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Objetivo. Establecer la relación de los trastornos temporomandibulares (TTM) de niños de 8 a 10 años, con lactancia artificial exclusiva con uso del biberón. Métodos. Estudio de casos y controles, (pareados por edad y sexo). Se incluyeron 38 niños, sin alteraciones del crecimiento ni parafunciones bucales severas, previo consentimiento (madres) y asentimiento (niños) informado. Los participantes fueron diagnosticados con TTM (19 casos) o sin diagnóstico de TTM (19 controles) utilizando los criterios diagnósticos para los TTM (CD/TTM), previa estandarización de la investigadora; kappa inter 0,98 e intraobservador 0,73. Los antecedentes de lactancia fueron registrados con cuestionario ex profeso: tipo y tiempo de administración y datos generales del niño y la madre. Se calculó estadística descriptiva e inferencial; Ji cuadrada para identificar la asociación entre TTM y lactancia artificial exclusiva con uso del biberón, y razón de posibilidades (OR), con valor significativo ≤0,05. Resultados. Edad 8,95±0,84 años, 57,9% sexo masculino, sin diferencias por grupos en la edad y escolaridad de las madres (p>0,05). El tipo de TTM más común fue dolor muscular (57,9%), seguido de luxación del disco con reducción y su combinación (21,1%). La media de apertura bucal, sitios musculares y articulares doloridos fue estadísticamente diferente entre los casos y controles (p<0,05). El porcentaje de alimentación con lactancia artificial exclusiva con uso del biberón fue igual en ambos grupos (57,9% p=1,00), el OR calculado fue de 1 con IC95% de 0,27-3,60. Conclusión. No se encontró relación entre la lactancia artificial con el uso del biberón y los TTM. El tipo de TTM más frecuente fue dolor muscular. Palabras clave: Niños; Conducta en la lactancia; Asimetría facial; Trastornos de la articulación temporomandibular; Odontología pediátrica (fuente DeCS BIREME).
Objective. To establish the relationship of temporomandibular disorders (TMD) in children aged 8 to 10 years, with exclusive artificial feeding. Methods. Case-control study (matched by age and sex). 38 children were included, without growth disturbances or severe oral parafunctions, with prior informed consent (mothers) and assent (children). Participants were diagnosed with TMD (19 cases) or without TMD diagnosis (19 controls) using the Diagnostic Criteria for TMD (CD / TMD), after standardization by the researcher; kappa inter 0.98 and intraobserver 0.73. The history of breastfeeding was recorded with an express questionnaire: type and time of administration, and general data of the child and the mother. Descriptive and inferential statistics were calculated; Chi square analysis was performed to identify the association between TMD and exclusive artificial feeding, and odds ratio (OR), with a significant value of ≤0.05. Results. Age 8.95 ± 0.84 years, 57.9% male, with no differences in age or education of the mother between groups (p> 0,05). The most common type of TMD was muscle pain (57.9%), followed by disc luxation with reduction and combination (21.1%). The mean mouth opening, muscle and joint pain sites were statistically different between cases and controls (p <0.05). The percentage of exclusive artificial feeding was the same in both groups (57.9% p = 1.00), the calculated OR was 1 with a 95% CI of 0.27-3.60. Conclusions. Artificial feeding with the use of a bottle was not related to TMD. The most common type of TMD was muscle pain.
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Introducción: los trastornos temporomandibulares (TTM) son una condición músculo esquelética dolorosa que afecta los músculos de la masticación, la articulación temporomandibular (ATM) y varias estructuras anatómicas del sistema estomatognático. Objetivo: comparar la calidad de vida; determinada con el instrumento OHIP 49-Mx, de adultos mayores con trastornos temporomandibulares (TTM) vs. libres de TTM. Método: se realizó un estudio observacional analítico en la población de adultos mayores en una Unidad Gerontológica de Puebla, México. Se estableció el diagnóstico de TTM en las instalaciones; con los criterios diagnósticos para TTM propuesto por Dworkin y mejorados por Schiffman en el 2014 por investigadora previamente capacitada. Adicionalmente, se evaluó la calidad de vida (OHIP 49-Mx) por la misma investigadora. El manejo estadístico fue realizado con U de MannWhitney (contraste de medianas) con valor significativo ≤0.05, en el programa SPSS v.21. Resultados: se evaluaron 192 adultos mayores; 131 (68,2 por ciento) con TTM; 84 por ciento mujeres. Los pacientes con TTM, presentaron medianas superiores en la mayoría de las dimensiones del instrumento OHIP 49 Mx: limitación funcional Md=16 vs. 13, p=0,06; dolor Md=8,0 vs. 4,0 p=0.02; incomodidad psicológica Md=3 vs. 3, p=0,31; inhabilidad física Md=11 vs. 3, p≤0,00; inhabilidad psicológica Md=1 vs. 1; p=0,03; inhabilidad social, Md=0 vs. 0; p=0,90 e incapacidad Md=1 vs. 1, p=0,03. Conclusiones: los adultos mayores con TTM, denotaron una menor calidad de vida relacionada con la salud bucal; específicamente en las dimensiones de limitación funcional, inhabilidad física, psicológica y dolor(AU)
Introduction: temporomandibular disorders (TMD) are a painful skeletal muscle condition that affects the muscles of the mastication, the temporomandibular joint (TMJ) and various anatomical structures of the stomatognathic system. Objective: to compare the quality of life; determined with the OHIP instrument 49-Mx, of older adults with temporomandibular disorders (TMD) vs. free of TTM. Method: an analytical observational study was conducted in the elderly population in a Gerontological Unit of Puebla, Mexico. The diagnosis of TMD was established in the facilities; with the diagnostic criteria for TTM proposed by Dworkin and improved by Schiffman in 2014 by a previously trained researcher. Additionally, the quality of life (OHIP 49-Mx) was evaluated by the same researcher. The statistical management was performed with Mann-Whitney U (medium contrast) with significant value ≤0.05, in the SPSSv.21 program. Results: 192 older adults were evaluated; 131 (68.2 per cent) with TTM; (84 per cent) women Patients with TMD had higher medians in most dimensions of the OHIP instrument 49 Mx: limitación functional Md=16 vs. 13, p=0,06; dolor Md=8,0 vs. 4,0 p=0.02; incomodidad psicológica Md=3 vs. 3, p=0,31; inhabilidad física Md=11 vs. 3, p≤0,00; inhabilidad psicológica Md=1 vs. 1; p=0,03; inhabilidad social, Md=0 vs. 0; p=0,90 e incapacidad Md=1 vs. 1, p=0,03. Md=16 vs. 13, p=0.06; pain Md=8.0 vs. 4.0, p=0.02; psychological discomfort Md=3 vs. 3, p=0.31; physical disability Md=11 vs. 3, p≤0.00; psychological disability Md=1 vs. one, p=0.03; social disability Md=0 vs. 0, p=0.90 and disability Md=1 vs. 1, p=0.03. Conclusions: the elderly with TMD, showed a lower quality of life related to oral health; specifically in the dimensions of functional limitation, physical, psychological and pain disability(AU)
Introdução: as disfunções temporomandibulares (DTM) são uma condição dolorosa do músculo esquelético que afeta os músculos da mastigação, a articulação temporomandibular (ATM) e diversas estruturas anatômicas do sistema estomatognático. Objetivo: comparar a qualidade de vida; determinado com o instrumento OHIP 49-Mx, de idosos com disfunção temporomandibular (DTM) vs. livre de TTM. Método: estudo observacional analítico foi realizado na população idosa em uma Unidade Gerontológica de Puebla, México. O diagnóstico de DTM foi estabelecido nas instalações; com os critérios diagnósticos para TTM propostos por Dworkin e aprimorados por Schiffman em 2014 por um pesquisador previamente treinado. Além disso, a qualidade de vida (OHIP 49-Mx) foi avaliada pelo mesmo pesquisador. O tratamento estatístico foi realizado com o teste Mann-Whitney U (meio de contraste) com valor significativo ≤0,05, no programa SPSS v.21. Resultados: 192 idosos foram avaliados; 131 (68,2 por cento) com TTM; 84por cento mulheres Pacientes com DTM apresentaram medianas mais altas na maioria das dimensões do instrumento OHIP 49 Mx: limitação funcional Md = 16 vs. 13, p = 0,06; dor Md = 8.0 vs. 4,0 p = 0,02; desconforto psicológico Md = 3 vs. 3, p = 0,31; deficiência física Md = 11 vs. 3, p <0,00; incapacidade psicológica Md = 1 vs. 1; p = 0,03; deficiência social, Md = 0 vs. 0; p = 0,90 e incapacidade Md = 1 vs. 1, p = 0,03. Conclusões: os idosos com DTM apresentaram menor qualidade de vida relacionada à saúde bucal; especificamente nas dimensões de limitação funcional, física, psicológica e incapacidade de dor(AU)
Assuntos
Idoso , Qualidade de Vida , Transtornos da Articulação Temporomandibular , Assistência Odontológica para IdososRESUMO
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Abstract: When we talk about drugs, we usually think about illicit substances. However some substances apparently innocuous such as caffeine and other legal ones like tobacco and alcohol, are considered as abuse substances. Nicotine has not been studied as extensively as other drugs. It is known that the pharmacological and behavioural processes that determine the addiction to nicotine are similar to those that determine the addiction to other drugs such as cocaine or heroine. The main adverse effect of nicotine is death. According to the Global Burden of Disease study of the World Health Organization, the World Bank, and Harvard University, in 2020, tobacco will be the first individual cause of death in the world even over AIDS. Nicotine dependence can appear at any age, though it generally begins during adolescence, and it acts on the brain mechanisms of reward, indirectly by endogenous opioid activity and directly by dopaminergic pathways. In the researches on drugs consumption among adolescents conducted in Mexico City during 1989, 1991 and 1993, it was observed that tobacco consumption has increased lightly but systematically, from 4.8% to 4.2%. The percentage of current users (in the last month) is 21.9%. At junior high school level it is 13.7%, and at high school level 34.4%. Attention Déficit Disorder With Hyperactivity (ADDH). Altough the relationship between ADDH and drugs consumption has been recognized none of the studies conducted in our country has included this variable. ADDH is a disorder with a frequency of 1.7% to 18.9%. The difference between the reported percentages is attributed to the fact that definitions and methods used in the studies are not the same. When the disorder is not treated, there is usually a gradual accumulation of adverse processes that increase the risk of pathology. The relationship between ADDH and drug consumption is complex. In a study of adolescents who received treatment for drug abuse, it was observed that 50% of them met the criteria for ADDH. As well, this disorder was a bad prognosis factor, either to the addiction evolution and its treatment. Another complex relationship is the one between ADDH and cigarette smoking. In a study conducted among adult smokers, the subjects with ADDH had an earlier onset of the tobacco addiction, compared to those who did not had ADDH. This finding was confirmed by Milberger, who in a four years follow up study, discovered that ADDH is a significant predictor on the early tobacco consumption. ADDH can be considered as a risk factor in developing other addictions. Although the relationship between ADDH and drug consumption has been studied, the reviewed researches show up some limitations : Only clinical samples have been studied. Most of the follow up studies have included just male individuals with ADDH. In our country the effect of the clinical variables on drugs use have not been studied. In ADDH as well as in drug consumption, it has been observed a remarkable influence of cultural variables, this emphasize the need of evaluating both problems in our country. The following study was conducted under the hypothesis that ADDH and general pathology symptoms are higher among adolescents that have consumed tobacco than those who have not. Material and methods A comparative, cross-sectional survey of adolescent with and without tobacco usage was performed. Fifteen junior high schools in Puebla City were randomly selected. First year junior high school students who agreed to answer the questionnaires were included. The studied variables were: symptoms of ADDH and general psychopathology symptoms. ADDH symptoms were dimensionally evaluated with the Conners-Wells Self Report Scale (long version). General psychopathology was rated with the SCL-90 which evaluates the intensity of symptoms in 9 subscales. Tobacco consumption was determined by the Junior High school Students Questionnaire, developed at the National Institute of Psychiatry, which was used in the Drug, Alcohol and Tobacco consumption surveys in Mexico City. Tobacco consumption was considered positive when the questions about lifetime, and last month consumption were affirmative. From the 15 junior high schools selected, a first year group was chosen at the beginning of the school term. A written authorization from the parents was requested, so the students could answer to the questionnaires. It was inferred that all of them accepted because none of the parents refused explicitely. The questionnaire about drug consumption was applied the first day. Before the application, it was explained to the adolescents, that the information would be confidentially handled; the questionnaire answers would be only known by the researchers and that the information would not be given to their parents or their teachers. The second day of evaluation, the Conners questionnaire was applied. The third day the students answered to the SCL-90. All the questionnaires were applied at the beginning of the daily activities. The 19 psychopathology subscales were compared between male and women and between the students with and without tobacco consumption in the last month and during lifetime. Although the statistical significance was determined with non parametric tests (Wilcoxon test), on the tables, means and standard deviations are shown. The analysis were done with the SAS 6.12. program. The significance level was determined at 0.05. Results From 590 students registered on the selected groups, 544 (92%) were evaluated, the rest of them did not show up during the week in which the evaluations were performed. The mean age was 12 years with a standard deviation of 1, 57.3% (n=295) were males. Twenty children (3.9%) have used tobacco during the last month. On the Conners-Wells Questionnaire, they had higher scores on all ten subscales. These differencies were statistically significant in seven subscales: Familial problems, Conduct problems, Cognitive problems, anger management problems, hyperactivity, Global index, and distractibility DSM IV. General psychopathology symptoms also were higher in those individuals who used tobacco during the last month, compared to those who did not, in seven of the nine subscales the differences were statistically significant. Regarding the experimental usage of tobacco (ever in lifetime), 84 children (15%) answered affirmatively. The scores of these children were higher than the scores of children who denied ever smoked in all subscales of the Conners-Wells Questionnaire. The differences were statistically significant in nine of the ten subscales. In the SCL-90 the scores of the children who have used tobacco during lifetime, were higher in all subscales, except in phobic anxiety. Discussion Our results confirm the proposed hypothesis that the students who consume tobacco present higher levels of psychopathology, compared to those students who have never used this substance. It is necessary to underline the fact that this is the first study in our country that correlates the tobacco consumption with psychopathology symptoms, evaluated in a structured way with valid and reliable instruments.
