Pior qualidade de sono está associada à disfunção temporomandibular e hábitos parafuncionais entre estudantes e profissionais de Odontologia / La peor calidad del sueño se asocia con disfunción temporomandibular y hábitos parafuncionales en estudiantes y profesionales de Odontología / Worse sleep quality is associated with temporomandibular disorders and parafunctional habits among dental students and professionals

Este estudo teve como objetivo avaliar a associação entre a qualidade do sono e a presença de disfunção temporomandibular (DTM) e hábitos parafuncionais em estudantes e profissionais de Odontologia durante a pandemia de COVID-19. Cirurgiões-dentistas, docentes e estudantes brasileiros de graduação e pós-graduação em Odontologia responderam a um questionário virtual composto pelos seguintes instrumentos: Índice de Qualidade do Sono de Pittsburgh, Lista de Verificação de Comportamentos Orais, Índice Anamnésico de Fonseca e questões socioeconômicas e demográficas. Os questionários foram disponibilizados online de agosto a novembro de 2020. A associação entre as variáveis preditoras e cada desfecho foi avaliada por meio da regressão de Poisson. A amostra foi composta por 449 participantes, sendo que 259 (59,5%) relataramdistúrbios do sono, 352 (78,4%) apresentavam DTM e 311 (69,3%) realizavam hábitos orais parafuncionais. Os distúrbios do sono foram associados à maior prevalência de hábitos orais parafuncionais (RP 1,61; IC 95% 1,36-1,91) e DTM (RP 1,16; IC 95% 1,04-1,29). Além disso, as mulheres apresentaram maior prevalência de DTM em relação aos homens, assim como indivíduos cuja renda era menor. Desta forma, os distúrbios do sono foram associados a hábitos orais parafuncionais e DTM em estudantes e profissionais de Odontologia durante a quarentena da COVID-19 (AU).

Este estudio tuvo como objetivo evaluar la asociación entre la calidad del sueño y la presencia de disfunción temporomandibular (DTM) y hábitos parafuncionales en estudiantes y profesionales de Odontología durante la pandemia de COVID-19. Odontólogos, profesores y estudiantes brasileños de pregrado y posgrado en Odontología respondieron un cuestionario virtual compuesto por los siguientes instrumentos: Índice de Calidad de Sueño de Pittsburgh, Lista de Verificación de Comportamiento Oral, Índice Anamnésico de Fonseca y preguntas socioeconómicas y demográficas. Los cuestionarios estuvieron disponibles virtualmente de agosto a noviembre de 2020. La asociación entre las variables predictoras y cada resultado se evaluó mediante regresión de Poisson. La muestra estuvo compuesta por 449 participantes, de los cuales 259 (59,5%) refirieron trastornos del sueño, 352 (78,4%) DTM y 311 (69,3%) hábitos orales parafuncionales. Los trastornos del sueño se asociaron con una mayor prevalencia de hábitos bucales parafuncionales (RP 1,61; IC 95% 1,36-1,91) y DTM (RP 1,16; IC 95% 1,04-1,29). Además, las mujeres tenían una mayor prevalencia de DTM que los hombres, así como las personas con ingresos más bajos. Así, los trastornos del sueño se asociaron con hábitos orales parafuncionales y DTM en estudiantes y profesionales de odontología durante la cuarentena por COVID-19 (AU).

This study aimed to assess the association between sleep quality and the presence of temporomandibular disorders (TMD) and parafunctional habits in dental students and professionals during the COVID-19 quarantine. Brazilian dentists, professors, and dental undergraduate and graduate students answered a virtual questionnaire composed of the following instruments: Pittsburgh Sleep Quality Index. Oral Behaviors Checklist, Fonseca Anamnestic Index, and socioeconomic and demographic questions. Questionnaires were available on-line from August to November 2020. The association between the predictor variables and each outcome were assessed using Poisson regression. The sample consisted of 449 participants, 259 (59.5%) of whom had sleep disorders, 352 (78.4%) had TMD, and 311 (69.3%) had parafunctional oral habits. Sleep disorders were associated with higher prevalence of parafunctional oral habits (PR 1.61; 95%CI 1.36-1.91) and TMD (PR 1.16; 95%CI 1.04-1.29). Furthermore, women showed a higher prevalence of TMD in comparison to men, as well as individuals with lower income. Sleep disorders were associated with parafunctional oral habits and TMD in dental students and professionals during COVID-19 quarantine (AU).

Local anaesthesia decreases nerve growth factor induced masseter hyperalgesia.

The aim of this investigation was to evaluate the effects of local anaesthesia on nerve growth factor (NGF) induced masseter hyperalgesia. Healthy participants randomly received an injection into the right masseter muscle of either isotonic saline (IS) given as a single injection (n = 15) or an injection of NGF (n = 30) followed by a second injection of lidocaine (NGF + lidocaine; n = 15) or IS (NGF + IS; n = 15) in the same muscle 48 h later. Mechanical sensitivity scores of the right and left masseter, referred sensations and jaw pain intensity and jaw function were assessed at baseline, 48 h after the first injection, 5 min after the second injection and 72 h after the first injection. NGF caused significant jaw pain evoked by chewing at 48 and 72 h after the first injection when compared to the IS group, but without significant differences between the NGF + lidocaine and NGF + IS groups. However, the mechanical sensitivity of the right masseter 5 min after the second injection in the NGF + lidocaine group was significantly lower than the second injection in the NGF + IS and was similar to the IS group. There were no significant differences for the referred sensations. Local anaesthetics may provide relevant information regarding the contribution of peripheral mechanisms in the maintenance of persistent musculoskeletal pain.

Effects of 4-Week Diacutaneous Fibrolysis on Myalgia, Mouth Opening, and Level of Functional Severity in Women With Temporomandibular Disorders: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to assess the effects of 4-week protocol of diacutaneous fibrolysis (DF) compared with simulated DF (sham-DF) on myalgia and mouth opening. METHODS: In a sham randomized controlled trial, 34 women with temporomandibular disorders and myofascial pain were randomly divided as intervention group (IG) and sham-DF group (SG). The IG received 4 weeks of real DF, and the SG received sham. Pain was assessed through the visual analog scale and pressure pain thresholds (PPTs) on the temporomandibular joint (TMJ), and over the temporal and masseter muscles. The Mandibular Function Impairment Questionnaire was used to classify the participants regarding to the severity of the functional limitation related to TMD. RESULTS: Pain scores decreased for both groups, but the IG showed lower values at week 4, with between-group differences. Bilateral temporal PPT showed higher values at week 4, with between-group differences. The SG had lower PPTs but the IG had higher PPTs, both compared to baseline results. The time-by-group interaction and the frequency of participants above 40 mm of mouth opening showed a significant difference for the IG over time with higher results at the 4-week assessment compared to its own baseline. Both groups showed lower MFIQ scores from baseline to 4-week assessment. There was a lower frequency of a moderate level of severity for the IG. No differences were observed for TMJ or for the masseter muscles PPT. CONCLUSION: Improvements were observed for visual analog scale scores and PPTs on temporal muscles. There was a group-by-time interaction in the IG, suggesting a possible potential use of DF for mouth opening.

Desafíos de la Red Asistencial Pública de Chile en la Especialidad de Trastornos Temporomandibulares y Dolor Orofacial / Challenges of the Chilean Public Health Care System Network in the Temporomandibular Disorders and Orofacial Pain Specialty

RESUMEN: Los Trastornos Temporomandibulares (TTM) son un conjunto de patologías musculares y articulares que afectan al sistema masticatorio. Según estadísticas nacionales, la prevalencia de al menos un diagnóstico de TTM en la población adulta corresponde al 49,6 %, mientras que el 19,6 % padece de un dolor temporomandibular severo. La atención de pacientes afectados por estos trastornos corresponde al odontólogo especialista en trastornos temporomandibulares y dolor orofacial (TTM y DOF), especialidad reconocida legalmente desde el año 2013 por el decreto 8 del Ministerio de Salud. Estas patologías no están incorporadas a las prestaciones de salud oral de las Garantías Explícitas en Salud (GES) y recientemente se han comenzado a establecer protocolos de derivación a la especialidad desde la Atención Primaria Odontológica. En el presente estudio se realiza un análisis de la situación actual de la especialidad de TTM y DOF en la red pública de atención y se plantean posibles soluciones y mejoras a los problemas encontrados.

ABSTRACT: Temporomandibular Disorders (TMD) comprise a heterogenous group of muscle and joint disorders that affect the masticatory system. According to national statistics, the prevalence of at least one diagnosis of TMD in the adult population is 49.6 %, while 19.6 % suffers from severe temporomandibular pain. Care of patients affected by these disorders corresponds to the dentist specialized in temporomandibular disorders and orofacial pain (TMD and OFP); these particular disorders and the specialty were incorporated by the Ministry of Health in 2013.. The pathologies are not incorporated in the Explicit Health Care Guarantees (GES) and only recently protocols for a referral program were established for Primary Dental Care in this area. In this study, the present situation of the specialty of TMD and OFP in the public health care network is analyzed, as well as possible solutions and improvements to the difficulties encountered therein.

The efficacy of transcranial direct current stimulation and transcranial magnetic stimulation for chronic orofacial pain: A systematic review.

BACKGROUND: Transcranial Direct Current Stimulation (tDCS) and Transcranial Magnetic Stimulation (TMS) have been described as promising alternatives to treat different pain syndromes. This study evaluated the effects of TMS and tDCS in the treatment of chronic orofacial pain, through a systematic review. METHODS: An electronic search was performed in major databases: MEDLINE, Scopus, Web of Science, Cochrane, Embase, LILACS, BBO, Open Gray and CINAHL. The eligibility criteria comprised randomized clinical trials (RCTs) that applied TMS or tDCS to treat chronic orofacial pain. The variables analyzed were pain, functional limitation, quality of life, tolerance to treatment, somatosensory changes, and adverse effects. The risk of bias was assessed through the Cochrane Collaboration tool, and the certainty of evidence was evaluated through GRADE. The protocol was registered in the PROSPERO database (CRD42018090774). RESULTS: The electronic search resulted in 636 studies. Thereafter, the eligibility criteria were applied and the duplicates removed, resulting in eight RCTs (four TMS and four tDCS). The findings of these studies suggest that rTMS applied to the Motor cortex (M1), the dorsolateral prefrontal cortex (DLPFC) and the secondary somatosensory cortex (S2) provide adequate orofacial pain relief. Two studies reported significant pain improvement with tDCS applied over M1 while the other two failed to demonstrate significant effects compared to placebo. CONCLUSIONS: rTMS, applied to M1, DLPFC or S2, is a promising approach for the treatment of chronic orofacial pain. Moreover, tDCS targeting M1 seems to be also effective in chronic orofacial pain treatment. The included studies used a wide variety of therapeutic protocols. In addition, most of them used small sample sizes, with a high risk of biases in their methodologies, thus producing a low quality of evidence. The results indicate that further research should be carried out with caution and with better-standardized therapeutic protocols.

Acute and neuropathic orofacial antinociceptive effect of eucalyptol.

Terpenes have a wide range of pharmacological properties, including antinociceptive action. The anti-inflammatory and antinociceptive effects of eucalyptol are well established. The purpose of this study was to evaluate the antinociceptive effect of eucalyptol on acute and neuropathic orofacial pain in rodent models. Acute orofacial and corneal nociception was induced with formalin, capsaicin, glutamate and hypertonic saline in mice. In another series, animals were pretreated with capsazepine or ruthenium red to evaluate the involvement of TRPV1 receptors in the effect of eucalyptol. In a separate experiment, perinasal tissue levels of IL-1ß, TNF-α and IFN-γ were measured. Rats were pretreated with eucalyptol before induction of temporomandibular joint pain with formalin or mustard oil. In another experiment, rats were submitted to infraorbital nerve transection (IONX) to induce chronic pain, followed by induction of mechanical hypersensitivity using Von Frey hairs. Locomotor performance was evaluated with the open-field test, and molecular docking was conducted on the TRPV1 channel. Pretreatment with eucalyptol significantly reduced formalin-induced nociceptive behaviors in all mouse strains, but response was more homogenous in the Swiss strain. Eucalyptol produced antinociceptive effects in all tests. The effect was sensitive to capsazepine but not to ruthenium red. Moreover, eucalyptol significantly reduced IFN-γ levels. Matching the results of the experiment in vivo, the docking study indicated an interaction between eucalyptol and TRPV1. No locomotor activity changes were observed. Our study shows that eucalyptol may be a clinically relevant aid in the treatment of orofacial pain, possibly by acting as a TRPV1 channel antagonist.

Antinociceptive activity of Syzygium cumini leaves ethanol extract on orofacial nociception protocols in rodents.

CONTEXT: Syzygium cumini (L.) Skeels (Myrtaceae) is a tree with dark purple fruits, popularly known as "jambolão" or "jambolan". In folk medicine, this plant is used for the treatment of diabetes and inflammatory conditions. OBJECTIVE: We investigated the antinociceptive effect of ethanol extract (EE) from S. cumini leaves on orofacial nociception. MATERIAL AND METHODS: The antinociceptive effects of the EE obtained from the leaves of S. cumini were evaluated in mice using formalin- and glutamate-induced orofacial nociception. RESULTS: ESI-MS/MS analyses demonstrated that major constituents in the analyzed samples coincided with the mass of the phenolic acids and flavonoids. In pharmacological approach, pre-treatment with EE (100, 200, or 400 mg/kg, p.o.) significantly reduced (p<0.05 or p<0.01) the percentage of paw licks time during phase 2 (43.2, 47.1, and 57.4%, respectively) of a formalin pain test when compared to control group animals. This effect was prevented by pretreatment with glibenclamide and N(G)-nitro-l-arginine (l-NOARG). The extract, all doses, also caused a marked inhibition (p<0.01 or p<0.001) of glutamate-induced orofacial nociception (38.8, 51.7, and 54.7%) when compared with the control group. No effect was observed with the rota-rod model. CONCLUSIONS: We can suggest that the antinociceptive effect of the EE is mediated by peripheral mechanisms, possibly involving KATP channels and the nitric oxide pathways. These effects appear to be related to the presence of flavonoids compounds, such as quercetin.

Características de los pacientes con desórdenes temporomandibulares del Hospital de San José / Characteristics of patients with temporomandibular joint disorders at Hospital de San José

Los desórdenes temporomandibulares son la causa más frecuente de dolor no dental en la región orofacial. Se caracterizan por dolor y disfunción del sistema masticatorio. Objetivo: Describir las características clínicas de los pacientes con desórdenes temporomandibulares del Hospital de San José. Materiales y métodos: Serie de casos. Se incluyeron los pacientes con diagnóstico de desórdenes temporomandibulares durante junio del 2010 a junio del 2013. Resultado: Se identificaron 284 registros, con un promedio de edad de 41,5 años (DE 17,3). El 81,7% eran mujeres. El síntoma reportado con mayor frecuencia por el paciente fue dolor, con el 86,6%. La media de apertura oral fue 3,8 cm (DE 0,7). La resonancia magnética constituyó el examen más solicitado, con el 16,5%. El tratamiento médico más indicado fue la combinación de placa miorrelajante, dieta blanda y terapia térmica, con el 57%. El 18,6% de los pacientes con disfunción temporomandibular requirieron manejo quirúrgico. Conclusión: Al describir las características de los pacientes con desórdenes temporo-mandibulares en el Servicio de Cirugía Maxilofacial del Hospital de San José, en el periodo de junio del 2010 a junio del 2013, se puede concluir que el sexo que más presenta esta patología es el femenino, en mayores de 40 años, posiblemente por alteraciones oclusales debidas a mala adaptación protésica o ausencia de piezas dentales, estrés, presencia de hábitos parafuncionales asociados a posibles cambios artrósicos por la edad...

Temporomandibular joint disorders are the most frequent cause of non-dental orofacial pain. They are characterized by pain and mastication system dysfunction. Objective: To describe the clinical characteristics of patients with temporomandibular joint disorders at Hospital de San José. Materials and methods: Case series. Patients diagnosed with temporomandibular joint disorders between June 2010 and June 2013 were included. Results: Overall, 284 records were identified of patients with a mean age 41.5 years (SD 17.3). Of those, 81.7% were women. The most frequent symptom reported by the patients was pain (86.6%). Mean oral opening was 3.8 cm (SD 0.7). Nuclear magnetic resonance was the most requested study (16.5%). The medical treatment most frequently indicated was a combination of splint, soft diet and thermal therapy (57 %). Of the patients with temporomandibular dysfunction, 18.6% required surgical management. Conclusion: Based on the description of the characteristics of patientes with temporomandibular joint disorders coming to the Maxillofacial Surgery Service at Hospital de San José, between June 210 and June 2013, it may be concluded that this disorder is more frequent in the female gender and in people over 40. This may be explained perhaps by the occlusion abnormalities due to poor prosthetic fitting or absence of teeth, stress, or habitus associated with potential age-related arthrosis changes...

Eficácia do aconselhamento no tratamento das disfunções temporomandibulares / Effectiveness of counseling in the treatment of temporomandibular disorders

O objetivo do presente ensaio clínico controlado foi avaliar a eficácia do aconselhamento sobre a dor, função e qualidade de vida, no tratamento a pacientes com Disfunção Temporomandibular (DTM). Para tanto, 51 pacientes consecutivos foram alocados para um dos grupos da pesquisa. Para o Grupo I, foi instituída terapia com aconselhamento e para o Grupo II, foi realizado tratamento convencional por meio de dispositivos oclusais. Os pacientes foram acompanhados em retornos de 7, 15, 30 e 60 dias após o baseline. No baseline, todos os pacientes foram examinados e diagnosticados como portadores de DTM através do índice RDC/TMD, que foi aplicado por um único examinador treinado e calibrado, além disso, os pacientes foram encaminhados para o tratamento específico de acordo com o grupo ao qual pertenciam. O grau de comprometimento clínico e funcional foi avaliado em cada uma das visitas por meio do Índice Temporomandibular (TMI). Em cada sessão, os pacientes foram ainda inquiridos a respeito do nível de dor por meio de uma Escala Visual Analógica (EVA). Para a análise do impacto da dor na qualidade de vida, foi utilizado o questionário OHIP-14. Os resultados apresentaram 26 pacientes do Grupo I com idade média de 35,15 ± 10,79 anos. No Grupo II foram tratados 25 pacientes, com faixa etária média de 27,36 ± 10,34 anos. O aconselhamento foi eficaz na redução da intensidade de dor (EVA), com melhora significativa observada já com 7 dias de acompanhamento (p<0,001). Para o comprometimento funcional (TMI), resultados significativos foram observados com 15 dias de acompanhamento (p=0,002). O aconselhamento também foi responsável pela melhora significativa do impacto da DTM na qualidade de vida (OHIP-14) em todos os momentos da análise (p<0,001). Quando da comparação entre os grupos de pesquisa, não foi observada diferença significativa para nenhum dos índices analisados (p>0,05) nas avaliações. Pôde-se concluir, portanto que, para a amostra estudada, o aconselhamento constituiu-se em uma opção de tratamento eficaz para o controle de sinais e sintomas da DTM, com resultados similares aos do grupo tratado por meio de dispositivos oclusais. (AU)

The aim of this controlled trial was to evaluate the effectiveness of counseling in pain, function and well-fare outcomes on the management of patients with temporomandibular disorder (TMD). Therefore, 51 consecutive patients were allocated to one of the research groups. In Group I, was instituted counseling therapy for Group II was conducted treatment as usual with occlusal splint. Patients were followed for returns at 7, 15, 30 and 60 days after baseline. At baseline, all patients were examined and assessed RDC/TMD form, which was administered by a single trained and calibrated examiner, in addition, the patients were referred for specific treatment according to the group to which belonged. The clinical and functional impairment was assessed at each visit through the Temporomandibular Index (TMI). In each session, the patients were also surveyed about pain intensity using a Visual Analogue Scale (VAS). To analyze the impact of pain on quality of life, OHIP-14 questionnaire was used. The results showed 26 patients in Group I with a mean age of 35.15 ± 10.79 years. 25 patients were allocated to Group II. The mean age was 27.36 ± 10.34 years. The counseling was effective in reducing the intensity of pain (VAS), with significant improvement observed at 7 day follow-up (p <0.001). The functional impairment (TMI) showed significant results at 15 days follow-up (p = 0.002). Counseling was also responsible for significant improvement in the impact of TMD on quality of life (OHIP-14) at all times of the analysis (p <0.001). When comparing research groups, no significant difference was observed for any of the analyzed indices (p> 0.05) nor in the short term (7 days) neither in long term (60 days). It was concluded therefore that, for the studied sample, counseling consisted in an effective treatment option for the control of signs and symptoms of TMD, with results in the short and long term similar to the usual treatment group. (AU)

Temporomandibular joint arthritis in sickle cell disease: a case report.

We report a rare case of aseptic arthritis in the temporomandibular joint of a patient with sickle cell anemia. A 22-year-old woman with sickle cell disease, in the 18th week of gestation, was referred by her hematologist to investigate a sudden mouth opening limitation and severe pain on her left cheek. The patient received a standard pain assessment protocol, clinical examination, and complementary exams (complete blood count, hemoglobin electrophoresis, blood solubility test, panoramic radiograph, and magnetic resonance imaging [MRI]). The blood results were consistent with a sickle cell crisis and the MRI showed an inflammatory process around the left temporomandibular joint. Treatment with opioid analgesics and blood transfusion provided good results. Sickle cell anemia is a disease that can cause arthritis of the temporomandibular joint, and although it is rare, clinicians should be attentive to the differential diagnosis in patients with this disease.

Thermographic and clinical correlation of myofascial trigger points in the masticatory muscles.

OBJECTIVES: The aim of the study was to identify and correlate myofascial trigger points (MTPs) in the masticatory muscles, using thermography and algometry. METHODS: 26 female volunteers were recruited. The surface facial area over the masseter and anterior temporalis muscles was divided into 15 subareas on each side (n=780). This investigation consisted of three steps. The first step involved thermographic facial examination, using lateral views. The second step involved the pressure pain threshold (PPT), marking the MTP pattern areas for referred pain (n=131) and local pain (n=282) with a coloured pencil, and a photograph of the lateral face with the head in the same position as the infrared imaging. The last step was the fusion of these two images, using dedicated software (Reporter® 8.5-SP3 Professional Edition and QuickReport® 1.2, FLIR Systems, Wilsonville, OR); and the calculation of the temperature of each point. RESULTS: PPT levels measured at the points of referred pain in MTPs (1.28±0.45 kgf) were significantly lower than the points of local pain in MTPs (1.73±0.59 kgf; p<0.05). Infrared imaging indicated differences between referred and local pain in MTPs of 0.5 °C (p<0.05). Analysis of the correlation between the PPT and infrared imaging was done using the Spearman non-parametric method, in which the correlations were positive and moderate (0.4≤r<0.7). The sensitivity and specificity in MTPs were 62.5% and 71.3%, respectively, for referred pain, and 43.6% and 60.6%, respectively, for local pain. CONCLUSION: Infrared imaging measurements can provide a useful, non-invasive and non-ionizing examination for diagnosis of MTPs in masticatory muscles.

Nociceptive and inflammatory responses induced by formalin in the orofacial region of rats: effect of anti-TNFalpha strategies.

This study evaluated the effects of different anti-TNFalpha strategies on the nociceptive and inflammatory responses triggered by formalin in the rat orofacial region. Formalin injection (2.5%) into the right upper lip caused a nociceptive response that was biphasic, with the first phase observed between 0 and 3 min and the second phase between 12 and 30 min. Plasma extravasation induced by formalin was time-related and reached the peak at 360 min. The monoclonal antibody anti-TNFalpha (25 and 50 pg/lip) significantly inhibited the second phase of formalin-induced nociceptive behavior, while the first phase remained unaltered. The systemic treatment with the chimeric anti-TNFalpha antibody infliximab also caused a significant inhibition of the second phase. Interestingly, the local administration of infliximab (50 pg/lip) produced a significant reduction of both phases of formalin-induced nociception. In addition, the systemic pretreatment with the preferential inhibitor of TNFalpha synthesis thalidomide (25 and 50 mg/kg, p.o) promoted a marked reduction of the first and second phases of formalin-evoked nociception. The local administration of the monoclonal antibody anti-TNFalpha (25 and 50 pg/lip) or infliximab (50 pg/lip) markedly reduced the plasma extravasation induced by formalin. Otherwise, formalin-elicited plasma extravasation was not significantly affected by the systemic administration of either infliximab (1 mg/kg; s.c) or thalidomide (50 mg/kg, p.o). Present data suggest that blocking TNFalpha effects, through different pharmacological tools, could represent a good alternative to control orofacial inflammatory pain that is refractory to other drugs.

Analysis of magnetic resonance imaging characteristics and pain in temporomandibular joints with and without degenerative changes of the condyle.

The aim of this study was to investigate temporomandibular joint (TMJ) pain and magnetic resonance imaging characteristics in 104 TMJs with and 58 without degenerative changes of the condyle, such as osteophytes, erosion, avascular necrosis, subcondral cyst and intra-articular loose bodies. TMJ images were also assessed for flattening, retropositioning and hypomobility of condyle and disc displacement. Comparison of the TMJ side-related data showed a significant relationship between disc displacement without reduction (DDwoR) and the presence of degenerative bony changes (p=0.00). Flattening, retropositioning and hypomobility of condyle showed no significant difference in relation to the presence or absence of degenerative bony changes. Retropositioning of the condyle was significantly associated to disc displacement with reduction (DDwR) (p=0.00), while condylar hypomobility was significantly more frequent in TMJ with DDwoR (p<0.05). Independent of the presence or type of DD, TMJ pain was more frequent in the presence of degenerative bony changes. When considering only DDwR, TMJ pain was significantly associated to a degenerative condition (p=0.03). When there were no degenerative bony changes, TMJ pain was significantly more frequent in DDwoR (p=0.04). Despite the present findings, the absence of symptoms in some patients with condylar bony changes suggests that the diagnosis of osteoarthritis should be established by evaluation of magnetic resonance images in association with clinical examination.

Characteristics of chief complaints of patients with temporomandibular disorders in a Brazilian population.

A retrospective survey of 894 patients with temporomandibular disorders was conducted in order to analyse the characteristics of chief complaints. The patients presented complaints of pain (82.1%), functional disturbance (12.3%), articular sounds (5.0%) and swelling (0.6%). Unilateral occurrence (66.5%) was more frequent than bilateral. The most frequent location of pain was the temporomandibular joint (TMJ) (82.1%) followed by ear (10.8%), face (2.3%), head (2.3%), mandible (1.0%), neck (0.9%), temporal (0.4%) and frontal (0.1%) areas. Pain in the TMJ occurred in isolation (87.9%) or associated to other locations. The most frequent functional disturbance was limitation of jaw opening (32.1%).

Stereotactic trigeminal nucleotomy for dysesthetic facial pain.

Trigeminal nucleotomy is a relatively simple, straightforward stereotactic procedure, acting at the deafferentation site, i.e., at the nucleus caudalis. Patients were operated on in a seated position, by a posterior suboccipital approach. Out of a series of 196 patients, 143 underwent trigeminal nucleotomy for deafferentation. Clinical diagnoses were 52 cases of postherpetic pain dysesthesia, 35 of anesthesia dolorosa, 46 of dysesthetic state with superimposed tic-like sequelae of trigeminal surgery performed elsewhere and 9 of posttraumatic neuropathy. Abolition of allodynia or marked reduction in, or disappearance of deep background pain was achieved in 72.0% of the cases overall. Results are analyzed for each clinical category. There were no side effects of any kind. Follow-up ranged from 4 to 17 years. This seems to be the procedure of choice for deafferentation facial pain.