Trigeminal nociceptive function and oral somatosensory functional and structural assessment in patients with diabetic peripheral neuropathy.

This case-control study primarily compared the trigeminal nociceptive function, the intraoral somatosensory profile and possible structural nerve changes between diabetic peripheral neuropathy (DPN, n = 12) patients and healthy participants (n = 12). The nociceptive blink reflex (nBR) was recorded applying an electrical stimulation over the entry zone of the right supraorbital (V1R), infraorbital (V2R) and mental (V3R) and left infraorbital (V2L) nerves. The outcomes were: individual electrical sensory (I0) and pain thresholds (IP); root mean square (RMS), area-under-the-curve (AUC) and onset latencies of R2 component of the nBR. Furthermore, a standardized full battery of quantitative sensory testing (QST) and intraepidermal nerve fibre density (IENFD) or  nerve fibre length density (NFLD) assessment were performed, respectively, on the distal leg and oral mucosa. As expected, all patients had altered somatosensory sensitivity and lower IENFD in the lower limb. DPN patients presented higher I0, IP, RMS and AUC values (p < 0.050), lower warm detection thresholds (WDT) (p = 0.004), higher occurrence of paradoxical heat sensation (PHS) (p = 0.040), and a lower intraoral NFLD (p = 0.048) than the healthy participants. In addition, the presence of any abnormal intraoral somatosensory finding was more frequent in the DPN patients when compared to the reference group (p = 0.013). Early signs of trigeminal nociceptive facilitation, intraoral somatosensory abnormalities and loss of intraoral neuronal tissue can be detected in DPN patients.

Reproducibility of quantitative sensory testing applied to musculoskeletal orofacial region: Site and sex differences.

BACKGROUND: This study estimated the inter-rater reliability and agreement of the somatosensory assessment performed at masseter and temporomandibular joint (TMJ) region in a group of healthy female and male participants. METHODS: Forty healthy participants (20 men and 20 women) were evaluated in two sessions by two different examiners. Cold detection threshold (CDT), warm detection threshold (WDT), thermal sensory limen (TSL), cold pain threshold (CPT), heat pain threshold (HPT), mechanical detection threshold (MDT), mechanical pain threshold (MPT), wind-up ratio (WUR) and pressure pain threshold (PPT) were assessed on the skin overlying TMJ and masseter body. Mixed ANOVA, intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were applied to the data (α = 5%). Nonoverlapping 95% confidence intervals (95% CI) of ICCs were considered significantly different. RESULTS: The ICCs of 77% of all quantitative sensory testing (QST) measurements were considered fair to excellent (ICCs: 0.47-0.97), and WUR presented the lowest values. The reliability of WDT, TSL and HPT of masseter was significantly higher than TMJ, whereas the MDT reliability of TMJ was higher than masseter. In addition, the following combination of test/sites presented significantly lower ICCs for women: HPT, MDT of TMJ and MPT of both TMJ and masseter. Finally, the highest SEM values were presented for CPT and MPT. CONCLUSION: The overall somatosensory assessment of the masticatory structures performed by two examiners can be considered sufficiently reliable to discriminate participants, except WUR. Possible site and sex influences on the reproducibility parameters should be taken into account for an appropriate interpretation and clinical application of QST. SIGNIFICANCE: The test site and participant's sex can significantly influence the relative reliability and agreement of quantitative sensory testing applied to musculoskeletal orofacial region, which affect the capacity to discriminate participants and to evaluate changes over time.

Muscle hardness and masticatory myofascial pain: Assessment and clinical relevance.

The impression of increased muscle hardness in painful muscles is commonly reported in the clinical practice but may be difficult to assess. Therefore, the aim of this review was to present and discuss relevant aspects regarding the assessment of muscle hardness and its association with myofascial temporomandibular disorder (TMD) pain. A non-systematic search for studies of muscle hardness assessment in patients with pain-related TMDs was carried out in PubMed, Cochrane Library, Embase and Google Scholar. Mechanical devices and ultrasound imaging (strain and shear wave elastography) have been consistently used to measure masticatory muscle hardness, although an undisputable reference standard is yet to be determined. Strain elastography has identified greater masseter hardness of the symptomatic side in patients with unilateral myofascial TMD pain when compared to the contralateral side and healthy controls (HC). Likewise, shear wave elastography has shown greater masseter elasticity modulus in patients with myofascial TMD pain when compared to HC, which may be an indication of muscle hardness. Although assessment bias could partly explain these preliminary findings, future randomised controlled trials are encouraged to investigate this relationship. This qualitative review indicates that the muscle hardness of masticatory muscles is still a rather unexplored field of investigation with a good potential to improve the assessment and potentially also the management of myofascial TMD pain. Nonetheless, the current evidence in favour of increased hardness in masticatory muscles in patients with myofascial TMD pain is weak, and the pathophysiological importance and clinical usefulness of such information remain unclear.

Test-retest reliability of quantitative sensory testing for mechanical somatosensory and pain modulation assessment of masticatory structures.

Assessing the reliability of medical measurements is a crucial step towards the elaboration of an applicable clinical instrument. There are few studies that evaluate the reliability of somatosensory assessment and pain modulation of masticatory structures. This study estimated the test-retest reliability, that is over time, of the mechanical somatosensory assessment of anterior temporalis, masseter and temporomandibular joint (TMJ) and the conditioned pain modulation (CPM) using the anterior temporalis as the test site. Twenty healthy women were evaluated in two sessions (1 week apart) by the same examiner. Mechanical detection threshold (MDT), mechanical pain threshold (MPT), wind-up ratio (WUR) and pressure pain threshold (PPT) were assessed on the skin overlying the anterior temporalis, masseter and TMJ of the dominant side. CPM was tested by comparing PPT before and during the hand immersion in a hot water bath. anova and intra-class correlation coefficients (ICCs) were applied to the data (α = 5%). The overall ICCs showed acceptable values for the test-retest reliability of mechanical somatosensory assessment of masticatory structures. The ICC values of 75% of all quantitative sensory measurements were considered fair to excellent (fair = 8·4%, good = 33·3% and excellent = 33·3%). However, the CPM paradigm presented poor reliability (ICC = 0·25). The mechanical somatosensory assessment of the masticatory structures, but not the proposed CPM protocol, can be considered sufficiently reliable over time to evaluate the trigeminal sensory function.

Headaches and myofascial temporomandibular disorders: overlapping entities, separate managements?

There are relevant clinical overlaps between some of the painful temporomandibular disorders (TMD) and headache conditions that may hamper the diagnostic process and treatment. A non-systematic search for studies on the relationship between TMD and headaches was carried out in the following databases: PubMed, Cochrane Library and Embase. Important pain mechanisms contributing to the close association and complex relationship between TMD and headache disorders are as follows: processes of peripheral and central sensitisation which take place in similar anatomical areas, the possible impairment of the descending modulatory pain pathways and the processes of referred pain. In addition, the clinical examination does not always provide distinguishing information to differentiate between headaches and TMD. So, considering the pathophysiology and the clinical presentation of some types of headache and myofascial TMD, such overlap can be considered not only a matter of comorbid relationship, but rather a question of disorders where the distinction lines are sometimes hard to identify. These concerns are certainly reflected in the current classification systems of both TMD and headache where the clinical consequences of diagnosis such as headache attributed to or associated with TMD are uncertain. There are several similarities in terms of therapeutic strategies used to manage myofascial TMD and headaches. Considering all these possible levels of interaction, we reinforce the recommendation for multidisciplinary approaches, by a team of oro-facial pain specialists and a neurologist (headache specialist), to attain the most precise differential diagnosis and initiate the best and most efficient treatment.

Effect of temporomandibular disorder therapy on otologic signs and symptoms: a systematic review.

The most common temporomandibular disorders (TMD) signs and symptoms are related to muscle sensitivity through palpation, restricted mouth opening, asymmetric mandibular movements, joint sounds, pain and otologic signs and symptoms. To date, counselling, occlusal splints, exercises, biofeedback and acupuncture are examples of conservative modalities proposed for TMD therapy. The aim of this systematic review was to investigate the effect of these conservative therapies for TMD on otologic signs and symptoms. The authors searched the following electronic databases published up to 1st May 2015: PubMed, LILACS, Scopus, Web of Science and Science Direct with no time or language limitations. Using a two-phase selection process, the authors identified 08 articles and used them to conduct a qualitative analysis. Methodological quality of each article was performed with the aid of 'Quality Assessment of a Cohort Study' and 'Quality Assessment of a Randomized Clinical Trial', developed by the Dutch Cochrane Centre, a centre of the Cochrane Collaboration. This systematic review showed in seven of the eight studies included that a total or partial resolution of otologic complains occurred after counselling, exercise therapies and occlusal splint therapy. Upon the limitations of the studies included in this systematic review, the present outcomes suggested that there is insufficient evidence in favour or against the conservative therapies for TMD on changes in otologic signs and symptoms. Thus, further studies with a higher level of evidence and more representative samples should be conducted to better understand the relationship of TMD therapy changes on otologic complains.

Somatosensory evaluation in Dysfunctional Syndrome patients.

Many chronic pain patients are refractory to treatment, which leads to the suspicion that somehow they are not fully effective and probably some mechanism of pain generation and/or maintenance is still unknown. The aim of this cross-sectional study was to provide evidence-based data on pain mechanisms in different types of chronic pain conditions. Eighty women, with 18-65 years old, were included, divided into four groups: myofascial pain of the masticatory muscles (n = 20), fibromyalgia (n = 20), chronic daily headache and healthy volunteers (n = 20). All patients were submitted to quantitative sensory tests: pressure pain threshold, mechanical detection threshold, mechanical pain threshold, ischaemic pain tolerance, cold pain sensitivity, aftersensation, wind-up ratio and conditioned pain modulation. Current perception threshold was also determined (Neurometer CPT/C - Neurotron). Three different zones were evaluated: trigeminal (masseter muscle), cervical and extratrigeminal (thenar eminence). Data were recorded and subjected to statistical analysis (anova, Tukey and Student's t-tests). Masticatory myofascial pain, fibromyalgia and chronic daily headache individuals presented lower pressure pain thresholds than healthy volunteers (P = 0.00). Chronic daily headache individuals had a significantly higher mechanical detection threshold than healthy volunteers (P = 0.01). Individuals of the symptomatic groups showed lower values for mechanical pain threshold and for ischaemic pain tolerance (P = 0.00) than healthy volunteers. The ability to activate the mechanism of endogenous modulation is impaired in women with fibromyalgia and myofascial pain (P = 0.00). These results reinforce evidence of central sensitisation and impaired endogenous modulation system in individuals with myofascial pain, fibromyalgia and chronic daily headache.

Headache attributed to masticatory myofascial pain: impact on facial pain and pressure pain threshold.

There is no clear evidence on how a headache attributed to temporomandibular disorder (TMD) can hinder the improvement of facial pain and masticatory muscle pain. The aim of this study was to measure the impact of a TMD-attributed headache on masticatory myofascial (MMF) pain management. The sample was comprised of adults with MMF pain measured according to the revised research diagnostic criteria for temporomandibular disorders (RDC/TMD) and additionally diagnosed with (Group 1, n = 17) or without (Group 2, n = 20) a TMD-attributed headache. Both groups received instructions on how to implement behavioural changes and use a stabilisation appliance for 5 months. The reported facial pain intensity (visual analogue scale--VAS) and pressure pain threshold (PPT--kgf cm(-2)) of the anterior temporalis, masseter and right forearm were measured at three assessment time points. Two-way anova was applied to the data, considering a 5% significance level. All groups had a reduction in their reported facial pain intensity (P < 0·001). Mean and standard deviation (SD) PPT values, from 1·33 (0·54) to 1·96 (1·06) kgf cm(-2) for the anterior temporalis in Group 1 (P = 0·016), and from 1·27 (0·35) to 1·72 (0·60) kgf cm(-2) for the masseter in Group 2 (P = 0·013), had significant improvement considering baseline versus the 5th-month assessment. However, no differences between the groups were found (P > 0·100). A TMD-attributed headache in patients with MMF pain does not negatively impact pain management, but does change the pattern for muscle pain improvement.

Determination of a pressure pain threshold cut-off value for the diagnosis of temporomandibular joint arthralgia.

Temporomandibular joint (TMJ) disorders are divided by the American Academy of Orofacial Pain into five categories. The most common ones are joint pain, as arthralgia and joint disorders, as disc displacements. An important clinical presentation of arthralgia is the painful tenderness to manual palpation or decreased pressure pain threshold (PPT). The authors conducted a study to determine the appropriate PPT value to discriminate asymptomatic TMJ individuals from those with moderate to severe arthralgia. Forty-nine individuals was evaluated and divided into groups: TMJ arthralgia, asymptomatic disc displacement and control group. Magnetic resonance images were obtained for all the groups, and algometry was performed on the TMJ lateral pole. Patients with arthralgia filled out a visual analogue scale (VAS). anova test with 1% of significance analysed the data. Specificity, sensitivity and ROC curve were also determined. Arthralgia group had significant lower PPT (mean of 1.07 kgf cm(-2) ) than the others. Asymptomatic disc displacement group (mean of 1.64 kgf cm(-2) ) has shown significant lower PPT than the control (mean of 2.35 kgf cm(-2) ). 89.66% of specificity and 70% of sensitivity were obtained when 1.36 kgf cm(-2) was applied to the TMJ (ROC area = 0.90). This value was considered to be the most appropriate to detected moderate to severe TMJ arthralgia. Indeed, the presence of disc displacement seems to significantly decrease PPT levels in asymptomatic subjects. The PPT value of 1.36 kgf cm(-2) can be used in the calibration procedures of the professionals involved with temporomandibular disorders and orofacial pain.

Behavioural changes and occlusal splints are effective in the management of masticatory myofascial pain: a short-term evaluation.

The aim of this research was to test the hypothesis that treatment with intra-oral appliances with different occlusal designs was beneficial in the management of pain of masticatory muscles compared with a control group. A total of 51 patients were analysed according to the research diagnostic criteria for temporomandibular disorders (RDC/TMD) to obtain the diagnosis of masticatory myofascial pain (MMP). The sample was then randomly divided into three groups: group I (n = 21) wore a full coverage acrylic stabilisation occlusal splint; group II (n = 16) wore an anterior device nociceptive trigeminal inhibitory (NTI) system; and group III (n = 14) only received counselling for behavioural changes and self-care (the control group). The first two groups also received counselling. Follow-ups were performed after 2 and 6 weeks and 3 months. In these sessions, patients were evaluated by means of a visual analogue scale (VAS) and pressure pain threshold (PPT) of the masticatory muscles. Possible adverse effects were also recorded, such as discomfort while using the appliance and occlusal changes. The results were analysed with Kruskal-Wallis, anova, Tukey's and Friedman tests, with a significance level of 5%. Group I showed improvement in the reported pain at the first follow-up (2 weeks), whereas for groups II and III, this progress was detected only after 6 weeks and 3 months, respectively. The PPT values did not change significantly. It was concluded that behavioural changes are effective in the management of pain in MMP patients. However, the simultaneous use of occlusal devices appears to produce an earlier improvement.

Temporomandibular disorders, otologic symptoms and depression levels in tinnitus patients.

The aim of this study was to determine the prevalence of signs and symptoms of temporomandibular disorders (TMD) and otologic symptoms in patients with and without tinnitus. The influence of the level of depression was also addressed. The tinnitus group was comprised of 100 patients with tinnitus, and control group was comprised of 100 individuals without tinnitus. All subjects were evaluated using the research diagnostic criteria for temporomandibular disorders (RDC/TMD) to determine the presence of TMD and depression level. Chi-square, Spearman Correlation and Mann-Whitney tests were used in statistical analysis, with a 5% significance level. TMD signs and symptoms were detected in 85% of patients with tinnitus and in 55% of controls (P≤0·001). The severity of pain and higher depression levels were positively associated with tinnitus (P≤0·001). It was concluded that tinnitus is associated with TMD and with otalgia, dizziness/vertigo, stuffy sensations, hypoacusis sensation and hyperacusis, as well as with higher depression levels.

Evaluation of minimum interdental threshold ability in dentate female temporomandibular disorder patients.

Minimum interdental threshold is the smallest thickness that can be detected between teeth during an occlusion and has an influence on the occlusal force and on the control of mandibular movements. The aim of this study was to assess the possible association of the signs and symptoms of temporomandibular disorders (TMD) with the ability to detect a minimum interdental threshold. Two hundred women were equally divided into four groups: asymptomatic (control), subjects with masticatory muscle pain, with articular [temporomandibular joint (TMJ)] pain and mixed (muscular and articular pain). Evaluation of the ability to detect a minimum interdental threshold was performed using aluminium foils with 0.010, 0.024, 0.030, 0.050, 0.080 and 0.094 mm of thickness in the premolar region. A total of 20 tests with each thickness for each patient were performed, starting with the thickest foil (0.094 mm) and ending with the thinnest one. The myogenic pain and articular groups presented significantly higher threshold values (0.020 and 0.022 mm, respectively), when compared to the control. Both groups reached the level of certain perceptiveness only at 0.030 mm. No significant correlation was found between minimum interdental threshold and age. These results suggest that discrimination of thicknesses can be disturbed as a consequence of TMD manifestations and not the cause of it. Clinicians should, therefore, be aware that changes on muscles and TMJ can secondarily lead to occlusion changes. The mechanisms involved in this process, however, are not well understood and warrant further investigation.

The impact of stress and anxiety on the pressure pain threshold of myofascial pain patients.

The purpose of this study was to evaluate the influence of stress and anxiety on the pressure pain threshold (PPT) of masticatory muscles and on the subjective pain report. Forty-five women, students, with mean age of 19.75 years, were divided into two groups: group 1:29 presenting with masticatory myofascial pain (MFP), according to the Research Diagnostic Criteria for Temporomandibular Disorders and group 2: 16 asymptomatic controls. An electronic algometer registered the pain thresholds on four different occasions throughout the academic year. To measure levels of stress, anxiety and pain, the Beck Anxiety Inventory, Lipp Stress Symptoms Inventory and Visual Analog Scale (VAS) were used. Three-way anova and Tukey's tests were used to verify differences in PPT between groups, times and sites. Levels of anxiety and VAS were compared using Mann-Whitney test, while Friedman's test was used for the within-groups comparison at different times (T1 to T4). The chi-squared and Cochran tests were performed to compare groups for the proportion of subjects with stress (alpha = 0.05). Differences in PPT recordings between time (P = 0.001) and sites (P < 0.001) were detected. Higher levels of anxiety and lower PPT figures were detected at T2 (academic examination) (P = 0.001). There was no difference between groups for anxiety and stress at any time (P > 0.05). The MFP group also has shown significant increase of VAS at the time of academic examination (P < 0.001). External stressors such as academic examinations have a potential impact on masticatory muscle tenderness, regardless of the presence of a previous condition such as masticatory myofascial pain.

Evaluation of maximal bite force in temporomandibular disorders patients.

The aim of this study was to evaluate the maximum bite force in temporomandibular disorders (TMD) patients. Two hundred women were equally divided into four groups: myogenic TMD, articular TMD, mixed TMD and control. The maximum bite force was measured in the first molar area, on both sides, in two sessions, using an IDDK (Kratos) Model digital dynamometer, adapted to oral conditions. Three-way anova, Tukey and Pearson correlation tests were used for the statistical analysis. The level of statistical significance was given when P < or = 0.05. The maximal bite force values were significantly higher in the control group than in the experimental ones (P = 0.00), with no significant differences between sides. Higher values were obtained in the second session (P = 0.001). Indeed, moderate negative correlation was found between age and bite force, when articular, mixed groups and all groups together were evaluated. A moderate negative correlation was also detected between TMD severity and the maximal bite force values for myogenic, mixed and all groups together. Authors concluded that the presence of masticatory muscle pain and/or TMJ inflammation can play a role in maximum bite force. The mechanisms involved in this process, however, are not well understood and deserve further investigation.

Evaluation of fracture resistance of endodontically treated maxillary premolars, restored with ceromer or heat-pressed ceramic inlays and fixed with dual-resin cements.

The aim of this study was to evaluate the fracture resistance of endodontically maxillary premolars restored with mesio-occlusal-distal (MOD) inlays made with ceramic (IPS-Empress 2) and ceromer (Targis) and luted with three different dual-cured resin cements (Enforce, Variolink II, Panavia F). Sixty maxillary premolars were randomly distributed into six groups, according to their mesio-distal and facio-lingual dimensions. The teeth were endodontically treated and MOD cavities prepared. After the restorations were cemented, the samples were thermocycled and submitted to an axial compressive load by the action of a rounded end steel cylinder contacting the incline planes of occlusal surfaces of the teeth. The mode of fracture was analysed with a microscope. The best results were found with the combinations (cement/restorative material) Enforce/Targis (107.57 kgf) and Enforce/Empress (90.21 kgf) followed by Variolink II/Targis (86.44 kgf)-Variolink II/Empress (84.07 kgf) and Panavia F/Targis (82.43 kgf)-Panavia F/Empress (76.73 kgf). Analysis of variance (P < 0.05) showed a significant difference between Enforce and Panavia cements regardless of the restorative material. Considering the same luting agent there was no statistically significant difference between the restorative materials. Fracture of lingual cusps occurred in 55 of the 60 teeth and most of them were of the cohesive type.

Pain measurement in TMD patients: evaluation of precision and sensitivity of different scales.

The aim of this study was to evaluate the precision and sensitivity of four different pain rating scales in 59 temporomandibular disorders (TMD) patients. The capacity of describing changes in symptoms during treatment was also addressed. All patients were asked to answer four pain scales: Visual Analogue Scale (VAS), Numerical Scale (NS), Behaviour Rating Scale (BRS) and Verbal Scale (VS). Two measurements were taken before any treatment. After beginning it, follow-ups and repeated measurements were taken 1 week, 15 days, and every month for 6 months. Statistical analysis showed significant differences (P < 0.05) for all scales, but the NS (P > 0.05), when the two initial measurements were analysed. Regarding the sensitivity, all pain scales demonstrated general symptom improvement of 30-50%, when initial and final figures were compared (P < 0.01). Also, the most significant improvement occurred in the first 2 months after beginning the management programme. Authors concluded that the NS was more accurate to measure reproducibility of pain. As for the capacity of expressing changes during the treatment, all scales demonstrated symptom decrease of 30-50% in a period of 6 months. Caution when analysing the results is recommended because of the subjective aspect of pain measurement, the absence of a 'gold standard' for comparison and the natural fluctuation of TMD symptoms.

Relationship between systemic joint laxity, TMJ hypertranslation, and intra-articular disorders.

The aim of this study was to evaluate the correlation between general joint hypermobility, temporomandibular joint (TMJ) hypertranslation and signs and symptoms of TMJ intra-articular disorders. One hundred twenty individuals constituted the sample, divided into two groups: Group I (symptomatic) included 60 patients with complaints of joint noises, pain, or jaw locking, and Group II (nonsymptomatic) included 60 people with no TMD complaints. The Beighton's hypermobility score addressed the systemic laxity while lateral x-rays taken in both closed and full open mouth positions measured TMJ mobility (condyle hypertranslation). No association was found between intra-articular disorders and systemic hypermobility (p > 0.05). A significant negative correlation (p < 0.05) was found between age and systemic hypermobility, while no correlation was detected between systemic and TMJ hypermobility (condyle hypertranslation).

Tissue sculpturing: an alternative method for improving esthetics of anterior fixed prosthodontics.

Esthetics associated with health of surrounding tissues in fixed prosthodontics is arduous, especially when treating the maxillary anterior region. An unfavorable relationship between residual ridge, pontic, and gingival papilla commonly compromises the final result. Alternative procedures based on biologic procedures can be developed to improve relationships and provide esthetic and functionally acceptable fixed partial dentures. This article describes a technique for the improvement of esthetics with conditioning of the tissue beneath the pontics, by displacing tissue with a treatment restoration. Lateral displacement of tissue under gradual, controlled pressure enhances the interdental papilla, which improves esthetics. The role of plaque control is also discussed in this article.

Low level laser therapy in the treatment of temporomandibular disorders (TMD): a double-blind pilot study.

The aim of this paper was to evaluate the efficacy of a Low-Level Laser therapy in patients with Temporomandibular Disorders (TMD) using a double-blind design. A sample of 20 patients with a chief complaint of pain was divided into myogenous and arthrogenous groups. The sample was also divided on the basis of the treatment rendered: real versus placebo treatment. An 830 nm Ga-Al-As Laser device with a energy power of 4 joules was used (OMNILASE, LASERDYNE PTY LTD.) in three treatment sessions. To evaluate the effectiveness of laser treatment, a Visual Analogue Scale (VAS) was used for pain and active range of motion (AROM) was used to measure changes in mandibular function. Using real laser treatment, the author found that there was a reported improvement in pain only for the myogenous pain patients (p < or = 0.02). For the arthrogenous pain patients, real laser treatment resulted in an improvement in Total Vertical Opening (TVO) (p < 0.05), Protrusive excursion (PROT) (p < 0.02) and Left lateral excursion (LATLEF) (p < 0.02). The placebo control group showed improvement in TVO and PROT for those patients having myogenous pain and LATLEF for those patients having arthrogenous pain. A repeated measurement one-way ANOVA demonstrated no significant differences between real and placebo groups. Considering the non-invasive and harmless characteristics of this modality, more research is recommended, using higher power and increased frequency of laser applications.

A cross-sectional study of prevalence and etiology of signs and symptoms of temporomandibular disorders in high school and university students.

The aim of this study was to evaluate the prevalence and need for treatment of temporomandibular disorders (TMD) in students living in Bauru, Brazil. The role of occlusal and emotional factors was also addressed. The presence and severity of TMD was determined by using a self-reported anamnestic questionnaire composed of 10 questions regarding common TMD symptoms. The symptoms were transposed into a severity classification according to the number and frequency of positive responses. Occlusal evaluation included an analysis of retruded contact position, intercuspal position, anterolateral guidance, and nonworking side contacts during mandibular movements. Palpation of the muscles and temporomandibular joints were performed to detect clinical signs of TMD. A chi square test was used to compare clinical and occlusal data with the presence and severity of TMD. A total of 0.65% of the subjects had severe TMD symptoms, 5.81% had moderate symptoms, and 34.84% had mild symptoms. Those with severe and moderate symptom levels were interpreted to be in need of treatment. Symptoms were found significantly more frequently in females than in males (P < .01). Self-reported emotional tension and parafunctional habits demonstrated strong associations with TMD (P < .01). Occlusion did not seem to influence the presence or severity of TMD. Based on these results, the efficacy of some traditional TMD treatments should be reconsidered, and reversible and conservative procedures should be the first choice for managing TMD patients.