Atypical odontalgia: pathophysiology, diagnosis and management / Odontalgia atípica: fisiopatologia, diagnóstico e tratamento

ABSTRACT BACKGROUND AND OBJECTIVES: Atypical odontalgia, a subtype of persistent idiopathic facial pain, is characterized by continuous pain in one tooth or more, or inside the alveolus after exodontia, with no apparent clinical causes. These patients run the risk of going through unnecessary dental/surgical procedures which would worsen their pain. Since the pathophysiology, diagnosis, and management of atypical odontalgia are not clear, this article aims to present an integrative literature review about these aspects. CONTENTS: A review of articles related to the topic was conducted on the Pubmed database using the keywords "atypical odontalgia" OR "phantom tooth pain" OR "idiopathic tooth pain" OR "odontalgia" OR "odontalgias" OR "atypical toothache". Applying the inclusion criteria (publications in the last ten years, in English, as clinical trials, multicenter studies, case reports, reviews, integrative and systematic reviews, 114 articles were found, and 39 were selected after the application of the exclusion criteria (articles with no relation to the topic). CONCLUSION: Although studies suggest the involvement of strong neuropathic mechanism, the psychological/psychiatric aspects might be considered not as a primary cause, but as an aggravator of the patient´s pain. Knowledge of other pathologies is recommended in order to determine the differential diagnosis. Also, complementary image tests, qualitative somatosensorial test, and reference to an orofacial pain specialist should be considered. In case of uncertain diagnosis, it is recommended to avoid any dental procedures because the pain can get worse.

RESUMO JUSTIFICATIVA E OBJETIVOS: A odontalgia atípica, um subtipo da dor facial idiopática persistente, se caracteriza por dor contínua em um ou mais dentes, ou no alvéolo, após exodontia sem qualquer causa aparente e é um desafio para o dentista. O desconhecimento por parte do profissional pode levar a procedimentos odontológicos desnecessários e mutiladores, piorando e/ou cronificando a dor do paciente. Diante desse panorama, o objetivo deste estudo foi apresentar informações referentes à fisiopatologia, diagnóstico e tratamento da odontalgia atípica através de uma revisão integrativa da literatura. CONTEÚDO: A busca na base de dados Pubmed foi realizada com os termos: "atypical odontalgia" OR "phantom tooth pain" OR "idiopathic tooth pain" OR "odontalgia" OR "odontalgias" OR "atypical toothache". Aplicando-se critérios de inclusão (publicações nos últimos 10 anos, de língua inglesa, tipo ensaio clínico, estudo multicêntrico, relato de caso, revisão, revisão integrativa científica e sistemática) foram encontrados 114 artigos, dos quais 39 foram selecionados após aplicação do critério de exclusão (trabalhos sem relação com o tema). CONCLUSÃO: Embora os estudos apontem forte envolvimento de mecanismos neuropáticos, aspectos psicogênicos/psiquiátricos devem ser levados em consideração como agravante do estado de dor do paciente. Sugere-se conhecimento sobre as outras doenças existentes para se realizar um diagnóstico diferencial, exames complementares de imagem, realização do teste somatossensorial qualitativo, encaminhamento a um especialista em dor orofacial e neurologista, e em casos de dúvida, não realizar nenhum procedimento a fim de não piorar a sua dor.

Utilização do hipoclorito de sódio na descontaminação de escovas dentais: estudo in vitro / The use of sodium hypochlorite for toothbrushes decontamination: in vitro study

Introdução: A escovação dentária é um método utilizado para controle do biofilme dental; entretanto, as escovas dentais tornam-se um meio de contaminação de microrganismos após seu uso, com lacunas importantes em relação a estes métodos de desinfecção, principalmente no uso coletivo. Objetivo: O objetivo desta pesquisa foi avaliar a descontaminação de escovas dentais contaminadas in vitro, utilizando-se hipoclorito de sódio 0,08% em diferentes períodos de tempo (5, 10 e 15 minutos). Material e método: Foram utilizadas, nesta pesquisa, 72 escovas dentais distribuídas em seis grupos, levando-se em conta o microrganismo utilizado para contaminação, sendo: grupo 1, contaminadas com Escherichia coli; grupo 2, com Stafilococcus aureus; grupo 3, com Streptococcus pyogenes; grupo 4, com Enterococus faecalis; grupo 5, com suspensões de todas as bactérias, e grupo 6, o grupo-controle. Após a contaminação, os grupos foram imersos na solução de hipoclorito de sódio a 0,08% por períodos de 5, 10 e 15 minutos, sendo considerado positivo para desinfecção a não turvação do meio de imersão. Resultado: No tempo de imersão de 5 minutos, ocorreu a desinfecção dos grupos 2 e 3; em 10 minutos, houve desinfecção dos grupos 1,2 e 3; após 15 minutos de imersão, ocorreu a desinfecção de todos os cinco grupos. Conclusão: O uso de hipoclorito de sódio 0,08% foi efetivo na descontaminação de escovas dentais contaminadas com bactérias Escherichia coli, Stafilococcus aureus, Streptococcus pyogenes, Enterococcus faecalis, num tempo de imersão de 15 minutos.

Aim: Tooth brushing is a method used to control the dental biofilm; however, toothbrush can be a contamination medium by microorganisms after its utilization, with significant weaknesses in relation to those disinfection methods, mainly on collective use. Objective: This study had as objective to evaluate the decontamination of toothbrushes contaminated in vitro using 0,08% sodium hypochlorite during different periods (5, 10 and 15 minutes). Material and method: It was studied 72 toothbrushes distributed in 6 groups according to the microorganism used for contamination, as follow: group 1 for Escherichia coli; group 2 for Stafilococcus aureus; group 3 for Streptococcus pyogenes; group 4 for Enterococus faecalis; group 5 for a mix of all bacteria; and group 6 for control group. After contamination, all groups were immersed into 0,08% sodium hypochlorite solution during 5, 10 and 15 minutes, and it was considered as positive for disinfection no turbidity of the immersion medium. Result: During the period of 5 minutes in immersion, it occurred the disinfection of the groups 2 and 3; during 10 minutes period, there was the disinfection of the groups 1, 2 and 3; after 15 minutes in immersion, all the 5 groups were disinfected. Conclusion: The use of 0,08% sodium hypochlorite was effective in the decontamination of the toothbrushes contaminated by Escherichia coli, Stafilococcus aureus, Streptococcus pyogenes, Enterococcus faecalis, during an immersion period of 15 minutes.

Orthodontic approach to treat complex hypodontia using miniscrews in a growing patient.

This article reports orthodontic treatment of a case of hypodontia of five premolars in an 11-year-old female patient with a positive tooth size-arch length discrepancy in both dental arches. The patient had a straight profile with balanced facial growth. Setup manufacture revealed the possibility of achieving ideal occlusion by mesializing permanent molars up to 15 mm, in addition to keeping a primary molar in the dental arch. With the aid of absolute anchorage, the proposed mechanics was performed and the occlusion predicted in the setup was achieved, while profile and facial growth pattern were maintained. The use of miniscrews for extensive orthodontic movements was successful. Furthermore, one primary molar was extensively mesialized. The indication of gingivoplasty to correct gingival smile proved effective. This is considered a useful technique for orthodontists.

Orthodontic approach to treat complex hypodontia using miniscrews in a growing patient

This article reports orthodontic treatment of a case of hypodontia of five premolars in an 11-year-old female patient with a positive tooth size-arch length discrepancy in both dental arches. The patient had a straight profile with balanced facial growth. Setup manufacture revealed the possibility of achieving ideal occlusion by mesializing permanent molars up to 15 mm, in addition to keeping a primary molar in the dental arch. With the aid of absolute anchorage, the proposed mechanics was performed and the occlusion predicted in the setup was achieved, while profile and facial growth pattern were maintained. The use of miniscrews for extensive orthodontic movements was successful. Furthermore, one primary molar was extensively mesialized. The indication of gingivoplasty to correct gingival smile proved effective. This is considered a useful technique for orthodontists.

Este artigo apresenta o tratamento ortodôntico de um caso com hipodontia de cinco pré-molares, em uma paciente, de 11 anos de idade, com discrepância positiva de modelo em ambas as arcadas. A paciente apresentava perfil reto, com crescimento facial equilibrado. Por meio da confecção de set-up, verificou-se a possibilidade de se estabelecer uma oclusão ideal por meio da mesialização, de até 15mm, dos molares permanentes e manutenção de um molar decíduo no arco. Com o auxílio de ancoragem absoluta, foi realizada a mecânica proposta, alcançando-se a oclusão prevista em set-up, além da manutenção do perfil e do padrão de crescimento facial. A utilização de mini-implantes para grandes movimentos ortodônticos foi favorável, incluindo a extensa mesialização de um molar decíduo. A indicação da gengivoplastia para correção do sorriso gengival se mostrou acertada, sendo essa uma técnica de grande auxílio à Ortodontia.

Shear bond strength of metallic brackets: an in vitro study

To evaluate in vitro the shear bond strength of metallic brackets.Material and Methods:Forty premolars were divided into four groups (n = 10) according to the type of brackets used (G1: Morelli® Light; G2: Morelli® Standard; G3: Morelli® Max; G4: Abzil® Agile). For bonding, Transbond XT® (3M Unitek) resin was used in all groups. Teeth were embedded in ¾ inch PVC tubes with special plaster stone, perpendicular to the ground. Brackets were fixed on the geometric centers of the exposed crowns. After bonding, teeth were stored in distilled water, incubated at 37ºC for 24 hours and submitted to 500 thermal cycles for 30 seconds in each bath (5°C and 55°C), respectively. The bond strength test was performed on the Instron® mechanical testing machine with 3kg load cell at speed of 0.5mm/min. Data were submitted to statistical analysis through the Statistica® software, version 5.0, by Kruscal Wallis test, ANOVA and Tukey (p< 0.05).Results:There was no statistically significant difference in the ARI scores; whereas for shear resistance, this difference was significant (Averages: G1 -Light: 17.53MPa; G2 -Standard: 18.11MPa; G3 -Max: 29.33MPa; G4 -Agile: 11.37MPa) and G3 showed better performance, compared to the others. All other groups showed similar behavior among themselves. Conclusion:Max bracket had the highest shear strength. Further studies should be conducted to investigate the meshes of brackets tested in this study...

Oral motor assessment in individuals with Moebius syndrome.

BACKGROUND: Moebius syndrome (MS) is a rare congenital condition that is characterised by facial hypomimia and congenital strabismus caused by complete or partial impairment of the 6th and 7th cranial nerves. MS may be further associated with other nerves or malformations, mainly involving the extremities. The objective of this study was to quantify the decrease in oral motor performance in people with MS compared with normoreactive individuals using the Oral Motor Assessment Scale (OMAS). METHODS: The study group comprised 33 subjects between the ages of 2 and 20 years (average age: 10 ± 5 years) with MS along with 46 age- and gender-matched control subjects. RESULTS: The study group displayed a lower average functional score than the control group (P < 0.0001). A significant lack of lip closure (P = 0.03) and anterior lingual seal during swallowing (P = 0.03) occurred in the study group; in most cases, the individuals with MS were classified as 'subfunctional'. In addition, individuals with MS in the older age group displayed better functional scores than those in the younger group (P = 0.05). CONCLUSIONS: Functional damage to oral motor function in individuals with MS is evident, but differs among patients with respect to severity and the movements that are compromised. However, overall, improvements in the functional patterns of these individuals can be observed as they mature in age.

Fatores de risco para disfunção temporomandibular e dor orofacial na infância e na adolescência / Risk factors for temporomandibular disorder and orofaciaI pain in childhood and adolescence

Sinais e sintomas de disfunção temporomandibular (DTM) podem ser detectados nas diferentes faixas etárias do crescimento e desenvolvimento do indivíduo, e a percepção do Odontopediatra para esse aspecto é de fundamental importância quando se pretende fazer o atendimento integral da criança ou do adolescente. Assim, como em qualquer doença, o conhecimento de fatores de risco serve de suporte para que o profissional possa estabelecer estratégias na tentativa de evitar ou postergar o início da condição clínica adversa. Tendo como base a premissa de promoção de saúde do indivíduo, a necessidade do entendimento das diversas situações que aparecem associadas com DTM precede, inclusive, ao conhecimento da identificação precoce de sinais e sintomas. Sendo importante ressaltar, nesse ponto, que apenas a presença de sinais e sintomas isolados de DTM podem não representar a doença em desenvolvimento. O emprego clínico dos conhecimentos dos fatores de risco é basicamente anamnético e não demanda a capacitação específica que o diagnóstico físico exige. A literatura ainda não documenta de forma satisfatória as influências que esses fatores porventura exerçam em crianças e adolescentes, nos seus diversos períodos, e muitas inferências de pesquisas em adultos ainda precisam ser feitas.

Signs and symptoms of temporomandibular disorders (TMD) can be detected at different ages of growth and development of the individual. When treating children and adolescents, it is important for the pedodontist to be able to perceive early signs of TMJ. Thus, as in any disease, the knowledge of the risk factors offers the support to the professional to establish strategies in an attempt to prevent or delay the onset of adverse clinical conditions. Based on the premise of promoting the health of the individual, the need to understand the different situations associated with TMD precedes even the knowledge of early identification of signs and symptoms of TMD may not represent the disease under development. The clinical use of comprehension of risk factors is basically anamnestic and does not require specific training that requires physical diagnosis. The literature has not satisfactorily documented the influences that these factors perhaps exert in children and adolescents, in each time period, and many inferences from research in adults have yet to be made.

Síndrome de eagle: relato de caso clínico / Eagle syndrome: case report

o alongamento do processo estilóide pode ser assintomático ou desencadear uma série de sintomas que incluem dor e desconforto, e tem sido descrita como síndrome de Eagle (SE). Esta condição pode ser um achado ocasional durante exames de rotina no consultó- rio odontológico. O Cirurgião-Dentista, que muitas vezes é o primeiro profissional a ter oportunidade de fazer o diagnóstico, deve ter conhecimento desta condição e prováveis . consequências para esclarecer o paciente e nortear a conduta a ser adotada. Portanto, o objetivo deste trabalho foi apresentar conceitos clínicos encontrados na literatura da SE e apresentação de caso clínico.

The elongation of the styloid process may be asymptomatic or cause a range of symp- toms including pain and discomfort, and this condition has been described as Eagle syn- drome. This condition can be an occasional finding during routine dental examination. The dentist, that many times is the first professional to have the opportunity to diagnose, must have the knowledge of this condition and its consequences to enlighten the patient and conduct the treatment. The aim of this paper is to review some concepts that can be found in the literature of Eagle's syndrome and to report a clinical case.

Abordagem terapêutica em molares decíduos anquilosados: relato de caso clínico / Terapeutícal approach of ankylosed decíduous molars: case report

A anquilose dento alveolar, comum em molares decíduos, é definida como uma intercorrência no processo da erupção dentária, caracterizada pela fusão anatõmica entre o cemento e/ou dentina com o osso alveolar. Pode apresentar diferentes graus de infraoclusão, ocorre em qualquer etapa do período eruptivo e a sua etiologia é desconhecida. O diagnóstico precoce é de extrema importância para evitar a instalação de má-oclusão. O objetivo deste trabalho é apresentar uma revisão de literatura sobre a anquilose, bem como o relato de um caso clínico com os respectivos tratamentos.

The dentoalveolar ankylosis, common in deciduous molars, is an anomaly of dental eruption, due to abnormal fusion between cemento and/or dentine with the alveolar bone. It is characterized by presents different degrees of infraocclusion that can occurs in distinct stages of eruptive period which etiology is ignored. In order to prevent malloclusions, the correct diagnosis of dentoalveolar ankylosis seems to be very important. This paper aims to presents a dentoalveolar ankylosis literature review and a clinical case report, with the respective treatment.

Influência de fármacos anticonvulsivantes no bruxismo de crianças com paralisia cerebral / Influence of anticonvulsivant drugs on bruxism in children with cerebral palsy

Esse estudo objetivou avaliar a influência de fármacos anticonvulsivantes no bruxismo de crianças com paralisia cerebral (PC) estudando uma amostra constituída de 203 indivíduos, divididos em três grupos pareados, sendo dois grupos de crianças PC (GE1 e GE2) e um grupo controle (GC), composto por crianças normoreativas. O primeiro constituído por crianças PC que não faziam uso de fármacos anticonvulsivates (GE1) e o segundo com crianças que faziam uso destes fármacos regularmente (GE2). A avaliação de bruxismo foi realizada mediante questionário aplicado aos cuidadores. Os principais grupos farmacológicos encontrados no GE2 foram: valproato, barbitúrico, benzodiazepínicos e carbamazepina...

The purpose of this study was to investigate the influence of anticonvulsant drugs on bruxism in children with cerebral palsy (CP), using a sample of 203 indiduals who were divided into three paired groups: two groups of children. The firts group constituted by children with CP who did not take anticonvulsant drugs (EG1) while children of the second group (EG2) took such meidcation on a regular basis Bruxism assessment was conducted through the use of a questionnaire directed to the caretakers...

Orofacial aspects in Noonan syndrome: 2 case report.

Noonan syndrome (NS) is an autosomal dominant disorder characterized by dysmorphic facial features in association with short stature and heart disease. A webbed neck, chest deformities, mental retardation, and bleeding disorders are also frequently associated with this pathology. NS is relatively common, with an estimated incidence of 1 per 1,000 to 1 per 2,500 live births. Many cases have been reported in the dental literature, yet only a few of them describe some details of the oral features. The aim of this paper is to describe 2 cases of Noonan syndrome, emphasizing oral and facial aspects and particularities of the dental treatment in subjects affected by this genetic disease.

Pallister-Killian syndrome (PKS): clinical case report.

Pallister-Killian Syndrome is a rare dysmorphic condition characterized by specific clinical manifestations and tetrasomy 12p. This paper focuses on the general and orofacial clinical manifestations.