Counselling and self-management therapies for temporomandibular disorders: a systematic review.

The aim of this review was to investigate the effectiveness of counselling and other self-management-based therapies on muscle and temporomandibular joint (TMJ) pain relief and increasing the functional abilities of patients with temporomandibular disorders (TMD). A systematic literature review was conducted by three independent reviewers and included articles published up to 2012. PubMed and Cochrane Library electronic databases were used in addition to hand-searching to assess clinical outcomes for counselling and self-management approaches for TMD treatment. The review yielded 581 records that were narrowed down to 7. All included studies were classified as blind-randomized controlled clinical trials. The selected articles analysed revealed that counselling was able to improve tenderness upon masticatory muscle palpation and maximum mouth opening with and without pain in patients with TMD, with similar results to those of interocclusal appliances approaches. Thus, counselling- and self-management-based therapies could be considered a conservative low-cost and beneficial treatment alternative for treating TMD to potentially improve psychological domains and remove harmful behaviours for the control of the signs and symptoms of TMD.

Mandibular implant-supported removable partial denture with distal extension: a systematic review.

The aim of this article is to investigate patient satisfaction, survival rate of implants, and prosthetic complications or maintenance for rehabilitation with removable partial dentures associated with implants in mandibular Kennedy class I and II cases. A systematic literature review was conducted by three independent reviewers including articles published from January 1981 through September 2011. Medline and Cochrane Library electronic databases were used in addition to hand searching to assess clinical outcomes for mandibular implant-supported removable partial denture with distal extension. This review yielded 1751 records that were narrowed down to 5. The studies revealed implant survival rates ranging from 95% to 100% with one failure reported of 98 implants. The removable partial dentures associated with implant in mandibular free-end arches showed some complications and need of repair for relining, pitting of the healing abutment, replacement of resilient component of the attachment, damage in framework, screw loosening and damage in acrylic denture base. Patient satisfaction was evaluated through a five-point questionnaire, and results ranged between 4.12 and 5.0, considering 1 as the least favourable situation. The literature review showed increase in patient satisfaction and high survival rates of implants associated with mandibular removable partial dentures with distal extensions. However, some complications and need of prosthetic repair were reported. Although this treatment approach could represent a low-cost and beneficial rehabilitation for free-end mandibular ridges, the lack of controlled and randomised well-designed clinical trials suggests further studies with more representative samples to validate the outcomes of this treatment modality.

Factors associated with active white enamel lesions.

OBJECTIVE: The aim of this study was to assess the factors associated with the presence of active white enamel lesions among public school students in the city of Natal, Brazil. METHODS: A convenience sample of 300 boys and girls aged between 7 and 12 years was selected among the pupils attending public schools in the city of Natal. Only those children presenting with opaque and rough-surface white lesions in a region of biofilm accumulation on the vestibular surface of permanent upper incisors were included. The investigation took the form of a cross-sectional study. A chart containing individual data was used, and a clinical examination was performed to determine the oral health status of the children, including caries (DMF-s(1), DMF-s(2), DMFdmf, dmf and total number of teeth with caries) and oral hygiene status (Gingival Bleeding Index and Visible Plaque Index). Data underwent descriptive analysis and analysis of variance, and chi-square tests were used for the comparison of continuous and dichotomous variables between groups with one, two, or three or more white lesions. RESULTS: On average, each child presented with 2.3 teeth affected by white lesions, relatively high indices of dental caries and poor oral hygiene, with an 85% rate of localized plaque on the surfaces of teeth with lesions. The presence of visible plaque was statistically significant between the three groups, based on the number of lesions (P = 0.006), indicating a positive association between the number of lesions and the presence of biofilm. CONCLUSION: There is a strong association between the presence of dental biofilm, high indices of caries and active white enamel lesions. Full professional effort is needed in order to motivate children to carry out oral hygiene sufficient for the adequate control of dental biofilm.