A recriação da mãe winnicottiana: o gesto espontâneo ameaçado / The recreating of the winnicottian mother: the threatened spontaneous gesture / La recreación de la madre winnicottiana: el gesto espontáneo amenazado / La réinvention de la mère winnicottienne: le geste spontané menacé

Este trabalho traz uma inquietação quanto ao destino dos bebês. Winnicott assinala que, para a mãe sair-se bem em sua tarefa, basta-lhe ser uma mulher comum. Não precisa ser inteligente, não necessita ser culta, nem assessorada, e menos ainda ser atrapalhada por teorias ou prescrições. A devoção materna basta para permitir a seus bebês que sigam espontâneos e capazes de uma expressividade própria. Hoje, contudo, essa mãe sobre a qual aprendemos a pensar na constituição do humano, que com sua existência e seus cuidados detém a função especial de apresentar o mundo externo ao bebê, tornando possível a ilusão, está em vias de desaparecimento. Deu-se uma ruptura nesse edifício sólido, coerentemente construído e experienciado, da antiga e preciosa unidade de mães-bebês-ambiente, que, ameaçada, corre risco de extinção. Assim, como pensar a experiência de maternagem constituinte do gesto espontâneo nas condições de busca e consolidação dos novos espaços ocupados pela mulher nas sociedades modernas? Como prescindir dela? Como receber os bebês que estão chegando? Donde recriar a mãe pensada por Winnicott?

This work brings a concern about the destiny of babies. Winnicott points out that for a mother to do well in her task, she simply needs to be an ordinary woman. She does not have to be intelligent; she does not need to be educated, advised or let alone be muddled by theories or prescriptions. The maternal devotion is enough to allow their babies to remain spontaneous and able to develop their own expressiveness. Today, however, this mother who we have learned to think about in the constitution of what is human, whose existence and care have detained the special function of presenting the external world to the baby, making illusion possible, is in the process of disappearing. There has been a rupture in this solid and coherently constructed building that lived on the old and accurate unit of mothers-babies-environment, which is endangered, threatened of extinction. Thus, how can we think of the experience of motherhood constituted in the spontaneous gesture in the conditions of a search for consolidation of new spaces occupied by women in modern societies? How to do without it? How to welcome the babies who are coming? Where can we recreate the mother conceived by Winnicott?

El presente trabajo presenta una inquietud al respecto del destino de los bebés. Winnicott señala que, para que a la madre le salga bien su función, es suficiente con que ella sea una mujer común. No es necesario que sea inteligente, no precisa ser culta ni asesorada y menos todavía tener que ser molestada por teorías y prescripciones. La dedicación materna es lo bastante para permitir que el bebé siga siendo espontáneo y capaz de tener una expresividad propia. Sin embargo, hoy en día, esa madre sobre la que aprendemos a pensar en la constitución de lo humano, que con su existencia y sus cuidados ejerce la función especial de presentarle el mundo externo a su bebé, haciendo posible así la ilusión, esta madre está en vías de desaparición. Se ha dado una ruptura en el edificio sólido, coherentemente construido y vivenciado de la antigua y preciosa unidad madre-bebé-ambiente, que al estar amenazada corre el peligro de extinguirse. De esta manera, ¿cómo podemos pensar el ejercicio de la experiencia de maternaje que es constitutiva del gesto espontáneo en las condiciones de búsqueda y consolidación de nuevos espacios ocupados por la mujer en las sociedades modernas? ¿Se puede prescindir de ellas? ¿Cómo recibir a los bebés que están llegando? ¿Desde dónde se puede recrear a la madre que ha sido pensada por Winnicott?

Cet article part d'une certaine inquiétation quant à l'avenir des bébés. Pour que la mère mène à bien sa tâche, souligne Winnicott, il ne lui suffit que d'être une "femme ordinaire". Elle n'a pas besoin d'être intelligente, d'avoir reçu une bonne éducation, d'être conseillée et encore moins d'être encombrée par des théories ou des prescriptions. Sa seule dévotion permettrait à son bébé d'être un sujet spontané et capable de manifester sa propre expressivité. Aujourd'hui toutefois cette mère - laquelle nous disons être à la base de la constitution de l'humain et qui, avec son existence et ses soins, a pour fonction spéciale de présenter le monde extérieur au bébé, lui permettant de rêver - est en voie de disparition. Il y a eu une rupture dans cette "construction solide", et érigée de manière cohérente, de l'ancienne et précieuse unité mère-bébé-environnement; elle est menacée à présent, voire en danger d'extinction. Comment peut-on alors penser l'expérience de la maternité [maternagem], qui constitue ce geste spontané, dans des conditions de recherche et d'occupation de nouveaux espaces par les femmes dans les sociétés modernes? Comment s'en passer? Comment "accueillir" les bébés qui arrivent? Comment réinventer la mère pensée par Winnicott?

Effect of cigarette smoking on pain intensity of TMD patients: a pilot study.

To evaluate the effect of cigarette smoking (CS) on pain intensity in a sample of temporomandibular disorder (TMD) patients, 352 clinical charts were reviewed. Subjects were first divided into two groups: smokers (YS) and nonsmokers (NS); then, YS were further divided into three subgroups: light smokers (LS), moderate smokers (MS), and heavy smokers (HS). Overall TMD pain intensity was higher in YS, compared to NS, and a correlation was found between pain intensity and the number of cigarettes smoked in a day by each subject. A significant difference was evident between NS and HS. The results were not evident in males; age was not correlated either with smoking or pain intensity, and the effect of CS on pain intensity was not correlated with any particular TMD diagnosis. CS seems to be a relevant factor affecting the intensity of TMD pain, thus, control of smoking habits should be considered when treating TMD patients.

As condições de surgimento da "Mãe Suficientemente Boa" / Las Condiciones del Surgimiento de la “Madre Suficientemente Buena” / The conditions of the Appearance of the “Good Enough Mother”

Este trabalho faz uma tentativa de pensar a respeito das possibilidades de constituição na subjetividade das mulheres das condições para o surgimento da ômãe suficientemente boaõ. Elege como referência a História, pensando-a como o passado em processo, e recolhe fragmentos do desenvolvimento das ideias sobre o corpo humano, sobre a concepção dos bebês e sobre o conceito de mãe dentro da psicanálise por meio de Freud, Melanie Klein e Winnicott. Por este caminho, de forma sucinta e limitada, endossa as palavras de Castoriadis quando diz que a mãe, que cuida e acalenta, até pelo modo como acalenta e cuida, é a História mais três milhões de anos de hominização. Por fim, propõe que a relação das mulheres com seu corpo, sua sexualidade e a vivência da maternidade estão intimamente ligados à experiência da relação com as mães, tanto as próprias, quanto aquelas que as antecederam na transmissão geracional.(AU)

Este trabajo trata de pensar sobre las posibilidades de constitución de la subjetividad en las mujeres, para el surgimiento de la ômadre suficientemente buenaõ. Elige como referencia la Historia, pensándola como el pasado en proceso, y recoge fragmentos del desarrollo de las ideas sobre el cuerpo humano, sobre la concepción de los bebes y sobre el concepto de madre dentro del Psicoanálisis a través de Freud, Melanie Klein y Winnicott. Por este camino, de forma sucinta y limitada, endosa las palabras de Castoriadis cuando dice que ôla madre, que cuida y acoge, hasta por el modo como acoge y cuida, es la Historia más tres millones de años de hominizaciónõ. Por fin, propone que la relación de las mujeres con su cuerpo, su sexualidad y la vivencia de la maternidad está íntimamente relacionada a la experiencia con sus madres, tanto las propias, cuanto aquellas que las antecedieron en la transmisión generacional.(AU)

This paper attempts to consider the possibilities of constituting the conditions leading to the appearance of the ôgood enough motherõ within the subjectivity of women. It chooses History as its reference, considering it as the past in process, and collects fragments of the development of ideas about the human body, about the conception of babies and aobut the concept of mother within Psychoanalysis through Freud, Melanie Klein and Winnicott. Through this path, in a succinct and limited manner, it endorses the words of Castoriadis when it claims that ôthe mother, who cares and nurtures, even through the way she nurtures and cares, is the History of over three million years of hominizationõ. Finally, it proposes that the relationship of women with their body, their sexuality and maternity is closely linked to the experience of the relationship with mothers, both their own as well as those who preceded them in the generational transmission.(AU)

As condições de surgimento da “Mãe Suficientemente Boa” / Las Condiciones del Surgimiento de la “Madre Suficientemente Buena” / The conditions of the Appearance of the “Good Enough Mother”

Este trabalho faz uma tentativa de pensar a respeito das possibilidades de constituição na subjetividade das mulheres das condições para o surgimento da ômãe suficientemente boaõ. Elege como referência a História, pensando-a como o passado em processo, e recolhe fragmentos do desenvolvimento das ideias sobre o corpo humano, sobre a concepção dos bebês e sobre o conceito de mãe dentro da psicanálise por meio de Freud, Melanie Klein e Winnicott. Por este caminho, de forma sucinta e limitada, endossa as palavras de Castoriadis quando diz que a mãe, que cuida e acalenta, até pelo modo como acalenta e cuida, é a História mais três milhões de anos de hominização. Por fim, propõe que a relação das mulheres com seu corpo, sua sexualidade e a vivência da maternidade estão intimamente ligados à experiência da relação com as mães, tanto as próprias, quanto aquelas que as antecederam na transmissão geracional.

Este trabajo trata de pensar sobre las posibilidades de constitución de la subjetividad en las mujeres, para el surgimiento de la ômadre suficientemente buenaõ. Elige como referencia la Historia, pensándola como el pasado en proceso, y recoge fragmentos del desarrollo de las ideas sobre el cuerpo humano, sobre la concepción de los bebes y sobre el concepto de madre dentro del Psicoanálisis a través de Freud, Melanie Klein y Winnicott. Por este camino, de forma sucinta y limitada, endosa las palabras de Castoriadis cuando dice que ôla madre, que cuida y acoge, hasta por el modo como acoge y cuida, es la Historia más tres millones de años de hominizaciónõ. Por fin, propone que la relación de las mujeres con su cuerpo, su sexualidad y la vivencia de la maternidad está íntimamente relacionada a la experiencia con sus madres, tanto las propias, cuanto aquellas que las antecedieron en la transmisión generacional.

This paper attempts to consider the possibilities of constituting the conditions leading to the appearance of the ôgood enough motherõ within the subjectivity of women. It chooses History as its reference, considering it as the past in process, and collects fragments of the development of ideas about the human body, about the conception of babies and aobut the concept of mother within Psychoanalysis through Freud, Melanie Klein and Winnicott. Through this path, in a succinct and limited manner, it endorses the words of Castoriadis when it claims that ôthe mother, who cares and nurtures, even through the way she nurtures and cares, is the History of over three million years of hominizationõ. Finally, it proposes that the relationship of women with their body, their sexuality and maternity is closely linked to the experience of the relationship with mothers, both their own as well as those who preceded them in the generational transmission.

The immediate effect of changing mandibular position on the EMG activity of the masseter, temporalis, sternocleidomastoid, and trapezius muscles.

This study investigated the immediate effect of changing mandibular position on the electromyographic (EMG) activity of the masseter (MS), temporalis (TM), sternocleidomastoid (SCM) and trapezius (TR) muscles. Thirty-three (33) asymptomatic subjects (16 males and 17 females), ages 23 to 52 were selected. Surface EMG recordings were obtained for all muscles bilaterally with the mandible in a relaxed open position (relaxed) and during maximal voluntary clenching (fullbite) for the following: a non-repositioning appliance (NONREPOS) and repositioning appliance (REPOS). REPOS significantly reduced EMG activity of all muscles bilaterally during fullbite. During relaxation, reduction in EMG activity was only found for TR bilaterally. NONREPOS decreased the EMG activity bilaterally for TM and TR and unilaterally (left) for MS and SCM during fullbite. During relaxation, NONREPOS decreased muscle activity bilaterally for TR and SCM. A unilateral reduction was found for TM (right). These findings suggest that immediate alterations in mandibular position affect the cranio-cervical system. Both mandibular positions tested lowered the EMG activity of masticatory and cervical muscles in the relaxed and fullbite positions. The trapezius muscle was the most responsive to alterations in mandibular position.

Use of Theraflex-TMJ topical cream for the treatment of temporomandibular joint and muscle pain.

This randomized, double-blind study was designed to evaluate the effectiveness of the topical cream Theraflex-TMJ (NaBob/Rx, San Mateo, CA) in patients with masseter muscle pain and temporomandibular joint (TMJ) pain. Fifty-two subjects (5 males and 47 females) were instructed to apply a cream over the afflicted masseter muscle(s) or over the jaw joint(s) twice daily for two weeks. Theraflex-TMJ cream was used by the experimental group, while a placebo cream was used by the control group. The means of pain ratings were calculated prior to the application of the cream (baseline), after ten days of tx (period 1), and 15 days of tx (period 2) days of treatment and five days after stopping the treatment (follow-up). There was a significant decrease in reported pain levels from baseline in the experimental group for period 1 (p < 0.01), period 2 (p < 0.001), and follow-up (p < 0.01). For the control group, no significant differences were found between the different time periods (p > 0.05). There was evidence of minor side effects such as skin irritation and/or burning on the site of the application in two subjects in the experimental as well as two subjects in the control groups. The data strongly suggest that Theraflex-TMJ topical cream is safe and effective for reducing pain in the masseter muscle and the temporomandibular joint.

Efficacy of pulsed radio frequency energy therapy in temporomandibular joint pain and dysfunction.

This randomized double-blind study evaluated the effectiveness of pulsed radio frequency energy therapy (PRFE) in patients with temporomandibular joint arthralgia. Forty subjects (age range 22 to 55 yrs.) were assigned randomly into two equal groups: (1) Experimental group received PRFE using the Energex unit (Energex, Inc. Emerson, New Jersey) and (2) Control group received PRFE placebo treatment using a sham device. Both groups received six applications to the TMJ area over two weeks. Data were analyzed for the following times: baseline, first and second follow-up visits. Numerical Rating Scale scores for TMJ pain showed a significant reduction over time for the experimental group (mean = 6.13 to 3.05, p < 0.001). There was also a significant effect for the controls (mean = 5.35 to 4.20, p = 0.01). The effect for experimental subjects was a mean reduction of 3.07 versus 1.15 for controls. The significant reduction in controls was attributed to the placebo effect. The experimental group showed a significant increase in mouth opening (mean = 34.95 to 41.70 mm, p = 0.002), right lateral movement (mean = 7.85 to 10.80 mm, p = 0.001) and left lateral movement (mean = 7.65 to 10.85 mm, p < 0.0001). No significant (p > 0.1) change in the control group occurred for mouth opening (mean = 38.50 to 39.65 mm), right lateral movement (mean = 8.60 to 8.75 mm) and left lateral movement (mean = 8.50 to 8.80 mm). No side effects were reported during the treatment and the two week follow-up. These results suggest strongly that PRFE is a safe and effective treatment for TMJ arthralgia as well as for increasing mandibular range of motion.

An index for the measurement of normal maximum mouth opening.

PURPOSE: The aim of this study was to evaluate the relationship between the width of 3 or 4 fingers of one hand and maximum mouth opening (MMO) in healthy subjects. METHODS: One hundred and forty dental students (age 21 to 42 years, mean 27.4 years) participated in the study. The ability of each subject to position 3 or 4 fingers, vertically aligned, between the upper and lower central incisors up to the first distal interphalangeal folds, was documented. Measurements of MMO and the width of 3 fingers (index, middle and ring fingers) and 4 fingers (index, middle, ring and little fingers) were recorded. RESULTS: All subjects were able to position 3 fingers (of both the right and left hands) between the upper and lower central incisors. Only 12 subjects were able to position 4 fingers (both right and left) in this way. There were no significant differences among the measurements of MMO (mean 48.8 mm), 3 fingers of the right hand (mean 47.3 mm) and 3 fingers of the left hand (mean 47.0 mm) (p > 0.05). However, MMO was significantly different from the width of 4 fingers of the right hand (mean 58.1 mm) and 4 fingers of the left hand (mean 57.5 mm) (p < 0.001). Moreover, there was a strong positive correlation between MMO and the 3-finger measurements (p < 0.0001). CONCLUSIONS: These findings strongly suggest that the ability to position 3 fingers in the mouth during dental examination is a convenient index for assessing normal MMO.

Repensando o feminino: a intrincada relação entre mães e filhas

Neste trabalho, procuramos pensar a especificidade do desenvolvimento do feminino a partir da intrincada trama da ligação entre mães e filhas, matriz a nosso ver, por excelência das vicissitudes e sortilégios da feminilidade. Os inúmeros conflitos gerados na tentativa de separar-se da mãe, ao mesmo tempo em que a menina e a mulher vivem uma intensa e permanente identificação com ela, dão origem a experiências especialmente femininas, que permearão e determinarão o seu desenvolvimento ao longo de toda a vida. Trata-se, então, de uma contínua oscilação entre aproximar-se e distanciar-se da figura materna, explicitados nos momentos críticos da vida da mulher: menarca, maternidade, menopausa e envelhecimento. Pensamos, portanto, que o intenso e permanente vínculo com a figura materna, real e fantasiada, externa e interna, assim como os intensos afetos de amor e ódio que regam permanentemente esta relação são determinantes da especificidade da maneira de viver da mulher, tanto na sua relação com o masculino e nas suas relações com autoridade e o poder, quanto nas possibilidades de desenvolvimento de sua criatividade, seja ela sexual, afetiva ou intelectual. Utilizamos, para pensar estas questões, exemplos da nossa clínica e a literatura disponível sobre as questões femininas (homossexualidade, questão transgeracional, etc.), questões que vêm sendo revistas por muitos analistas, em sua grande maioria mulheres, e que têm mostrado à necessidade de se repensar as idéias sobre o desenvolvimento feminino a partir de novos paradigmas.(AU)

This paper examines the specificity of the feminine development that evolves from the intricate web of connections between mothers and daughters. In our point of view, the web represents a matrix of vicissitudes and sortileges of femininity. The countless conflicts are generated in a first moment by the reality of the daughter living part of her life separated from her mother while at the same time living at least and equal part of her life in an intense and permanent identification with the mother. This push and pull, ebb and tide, gives rise to specific feminine experiences that will shape the daughter’s personality and will continue to determine her development during her whole life. So, there is an enduring oscillation between the daughter becoming a close approximation of the mother and a moving away from the mother figure, and this swing is most pronounced at the critical moments of every woman’s life: menstruation, maternity, menopause and when old age is finally acknowledged. We think that the intense and permanent link with the mother figure, real and fantasized, external and internal, together with the intense effects of love and hate that nourish permanently this relationship arte determinants of the specific way women function in their relationships with the masculine and their relationships with authority and power, as well as crucial to the developmental possibilities of creativity, sexuality, and intellect.(AU)

Atypical odontalgia: a review of the literature.

OBJECTIVE: To review previous reports of cases of atypical odontalgia to examine its epidemiological and clinical characteristics and to explore the etiology and pathophysiology of the disease. BACKGROUND: Atypical odontalgia is one of many painful conditions that affect the oral cavity and is often overlooked in the differential diagnosis. METHODS: A search of the literature was performed for all cases of atypical odontalgia reported from 1966 to the present. RESULTS: The typical clinical presentation of atypical odontalgia that has been reported involves pain in a tooth in the absence of any sign of pathology; the pain may spread to areas of the face, neck, and shoulder. The existing literature suggests that this condition occurs in 3% to 6% of the patients who undergo endodontic treatment, with high female preponderance and a concentration of cases in the fourth decade of life. Deafferentation seems to be the most likely mechanism to initiate the pain, but psychological factors, alteration of neural mechanisms, and even an idiopathic mechanism have been implicated. Not all reported cases were preceded by trauma to the teeth or gums. The treatment of choice is a tricyclic antidepressant, alone or in combination with a phenothiazine. The outcome is usually fair, with many patients obtaining complete relief from pain. Especially in the absence of overt pathology, particular attention should be paid to avoiding any unnecessary and potentially dangerous dental intervention on the teeth. CONCLUSION: Atypical odontalgia is surprisingly common, of uncertain origin, and potentially treatable.

The effect of stepwise increases in vertical dimension of occlusion on isometric strength of cervical flexors and deltoid muscles in nonsymptomatic females.

This mixed, single-double blind study examined the effect of a stepwise increase in vertical dimension of occlusion (VDO) on the isometric strength of cervical flexor and deltoid muscles in 20 asymptomatic females with deep bite (age range 20-40 years). Vertical dimension of occlusion was increased by mandibular acrylic bite plates, 2, 4, 6 and 12 mm. Subjects were instructed to bite while resisting: 1. an increasing horizontal force was applied to the forehead; and 2. an increasing vertical downward force to the wrist of each extended arm. Forces were applied by a hand-held strain gauge until resistance yielded. The force applied at the point of yielding was recorded as isometric peak strength of that trial. The peak strength for each muscle group was measured twice and averaged to produce a mean peak strength measure. This procedure was repeated in the subject's habitual occlusion and for the four increased VDOs. Mean strength of cervical flexors with increased VDO (12.0 kg) was significantly greater than that for existing vertical dimension occlusion (9.6 kg). With the exception of pre-experimental existing VD of occlusion, strength for right and left deltoids did not differ, but mean deltoid strength in the increased condition (8.6 kg) was significantly greater than biting in without a bite plate (6.6 kg). In the peak condition, cervical flexor strength increased 24% and deltoid strength increased an average of 29% from that of biting without an increase. As VDO increased further, strength in all sites was found to diminish. Repeating the strength test without a bite plate, after all trials were administered, did not show differences from pre-experimental levels, indicating that fatigue was not an important factor. The findings demonstrate that isometric strength of the cervical flexors and deltoids increases significantly from habitual occlusion as the VDO is increased, then diminishes as VDO is increased further. The strength of both cervical flexors and deltoids varied in concert with changes of VDO.

Complex regional pain syndrome in the head and neck: a review of the literature.

This article reviews the features of complex regional pain syndrome (CRPS), including its pathophysiology, diagnosis, and treatment. CRPS is a pathology that has been described as occurring almost always in a limb, but this review provides a focus on the literature reporting cases in which the face, head, and neck were affected. Very few cases were found that seemed to meet the International Association for the Study of Pain criteria for the disease. The clinical characteristics were similar to those of CRPS elsewhere in the body, with the main features being burning pain, hyperalgesia, and hyperesthesia starting after a trauma to the craniofacial region. Physical signs were reported less frequently. The treatment of choice was seen to be a series of stellate ganglion anesthetic blocks, which resulted in a good outcome in all the cases reviewed.