BACKGROUND: Primary care dentists are often the first point of call for people with temporomandibular disorders (TMD) but it is not known how many people present to their dentist with TMD or the forms of first-line management that are routinely offered. OBJECTIVES: To report rates of presentation of TMD and management offered in primary care by general dental practitioners in two similarly urban areas, Santiago, Chile and North-East England. METHODS: An online survey was developed and distributed to primary care dentists in both regions. Descriptive data were presented to quantify presentation rates and forms of management offered. RESULTS: Responses were received from 215 dentists practising in Chile and 46 in Newcastle. The majority reported seeing 1-2 patients weekly with TMD and less than one new presentation each week. Symptoms were most often treated conservatively and with self-management according to international guidelines. The form of self-management varied however and verbal instructions were often not backed up by written information. CONCLUSIONS: This research provides a useful starting point in understanding the presentation to, and initial treatment of TMD in primary care internationally. Limitations included the method of recruitment and potentially non-representative samples. Further research could build on this work by including more countries and using more structured sampling methods. The work will be useful in understanding and planning early care pathways for people experiencing TMD.
Dentists , Temporomandibular Joint Disorders , Humans , Professional Role , Surveys and Questionnaires , Temporomandibular Joint Disorders/diagnosis , Temporomandibular Joint Disorders/therapy , Primary Health Care
BACKGROUND: Despite advances in temporomandibular disorders' (TMDs) diagnosis, the diagnostic process continues to be problematic in non-specialist settings. OBJECTIVE: To complete a Delphi process to shorten the Diagnostic Criteria for TMD (DC/TMD) to a brief DC/TMD (bDC/TMD) for expedient clinical diagnosis and initial management. METHODS: An international Delphi panel was created with 23 clinicians representing major specialities, general dentistry and related fields. The process comprised a full day workshop, seven virtual meetings, six rounds of electronic discussion and finally an open consultation at a virtual international symposium. RESULTS: Within the physical axis (Axis 1), the self-report Symptom Questionnaire of the DC/TMD did not require shortening from 14 items for the bDC/TMD. The compulsory use of the TMD pain screener was removed reducing the total number of Axis 1 items by 18%. The DC/TMD Axis 1 10-section examination protocol (25 movements, up to 12 sets of bilateral palpations) was reduced to four sections in the bDC/TMD protocol involving three movements and three sets of palpations. Axis I then resulted in two groups of diagnoses: painful TMD (inclusive of secondary headache), and common joint-related TMD with functional implications. The psychosocial axis (Axis 2) was shortened to an ultra-brief 11 item assessment. CONCLUSION: The bDC/TMD represents a substantially reduced and likely expedited method to establish (grouping) diagnoses in TMDs. This may provide greater utility for settings requiring less granular diagnoses for the implementation of initial treatment, for example non-specialist general dental practice.
Facial Pain , Temporomandibular Joint Disorders , Humans , Facial Pain/diagnosis , Headache/diagnosis , Physical Examination , Palpation
Temporomandibular disorders (TMDs) are complex multi-system disorders for which common traditional dental-centric approaches to research and care unfortunately continue to prevail. A committee appointed by the National Academies of Sciences, Engineering and Medicine (NAM) of the United States of America summarized important recommendations regarding the urgent need to transform, from the predominantly biomedical model, the research, professional education/training, and patient care for TMDs into the biopsychosocial model that is standard in the rest of pain medicine. The release of the Consensus Study Report identifies eleven short-term and long-term recommendations regarding gaps and opportunities oriented towards the situation in the US, which are equally applicable to the situation in Chile. The first four recommendations focus on basic and translational research, public health research and strengthening clinical research. The next three recommendations concern risk assessment, diagnostics, and dissemination of clinical practice guidelines and care metrics to improve patient care and expand its access. Recommendations eight to ten propose Centers of Excellence for Temporomandibular Disorders and Orofacial Pain Treatment, improving professional school education, and expanding specialized continuing education for healthcare providers. The eleventh recommendation focuses on patient education and stigma reduction. This article highlights the published recommendations and addresses what should be considered by Chilean professionals, as a first step of a major effort to shift TMD research, treatment, and education paradigms for the years to come.
Los trastornos temporomandibulares son complejos trastornos multisistémicos para los que, lamentablemente, siguen prevaleciendo los enfoques tradicionales odontocéntricos comunes de la investigación y la atención. Un comité designado por las Academias Nacionales de Ciencias, Ingeniería y Medicina de los Estados Unidos de América resumió importantes recomendaciones relativas a la urgente necesidad de transformar, desde el modelo predominantemente biomédico, la investigación, la educación/formación profesional y la atención al paciente para los trastornos temporomandibulares en el modelo biopsicosocial que es estándar en el resto de la medicina del dolor. La publicación del informe del estudio de consenso identifica once recomendaciones de corto y largo plazo respecto a brechas y oportunidades orientadas a la situación en Estados Unidos, que son igualmente aplicables a la situación en Chile. Las primeras cuatro recomendaciones se centran en la investigación básica y traslacional, la investigación en salud pública y el fortalecimiento de la investigación clínica. Las tres recomendaciones siguientes se refieren a la evaluación de riesgos, el diagnóstico y la difusión de guías de práctica clínica y métricas asistenciales para mejorar la atención de los pacientes y ampliar su acceso. Las recomendaciones octavas a décima proponen centros de excelencia para el tratamiento de los trastornos temporomandibulares y el dolor orofacial, la mejora de la formación en los centros profesionales y la ampliación de la formación continua especializada para los profesionales sanitarios. La undécima recomendación se centra en la educación de los pacientes y la reducción del estigma. Este artículo destaca las recomendaciones publicadas y aborda lo que debiesen considerar los profesionales chilenos, como primer paso hacia un gran esfuerzo por cambiar los paradigmas de investigación, tratamiento y educación sobre los trastornos temporomandibulares para los próximos años.
Temporomandibular Joint Disorders , Humans , United States , Chile , Temporomandibular Joint Disorders/therapy , Temporomandibular Joint Disorders/psychology , Facial Pain/therapy , Pain Management
Los trastornos temporomandibulares son complejos trastornos multisistémicos para los que, lamentablemente, siguen prevaleciendo los enfoques tradicionales odontocéntricos comunes de la investigación y la atención. Un comité designado por las Academias Nacionales de Ciencias, Ingeniería y Medicina de los Estados Unidos de América resumió importantes recomendaciones relativas a la urgente necesidad de transformar, desde el modelo predominantemente biomédico, la investigación, la educación/formación profesional y la atención al paciente para los trastornos temporomandibulares en el modelo biopsicosocial que es estándar en el resto de la medicina del dolor. La publicación del informe del estudio de consenso identifica once recomendaciones de corto y largo plazo respecto a brechas y oportunidades orientadas a la situación en Estados Unidos, que son igualmente aplicables a la situación en Chile. Las primeras cuatro recomendaciones se centran en la investigación básica y traslacional, la investigación en salud pública y el fortalecimiento de la investigación clínica. Las tres recomendaciones siguientes se refieren a la evaluación de riesgos, el diagnóstico y la difusión de guías de práctica clínica y métricas asistenciales para mejorar la atención de los pacientes y ampliar su acceso. Las recomendaciones octavas a décima proponen centros de excelencia para el tratamiento de los trastornos temporomandibulares y el dolor orofacial, la mejora de la formación en los centros profesionales y la ampliación de la formación continua especializada para los profesionales sanitarios. La undécima recomendación se centra en la educación de los pacientes y la reducción del estigma. Este artículo destaca las recomendaciones publicadas y aborda lo que debiesen considerar los profesionales chilenos, como primer paso hacia un gran esfuerzo por cambiar los paradigmas de investigación, tratamiento y educación sobre los trastornos temporomandibulares para los próximos años.
Temporomandibular disorders (TMDs) are complex multi-system disorders for which common traditional dental-centric approaches to research and care unfortunately continue to prevail. A committee appointed by the National Academies of Sciences, Engineering and Medicine (NAM) of the United States of America summarized important recommendations regarding the urgent need to transform, from the predominantly biomedical model, the research, professional education/training, and patient care for TMDs into the biopsychosocial model that is standard in the rest of pain medicine. The release of the Consensus Study Report identifies eleven short-term and long-term recommendations regarding gaps and opportunities oriented towards the situation in the US, which are equally applicable to the situation in Chile. The first four recommendations focus on basic and translational research, public health research and strengthening clinical research. The next three recommendations concern risk assessment, diagnostics, and dissemination of clinical practice guidelines and care metrics to improve patient care and expand its access. Recommendations eight to ten propose Centers of Excellence for Temporomandibular Disorders and Orofacial Pain Treatment, improving professional school education, and expanding specialized continuing education for healthcare providers. The eleventh recommendation focuses on patient education and stigma reduction. This article highlights the published recommendations and addresses what should be considered by Chilean professionals, as a first step of a major effort to shift TMD research, treatment, and education paradigms for the years to come.
Current selective modification methods, coupled with functionalization through organic or inorganic molecules, are crucial for designing and constructing custom-made molecular materials that act as electroactive interfaces. A versatile method for derivatizing surfaces is through an aryl diazonium salt reduction reaction (DSRR). A prominent feature of this strategy is that it can be carried out on various materials. Using the DSRR, we modified gold surface electrodes with 4-aminebenzene from 4-nitrobenzenediazonium tetrafluoroborate (NBTF), regulating the deposited mass of the aryl film to achieve covering control on the electrode surface. We got different degrees of covering: monolayer, intermediate, and multilayer. Afterwards, the ArNO2 end groups were electrochemically reduced to ArNH2 and functionalized with Fe(II)-Phthalocyanine to study the catalytic performance for the oxygen reduction reaction (ORR). The thickness of the electrode covering determines its response in front of ORR. Interestingly, the experimental results showed that an intermediate covering film presents a better electrocatalytic response for ORR, driving the reaction by a four-electron pathway.
Four N-acylhydrazones of general formulae [R1-C(O)-NH-N=C(R2)(5-nitrofuryl)] with (R1 = ferrocenyl or cyrhetrenyl and R2 = H or Me) are synthesized and characterized in solution and in the solid-state. Comparative studies of their stability in solution under different experimental conditions and their electrochemical properties are reported. NMR studies reveal that the four compounds are stable in DMSOd6 and complementary UV-Vis studies confirm that they also exhibit high stability in mixtures DMSO:H2O at 37 °C. Electrochemical studies show that the half-wave potential of the nitro group of the N-acylhydrazones is smaller than that of the standard drug nifurtimox and the reduction process follows a self-protonation mechanism. In vitro studies on the antiparasitic activities of the four complexes and the nifurtimox against Trypanosoma cruzi and Trypanosoma brucei reveal that: i) the N-acylhydrazones have a potent inhibitory growth activity against both parasites [EC50 in the low micromolar (in T. cruzi) or even in the nanomolar (in T. brucei) range] and ii) cyrhetrenyl derivatives are more effective than their ferrocenyl analogs. Parallel studies on the L6 rat skeletal myoblast cell line have also been conducted, and the selectivity indexes determined. Three of the four N-acylhydrazones showed higher selectivity towards T. brucei than the standard drug nifurtimox. Additional studies suggest that the organometallic compounds are bioactivated by type I nitroreductase enzymes.
Ferrous Compounds/chemistry , Hydrazones/chemistry , Hydrazones/pharmacology , Nitrofurans/chemistry , Trypanocidal Agents/pharmacology , Animals , Cell Line , Electrochemistry/methods , Humans , Nifurtimox/pharmacology , Nitroreductases/metabolism , Organometallic Compounds/chemistry , Rats , Trypanosoma brucei brucei/drug effects , Trypanosoma cruzi/drug effects
The synthesis and characterization of the novel ferrocenyl sulfonyl hydrazide [Fe(η5-C5H5){(η5-C5H4)-S(O)2-NH-NH2}] (2) is reported. Additional studies on its reactivity using acetone or the ferrocenyl-, cyrhetrenyl- or cymantrenyl-aldehydes have allowed us to isolate and characterize [Fe(η5-C5H5){(η5-C5H4)-S(O)2-NH-N[double bond, length as m-dash]CMe2}] (3), the bis(ferrocenyl) derivative [Fe(η5-C5H5){[(η5-C5H4)-S(O)2-NH-N[double bond, length as m-dash]CH-(η5-C5H4)]Fe(η5-C5H5)}] (4) and the heterodimetallic compounds [Fe(η5-C5H5){[(η5-C5H4)-S(O)2-NH-N[double bond, length as m-dash]CH-(η5-C5H4)]M(CO)3}] with M = Re (5a) or Mn (5b). The X-ray crystal structures of compounds 3, 5a and 5b are also reported. A comparative study of their electrochemical and spectroscopic properties is also described. Additional computational calculations based on the DFT methodology have allowed us to elucidate the effect produced by the replacement of the terminal -NH2 (in 2) by the -N[double bond, length as m-dash]CMe2 (in 3) and -N[double bond, length as m-dash]CHR (in 4, 5a and 5b) moieties on the electronic distribution and to explain the differences detected in their electrochemical properties and absorption spectra. In vitro cytotoxicity studies of compounds 2, 4, 5a and 5b on the HCT-116 (colon), MCF7 and MDA-MB231 (breast) cancer cell lines reveal that compound 2 has no significant activity (IC50 > 100 µM), while its derivatives 4, 5a and 5b proved to be active in the three cancer cell lines selected in this study. The growth inhibition potency of compounds 5a and 5b against the triple negative MDA-MB231 breast cancer cell line is similar (or slightly) greater than that of cisplatin. Moreover, compounds 2, 4, 5a and 5b are less toxic than cisplatin in the normal and non-tumoral BJ fibroblasts, and the heterodimetallic complexes 5a and 5b with selective index >2.1 show an outstanding selective toxicity towards the MDA-MB231 cancer cells.
Temporomandibular disorders (TMD) is a collective term for a group of musculoskeletal conditions involving pain and/or dysfunction in the masticatory muscles, temporomandibular joints (TMJ) and associated structures. It is the most common type of non-odontogenic orofacial pain and patients can present with pain affecting the face/head, TMJ and or teeth, limitations in jaw movement, and sounds in the TMJ during jaw movements. Comorbid painful and non-painful conditions are also common among individuals with TMD. The diagnosis of TMD have significantly improved over time with the recent Diagnostic Criteria for TMD (DC/TMD) being reliable and valid for most common diagnoses, and an efficient way to communicate in multidisciplinary settings. This classification covers 12 most common TMD, including painful (myalgia, arthralgia and headache attributed to TMD) as well as the non-painful (disc displacements, degenerative joint disease and subluxation) TMD diagnoses. Recent studies have demonstrated that the pathophysiology of common painful TMD is biopsychosocial and multifactorial, where no one factor is responsible for its development. Importantly, research has suggested different predisposing, initiating and perpetuating factors, including both peripheral and central mechanisms. This is an active field of investigation and future studies will not only seek to clarify specific causal pathways but translate this knowledge into mechanism-directed diagnosis and treatment. In accordance with this complex aetiology, current evidence supports primarily conservative multidisciplinary treatment including self-management strategies, behavioural therapy, physical therapy and pharmacotherapy. The aim of this review is to present an overview of most recent developments in aetiology, pathophysiology, diagnosis and management of TMD.
Distress, suffering and care-seeking behaviour are characteristics of pain-related disease and illness. Pain that transitions from an acute to a chronic phase carries with it the potential of further effects: these include a worsening of the disease or illness; high-impact chronic pain; and substantial personal, societal and economic burden. The biopsychosocial model directly addresses these multiple processes, yet clinical frameworks supporting this model are not universally implemented. This paper explores barriers to clinical implementation of a full biopsychosocial framework for temporomandibular disorders (TMD) and other oro-facial pain (OFP) conditions. In June 2016, INfORM invited OFP researchers to a workshop designed to optimise the DC/TMD Axis-II. Workshop groups identified five sources of implementation barriers: (1) cultures and societies, (2) levels-of-care settings, (3) health services, (4) cross-cultural validity of self-report instruments and (5) provider and patient health literacy. Three core problems emerged: (A) mental health aspects are seldom fully considered, thus impairing the recognition of illness, (B) training in use of validated multi-axial assessment protocols is under-rated and insufficiently used, and (C) clinical assessment often fails to recognise that sensory and emotional dimensions are fundamental aspects of pain. To improve patient care, these barriers and problems require action. Most importantly, TMD/OFP educators and researchers need to coordinate globally and (i) be educated in the biopsychosocial model, (ii) implement evidence-based biopsychosocial guidelines for assessment and management of OFP conditions at their institutions, (iii) incorporate this model in undergraduate and postgraduate dental curricula and (iv) be responsive to stakeholders, including regulatory authorities and practitioners.
Chronic Pain , Temporomandibular Joint Disorders , Facial Pain , Humans , Patient Acceptance of Health Care , Self Report
The understanding of the mean free path (MFP) distribution of the energy carriers in materials (e.g., electrons, phonons, magnons, etc.) provides a key physical insight into their transport properties. In this context, MFP spectroscopy has become an important tool to describe the contribution of carriers with different MFP to the total transport phenomenon. In this work, we revise the MFP reconstruction technique and present a study on the impact of the regularization parameter on the MFP distribution of the energy carriers. By using the L-curve criterion, we calculate the optimal mathematical value of the regularization parameter. The effect of the change from the optimal value in the MFP distribution is analyzed in three case studies of heat transport by phonons. These results demonstrate that the choice of the regularization parameter has a large impact on the physical information obtained from the reconstructed accumulation function, and thus cannot be chosen arbitrarily. The approach can be applied to various transport phenomena at the nanoscale involving carriers of different physical nature and behavior.
The syntheses, characterization, X-ray crystal structures, electrochemical properties and anticancer and antichagasic activities of the first examples of 2-substituted 2,4-dihydro-1H-3,1-benzoxazines with half-sandwich organometallic arrays, [M(η5-C5H4)(CO)3] (M = Re or Mn), at position-2 are described. Experimental and computational studies based on DFT calculations on the open forms [Schiff bases of general formulae R-CH[double bond, length as m-dash]N-C6H4-2-CH2OH] (5), with R = ferrocenyl (a), phenyl (b), cyrhetrenyl (c) or cymantrenyl (d), and their tautomeric forms (2-substituted 2,4-dihydro-1H-3,1 benzoxazines) have allowed us to establish the influence of substituents a-d and solvents on: (a) the extent of tautomeric equilibria (5a-5d) â (6a-6d) and (b) their electrochemical properties and the electronic distribution on the open and closed forms. Despite the formal similarity between 6c and 6d, their anticancer and antiparasitic activities are markedly different. Compound 6d is inactive in the HCT116, MDA-MB231 and MCF7 cancer cell lines, but 6c shows moderate activity in the latter cell line, while the Mn(i) complex (6d) is a more potent anti-Trypanosoma cruzi agent than its Re(i) analogue (6c).
The synthesis and characterization of two novel and isomeric hybrid ferrocenyl/cyrhetrenyl aldimines [(η5-C5H5)Fe{(η5-C5H4)-CH[double bond, length as m-dash]N-(η5-C5H4)}Re(CO)3] (1) and [(η5-C5H5)Fe{(η5-C5H4)-N[double bond, length as m-dash]CH-(η5-C5H4)}Re(CO)3] (2) are reported. Their X-ray crystal structures reveal that both adopt the E form. However, molecules of 1 and 2 differ in the relative arrangement of the "Fe(η5-C5H5)" and "Re(CO)3" units (anti in 1 and syn in 2). This affects the type of intermolecular interactions, the assembly of the molecules and therefore their crystal architecture. Comparative studies of their electrochemical, spectroscopic and photo-physical properties have allowed us to clarify the effect produced by the location of the organometallic arrays (ferrocenyl or cyrhetrenyl) on electronic delocalization, the proclivity of the metals to undergo oxidation and their emissive properties. Theoretical studies based on Density Functional Theory (DFT) calculations on the two compounds have also been carried out in order to rationalize the experimental results and to assign the bands detected in their electronic spectra. The cytotoxic activities of compounds 1 and 2 against human adenocarcinoma cell lines [breast (MCF7 and MDA-MB-231) and colon (HCT-116)] reveal that imine 2 has a greater inhibitory growth effect than 1 and it is ca. 1.8 times more potent than cisplatin in the triple negative MDA-MB 231 and in the cisplatin resistant HCT-116 cell lines. A comparative study of their effect on the normal and non-tumour human skin fibroblast BJ cell lines is also reported.
OBJECTIVES: This study investigated the relationship between urease and arginine deiminase system (ADS) activities and dental caries through a cross-sectional study. MATERIAL AND METHODS: Urease and ADS activities were measured in saliva and plaque samples from 10 caries-free subjects and 13 caries-active. Urease activity was obtained from the ammonia produced by incubation of plaque and saliva samples in urea. ADS activity was obtained from the ammonia generated by the arginine-HCl and Tris-maleate buffer. Specific activity was defined as micromoles of ammonia per minute per milligram of protein. Shapiro-Wilk statistical test was used to analyze the distribution of the data, and Mann-Whitney test was used to determine the significance of the data. RESULTS: The specific urease activity in saliva and plaque was significantly higher in individuals with low DMFT scores. ADS activity in saliva (6.050 vs 1.350, p=0.0154) and plaque (8.830 vs 1.210, p=0.025) was also higher in individuals with low DMFT scores. CONCLUSIONS: Caries-free subjects had a higher ammonia generation activity by urease and arginine deiminase system for both saliva and plaque samples than low caries-active subjects. High levels of alkali production in oral environment were related to caries-free subjects.
Dental Caries/enzymology , Dental Plaque/enzymology , Hydrolases/analysis , Saliva/enzymology , Urease/analysis , Alkalies/metabolism , Ammonia/analysis , Case-Control Studies , Cross-Sectional Studies , DMF Index , Dental Plaque/chemistry , Female , Humans , Male , Reference Values , Risk Factors , Saliva/chemistry , Statistics, Nonparametric
Objectives: This study investigated the relationship between urease and arginine deiminase system (ADS) activities and dental caries through a cross-sectional study. Material and Methods: Urease and ADS activities were measured in saliva and plaque samples from 10 caries-free subjects and 13 caries-active. Urease activity was obtained from the ammonia produced by incubation of plaque and saliva samples in urea. ADS activity was obtained from the ammonia generated by the arginine-HCl and Tris-maleate buffer. Specific activity was defined as micromoles of ammonia per minute per milligram of protein. Shapiro-Wilk statistical test was used to analyze the distribution of the data, and Mann-Whitney test was used to determine the significance of the data. Results: The specific urease activity in saliva and plaque was significantly higher in individuals with low DMFT scores. ADS activity in saliva (6.050 vs 1.350, p=0.0154) and plaque (8.830 vs 1.210, p=0.025) was also higher in individuals with low DMFT scores. Conclusions: Caries-free subjects had a higher ammonia generation activity by urease and arginine deiminase system for both saliva and plaque samples than low caries-active subjects. High levels of alkali production in oral environment were related to caries-free subjects. .
Humans , Male , Female , Dental Caries/enzymology , Dental Plaque/enzymology , Hydrolases/analysis , Saliva/enzymology , Urease/analysis , Alkalies/metabolism , Ammonia/analysis , Case-Control Studies , Cross-Sectional Studies , DMF Index , Dental Plaque/chemistry , Reference Values , Risk Factors , Saliva/chemistry , Statistics, Nonparametric
Los pacientes con trastornos temporomandibulares (TTM) presentan trastornos psicológicos y psiquiátricos frecuentemente. Estos pacientes frecuentemente muestran somatización, depresión, ansiedad, reacción al estrés y catastrofismo, lo que juega un rol en la predisposición, iniciación y perpetuación de los TTM y en la respuesta al tratamiento. Esta revisión presenta opciones terapéuticas que comprometen al eje psicológico de los pacientes con TTM, las cuales buscan principalmente reducir la ansiedad y la tensión emocional presentes, modificar las distintas percepciones del dolor y cómo afrontarlo. Existen diversas posibilidades, dentro de las cuales se encuentran: educación del paciente, identificación de las situaciones que incrementan esa tensión para evitarlas, enseñanza de técnicas de relajación como biofeedback, hipnosis y yoga. En cuanto al tratamiento psicológico, la que presenta mejor resultado para los TTM, es la terapia cognitiva conductual (TCC). La intervención psicológica adecuada y eficaz puede reducir el dolor de los TTM, disminuyendo la probabilidad de que el cuadro se haga más complejo. Dentro de las alternativas de tratamiento psicológico para los TTM, un tratamiento estándar conservador (educación, instrucción de autocuidado, evitación de movimientos dolorosos, dieta blanda), incluso el más breve, puede ser suficiente a corto plazo para la mayoría de los pacientes que presentan TTM, sobretodo en los casos de cuadros agudos. La adición de una TCC, por parte de un especialista, entrega habilidades de afrontamiento que se sumarán a la eficacia, especialmente en los casos crónicos, obteniendo mejores resultados a largo plazo.
Patients with temporomandibular disorders (TMD) frecuently present psychological and psychiatric problems. These patients often show increased somatization, depression, anxiety, stress reaction and catastrophism, wich plays a role in the predisposition, initiation and perpetuation of TMD and treatment response. This review presents thaerapeutic options that compromise the psychological axis of patients with TMD, wich primarily seek to reduce the anxiety and the emotional stress present, modify different perceptions of pain and coping. There are different posibilities, within wich are: patient education, identifying situations that increase the tension to avoid them, teaching relaxation techniques such as biofeedback, hipnosis and yoga. As for psychological treatment, the most common for chronic orofacial pain is cognitive behavioral therapy (CBT). The appropriate and effective psychological intervention can reduce TMD pain, decreasing the probability that the symptoms become more complex. Within psychological treatment options for TMD, conservative standard treatment (education, self-instruction, avoidance of painful movements, soft diet), even the shortest, may be sufficient in the short term for most patients with TMD, especially in cases of acute conditions. The addition of CBT, by a specialist, gives coping skills that will add to the effectiveness, especially in chronic cases, obtaining better results in the long term.
Humans , Psychotherapy/methods , Temporomandibular Joint Disorders/psychology , Temporomandibular Joint Disorders/therapy , Anxiety , Cognitive Behavioral Therapy , Stress, Psychological
El objetivo de este estudio in vitro fue describir la superficie coronaria y radicular alrededor de restauraciones de resina compuesta posterior a su pulido. Materiales y método: se realizaron 50 restauraciones estandarizadas sobre la superficie coronaria y 50 sobre la superficie radicular de dientes extraídos por indicación ortodóncica. Las cavidades se prepararon utilizando fresas cilíndricas de carbide (Meissinger®) con alta velocidad (Champion Dental Products Inc) bajo irrigación y fueron restauradas con resina compuesta híbrida (Filtek® Z 250, 3M®). Fueron separadas aleatoriamente en 5 grupos de 10 restauraciones coronarias y 10 radiculares. Cada grupo fue pulido utilizando un sistema diferente, siguiendo las indicaciones del fabricante. Grupo 1 (PB): Piedras de Arkansas (Dedeco). Grupo 2 (PD): piedras de diamante finas, extrafinas y ultrafinas (Diatech®). Grupo 3 (DOA): discos de óxido de aluminio (Sof lex®, 3M®). Grupo 4 (PG): puntas Enhance® (Dentsply®). Grupo 5 (FCT): fresas de carburo tungsteno de 16 y 30 cuchillo (Komet®). 10 dientes sin tratamiento se dejaron como grupo control (Grupo 6). Todas las muestras fueron observadas y fotografiadas mediante microscopía electrónica de barrido (TEAC Siemens®) y microscopía óptica (Carl Zeiss®). Las imágenes se compararon con las del grupo control. Resultados: la comparación de las microfotografías de los grupos tratados con las del grupo control mostró cambios en la corona y en la raíz en los grupos 1, 2, 3 y 4. En la corona se observó una pérdida de las características superficiales del esmalte y en la raíz una pérdida del cemento y exposición de dentina. En el grupo 5 algunas muestras presentaron modificación de la estructura superficial normal y otras no. Conclusión: los 5 sistemas de pulido de resinas compuestas analizados en este estudio modificaron la superficie del esmalte y el cemento.
The aim of this IN VITRO study was to describe the crown and root surface surrounding composite restorations, after polishing procedures. Materials and Methods: 50 standardized restorations were made over the crown surface and 50 over the root surface of teeth extracted by orthodontics indications. The cavities were prepared using cylindrical carbide burs (Meissinger) under water irrigation with a high speed hand piece (Champion Dental Products Inc) and restored with hybrid composite (Filtek Z250®, 3M®). They were randomized and separated into five groups of 10 restorations either in crown and root. Each group was polished using different systems, according to manufacturers instructions. Group 1(PB): Arkansas Stone (Dedeco). Group 2 (PD): Fine, extrafine and ultrafine Diamond Burs (Diatech®). Group 3 (DOA): Aluminum Oxide Discs (Sof lex® 3M®). Group 4 (PG): Enhance® Points (Dentsply®). Group 5 (FCT): 16 and 30 blades Tungsten Carbide Burs (Komet®). 10 teeth without treatment were used as control group (Group 6). All samples were analyzed and photographed by SEM (TEAC Siemens®), and Optical microscope (Carl Zeiss®). The images were compared with control group. Results: The comparison of the microphotography with control group showed changes in both crown and root surfaces in groups 1, 2, 3 and 4. It was seen a loss of the enamel superficial characteristics, in crown surfaces and a loss of the cementum and exposure of dentin in root. In group 5 some specimens resulted in a modification of normal tooth surface characteristics and in others there were no changes. Conclusions: The five composites polishing systems analyzed in this study resulted in enamel and cementum modification.
