Removable prostheses improve oral health-related quality of life and satisfaction of elderly people with rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease that affects joint tissues and causes severe physical and functional impairments on quality of life due to muscular and articular pain. The involvement of temporomandibular joint in RA interferes with mouth opening and masticatory process. However, no studies addressed the impact of RA on oral health-related quality of life (OHRQoL) and satisfaction with prostheses use in elderly people. Aim: This study assessed the impact of oral rehabilitation with conventional dentures on the OHRQoL and prostheses satisfaction in elderly patients with RA, associated or not with temporomandibular disorder (TMD). Methods: Forty-five elderly were enrolled and divided into three groups: (1) RA and TMD (n=15, experimental), (2) RA without TMD (n=15, experimental), and (3) without RA and without TMD (n=15, control). The OHRQoL and the prostheses satisfaction were evaluated before and after new oral rehabilitation with partial and/or complete dentures. The OHRQoL and prosthesis satisfaction were assessed and verified through OHIP-14 questionnaire and visual analogue scale, respectively. Results: TMD group exhibited the worst mean values (P<0.05) for all OHIP-14 domains before insertion of new dentures. Group 2 showed worst means (P<0.05) compared to controls for functional limitation and physical pain domains of the OHIP-14, but not in the general score. Patients showed better outcomes of satisfaction with prostheses use only after the new rehabilitation. Conclusion: The use of new and well-fitted dentures improves all domains of OHRQoL in patients with RA and TMD and all groups were satisfied with prostheses use after the new rehabilitation with conventional dentures

Mandibular movements in older people with rheumatoid arthritis.

OBJECTIVE: The aim of this study was to compare the mandibular movements in older people with and without temporomandibular disorder (TMD) associated with rheumatoid arthritis (RA). STUDY DESIGN: Thirty partially or completely edentulous older adults (65.33 ± 4.7 years) were assigned to 2 groups: (1) with RA and TMD and (2) without RA and TMD. Chewing movements of the jaws during mastication of the test material (Optocal) and the range of mandibular movements were evaluated by using the JT-3-D kinesiographic device before and after new removable prosthesis insertion. Multiple comparisons were made with analysis of variance (ANOVA) and the Tukey-Kramer test. RESULTS: Comparisons between the 2 groups before and after new prosthesis insertion revealed that the RA and TMD group had reduced opening angles (P < .05) during chewing. After insertion of new prostheses, both groups showed increased opening and closing angles during chewing (P < .05). The mandibular range of motion results showed that patients with RA and TMD exhibited lower aperture and laterality movements (P < .05) compared with controls before and after new prosthesis insertion. However, there was an increase in aperture, lefty laterality, and protrusion values after new prosthesis insertion in both groups. CONCLUSIONS: TMD associated with RA may impair mandibular movements. Well-fitted prostheses may improve mandibular movements in older adults, especially those with RA.

Trial of an experimental castor oil solution for cleaning dentures.

Denture hygiene is essential because denture biofilm is involved in oral infections and systemic diseases. Although there are chemical agents available on the market, none of them have ideal properties and research on such products is still necessary. The aim of this study was to evaluate the efficacy of a castor bean (Ricinus communis)-based solution for removing denture biofilm, compared to two traditional products (sodium hypochlorite and alkaline peroxide). Fifty maxillary complete denture wearers were instructed to brush their dentures after meals and to immerse their dentures once a day in the following solutions: Saline (20 min; control), Polident alkaline peroxide (3 min), NaOCl (20 min) and 2% castor oil solution (20 min). Participants used each solution for a period of 7 consecutive days, according to a random sequence. After each period, the internal surfaces of maxillary complete dentures were stained with a disclosing solution (1% neutral red), photographed and the disclosed biofilm was quantified with the aid of specific software. The influence of treatments on results was verified by the Friedman test (α=0.05). Tested solutions presented significant difference (Fr=51.67; p<0.001). Saline and NaOCl were significantly different (median: 2.0% and 0.0%) whereas Polident and castor oil presented intermediate results (median: 1.0% and 1.5%, respectively). It can be concluded that the castor oil solution tested in this study was comparable to alkaline peroxide in terms of efficiency in denture biofilm removal.

Trial of an Experimental Castor Oil Solution for Cleaning Dentures

Denture hygiene is essential because denture biofilm is involved in oral infections and systemic diseases. Although there are chemical agents available on the market, none of them have ideal properties and research on such products is still necessary. The aim of this study was to evaluate the efficacy of a castor bean (Ricinus communis)-based solution for removing denture biofilm, compared to two traditional products (sodium hypochlorite and alkaline peroxide). Fifty maxillary complete denture wearers were instructed to brush their dentures after meals and to immerse their dentures once a day in the following solutions: Saline (20 min; control), Polident alkaline peroxide (3 min), NaOCl (20 min) and 2% castor oil solution (20 min). Participants used each solution for a period of 7 consecutive days, according to a random sequence. After each period, the internal surfaces of maxillary complete dentures were stained with a disclosing solution (1% neutral red), photographed and the disclosed biofilm was quantified with the aid of specific software. The influence of treatments on results was verified by the Friedman test (α=0.05). Tested solutions presented significant difference (Fr=51.67; p<0.001). Saline and NaOCl were significantly different (median: 2.0% and 0.0%) whereas Polident and castor oil presented intermediate results (median: 1.0% and 1.5%, respectively). It can be concluded that the castor oil solution tested in this study was comparable to alkaline peroxide in terms of efficiency in denture biofilm removal.

A higiene de próteses totais é essencial, uma vez que o biofilme da prótese está envolvido com infecções orais e doenças sistêmicas. Apesar de existirem agentes químicos disponíveis no mercado, nenhum deles apresenta propriedades ideais e pesquisas com esses produtos ainda são necessárias. O objetivo neste estudo foi avaliar a eficácia de uma solução de mamona (Ricinus communis) para a remoção do biofilme de prótese total, comparada com dois produtos comerciais (NaOCl e peróxido alcalino). Cinqüenta usuários de próteses totais maxilares foram instruídos a escovar as próteses após as refeições e imergi-las uma vez por dia nas seguintes soluções: soro fisiológico (20 min), Peróxido alcalino Polident (3 min), NaOCl a 1% (20 min) e solução de mamona (20 min). Os participantes utilizaram cada solução por um período de sete dias consecutivos, de acordo com uma sequência aleatória. Após cada período, as superfícies internas das próteses totais superiores foram coradas com solução evidenciadora (vermelho neutro a 1%), fotografadas e o biofilme evidenciado foi quantificado com software. A influência dos tratamentos sobre os resultados foi verificada pelo teste de Friedman (α=0,05). Houve diferença significativa entre as soluções (Fr=51,67;p<0,001). O soro fisiológico e o NaOCl foram significativamente diferentes (mediana: 2,0% e 0,0%), enquanto o Polident e a solução de mamona apresentaram resultados intermediários (mediana: 1,0% e 1,5%, respectivamente). Concluiu-se que a solução de mamona avaliada é comparável ao peróxido alcalino, em termos de remoção do biofilme de prótese total.

Anterior and medial angulations of the styloid process in subjects with TMD: clinical and radiographic findings.

This study investigated the existence of association between the angulation of the styloid process on the anterior and medial directions with the intensity of temporomandibular dysfunction (TMD) symptoms. Fifty patients (8 men and 42 women) aged 25 to 70 years, with relevant TMD symptoms were evaluated. Clinical examinations were performed to determine the severity of TMD symptoms (orofacial pain, headache, tinnitus and dizziness) based on the RDC/TMD criteria and the visual analogue scale (VAS), and digital radiographic images of the styloid process were obtained: lateral cephalometric skull radiograph (analysis of anterior angulation) and posteroanterior skull radiograph (reverse Towne's projection) (analysis of medial angulation). The anterior angulation average of the styloid process was 20.89° while the medial angulation average was 19.1° in the right side and 19.04° in the left side. There was no statistically significant difference among the patient groups (severe, moderate and mild symptoms) associating the TMD symptoms and the anterior or medial angulation of the styloid process (p>0.05). There was no correlation between the intensity of the TMD symptoms and the measurements of anterior and medial angulation of the styloid process using either lateral cephalometric or posteroanterior radiographs (reverse Towne's projection).

Anterior and medial angulations of the styloid process in subjects with TMD: clinical and radiographic findings

This study investigated the existence of association between the angulation of the styloid process on the anterior and medial directions with the intensity of temporomandibular dysfunction (TMD) symptoms. Fifty patients (8 men and 42 women) aged 25 to 70 years, with relevant TMD symptoms were evaluated. Clinical examinations were performed to determine the severity of TMD symptoms (orofacial pain, headache, tinnitus and dizziness) based on the RDC/TMD criteria and the visual analogue scale (VAS), and digital radiographic images of the styloid process were obtained: lateral cephalometric skull radiograph (analysis of anterior angulation) and posteroanterior skull radiograph (reverse Towne's projection) (analysis of medial angulation). The anterior angulation average of the styloid process was 20.89° while the medial angulation average was 19.1° in the right side and 19.04° in the left side. There was no statistically significant difference among the patient groups (severe, moderate and mild symptoms) associating the TMD symptoms and the anterior or medial angulation of the styloid process (p>0.05). There was no correlation between the intensity of the TMD symptoms and the measurements of anterior and medial angulation of the styloid process using either lateral cephalometric or posteroanterior radiographs (reverse Towne's projection).

Este estudo investigou a existência de associação entre a angulação do processo estiloide nas direções anterior e medial e a intensidade dos sintomas de disfunção temporomandibular. Cinquenta pacientes (8 homens e 42 mulheres) com idade entre 25 a 70 anos, com sintomas relevantes de DTM foram avaliados. Os exames clínicos foram realizados para determinar a severidade dos sintomas da DTM (dor orofacial, cefaleia, zumbido e tontura) com base nos critérios do RDC / DTM e na escala visual analógica (EVA), e imagens de radiografias digitais do processo estiloide foram obtidas: cefalométrica lateral com incidência reversa (análise de angulação anterior), e póstero-anterior do crânio (projeção reversa de Towne) (análise de angulação medial). A média de angulação anterior do processo estilóide foi 20,89°, enquanto a média da angulação medial foi 19,1° no lado direito e 19,04° no lado esquerdo. Não houve diferença estatisticamente significativa entre os grupos de pacientes (sintomas severos, moderados ou leves) em associação com os sintomas de DTM e as angulações anterior ou medial do processo estiloide (p>0,05). Não houve correlação entre a intensidade dos sintomas de DTM e as medidas das angulações anterior e medial do processo estiloide utilizando a radiografia cefalométrica lateral ou a póstero-anterior (projeção reversa de Towne).

Styloid process elongation and calcification in subjects with tmd: clinical and radiographic aspects

Knowledge of the Eagle's syndrome shows that its symptoms can be very easily confused with other types of craniomandibular disorders, especially temporomandibular disorders (TMD). The aim of this study was to find a possible correlation between the presence of TMD and elongation of the styloid process as well relate to presence of calcification of the stilohyoid chain. Fifty patients with TMD, confirmed from the RDC/TMD, were examined clinically and radiographically. Radiographic documentation consisted of digital panoramic radiograph and digital lateral cephalometric radiograph. Radiocef software (Radiomemory) was used for the analysis of radiographs by means of specific cephalometric tracing and linear measurements of the styloid process. Each radiograph was traced and measured three times with intervals of 1 month to spread the error. Statistical analysis was performed by Pearson's test (p=0.001) using Biostat 4.0 statistical software. Result showed an incidence of 76% elongation of the styloid process in the sample. There was a correlation between the bilateral measures taken in panoramic radiographs (?<0.001) and also for measures of styloid process length carried out in different panoramic radiographs and lateral cephalometric radiographs (?<0.001). It was concluded that there is prevalence of elongated styloid process in patients with TMD. However, no relationship was found between measurements on the stylohyoid chain and symptoms of headache, orofacial pain, tinnitus and vertigo.

O conhecimento adquirido sobre a síndrome de Eagle demonstra que sua sintomatologia pode ser confundida muito facilmente com outros tipos de desordens craniomandibulares, principalmente a disfunção temporomandibular (DTM). O objetivo do estudo foi encontrar uma possível correlação entre a presença de DTM e o alongamento do processo estilóide, assim como a relação com a calcificação da cadeia estilo-hiódea. Para tanto foram analisados 50 pacientes com DTM, confirmada a partir do RDC/TMD. Foi realizado o exame clínico e documentação radiográfica de cada paciente, composta por: radiografia panorâmica digital e cefalométrica lateral digital. Para a análise das radiografias foi utilizado o programa computacional Radiocef (Radiomemory), onde foram realizados traçados cefalométricos por análise específica e medidas lineares do processo estilóide. Cada radiografia foi traçada e medida por três vezes, com intervalos de tempo de 1 mês entre as medições a fim de diluir o erro. Foi realizada a estatística através do Programa Biostat 4.0 e o teste de Pearson (?=0,001). Como resultado foi encontrada uma incidência de 76% de alongamento do processo estilóide na amostra. Houve correlação positiva para as medidas bilaterais realizadas na radiografias panorâmicas (?<0,001) e também para as medidas de comprimento do processo estilóide realizados nas diferentes tomadas radiográficas panorâmicas e cefalométricas laterais (?<0,001). Concluiu-se que há prevalência de alongamento do processo estilóide em pacientes com DTM, embora não tenha sido encontrada relação entre as medidas realizadas na cadeia estilo-hióidea com os sintomas de cefaléia, dor orofacial, zumbido e vertigem.

Avaliação do risco à osteopenia/osteoporose através do questionário avaliativo e sua associação com a análise morfológica do cortéx inferior da mandíbula realizadas em radiografias panorámicas / Risk assessment of osteopenia/osteoposis through the evaluation questionnaire and its association with the morphological analysis of the mandibular inferior cortex in panoramics radiographs

Objetivo: os autores apresentam uma proposta de questionário e conduta para referenciar pacientes com risco de osteoporose para avaliação médica...

Objective: The authors prepared a questionnaire for referring patients about the risk at osteoporosis...

A relação entre a sintomatologia de DTMS e a síndrome de eagle / The relationship between the symptoms of TMD and eagle syndrome

O objetivo deste estudo foi avaliar a presença de sintomas característicos da Síndrome de Eagle em pacientes com disfunção temporomandibular (DTM)...

The aim of this study was to assess the presence of characteristic symptoms of Eagle syndrome in patients with temporomandibular disorders (TMD)...