension in the apical region, while for load in all pillars, G35 inclination increases stress values in the cervical region.

Stress analysis of different configurations of 3 implants to support a fixed prosthesis in an edentulous jaw.

This study's aim was to evaluate the stress distribution in a mandibular implant-supported prosthesis and peri-implant bone considering implant quantity, diameter and position using linear 3-D finite element analysis. Models of an anterior jaw comprised 4 groups according to implant quantity, diameter, and position: control group C, 5 regular implants; R, 3 regular implants; W, 3 wide implants; and DTR, 3 regular implants with the distal ones tilted 30° distally. The cantilever was loaded with an axial load of 50 N. Data was evaluated using von Mises stress on implants and maximum principal stress and microstrain on the bone. The W group showed the lowest value of maximum principal stress in peri-implant bone of the loaded side (4.64 MPa) when compared to C (5.27 MPa), DTR (5.94 MPa), and R (11.12 MPa). Lower stress values in the loaded implants were observed in the experimental groups when compared to the C group. However, the unloaded implants presented opposite results. All the screws of the W group presented lower stress values when compared to the C group. However, the R and DTR groups presented an increase in stress values with the exception of the loaded screw. A reduction in the number of implants associated with wider implants reduced the stress in the bone and prosthetic components.

Influence of post-thickness and material on the fracture strength of teeth with reduced coronal structure.

PURPOSE: To evaluate the fracture strength of endodontically treated teeth with reduced coronal structure reinforced with glass-fiber posts and cast posts and core (nickel-chromium alloy) with different thickness. MATERIALS AND METHODS: Forty maxillary central incisors were sectioned at 1 mm of the cementoenamel junction and endodontically treated. The teeth were divided into four groups (n = 10) and restored with cast post and core and glass-fiber posts with diameters of 1.5 mm and 1.1 mm. The fracture strength was evaluated using a Universal Testing Machine (Instron 1144) at 45° of angulation. The results were submitted to analysis of variance two-way and Tukey's test (P < 0.05). The failure mode was also evaluated. RESULTS: Cast post and core were statistically superior to the glass-fiber posts with the self-post diameter (P = 0.001). When the self-post material was considered, no significant difference was observed between the two post-diameters (P = 0.749). The glass-fiber post-groups presented more fractures in the cervical third than the cast post and core groups. CONCLUSION: Teeth restored with cast post and cores present higher fracture strength than those reinforced with glass-fiber posts. An increased post-thickness does not increase the fracture strength. Glass-fiber posts lead to less severe fractures.

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.

Short implants to support mandibular complete dentures - photoelastic analysis

Abstract This study evaluated the stress behavior around short implants in edentulous atrophic mandibles. Six groups included implants with two diameters regular and wide (4 and 5 mm) and three lengths (5, 7 and 9 mm) as follows: Ci9 (9 x 4 mm), Ci7 (7 x 4 mm), Ci5 (5 x 4 mm), Wi9 (9 x 5 mm), Wi7 (7 x 5 mm) and Wi5 (5 x 5 mm). These groups were compared to the control group CG (11 x 4 mm). The analysis was performed with the photoelastic method (n = 6). Each model comprised 4 implants with the same length and diameter connected by a chromium-cobalt bar that simulates a fixed denture. A 0.15 kg force was applied at the end of the cantilever (15 mm), and the maximum shear stress was recorded around the distal and subsequent implants. The stress values were determined, and the quantitative data (Fringes®) were submitted to statistical analysis with one-way ANOVA and the Dunnett test (p < 0.05). It was observed that the reduction in implant length increased stress values with a significant difference (p < 0.05) between CG Ci7 and Ci5, while the increase in implant diameter reduced the stress values without any differences found between short and long implants. Implants with 5 and 7 mm with regular diameter increased stress levels while short implants with larger diameters experienced similar stress to that of longer implants.

Relação de distúrbios temporomandibulares e alterações do padrão de sono na síndrome da fibromialgia ­ revisão da literatura / Relationship of temporomandibular disorders and sleep patterns in fibromyalgia syndrome

A fibromialgia é uma síndrome reumática caracterizada por quadros dolorosos intensos. A presença da dor muitas vezes chega a causar incapacidade e indisposição, mesmo para realização de atividades rotineiras, bem como parece afetar o sono em grande parte dos pacientes. Acredita-se que a perpetuação de alterações no padrão de sono crie uma situação cíclica que intensifica os quadros dolorosos e a fadiga. Os distúrbios temporomandibulares (DTM) que são caracterizados por quadros de dor também vêm sendo relacionados com alterações no sono. Essas duas condições, apesar de distintas, parecem coexistir em um grande número de portadores de fibromialgia, levando-se a pesquisas que visam buscar a influência dessa relação como causa e efeito dentro deste grupo de pacientes. Neste contexto, este trabalho teve o objetivo de recolher informações dentro da literatura sobre essas duas condições, sua influência nas alterações do sono, bem como reunir estudos que busquem esclarecer a relação existente entre as duas condições. Para isto foram reunidos trabalhos publicados na base de dados PubMed, LILACSeMEDLINEutilizando-se os termos fibromialgia, DTM e sono, nos idiomas inglês e português. Os trabalhos apontam que há uma prevalência alta entre mulheres e que os portadores de fibromialgia apresentam alterações específicas no padrão de sono, bem como há uma importante correlação desta condição com os distúrbios temporomandibulares (AU).

Fibromyalgia syndrome is characterized by severe painful conditions. The presence of pain can result in some disability and even unwillingness to perform routine activities, and seems to affect sleep in most patients. It is believed that the changes in sleep pattern creates a cyclic condition and can increase fatigue painful conditions. The temporomandibular disorder (TMD) is characterized by pain frameworks have also been related to changes in sleep. These two conditions, while distinct, seem to coexist in a large number of patients with fibromyalgia, leading several researchs concerning the influence of this relationship within this group of patients. Therefore, this work aimed to collect information in the literature on these two conditions, its influence on sleep disorders as well as gathering studies that seek to clarify the relationship between these two conditions. For this were selected studies published in PubMed, LILACS, and MEDLINE using the terms fibromyalgia, TMD and sleep, in English and Portuguese. The studies indicate that there is a high prevalence among women and that patients with fibromyalgia have specific changes in sleep patterns, and there is a significant correlation of this condition with temporomandibular disorders (AU).

Stress analysis in maxillary all-on-four model / Análisis del estrés en un modelo maxilar del concepto all-on-four

The aim of this research was to evaluate the load distribution in tilted distal implants used in the all-on-four system. Two implant schemes were used. In both, two vertical anterior implants and tilted posterior implants were installed, one group with an angulation of 15 and another with an angulation of 35. The implants were installed together with a bar binding them all in a photoelastic model obtained from a replica of an edentulous maxilla. In this model, loads were produced in the sector of the bar cantilever, the abutment of the tilted implants and over the four implants using devices specially designed for this purpose. The bands were recorded with a digital camera, and the qualitative and quantitative analyses were carried out by means of student's t-test and the Mann-Whitney test in Biostat v. 5.0, considering a level of p<0.05 to establish a statistically significant relation. In the qualitative analysis, the implant with 35 presented the greatest amount of stress on the cantilever forces at cervical level. The quantitative studies showed fewer differences in all aspects assessed, although significant differences were observed between the two systems when loads were applied at cantilever level. It can be concluded that there are minimal differences in the stress distribution when comparing implants with angulations of 15 or 35. However, there is a greater concentration of stress at the cervical level in implants tilted to 35.

El objetivo de esta investigación fue evaluar la distribución de cargas en implantes angulados distales utilizados en el sistema "All-On-Four". Dos esquemas de implantes fueron empleados. En ambos, dos implantes verticales en el área anterior y dos implantes angulados en el sector posterior fueron instalados, utilizando angulaciones de 15 y 35 o en estos últimos. Los implantes fueron instalados de forma conjunta mediante una barra unida al sistema de resina fotoelástica obtenida de una replica de una maxila edéntula. En este modelo, las cargas fueron producidas en el sector del cantiléver de la barra, el pilar del implante angulado y, mediante un sistema genérico, sobre la totalidad de los implantes. Las bandas de estrés fueron reconocidas en una cámara digital donde los análisis cualitativos y cuantitativos fueron realizados utilizando las pruebas t de Student y Mann-Whitney en el programa computacional Biostat v. 5.0, considerando un valor de p<0,05 para establecer diferencias significativas. En el análisis cualitativo, los implantes con 35 presentaron una gran cantidad de estrés en el área de cantiléver, principalmente a nivel cervical. Los estudios cuantitativos mostraron limitadas diferencias en todos los aspectos, aunque diferencias significativas fueron alcanzadas cuando se compararon ambos sistemas después de la carga a nivel del cantiléver. Se puede concluir que hay diferencias menores en la distribución de estrés cuando se comparan implantes dentales con angulación de 15 y 35. Sin embargo, existe una mayor cantidad de concentraciones de estrés a nivel cervical en los implantes con 35 de angulación.

Stress analysis of different configurations of 3 implants to support a fixed prosthesis in an edentulous jaw

This study's aims was to evaluate the stress distribution in a mandibular implant-supported prosthesis and peri-implant bone considering implant quantity, diameter and position using linear 3-D finite element analysis. Models of an anterior jaw comprised 4 groups according to implant quantity, diameter, and position: control group C, 5 regular implants; R, 3 regular implants; W, 3 wide implants; and DTR, 3 regular implants with the distal ones tilted 30º distally. The cantilever was loaded with an axial load of 50 N. Data was evaluated using von Mises stress on implants and maximum principal stress and microstrain on the bone. The W group showed the lowest value of maximum principal stress in peri-implant bone of the loaded side (4.64 MPa) when compared to C (5.27 MPa), DTR (5.94 MPa), and R (11.12 MPa). Lower stress values in the loaded implants were observed in the experimental groups when compared to the C group. However, the unloaded implants presented opposite results. All the screws of the W group presented lower stress values when compared to the C group. However, the R and DTR groups presented an increase in stress values with the exception of the loaded screw. A reduction in the number of implants associated with wider implants reduced the stress in the bone and prosthetic components.

Uso de prótese fixa adesiva como mantenedor de espaço em dentes anteriores decíduos: um relato de caso / Use of fixed adhesive prosthesis as a space maintainer in anterior deciduous teeth: a case report

Apesar do curto período no qual os dentes decíduos permanecem na cavidade bucal, possuem um papel fundamental no crescimento e desenvolvimento da criança. A perda prematura dos dentes decíduos pode ocasionar vários problemas funcionais, psicológicos e sociais. Objetivo: O presente artigo relata um caso de perda precoce de incisivo central decíduo devido a um trauma. A criança possuía o hábito de colocar e pressionar a língua no espaço correspondente ao dente perdido. Foi proposta a manutenção do espaço com o auxílio de uma prótese fixa adesiva. Conclusão: A prótese fixa adesiva constitui uma solução prática para os casos de perda precoce de dentes anteriores decíduos, pois é de fácil execução, conservadora e preenche os requisitos funcionais e estéticos da criança...

Despite the short period that the deciduous teeth remain in the mouth, they have an important role in the growth and development of the child. The premature loss of deciduous teeth can cause several functional, psychological and social problems. Objective: This article reports a case of early loss of deciduous central incisor due to trauma. The child had a habit of pressing his tongue against the space corresponding to the missing tooth. It was proposed to maintain the space using a fixed adhesive prosthesis. Conclusion: The fixed adhesive prosthesis is a practical solution in cases of early loss of primary teeth since it is easy to perform, conservative and meets the functional and aesthetic requirements of the child...

Mimetização de prótese parcial fixa em caso de fluorose dentária / Partial fixed prosthesis mimicking in case of dental fluorosis

Introdução: O sucesso estético em prótese dentária, seja em reabilitações extensas ou unitárias, se baseia na mimetização da peça protéica. A não percepção da substituição da estrutura dentária perdida é o objetivo atual na Odontologia Restauradora. A presença de manchas ou características específicas torna essa camuflagem mais difícil e, a necessidade de esconder a prótese torna-se um desafio. Descrever a confecção de uma prótese fixa metalocerâmica caracterizada em paciente diagnosticado com fluorose intensa e generalizada. Foi utilizada a técnica da estratificação com representação de manchas opacas através de ranhuras irregulares, bem como o registro fotográfico como método auxiliar na transmissão de informação entre o protesista e o laboratório. A caracterização das manchas se mostrou um método importante a ser considerado na reabilitação bucal, tornando o sorriso mais harmonioso

Introduction: The esthetic success of dental restorations in either extensive or unit cases is based on mimicking the prosthesis. Not percepting the lost tooth replacement is the current objective in restorative dentistry. Additionally, the presence of staining or specifc characteristics makes the dental camouflage more diffcult. In these cases, the need for hiding the prosthesis becomes a challenge. Objective: This report aims to describe the mimicking of a ceramic fxed partial denture in a patient diagnosed with severe and widespread fluorosis. Case report: The layering technique was used in this case, which allowed the characterization of the stains with irregular groves. It was also used the photographic record as an auxiliary method in information transmission between prosthodontist and laboratory. Conclusion: Mimicking of fxed partial denture was showed as an important alternative to be considered in oral rehabilitation, making the smile more harmonious.

Biossegurança: comportamento dos alunos de Odontologia em relação ao controle de infecção cruzada / Biosecurity: behavior of dental students in control of cross infection

O objetivo deste trabalho foi avaliar o comportamento de acadêmicos de Odontologia com relação ao controle da infecção cruzada, verificando se alunos que estão mais adiantados no curso de formação profissional apresentam melhores condutas de biossegurança. Os temas abordados contemplaram: etapas dos processos de esterilização (desinfecção pré-lavagem, lavagem e esterilização); desinfecção de superfícies e utilização de barreira mecânica. Para isto foram sorteados 117 alunos matriculados nas clínicas da faculdade, convidados a responder um questionário com 19 perguntas objetivas. As respostas foram submetidas à análise descritiva e ao teste do χ². Foi verificado que 94,0% dos alunos não realizam desinfecção pré-lavagem, 86,2% sempre fazem a lavagem dos instrumentais antes da esterilização e 2,5% utilizam proteção das mãos adequada para este fim. A desinfecção das superfícies é realizada por 52% dos alunos e a barreira mecânica é habitualmente utilizada por 73% deles. A análise estatística identificou que alunos do oitavo e nono períodos apresentam melhor comportamento na conduta de organização do instrumental para esterilização e desinfecção de superfícies. E constatou-se que alunos dos períodos mais avançados apresentam melhores condutas. Não há uma padronização no comportamento a respeito da prevenção da infecção cruzada no que diz respeito às etapas básicas de biossegurança no centro acadêmico avaliado.

The aim of this study was to evaluate the behavior of dental students regarding cross infection control, verify that students who are more advanced in the course had better biosecurity conduct. The topics covered included: stages of sterilization processes (disinfection pre-washing, washing and sterilization), surface disinfection and use of mechanical barrier. For this 117 students enrolled in clinical discipline were randomly selected and invited to answer a questionnaire with 19 objective questions. The responses were analyzed descriptively and the χ² test. It was found that 94.0% of students do not perform disinfection prewash, 86.2% always do the washing of instruments prior to sterilization and 2.5% use hand protection appropriate for this purpose. Disinfection of surfaces is performed by 52% of the students and the mechanical barrier is commonly used by 73% of them. Statistical analysis identified that students in eighth and ninth periods have better behavior in to organization of the instrumental for sterilization and to disinfection of surfaces. It was found that students in the later periods show better behavior. There is no a pattern in behavior regarding the prevention of cross infection to the basic steps of biosafety academic center evaluated.

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