Effect of Dry Needling on the Masseter Muscle in the Tinnitus Perception of Patients with Temporomandibular Disorder.

Objective: To evaluate the effect of dry needling on the masseter muscle in the perception of tinnitus in patients with temporomandibular disorder. Methods: Twenty-five patients with tinnitus and muscular temporomandibular disorders were randomly assigned to groups study (n = 13) and control (n = 12). Three sessions of dry needling (study) and sham (control) were performed. Follow-up was performed 30, 60 and 90 days after the end of treatment. The Analog Visual Scale and Tinnitus Handicap Inventory (THI) were used to evaluate the treatment. Results: In study group, 76.9% presented a reduction in the intensity and tinnitus discomfort and total THI. In control group, 66.7% presented a decrease in tinnitus intensity and total THI, and 58.3% reported a decrease in tinnitus discomfort. After 90 days, in the study group, 84.6% maintained improvement in pain intensity and reduction in THI score and 69.2% reported improvement in both intensity and discomfort caused by tinnitus. In control group, 75% achieved improvement in pain intensity, 33.2% maintained improvement in tinnitus intensity, and 41.7% maintained improvement in discomfort caused by tinnitus and total THI. In the total THI score, the study group presented improvement (p = 0.041). Conclusion: Dry needling combined with counseling was associated with improvement in pain intensity and tinnitus, decrease in tinnitus discomfort and reduction in total THI score.

Fatores biopsicossociais do Eixo II dos Critérios de Diagnóstico para Pesquisa das Desordens Temporomandibulares em indivíduos com disfunção temporomandibular muscular e migrânea / Biopsychosocial factors of Axis II of the Research Diagnostic Criteria for Temporomandibular Disorders in individuals with muscular temporomandibular disorder and migraine

RESUMO JUSTIFICATIVA E OBJETIVOS: Relacionar as variáveis biopsicossociais do Research Diagnostic Criteria for Temporomandibular Disorders com os grupos de pacientes com disfunção temporomandibular, com disfunção temporomandibular e migrânea e grupo controle. MÉTODOS: Estudo do tipo observacional transversal onde foram avaliados 280 pacientes consecutivos, divididos em 3 grupos: grupo I (140 indivíduos controle); grupo II (65 indivíduos com disfunção temporomandibular muscular) e grupo III (75 indivíduos com migrânea e disfunção temporomandibular muscular). Os critérios de exclusão foram indivíduos que apresentaram histórico clínico de processos inflamatórios musculares, espasmos musculares, contraturas e injúria traumática aguda na articulação temporomandibular. RESULTADOS: Os indivíduos do grupo III apresentaram associação com depressão grave (p<0,0001), grau 4 na variável intensidade da dor (p=0,004), sintomas físicos não específicos sem dor intensa (p<0,0001) e sintomas físicos não específicos com dor intensa (p<0,0001). Houve diferença significativa entre os gêneros feminino e masculino no grupo III (Z=2,59; p=0,001), evidenciando maior tempo de dor no gênero feminino. A porcentagem de mulheres no grupo III foi significativamente maior em relação aos homens (p=0,004). CONCLUSÃO: A relação entre as variáveis e os três grupos mostrou maior número de indivíduos acometidos com maior intensidade de sintomas no grupo III. Dessa forma, entende-se que a migrânea é uma condição mórbida frequentemente associada à disfunção temporomandibular, potencializando os sintomas descritos pelos pacientes. Há necessidade de avaliações clínicas multidisciplinares nesses indivíduos para que o tratamento seja otimizado, minimizando a morbidade e diminuindo os custos e o número de consultas prestadas aos pacientes.

ABSTRACT BACKGROUND AND OBJECTIVES: To relate biopsychosocial variables of Research Diagnostic Criteria for Temporomandibular Disorders to groups of patients with temporomandibular disorders, temporomandibular disorders and migraine and a control group. METHODS: This is a cross-sectional observational study where 280 consecutive patients were evaluated and distributed in three groups: group I (140 control individuals); group II (65 individuals with muscle temporomandibular disorders) and group III (75 individuals with migraine and muscle temporomandibular disorders). Exclusion criteria were individuals with clinical history of muscle inflammatory processes, muscle spasms, contractures and acute temporomandibular joint traumatic injury. RESULTS: Group III individuals had association with severe depression (p<0.001), level 4 in pain severity (p=0.004), unspecific physical symptoms without severe pain (p<0.0001) and unspecific symptoms with severe pain (p<0.00001). There has been significant difference between females and males in group III (Z=2.59; p=0.001), with longer pain duration among females. The percentage of females in group III was significantly higher as compared to males (p=0.004). CONCLUSION: The relationship between variables and the three groups has shown a higher number of individuals with more severe symptoms in group III. So, it is understood that migraine is a morbid condition often associated to temporo mandibular disorders, worsening symptoms referred by patients. There is the need for multidisciplinary evaluation of these individuals to optimize treatment and minimize morbidity, costs and the number of medical visits.

Muscle fiber type composition, fiber diameter, capillary density in temporalis and masseter muscles and correlation with bite force / Tipos de fibras musculares, diámetro de fibras y densidad capilar en los músculos masetero y temporal y su correlación con la fuerza de mordida

The jaw muscles are essential components in the stomatognatic system. Their complex architecture allows them to execute several motor tasks. One of the structural peculiarities is the presence of hybrid and neonatal fibers.We studied the differences of the fiber-type in masseter and temporalis muscles along the first to nineth decades in both genders. Seventy-four (74) samples were analyzed by immunohistochemistry. Slow and fast muscle fibers distribution was similar in both muscles in both genders. Hybrid fiber was observed in all decades, and its frequency decreased significantly (p<0.001) with aging in masseter. Neonatal myosin expression was observed in all decades, its expression was more frequent in masseter (p=0.01), and males in temporalis (p=0.025). Decrease of the cross sectional area of fast and slow fibers, and decrease of capillary density were detected with aging. These morpho-immunohistochemical alterations on masseter and temporalis muscles correlated to the decrease in bite force with aging.

Los músculos cráneomandibulares son componentes esenciales en el sistema estomatognático. Su arquitectura compleja les permite ejecutar variadas tareas motoras. Una de sus características estructurales es la presencia de fibras musculares híbridas y neonatales. Se estudiaron las diferencias del tipo de fibra en los músculos masetero y temporal en la primera a novena décadas dela vida en ambos sexos. Setenta y cuatro (74) muestras se analizaron por inmunohistoquímica. La distribución de lãs fibras musculares lentas y rápidas fue similar en ambos músculos en ambos sexos. Fibras musculares híbridas fueron observadas en todas las décadas, pero su frecuencia disminuyó significativamente (p <0,001) con el envejecimiento en el masétero. La expresión de miosina neonatal se observo em todas los grupos analizados, aunque su expresión era más frecuente en los músculos maseteros (p = 0,01) y en varones en el temporal (p = 0,025). Se observo una disminución del área de la sección transversal de las fibras rápidas y lentas, y disminución de la densidad capilar al aumentar La edad. Estas alteraciones morfológicas en los músculos masetero y temporal se correlacionan con la disminución de la fuerza asociada al envejecimiento.

Análise crítica da concentraçäo de íons flúor em três águas minerais comercializadas no município de Säo Paulo, e sua importância nos esquemas terapêuticos com os compostos fluorados / Critical analysis of fluoride ions in three mineral waters sold in the city of Säo Paulo and its importance in fluoride therapeutic schedule

O objetivo deste estudo foi mostrar, na situaçäo descrita, o grande risco de fluorese dentária em alunos na idade pré-escolar. Avaliaçäo da concentraçäo de íons flúor em três águas minerais comercializadas no município de Säo Paulo. Imporancia nos esquemas terapêuticos de regiöes onde se faz o uso de água fluorada, e ocorre a ingestäo inadvertida de dentifrícios e suplementos dietéticos fluorados.(au)