Relationship between anxiety and temporomandibular disorders in dental students.

OBJECTIVE: To evaluate the prevalence of temporomandibular disorder (TMD) in dental students and its correlation with anxiety. METHODS: After probability sampling, 105 students were selected. The diagnosis of TMD was carried out using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) - Axis I; the anxiety level was obtained by the State-Trait Anxiety Inventory (STAI). Data from TMD and anxiety were calculated through frequency and Chi-square test to assess the association between TMD and anxiety, considering a significance level of 5%. RESULTS: TMD was present in 36.2% of the students; disc displacement (42.1%), and arthralgia (42.1%) were the most prevalent subtypes. The majority of students presented both traits (57.1%) and state (65.7%) anxiety in mild levels, followed by moderate levels. No statistical association between TMD and anxiety was found (p > 0.05). CONCLUSION: Joint TMD was the most prevalent subtype of TMD in dental students and was not associated with anxiety levels.

Cervical posture analysis in dental students and its correlation with temporomandibular disorder.

OBJECTIVE: To evaluate the relationship between temporomandibular disorders (TMD) and craniocervical posture in the sagittal plane measured from lateral radiographs of the head. METHODS: The sample was comprised of 80 randomly selected students of dentistry at the Federal University of Rio Grande do Norte. Research Diagnostic Criteria for TMD (RDC/TMD) was used to evaluate the signs and symptoms of TMD. Lateral radiographs of each individual were used to measure the position of the hyoid bone, the craniocervical angle, and the occiput-atlas distance. A chi-square test was used to evaluate the relationships between craniocervical posture measures and TMD. RESULTS: No relationship was found between TMD and the craniocervical posture measured by the positioning of the hyoid bone, head rotation, and the extension/flexion of the head (p > 0.05). CONCLUSION: It can be concluded, therefore, that no relationship exists between cervical posture in the sagittal plane and TMD.

Prevalência da disfunção temporomandibular em estudantes de odontologia por meio de diferentes índices / Prevalence of temporomandibular disorders in dental students through different indexes

A epidemiologia das Disfunções Temporomandibulares apresenta grande variação na literatura. O objetivo deste estudo foi verificar a prevalência da DTM nos estudantes do curso de Odontologia da Universidade Federal do Rio Grande do Norte avaliada por diferentes índices. A amostra constou de 101 indivíduos selecionados por um processo de amostragem probabilística, cujo delineamento geral foi de amostragem sistemática. Para avaliação dos sinais e sintomas da DTM utilizou-se um índice anamnésico, o protocolo de Fonseca, e dois índices clínicos, o RDC/TMD (Research Diagnostic Criteria for Temporomandibuar Disorders), ou índice padrão, e o Índice de Disfunção Clínica de Helkimo. Os dados foram analisados por meio do teste Qui-Quadrado e teste de concordância kappa, além da verificação da sensibilidade e especificidade (significância de 5%). O diagnóstico de DTM pelos diferentes índices revelou uma variação na prevalência de 72,3% (índice clínico de Helkimo), 64,4% (índice anamnésico de Fonseca) e 35,6% (RDC/TMD). Não houve diferença estatística entre os sexos para o RDC/TMD, embora essa diferença tenha sido encontrada para os índices de Fonseca e Helkimo (p<0,05). O tipo de DTM mais frequente foi a DTM articular (Grupos II e III), nos subtipos deslocamento de disco com redução (17,8%) e artralgia (15,8%).

A maioria dos indivíduos apresentou a forma mais leve da DTM (45,5%) para ambos os índices, Fonseca e Helkimo. Quando comparados os tipos de diagnósticos, RDC/TMD com o Fonseca e Helkimo, baixas concordâncias foram encontradas (k=0,17 e k=0,35, respectivamente). Uma concordância moderada entre a severidade da DTM foi obtida (kp=0,53) para o protocolo de Fonseca e o índice de Helkimo. Alta sensibilidade e baixa especificidade foram vistas para ambos os diagnósticos em relação ao padrão, resultando em excesso de falsos-positivos. Dentro das limitações do estudo, conclui-se que a prevalência das DTMs pode apresentar grandes variações, dependendo do índice utilizado para seu diagnóstico. (AU)

The epidemiology of temporomandibular disorders varies widely in the literature. The aim of this study was to determine the prevalence of TMD in dental students of the Federal University of Rio Grande do Norte assessed by different indexes. The sample consisted of 101 individuals selected by a randomized process, whose general outline was systematic sampling. For evaluation of the signs and symptoms of TMD, an anamnestic index, Fonseca s protocol, and two clinical indexes, the RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders), or standard index, and the Helkimo s Clinical Dysfunction Index were applied. Data were analyzed using the chi-square test and kappa, besides verifying the sensitivity and specificity (5% significance). The diagnosis of TMD by different indexes showed a variation in the prevalence between 72.3% (Helkimo s Clinical index), 64.4% (Fonseca s anamnestic index) and 35.6% (RDC/TMD). There was no statistical difference between the sexes for the RDC/TMD, although this difference was found for Fonseca s and Helkimo s indexes (p<0.05). The most frequent type of TMD were joint disorders (Groups II and III), and the subtypes disc displacement with reduction (17.8%) and arthralgia (15.8%). Most individuals showed a mild TMD (45.5%) for both indexes, Fonseca and Helkimo. When comparing the types of diagnoses, RDC/TMD with Fonseca and Helkimo, low agreement was found (k=0.17 and k= 0.35, respectively). A moderate correlation between the severity of TMD was obtained (kw= 0.53) for Fonseca s protocol and Helkimo s index. High sensitivity and low specificity were seen for both diagnoses compared to standard, resulting in excessive false positives. Within the limitations of the study, it was concluded that the prevalence of TMD can vary widely, depending on the index used for its diagnosis. (AU)

Success and survival rates of mandibular overdentures supported by two or four implants: a systematic review.

This systematic review evaluated the influence played by the number of implants on the results of rehabilitation treatment with mandibular overdentures on 2 or 4 implants. The literature search was conducted using PubMed, Embase and Cochrane databases. Specific terms were used in performing a search from January 1980 to January 2013. The search strategy was applied by two reviewers who extracted the data and compared the results. Discrepancies were resolved by discussion. Great heterogeneity was seen among the selected studies, in regard to survival rates, prosthesis failure and function rates. A medium degree of quality and methodological consistency was found in one study, and no studies showed a high degree. When considering the prosthesis success rate for 2 implants, there was a variation of 23% to 100%. However, when considering the survival rate, the result was 92% to 100%. For 4 implants, prosthesis survival rates showed less variation, i.e., 97.7% to 100%. Ball attachments were the most common type of abutment for 2 implants; however, there was a higher prevalence of bar abutments for 4 implants. Rehabilitations with 2 implants showed more complications and required more maintenance according to the connection type. Given the limitations of this review, mandibular overdentures with 4 implants showed better results with respect to survival and success rates, especially those with a bar connection. Further studies comparing these two treatment types are necessary to improve the scientific evidence in this area.

Success and survival rates of mandibular overdentures supported by two or four implants: a systematic review

This systematic review evaluated the influence played by the number of implants on the results of rehabilitation treatment with mandibular overdentures on 2 or 4 implants. The literature search was conducted using PubMed, Embase and Cochrane databases. Specific terms were used in performing a search from January 1980 to January 2013. The search strategy was applied by two reviewers who extracted the data and compared the results. Discrepancies were resolved by discussion. Great heterogeneity was seen among the selected studies, in regard to survival rates, prosthesis failure and function rates. A medium degree of quality and methodological consistency was found in one study, and no studies showed a high degree. When considering the prosthesis success rate for 2 implants, there was a variation of 23% to 100%. However, when considering the survival rate, the result was 92% to 100%. For 4 implants, prosthesis survival rates showed less variation, i.e., 97.7% to 100%. Ball attachments were the most common type of abutment for 2 implants; however, there was a higher prevalence of bar abutments for 4 implants. Rehabilitations with 2 implants showed more complications and required more maintenance according to the connection type. Given the limitations of this review, mandibular overdentures with 4 implants showed better results with respect to survival and success rates, especially those with a bar connection. Further studies comparing these two treatment types are necessary to improve the scientific evidence in this area.