Impact of chronic orofacial pain of temporomandibular disorder and anxiety on the academic performance of dental students / Impacto da dor orofacial crônica da disfunção temporomandibular e ansiedade no desempenho acadêmico de estudantes de odontologia

Introduction: The presence of chronic pain and mood disorders can be related to the performance of intellectual and technical tasks. Objective: This study evaluated the correlation between anxiety level, chronic orofacial pain of temporomandibular disorders (TMD), and academic performance in dental students. Methods: One hundred ninety-five students (74 men and 121 women) answered the Spielberger's trait­state anxiety inventory to evaluate the level of anxiety; the Research Diagnostic Criteria for TMD (RDC/TMD) was used to analyze chronic orofacial pain of TMD, and the academic performance was evaluated through the average grade of all college subjects concluded by the students. Correlations between the presence of chronic orofacial pain of TMD, trait, and state anxiety levels, chronic pain grade (CPG), chronic pain intensity (CPI), and academic performance were tested using Pearson's correlation test. Results: The mean age of the students was 21.8 years (SD=2.3). Chronic TMD was observed in 37.5% of the students. The majority of students had moderate trait and state anxiety. A significant correlation was observed between traitanxiety level and CPG (r=0.148, p=0.044), and CPI (r=0.187, p=0.009). No significant correlation was found between academic grade and presence of chronic pain of TMD (r=0.041, p=0.571), trait (r=0.079, p=0.273) and state-anxiety (r=0.107, p=0.136). Conclusion: The CPG and CPI increase in participants with higher trait-anxiety levels, however, no significant correlation was found between academic performance and trait/state anxiety or chronic orofacial pain of TMD.

Treatment of Masticatory Muscle Pain with Acupuncture: Is It Necessary to Associate with Occlusal Splints?

Background: Temporomandibular disorders (TMDs) are treated by different modalities including splints, physiotherapy, and acupuncture. Although all of these offer evidencebased benefits to the patients, avoiding overtreatment is of paramount importance. Objectives: To assess the effectiveness of muscle pain treatment with acupuncture combined with or without occlusal splints. Methods: Recruited patients were allocated to G1 (acupuncture) and G2 (acupuncture and occlusal splint) groups and treated in four consecutive weekly sessions (P1, P2, P3, and P4). The reported pain (RP) and the pressure pain threshold (PPT) of the masseter and temporalis muscles were assessed before and after each session. Results: RP decreased after each session in G1, except at P4. In G2, the RP decreased only after the first session, and the PPT did not vary. Conclusion: The assessed treatments did not influence the PPT levels of the masseter and anterior temporalis muscles in patients with temporomandibular disorders. Our findings suggest that occlusal splints may not be mandatory along with the acupuncture treatment.

Precisão dimensional de modelos obtidos de moldes de alginato pelos métodos invertido e não invertido / Dimensional accuracy of models obtained from pouring molds by inverted and non-inverted methods

Este é um estudo cuja finalidade foi demonstrar as possíveis deformações que podem ocorrer nos modelos obtidos de moldes de alginato, dependentes da forma de vazamento. Foram obtidos 20 moldes de alginato da marca Hydrogum 5 (Zhermack, Badia Polesine, Italy), através de um modelo de resina acrílica previamente preparado, divididos em dois grupos de 10: com vazamento invertido e não invertido. Os modelos foram analisados por fotografias, mensurados por um programa de computação (Corel Draw X3 Graphics Suíte (Corel Corporation ­ USA) e comparados com o modelo padrão. Os resultados mostraram que os vazamentos invertidos e não invertidos apresentaram valores clínicos diferentes do modelo padrão, mas que na comparação entre as técnicas, dos quatro segmentos analisados, apenas um apresentou diferença estatística significante(AU)

This is a study whose purpose was to demonstrate the possible deformations that may occur in the models obtained from alginate molds, depending on the form of flow. 20 alginate molds of Hydrogum 5 (Zhermack, Badia Polesine, Italy) were obtained through a previously prepared acrylic resin model, divided into two groups of 10: with inverted and non inverted casting. The models were analyzed by photographs, measured by a computer program (Corel Draw X3 Graphics Suite (Corel Corporation - USA) and compared with the standard model.The results showed that inverted and non inverted flow presented clinical values different from the standard model, But that in the comparison between the techniques, of the four analyzed segments, only one presented significant statistical difference(AU)

Does pain in the masseter and anterior temporal muscles influence maximal bite force?

OBJECTIVE: The aim of this study was to evaluate changes in pain and muscle force, and the relationship between them, in patients with muscle pain and bruxism, prior to and after treatment. METHODS: Thirty women with bruxism and myofascial pain (Ia) were included in this study. Sleep bruxism diagnosis was made based on clinical diagnostic criteria, and awake bruxism diagnosis was made by patient questionnaires and the presence of tooth wear. The diagnosis of myofascial pain was established according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD). Dentulous or partially edentulous patients (rehabilitated with conventional fixed prostheses) were included in the study according to the inclusion and exclusion criteria. The pain treatment protocol included occlusal splints, patient education, and physiotherapy for 30days. Bite force was measured using a dynamometer at the central incisor and the first molar regions on both sides. The exams were performed at baseline, after 7days, and 30days after treatment. The Wilcoxon test was used to compare patient pain level response among the periods analyzed in the study. Bite force data were submitted to two-way repeated-measures ANOVA, followed by the Tukey HSD test (p<0.05). A simple regression analysis was performed to verify the relation between pain level and bite force. RESULTS: Results revealed that there was a statistical difference in pain level over time for both muscles and sides (p<0.01). In the molar region, the bite force exhibited significantly higher values after 30days of treatment, when compared with the baseline (p<0.001). There was a correlation between pain level and bite force only for the temporal muscle in all periods analyzed (p<0.05). There was no strong correlation in the response level points to support the association of pain and bite force. CONCLUSIONS: Pain level decreased and bite force increased in the molar region after treatment. No strong correlation or dispersion in the relationship between pain levels and bite force was seen in women with myofascial pain and bruxism.

Effect of Acupuncture on Post-implant Paresthesia.

Paresthesia is defined as an alteration in local sensibility, associated with numbness, tingling, or unpleasant sensations caused by nerve lesions or irritation. It can be temporary or permanent. The treatment protocol for facial paresthesia is primarily based on the use of drugs and implant removal, which may not be completely effective or may require other risk exposure when there is no spontaneous regression. However, other therapeutic modalities such as acupuncture can be used. The aim of this study is to report a case of a patient with paresthesia of the inferior alveolar nerve and pain caused by an implant surgery performed 2 years earlier. The patient received acupuncture treatment during 4 months of weekly sessions. Six points were used: Large Intestine (LI4), Large Intestine (LI11), Stomach (ST36), Liver (LR3), Extra Head and Neck (E-HN-18), and Stomach (ST5). The visual analog scale was used before and after each session for the analysis of paresthesia and pain, together with assessment of the paresthesia by delimitation of the desensitized region of the skin and presented discomfort. Pain remission and reduction in the size of the paresthesia area occurred after four sessions.

Diagnóstico diferencial de limitação de abertura bucal / Differential diagnosis of limited mouth opening

O objetivo do presente estudo é apresentar uma revisão de literatura exemplificando alguns dos possíveis fatores etiológicos de limitação de abertura bucal e ilustrar o caso de um paciente diagnosticado com hiperplasia do processo coronoide. Foi realizada uma busca nas bases de dados PUBMED/MEDLINE, Scielo, Bireme e Google Acadêmico utilizando-se inicialmente o termo "limited mouth opening" e "limitação de abertura bucal" no mês de novembro de 2016. Além disso, foi realizada busca manual em periódicos e nas bases de dados com novas palavras-chave como disfunção temporomandibular, tétano, traumas, doenças genéticas e imitação de abertura bucal e hiperplasia do processo coronóide. Foram incluídos estudos clínicos, revisões de literatura, revisões sistemáticas e relatos de caso publicados em idioma inglês ou português. Foram descritos os aspectos relevantes sobre desordens na articulação temporomandibular, tétano, traumas e fraturas, lesões orais, neoplasias e efeito colateral de radio e quimioterapia, desordens genéticas, hiperplasia do processo coronóide. O diagnóstico da limitação de abertura bucal é complexo devido ao grande número de fatores que podem provocar o problema. Diante disso, é de suma importância que seja realizada correta anamnese e investigação minuciosa do histórico do paciente, além da realização de exames complementares, permitindo assim, que a causa do problema seja detectada e que o tratamento correto seja aplicado, por meio de abordagem multidisciplinar, melhorando a qualidade de vida e devolvendo saúde ao paciente(AU)

The objective of this study is to present a review of literature exemplifying some of the possible etiological factors of oral opening limitation and to illustrate the case of a patient diagnosed with coronoid hyperplasia. A searched was made on PUBMED / MEDLINE, Scielo, Bireme and Google Scholar databases initially using the term "limited mouth opening" and "limitação de abertura bucal" in the month of November 2016. In addition, a manual search was carried out in journals and with new keywords like temporomanbidular disorders, tetanus, traumas, genetic disorders and limited open mouth and coronoid process hiperplasia. Clinical studies, literature reviews, systematic reviews and case reports published in English or Portuguese were included in the review. Relevant aspects of temporomandibular joint disorders, tetanus, trauma and fractures, oral lesions, neoplasys and side effects of radiotherapy and chemotherapy, genetic disorders, and coronoid process hyperplasia were described. The diagnosis of oral opening limitation is complex because of the many causes of the problem. Therefore, it is very important that a correct anamnesis and detailed investigation of the patient's history be performed, in addition to performing complementary tests, thus allowing the cause of the problem to be detected and treated correctly, through a multidisciplinary approach, improving the quality of life and healing the patient(AU)

Fratura de côndilo mandibular não tratada e disfunção temporomandibular: relato de caso / Untreated mandibular condyle fracture and temporomandibular dysfunction: a case report

A fratura de côndilo mandibular é um dos tipos de traumas faciais mais comuns, podendo ser diagnosticado por diversos meios, sendo que uma variedade de planos de tratamentos podem ser instaurados. Este tipo de fratura configura também uma das etiologias da disfunção temporomandibular (DTM), portanto, é indispensável que o profissional realize exames minuciosos, inclusive por meio de exames complementares de imagem para o correto diagnóstico e conduta curativa, tanto da fratura, quanto da disfunção. Sendo assim, o objetivo deste estudo foi descrever um caso de fratura de côndilo mandibular não tratada seguida de DTM. Paciente de 36 anos do gênero masculino com histórico de acidente automobilístico há cinco anos, resultando em fratura de côndilo, com diagnóstico tardio e consolidação em posição inadequada buscou tratamento na Faculdade de Odontologia de Araçatuba - UNESP. A conduta por meio do uso de placa interoclusal levou à eliminação da sintomatologia dolorosa(AU)

The condylar fracture is one of the most common types of facial trauma and can be diagnosed by different methods, and a variety of treatment plans can be used. This type of fracture also constitutes one of the etiologies of temporomandibular disorders (TMD). Therefore, it is essential that the professional conduct thorough examinations, including complementary imaging tests for the correct diagnosis and treatment of the fracture and the dysfunction. Thus, the aim of this study was to describe a case of untreated condylar fracture followed by the development of TMD. A 36-year-old male patient with a history of automobile accident five years ago, resulting in condylar fracture, sought treatment at the Aracatuba Dental School - UNESP. The fracture had late diagnosis and consolidation in a wrong position. The conduct treatment through the use of occlusal splint led to the elimination of the painful symptomatology(AU)

Influência de diferentes espessuras da camada de silicone e carga de prensagem na estabilidade dimensional de próteses totais / Influence of different thicknesses of the layers of silicone and pressure load on the dimensional stability of complete denture

Introdução: As alterações dimensionais do processamento das bases das dentaduras prejudicam a retenção associada à alteração da oclusão, considerada um fator relevante na construção das prótese completas. Portanto, estas alterações devem ser minimizadas para produzir próteses com menores imperfeições, considerando os materiais utilizados, e o conhecimento profissional das técnicas de inclusão e polimerização. Objetivos: O propósito deste estudo foi avaliar o deslocamento linear dos dentes artificiais durante o processamento de uma prótese total maxilar, submetida a prensagem com três diferentes camadas de silicone e três cargas de pressão. Materiais de Método: Foram obtidas 45 próteses em cera onde foram demarcados pontos nas superfícies incisal do incisivo central direito e nas cúspides dos segundo molares formando os segmentos A, B e C, para permitir suas mensurações através do software AutoCAD. A avaliação dos deslocamentos dos dentes artificiais foi realizada em diferentes situações, variando a espessura do silicone (1,25mm, 2,50 mm, e 3,75 mm) e a aplicação de diferentes cargas durante as prensagens (800 Kgf, 1000Kgf e 1200 Kgf). Resultados: Clinicamente, pode ser notado que a menor espessura de silicone com carga mais baixa produziu alterações menores. De um ponto de vista estatístico, não houve diferenças significantes. Conclusões: Em todos os grupos foram alteradas a posição dos dentes artificiais. Aqueles incluídos com camada de 1,25mm e 800Kgf mostrou as menores alterações, e com 3,75 milímetros as maiores

The influence of different thickness of the silicon layer and pressing load on the dimensional stability of dentures. Introduction: The dimensional alterations of denture base processing jeopardize adaptation and retention associated to altered occlusion, which are considered relevant factors for fabrication of complete dentures. Therefore, these changes should be minimized to produce prostheses with minor imperfections, considering the materials used, and the professional knowledge of the techniques of inclusion and polymerization. Objective: The aim of this study was to evaluate linear tooth displacement during processing of maxillary complete dentures submitted to three layers of silicon and three loads during pressing. Material and Method: 45 prostheses were obtained in wax and points were marked on incisal surface of right central incisor and cusp of second molars forming A, B and C segments to allow linear measurement of the replicas through the software AutoCAD. The evaluation of displacement of artificial teeth was carried out in different situations varying the thickness of silicone (1.25 mm, 2.50 mm, and 3.75 mm) and loads applied during the pressings (800 kgf, 1000Kgf and 1200 kgf). Results: Clinically it may be noted that the smaller thickness silicon with lower load produced minor changes. From a statistical point of view there were no significant differences. Conclusion: All groups have changed the position of the artificial teeth. Those included with 1.25 mm layer and 800Kgf showed minor changes and with 3.75 mm the largest

Does the habitual mastication side impact jaw muscle activity?

OBJECTIVE: To compare electrical activity in the anterior temporal and masseter muscles on the habitual (HMS) and non-habitual mastication side (NHMS), during mastication and in the mandibular postural position. In addition, the increase in electrical activity during mastication was assessed for the HMS and NHMS, analysing both working (WSM) and non-working side during mastication (NWSM). METHODS: A total of 28 healthy women (18-32 years) participated in the study. They were submitted to Kazazoglu's test to identify the HMS. Bioresearch 'Bio EMG' software and bipolar surface electrodes were used in the exams. The exams were conducted in the postural position and during the unilateral mastication of raisins, on both the HMS and NHMS. The working and non-working side on HMS and NHMS were assessed separately. The obtained data were then statistically analysed with SPSS 20.0, using the Paired Samples Test at a significance level of 95%. RESULTS: The differences in the average EMG values between HMS and NHMS were not statistically significant in the postural position (Temporal p=0.2; Masseter p=0.4) or during mastication (Temporal WSM p=0.8; Temporal NWSM p=0.8; Masseter WSM p=0.6; Masseter NWSM p=0.2). Differences in the increase in electrical activity between the masseter and temporal muscles occurred on the working side, on the HMS and NHMS (p=0.0), but not on the non-working side: HMS (p=0.9) and NHMS (p=0.3). The increase in electrical activity was about 35% higher in the masseter than in the temporal muscle. CONCLUSIONS: Mastication side preference does not significantly impact electrical activity of the anterior temporal and masseter muscles during mastication or in postural position.

Evaluation of silent period on masticatory cycles of different muscles in dentate oral contraceptives users and nonusers.

OBJECTIVE: The aim of this study was to evaluate the influence of oral contraceptive use on the silent period (SP) of anterior temporal and masseter muscles during the menstrual cycle. MATERIALS AND METHODS: Totally, 28 women on reproductive age were selected including 15 nonusers of any hormone and 13 contraceptive users. All patients were dentate without muscular temporomandibular disorders. Electromyography (SP test) of the anterior temporal and masseter muscles was conducted every week during three consecutive menstrual cycles at 1(st) day of menstruation (P1), 7(th) day (P2), 14(th) day (P3) and 21(st) day (P4). RESULTS: The SP values in the anterior temporal and masseter muscles were measured at both sides. The SP values of the right side (13.49 ms) at P2 were significantly different compared to the left side (12.28 ms). However, there was no significant difference on the interactions among the three factors. CONCLUSION: It can be concluded that the SP values in healthy women in reproductive age may not be influenced by the menstrual cycle with similar results for both muscles.

Relation between bruxism and dental implants / Relação entre bruxismo e próteses sobre implantes

OBJECTIVE: The aim of this study was to gather information and discuss the predictability of implant-supported prostheses in patients with bruxism by performing a literature review. METHODS: In order to select the studies included in this review, a detailed search was performed in PubMed and Medline databases, using the following key words: bruxism, dental implants, implant supported prosthesis, and dental restoration failure. Items that were included are: case reports, randomized controlled trials, in vitro studies, literature and systematic reviews, with or without meta-analysis, of the last 20 years that addressed the theme. Articles without abstracts, animal studies, articles in languages other than English and articles from journals unrelated to the dental field were excluded. RESULTS: after analysis according to inclusion and exclusion criteria, 28 articles were selected from a total of 54. It is known from the array of scientific articles which have assessed, either through retrospective, prospective or experimental studies, that the biomechanical and biological impact of bruxism on implant-supported prostheses is small, and that the literature has contributed little to exemplify the prosthetic limits of safety for the specialist from a clinical point of view. CONCLUSION: Although there is still no general consensus on this matter, most of the literature review articles do provide clinical guidelines that contribute to implant supported prostheses longevity and stability in patients with bruxism. .

OBJETIVO: Realizar uma revisão sistemática, a fim de reunir informações e discutir a previsibilidade de próteses sobre implantes em pacientes com bruxismo. MÉTODOS: Para a identificação dos estudos dessa revisão, foi realizada uma estratégia de busca detalhada e avançada nos bancos de dados PubMed e Medline. Foram utilizados como descritores: bruxismo, implantes dentários, prótese implantossuportada e falha da restauração dentárial; bruxism, dental implants, implant-supported prosthesis e dental restoration failure. Os critérios de inclusão foram: artigos clínicos, estudos controlados aleatórios, estudos in vitro, revisões de literatura e revisões sistemáticas com e sem meta-análise dos últimos 20 anos que abordassem o tema proposto. Os critérios de exclusão foram: artigos sem resumo, estudos em animais, artigos cujo idioma não fosse o inglês e artigos de periódicos que não pertencessem à área odontológica. RESULTADOS: De um total de 54 artigos, após uma análise segundo o critério de inclusão e exclusão, foram selecionados 28 artigos. É sabido que a quantidade de artigos científicos que avaliaram, seja através de estudos retrospectivos, prospectivos ou experimentais, o impacto biológico e biomecânico do bruxismo em próteses sobre implantes é pequena e pouco tem contribuído para melhor exemplificação e discernimento dos limites protéticos de segurança para o especialista sob um ponto de vista clínico. CONCLUSÃO: Portanto, ainda não há um consenso geral acerca desse assunto, porém, a maioria dos artigos de revisão de literatura fornecem guias de orientação clínica, os quais auxiliam na longevidade e estabilidade de próteses sobre implantes em pacientes com bruxismo. .

Halitose na geriatria: diagnóstico, causas e prevalência / Oral malodor in geriatric population: diagnosis, causes and prevalence

Halitose é o odor desagradável do ar expelido pela cavidade oral, narinas ou faringe. Este odor origina-se principalmente pela presença de compostos sulfurados voláteis produzidos por bactérias presentes na cavidade oral. Pode ter origem fisiológica (estresse, hálito da manhã, jejum prolongado, dietas inadequadas); razões locais (má-higiene bucal, biofilme retido na língua e/ou amígdalas, baixa produção de saliva, gengivites e periodontites) ou mesmo razões sistêmicas (diabetes, problemas renais ou hepáticos, dentre outros). Na Terceira Idade, este problema tende a aumentar significativamente, devido a diversos fatores. Dessa forma, o objetivo deste estudo foi diagnosticar a presença de halitose no grupo geriátrico atendido na clínica odontológica da UNIRP, identificando sua incidência e principais causas. A amostra constituiu-se de 48 pacientes voluntários com 60 anos ou mais e abrangeu mais de 90% dos pacientes nessa faixa etária ali atendidos. Foram realizados uma anamnese e exame físico intra-oral e a halitose foi detectada utilizando um halímetro portátil. No grupo pesquisado, aproximadamente 54,16% apresentou halitose, destes 84,61% eram usuários de prótese. A saburra lingual esteve presente em 80,76% dos indivíduos com halitose. Após a escovação lingual, 88,46% dos portadores de halitose tiveram o índice inicialmente aferido pelo halímetro diminuído. Com base nos resultados deste estudo, concluiu-se que fatores como uso de próteses dentárias e presença de saburra lingual são determinantes etiológicos no surgimento da halitose

Halitosis is the unpleasant odor of exhaust air through the mouth and lungs. There are over 50 causes, and approximately 90% of cases, is of oral origin. May have physiological origin (stress, breath of morning, fasting, and inappropriate diets), local reasons (bad oral hygiene, bacterial plaque retained on the tongue and/or tonsils, lower production of saliva, gum disease) or systemic reasons (diabetes, kidney or liver problems, constipation, etc.). In the Third Age, this problem tends to increase significantly. Thus, the aim of this study was to detect the presence of halitosis in the geriatric group attended in the dental clinic of UNIRP, identifying their incidence and principal causes. The sample consisted of 48 volunteer patients aged 60 years or older and included more than 90% of patients treated in this age group. It was performed a anamnesis and physical examination. The intra-oral halitosis was detected using a breath meter (halimeter). In the group studied, approximately 54.16% had halitosis, 84.61% of these were users of the prosthesis. The tongue coating was present in 80.76% of individuals with halitosis. After brushing the tongue, 88.46% of patients with halitosis have had the initial index oral malodor decreased. Based on the results of this study it was concluded that factors as dental prostheses and tongue coating are critical factors in causing halitosis

Disfunção temporomandibular na visão de profissionais e acadêmicos de odontologia / Temporomandibular disorders from the perspective of dentistry academics and professionals

Este artigo apresenta os resultados de uma pesquisa qualitativa aplicada a alunos e profissionais de Odontologia que trabalham com pessoas que sofrem de disfunção temporomandibular. Objetivou-se investigar a forma como os profissionais e acadêmicos de Odontologia percebem seus pacientes acometidos por essa disfunção, seus sentimentos diante do sofrimento dos mesmos e a importância de uma abordagem multidisciplinar, pontuando quais os tratamentos utilizados. Vale ressaltar que, na problemática da disfunção temporomandibular, estão envolvidos vários fatores, dentre eles o emocional, citado pela maioria dos entrevistados. Os dados obtidos em relação ao conhecimento dos profissionais e alunos quanto ao atendimento do paciente com disfunção temporomandibular foi considerado adequado; entretanto, mostraram inadequações importantes, como o fato de os profissionais não investigarem melhor o histórico de vida do paciente em seu aspecto psicossocial.(AU)

This paper presents the results of an applied qualitative study with dental students and professionals who work with people suffering from temporomandibular disorder. The aim was to investigate the way that dental practitioners and students perceive patients affected by this disorder, how they feel faced with the patients' suffering, and the importance they assign to a multidisciplinary approach, highlighting the treatments used. It is noteworthy that various factors are involved in the temporomandibular disorder framework, including emotional factors, as cited by the majority of the respondents. The data obtained indicated that the knowledge of the professionals and students related to caring for people with temporomandibular disorders was appropriate, however, important inadequacies were highlighted, such as the fact that professionals do not investigate the life history of the person in their psychosocial context.(AU)

Disfunção temporomandibular na visão de profissionais e acadêmicos de odontologia / Temporomandibular disorders from the perspective of dentistry academics and professionals

Este artigo apresenta os resultados de uma pesquisa qualitativa aplicada a alunos e profissionais de Odontologia que trabalham com pessoas que sofrem de disfunção temporomandibular. Objetivou-se investigar a forma como os profissionais e acadêmicos de Odontologia percebem seus pacientes acometidos por essa disfunção, seus sentimentos diante do sofrimento dos mesmos e a importância de uma abordagem multidisciplinar, pontuando quais os tratamentos utilizados. Vale ressaltar que, na problemática da disfunção temporomandibular, estão envolvidos vários fatores, dentre eles o emocional, citado pela maioria dos entrevistados. Os dados obtidos em relação ao conhecimento dos profissionais e alunos quanto ao atendimento do paciente com disfunção temporomandibular foi considerado adequado; entretanto, mostraram inadequações importantes, como o fato de os profissionais não investigarem melhor o histórico de vida do paciente em seu aspecto psicossocial...

This paper presents the results of an applied qualitative study with dental students and professionals who work with people suffering from temporomandibular disorder. The aim was to investigate the way that dental practitioners and students perceive patients affected by this disorder, how they feel faced with the patients' suffering, and the importance they assign to a multidisciplinary approach, highlighting the treatments used. It is noteworthy that various factors are involved in the temporomandibular disorder framework, including emotional factors, as cited by the majority of the respondents. The data obtained indicated that the knowledge of the professionals and students related to caring for people with temporomandibular disorders was appropriate, however, important inadequacies were highlighted, such as the fact that professionals do not investigate the life history of the person in their psychosocial context...

Recuperação da dimensão vertical em paciente com parafunção severa / Recovery of vertical dimension in patient with severe parafunction

A associação entre o estresse emocional e o bruxismo intenso, tem como consequência a Disfunção Temporomandibular (DTM), que representa um problema cada vez mais frequente na clínica odontológica, exigindo meios criteriosos de diagnóstico e, principalmente, de tratamento.. Diversos fatores, de equivalente importância, podem estar relacionados com a DTM, um deles é a alteração da Dimensão Vertical de Oclusão (DVO), sendo os hábitos parafuncionais e também a perda de contatos estáveis entre os dentes posteriores ou ausência dos mesmos, o que gera um aumento funcional excessivo aos dentes anteriores e consequente desgaste ou vestibularização. Este trabalho se propõe através de um caso clínico, a apresentar e discutir as etapas clínicas para diagnóstico, planejamento e execução da reabilitação oral com Prótese Parcial Fixa para o restabelecimento da dimensão vertical de oclusão em paciente com parafunção severa. A reabilitação Oral destes pacientes deve ser rigorosamente planejada, respeitando os aspectos funcionais e estéticos. O controle da parafunção mediante o acompanhamento da Disfunção Temporomandibular é essencial ao prognóstico longitudinal da reabilitação executada nestes tipos de tratamento reabilitadores

The association between emotional stress and intense bruxism has as consequence the Temporomandibular Disorder (TMD), which is an increasingly apparent problem at the dental clinic, requiring judicious means of diagnosis and especially treatment. Several factors, of equivalent importance, may be related to the DTM, one of them is the loss of vertical dimension of occlusion (VDO), and parafunctional habits and also the loss of stable contacts between the posterior teeth or lack thereof, which generates an increase functional anterior teeth for excessive wear or buccal and consequent. This paper proposes using a clinical case, to present and discuss the steps for clinical diagnosis, planning and execution of oral rehabilitation with Fixed Partial Denture for restoring vertical dimension of occlusion in a patient with severe parafunction. Oral rehabilitation of these patients should be carefully planned, respecting the functional and aesthetic aspects. The parafunction control by monitoring the Temporomandibular Disorder is essential to the longitudinal prediction of rehabilitation performed in these types of rehabilitative treatment

Variação da temperatura superficial dos músculos masseter e temporal anterior durante o apertamento dental voluntário com placas interoclusais maxilares de duas diferentes espessuras / Variation of surface temperature on superficial masseter and anterior temporal muscles during voluntary teeth clenching with maxillary splints of two different thicknesses

A atividade muscular tem sido estudada de maneira indireta pela análise da variação da temperatura superficial cutânea sobre os músculos mastigatórios. Essas mensurações podem representar uma ferramenta valiosa na avaliação clínica da atividade e do progresso das desordens temporomandibulares, bem como no acompanhamento do protocolo terapêutico adotado, justificando sua utilização para verificar alterações patológicas na circulação sanguínea e/ou atividade metabólica nos tecidos abaixo da pele, como os músculos mastigatórios. Em vista disso, o objetivo do presente estudo foi verificar o efeito da espessura da placa interoclusal sobre a variação da temperatura superficial dos músculos temporal anterior e masseter, durante o repouso e o apertamento dental, considerando-se a condição assintomática de 20 indivíduos (10 do gênero masculino e 10 do gênero feminino) selecionados através do questionário Research Diagnostic Criteria (RDC). A temperatura em graus Celsius (ºC) da superfície dos músculos masseter e temporal anterior foi medida com o auxílio de um termômetro digital, com um sistema de leitura por irradiação infravermelha. A temperatura superficial dos músculos temporal anterior e masseter apresentou redução significativa diante do apertamento dental em relação à posição de repouso mandibular. Entretanto, não houve diferenças significantes entre as condições com e sem placa interoclusal, bem como entre as distintas espessuras de placas interoclusais analisadas. Adicionalmente, os músculos mastigatórios apresentaram uma considerável semelhança entre os lados, sem haver também distinções significantes entre o gênero masculino e o feminino.

Muscle activity has been studied indirectly through analyses of temperature variation in skin surface temperature on the masticatory muscles. These procedure may be an important tool for clinical evaluation and assessment of the evolution of temporomandibular disorders, as well as monitoring the adopted protocol. Thus, its utilization for identified pathological alterations on blood circulation and/or on metabolic activity in subcutaneous tissues, such as the masticatory muscles, is justified. The aim of this study was to investigate the effect of occlusal splintsÆ thickness on the variation of surface temperature of the anterior temporal and masseter muscles during rest and clenching. It were analyzed 20 asymptomatic subjects (10 males and 10 females) selected through the Research Diagnostic Criteria (RDC) questionnaire. Temperature expressed in degrees Celsius (ºC) was measured on the surface of both muscles measured with the aid of a digital thermometer with an infrared radiation reading system. The surface temperature of the anterior temporal and masseter muscles presented significant reduction during teeth clenching in relation to the mandibular rest position. However, there were no significant differences between conditions with and without occlusal splint or between the different thicknesses of splints analyzed. Masticatory muscles showed a considerable similar behavior for both sides, and no significant distinctions were observed between male and female patients.

Aspectos oclusais na etiologia das desordens temporomandibulares / Occlusal aspects related to the etiology of temporomandibular disorders

Introdução: A oclusão por estar presente em quase todas as especialidades da odontologia, tem ao longo do tempo mostrado sua relação com a saúde do paciente. A etiologia das desordens temporomandibulares é multifatorial considerando a oclusão como um fator etiológico. Esse trabalho objetivou discutir os aspectos oclusais funcionais e a presença de DTMs. Revisão da Literatura: A desarmonia do equilíbrio ortopédico pode ocasionar a desordem temporomandibular. A partir de então, a oclusão fisiológica ou funcional vem sendo analisada na relação dental. Entre os fatores oclusais funcionais analisados com maior relação às desordens temporomandibulares têm-se os desvios de relação central para máxima intercuspidação habitual, interferências oclusais, ausência de dentes posteriores, alteração na dimensão vertical de oclusão, má-oclusão e tratamento ortodôntico, e parafunção. Conclusão: Os fatores oclusais mais relacionados às disfunções temporomandibulares são bastante frequentes, devendo, no entanto o diagnóstico e o tratamento ser analisado individualmente

Introduction: Since the occlusion area is presented in almost all specialties of Dentistry, its relationship with the health of the patient has been shown. The etiology of temporomandibular disorders is multifactorial and the occlusion is considered an etiologic factor. This study aimed to discuss the functional occlusion aspects and the presence of temporomandibular disorders. Literature Review: The loss of orthopedic balance can induce temporomandibular disorder. Therefore, both the physiological and functional occlusions have been analyzed as a dental relation. Several functional occlusal factors have been linked to the temporomandibular disorders such as deviations of centric relation to maximum intercuspation, occlusal interferences, absence of posterior teeth, changes on the occlusion vertical dimension, malocclusion, orthodontic treatment and parafunction. Conclusion: The most common occlusal factors related to temporomandibular disorders are quite frequent; however, the diagnosis and treatment of such disorders should be considered individually

Effect of occlusal splint thickness on electrical masticatory muscle activity during rest and clenching.

The extent of separation between the maxillary and mandibular teeth in the fabrication of interocclusal splints designed to achieve efficiency and muscle relaxation is controversial and undefined in the literature. Based on this premise, the aim of this study was to evaluate the effect of interocclusal splint thicknesses of 3 and 6 millimeters on the electrical activity of the anterior temporal and masseter muscles during rest and dental clenching. Twenty asymptomatic individuals (10 males and 10 females) were selected using the Research Diagnostic Criteria (RDC). Electromyography (EMG) was performed both with and without the 3- and 6-mm splints using the Bio EMG software package, which recorded values given in microvolts (µV). The results, which were assessed using analysis of variance (ANOVA) to a 5% significance level (p < 0.05), showed increased electrical activity of the masticatory muscles during dental clenching compared with at rest, with greater activity in the masseter muscle. The electrical activity did not differ according to the thickness of the splints or between males and females. We can conclude that both splint thicknesses are effective in treating muscle hyperactivity given their similar clinical behavior for asymptomatic individuals.

Temporomandibular joint vibration before and after exercises and occlusal splints.

Temporomandibular joint (TMJ) sounds are frequent in patients. The aim of this study was to analyze patients with clicking at the end of opening and at the beginning of closing their mouths treated by muscular exercises through chewing and by occlusal splints. Fifteen patients with clinically verified clicking and TMJ and 15 patients without sounds were selected by the Research Diagnostic Criteria for Temporomandibular Disorders. They were submitted to electrovibratography at consultation and 60 and 120 days of treatment by occlusal splints and exercises. Patients demonstrated significant reduction of TMJ sounds after treatment, but vibration intensity was not similar with that of the control group after 120 days.