Cephalometric Evaluation of Maxillary Incisors Torque and Vertical Changes Utilizing Standard Edgewise Mechanics

In 1995 Gebeck & Merrifield studied a successful and unsuccessful treated Class I and Class II's samples; they found a -1.33 mm intrusion in the former and a 0.80 mm extrusion in the latter. The purpose of this article was to perform a cephalometric evaluation of maxillary incisors torque and vertical changes. We studied a sample of 129 patients, 30 males and 99 females, taken from The Charles H. Tweed Foundation Long Term Study, at pretreatment mean age 12.93 years, posttreatment mean age 16.19 years and follow up post retention mean age 29.83 years, a 13.88 years interval. The records were collected from private practitioners across the North American continent who used Standard Edgewise Mechanics and were members of the Charles H. Tweed Foundation. All patients were Class I and II American whites treated with the extraction of 4 premolars. We found an Upper anterior incisal edge to PP vertical linear measurement 28.7 and 29.2 mm, +0.53 mm (p<0.019) from pretreatment to posttreatment. The average Upper 1 to SN angle was 103.2 ° at pretreatment and 100.1° at posttreatment, -3.2° (p<0.000), Upper 1 to PP 111.0° and 108.9°, -2.2° (p<0.000), the three of them statistically significant. Conversely, Upper 1 to commissure was not. The four measurements were also statistically significant posttreatment to follow up, upper anteriors kept losing torque after posttreatment, and less upper anteriors surface was below the commissure. Some torque loss and vertical extrusion can be expected while treating patients with extractions of four premolars, therefore, upper incisor inclination increase and vertical change by itself cannot determine the success of treatment.

En 1995, Gebeck y Merrifield estudiaron muestras de Clase I y Clase II tratadas con éxito y sin éxito; encontraron una intrusión de -1,33 mm en el primero y una extrusión de 0,80 mm en el segundo. El propósito de este artículo fue realizar una evaluación cefalométrica del torque y los cambios verticales de los incisivos maxilares. Estudiamos una muestra de 129 pacientes, 30 hombres y 99 mujeres, tomados del estudio a largo plazo de la Fundación Charles H. Tweed, con una edad media previa al tratamiento de 12,93 años, una edad media posterior al tratamiento de 16,19 años y una edad media de seguimiento posterior a la retención de 29,83 años, con un intervalo de de 13,88 años. Los registros se recopilaron de médicos privados en todo el continente norteamericano que utilizaron Standard Edgewise Mechanics y eran miembros de la Fundación Charles H. Tweed. Todos los pacientes eran blancos americanos Clase I y II tratados con extracción de 4 premolares. Encontramos una medida lineal vertical del borde incisal anterior superior a PP de 28,7 y 29,2 mm, +0,53 mm (p<0,019) desde el pretratamiento hasta el postratamiento. El promedio del ángulo Superior 1 a SN fue de 103,2° en el pretratamiento y 100,1° en el postratamiento, -3,2° (p<0,000), Superior 1 a PP 111,0° y 108,9°, -2,2° (p<0,000), los tres estadísticamente significante. Por el contrario, Superior 1 a la comisura no lo era. Las cuatro mediciones también fueron estadísticamente significativas para el seguimiento después del tratamiento, los dientes anteriores superiores siguieron perdiendo torsión después del tratamiento y se observó menor superficie de los dientes anteriores superiores debajo de la comisura. Se puede esperar cierta pérdida de torque y extrusión vertical al tratar a pacientes con extracciones de cuatro premolares, por lo tanto, el aumento de la inclinación del incisivo superior y el cambio vertical por sí mismos no pueden determinar el éxito del tratamiento.

Bruxismo de la vigilia

El bruxismo del sueño ha sido extensamente estudiado en las últimas décadas pero aún persiste una considerable controversia científica en relación al bruxismo de la vigilia. El presente trabajo de revisión se focalizó en este tema, incluyendo 45 artículos publicados entre los años 2011 al año 2020. Los consensos internacionales plantean avances en nuevas clasificaciones diagnósticas, que contemplan herramientas como cuestionarios, examen clínico, electromiografía, polisomnografía, evaluación ecológica momentánea y métodos de muestreo de experiencias. Se considera al bruxismo de la vigilia un problema comportamental, pasible de ser tratado mediante terapias comportamentales que lo controlen. La evaluación ecológica momentánea permite capturar información comportamental en tiempo real y se presenta como una herramienta valiosa para el diagnóstico y evaluación del bruxismo de la vigilia. A pesar de numerosos avances presentados en esta revisión, aún se requieren estudios que exploren esta área del conocimiento, especialmente en los mecanismos fisiopatológicos y los posibles tratamientos.

O bruxismo do sono tem sido amplamente estudado nas últimas décadas, mas ainda persiste considerável controvérsia científica em relação ao bruxismo de vigília. O presente trabalho de revisão focou nesse tema, incluindo 45 artigos publicados entre 2011 e 2020. Consensos internacionais propõem avanços em novas classificações diagnósticas, que incluem ferramentas como questionários, exame clínico, eletromiografia, polissonografia, avaliação ecológica momentânea e métodos de amostragem de experiência. O bruxismo de vigília é considerado um problema comportamental, que pode ser tratado por terapias comportamentais que o controlam. A avaliação ecológica momentânea permite capturar informações comportamentais em tempo real e se apresenta como uma ferramenta valiosa para o diagnóstico e avaliação do bruxismo em vigília. Apesar dos inúmeros avanços apresentados nesta revisão, ainda são necessários estudos para explorar essa área do conhecimento, principalmente nos mecanismos fisiopatológicos e possíveis tratamentos.

A novel artificial neural network for the diagnosis of orofacial pain and temporomandibular disorders.

BACKGROUND: Temporomandibular disorders (TMD) and orofacial pain are highly prevalent. This prevalence can be compared to that of leading non-communicable diseases (NCDs). However, it is surprising to still find a high degree of controversy regarding its diagnosis and management. Patients usually experience treatment delays, missed diagnoses, and receive unnecessary therapies. New artificial intelligence algorithms have helped diagnose numerous diseases. Nevertheless, no studies have focused on the use of artificial intelligence to diagnose these conditions. OBJECTIVES: This study aimed to develop and test the performance of a novel neural network (multilayer perceptron) with diagnostic capabilities in orofacial pain and TMD, including some types of referred pain. METHODS: A multilayer perceptron (MLP) was developed with one input layer, five hidden layers, and one output layer. It was trained using backpropagation algorithms. Several categories of orofacial pain and TMD clinical cases were presented to 12 general dental clinicians, and their diagnoses were contrasted to those provided by the artificial intelligence neural network. RESULTS: Overall, the diagnostic accuracy of the artificial intelligence was superior to that of the general dental clinicians (p = .0072). This was more evident in the clinical cases involving non-dental and referred orofacial pains (e.g. neuropathic pain, referred cardiac pain, neurovascular pain). CONCLUSIONS: This study showed, for the first time, that an artificial neural network can help medical and general dental clinicians diagnose several types of orofacial pain and dysfunction, including TMD, neuropathic, neurovascular, and referred cardiac pain. In some cases, the MLP appears to have a life-saving role.

Detección de drogas en saliva: aspectos metodológicos y legales / Detection of drugs in saliva: methodological and legal aspects

El análisis de drogas en saliva es una alternativa no invasiva para evidenciar su presencia en el organismo. La finalidad es amplia, pero se ha utilizado en medicina legal y forense, en especial para drogas ilícitas. La recolección de saliva no implica riesgo, ni personal especializado. El objetivo fue valorar diversos aspectos metodológicos y de validez del test de drogas en saliva para el diagnóstico de su consumo. Asimismo, se analizaron algunos aspectos relativos a la legislación de drogas. Las sustancias psicoactivas a evaluar fueron marihuana, cocaína, anfetaminas y opiáceos. Se realizó una búsqueda en las bases de Pubmed/MEDLINE, Embase, LILACS, Scopus, SciELO y de literatura gris. La identificación de drogas en fluidos biológicos incluye técnicas inmunoquímicas, cromatográficas y procedimientos espectrométricos. Resultados positivos obtenidos mediante una técnica deberían confirmarse con un segundo análisis basado en distintos principios químicos o físicos. Se han detectado en saliva marihuana, cocaína, opiáceos y anfetaminas, entre otras, mediante métodos analíticos, como inmunoensayo y cromatografía de gases / espectrometría de masas en tándem. En el fluido oral, se pueden detectar drogas de abuso durante 5-48 horas posteriores al consumo, a un nivel bajo de nanogramos por mililitro. Se concluyó que la detección de drogas en saliva es una opción indicada ante sospecha de su consumo, por signos o síntomas que sugieren abuso de drogas o para la vigilancia del usuario en un centro de tratamiento por dependencia. En el aspecto legal el uso de test de drogas en saliva es una posibilidad para determinadas circunstancias.

The analysis of drugs in saliva is a non-invasive alternative to demonstrate their presence in the body. The purpose is broad, but it has been used in forensic and legal medicine, especially for illicit drugs. The collection of saliva is not risky and does not require specialized personnel. The objective was to assess various methodological and validity aspects of the saliva drug test for the diagnosis of drug use. Likewise, some aspects related to drug legislation were analyzed. The psychoactive substances to be evaluated were marijuana, cocaine, amphetamines and opiates. A search was carried out in the Pubmed / MEDLINE, Embase, LILACS, Scopus, SciELO and gray literature databases. Identification of drugs in biological fluids was found to include immunochemical, chromatographic and spectrometric procedures. Positive results obtained by one technique must be confirmed with a second analysis based on different chemical or physical principles. Marijuana, cocaine, opiates and amphetamines, among other drugs, have been detected in saliva by various analytical methods, like immunoassay and gas chromatography / tandem mass spectrometry. In oral fluid, drugs of abuse can be detected for 5-48 hours post-consumption, at a low level of nanograms per milliliter. It was concluded that the detection of drugs in saliva is an option that is indicated in the event of suspected drug use, for signs or symptoms that suggest drug abuse, or for monitoring the user in a dependency treatment center. In the legal aspect, the use of drug tests in saliva is a possibility for certain circumstances.

Bruxist Activity Monitor System (BAMS): An instrumental approach tool in the assessment of Bruxism.

The magnitude of harmful effects on dental structures, periodontium, masticatory muscles, and the temporomandibular joint, derived from temporomandibular disorders, specifically from sleep Bruxism, generates evidence that needs to be objectively collected. This paper introduces a portable device aiming at extracting and analyzing parameters (like timestamp, duration, or latency) from recordings obtained from the monitoring of occlusal activity, throughout a complete sleep cycle. An electronic device embedded in a mid-density medical grade silicon occlusal splint detects the moment in which the subject exerts sustained force, and records the time and length of the event, keeping the device on hold until a new event arises. The electronic device, based on a microcontroller, identifies occlusive events from an array of two piezo-resistive sensors and has a storage capacity of up to 36 hours of continuous activity. The collected data is wirelessly transmitted to an external module that is connected via USB to a PC. In the PC, the data is decoded, processed, analyzed, displayed, and stored in ordered files for case subjects, updating every recorded test for a complete history review. The proposed Bruxist Activity Monitor System (BAMS) was tested in one subject for more than 40 hours (5 sessions in 7 days). Preliminary results show the oral appliance endure without any significant damage over its surface nor undermining its functionality.

Effect of the incorporation of hydroxyapatite on the diametral tensile strength of conventional and hybrid glass ionomer cements.

The objective was to evaluate the effect of the incorporation of calcium hydroxyapatite particles (HAp) in the diametral tensile strength of a conventional type II glass ionomer (GC Gold Label 2) and a resin-modified glass ionomer cement (GC Gold Label 2 LC R). Two experimental HAp (E1HAp or E2HAp) were synthesized and characterized using X-ray diffraction and Confocal Raman spectroscopy. Both HAp were added into the powder of a conventional or resin-modified glass ionomer cement at 5 or 10 wt.%. A commercial HAp (CHAp) was used as reference material. For each glass ionomer cement, a group without the incorporation of HAp was used as a control. A universal testing machine was used for the mechanical test. The results were analyzed through a two-way ANOVA test followed by a complementary Tukey test. For all analyzes, the level of significance was set at α = 0.05. The average particle size for E1Hap was 15 µm, E2HAp was 35 µm and for CHAp was 1 µm. For conventional GIC, the addition of 10% E1HAp and 5% CHAp significantly increased the diametral tensile strength values (p ≤ 0.005). On the other hand, for the resin-modified GIC, except for the 5% E2HAp group, all experimental groups significantly reduced the values of diametral tensile strength (p ≤ 0.007). The addition of HAp improved the mechanical properties only for the conventional glass ionomer cement.

Orofacial Pain and Toothache as the Sole Symptom of an Acute Myocardial Infarction Entails a Major Risk of Misdiagnosis and Death.

AIMS: To provide an update of knowledge regarding the clinical presentation and neurophysiologic aspects of orofacial pain of cardiac origin in the form of a literature review. METHODS: The peer-reviewed databases Scopus/Embase, NCBI (PubMed), and Science Direct were searched up to December 2018. RESULTS: Patients with myocardial infarction presenting without chest pain run a higher risk of death due to missed diagnosis and subsequently a significantly greater delay between the onset of symptoms and arrival at the hospital. During myocardial ischemia, orofacial pain is reported by 4 in 10 patients and described as oppressive and/or burning. Up to 4% of myocardial infarction patients experience pain solely in the orofacial structures, women more often than men. Orofacial pain during myocardial ischemia is associated with ischemia within the inferior wall of the heart, suggesting the involvement of the vagal system. CONCLUSION: The clinician's awareness of the full spectrum of clinical characteristics of a myocardial infarction constitutes a key factor in accurate diagnosis. Health care professionals and the general public should be aware of the possibility of myocardial infarction presenting with orofacial pain, toothache, or ear/temporomandibular joint pain as the only symptom.

Prevalencia de signos y síntomas de trastornos témporomandibulares en una población joven al inicio del tratamiento por drogodependencia / Prevalence of signs and symptoms of temporomandibular disorders in a young population at the beginning of treatment for drug dependence

Introducción: El consumo de drogas puede constituir un agente etiológico de trastornos témporomandibulares (TTM), lo cual debe ser tenido en cuenta al momento del diagnóstico y en la elaboración de un plan de tratamiento. Objetivo: Estimar la prevalencia de signos y síntomas de TTM en una población con dependencia a las drogas al inicio del régimen de internación y analizar posibles factores asociados. Material y método:Fue un estudio descriptivo y transversal, que incluyó pacientes consecutivos al inicio del tratamiento por consumo problemático de drogas. Participaron 135 pacientes internados en el Portal Amarillo y examinados por un investigador calibrado. Se solicitó consentimiento informado al participante y/o su representante legal. Resultados: La prevalencia de participantes con uno o más signos actuales de TTM fue de 29,7% y con uno o más síntomas actuales de TTM fue de 68,8%. La prevalencia de síntomas actuales de TTM presentó asociación significativa con autopercepción de estrés (p=.03), consumo de mate (p=.03) y de alcohol (p=.03). Conclusiones: La prevalencia de síntomas de TTM en una población en tratamiento por dependencia a las drogas es elevada respecto a la población general. Esto debe ser tenido en cuenta a la hora de desarrollar políticas de prevención y tratamiento.

Introduction: Drug consumption may be an etiological agent of temporomandibular disorders (TMD) which should be considered when diagnosing a patient and developing a treatment plan. Objective: To estimate the prevalence of TMD signs and symptoms in a drug-dependent population at the beginning of their admission, and to analyze possible associated factors. Materials and methods: This was a descriptive cross-sectional study that included patients at the beginning of treatment for problematic drug use. We studied 135 subjects admitted to Portal Amarillo, Uruguay. The patients were examined by a calibrated researcher. Informed consent was requested from each participant and/or their legal representative. Results: The prevalence of subjects with one or more current TMD signs was 29.7%, and those with one or more current TMD symptoms accounted for 68.8%. The prevalence of current TMD symptoms showed a significant association with self-perceived stress (p=.03), mate consumption (p=.03) and alcohol consumption (p=.03). Conclusions: The prevalence of current TMD symptoms in the population under treatment for drug dependence is high compared to the general population. This should be considered when developing prevention and therapeutic strategies.

Regulación voluntaria de la actividad contráctil del músculo masetero en individuos sanos y con trastornos temporomandibulares. Un potencial test diagnóstico / Voluntary regulation of the contractile activity of the masseter muscle in healthy individuals vs. patients with temporomandibular disorders: a potential diagnostic test

El presente trabajo buscó analizar aspectos electrofisiológicos del control voluntario de la actividad contráctil del músculo masetero estudiando una nueva variable, presentada previamente por nuestro grupo. Con este objetivo se realizó un estudio comparativo entre un grupo de voluntarios sanos y otro de pacientes con trastornos temporomandibulares. Se utilizó un sistema experimental que utilizó retroalimentación visual a tiempo real para controlar el esfuerzo contráctil del músculo masetero y se calculó para cada registro electromiográfico, el tiempo que cada individuo necesitó para controlar la trayectoria de la actividad motora. Los coeficientes de variación y los desvíos estándar fueron diferentes entre los grupos analizados (p< 0.01 y p=0.02 respectivamente). Un coeficiente de variación mayor a 0.936 fue encontrado, determinando de esta manera, una especificidad del 93.7%. Asimismo se verificó una sensibilidad del 60%. Esta nueva variable mostró un potencial diagnóstico prometedor, con alta especificidad. Es posible que la sensibilidad pueda aumentarse si se realizan más repeticiones para cada individuo, de modo de analizar mejor el impacto de la dispersión.

This study analyzed the electrophysiological aspects of the voluntary control of the contractile activity of the masseter muscle studying a new variable, previously presented by our group. We conducted a comparative study among healthy volunteers and patients with temporomandibular disorders. We used an experimental system that included real time visual feedback to control the contractile effort of the masseter muscle. The time that each individual needed to control the trajectory of the motor activity was calculated for each electromyographic record. Coefficients of variation and standard deviations were different in the groups analyzed (p<0.01 and p = 0.02 respectively). We found a coefficient of variation greater than 0.936, which determines a 93.7% specificity. Additionally, a 60% sensitivity was verified. This new variable showed promising diagnostic potential, with high specificity. Sensitivity can be increased if more repetitions are conducted for each individual, so as to better analyze the impact of dispersion.

Craniofacial pain can be the sole prodromal symptom of an acute myocardial infarction: an interdisciplinary study.

We recently found craniofacial pain to be the sole symptom of an acute myocardial infarction (AMI) in 4% of patients. We hypothesized that this scenario is also true for symptoms of prodromal (pre-infarction) angina. We studied 326 consecutive patients who experienced myocardial ischemia. Intra-individual variability analyses with respect to ECG findings and pain characteristics were performed for those 150 patients who experienced at least one recurrent ischemic episode. AMI patients (n=113) were categorized into two subgroups: "abrupt onset" (n=81) and "prodromal angina" (n=32). Age, gender and risk factor comparisons were performed between groups. Craniofacial pain constituted the sole prodromal symptom of an AMI in 5% of patients. In those who experienced two ischemic episodes, women were more likely than men to experience craniofacial pain in both episodes (p<0.01). There was no statistically significant difference between episodes regarding either ECG findings or the use of the two typical pain quality descriptors "pressure" and "burning". This study is to our knowledge the first to report that craniofacial pain can be the only symptom of a pre-infarction angina. Craniofacial pain constitutes the sole prodromal AMI symptom in one out of 20 AMI patients. Recognition of this atypical symptom presentation is low because research on prodromal AMI symptoms has to date studied only patients with chest pain. To avoid a potentially fatal misdiagnosis, awareness of this clinical presentation needs to be brought to the attention of clinicians, researchers and the general public.

En un estudio previo encontramos que un dolor en la región cráneo-facial puede ser el único síntoma de un infarto agudo de miocardio (IAM) en el 4% de los casos. En el presente trabajo la hipótesis fue que este escenario es cierto también para la angina pre-infarto o angina prodrómica. En el estudio se incluyeron 326 pacientes consecutivos con isquemia cardiaca sintomática. Se realizó un análisis intraindividual con respecto a características del dolor y hallazgos electrocardiográficos en los 150 pacientes que presentaron episodios recurrentes de isquemia cardiaca. Los pacientes con infarto agudo se categorizaron en dos grupos: "comienzo abrupto" (n=81) y "angina prodrómica" (n=32). Se realizaron comparaciones entre grupos con respecto a edad, género y factores de riesgo cardiovasculares. El dolor en la región cráneofacial constituyó el único síntoma prodrómico (pre-infarto) de un IAM en el 5% de los casos. En aquellos pacientes que experimentaron dos episodios isquémicos, las mujeres tuvieron una mayor prevalencia de dolor cráneo-facial en los dos episodios (p<0.01). No se detectaron diferencias estadísti cas entre episodios con respecto a hallazgos electrocar dio grá ficos o al empleo de los descriptores verbales del dolor de origen cardíaco "opresivo" y "quemante". Este es el primer estudio de investigación en documentar que el dolor en la región cráneo-facial puede ser el único síntoma de una angina pre-infarto. En efecto, esto ocurre en uno de cada 20 casos de IAM. El reconocimiento de esta presentación clínica es baja debido a que históricamente los criterios de inclusión de los estudios de angina pre-infarto incluyeron únicamente pacientes con dolor de pecho. Para evitar el error diagnóstico con consecuencias fatales para el paciente, es importante que esta información llegue tanto a los clínicos como al público en general.

Craniofacial pain can be the sole prodromal symptom of an acute myocardial infarction: an interdisciplinary study / El dolor cráneo-facial puede ser el único síntoma prodrómico de un infarto agudo de miocárdio: estudio interdisciplinario

We recently found craniofacial pain to be the sole symptom of anacute myocardial infarction (AMI) in 4% of patients. Wehypothesized that this scenario is also true for symptoms ofprodromal (pre-infarction) angina. We studied 326 consecutivepatients who experienced myocardial ischemia. Intra-individualvariability analyses with respect to ECG findings and paincharacteristics were performed for those 150 patients whoexperienced at least one recurrent ischemic episode. AMI patients(n=113) were categorized into two subgroups: “abrupt onset”(n=81) and “prodromal angina” (n=32). Age, gender and riskfactor comparisons were performed between groups. Craniofacialpain constituted the sole prodromal symptom of an AMI in 5% ofpatients. In those who experienced two ischemic episodes, womenwere more likely than men to experience craniofacial pain in bothepisodes (p<0.01). There was no statistically significant differencebetween episodes regarding either ECG findings or the use of thetwo typical pain quality descriptors “pressure” and “burning”. This study is to our knowledge the first to report that craniofacialpain can be the only symptom of a pre-infarction angina.Craniofacial pain constitutes the sole prodromal AMI symptomin one out of 20 AMI patients. Recognition of this atypicalsymptom presentation is low because research on prodromalAMI symptoms has to date studied only patients with chest pain.To avoid a potentially fatal misdiagnosis, awareness of thisclinical presentation needs to be brought to the attention ofclinicians, researchers and the general public.

En un estudio previo encontramos que un dolor en la región cráneo-facial puede ser el único síntoma de un infarto agudo de miocardio (IAM) en el 4 por ciento de los casos. En el presentetrabajo la hipótesis fue que este escenario es cierto también para la angina pre-infarto o angina prodrómica.En el estudio se incluyeron 326 pacientes consecutivos con isquemia cardiaca sintomática. Se realizó un análisis intraindividual con respecto a características del dolor y hallazgoselectrocardiográficos en los 150 pacientes que presentaron episodios recurrentes de isquemia cardiaca. Los pacientes con infarto agudo se categorizaron en dos grupos: “comienzoabrupto” (n=81) y “angina prodrómica” (n=32). Se realizaron comparaciones entre grupos con respecto a edad, género y factores de riesgo cardiovasculares. El dolor en la región cráneofacial constituyó el único síntoma prodrómico (pre-infarto) de un IAM en el 5 por ciento de los casos. En aquellos pacientes que experimentaron dos episodios isquémicos, las mujeres tuvieron una mayor prevalencia de dolor cráneo-facial en los dos episodios (p<0.01). No se detectaron diferencias estadísticas entre episodios con respecto a hallazgos electrocardiográ ficos o al empleo de los descriptores verbales del dolor de origen cardíaco “opresivo” y “quemante”.Este es el primer estudio de investigación en documentar queel dolor en la región cráneo-facial puede ser el único síntoma de una angina pre-infarto. En efecto, esto ocurre en uno decada 20 casos de IAM. El reconocimiento de esta presentación clínica es baja debido a que históricamente los criterios de inclusión de los estudios de angina pre-infarto incluyeron únicamente pacientes con dolor de pecho. Para evitar el error diagnóstico con consecuencias fatales para el paciente, es importante que esta información llegue tanto a los clínicos como al público en general.

Estado dental y periodontal de población en tratamiento por consumo de drogas: Estudio piloto / Dental and periodontal condition of a population in treatment for drug use: Pilot study

El uso problemático de drogas puede afectar la salud oral de los consumidores. El presente estudio pretendió detectar la prevalencia de patología dentaria y periodontal en una población adolescente y adulta joven en tratamiento por drogo-dependencia. Se diseñó un estudio transversal, observacional y descriptivo, incluyendo a 72 individuos que se asisten por su adicción en el Portal Amarillo, centro de referencia nacional. La media del índice CPOD fue de 8,04. Al discriminar por franja etaria, la comprendida entre 15 y 24 años tuvo un CPOD de 5,31, mientras que la comprendida entre 25 y 35 años tuvo un valor de 11,27. El relevamiento paradencial mostró que el 65% de los participantes presentaron gingivitis y el 18% cuadros de periodontitis. Los resultados obtenidos mostraron que existe una mayor prevalencia de enfermedad oral en pacientes drogo-dependientes que la población general. Los servicios de salud del primer nivel deberían desarrollar acciones especiales de prevención y detección precoz en pacientes drogo-dependientes...

Problematic drug use may affect the oral health of consumers. This research was designed to detect the prevalence of dental and periodontal pathology in an adolescent and young adult population in treatment for drug dependence. A transversal, observational, descriptive study was conducted. It included 72 subjects being treated for drug addiction at Portal Amarillo, a national reference centre. The mean value of the DMF index was 8.04. When discriminating by age group, in the ages between 15 and 24 the DMF Index was 5.31, while in the ages between 25 and 35 it was 11.27. The periodontal survey showed that 65% of the participants suffered from gingivitis and 18% from periodontitis. The results showed a greater prevalence of oral disease in patients who are drug addicts than in the rest of the population. First level health services should take special prevention and early detection measures when treating patients who are drug addicts...

Craniofacial pain of cardiac origin is associated with inferior wall ischemia.

AIMS: To investigate possible associations between the presence of craniofacial pain of cardiac origin and the location of cardiac ischemia and conventional risk factors. METHODS: A total of 326 consecutive patients with confirmed myocardial ischemia (192 males, 134 females, mean age 64 years) were studied. Demographic details, health history, factors, prodromal symptoms, electrocardiogram (ECG) findings, and pain characteristics during the ischemic episode were assessed. The location of the ischemia according to the ECG findings was categorized as anterior, inferior, or lateral. Univariate chi-square analyses and a multivariate logistic regression model were used for data analysis. Two age subgroups (< 65 and > 65) were established when controlling for covariates. RESULTS: Craniofacial pain of cardiac origin was significantly associated with an inferior localization of cardiac ischemia (P < .001) and was more frequently reported in diabetic patients (P = .014). Thirty-eight patients (12%) did not experience chest pain during the myocardial ischemia. Nine patients (3%) experienced a prodromal angina episode without chest pain. CONCLUSION: The occurrence of craniofacial pain during myocardial ischemia, with or without an acute myocardial infarction, was associated with ischemia within the inferior wall. This result suggests the involvement of the vagal afferent system in the mechanisms of craniofacial pain of cardiac origin.

Presentación y análisis de una nueva variable para el estudio electromiográfico de la función cráneo-mandibular. Estudio piloto / Presentation and analysis of a new variable for eletromyographic study of the function skull-jaw. Pilot study

Objetivos. A pesar de décadas de investigación en el área de la electromiografía, su empleo en odontología es aún controversial, debido a la baja sensibilidad de las variables estudiadas. Se definió y analizó una nueva variable, que es la capacidad del individuo para controlar su trayectoria muscular durante un esfuerzo voluntario estandarizado, con el objetivo de analizar posibles patrones de normalidad.Métodos. Se utilizó retroalimentación visual para controlar el esfuerzo contráctil de los músculos masetero, trapecio y frontal. Se midió, para cada músculo, el tiempo que cada individuo necesitó para controlar la trayectoria de la actividad motora.Resultados. Se demostró que la capacidad de una persona sana para controlar esa trayectoria era diferente para los músculos inervados por distintos pares craneales. Un posible patrón de “normalidad” fue más evidente en los músculos maseteros.Conclusiones. Se define y analiza, en un trabajo piloto, una nueva variable para el estudio de la función cráneo-mandibular. Se requerirá un futuro estudio, con una muestra ampliada, para confirmar estos resultados preliminares.

Objectives. Despite decades of research in the area of electromyography, its use in dentistry is still controversial because low sensitivity of the proposed variables. We defined and analyzed a new variable, which is the ability of the subject to control the muscle force trajectory, with the aim to find possible normality patterns.Methods. Real-time visual biofeedback was used to control the muscle force trajectory of the masseter, trapezius and frontal muscles. We measured the time that each individual needed to control the trajectory under a standardized set of experimental conditions.Results. We showed that the ability to control the muscle force trajectory can vary for muscles innervated by different cranial nerves. A possible ¨normality¨ pattern was more evident in the masseter muscle.Conclusions. We defined and analyzed, in a pilot research, a new variable for the study of the craniomandibular function. Further research, with an increased sample size, will be needed in order to confirm these preliminary results.

Dolor cráneo-facial como síntoma aislado de isquemia cardíaca: estudio prospectivo y multicéntrico / Cranifacial pain as the sole system of cardiac ischemia: a prospective multicenter

Antecedentes. El dolor craneofacial puede ser el único síntoma de una isquemia cardíaca. El fracaso en reconocer el origen cardíaco de dicho dolor puede poner en riesgo la vida del paciente. Los autores realizaron un estudio para revelar la prevalencia, la distribución y las diferencias entre sexos en lo que respecta al dolor craneofacial de origen cardíaco. Métodos. Los autores seleccionaron de forma prospectiva pacientes consecutivos (n=186) que habían presentado un episodio isquémico cardíaco verificado. Estudiaron en detalle la localización y distribución del dolor craneofacial e intraoral. Resultados: El dolor cráneofacial fue el único síntoma durante el episodio isquémico en 11 pacientes (6 por ciento), tres de los cuales presentaron un infarto agudo de miocardio (IAM). Otros 60 pacientes (32 por ciento) comunicaron dolor cráneofacial concomitantemente a dolor en otras regiones. Las localizaciones más frecuentes del dolor cráneofacial fueron la garganta, la región mandibular izquierda, la región mandibular derecha, la articulación temporomandibular izquierda / oído y dientes. El dolor cráneofacial se manifestó de forma predominante en mujeres (P=0.031) y fue el síntoma dominante en ambos sexos en ausencia de dolor torácico. Conclusiones: El dolor cráneofacial es inducido frecuentemente por isquemia cardíaca. Esta causa debe tenerse en cuenta en el diagnóstico diferencial del dolor dental y orofacial. Implicaciones clínicas: Debido a que los pacientes que tienen un IAM sin dolor torácico corren un mayor riesgo de no ser correctamente diagnosticados y de muerte, el alerta del clínico sobre esta sintomatología, puede ser crucial para el diagnóstico precoz y un rápido tratamiento.

Background. Craniofacial pain can be the only symptom of cardiac ischemia. Failure to recognize its cardiac source can put the patient’s life at risk. The authors conducted a study to reveal the prevalence of, the distribution of and sex differences regarding craniofacial pain of cardiac origin. Methods. The authors prospectively selected consecutivepatients (n = 186) with a verified cardiacischemic episode. They studied the location and distribution of craniofacial and intraoral pain in detail. Results. Craniofacial pain was the only complaintduring the ischemic episode in 11 patients (6 per cent), three of them who had acute myocardial infarction (AMI). Another 60 patients (32 per cent) reported craniofacial pain concomitant with pain in other regions. The most common craniofacial pain locations were the throat, left mandible, right mandible, left temporomandibular joint/ear regionand teeth. Craniofacial pain was preponderantly manifested in female subjects (P = 0.031) and was the dominating symptom in both sexes in theabsence of chest pain. Conclusions. Craniofacial pain commonly is induced by cardiac ischemia. This must beconsidered in differential diagnosis of toothache and orofacial pain. Clinical Implications. Because patients sufferingAMI without chest pain run a higher risk of missed diagnosis and death, the clinician’s awareness of this symptomatology can be crucial for early diagnosis and timely treatment.

Estudio comparativo del complejo electromiográfico post-estímulo del músculo masetero en pacientes rehabilitados con prótesis completa bimaxilar mediante técnica piezográfica y técnica convencional / A comparative study of the post-stimulus electromiographic complex in edentulous patients who underwent conventional vs piezographic rehabilitation

El estudio de los períodos de silencio electromiográfico se han aplicado en varia áreas odontológicas, aunque hasta el momento no se habían utilizado para evaluar la rehabilitación piezográfica. Considerando que dicha técnica se base en el respeto de la musculatura paraprotética y la estabilidad funcional, resultó pertinente realizar un estudio comparativo del complejo electromiográfico post-estímulo del músculo masetero entre pacientes desdentados totales rehabilitados mediante técnica piezográfica y mediante técnica convencional de prótesis completa. Se utilizó un sistema de registros automático que permitió el análisis basal del complejo electromiográfico post-estímulo del músculo masetero así como un seguimiento a corto y a mediano plazo. Los resultados mostraron cambios en los parámetros electrofisiológicos estudiados con ambos tratamientos, con una tendencia más favorable frente a la rehabilitación piezográfica. En suma, los estudios refleximétricos realizados permitieron realizar una evaluación objetiva del impacto de este tipo de rehabilitaciones extensas en el sistema neuromuscular.

Validation of a simplified sham acupuncture technique for its use in clinical research: a randomised, single blind, crossover study.

OBJECTIVES: The validity of a new sham acupuncture technique was tested on acupuncture naïve healthy subjects. METHODS: The procedure was tested in accupoints LI4 and ST6 in a randomised, single blind and crossover study. The participants were blind to which technique they received. 32 healthy volunteers (15 men, 17 women, aged between 20 and 62 years, mean age 34 years) were recruited at the Universidad de la República, Uruguay. Interventions Participants were randomly assigned to one of two groups: (1) real acupuncture or (2) sham acupuncture. After 30 min, the patients were 'needled' again in a crossover design. Main outcome measures A yes/no questionnaire was used to assess the credibility and characteristics of the procedure. RESULTS: For the credibility question (do you think you received real acupuncture?) no statistically significant group differences were evident before or after the crossover. Subjects who answered yes to this question ranged from 14/16 (87.5%) before crossover to 10/16 (62.5%) after crossover for the sham and 12/16 (75%) before crossover to 15/16 (93.8%) after crossover for the real acupuncture. The question that showed a significant difference (only after crossover) was the question, "did you feel the needle penetrating the skin?"; after crossover 12/16 (75%) subjects in the real acupuncture group said yes and 2/16 (12%) subjects in the sham group said yes to this question (p<0.01). CONCLUSIONS: These data suggests that this method is credible and constitutes a simple and inexpensive technique for use as a control in clinical research in acupuncture naïve subjects.

Craniofacial pain as the sole symptom of cardiac ischemia: a prospective multicenter study.

BACKGROUND: Craniofacial pain can be the only symptom of cardiac ischemia. Failure to recognize its cardiac source can put the patient's life at risk. The authors conducted a study to reveal the prevalence of, the distribution of and sex differences regarding craniofacial pain of cardiac origin. METHODS: The authors prospectively selected consecutive patients (N = 186) who had had a verified cardiac ischemic episode. They studied the location and distribution of craniofacial and intraoral pain in detail. RESULTS: Craniofacial pain was the only complaint during the ischemic episode in 11 patients (6 percent), three of them who had acute myocardial infarction (AMI). Another 60 patients (32 percent) reported craniofacial pain concomitant with pain in other regions. The most common craniofacial pain locations were the throat, left mandible, right mandible, left temporomandibular joint/ear region and teeth. Craniofacial pain was pre-ponderantly manifested in female subjects (P = .031) and was the dominating symptom in both sexes in the absence of chest pain. CONCLUSIONS: Craniofacial pain commonly is induced by cardiac ischemia. This must be considered in differential diagnosis of toothache and orofacial pain. CLINICAL IMPLICATIONS: Because patients who have AMI without chest pain run a higher risk of experiencing a missed diagnosis and death, the dentist's awareness of this symptomatology can be crucial for early diagnosis and timely treatment.