Trastornos temporomandibulares en escolares mexicanos / Temporomandibular disorders in Mexican schoolchildren

Objetivo: determinar la frecuencia de trastornos temporomandibulares (TTM) en escolares. Material y Métodos: se incluyeron 981 escolares de tres escuelas primarias públicas, se registraron variables sociodemográficas y evaluación de la articulación temporomandibular con el índice clínico de Helkimo empleado por la Organización Mundial de la Salud, las evaluaciones fueron realizadas por 10 pasantes de odontología previamente capacitados (Kappa interobservador=0.850), la información fue procesada en SPSS V.21.0; para determinar la prevalencia de TTM se utilizó estadística descriptiva, para evaluar la asociación de TTM con el sexo se utilizó X2. Resultados: la edad promedio fue 8.6±1.6 años, el 54% fueron niñas. 43.4% de la muestra presentó trastornos temporomandibulares; 72.3% con trastorno único, 20.4% con dos TTM y 7.3% más de dos TTM. Los TTM no mostraron asociación con el sexo ni con la edad (p>0.05). Discusión: El diagnóstico de TTM en escolares es poco frecuente, el crecimiento y desarrollo de los niños puede modificar la frecuencia y severidad de los trastornos. La frecuencia de TTM fue del 43.4%, su distribución fue similar en ambos sexos

Objective: To determine temporomandibular disorders (TMD) frequency in schoolchildren. Material and methods: Included 891 school children of three elementary public schools, we registered sociodemographic variables and temporomandibular evaluation with Helkimo clinic index used by World Health Organization, all evaluations were performance by ten undergraduates dentist with prior capacitation (interobserver Kappa=0,850) information was processed in SPSS V.21.0; to determine TMD prevalence we used descriptive statistics, to evaluate association between TMD with sex X2 was used. Results: Mean of age was 8.6±1.6 years, 54% were girls, 43.4% of students had temporomandibular disorders, 72.3% only one disorder, 20.4% two and 7.3% more than two disorders. TMD had no association with sex neither age (p>0.05). Discussion: TMD diagnostics in schoolchildren is infrequent, frequency and severity of this disorders will be modified by children's growth and development. TMD frequency was 43.3%, its distribution was similar in both sexes

Efectividad del láser terapéutico en padecimientos con dolor orofacial / Therapeutic laser effectiveness in ailment with orofacial pain

Introducción: La terapia láser de baja potencia ha demostrado ser eficaz, poco invasiva y carente de efectos secundarios graves para numerosas enfermedades, produce analgesia, acción antiinflamatoria, relajación muscular, regeneración y reparación de tejidos, reducción de edema e hiperemia; el objetivo de este trabajo fue determinar la efectividad analgésica del láser terapéutico de baja potencia en el trauma facial, neuralgia trigeminal, parálisis facial y trastornos temporomandibulares. Material y Métodos: Se incluyeron 30 pacientes consecutivos que acudieron al servicio de cirugía maxilofacial del Hospital Regional Adolfo López Mateos del ISSSTE con dolor crónico, fracaso de tratamientos conservadores y sin medicamentos controlados. Se aplicó terapia con láser diódico de Arseniuro de Galio y Aluminio cada 15 días hasta que el dolor desapareció o completar seis meses. Para analizar la asociación entre la intensidad del dolor y los padecimientos se usó X2 y para determinar la efectividad del láser F de Friedman. La información se procesó en SPSS v.15.0. Resultados: Predominó el sexo femenino (93.3%), la media de edad fue 48±12 años. A los seis meses el 80% de los casos se reportaron sin dolor, el resto disminuyó significativamente. No existió asociación estadísticamente significativa entre los padecimientos y la evaluación basal X2=38.245 (p=0.074). La prueba de Friedman fue estadísticamente significativa (p<0.001) concluyendo que la aplicación de terapia láser disminuyó significativamente la intensidad del dolor en los cuatro padecimientos. Discusión: La inclusión de diversos padecimientos dolorosos orofaciales con el mismo protocolo de tratamiento permitió contrastar los resultados de esta terapia alternativa

Introduction: Laser Low Level Therapy is effective, minimally invasive and without serious side effects for many diseases, it produces analgesia, anti-inflammatory action, muscle relaxation, tissue regeneration and repair, reduction of edema and hyperemia; the aim was to determine analgesic effectiveness of therapeutic laser in facial trauma, trigeminal neuralgia, facial palsy and temporomandibular disorders. Methods: included 30 consecutive patients attended in maxillofacial surgery department in Regional Hospital Adolfo López Mateos of ISSSTE, with chronic pain, failure of conservative treatment without use of controlled drugs. Diode laser of Galium and Aluminum Arsenide was applied each fifteen days until pain disappeared or up to six months. To evaluate association between pain intensity and ailment we used X2, to determinate laser effectiveness F de Friedman was used. The information was processed in SPSS v.15.0. Results: female was predominant (93,3%) mean age was 48±12 years. Over six months 80% of patients reported no pain, in the others, pain decreased significantly, there was no association between ailment and pain intensity X2=38.245 (p=0.074). Pain decreased was statistically significant, Friedman test (p<0.001). We concluded that Laser therapy decreased significantly pain intensity in all ailments. Discussion: The inclusion of several painful orofacial ailments with the same treatment protocol allowed contrasting the results of this alternative therapy

Incidencia de infecciones postquirúrgicas de terceros molares en pacientes atendidos en clínica de enseñanza odontológica / Incidence of postoperative third molars infections in patients treated in teaching care clinic

Objetivo: Determinar la incidencia de infecciones postquirúrgicas de terceros molares. Material y métodos: Se estudiaron 149 pacientes consecutivos que acudieron a la clínica de cirugía bucal en la Facultad de Odontología de la UNAM con indicación quirúrgica de tercer molar, sin compromiso sistémico, medicación en los siete días previos y ausencia de sintomatología infecciosa. Se registraron características sociodemográficas, de los molares y de la cirugía. Los procedimientos fueron realizados en una clínica de enseñanza odontológica universitaria por alumnos del cuarto año de licenciatura con ayuda y supervisión de profesores especialistas. Se diagnosticó la presencia de infección a los siete y quince días postquirúrgicos. Para determinar la incidencia de infección se utilizó estadística descriptiva. La información se procesó en el programa SPSS 17.0. Resultados: El 51% de los pacientes fue de sexo masculino con una edad media de 25±7,5 años, se incluyeron 347 molares (161 maxilares y 186 mandibulares). El 1,3% de los pacientes desarrolló infección todos en mandíbula izquierda. Se encontró asociación significativa p<0,05 del desarrollo de infección con la posición del tercer molar (posición B y C), complejidad operatoria (retención parcial y completa en hueso), alcohol y tabaco. Discusión: La incidencia de infecciones fue el 1,3% de los pacientes, todos los molares fueron mandibulares izquierdos (AU)

Objective: To determine third molar postsurgical infections incidence. Material and methods: 149 consecutive patients who attended the oral surgery clinic at UNAM School of Dentistry with surgical indication for third molar, without systemic involvement or medication in the previous seven days and no signs of infectious symptomatology were studied. Socio-demographic, molars and surgery characteristics were registered. The surgeries were performed in University healthcare and teaching clinic by fourth year students under specialist teachers supervision. Infection was evaluated at seventh and fifteenth postsurgical days. To determine infection incidence, descriptive statistic was used. The information was processed in SPSS 17.0 software. Results: 51% of patients were male with mean age of 25±7.5 years, were included 347 molars (161 maxillary and 186 mandibular). 1.3% of patients developed infection all were in left mandibular molars. There was significant association p<0.05 between infection development and the third molar position (B and C position), operative complexity (partial and complete retention in bone), alcohol and smoke. Conclusions: The incidence of infections was 1.3% of patients, all left mandibular (AU)

Clasificación del estado físico de los pacientes según la sociedad americana de anestesiología (saa) en adultos atendidos por emergencia odontológica / Health status of patients attended by dental emergency using the classification of american society of anesthesiologists(asa)

Determinar el estado físico de los pacientes atendidos por emergencia odontológica en la Clínica Periférica Azcapotzalco de la U.N.A.M. usando la clasificación ASA. Se incluyeron 102 historias clínicas de emergencia odontológica de pacientes adultos atendidos en la Clínica Periférica Azcapotzalco turno vespertino de la Facultad de Odontología de la U.N.A.M. en el año lectivo 2009-2010, se registraron variables sociodemográficas, motivo de la consulta y el estadio ASA de cada paciente. Se utilizaron proporciones, medidas de tendencia central y de dispersión. La información se capturó y analizó en el programa SPSS 15.0. Casi dos terceras partes de la población (65.7%) atendida se clasificó como ASA I, el 26.5% se situaron en ASA II y el 7.8% obtuvieron clasificación ASA III. El principal motivo de consulta fue dolor dental (96.1%). 1) La mayoría de los pacientes atendidos de urgencia dentaria fueron clasificados como ASA I...

To establish the health status of patients attended by dental emergency in the Azcapotzalco peripheral clinic of UNAM, using ASA classification. Materials and We included 102 emergency medical records of adult patients treated at the Azcapotzalco peripheral clinic in the afternoon shift at the Faculty of Dentistry, UNAM in the 2009-2010 school year, we recorded demographic variables, reason for consultation and ASA stage of each patient. We used proportions, measures of central tendency and dispersion. The information was captured and analyzed in SPSS 15.0 software. Almost two thirds of the population (65.7%) were classified as ASA I, 26.5% were at ASA II and 7.8% were ASA III. The main reason for consultation was dental pain (96.1%). 1) Most of emergency patients seen were classified as ASA I...

[Evaluation of Spanish websites useful for the primary care physicians]. / Evaluación de las páginas web en lengua española útiles para el médico de atención primaria.

OBJECTIVE: To assess the usefulness of medical websites in spanish for the primary care physicians using quality criteria chosen by themselves. DESIGN: Observational, descriptive, cross-sectional study. SETTING: Internet. PARTICIPANTS: The search was performed in Google and Yahoo using as key words the name of Spanish National Health Service medical specialities, primary care and synonyms. The first one hundred links in spanish for every keyword were included in the study. EXCLUSION CRITERIA: paysites, commercial sites, non-clinical content, link sites, patient oriented sites and on-line editions of printed issues. METHODS: A survey was carried out asking the primary care physicians of area IV in Asturias which were the most important criteria that a medical website should fulfil. The results of this survey were used to make an assessment questionnaire. Every site was analysed randomizedly by two researchers and was classified as excelent, good, medium or bad. RESULTS: 2.095 medical websites in spanish were found, being repeated 1.218 (58.14%). From the 877 analysed websites, 597 (68.07%) were excluded. The Intraclass Correlation Coefficient (ICC) was 0.73 (95% CI, 0.66%-0.785%). 5 websites (1.8%) were rated as excelent and the 77.2% as medium or bad. The sites with better ratings were those oriented to the primary care professionals. CONCLUSIONS: The most websites were rated as medium or bad. The evaluation questionnaire is useful for futures studies.

Evaluación de las páginas web en lengua española útiles para el médico de atención primaria / Evaluation of Spanish websites useful for the primary care physicians

Objetivo. Evaluar las páginas web en lengua española útiles para el médico de atención primaria a partir de criterios de calidad determinados por los propios médicos. Diseño. Estudio descriptivo transversal. Emplazamiento. Internet. Participantes. Cien primeros enlaces en lengua española encontrados en Google y Yahoo empleando como palabras claves las especialidades reconocidas por el Ministerio de Educación y Ciencia de España, así como atención primaria, sus sinónimos y los distintos programas de salud. Se excluyeron páginas de pago, comerciales, de contenido no clínico, destinadas a pacientes, revistas, y las constituidas únicamente por enlaces. Métodos. Cuestionario de evaluación elaborado a partir de los resultados de una encuesta realizada entre los médicos de atención primaria del Área IV de Asturias, sobre los criterios más importantes que debía presentar una web médica. Cada página fue evaluada de forma aleatoria por dos observadores independientes. El análisis se realizó por ponderación de cada una de las preguntas según a los resultados de la encuesta clasificándose cada página en mala, regular, buena o excelente. Resultados. Se encontraron 2.095 páginas, 1.218 (58,14 por ciento) estaban repetidas. De las 877 analizadas 597 (68,07 por ciento) cumplían algún criterio de exclusión; evaluándose 280.El coeficiente de correlación intraclase fue de 0,73 (IC del 95 por ciento, 0,66-0,78 por ciento). Cinco páginas (1,8 por ciento) obtuvieron la calificación de excelentes, mientras que el 72,2 por ciento fue clasificado como regular-malo. Conclusiones. La mayoría de las páginas presentan una calidad regular o mala. El cuestionario ofrece una buena correlación entre observadores que permite su utilización en posteriores estudios (AU)

Periodontium response to a root canal condensing device (Endotec).

Two Macaca (fascicularis) monkeys were used to study the effect of two warm endodontic condensation techniques (Endotec and vertical condensation method) on periodontal tissues. The specimens were histologically evaluated at 3 and 32 days after the endodontic treatments were completed. In this study the periodontium was divided into coronal, middle, and apical thirds. Results indicated that there was no heat-related damage to periodontal tissues from either of the two methods employed. However, some Endotec specimens generated small, reactive inflammatory infiltrates that were restricted to the root canal opening or adjacent periodontal membrane. Similarly, some vertical condensation specimens developed periapical inflammatory processes as well, but they were more extensive and comprised the alveolar bone and marrow spaces.

Healing and revascularization of apical periodontium and dental pulps in apicoectomized and nonapicoectomized tooth replants in monkeys. A study of fully developed teeth.

This report primarily concerns an experimental study of the effect of apicoectomy on the healing and revascularization of the periodontal membrane and dental pulps in tooth replants. Five rhesus monkeys (Macaca mulatta) were subjected to surgical procedures in which twenty incisor teeth were extracted and immediately replanted. Ten of these incisors were subjected to apicoectomy. Healing and revascularization of periapical tissues and dental pulps were evaluated by histologic and India-ink-perfusion techniques. Apicoectomized replants were characterized by (1) loss of dental substance (tooth apex) and creation of large periapical spaces, (2) exposure of dental pulps and production of periapical inflammatory processes with destruction of alveolar bone, and (3) blocking of normal healing because of persistence of chronic periapical inflammatory processes. In contrast, nonapicoectomized replants depicted short-lived primary inflammatory responses and healing processes characterized by variable histologic responses.

Histopathologic findings in temporomandibular joints of aged individuals.

Twenty-four TMJs from well preserved 62- to 97-year-old human cadavers, 12 men and 12 women, were used in this study. The TMJs were routinely processed to identify (1) the histologic and histopathologic changes present in the articulations and (2) the components of the joint most frequently affected by these changes. The most significant histopathologic findings were (1) intense fibrocartilaginous proliferations of the condylar head and articular eminence linings, (2) neovascularization or myxomatoid degenerative changes in articular disks, and (3) proliferation of synovial villi, subsynovial tissue, and muscular fibers. The components of the joint most frequently affected were (1) the condylar head (30.4%), (2) the articular disk (21.7%), (3) the synovial lining (13%), (4) the articular eminence (8.6%), and (5) the lining of the articular fossa (4.3%). Five joints were considered to be within normal histologic limits, and one joint was excluded from the study because of metastatic malignancy.

Some histological changes in carpal tunnel contents and their biomechanical implications.

The purpose of this study was to investigate the pathological influence of mechanical stresses that occur inside the carpal tunnel during exertions of the hand. Microscopic changes in fibrous tissue density, in synovial, subsynovial, and adjacent connective tissue density, and in median nerve epineurium density, arteriole wall muscle thickness, and arterial and venule endoproliferation were investigated at 5-mm increments along a 9-cm range of six postmortem wrist specimens. All of these changes increased from normal in the proximal portions of the wrist, -30 to -40 mm from the wrist crease, to maximal values 0- to 20-mm distal to the wrist crease. The changes then decreased toward normal in the distal sections, 20 to 40 mm. The location and character of these changes suggest that repeated exertions with a flexed or extended wrist are an important factor in their etiology. The consistency with which they are found in this and other studies suggests that extreme changes associated with highly repetitive work or additional stress factors are required to produce symptoms in most cases of carpal tunnel syndrome.

Vascular response of the periodontal membrane after replantation of teeth.

Thirteen replanted maxillary central incisors were studied by means of histologic and cleared sections to evaluate the pattern of revascularization of the periodontal membrane and the modification of its vasculature due to root resorption, dentoalveolar ankylosis, and periapical processes. Early reparative activity was noted in the apical and cervical parts of the replanted membrane where proliferating vessels were intermingling with reparative cells and interrupted collagenous fibers. These areas of the membrane corresponded with those receiving a better vascular supply after replantation. The middle third of the membrane, however, showed a scarcity or absence of reparative cells as a result of delayed revascularization. Root resorption, dentoalveolar ankylosis, or periapical processes changed both the tissue specificity of the replanted membrane and its pattern of vascular supply. Revascularization of the pulps showed vacuolar degeneration due to lack of nutrition.

Intraneural connective tissue proliferation of the median nerve in the carpal tunnel.

Segments from the median nerve were removed from the distal fourth of the right forearm and the carpal tunnel area of 23 embalmed human cadavers (12 men, 11 women) to evaluate the proliferation of the intraneural connective tissue and its intrinsic vasculature. The findings suggest that: (1) The proliferative increase of the intraneural connective tissue, primarily, the epineurial layers, is a localized characteristic of the median nerve in the carpal tunnel; (2) this increase in a normal occurrence in males and females; and (3) thicker-walled arterioles and venules are common in the highly dense epineurial tissue; this condition, regarded as an adjunct protective feature, could oppose increased intratunnel pressure and lessen the chances of vascular collapse.

Effect of renovascular hypertension of the morphology of oral blood vessels.

Renovascular hypertension was created in twenty adult male rats to study the effects of systolic hypertension on the morphology of vessels supplying the gingiva, periodontal membrane, pulp tissue, and alveolar bone. Gingival arterioles showed changes consisting mainly of proliferation of the intima and elastic layers, some hyalinization of the wall, and reduction of the lumen. Similar but less frequent changes were observed in the vessels feeding the periodontal membrane; however, pulp tissue and alveolar arterioles were unaltered.

Gingival response to silk, cotton, and nylon suture materials.

Silk, cotton, and nylon suture materials were implanted in the tunica propria of the gingiva in seven adult rhesus monkeys. The histologie study of twenty-four biopsy specimens indicated that there was neither an increase in the vascular permeability nor a leukocytic margination and migration into the tissues adjacent to the suture materials. However, there was a variable histiocytic reaction, with multinucleated cell formation. This reaction was quite intense with cotton, less intense with silk, and practically absent with nylon. The greater cellular response to cotton was probably due to its more active capacity for modifying the internal biologic medium of the gingvia.

Cheek mucosa response to silk, cotton, and nylon suture materials.

The cheek mucosa reacted to the implantation of cotton and silk with an aseptic inflammatory exudate which was found 24 hours and 4 days postoperatively. The leukocytic infiltrate was followed by a histiocytic reaction. Which was established at 7 days but which later progressively declined. The comparison of these findings with those previously obtained from gingival tissues revealed that the leukocytic infiltration in the gingiva was minimal or nonexistent. Probably, the difference in the leukocytic reacting capacity of the gingiva and cheek mucosa was due to the different histologic architecture present in both tissues and directly related to the active capacity of the suture materials to modify the internal biologic medium.

Primary mucinous adenocarcinoma of thyroid gland.

A mucin-producing carcinoma in the thyroid gland found in a 44-year-old man was first thought to be a metastatic carcinoma, possibly from salivary gland. However, follow-up examinations for 8 years have not demonstrated another neoplasm, and it seems reasonable to conclude that this lesion was a rare primary mucinous adenocarcinoma of the thyroid gland.

Interruption of the arterial inferior alveolar flow and its effects on mandibular collateral circulation and dental tissues.

The interruption of circulation through the inferior alveolar artery was followed by the establishment of a fast retrograde blood flow through the vessel. The mental artery and the mandibular branch of the sublingual artery were the main vessels to contribute to that flow. No histopathologic changes were found in the experimental hemimandibles; however, temporary regressive changes were found in the dental pulps of molars.