Is catechol-O-methyltransferase gene associated with temporomandibular disorders? A systematic review and meta-analysis.

BACKGROUND: Temporomandibular disorder (TMD) is a condition, in which multiple factors act synergistically to determine the outcome of the disorder. AIM: A systematic review and meta-analysis was conducted to evaluate the association between genetic polymorphisms in catechol-O-methyltransferase (COMT) and TMD. DESIGN: Observational studies that investigated this association were included. The risk of bias and study quality were evaluated according to the Newcastle-Ottawa tool. The meta-analysis was performed for each polymorphism associated with TMD signs and symptoms. RESULTS: A total of 1903 articles were identified. Ten remained in the qualitative analysis: six were classified as low risk of bias and four with moderate risk of bias, and three were included in the meta-analysis. The polymorphism rs6269, in the genotypic model (0.65; CI = 0.44-0.97; P = .04) and in the allelic model (0.73; CI = 0.54-0.98; P = .04), was associated with myofascial pain. The rs9332377 was associated with myofascial pain in the genotypic model (2.69; CI = 1.51-4.76; P = .0007) and in the allelic model (1.46; CI = 1.01-2.13; P = .05) and with painful TMD in the genotypic model (2.08; CI = 1.27-3.40; P = .004) and in the allelic model (1.34 CI = 0.98-1.82; P = .06). CONCLUSION: The polymorphisms in COMT were significantly associated with TMD.

Prevalence of diagnosed temporomandibular disorders: A cross-sectional study in Brazilian adolescents.

BACKGROUND: The prevalence of signs and symptoms of temporomandibular disorders (TMD) increases during adolescence and adulthood. Few studies have examined TMD prevalence in Brazilian adolescents. AIM: To investigate the prevalence of TMD in Brazilian adolescents. METHODS: A representative population-based sample of 934 adolescents (10-14-years-old) was examined. TMD screening was performed using a questionnaire by the American Academy of Orofacial Pain. TMD diagnoses used research diagnostic criteria for temporomandibular disorders (RDC/TMD-Axis-I). Examinations were performed by a single calibrated examiner (kappa > 0.80). RESULTS: The prevalence of TMD symptoms was 34.9%; the most frequently reported symptoms were headache and neck ache (20.9%), followed by joint sounds (18.5%). Myofascial pain was the most prevalent type (10.3%), followed by disc displacement with reduction (8.0%) and arthralgia (3.5%). There was a significant association between sex and TMD symptoms; prevalence was significantly higher in girls (RP = 1.37; 95% CI = 1.14-1.65; p = 0.001). Myofascial pain of TMD and displacement with reduction were more prevalent in girls (RP = 1.76; p = 0.007 and RP = 2.06; p = 0.004, respectively). CONCLUSION: TMD symptoms were present in 34.9% of adolescents, with myofascial pain being the most prevalent type (10.3%). TMD was significantly more common in girls. Routine pediatric dental care should include a TMD screening.

Oral health status in victims of child abuse: a case-control study.

BACKGROUND: Few studies have evaluated the oral health status of children with a history of maltreatment. AIM: This case-control study evaluated oral health in children who were victims of abuse and in child protective services in Curitiba, Brazil. DESIGN: One hundred twenty-two children who were victims of abuse and 240 children with no history of abuse (mean ages, 8.56 and 8.24 years, respectively) were included in the study. Dental caries were assessed according to the Decayed, Missing, or Filled Teeth index (dmft index and DMFT index) by two calibrated examiners. The presence of anterior open bite and posterior crossbite was recorded. Data were analyzed using bivariate and adjusted odds ratios using a multivariate logistic regression model analyses. RESULTS: In the case group, we found a higher DMFT index (P < 0.001) and a significantly higher prevalence of missing primary teeth (P = 0.04), untreated decayed permanent teeth (P < 0.001), filled permanent teeth (P < 0.001), and anterior open bite (P = 0.04). Children who were victims of abuse presented an odds ratio of 6.48 (95% CI: 3.52-11.95) for caries in permanent teeth and an odds ratio of 2.28 (95% CI: 1.04-4.99) for open bite. CONCLUSION: Victims of child abuse had a worse oral health status, demonstrating the need to establish special policies for oral healthcare for this population.

Hidden caries' challenge diagnosis: case report

Introduction: Hidden caries is a term used to describe occlusal dentine caries that is missed on a visual examination, but is large and demineralised enough to be detected by another exam for example, radiographs. Case report: This article reports a case of large dentine caries, which presented as to be a small pit-and-fissure carious lesion on the occlusal surface of the right mandibular permanent first molar in a 10-year-old girl. The treatment included root canal treatment and the sealing of the cavity with composite resin. Conclusion: Careful visual examination, with cleaning and drying of teeth, associated to bitewing radiographs may improve occlusal caries detection. Dentists should examine bitewing radiographs carefully for proximal caries and occlusal demineralization. Radiographs are an effective method of caries diagnosis that can avoid large destruction and allows less invasive treatment.

Traumatismo dentoalveolar na dentição decídua / Dentoalveolar trauma in the primary dentition

O atendimento a crianças com traumatismos na dentição decídua requer uma abordagem diferente daquela utilizada na dentição permanente, isso porque existe uma relação muito próxima entre o ápice do dente decíduo afetado pelo trauma e o germe do dente permanente sucessor. As possíveis repercussões sobre o dente permanente devem ser consideradas ao se realizar o tratamento imediato, de modo a evitar danos adicionais. também precisam ser levadas em conta as prováveis seqüelas tardias do trauma, tanto para a própria dentição decídua como para a permanente. Diante da importância do assunto, este capítulo procurou abordar tal tema de maneira ampla, desde a anamnese até os exames gerais, intrabucal e radiográfico, com vistas a analisar integralmente o paciente. Além da classificação das lesões traumáticas nos tecidos dentários e de sustentação, enfatizam-se o diagnóstico, o tratamento indicado, o prognóstico e a proservação de cada situação clínica. Um tópico sobre lesão em tecido mole foi incluído, pois esta tem grande impacto para a criança e sua família e pode estar associada a outros tipos de traumatismos. Como a análise da situação vacinal da criança é sugerida, ante a existência de casos que exigem que a vacina antitetânica esteja na sua validade, acrescentou-se a recomendação do Ministério da Saúde quanto á imunização antitetânica. Há também um item sobre contenção, orientação aos pais e repercussões do trauma para os dentes decíduos e os permanentes sucessores. Ao final do capítulo, duas tabelas resumem o tratamento das lesões traumáticas em tecidos dentários e polpa e o tratamento das lesões em tecidos de sustentação na dentição decídua em situações de tratamento imediato e tardio.

The treatment of children presenting dental trauma in the primary dentition requires a different approach from that used in the permanent dentition, because there is a very close relation between the apex of the traumatized primary tooth and the successor permanent bud. The possible consequences on the permanent teeth should be considered when performing early treatment in order to prevent further damage. Also, the probable trauma?s late sequelae should be taken into account both for primary and permanent dentition. Given the subject?s importance, this chapter aimed to report this issue broadly. This comprises the anamnesis, general, intraoral, and radiographic examination and the comprehensive treatment of the patient. Additionally to the classification of dental injuries, we highlighted the diagnosis, required treatment, prognosis, and follow-up of each clinical situation. A topic on soft tissue lesion was included, because it has a great impact on both the child and family. Moreover, it could be associated with other trauma types. Since the analysis of the child?s vaccination status is suggested, in face of cases demanding that tetanus vaccine be valid, the recommendation of the Brazilian Ministry of Health was also informed. Furthermore, there is an item on dental splinting, parenting advice, and trauma consequences on primary and successor permanent teeth. At the end of the chapter, two tables summarize the early and delayed treatment of trauma involving primary tooth?s enamel, dentin, pulp, and supportive tissues.

Disfunção da articulação temporomandibular em crianças- revisão de literatura / Temporomandibular dysfunction in children-literature review

Introdução e Objetivo Este trabalho teve como objetivo abordar aspectos relacionados às DTM em crianças como etiologia, diagnóstico e tratamento, ressaltando a importância do diagnóstico correto, uma vez que estes pacientes estão em fase de crescimento e desenvolvimento facial. Revisão de literatura As disfunções temporomandibulares (DTM) apresentam vários problemas clínicos que envolvem os músculos da mastigação, articulação temporomandibular e estruturas adjacentes. Em crianças os sintomas desta síndrome estão presentes, porém com menor intensidade quando comparados aos adultos. Quanto à prevalência há uma grande discordância entre os autores. As DTM em crianças possuem etiologia multifatorial, e os fatores mais citados são: hábitos parafuncionais, traumas, fatores oclusais, sistêmicos e psicológicos. Conclusão: Os sinais e sintomas de DTM em populações pediátricas são geralmente suaves e aumentam com a idade, sendo de grande importância o diagnóstico precoce e a inclusão desse tipo de exame em consultas de rotina.

Introduction and Objective The aim of this study was to review the aspects related to TMD in children like etiology, diagnosis and treatment, emphasizing the importance of the corret diagnosis since the pacients are having a growth and development of their faces. Literature Review The Temporomandibulars Dysfunctions (TMD) include many clinical problems that involve the mastigatory muscles, the temporomandibular joint and the near structures. In children the symptoms of this syndrome are presents although with mild intensity when compared with adults and there are a grate amount of discordance in a prevalence of these dysfunctions. The etiology of the TMD are multifatorial and the most citeds in literature are parafunctional habits, traumas, occlusal, systemic and psychological factors. Conclusions The signs and symptoms of the TMD in pediatric populations are generally mild and increase with age, so the early diagnosis is very important and this kind of exam should be include in a routine examination

Puberdade precoce: informações de interesse para o ortodontista / Early puberty: information of interest to the orthodontist

A puberdade é um período de modificações biopsicossociais intensas, pelo qual os indivíduos passam até que alcancem a maturidade sexual. Pode ser diagnosticada, clinicamente, por meio do surgimento das características sexuais secundárias. Nesse período, ocorrem as taxas de crescimento mais significativas da face, constituindo um momento de grande interesse para o ortodontista, no manejo das desarmonias esqueléticas faciais. Algumas crianças atingem a puberdade em idade anterior à média populacional, o que é denominado puberdade precoce. Este trabalho visa apresentar uma revisão da literatura sobre puberdade normal e puberdade precoce, direcionada ao diagnóstico ortodôntico, ilustrando idades dentária e esquelética precoces, em relação à idade cronológica, em uma paciente de 8 anos de idade. A idade óssea é a forma mais indicada para determinar o melhor momento de intervenção ortopédica na face, inclusive em pacientes portadores de puberdade precoce, nos quais o crescimento puberal pode ser finalizado antes mesmo de ser completada a troca dos molares decíduos.

Evaluation of the signs and symptoms of temporomandibular disorders in children with headaches.

PURPOSE: The purpose of this study was to evaluate the presence of signs and symptoms of temporomandibular disorders (TMD) in children with headaches in a neuropediatric ambulatory. METHOD: Fifty patients between 4 and 18 years of age were examined: 31 had headaches (24 migraine, 4 tension type and 3 unspecific headache) and 19 formed the control group. The data collection was comprised of a structured questionnaire answered by the children's parents, and a subjective evaluation about the childrens emotional state. A specific questionnaire for TMD was applied, followed by a clinical dental examination of the children. As signs of TMD, mouth opening limitation, mandibular trajectory deviation in opening mouth, and joint noise were considered. As symptoms, pain on palpation of masseter and temporal muscles and on the poromandibular joint. RESULTS: A significant increase in signs and symptoms of TMD was found in patients with headaches when compared to the control group. There was also a significant difference in signs and symptoms of TMD according to age (increased with age) and emotional state (tense>calm). CONCLUSION: There is a higher frequency of TMD in pediatric patients with headaches; thus, it is important to look for TMD signs and symptoms in this population.

Evaluation of the signs and symptoms of temporomandibular disorders in children with headaches

PURPOSE: The purpose of this study was to evaluate the presence of signs and symptoms of temporomandibular disorders (TMD) in children with headaches in a neuropediatric ambulatory. METHOD: Fifty patients between 4 and 18 years of age were examined: 31 had headaches (24 migraine, 4 tension type and 3 unspecific headache) and 19 formed the control group. The data collection was comprised of a structured questionnaire answered by the children's parents, and a subjective evaluation about the childrenÆs emotional state. A specific questionnaire for TMD was applied, followed by a clinical dental examination of the children. As signs of TMD, mouth opening limitation, mandibular trajectory deviation in opening mouth, and joint noise were considered. As symptoms, pain on palpation of masseter and temporal muscles and on the poromandibular joint. RESULTS: A significant increase in signs and symptoms of TMD was found in patients with headaches when compared to the control group. There was also a significant difference in signs and symptoms of TMD according to age (increased with age) and emotional state (tense> calm). CONCLUSION: There is a higher frequency of TMD in pediatric patients with headaches; thus, it is important to look for TMD signs and symptoms in this population.

OBJETIVO: Avaliar a presença de sinais e sintomas de disfunção temporomandibular (DTM) em crianças com cefaléias em um ambulatório de neuropediatria. MÉTODO: Foram examinados 50 pacientes com idade entre 4 e 18 anos, 31 com cefaléias (24 com enxaqueca, 4 com cefaléia tensional e 3 com cefaléia inespecífica) e 19 do grupo controle. Os dados compreenderam um questionário estruturado respondido pelos pais e uma avaliação subjetiva sobre o estado emocional das crianças. Foi aplicado um questionário específico para DTM e realizado um exame clínico dental. Foram considerados como sinais de DTM: limitação da abertura bucal, desvio da trajetória ao abrir a boca e ruído articular. Quanto aos sintomas, foram considerados: dor à palpação dos músculos masseter e temporal e na articulação temporomandibular. RESULTADOS: Foi encontrado um aumento significante de sinais e sintomas de DTM em pacientes com cefaléias quando comparados com o grupo controle. Houve, também, uma diferença significante de sinais e sintomas de DTM de acordo com a idade (aumento com a idade) e estado emocional (tenso>calmo). CONCLUSÃO: Há maior freqüência de sinais e sintomas de DTM no grupo de pacientes pediátricos com cefaléias, sendo importante avaliar essa patologia nessa população.

A neuralgia do trigêmeo: um enfoque odontológico / Trigeminal neuralgia: an odontologic point of view

A neuralgia do trigêmio, também chamada tic douloureux, é um tipo de dor orofacial caracterizado por episódios dolorosos paroxísticos do tipo "choque elétrico", que duram de poucos segundos até dois minutos. A dor é desencadeada a partir de pontos-gatilho, que podem estar presentes na face ou na mucosa bucal e podem ser estimulados por atividades do cotidiano, como fazer a barba ou mesmo escovar os dentes. Tais sintomas podem ser confundidos com dores de origem odontogênica e, pelo fato de confundirem o diagnóstico desta doença muitos cirurgiões-dentistas realizam procedimentos desnecessários em seus pacientes. Este estudo tem como objetivo alertar o Clínico Geral sobre a importância de se fazer o correto diagnóstico. Avaliaram-se quatro casos clínicos de pacientes entre 69 e 77 anos que tiveram seus dentes tratados endodonticamente ou até mesmo extraídos desnecessariamente, devido à neuralgia do trigêmeo. Destes pacientes, três apresentaram neuralgia idiopática e um, neuralgia causada por tumor intracraniano. O tratamento foi realizado através de microdescompressão vascular em três dos casos e de controle com carbamazepina no outro