Photobiomodulation Therapy on the Palliative Care of Temporomandibular Disorder and Orofacial/Cervical Skull Pain: Preliminary Results from a Randomized Controlled Clinical Trial.

The main symptoms of temporomandibular disorders (TMDs) are pain from musculoskeletal and/or joint-in the head and neck region-and complaints of difficulty in mandibular movements. The photobiomodulation therapy (PBMT) has been reported as a promising treatment in the management of these symptoms. The objective of this research was to assess the effect of PBMT immediately after irradiation on TMDs symptoms under a prospective clinical trial, randomized, triple-blinded, placebo-controlled, and with two parallel arms. According to the RDC/TMD, maximum mouth opening (MMO) and pain in the orofacial/cervical muscles and temporomandibular joint (TMJ) were recorded. One hundred forty-five participants (71 placebo and 74 PBMT experimental) were analyzed after irradiation protocols (sham-PBMT or PBMT) at the orofacial/cervical skull musculature and at the TMJ. The results showed a reduction in the total pain score (p = 0.026), a reduction in the number of painful points (p = 0.013), and an increase in the MMO (p = 0.016) in the PBMT protocol group when compared to the placebo protocol (sham-PBMT). The PBMT was shown to be effective in reducing orofacial/cervical skull pain immediately after the irradiation. It is clinically relevant and should be taken into consideration by professionals who are dedicated to treating this pathology because, in addition to bringing comfort to patients who need dental treatment, it also consists of a low-cost and low technical complexity clinical approach.

Photobiomodulation therapy on the palliative care of temporomandibular disorder and orofacial/cervical skull pain: study protocol for a randomized controlled clinical trial.

BACKGROUND: Temporomandibular disorder (TMD) is the most common cause of orofacial and cervical skull pain and is considered to be a public health problem, affecting 5% to 12% of the world population. TMD is multifactorial and there are several types of treatment, with the conservative types being indicated more often as they are less aggressive and reversible. The main aim of these treatments is to relieve symptoms, reduce of pain, and restore orofacial and cervical skull functions. Photobiomodulation therapy (PBMT), a noninvasive therapy, is an option for the management of musculoskeletal disorders due to its analgesic, anti-inflammatory, and regenerative effects. METHODS: The aim of the proposed study is to verify whether PBMT is effective for use in palliative care of TMD and orofacial and cervical skull pain. A randomized, triple-blinded, placebo-controlled clinical trial is proposed. This study will involve 200 adult participants (over 18 years of age) who will be randomly divided into two groups (n = 100): Group 1, active treatment (PBMT); and Group 2, placebo. Participants will be subjected to three sessions of PBMT or placebo and will be evaluated using the research diagnostic criteria (RDC) for TMD. Pain level (measured by a visual analog scale (VAS)), mandibular movements (measured by ruler and caliper), quality of life (measured by the Oral Health Impact Profile (OHIP)-14), and quality of sleep (measured by the Epworth scale) will be recorded. This study is being conducted at the Special Laboratory of Lasers in Dentistry (LELO) of the School of Dentistry of the University of Sao Paulo (USP). DISCUSSION: This study will verify whether PBMT is effective in reducing TMD and orofacial and cervical skull pain. PBMT may be an option for the management of musculoskeletal disorders due to its analgesic, anti-inflammatory, and regenerative effects, in addition to being a noninvasive technique. TRIAL REGISTRATION: Registro Brasileiro de Ensaios Clínicos, RBR-9b6mnj . Registered on 27 March 2018. Trial registry name: Laser de baixa potência no cuidado paliativo da disfunção temporomandibular e dor crânio orofacial e cervical. Ethics committee: #1774930 approved on 14 October 2016.

Sleep-disordered breathing and orthodontic variables in children--pilot study.

INTRODUCTION: Sleep Disordered Breathing (SDB) is a highly prevalent condition associated with orofacial and dentofacial characteristics. OBJECTIVE: The aim of this study was to verify the association of dental malocclusion, molar relationship, crossbite, open bite, overjet, overbite, and crowding with SDB in children aged 7-9 years. MATERIALS AND METHODS: Participating schools were selected randomly from within the public elementary school system. In the first phase of the study, the parents of 1216 children aged between 7 and 9 years old completed the Sleep Disturbance Scale for Children (SDSC) questionnaire and the children had to participate in a dental examination. The evaluation of occlusion was divided into sagittal analysis, vertical analysis, and transverse analysis. In the second phase, 60 children were selected randomly to be undergone polysomnography (PSG) at a sleep clinic. RESULTS: Among the children included, 242 (19.9%) children had normal occlusion. Of the 60 children, 50 underwent PSG and 40 (80%) had SDB. The crossbite and open bite showed association with SDB, p=0.04 in both. CONCLUSION: Crossbite and open bite malocclusions were associated with SDB, and may be predictive of SDB in children. Studies with larger numbers of participants are needed to investigate the association of other malocclusions with SDB, and randomized clinical trials are also needed to see whether orthodontic and/or functional jaw orthopedic treatment is an option for treating children with malocclusion and SDB.

Intra- and interobserver agreement in the diagnosis of malocclusion in sleep-disordered breathing.

UNLABELLED: Sleep-disordered breathing (SDB) is often related to malocclusion, and dentists should be able to recognize occlusal changes that may be associated with the development, onset, or persistence of SDB. Although clinical examination is routinely used by specialists in orthodontics and functional jaw orthopedics, differences in diagnosis are very common. METHOD: Two observers, both dentists specializing in functional jaw orthopedics, examined 56 children aged 7 to 9 years. Intra- and interobserver agreement in identification of functional orthopedic and orthodontic conditions were assessed. RESULTS: Intraobserver agreement was strong for all variables. Interobserver agreement was also strong, except for the variable overbite, which showed good agreement. CONCLUSION: Diagnostic criteria provide an opportunity for dentists to recognize dental malocclusions that may be associated with sleep-disordered breathing.

Intra- and interobserver agreement in the diagnosis of malocclusion in sleep-disordered breathing / Concordancia intra e inter observadores no diagnostico da ma oclusao dentaria nos disturbios respiratorios do sono

Sleep-disordered breathing (SDB) is often related to malocclusion, and dentists should be able to recognize occlusal changes that may be associated with the development, onset, or persistence of SDB. Although clinical examination is routinely used by specialists in orthodontics and functional jaw orthopedics, differences in diagnosis are very common. Method : Two observers, both dentists specializing in functional jaw orthopedics, examined 56 children aged 7 to 9 years. Intra- and interobserver agreement in identification of functional orthopedic and orthodontic conditions were assessed. Results : Intraobserver agreement was strong for all variables. Interobserver agreement was also strong, except for the variable overbite, which showed good agreement. Conclusion : Diagnostic criteria provide an opportunity for dentists to recognize dental malocclusions that may be associated with sleep-disordered breathing. .

Os distúrbios respiratórios do sono podem estar relacionados com problemas de má oclusão. O cirurgião dentista deve estar apto a reconhecer as alterações oclusais que possam estar associados com o desenvolvimento, instalação ou manutenção dos distúrbios respiratórios do sono. Apesar do exame clínico ser rotineiramente utilizado pelos especialistas em ortodontia e ortopedia funcional dos maxilares, a divergência no diagnóstico é muito frequente. Método : Dois observadores, cirurgiões dentistas, ortopedistas funcionais dos maxilares, examinaram 56 crianças entre 7 e 9 anos de idade para verificar a concordância intra e inter observador na identificação de problemas ortodônticos e ortopédicos funcionais. Resultados : A concordância intraobservador foi forte em todas as variáveis pesquisadas. A concordância interobservador também foi forte exceto na variável sobremordida que foi apresentou boa concordância. Conclusão : O estabelecimento de critérios diagnósticos explícitos dá oportunidade ao cirurgião dentista de reconhecimento das más oclusões dentárias potencialmente associadas aos distúrbios respiratórios do sono. .