Valoración del control postural y del equibrio en personas con trastornos temporomandibulares: revisión sistemática / Assessment of postural control and balance in persons with temporomandibular disorders: A systematic review

El sistema estomatognático es la unidad anatomofuncional de la región craneocervicofacial. Existen disfunciones condicionantes en su control motor. El objetivo fue estudiar la utilidad clínica de las diferentes escalas e instrumentos empleados en la valoración del control postural en personas con trastornos termporomandibulares. Se realizó una revisión sistemática, por 2revisores independientes, en las bases de datos PubMed, Medline, Ebsco, Science Direct y PEDro, seleccionando estudios observacionales publicados entre enero de 2006 y marzo de 2017. Se analizó el riesgo de sesgo y la calidad metodológica siguiendo las indicaciones Cochrane y la escala de Downs and Black. Se incluyeron 10estudios, de los que 9emplearon plataformas computarizadas, uno sumó la fotogrametría y uno usó electromiografía. Siete estudios fueron clasificados como de calidad moderada y 3de calidad baja. La posturografía es el instrumento de valoración más utilizado. Diversidades metodológicas no permiten determinar sus implicaciones clínicas ni la relación entre el equilibrio y la presencia de trastornos temporomandibulares

The stomatognathic system is the anatomo-functional unit of the cranio-cervico-facial region. Some dysfunctions affect its motor control. The aim of this study was to analyse the clinical usefulness of the various scales and instruments used in the assessment of postural control in people with temporomandibular disorders. A systematic review was carried out by 2independent reviewers in the PubMed, Medline, Ebsco, Science Direct and PEDro databases, selecting observational studies published between January 2006 and March 2017. The risk of bias and methodological quality was analysed following Cochrane indications and the Downs and Black quality scale. Ten studies were included, of which 9used computerised platforms, one added photogrammetry and one used electromyography. Seven studies were classified as moderate quality and 3as low quality. Posturography was the most widely used assessment instrument. Methodological differences did not allow determination of their clinical implications or the relationship between balance and the presence of temporomandibular disorders

Inflammatory Cytokines and Sleep Disturbance in Patients with Temporomandibular Disorders.

AIMS: To assess the degree and interrelationship of sleep disturbance and plasma cytokine levels in temporomandibular disorder (TMD) pain patients. METHODS: Forty female TMD patients and 20 age-, sex-, and body mass index (BMI)-matched healthy subjects were enrolled. TMD was diagnosed using the Research Diagnostic Criteria for TMD. The TMD patients were classified as having low or high disability according to Graded Chronic Pain Scale findings. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to measure sleep quality. Plasma concentrations of interleukin (IL)-1ß, IL-6, IL-10, tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) were measured from blood samples collected between 9 am and noon. Statistical analyses included Kruskal-Wallis and one-way analysis of variance tests to compare results between different groups and multivariate general linear models to evaluate the effect of sleep status on cytokine levels. RESULTS: The high-disability group had the highest PSQI and ESS scores (P < .001). Plasma levels of IL-1ß, IL-6, IL-10, and TNF-α were significantly higher in the patient groups, with the high-disability group exhibiting the highest values (P ≤ .001). The plasma cytokine levels were significantly correlated with PSQI scores (P < .05). Plasma levels of IL-10 and TNF-α were significantly associated with the disability level after adjusting for both sleep indices (both P < .05). CONCLUSION: Patients with TMD, especially those with high disability, had elevated plasma cytokine levels and increased ESS and PSQI scores suggestive of sleep disturbance.

Association between mandibular condylar position and clinical dysfunction index.

OBJECTIVES: Condylar position in the glenoid fossa has been associated with temporomandibular disorders. The purpose of the present study was to investigate the correlation between clinical dysfunction index (Di) and mandibular condylar position in patients with temporomandibular joint dysfunction (TMD) using cone beam computed tomography (CBCT). METHODS: In this cross-sectional study, participants were recruited from the Department of Maxillofacial Radiology at Shiraz Dental University in Iran. The condylar position was assessed on the CBCT images of 120 temporomandibular joints in 60 patients with TMD. Patients were divided into 3 groups based on Helkimo's clinical Di. The chi-square test was used to correlate degree of the Helkimo's Di with the mandibular condylar position. The p value was set at 0.05. RESULTS: A total of 60 patients (42 women and 18 men; mean age, 33.4 years) participated in this study. Significant differences in condylar position were found among the 3 groups (Di I, II, and III) (p < 0.05). Patients with mild to moderate TMD were found to have anteriorly and concentric seated condyles. Posteriorly seated condyles were found in patients with severe TMD. CONCLUSION: Condylar position is associated with different severity of TMD.

Comparison of nonsurgical treatment options in pediatric condylar fractures: rigid intermaxillary fixation versus using guiding elastic therapy.

A prospective study was done to compare rigid intermaxillary fixation and guiding elastic for treatment of condylar fractures in pediatric patients. Sixty-one children younger than 12 years with condylar fractures were studied in 2 groups. Group 1 consisted of 31 patients who were treated with arch bar and intermaxillary fixation for 7 to 12 days, and group 2 consisted of 30 patients who were treated with arch bar and elastics without rigid intermaxillary fixation. Patients had minimal function during treatment time, which lasted 7 to 12 days. Evaluation of deviation on opening between both groups (groups 1 and 2) with a χ test did not show any relationship between them. Incidence of temporomandibular dysfunction signs was 25.8% in group 1 patients and 23.3% in group 2 patients. Comparison of temporomandibular dysfunction signs in both treatment groups did not show a statistically significant relationship. Our study showed the same results using guiding elastics as using rigid intermaxillary fixation in pediatric condylar fractures. Guiding elastic is more tolerable, and children have function during treatment.

Do malocclusion and Helkimo Index ≥ 5 correlate with body posture?

Whether there are correlations between the stomatognathic system and body posture remains controversial. Here, we have investigated whether malocclusal traits and having a Helkimo Index ≥ 5 show detectable correlations with body-posture alterations in children and young adults. A total of 1178 11- to 19-year-old subjects were divided into four groups: (i) controls; (ii) malocclusion; (iii) Helkimo Index ≥ 5 and (iv) malocclusion + Helkimo Index ≥ 5. Dental occlusion assessment included the following: overbite, overjet, posterior crossbite, scissorbite, mandibular crowding and dental class. Subsequently, body-posture assessments were performed through static analyses of body inclination and trunk asymmetry, and according to the dynamic Fukuda stepping test. Univariate and multivariate statistical analyses were performed. Although at the univariate level both the trunk asymmetry and Fukuda stepping test showed significant differences among the groups, the multivariate level revealed that age and gender were mostly responsible for this. The only significant correlation that was seen was for the malocclusion + Helkimo Index ≥ 5 group: these subjects had a positive (worse) trunk asymmetry and a negative (better) Fukuda stepping test performance. At the further multivariate analyses of each single malocclusal trait /Helkimo Index ≥ 5 (irrespective of the groups), only an increased overbite showed a statistically significant association with a slightly better Fukuda stepping test performance. Given the small number of significant associations seen and their limited entities, this study does not support the existence of clinically relevant correlations for malocclusal traits and Helkimo Index ≥ 5 with body posture in children and young adults.

Correlation of RDC/TMD axis I diagnoses and axis II pain-related disability. A multicenter study.

As part of an ongoing multicenter investigation involving four highly specialized tertiary clinics for temporomandibular disorders (TMD) treatment, retrospective analysis of Research Diagnostic Criteria for TMD (RDC/TMD) axis I and axis II data gathered on clinic and community cases were assessed with a twofold aim: (1) to search for a correlation between axis I diagnoses and axis II pain-related disability, and (2) to identify clinical (axis I) and psychosocial (axis II) predictors of high pain-related disability. Two samples of patients seeking treatment for TMD (clinic cases, N = 1,312) and a sample of general population subjects (community cases, N = 211) underwent a thorough assessment in accordance with the RDC/TMD version 1.0 [1] guidelines to receive both axis I and axis II diagnoses. Spearman's test was performed to assess the level of correlation between axis I diagnoses and Graded Chronic Pain Scale (GCPS) pain-related disability. A stepwise multiple logistic regression model was used to identify the significant associations between 12 clinical and psychosocial predictors and the presence of high pain-related disability. Axis I findings were related with pain-related impairment (GCPS scores) in the overall study sample including both clinic community cases (Spearman correlation = 0.129, p = 0.000), but the results of the correlation analyses performed on the clinic sample alone were not significant (Spearman correlation = -0.018, p = 0.618). Predictors for high disability were related to axis II findings (severe depression and somatization) or psychosocial aspects related to the pain experience (pain lasting from more than 6 months; treatment-seeking behavior), while none of the axis I diagnoses remained in the final logistic regression model. The final model predicted the level of pain-related impairment at a fair level (R(2) = 26.7%). The correlation between axis I diagnoses and pain-related impairment is not significant in the patients populations. Treatment-seeking behavior and other factors related with the pain experience are likely to be more important than the physical findings to determine the degree of psychosocial impairment.

Classification of chronic orofacial pain: applicability of chronic headache criteria.

OBJECTIVE: The aim of this study was to test the temporal definitions of chronic daily headache (CDH) in an orofacial pain population and examine the features of the so-defined chronic orofacial pain (COFP). STUDY DESIGN: Patients with orofacial pain presenting for >3 months were prospectively collected for 2 years. Temporal patterns were applied based on the headache literature, and patients were subdivided into: COFP: ≥15 days monthly, lasting >4 hours (long-lasting CDH); daily orofacial pain (DOFP): ≥15 days monthly, but mean attack duration ≤4 hours (short-lasting CDH); and episodic orofacial pain (EOFP): <15 days monthly (episodic headaches). RESULTS: A total of 328 patients were examined. The temporal criteria defined 149 patients as COFP, 116 as DOFP, and 41 as EOFP. COFP was not distinctive in the parameters used in the diagnostic process (laterality, severity, muscle tenderness, waking) or demographic features. These were, however, significantly associated with specific diagnosis. CONCLUSION: This study provides a base for the clear definition of COFP that has the distinctive advantage of being identical to that used in headache. Additionally, our results clearly show that COFP should be regarded as a temporal definition and not a diagnosis.

Classifying degenerative joint disease by the RDC/TMD and by panoramic imaging: a retrospective analysis.

The purposes of the study were to evaluate the utility of diagnosing degenerative joint disease (DJD) by the clinical finding of coarse crepitus alone, without supporting imaging studies, as defined by the RDC/TMD, and to evaluate the contribution of panoramic radiography as an aid in the diagnosis of DJD. A retrospective analysis of 372 consecutive patients with TMD was conducted. Their panoramic radiographs were evaluated for the extent of their contribution to the final diagnosis. Panoramic radiography was of no diagnostic value in 94.4% of the cases when the group was considered as a whole. When patients diagnosed with DJD were considered separately, panoramic radiography was completely sufficient for reaching the final diagnosis in 20.0% of the cases. In almost 90% of these patients, however, the clinical examination did not support the diagnosis of DJD (no coarse crepitus was found). This raises some doubts about the effectiveness of the clinical examination according to the RDC/TMD and about the utility of panoramic radiography in the definitive diagnosis of DJD, because both techniques have low accuracy (11.1% and 20%, respectively). The present study supports the current recommendations that panoramic radiography should not be ordered routinely to assess DJD, but still it is first choice when any dental problem is suspected. Further additional imaging (computerized tomography, magnetic resonance imaging) should be considered only if there is reason to expect that the findings might affect diagnosis and management. This study adds to recent criticisms of the clinical validity of the RDC/TMD, with regard to DJD.

Correlation of the temporomandibular dysfunction classification index with cephalometric indicators of facial structure: a study on adult female subjects.

AIM: The aim of this study was to determine whether associations exist between temporomandibular dysfunction index (TMI) and craniofacial morphology. METHODS: The sample consisted of 30 symptomatic (mean age 28.3+/-6.7; range 24-39 years, TMI 0.48+/-0.21) and 30 asymptomatic women (mean age 27.4+/-9.2; range 22-42 years, TMI 0.1+/-0.05) seeking orthodontic treatment at Department of Dental Sciences ''G. Messina'', University of Palermo, who had routine lateral cephalograms. Symptoms and signs of temporomandibular joint dysfunction (TMD) were assessed by a standardized clinical examination and the TMI (a clinical measure of dysfunction used to evaluate the severity of TMD). Linear and angular cephalometric measurements were taken to evaluate skeletal and dental characteristics of the two groups. Unpaired t test was used to compare the symptomatic subjects with the control subjects. RESULTS: The sella-nasion-supramentale (SNB) angle (P<0.038, indicating mandibular retrognathism relative to cranial base), the lower facial height and the palatal plane-mandibular plane angle (P<0.025 and P<0.037 respectively, indicating hypodivergent facial profile) were significantly smaller in the symptomatic than in the asymptomatic women. The occlusal plane was steeper (P<0.033) and the cranial flexion was higher (P<0.035) in the symptomatic group than in the asymptomatic group. In addition the overjet (P<0.008) and the overbite (P<0.005) were significantly greater in symptomatic group than in the asymptomatic group. CONCLUSION: This study showed a significant correlation between dentofacial characteristics and TMD.

Classification, causation and treatment of masticatory myogenous pain and dysfunction.

This article focuses on chronic myogenous pains affecting the masticatory muscles, including focal myalgia, regional myalgia, myofascial pain, and fibromyalgia. The probable mechanisms are discussed and treatment options, including self-directed treatment, physical medicine modalities, and several types of pharmacologic agents, are presented.

ATM: denominación actual, clasificación y componentes / TMJ: current denomination, classification and components

El presente trabajo intenta unificar los variados y extensos criterios que existen al tratar la anatomía de la articulación más compleja del organismo y así adoptar una terminología adecuada para la era científico-tecnológica que vivimos. La extensa bibliografía consultada y el criterio anatómico adoptado hacen del trabajo un arma indispensable para enfrentar los tan variados trastornos de la articulación y arribar de esta manera a la armonía de todo el sistema estomatognático (AU)

ATM: denominación actual, clasificación y componentes / TMJ: current denomination, classification and components

El presente trabajo intenta unificar los variados y extensos criterios que existen al tratar la anatomía de la articulación más compleja del organismo y así adoptar una terminología adecuada para la era científico-tecnológica que vivimos. La extensa bibliografía consultada y el criterio anatómico adoptado hacen del trabajo un arma indispensable para enfrentar los tan variados trastornos de la articulación y arribar de esta manera a la armonía de todo el sistema estomatognático

Searching for an assessment instrument to determine temporomandibular disorder pain profiles for the purposes of primary health care.

The objective was to study the utility of the graded chronic pain (GCP) scale of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the purpose of recognizing TMD pain profiles in primary health care. The GCP scale was used to gather data from 93 consecutive TMD patients seeking treatment in a primary health care setting. The GCP data were compared with pain profiles assessed by scales similar to the more complicated multidimensional pain inventory (MPI). The scales used were able to produce the similar 'dysfunctional profiles' in the TMD patients as the original MPI scale in the sample of chronic pain patients. Also, the original MPI profiles of 'adaptive copers' and 'interpersonally distressed' were produced with distinctive features. The GCP grades distributed almost identically among the subgroups produced by the pain profiles. Most grade I patients were classified as adaptive copers (82--86%), most grade II patients were interpersonally distressed (59%) and all except one of the grade III patients were classified as dysfunctional (83%). The results seem to support the main assumption of our study that the GCP scale is a simple screening tool suitable for identifying primary care TMD patients with various types of pain profiles.

Prevalence of temporomandibular disorder subtypes, psychologic distress, and psychosocial dysfunction in Asian patients.

AIMS: To use the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) to investigate the physical diagnoses, psychologic distress, and psychosocial dysfunction in Asian TMD patients. The RDC/TMD Axis I and II findings were compared to those of Swedish and American TMD patients. METHODS: One hundred ninety-one patients (53 male and 138 female) referred to 2 institutionalized TMD clinics in Singapore were enrolled in the study. The mean age of the predominantly Chinese population (83.2%) was 33.6 +/- 9.3 years. Data from a RDC/TMD history questionnaire and clinical examination were fed directly by patients and clinicians into a computerized diagnostic system (NUS TMDv1.1). Axis I and II findings were generated on-line, based on RDC/TMD rule engines. Data were automatically exported to SPSS for statistical analysis. RESULTS: Group I (muscle) disorders were found in 31.4% of the patients; Group II (disc displacement) disorders were found in 15.1% and 15.7% of the patients in the left and right temporomandibular joints, respectively; and Group III (arthralgia, arthritis, and arthrosis) disorders were found in 12.6% and 13.0% of the patients in the left and right joints, respectively. Axis II assessment of psychologic status showed that 39.8% of patients experienced moderate to severe depression and 47.6% had moderate to severe nonspecific physical symptom scores. Psychosocial dysfunction was observed in only 4.2% of patients based on graded chronic pain scores. CONCLUSION: Axis I and II findings of Asian TMD patients were generally similar to their Swedish and American cohorts. In all 3 populations, women of child-bearing age represented the majority of patients. Muscle disorders were the most prevalent type of TMD. A substantial portion of TMD patients were depressed and experienced moderate to severe somatization.

Diagnostic targeting of temporomandibular disorders.

This article describes a diagnostic chart that is organized for a versatile representation of various conditions of temporomandibular disorders (TMD). It facilitates the grading of disorder severity and visualization of probable mutual effects between groups of disorders. It also enhances the clinician's awareness of potential systemic involvement in TMD by incorporating it into the chart. Comparison of charts completed at consecutive examinations is helpful for the assessment of disorder progression, regression or for the refining of diagnoses.

Diagnóstico y prevención de la disfunción de la articulación temporomaxilar causada por alteraciones de las cadenas musculares a nivel cervical / Diagnosis and prevention of the dysfunction of the temporomaxillary articulation caused by alterations of the muscular chains at cervical level

Las disfunciones de la articulación temporamaxilar, se traduce como una sensación de disconformidad, de angustia o agonía, como resultado de la estimulación de extremidades nerviosas especializadas. A la vez como un mecanismo protector que induce a superar la causa que origina dicho dolor. El dolor es característico y es completamente personal, perteneciendo solamente al que lo sufre. Personas diferentes sintiendo idéntica estimulación nociva, sienten el dolor de distintas maneras y reaccionan con diferentes niveles de sufrimiento, es imposible para una persona sentir exactamente lo que otra siente. Por lo que para el examinador representa un reto el obtener la información suficiente para brindar todo el apoyo necesario para la persona que está aquejada por el dolor, tan significativio para ella...

Classificaçäo da DCM em pacientes do serviço de disfunçäo craniomandibular do Curso de Odontologia da Universidade Federal do Pará / Classification of CMD in patients seen at the craniomandibular dysfunction service, Federal University of Pará

Uma amostra de 120 pacientes, colhida no Serviço de Disfunçäo Craniomandibular do Curso de Odontologia da Universidade Federal do Pará, foi submetida ao questionário proposto por Martti Helkimo (1974). Foi considerado o sexo, a idade, cada resposta ao questionário e o nível de DCM obtido pela somatória das notas de cada pergunta. As respostas ao questionário foram caracteristicamente dicotômicas, na grande maioria dos casos ou houve aceitaçäo total ou rejeiçäo total das perguntas. E, com base nesse resultado, infere-se sobre o caráter influente do questionário. Os dados referentes a cada resposta foram submetidos à análises multivariadas, sendo as dez perguntas reduzidas a quatro fatores e aos 120 pacientes a 11 grupos. As perguntas que apresentaram caráter discriminante puderam ser definidas como referentes a (i) dor na cavidade bucal, (ii) sintomas indiretos e comportamentais, (iii) articulaçäo dos dentes e (iv) bruxismo. Apenas os grupos (i) e (iii) apresentaram correlaçäo com o nível de DCM, sendo que o primeiro a apresentou de maneira mais contudente