RESUMO
A 48-year old woman in good general health was referred to the orofacial pain clinic in a centre for special dentistry with a toothache in the premolar region of the left maxillary quadrant. The complaints had existed for 15 years and various dental treatments, including endodontic treatments, apical surgery, extraction and splint therapy, had not helped to alleviate the complaints. As a result of the fact that anti-epileptic drugs were able to reduce the pain it was concluded that this 'toothache' satisfied the criteria of an atypical odontalgia: 'toothache' with a neuropathic background.
Assuntos
Dor Crônica/diagnóstico , Pregabalina/uso terapêutico , Odontalgia/diagnóstico , Odontalgia/etiologia , Neuralgia do Trigêmeo/diagnóstico , Analgésicos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Neuralgia do Trigêmeo/tratamento farmacológicoRESUMO
Patients with Duchenne muscular dystrophy (DMD) experience negative effects upon feeding and oral health. We aimed to determine whether the mandibular range of motion in DMD is impaired and to explore predictive factors for the active maximum mouth opening (aMMO). 23 patients with DMD (mean age 16.7 ± 7.7 years) and 23 controls were assessed using a questionnaire about mandibular function and impairments. All participants underwent a clinical examination of the masticatory system, including measurement of mandibular range of motion and variables related to mandibular movements. In all patients, quantitative ultrasound of the digastric muscle and the geniohyoid muscle and the motor function measure (MFM) scale were performed. The patients were divided into early and late ambulatory stage (AS), early non-ambulatory stage (ENAS) and late non-ambulatory stage (LNAS). All mandibular movements were reduced in the patient group (P < 0.001) compared to the controls. Reduction in the aMMO (<40 mm) was found in 26% of the total patient group. LNAS patients had significantly smaller mandibular movements compared to AS and ENAS (P < 0.05). Multiple linear regression analysis for aMMO revealed a positive correlation with the body height and disease progression, with MFM total score as the strongest independent risk factor (R(2) = 0.71). Mandibular movements in DMD are significantly reduced and become more hampered with loss of motor function, including the sitting position, arm function, and neck and head control. We suggest that measurement of the aMMO becomes a part of routine care of patients with DMD.
Assuntos
Mandíbula/fisiopatologia , Músculos da Mastigação/fisiopatologia , Distrofia Muscular de Duchenne/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Humanos , Modelos Lineares , Masculino , Fatores de Risco , Inquéritos e Questionários , Adulto JovemRESUMO
Patients with Duchenne muscular dystrophy (DMD) report masticatory and swallowing problems. Such problems may cause complications such as choking, and feeling of food sticking in the throat. We investigated whether masticatory performance in DMD is objectively impaired, and explored predictive factors for compromised mastication. Twenty-three patients and 23 controls filled out two questionnaires about mandibular function, and underwent a clinical examination of the masticatory system and measurements of anterior bite force and masticatory performance. In the patients, moreover, quantitative ultrasound of the tongue and motor function measurement was performed. The patients were categorized into ambulatory stage (early or late), early non-ambulatory stage, or late non-ambulatory stage. Masticatory performance, anterior bite force and occlusal contacts were all reduced in the patient group compared to the controls (all p < 0.001). Mastication abnormalities were present early in the disease process prior to a reduction of motor function measurement. The early non-ambulatory and late non-ambulatory stage groups showed less masticatory performance compared to the ambulatory stage group (p < 0.028 and p < 0.010, respectively). Multiple linear regression analysis revealed that stage of the disease was the strongest independent risk factor for the masticatory performance (R(2) = 0.52). Anterior bite force, occlusal contacts and masticatory performance in DMD are severely reduced.
Assuntos
Força de Mordida , Mastigação , Distrofia Muscular de Duchenne/fisiopatologia , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Estudos de Coortes , Progressão da Doença , Humanos , Modelos Lineares , Masculino , Boca/diagnóstico por imagem , Boca/fisiopatologia , Distrofia Muscular de Duchenne/diagnóstico por imagem , Exame Físico , Fatores de Risco , Inquéritos e Questionários , Ultrassonografia , Adulto JovemRESUMO
A 30-year-old woman appeared at the gnathology department of a centre for special dentistry complaining of migraine attacks which were preceded each time by severe odontalgic pain. Furthermore, she suffered from an autoimmune disease as well as from tension headaches. The oral health care provider in charge suspected that the episodes of odontalgic pain, which lasted for several hours or even several days, were caused by bruxism. Treatment of the bruxism resulted in reduced pain as well as reduced severity of the migraine attacks.
Assuntos
Bruxismo/complicações , Bruxismo/terapia , Transtornos de Enxaqueca/etiologia , Odontalgia/complicações , Adulto , Bruxismo/diagnóstico , Feminino , Humanos , Transtornos de Enxaqueca/epidemiologia , Odontalgia/diagnóstico , Odontalgia/terapia , Resultado do TratamentoRESUMO
OBJECTIVE: In patients with spinal muscular atrophy (SMA) type II, feeding problems and dysphagia are common, but the underlying mechanisms of these problems are not well defined. This case control study was designed to determine the underlying mechanisms of dysphagia in SMA type II. METHODS: Six children with SMA type II and 6 healthy matched controls between 6.4 and 13.4 years of age were investigated during swallowing liquid and solid food in 2 different postures using surface EMG (sEMG) of the submental muscle group (SMG) and a video fluoroscopic swallow study (VFSS). RESULTS: The VFSS showed postswallow residue of solid food in the vallecula and above the upper esophageal sphincter (UES), which can be responsible for indirect aspiration. Better results in swallowing were achieved in a more forward head position. These findings were supported by the sEMG measurements of the SMG during swallowing. CONCLUSIONS: Dysphagia in spinal muscular atrophy type II is due to a neurologic dysfunction (lower motor neuron problems from the cranial nerves in the brainstem) influencing the muscle force and efficiency of movement of the tongue and the submental muscle group in combination with a biomechanical component (compensatory head posture). The results suggest an integrated treatment with an adapted posture during meals and the advice of drinking water after meals to prevent aspiration pneumonias.
Assuntos
Paralisia Bulbar Progressiva/etiologia , Transtornos de Deglutição/etiologia , Atrofias Musculares Espinais da Infância/complicações , Adolescente , Estudos de Casos e Controles , Criança , Deglutição/fisiologia , Eletromiografia/métodos , Comportamento Alimentar , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Postura/fisiologia , Gravação em Vídeo/métodosRESUMO
In every case of restorative care, dentists deal with reference positions of the mandible. For this purpose, the intercuspal position and the retruded contact position are the most often used reference positions. Concerning how precisely these clinically relevant positions could be determined, insufficient knowledge was available 25 years ago. There was also uncertainty concerning the causal role of the occlusion in cases of temporomandibular disorders. It was established that the reproducibility of the retruded contact position and other reference positions established by the dentist, did not differ from one another. The position of the patient had no influence on reproducibility, nor did the choice of bite registration material. The intercuspal position is the most reproducible reference position in all conditions tested. The opinion, widely held at the time, that a discrepancy between the reference positions would lead to temporomandibular disorders was addressed in the dissertation 'Reference positions in the mandible'.
Assuntos
Registro da Relação Maxilomandibular , Mandíbula/anatomia & histologia , Mandíbula/fisiologia , Oclusão Dentária , Humanos , Valores de ReferênciaRESUMO
Masticatory function can be impaired in temporomandibular disorders (TMDs) patients. We investigated whether treatment of subacute non-specific TMD patients may influence oral function and clinical outcome measures. Fifteen patients with subacute TMD participated in the study. We quantified masticatory performance, maximum voluntary bite force, muscle activity and chewing cycle duration before and after treatment. Masticatory performance and bite force of patients were compared with the results obtained for an age- and gender-matched group of subjects without TMD complaints. Furthermore, we determined possible changes in anamnestic and clinical scores from questionnaires (mandibular function impairment questionnaire; MFIQ), pain scores and clinical outcome measures. Maximum bite force significantly increased, although the values after treatment were still significantly lower than those of the subjects without TMD complaints. The corresponding electromyography values did not show significant change after treatment. The masticatory performance of the patients remained unaltered; patients chewed significantly less efficient than controls. The average duration of chewing cycles significantly decreased after treatment. We observed a significant improvement in MFIQ scores. During the clenching and chewing tasks, the visual analogue scale scores were significantly higher than before these tasks. We may conclude that subacute temporomandibular joint disorders negatively influence chewing behaviour. Bite force, chewing cycle duration and also perceived mandibular function significantly improved after treatment, although the masticatory performance remained unaltered.
Assuntos
Dor Facial/fisiopatologia , Mastigação/fisiologia , Amplitude de Movimento Articular/fisiologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Adolescente , Adulto , Idoso , Análise de Variância , Força de Mordida , Eletromiografia , Dor Facial/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Inquéritos e Questionários , Transtornos da Articulação Temporomandibular/terapia , Resultado do Tratamento , Adulto JovemRESUMO
The Council of the European Academy of Craniomandibular Disorders charged the Educational Committee with the task of establishing Guidelines and Recommendations for the examination, diagnosis, and management of patients with temporomandibular disorders and orofacial pain by the general dental practitioner. It was not their purpose to present a thorough and critical review of the vast amount of literature available but to summarize the at-present generally accepted clinical approach. These recommendations are based as much as possible on scientific evidence and on sound clinical judgment in cases where only partial evidence or contradictory data were found.
Assuntos
Dor Facial/diagnóstico , Transtornos da Articulação Temporomandibular/diagnóstico , Adolescente , Analgésicos/uso terapêutico , Criança , Prótese Dentária , Diagnóstico Diferencial , Dor Facial/cirurgia , Dor Facial/terapia , Feminino , Odontologia Geral , Humanos , Masculino , Programas de Rastreamento , Anamnese , Ajuste Oclusal , Placas Oclusais , Ortodontia Corretiva , Planejamento de Assistência ao Paciente , Educação de Pacientes como Assunto , Exame Físico , Modalidades de Fisioterapia , Transtornos da Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/terapiaRESUMO
Implementation of research findings in patient care ideally will follow in a continuous cycle, and clinical questions from practitioners should stimulate research. Even in the most optimal situations, there will be a gap between the steady flow of new findings from research and their eventual implementation in clinical practice. In the clinical practice of temporomandibular disorders and orofacial pain (TMD/OFP) simple cases outnumber the more complex cases by far. Therefore, research implications for the general dental practitioner, whose patients are rarely represented in research populations, may differ from what is published and taught. Treatment options like counselling, occlusal treatments (reversible as a rule and irreversible by exception) and physiotherapy can be very successful in the hands of the general dental practitioner. European dental schools should define additional amendments to the recently proposed profile and competencies for the European dentist, in order to focus on the relevant and current knowledge on temporomandibular disorders and orofacial pain. These amendments should address the adequate diagnosis and management of non-complex TMD cases and the need to refer to a TMD/OFP specialist in complex cases. Professional organizations such as the European Academy of Craniomandibular disorders can endorse better TMD/OFP education and training.
Assuntos
Competência Clínica , Educação em Odontologia/métodos , Dor Facial/terapia , Transtornos da Articulação Temporomandibular/terapia , Europa (Continente) , Humanos , Guias de Prática Clínica como Assunto , Faculdades de Odontologia , Sociedades OdontológicasRESUMO
In a pilot study, the masticatory function of patients with juvenile idiopathic arthritis was studied. The chewing efficiency and maximum bite force were measured in five adult patients and compared with a control group consisting of healthy individuals. The chewing efficiency of the patients with juvenile idiopathic arthritis was statistically significantly compromised compared to that of the control group. The maximum bite force was not statistically significantly smaller within this small group. The results of this pilot study support the hypothesis that the masticatory function of patients with juvenile idiopathic arthritis is compromised. We concluded that a more extensive study is necessary to investigate the masticatory function of patients with juvenile idiopathic arthritis and to evaluate the consequences with regard to the quality of life.
Assuntos
Artrite Juvenil/complicações , Odontologia/normas , Mastigação/fisiologia , Especialidades Odontológicas , Adulto , Força de Mordida , Estudos de Casos e Controles , Currículo , Educação Continuada em Odontologia , Humanos , Países Baixos , Projetos PilotoRESUMO
The guiding principle in postgraduate programmes is to enable dentists to build on and extend the competencies acquired in the basic academic programme. This requires the examination and treatment of sufficient numbers of patients. Given the incidence and prevalence of temporomandibular disorders and orofacial pain, basic academic training will be limited to referral or to diagnosing and treating acute and non-complex cases, whereas the specialist in temporomandibular disorders(TMD) will focus especially on chronic temporomandibular disorders and orofacial pain, in a multidisciplinary setting. In case of orofacial pain, the general dental practitioner is the obvious person to determine if there may be odontogenic causes. The specialist in TMD can either advise the general practitioner or coordinate the patient's care him- or herself. In order to be able to perform well within a (partly medical) multidisciplinary setting there is a need for differentiated education, above and beyond the basic academic curriculum. The competencies of the specialist in TMD should comprise care in a broad sense, providing evidence-based care and educating patients, being able to work well within an organization, clinical reasoning and professional development through life-long learning and teaching. The specialist in TMD may either work in private practice or in special dental care clinics.
Assuntos
Odontologia/normas , Educação de Pós-Graduação em Odontologia/organização & administração , Especialidades Odontológicas , Transtornos da Articulação Temporomandibular/terapia , Competência Clínica , Currículo , Educação Continuada em Odontologia , Humanos , Países BaixosRESUMO
The aim of this longitudinal study was to determine the effects of orthognathic surgery on signs and symptoms of temporomandibular disorders (TMD) and on pressure pain thresholds (PPTs) of the jaw muscles. Fourteen consecutive class III patients undergoing pre-surgical orthodontic treatment were treated by combined Le Fort I osteotomy and bilateral sagittal ramus osteotomy. The clinical examination included the assessment of signs and symptoms of TMD and the assessment of PPTs of the masseter and temporalis muscles. Anamnestic, clinical and algometric data were collected during five sessions over a 1-year period. Seven out of 14 patients presented with disc displacement with reduction at baseline, whereas four patients (two of them were new cases) did so at the end of follow up (p>0.05). None of the patients were diagnosed with myofascial pain of the jaw muscles at the beginning or end of follow up. PPTs of the masseter and temporalis muscles did not change significantly from baseline values throughout the whole study period. The occurrence of signs and symptoms of TMD fluctuates with an unpredictable pattern after orthognathic surgery for class III malocclusions.
Assuntos
Má Oclusão Classe III de Angle/cirurgia , Músculo Masseter/fisiologia , Limiar da Dor/fisiologia , Músculo Temporal/fisiologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Adolescente , Adulto , Dor Facial/fisiopatologia , Feminino , Seguimentos , Humanos , Luxações Articulares/fisiopatologia , Estudos Longitudinais , Masculino , Mandíbula/cirurgia , Maxila/cirurgia , Osteotomia/métodos , Osteotomia de Le Fort/métodos , Complicações Pós-Operatórias , Amplitude de Movimento Articular/fisiologia , Som , Disco da Articulação Temporomandibular/fisiopatologiaRESUMO
It has been suggested that occlusal interferences may lead to pain and tenderness of the masticatory muscles. Tender jaw muscles are more sensitive to pressure pain, as assessed by means of pressure algometry. We tested the effects of occlusal interferences on the pressure pain threshold of the jaw muscles by means of a double-blind randomized crossover experiment carried out on 11 young healthy females. Golden strips were glued either to an occlusal contact area (active interference) or to the vestibular surface of the same tooth (dummy interference) and left for 8 d each. Pressure pain thresholds of the masseter and anterior temporalis muscles were assessed under interference-free, dummy-interference and active-interference conditions. The results indicated that the application of an active occlusal interference, as used in this study, did not influence significantly the pressure pain thresholds of these muscles in healthy individuals.
Assuntos
Má Oclusão/fisiopatologia , Músculo Masseter/fisiopatologia , Limiar da Dor/fisiologia , Músculo Temporal/fisiopatologia , Adulto , Estudos Cross-Over , Oclusão Dentária Central , Método Duplo-Cego , Eletromiografia , Feminino , Seguimentos , HumanosRESUMO
Stabilization splints are often used to treat musculoskeletal disorders of temporomandibular joints. Historically, the centric relation is advocated as the reference position for a stabilization splint. Centric relation as the reference position is subject of discussion, since this position has been defined for a healthy stomatognathic system. In case of temporomandibular disorders, the temporomandibular joints and muscles are compromised. Apart from degenerative changes in all components of the temporomandibular joints, the presence of pain may influence the establishment of a therapeutic position. In this article the biological plausibility of the centric relation as a reference position in patients suffering from temporomandibular disorders, is discussed. It is advocated to maintain the existing occlusion.
Assuntos
Placas Oclusais , Transtornos da Articulação Temporomandibular/terapia , Articulação Temporomandibular , Cartilagem Articular/fisiologia , Cartilagem Articular/fisiopatologia , Humanos , Articulação Temporomandibular/anatomia & histologia , Articulação Temporomandibular/fisiologia , Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/fisiopatologiaRESUMO
Occlusal appliances are used as a reversible treatment modality of temporomandibular disorders. This article describes a protocol to produce a stabilization splint with a minimum of chair time, and an improved compliance, aiming at an overall improvement of the therapeutic potential. Maintaining the existing occlusion in stead of using centric relation is part of the procedure. The main phases of the protocol are the initial clinical phase of impressions and recording treatment position of the mandible, the technical phase, the control phase, and the insertion of the appliance.
Assuntos
Placas Oclusais , Transtornos da Articulação Temporomandibular/terapia , Articulação Temporomandibular , Humanos , Articulação Temporomandibular/anatomia & histologia , Articulação Temporomandibular/fisiologia , Articulação Temporomandibular/fisiopatologiaRESUMO
Recent evidence suggests that evaluation of muscle tenderness in temporomandibular disorders (TMDs) patients might be improved by the use of pressure algometry; nevertheless, the evaluation of the diagnostic value of this tool has received little attention. The aim of this study was to assess the diagnostic value of pressure algometry in myofascial pain of the jaw muscles, by calculation of sensitivity (Se), specificity (Sp) and positive predictive values (PPV). Pressure pain thresholds (PPTs) of masseter and anterior temporalis muscles were assessed in 40 female myogenous TMD patients and 40 age-matched female controls. PPTs were significantly lower (P<0.001) in TMD patients than in control subjects for both masseter and temporalis muscles, being 40-50% of the control values. Setting a cutoff value 1 s.d. below the mean PPT values of control subject, sensitivity and specificity were 0.67 and 0.85, respectively, for the masseter muscle and 0.77 and 0.87, respectively, for the temporalis muscle. When taking into account the prevalences of myofascial pain in the general population and in TMD clinics, the PPV ranged from 0.5 to 0.7. As a result of the low PPV, pressure algometry has strong limitations when used as a solitary diagnostic tool.
Assuntos
Músculos da Mastigação/fisiopatologia , Medição da Dor/métodos , Síndrome da Disfunção da Articulação Temporomandibular/diagnóstico , Adulto , Feminino , Humanos , Medição da Dor/instrumentação , Medição da Dor/estatística & dados numéricos , Limiar da Dor/fisiologia , Pressão , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Síndrome da Disfunção da Articulação Temporomandibular/fisiopatologiaRESUMO
Two patients, a woman aged 21 and a man aged 29, with asymmetrical swellings of both mandibular angles and a painful, heavy sensation in the masticatory muscles (and in the woman also round the maxillary joint), were diagnosed as having hypertrophy of the masseter muscles. Both had the habit of jaw clenching and tooth grinding. Treatment consisted not of the traditional surgical debulking which also allows correction of overdeveloped osseous mandibular angles, but of injections with botulinum toxin type A. Injection of 40-60 IU (product: Botox) per muscle was followed by some atrophy; cosmetically satisfactory results were achieved after repetition of the treatment a few months later. Reduction of muscle volume was confirmed by a quantitative volumetric assessment of MRI scans. In the female patient, the pain also abated.
Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Músculo Masseter/efeitos dos fármacos , Músculo Masseter/patologia , Fármacos Neuromusculares/uso terapêutico , Adulto , Bruxismo/complicações , Feminino , Humanos , Hipertrofia/diagnóstico , Hipertrofia/tratamento farmacológico , Hipertrofia/etiologia , Imageamento por Ressonância Magnética , Masculino , Mandíbula/patologiaRESUMO
The purpose of the study was to evaluate the effect of early orthodontic treatment of functional unilateral posterior crossbite (FUPC) and to evaluate temporomandibular function in the short and long term. Orthodontic treatment consisted of slow expansion of the maxillary dental arch by means of a removable expansion plate, with flat coverage of the occlusal surfaces of the left and right posterior teeth. Evaluation of the occlusion showed a strong correlation between the crossbite side and the direction of the RCP-ICP slide and with the side of first occlusal contact in RCP. In 26 of 27 children that were treated (one withdrew), the average time required for correction of the crossbite was 7 months, followed by a retention period, on average, for 6 months after completion of treatment. Early orthodontic treatment resulted in an elimination of occlusal disturbances, and the crossbite remained stable on follow-up during an average of 8 years after the retention period, except in two children with a class III tendency. In nine other children an orthodontic anomaly had developed requiring further treatment (two children showed crowding and seven children showed a class II malocclusion). This study showed that FUPC can be treated adequately by early orthodontic intervention; however, its correction does not guarantee the absence of functional disturbances at a later age. Therefore, FUPC should be treated early in order to achieve normal growth and development rather than to prevent temporomandibular disorders.
Assuntos
Má Oclusão/terapia , Ortodontia Corretiva , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Má Oclusão/diagnóstico , Má Oclusão/fisiopatologia , Modelos Dentários , Aparelhos Ortodônticos Removíveis , Ortodontia Corretiva/estatística & dados numéricos , Estatísticas não Paramétricas , Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/diagnóstico , Dente DecíduoRESUMO
This study was performed to assess the prevalence of signs and symptoms of temporomandibular disorders (TMD) in patients with cervical spine disorders (CSD) and to compare patients with CSD and subgroups of patients with TMD with regard to the results of orthopaedic tests of the stomatognathic system. A group of 103 consecutive patients with signs and symptoms of CSD and a group of 111 consecutive patients with TMD were examined. All subgroups of TMD patients showed a significantly smaller range of motion than the CSD patients. Patients with TMD had limited mouth opening (< 40 mm) on active and passive mouth opening more often than CSD patients. TMD patients with myogenous problems reported oral habits more often than CSD patients, although no objective differences between CSD and TMD patients were found. Subgroups of TMD patients reported joint sounds, and pain on palpation and joint play tests of the temporomandibular joint (TMJ) more frequently than CSD patients. Joint sounds on active movements, pain on palpation of the TMJ, and pain on joint play tests correctly classified 82% of the patients with TMD and 72% of the patients with CSD. In spite of the biomechanical and anatomical relationship between the neck and the stomatognathic system, the results of the study show that CSD patients have signs and symptoms of TMD comparable with those of the adult Dutch population. It was concluded that the function of the masticatory system should be evaluated in patients with neck complaints in order to rule out a possible involvement of the masticatory system.