The changes on salivary flow rates, buffering capacity and chromogranin A levels in adults after bariatric surgery.

OBJECTIVES: This study aimed to investigate changes in salivary flow rates, buffering capacity, and salivary chromogranin A (CHGA) levels in adults undergoing bariatric surgery (BS) compared with a non-obese control group. MATERIALS AND METHODS: Salivary analyses were performed on 62 participants aged over 50 years, stratified into two groups matched for age and gender-individuals who had undergone bariatric surgery (BS) (n = 31) and a corresponding healthy control group (n = 31). Before saliva collection, participants completed a comprehensive 11-point visual numerical rating scale (NRS 0-10) xerostomia questionnaire, assessing subjective perceptions of two key aspects: dryness of the oral mucosa and resultant impact on oral functional ability. Three distinct saliva measurements were obtained: unstimulated whole saliva (UWS), stimulated whole saliva (SWS), and unstimulated upper labial saliva (ULS). The buffering capacity of unstimulated saliva was assessed using pH indicator strips, and concentrations of salivary Chromogranin A (CHGA) were quantified in stimulated saliva via enzyme-linked immunosorbent assay (ELISA). RESULTS: After BS, more than 40% of BS group patients reported xerostomia, with 16.1% experiencing only mild symptoms without significant functional impact (p = 0.009). The prevalence of xerostomia and tongue dryness was higher in the BS group compared to the control group (p = 0.028 and p = 0.025, respectively). The comparative analysis unveiled no statistically significant differences in flow rates of unstimulated upper labial saliva (ULS), unstimulated whole saliva (UWS), and stimulated whole saliva (SWS) between the control group and patients who underwent bariatric surgery. However, in patients undergone BS with xerostomia, both ULS and UWS flow rates were significantly lower than in controls with xerostomia (p = 0.014 and p = 0.007, respectively). The buffering capacity was significantly lower in patients undergone BS than in controls (p = 0.009). No differences were found between groups regarding CHGA concentration and output values, nevertheless, higher values of CHGA concentrations were significantly correlated to lower flow rates. CONCLUSION: According to the results, this study suggests that individuals undergoing BS may exhibit altered salivary buffering capacity and reduced unstimulated salivary flows in the presence of xerostomia. Additionally, the findings suggest that elevated concentration of salivary CHGA might be associated, in part, with salivary gland hypofunction. CLINICAL RELEVANCE: The clinical significance of this study lies in highlighting the changes in salivary functions after BS. The identified salivary alterations might be attributed to adverse effects of BS such as vomiting, gastroesophageal reflux, and dehydration. Understanding these changes is crucial for healthcare professionals involved in the care of post-BS patients, as it sheds light on potential oral health challenges that may arise as a consequence of the surgical intervention. Monitoring and managing these salivary alterations can contribute to comprehensive patient care and enhance the overall postoperative experience for individuals undergoing BS.

Bariatric Surgery and Vitamin D: Trends in Older Women and Association with Clinical Features and VDR Gene Polymorphisms.

(1) Background: Obesity and its comorbidities can cause burdens and limitations. Bariatric surgery (BS) is indicated as a safe procedure to reduce body mass and improve present comorbidities. However, several complications were reported, such as vitamin D [25(OH)D] deficiency. We evaluated if 25(OH)D serum levels relate to clinical characteristics, symptoms, or habits in women after their BS, and whether the vitamin D receptor (VDR) gene's TaqI and FokI polymorphisms affected 25(OH)D levels and the total body bone mineral density (TBBMD). (2) Methods: This cohort cross-sectional comparative analytical prospective study consisted of 27 women, 61.6 ± 5.0 years, submitted to BS one year prior at a public reference hospital, DF-Brazil. All participants were asked to follow the physical and dietary activity recommendations and received vitamin D3 supplements. Their anthropometric, biochemical, and immunological measurements and blood samples were obtained. (3) Results: 73.3% of participants had low 25(OH)D levels, and their levels correlated positively with TBBMD and negatively with systolic pressure. VDR TaqI did not affect 25(OH)D levels, whereas VDR FokI's allele f presence correlated to a median rise in 25(OH)D levels. Neither polymorphism correlated to TBBMD. (4) Conclusions: 25(OH)D levels were positively correlated with TBBMD, negatively with systolic blood pressure, and were higher in those with the VDR FokI allele f.

Systemic conditions of diabetic patients diagnosed with apical periodontitis / Condições sistêmicas de pacientes diabéticos diagnosticados com periodontite apical

ABSTRACT Objective: This study aimed to evaluate the association between glycemic control status in type 2 diabetes mellitus (T2DM) patients and apical periodontitis. Methods: Twenty-seven patients were involved in this study. The survey was based on anamnesis, intra and extra oral examination and radiographic evaluation. Diabetes mellitus information involved type of diabetes and blood glucose analysis. Patients were divided according to their metabolic control status (glycemic controlled and poorly controlled T2DM patients). Results: A higher fasting blood glucose level (p = 0.004) and a higher percentage of HbA1c (p = 0.0001) were demonstrated in poorly controlled T2DM patients when compared to glycemic controlled T2DM. However, the frequency of apical periodontitis and the elapsed time since diabetes mellitus diagnosis were higher in controlled T2DM patients, reaching 64%. Nevertheless, controlled T2DM patients presented a higher number of apical periodontitis cases (p < 0.05). Findings support that controlled patients T2DM presented higher presence of apical periodontitis than poorly controlled T2DM ones. In these patients, the time elapsed since the diagnosis was higher, which may have provided a longer period of oscillation and/or uncontrolled metabolism. Conclusions: Therefore, it might contribute to the development and maintenance of apical periodontitis in glycemic controlled patients of this study.

RESUMO Objetivo: Este estudo objetivou avaliar a associação entre o estado de controle glicêmico em pacientes com diabetes mellitus tipo 2 (DM2) e a periodontite apical. Métodos: Vinte e sete pacientes foram envolvidos neste estudo. A pesquisa baseou-se na anamnese, exame intra e extraoral e avaliação radiográfica. As informações sobre o diabetes mellitus envolveram o tipo de diabetes e a análise da glicose sanguínea. Os pacientes foram divididos de acordo com seu estado de controle metabólico (pacientes com DM2 com controle glicêmico e pacientes com DM2 mal controlados). Resultados: Um maior nível de glicose em jejum (p = 0,004) e uma maior porcentagem de HbA1c (p = 0,0001) foram demonstrados em pacientes com DM2 mal controlada quando comparados com DM2 com controle glicêmico. Porém, a frequência de periodontite apical e o tempo decorrido desde o diagnóstico de diabetes mellitus foram maiores nos pacientes com DM2 controlado, chegando a 64%. No entanto, os pacientes com DM2 controlada apresentaram um maior número de casos de periodontite apical (p < 0,05). Os achados suportam que pacientes controlados com DM2 apresentam maior presença de periodontite apical do que pacientes com DM2 mal controlada. Nesses pacientes, o tempo decorrido desde o diagnóstico foi maior, o que pode ter proporcionado um período maior de oscilação e/ou metabolismo descontrolado. Conclusão: Portanto, pode contribuir para o desenvolvimento e manutenção da periodontite apical nos pacientes com controle glicêmico deste estudo.

Oral lichen planus and malignant transformation: The role of p16, Ki-67, Bub-3 and SOX4 in assessing precancerous potential.

The association of oral lichen planus (OLP) lesions with malignant transformation risk has remained a controversial topic and is of clinical importance. Therefore, the present study evaluated the expression levels of p16, Ki-67, budding uninhibited by benzimidazoles 3 (Bub-3) and sex-determining region Y-related high mobility group box 4 (SOX4), and their roles as precancerous biomarkers in OLP. A retrospective study was performed, in which tissue blocks of OLP, oral dysplasia (OD), cutaneous lichen planus (CLP) and oral fibrous hyperplasia (OFH) were used (n=120). A positivity index (PI) for p16, BUB3, Ki-67 and SOX4 expression was calculated in each group. The PI for p16 was 20.65% for OLP, 7.85% for OD, 86.59% for CLP and 11.8% for OFH, and the difference between these groups was statistically significant (P<0.001). PIs of Ki-67 were indicated as 11.6% for OLP, 14.4% for OD, 8.24% for CLP and 5.5% for OFH, and a statistically significant difference was observed between the groups (P<0.001). Notably, the expression levels of BUB3 were not statistically different among groups. The highest expression levels of SOX4 were identified in CLP (P<0.001 vs. OLP/CLP; P=0,001 vs. CLP/OD). The determined expression levels of p16 and Ki-67 suggest that specific OLP lesions may have an intermediate malignant potential and should be carefully followed up. The intense SOX4 staining in CLP indicated a different proliferation pattern of epithelium compared with oral mucosa cells. These findings suggest that SOX4 expression may also be associated with the different clinical courses of OLP and CLP.

Salivary function impairment in type 2 Diabetes patients associated with concentration and genetic polymorphisms of chromogranin A.

OBJECTIVES: The purpose of this study was to evaluate the effect of type 2 diabetes mellitus (T2DM) on salivary function impairments according to glycemic control status and subsequently compare the concentration of chromogranin A (CHGA) with its genetic profile. MATERIALS AND METHODS: Thirty-six patients with controlled T2DM, 36 with poorly controlled T2DM, and 38 nondiabetic subjects underwent salivary flow rate measurements by means of unstimulated labial (ULS), unstimulated whole (UWS), and stimulated whole saliva (SWS) collections. CHGA concentrations were determined in saliva and plasma with ELISA, and two CHGA polymorphisms (T-415C and Glu264Asp) were analyzed by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: T2DM patients presented significantly lower ULS and UWS flow rates regardless of glycemic control status compared to controls (P = 0.002 and P = 0.027, respectively). The SWS flow rate in the poorly controlled T2DM was the lowest among the groups (P = 0.026). Significantly higher plasma and salivary CHGA levels were found in T2DM groups (P = 0.019 and P < 0.001, respectively). CHGA gene variants (T-415C and Glu264Asp) revealed significant differences between diabetics and control subjects when associated with lower salivary flow and higher salivary CHGA production (P < 0.05). CONCLUSIONS: T2DM causes abnormalities in the function of salivary glands. However, poorly controlled T2DM has the most influence on SWS flow rates. Our findings indicate an association between plasma and salivary CHGA levels and T2DM patients. Furthermore, the results suggest that CGHA polymorphisms might be associated with salivary gland hypofunction and higher salivary CHGA production in T2DM patients. Nevertheless, further epidemiological studies are required to elucidate this clinical implication. CLINICAL RELEVANCE: Salivary impairments and high levels of CHGA are associated with T2DM patients. In addition, CGHA polymorphisms might be associated with salivary gland hypofunction and higher salivary CHGA production in T2DM patients. This could be a significant insight to establish a role for salivary CHGA as a potential clinical biomarker to T2DM.

Impact of glycemic control on oral health status in type 2 diabetes individuals and its association with salivary and plasma levels of chromogranin A.

OBJECTIVE: To evaluate the effect of glycemic control status in type 2 diabetes mellitus (T2DM) individuals on clinical oral health indicators and to compare the concentrations of plasma and salivary chromogranin A (CHGA) among nondiabetic subjects and T2DM patients, exploring their associations. DESIGN: In this cross-sectional study, 32 patients with controlled T2DM, 31 with poorly controlled T2DM and 37 nondiabetic subjects underwent a clinical and periodontal examination. CHGA concentrations were determined in saliva and plasma with ELISA. RESULTS: Poorly controlled T2DM group exhibited significantly higher mean buffering capacity, plaque index and bleeding on probing than other groups (P<0.05). No difference was found to DMFT (decayed, missed and filled teeth) index between groups. Sites with clinical attachment loss (CAL) of 4 and 5-6mm were significantly higher in both diabetic groups compared to control group (P<0.05). Poorly controlled T2DM group had significantly higher sites with CAL ≥ 7 mm than other groups (P=0.001). Significantly higher plasma and salivary CHGA levels were found in T2DM groups (P<0.05). In both diabetic groups, probing depths 5-6mm and CAL 5-6mm were associated with higher salivary CHGA concentration (P<0.05). CONCLUSIONS: The findings revealed that T2DM patients were more prone to periodontal tissue damage than to caries risk. The results also provide some evidence that the degree of attachment loss deteriorates significantly with poor glycemic control in T2DM (CAL ≥ 7 mm). Moreover, the results suggest that high concentrations of salivary CHGA are associated with worse periodontal parameters and T2DM, and this could be related to the pathogenesis of both diseases.

Percepções de pacientes sobre a relação entre diabetes mellitus e saúde oral: um estudo transversal / Patients perceptions towards diabetes mellitus and oral health: a cross-sectional study

Purpose: To evaluate the knowledge of diabetic patients towards the connection between diabetes mellitus (DM) and oral diseases. Oral status was also assessed in order to evaluate the correlation among patients' perception and their oral health. Material and Methods: A sample of 132 diabetic subjects answered a questionnaire containing 12 questions addressing their knowledge, attitudes and practices related to oral health. Oral examination accessed the presence of cavity carious lesions, residual roots, dental biofilm, calculus, gingivitis, tooth mobility and gingival recession. Results: Fifty-four percent of the sample had never been instructed by their health professionals that DM could cause oral diseases. However, 66% presumed being more vulnerable to develop oral illnesses and 57.5% answered that they assumed having no oral disturbances at that moment. In contrast, intraoral clinical examination showed that 99% presented at least one oral injury such as caries lesions, plaque/calculus, gingival inflammation, tooth mobility, residual root and xerostomia. Conclusions: Health care professionals usually neglect oral status in diabetic patients. Above all, there is a huge gap between patients' perceptions towards oral health and their real oral status. This study highlights the need of developing new models of prevention that properly address the important clinical relation between oral diseases and DM.(AU)

The influence of gender and bruxism on human minimum interdental threshold ability

OBJECTIVE: To evaluate the influence of gender and bruxism on the ability to discriminate minimum interdental threshold. MATERIAL AND METHODS: One hundred and fifteen individuals, representing both genders, bruxers and non-bruxers, with a mean age of 23.64 years, were selected for this study. For group allocation, every individual was subjected to a specific physical examination to detect bruxism (performed by three different examiners). Evaluation of the ability to discriminate minimum interdental threshold was performed using industrialized 0.010 mm-, 0.024 mm-, 0.030 mm-, 0.050 mm-, 0.080 mm- and 0.094 mm-thick aluminum foils that were placed between upper and lower premolars. Data were analyzed statistically by multiple linear regression analysis at 5% significance level. RESULTS: Neither gender nor bruxism influenced the ability to discriminate minimum interdental threshold (p>0.05). CONCLUSIONS: Gender and the presence of bruxism do not play a role in the minimum interdental threshold.

The influence of gender and bruxism on human minimum interdental threshold ability.

OBJECTIVE: To evaluate the influence of gender and bruxism on the ability to discriminate minimum interdental threshold. MATERIAL AND METHODS: One hundred and fifteen individuals, representing both genders, bruxers and non-bruxers, with a mean age of 23.64 years, were selected for this study. For group allocation, every individual was subjected to a specific physical examination to detect bruxism (performed by three different examiners). Evaluation of the ability to discriminate minimum interdental threshold was performed using industrialized 0.010 mm-, 0.024 mm-, 0.030 mm-, 0.050 mm-, 0.080 mm- and 0.094 mm-thick aluminum foils that were placed between upper and lower premolars. Data were analyzed statistically by multiple linear regression analysis at 5% significance level. RESULTS: Neither gender nor bruxism influenced the ability to discriminate minimum interdental threshold (p>0.05). CONCLUSIONS: Gender and the presence of bruxism do not play a role in the minimum interdental threshold.

The influence of gender and bruxism on the human maximum bite force

The objective of this research was to evaluate the influence of gender and bruxism on the maximum bite force. The concordance for the physical examination of bruxism between examiners was also evaluated. One hundred and eighteen individuals, from both genders, bruxists and non-bruxists, with an average age of 24 years, were selected for this purpose. For group establishment, every individual was submitted to a specific physical examination for bruxism (performed by three different examiners). Subjects were then divided into four groups according to gender and the presence of bruxism. The maximum bite force was measured using a gnathodynamometer at the first molar area, three times on each side, performed twice. The two measurements were made with a 10-day interval. The highest value was recorded. The mean maximum bite force was statistically higher for males (587.2 N) when compared to females (424.9 N) (p<0.05), regardless of the presence of bruxism. The presence of bruxism did not influence the bite force (mean maximum bite force value for bruxists: 490.1 N, and for non bruxists: 522.1 N) (p>0.05). The concordance between examiners for physical examination of bruxism was considered optimal.

O objetivo dessa pesquisa foi avaliar a influência do gênero e do bruxismo na força máxima de mordida. A concordância interexaminadores para o exame físico de bruxismo também foi avaliada. Cento e dezoito voluntários, com idade média de 24 anos, divididos por gênero e pela presença de bruxismo, foram selecionados. Para o estabelecimento da amostra todos os voluntários foram submetidos a um exame físico específico para bruxismo (realizado por três examinadores). Então, os voluntários foram divididos em quarto grupos de acordo com o gênero e a presença de bruxismo. A força máxima de mordida foi mensurada, com o auxílio de um gnatodinamômetro, na região de primeiro molar, três vezes de cada lado, em duas sessões distintas. As sessões foram separadas por um intervalo de 10 dias. O maior valor dentre os doze obtidos, foi utilizado como sendo a força máxima. A força máxima de mordida foi estatisticamente maior para o gênero masculino (587.2 N) quando comparado com o gênero feminino (424.9 N) (p<0.05), independentemente da presença de bruxismo. A presença de bruxismo não demonstrou influência na força máxima de mordida (média da força máxima de mordida para bruxômanos = 490.1 N, e para não bruxômanos = 522.1 N) (p>0.05). A concordância entre os examinadores para o exame físico de bruxismo foi considerada favorável.

The treatment of painful temporomandibular joint clicking with oral splints: a randomized clinical trial.

BACKGROUND: The authors compared the efficacy of bilateral balanced and canine guidance (occlusal) splints in the treatment of temporomandibular joint (TMJ) pain in subjects who experienced joint clicking with a nonoccluding splint in a double-blind, controlled randomized clinical trial. METHODS: The authors randomly assigned 57 people with signs of disk displacement and TMJ pain into three groups according to the type of splint: bilateral balanced, canine guidance and nonoccluding. The authors followed the groups for six months using analysis of a visual analog scale (VAS), palpation of the TMJ and masticatory muscles, mandibular movements and joint sounds. They used repeated analysis of variance and a chi(2) test to test the hypothesis. RESULTS: The type of guidance used did not influence the pain reduction, yet both occlusal splints were superior to the nonoccluding splint, on the basis of the VAS. Despite similar outcomes in relation to opening, left lateral and protrusive movements, TMJ and muscle pain on palpation, subjects who used the occlusal splints had improved clinical outcomes. The frequency of joint noises decreased over time, with no significant differences among groups. Subjects in the groups using the occlusal splints reported more comfort. CONCLUSION: The type of lateral guidance did not influence the subjects' improvement. All of the subjects had a general improvement on the VAS, though subjects in the occlusal splint groups had better results that did subjects in the nonoccluding splint group.

TENS and low-level laser therapy in the management of temporomandibular disorders

Pain relief and reestablishment of normal jaw function are the main goals of conservative management of Temporomandibular Disorders (TMD). Transcutaneous electrical nerve stimulation (TENS) and laser therapy are part of these modalities, although little is known about their real efficacy in controlled studies. This research compared these two treatments in a sample of 18 patients with chronic TMD of muscular origin, divided into two groups (LASER and TENS). Treatment consisted of ten sessions, in a period of 30 days. Active range of motion (AROM), visual analogue scale (VAS) of pain and muscle (masseter and anterior temporalis) palpation were used for follow-up analysis. Data were analyzed by Friedman test and ANOVA for repeated measurements. Results showed decrease in pain and increase in AROM for both groups (p<0.05), and improvement in muscle tenderness for the LASER group. Authors concluded that both therapies are effective as part of TMD management and a cumulative effect may be responsible for the improvement. Caution is suggested when analyzing these results because of the self-limiting feature of musculoskeletal conditions like TMD.

O tratamento das Disfunções Temporomandibulares (DTM) objetiva ser conservador e reversível para alívio da dor e restauração da função normal. Sendo assim, tratamentos como a estimulação neural elétrica transcutânea (TENS) e o laser de baixa freqüência têm sido utilizados. Portanto, foi premissa deste trabalho a comparação do TENS com o a terapia com laser de baixa freqüência no tratamento de pacientes com DTM. Foram selecionados dezoito pacientes com sinais e sintomas de DTM crônica de origem muscular. O grupo LASER recebeu aplicação de laser e o grupo TENS, estimulação elétrica, totalizando 10 sessões, três vezes por semana, durante um mês. A avaliação foi feita imediatamente antes e 5 minutos após cada sessão terapêutica, por meio da escala de análise visual (EAV) para o registro da sensação de dor mensuração de abertura máxima e palpação muscular ( masseter e temporal anterior). Para análise estatística foram utilizados o teste de Friedman e ANOVA para mensurações repetidas. Os resultados demonstraram decréscimo na EAV e aumento da abertura bucal máxima de ambos os grupos (p<0,05). A palpação muscular apresentou diferença significante para o grupo LASER (p<0,05). Baseado na análise da EAV e movimentação ativa, concluiu-se que ambas as terapias propostas foram efetivas no tratamento das DTM, sendo que o efeito acumulativo pode ser o responsável pela melhora obtida. Porém, é sugerida cautela quando se analisa o presente resultado, devido ao aspecto auto-limitante das condições músculo-esqueletais como as DTMs.

TENS and low-level laser therapy in the management of temporomandibular disorders%Aplicação de TENS e laser de baixa freqüência no tratamento das disfunções temporomandibulares

O tratamento das Disfunções Temporomandibulares (DTM) objetiva ser conservador e reversível para alívio da dor e restauração da função normal. Sendo assim, tratamentos como a estimulação neural elétrica transcutânea (TENS) e o laser de baixa freqüência têm sido utilizados. Portanto, foi premissa deste trabalho a comparação do TENS com o a terapia com laser de baixa freqüência no tratamento de pacientes com DTM. Foram selecionados dezoito pacientes com sinais e sintomas de DTM crônica de origem muscular. O grupo LASER recebeu aplicação de laser e o grupo TENS, estimulação elétrica, totalizando 10 sessões, três vezes por semana, durante um mês. A avaliação foi feita imediatamente antes e 5 minutos após cada sessão terapêutica, por meio da escala de análise visual (EAV) para o registro da sensação de dor mensuração de abertura máxima e palpação muscular ( masseter e temporal anterior). Para análise estatística foram utilizados o teste de Friedman e ANOVA para mensurações repetidas. Os resultados demonstraram decréscimo na EAV e aumento da abertura bucal máxima de ambos os grupos (p<0,05). A palpação muscular apresentou diferença significante para o grupo LASER (p<0,05). Baseado na análise da EAV e movimentação ativa, concluiu-se que ambas as terapias propostas foram efetivas no tratamento das DTM, sendo que o efeito acumulativo pode ser o responsável pela melhora obtida. Porém, é sugerida cautela quando se analisa o presente resultado, devido ao aspecto auto-limitante das condições músculo-esqueletais como as DTMs

TENS and low-level laser therapy in the management of temporomandibular disorders.

Pain relief and reestablishment of normal jaw function are the main goals of conservative management of Temporomandibular Disorders (TMD). Transcutaneous electrical nerve stimulation (TENS) and laser therapy are part of these modalities, although little is known about their real efficacy in controlled studies. This research compared these two treatments in a sample of 18 patients with chronic TMD of muscular origin, divided into two groups (LASER and TENS). Treatment consisted of ten sessions, in a period of 30 days. Active range of motion (AROM), visual analogue scale (VAS) of pain and muscle (masseter and anterior temporalis) palpation were used for follow-up analysis. Data were analyzed by Friedman test and ANOVA for repeated measurements. Results showed decrease in pain and increase in AROM for both groups (p<0.05), and improvement in muscle tenderness for the LASER group. Authors concluded that both therapies are effective as part of TMD management and a cumulative effect may be responsible for the improvement. Caution is suggested when analyzing these results because of the self-limiting feature of musculoskeletal conditions like TMD.

The influence of gender and bruxism on the human maximum bite force.

The objective of this research was to evaluate the influence of gender and bruxism on the maximum bite force. The concordance for the physical examination of bruxism between examiners was also evaluated. One hundred and eighteen individuals, from both genders, bruxists and non-bruxists, with an average age of 24 years, were selected for this purpose. For group establishment, every individual was submitted to a specific physical examination for bruxism (performed by three different examiners). Subjects were then divided into four groups according to gender and the presence of bruxism. The maximum bite force was measured using a gnathodynamometer at the first molar area, three times on each side, performed twice. The two measurements were made with a 10-day interval. The highest value was recorded. The mean maximum bite force was statistically higher for males (587.2 N) when compared to females (424.9 N) (p<0.05), regardless of the presence of bruxism. The presence of bruxism did not influence the bite force (mean maximum bite force value for bruxists: 490.1 N, and for non bruxists: 522.1 N) (p>0.05). The concordance between examiners for physical examination of bruxism was considered optimal.

Evaluation of the efficacy of low-level laser therapy (LLLT) and the microelectric neurostimulation (MENS) in the treatment of myogenic temporomandibular disorders: a randomized clinical trial

OBJETIVO: Avaliar a efetividade do laser de baixa freqüência e do estímulo muscular microelétrico (MENS) no tratamento de pacientes com disfuncões temporomandibulares (DTM). MATERIAL E MÉTODOS: Uma amostra de 19 indivíduos com sinais e sintomas de DTM de origem muscular, foi dividida em dois grupos (I -laser e II - MENS). O tratamento consistiu de 10 sessões, três vezes por semana, durante um mês. Os critérios de avaliacão dos pacientes foram: escala de análise visual (EAV), mensuracão de abertura máxima bucal e palpacão muscular, estes foram avaliados imediatamente antes e 5 minutos após cada sessão terapêutica, num estudo do tipo controlado. Para análise estatística, foram aplicados ANOVA para mensuracões repetidas e Mann-Whitney. RESULTADOS: Os resultados demonstraram aumento da abertura bucal máxima e diminuicão na sensibilidade à palpacão em ambos os grupos e, em relacão à EAV, ambos os grupos demonstraram decréscimo, mas houve uma diferenca estatisticamente significante entre os grupos, já que o grupo laser apresentou os melhores resultados p<0,05. CONCLUSAO: Os autores concluíram que as duas terapias foram efetivas como parte do tratamento das DTM, e o efeito cumulativo podem ter sido responsável pela melhora. Porém sugere-se cautela quando se analisam os resultados devido ao aspecto autolimitante das condicões músculo-esqueletais como as DTM.

Comparative evaluation of two different vestibuloplasty surgical procedures in cleft patients: a pilot study.

OBJECTIVE: Patients with a cleft lip or palate often present alterations in the labial aspect of the ridge, resulting in a shallow vestibule. This study compares the results of two different surgical procedures on deepening of the labial sulcus. INTERVENTIONS: Ten patients with a cleft lip and palate were separated into two groups and underwent different vestibuloplasty procedures. An experimental group used a removable retention splint. Preoperative and 4-month postoperative sulcus heights were measured and analyzed statistically. RESULTS: No statistically significant differences could be detected between groups. CONCLUSION: The results indicated that to reach consistent results, a larger number of patients must be submitted to this evaluation.

Evaluation of the efficacy of low-level laser therapy (LLLT) and the microelectric neurostimulation (MENS) in the treatment of myogenic temporomandibular disorders: a randomized clinical trial.

OBJECTIVE: The aim of the present study was to evaluate the efficacy of low-level laser therapy (LLLT) and the microelectric neurostimulation (MENS) in the treatment of patients with temporomandibular disorders (TMD). MATERIAL AND METHODS: A sample of 19 individuals presenting with signs and symptoms of myogenic TMD was randomly divided into two groups (I - LLLT and II - MENS). Therapy was done in 10 sessions, three times a week, for one month. Patients were evaluated by the Visual Analogue Scale (VAS), measurement of active range of motion (AROM) and muscle palpation, performed immediately before and 5 minutes after each therapeutic session by a blinded TMD specialist. The ANOVA for repeated measurements and Mann-Whitney tests were used for the statistical analysis. RESULTS: The results showed an increase in maximum mouth opening and a decrease in tenderness to palpation for both groups. The VAS reduced for both groups, although more evident for the laser group (p<0.05). CONCLUSION: Authors concluded that both therapies were effective as part of the TMD treatment, and the cumulative effect may have been responsible for this fact. However, caution is recommended when judging the results due to the self-limiting aspect of musculoskeletal conditions such as TMD.

Relação central: aplicação clínica das evidências científicas / Centric relation: clinic application of scientific evidence

A relação cêntrica (RC) é uma posição maxilomandibular clássica de referência e tratamento. Tal posição provê aos Cirurgiões-dentistas as características de ser estável e reproduzível, essencial para a reconstrução da dentição. Muitas controvérsias existem em relação ao conceito da RC e uma variedade de técnicas tem sido utilizada para obtê-la. Apesar de muitos estudos tentarem desmistificar a RC, a falta de um claro conhecimento, falha no desenvolvimento das habilidades requeridas para se localizar, verificar e registrar a RC levará, com certeza, a um comportamento dos resultados clínicos. Com isso, este estudo revisa a literatura sobre vários aspectos da RC, que ainda é um assunto muito controverso entre os Protesistas e Ortodontistas