Effectiveness of Laser Acupuncture for Reducing Pain and Increasing Mouth Opening Range in Individuals with Temporomandibular Disorder: A Systematic Review and Network Meta-Analysis.

PURPOSE OF REVIEW: Laser acupuncture (LA) demonstrates promising results in the treatment of musculoskeletal disorders. However, its effects on temporomandibular disorder (TMD) are not yet fully understood. Thus, the aim of this systematic review and network meta-analysis was to assess the effectiveness of LA on pain intensity and maximum mouth opening range (MMO) related to TMD. A search was carried out in 11 electronic databases and references of included studies to locate randomized clinical trials (RCTs) that evaluated LA as a primary treatment for TMD. The risk of bias was assessed using the RoB 2 tool. Network meta-analysis was conducted on the MetaInsight platform, considering the pain intensity and counseling (C) as the outcome of reference. The GRADE system was used to assess the certainty of the evidence. RECENT FINDINGS: Five studies evaluated pain intensity, four with a high risk of bias and one with a low risk. Two studies evaluated pain intensity on palpation (one with high and one with low risk of bias), and one study with high risk of bias evaluated MMO. Laser parameters were: 690-810 nm, 40-150 mW, and 7.5-112.5 J/cm2. Occlusal splint (OS) [- 2.47; CI 95% - 3.64, - 1.30] and Physiotherapy (PT) [-2.64; CI 95% - 3.94, - 1.34] reduced pain intensity compared to C. The ranking of treatments in order of effectiveness was PT > OS > LA > C > CR (craniopuncture). The certainty of the evidence was very low or low. The data do not support the indication of LA for the treatment of TMDs and new placebo-controlled RCTs must be conducted to demonstrate its effectiveness more precisely.

Temporomandibular disorders: knowledge, competency, and attitudes of predoctoral dental students.

OBJECTIVE: To evaluate knowledge, competency, and attitudes related to temporomandibular disorders (TMD) among predoctoral dental students, and to investigate the curricular organization of contents related to TMD and occlusion. METHODS: Predoctoral dental students (n = 147) answered a questionnaire with topics related to TMD. Another questionnaire evaluated the organization of TMD and occlusion courses. RESULTS: Contents related to TMD and occlusion were taught in the same course in all dental schools. The students' responses showed low agreement with the current gold standards pertaining to TMD. Most students declared that they did not feel confident to treat patients with TMD (62.6%), were not satisfied with the content pertaining to TMD (55.8%), and considered a lack of clinical practice to be the primary limitation in their training (59.2%). DISCUSSION: Students' knowledge of basic concepts related to TMD was limited, highlighting the need for readjustment of the dental curriculum to increase clinical experience.

Enhancement patterns of adrenal nodules on magnetic resonance imaging

ABSTRACT Objective: To compare enhancement patterns of typical adrenal adenomas, lipid-poor adenomas, and non-adenomas on magnetic resonance imaging (MRI). Materials and Methods: Evaluation of adrenal nodules larger than 1.0 cm, with at least 2-year follow-up, evaluated on MRI in January 2007 and December 2016. Two different protocols were included - upper abdomen MRI (delayed phase after 3 minutes) and abdomen and pelvis MRI (delayed phase after 7 minutes) - and nodules were divided in typical adenomas (characterized on out-of-phase MRI sequence), lipid-poor adenomas (based on follow-up imaging stability) and non-adenomas (based on pathological finding or follow-up imaging). T2-weighted and enhancement features were analyzed (absolute and relative washout and enhancement curve pattern), similarly to classic computed tomography equations. Results: Final cohort was composed of 123 nodules in 116 patients (mean diameter of 1.8 cm and mean follow up time of 4 years and 3 months). Of them, 98 (79%) nodules had features of typical adenomas by quantitative chemical shift imaging, and demonstrated type 3 curve pattern in 77%, mean absolute and relative washout of 29% and 16%, respectively. Size, oncologic history and T2-weighted features showed statistically significant differences among groups. Also, a threshold greater than 11.75% for absolute washout on MRI achieved sensitivity of 71.4% and specificity of 70.0%, in differentiating typical adenomas from non-adenomas. Conclusion: Calculating absolute washout of adrenal nodules on MRI may help identifying proportion of non-adenomas.

Enhancement patterns of adrenal nodules on magnetic resonance imaging.

OBJECTIVE: To compare enhancement patterns of typical adrenal adenomas, lipid-poor adenomas, and non-adenomas on magnetic resonance imaging (MRI). MATERIALS AND METHODS: Evaluation of adrenal nodules larger than 1.0 cm, with at least 2-year follow-up, evaluated on MRI in January 2007 and December 2016. Two different protocols were included - upper abdomen MRI (delayed phase after 3 minutes) and abdomen and pelvis MRI (delayed phase after 7 minutes) - and nodules were divided in typical adenomas (characterized on out-of-phase MRI sequence), lipid-poor adenomas (based on follow-up imaging stability) and non-adenomas (based on pathological finding or follow-up imaging). T2-weighted and enhancement features were analyzed (absolute and relative washout and enhancement curve pattern), similarly to classic computed tomography equations. RESULTS: Final cohort was composed of 123 nodules in 116 patients (mean diameter of 1.8 cm and mean follow up time of 4 years and 3 months). Of them, 98 (79%) nodules had features of typical adenomas by quantitative chemical shift imaging, and demonstrated type 3 curve pattern in 77%, mean absolute and relative washout of 29% and 16%, respectively. Size, oncologic history and T2-weighted features showed statistically significant differences among groups. Also, a threshold greater than 11.75% for absolute washout on MRI achieved sensitivity of 71.4% and specificity of 70.0%, in differentiating typical adenomas from non-adenomas. CONCLUSION: Calculating absolute washout of adrenal nodules on MRI may help identifying proportion of non-adenomas.

Human anatomy education and management of anatomic specimens during and after COVID-19 pandemic: Ethical, legal and biosafety aspects.

COVID-19 is an infection caused by the SARS-CoV-2 virus, initially identified in the city of Wuhan, China, in December 2019. Since then, the virus has spread to the continents, causing a major pandemic. The impacts of this pandemic on the education of human anatomy interfere in at least two aspects: (1) receiving and managing anatomical specimens in anatomy laboratories and (2) adaptations for classes on remote virtual teaching. Therefore, this study reviewed and discussed the legal and bioethical aspects, considering the scenario of a South American Country, aiming to stimulate the debate on these two relevant themes in the international community. Because of the COVID-19 pandemic and the impossibility of mass testing, anatomists and other workers in the field must deal with the risk of receiving bodies infected with SARS-CoV-2. In this situation, additional care measures in biosafety practices are essential to protect the staff. Such measures are: the bodies must be preserved by the perfusion of formaldehyde or other fixative solutions; embalming must be performed in ventilated rooms with a good air exhaust system; to avoid excessive manipulation of bodies and procedures such as pulmonary insufflation or craniotomy; and proper use of personal protective equipment, including lab coat, gloves and masks. As for exposure of body images in online classes, this review showed that there are no legal impediments to this end. However, anatomists must adopt measures aimed at protecting the memory of the deceased, such as using secure digital platforms with restricted access; family authorization/consent and student awareness.

Photobiostimulation activity of different low-level laser dosage on masticatory muscles and temporomandibular joint in an induced arthritis rat model.

This study aimed to investigate the anti-inflammatory effects of different dosage of low-level laser therapy (LLLT) in an experimental model of temporomandibular joint (TMJ) arthritis. One hundred male Wistar rats were used and divided into the following groups: CG, control group; AG, animals group with left TMJ arthritis induced by intra-articular injection of Complete Freund's adjuvant - CFA; LG5, LG10 and LG20 - animals with arthritis and treated with LLLT at doses 5, 10, and 20 J/cm2, respectively. Morphological analysis was performed by TMJ histological sections stained with hematoxylin-eosin (HE), picrosirius (PSR), and toluidine blue (TB), as well as histomorphometric evaluation of cartilage, articular disc, and masticatory muscles. The amount of feed consumed within 3 weeks was evaluated, and biochemical analysis of TMJ tissues included measurement of sulfated glycosaminoglycans (GAGs), matrix metalloproteinases (MMPs) 2 and 9 zymography, and ELISA for cytokines IL-6, TNF-α, and IL-1ß. Only the 20 J/cm2 dose promoted higher feed intake compared to AG. On the other hand, all LLLT doses promoted better organization of articular disc collagen fibers, greater number of proteoglycans in articular cartilage, increased area and diameter of left lateral pterygoid fibers, reduced latent and active MMP 9 and 2 activity, and lower IL-1ß concentration compared to AG. Considering the study limitations, it was observed that LLLT treatments were effective in protecting and tissue cleansing joint structures, accelerating tissue repair, especially at lower doses.

Polishing Methods' Influence on Color Stability and Roughness of 2 Provisional Prosthodontic Materials.

PURPOSE: To evaluate the roughness and color change of a conventional acrylic resin and a bis-acryl resin, submitted to different types of polishing and exposed to a staining solution. MATERIALS AND METHODS: One hundred specimens were manufactured from an autopolymerizing conventional acrylic resin (Duralay, shade 66) (n = 50) and a bis-acryl resin (Protemp 4, shade A3) (n = 50) according to the manufacturers' instructions. Specimens were subdivided into 10 groups (n = 10), according to the type of resin and polishing method, including no-polishing (control groups for acrylic resin [tungsten bur finishing] and bis-acryl resin [cotton and alcohol]), Enhance System, Edenta kit, Labordental kit, and sandpaper. The specimens were immersed in a staining solution (coffee at 60°C) for 7 days. Surface roughness was evaluated before the first immersion (baseline - Ra1) and after 7 days (Ra2). The color change (∆E) was determined after 24 hours (∆E1) and 7 days (∆E2), by CIE L* a* b* scale. Data were statistically analyzed with 3-way ANOVA for repeated measures test and Tukey test (α = 0.05). RESULTS: According to 3-way ANOVA test, material, polishing techniques, and polishing*material factors exhibited statistically significant influence (p < 0.0001) on the roughness, and, for color change, material, polishing techniques, time, polishing*material, and material*time factors were statistically significant (p < 0.0001). The polishing techniques successfully reduced the surface roughness of acrylic resin groups, when compared to control (p < 0.001), but for bis-acryl resin, results were not different from the control group (Enhance: p = 0.954, Edenta: p = 0.866, sandpaper: p = 0.366, Labordental: p = 0.945). Surface roughness was not affected by the immersion in staining solution for 7 days. Color change of acrylic resin groups after 24 hours and 7 days of immersion exhibited a clinically acceptable value (ΔE < 3.7) with the exception of the Enhance group, and all bis-acryl resin groups exhibited a clinically unacceptable color change value (ΔE > 3.7) independent of polishing technique and time interval (∆E1 and ∆E2). CONCLUSIONS: Roughness of both materials was similar when the polishing techniques studied were performed, although Ra values were superior to the clinically acceptable values (0.20 µm), and were not affected by the immersion protocol studied; however, when esthetics are critical, the selection of material type is more important than the surface treatment technique used, and bis-acryl resin was more susceptible to clinically unacceptable color change after immersion in a staining solution.

Experimental model of temporomandibular joint arthritis: Evaluation of contralateral joint and masticatory muscles.

OBJECTIVE: To investigate morphological and biochemical changes in an experimental model of temporomandibular joint (TMJ) arthritis, as well as examine contralateral joint involvement and morphometric aspects of masticatory muscles in affected animals. DESIGN: Forty Wistar rats were allocated into three groups, as follows: a healthy control group (HG); and a group with arthritis induced in the left TMJ (IG); and a contralateral group with noninflamed right TMJ (CG). Arthritis was induced by intra-articular injection of 50 µL of Complete Freund's Adjuvant (CFA). Morphological analysis was performed using histological sections of TMJs stained with hematoxylin-eosin, picrosirius and toluidine blue. In addition, histomorphometric analyses of the articular cartilage, articular disc and masticatory muscles, were performed. Biochemical analysis of TMJ tissues included dosage of sulfated glycosaminoglycans (GAGs), zymography of the Matrix Metalloproteinases (MMPs) 2 and 9 and ELISA for the cytokines IL-6, TNF-α and IL-1ß. The data were analyzed by paired and unpaired t-tests, with a p < 0.05. RESULTS: IG animals presented morphological and biochemical changes in their TMJ, including synovial membrane hyperplasia; chronic inflammatory infiltrate; collagen fiber disorganization in the disc; reduced proteoglycans in the cartilage; greater disc thickness; lower cartilage thickness; lower feed intake; higher activity of MMP-9 and MMP-2, and higher concentration of IL-6, TNF-α, and IL-1ß, as compared to HG. CG animals showed posterior disc thickening; reduced proteoglycans in the cartilage; lower collagen fiber organization of the disc; active MMP-9, and higher concentration of IL-6 and TNF-α compared to HG animals. Articular inflammation reduced the area and diameter of fibers of the temporal (right), medial pterygoid (left), and lateral pterygoid (right and left) muscles as compared to HG animals. CONCLUSION: TMJ arthritis reduced the area and diameter of masticatory muscle fibers and caused morphological and molecular changes in the contralateral joint.

Prevalência de sinais e sintomas de disfunção temporomandibular em estudantes pré-vestibulandos: associação de fatores emocionais, hábitos parafuncionais e impacto na qualidade de vida / Prevalence of signs and symptoms of temporomandibular disorders in college preparatory students: associations with emotional factors, parafunctional habits, and impact on quality of life

Resumo O objetivo deste estudo foi avaliar a prevalência de sinais e sintomas de disfunção temporomandibular (DTM), sua associação com gênero, hábitos parafuncionais, tensão emocional, ansiedade e depressão e, o seu impacto sobre a qualidade de vida relacionada com a saúde oral (QVRSO) em estudantes pré-vestibulandos de instituições públicas e privadas de João Pessoa/PB. A presença de sintomas de DTM foi determinada através de questionário anamnésico, contendo também questões relacionadas à presença de hábitos parafuncionais e tensão emocional. Um protocolo simplificado de avaliação clínica foi aplicado. Ansiedade e depressão foram determinadas através da escala Hospital Anxiety and Depression (HAD) e, a QVRSO avaliada por meio da versão resumida do Oral Health Impact Profile (OHIP-14). Foram realizados testes de Qui-quadrado, Exato de Fisher, Mann Whitney e Kruskal-Wallis. A presença de sinais e sintomas de DTM foi estatisticamente associada ao gênero feminino, hábitos parafuncionais, tensão emocional e ansiedade, e representou maior comprometimento da QVRSO. A elevada prevalência de sinais e sintomas de DTM entre os estudantes pré-vestibulandos sinaliza a necessidade de divulgação e esclarecimento de professores e alunos visando o diagnóstico precoce e a prevenção.

Abstract The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) signs and symptoms, its correlation with gender, parafunctional habits, emotional stress, anxiety, and depression and its impact on oral health-related quality of life (OHRQL) in college preparatory students at public and private institutions in João Pessoa, Paraíba (PB). The sample consisted of 303 students. Presence of TMD symptoms was determined by an anamnesis questionnaire containing questions related to the presence of parafunctional habits and emotional stress. A simplified clinical evaluation protocol was used. Anxiety and depression were determined with the Hospital Anxiety and Depression (HAD) scale and the OHRQL using the short version contained in the Oral Health Impact Profile (OHIP-14). The Chi-square, Fisher Exact, Mann Whitney, and Kruskal-Wallis tests were performed. Presence of signs and symptoms of TMD was statistically associated (p ≤ 0,05) with female gender, parafunctional habits, emotional stress, and anxiety, and represented greater impairment of the OHRQL. The physical pain domain was the most affected. The increased prevalence of signs and symptoms of TMD among college preparatory students indicates that there is a need for education and clarification among teachers and students to improve early diagnosis and to prevent the problem.

Prevalence of signs and symptoms of temporomandibular disorders in college preparatory students: associations with emotional factors, parafunctional habits, and impact on quality of life. / Prevalência de sinais e sintomas de disfunção temporomandibular em estudantes pré-vestibulandos: associação de fatores emocionais, hábitos parafuncionais e impacto na qualidade de vida.

The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) signs and symptoms, its correlation with gender, parafunctional habits, emotional stress, anxiety, and depression and its impact on oral health-related quality of life (OHRQL) in college preparatory students at public and private institutions in João Pessoa, Paraíba (PB). The sample consisted of 303 students. Presence of TMD symptoms was determined by an anamnesis questionnaire containing questions related to the presence of parafunctional habits and emotional stress. A simplified clinical evaluation protocol was used. Anxiety and depression were determined with the Hospital Anxiety and Depression (HAD) scale and the OHRQL using the short version contained in the Oral Health Impact Profile (OHIP-14). The Chi-square, Fisher Exact, Mann Whitney, and Kruskal-Wallis tests were performed. Presence of signs and symptoms of TMD was statistically associated (p ≤ 0,05) with female gender, parafunctional habits, emotional stress, and anxiety, and represented greater impairment of the OHRQL. The physical pain domain was the most affected. The increased prevalence of signs and symptoms of TMD among college preparatory students indicates that there is a need for education and clarification among teachers and students to improve early diagnosis and to prevent the problem.

O objetivo deste estudo foi avaliar a prevalência de sinais e sintomas de disfunção temporomandibular (DTM), sua associação com gênero, hábitos parafuncionais, tensão emocional, ansiedade e depressão e, o seu impacto sobre a qualidade de vida relacionada com a saúde oral (QVRSO) em estudantes pré-vestibulandos de instituições públicas e privadas de João Pessoa/PB. A presença de sintomas de DTM foi determinada através de questionário anamnésico, contendo também questões relacionadas à presença de hábitos parafuncionais e tensão emocional. Um protocolo simplificado de avaliação clínica foi aplicado. Ansiedade e depressão foram determinadas através da escala Hospital Anxiety and Depression (HAD) e, a QVRSO avaliada por meio da versão resumida do Oral Health Impact Profile (OHIP-14). Foram realizados testes de Qui-quadrado, Exato de Fisher, Mann Whitney e Kruskal-Wallis. A presença de sinais e sintomas de DTM foi estatisticamente associada ao gênero feminino, hábitos parafuncionais, tensão emocional e ansiedade, e representou maior comprometimento da QVRSO. A elevada prevalência de sinais e sintomas de DTM entre os estudantes pré-vestibulandos sinaliza a necessidade de divulgação e esclarecimento de professores e alunos visando o diagnóstico precoce e a prevenção.

Low-level laser therapy stimulates tissue repair and reduces the extracellular matrix degradation in rats with induced arthritis in the temporomandibular joint.

The objective of this study was to characterize morphological and biochemistry action of low-level laser therapy (LLLT) on induced arthritis in the temporomandibular joint (TMJ) of rats. Twenty-four male Wistar rats were randomly divided into groups with 12 animals each: (AG) group with arthritis induced in the left TMJ and (LG) group with arthritis induced in the left TMJ and treated with LLLT (830 nm, 30 mW, 3 J/cm(2)). Right TMJs in the AG group were used as noninjected control group (CG). Arthritis was induced by intra-articular injection of 50 µl Complete Freund's Adjuvant (CFA) and LLLT began 1 week after arthritis induction. Histopathological analysis was performed using sections stained with hematoxylin-eosin, Toluidine Blue, and picrosirius. Biochemical analysis was determined by the total concentration of sulfated glycosaminoglycans (GAGs) and evaluation of matrix metalloproteinases (MMP-2 and MMP-9). Statistical analysis was performed using paired and unpaired t tests, with p < 0.05. Compared to AG, LG had minor histopathological changes in the TMJ, smaller thickness of the articular disc in the anterior (p < 0.0001), middle (p < 0.0001) and posterior regions (p < 0.0001), high birefringence of collagen fibers in the anterior (p < 0.0001), middle (p < 0.0001) and posterior regions (p < 0.0001) on the articular disc, and statistically lower activity of MMP-2 latent (p < 0.0001), MMP-2 active (P = 0.02), MMP-9 latent (p < 0.0001), and MMP-9 active (p < 0.0001). These results suggest that LLLT can increase the remodeling and enhancing tissue repair in TMJ with induced arthritis.

Atenção em saúde bucal: avaliação dos centros de especialidades odontológicas da Paraíba / Attention to oral health: evaluation of the dental specialty centers in Paraíba

Este estudo objetivou avaliar a Política Nacional de Saúde Bucal na atenção de média complexidade, considerando o desempenho dos Centros de Especialidades Odontológicas (CEOs) da Paraíba. Foram avaliados 19 CEOs, utilizando-se dados secundários da produção de 2007 a 2010, registrados pelo Sistema de Informação Ambulatorial do Sistema Único de Saúde (SIA/SUS). Os dados foram obtidos, tabulados e organizados de acordo com os subgrupos de procedimentos odontológicos, segundo a Portaria Ministério da Saúde/Gabinete do Ministro n° 600. O desempenho insatisfatório dos CEOs é revelador de falhas, especialmente na gestão e na organização desses serviços. O processo de avaliação é uma etapa fundamental para garantir uma melhor qualidade dos serviços à população.

This study aimed to evaluate the National Policy of Oral Health in the attention of medium complexity, considering the performance of Dental Specialty Centers (DSC) in the state of Paraíba. Were evaluated 19 DSCs, using secondary data of the production from 2007 to 2010, recorded by the Outpatient Information System of the Unified Health System (SIA/SUS). Data were collected, tabulated, and organized according to subgroups of dental procedures, according to the Decree Ministry of Health/Office of the Minister, nº 600. The poor performance of the DSCs is fault revealing, especially in the management and in the organization of these services. The evaluation process is a critical step to ensure better quality of services to the population.

Joint immobilization: effects on muscular tissue of obese and malnourished mice / Imobilização articular: efeitos sobre o tecido muscular de camundongos obesos e desnutridos

Abstract Although it is a widely used resource for the treatment of musculoskeletal injuries, immobilization causes deleterious effects in muscle tissue after a short period of time. This study aimed to evaluate the gastrocnemius and tibialis anterior muscles of obese and protein malnourished animals under joint immobilization condition. Overall, 28 adult male mice were used (C57 / BL6), being divided into four groups (N = 7): Control Group (CG), Immobilized Control Group (ICG), Immobilized Obese Group (IOG) and Immobilized Malnourished Group (IMG). The immobilization protocol was performed by the use of adhesive tape and plaster. The conditions and obesity and protein malnutrition have been developed through the ingestion of diets specific for each group of animals. The histomorphometric analysis of muscles evaluated area and the diameter of muscle fibers. All immobilized groups showed reduction in the area and diameter of muscle fibers when compared to GC. Comparisons among immobilized groups showed that the area and diameter of muscle fibers of IOG and IMG were lower than ICG. The immobilization protocol caused reduction in muscle trophism in animals, and obese and malnourished animals suffered high losses under condition of muscle atrophy.

Resumo Embora seja um recurso muito utilizado para tratamento de lesões musculoesqueléticas, a imobilização causa efeitos deletérios no tecido muscular após curto período de tempo. O presente estudo teve como objetivo avaliar os músculos gastrocnêmio e tibial anterior de animais obesos e desnutridos proteicamente sob a condição de imobilização articular. Foram utilizados 28 camundongos (C57/BL6) machos adultos, distribuídos em quatro grupos (N=7): Grupo controle (GC), Grupo Controle Imobilizado (GCI), Grupo Obeso imobilizado (GOI) e Grupo Desnutrido Imobilizado (GDI). O protocolo de imobilização foi realizado por meio da utilização de tiras de esparadrapo e faixa gessada. As condições de obesidade e desnutrição proteica foram desenvolvidas por meio da ingestão de dietas específicas para cada grupo de animais. A análise histomorfométrica dos músculos avaliou a área e o diâmetro das fibras musculares. Todos os grupos imobilizados apresentaram redução na área e no diâmetro das fibras musculares quando comparados ao GC. As comparações entre os grupos imobilizados mostraram que os valores do diâmetro e área de fibras dos grupos GOI e GDI foram menores do que o GCI. O protocolo de imobilização provocou redução do trofismo muscular nos animais estudados e os animais obesos e desnutridos sofreram prejuízo elevado na condição de atrofia muscular.

O uso do correio eletrônico na comunicação entre usuários e uma equipe de saúde da família: relato de experiência / The use of electronic mail between users and a primary health care team: a case report / El uso del correo electronico en la comunicación entre usuarios y un equipo de atención primaria: relato de experiencia

Este relato descreve o uso do correio eletrônico por uma equipe de saúde da família para comunicação com os pacientes e agendamento. Tal uso surgiu como consequência de um processo de facilitação do acesso presencial e não presencial. No período de 25 meses houve crescimento no número de mensagens e de remetentes. Das 1437 mensagens recebidas, 61,5% foram para agendar consultas, 27,8% solicitavam informações em saúde e 7,6% eram sobre serviços oferecidos. As mulheres enviaram 87% das mensagens (63,3% delas tinham 20-40 anos). Em 60% das vezes, o contato referia-se à demanda do remetente e mais de 30% à de familiares. A equipe respondeu a 83% das mensagens em até 8 horas úteis. Na percepção da equipe, o uso do correio eletrônico melhorou a comunicação e o acesso e foi bem aceito pelos usuários, não prejudicando grupos mais vulneráveis. Investigações mais aprofundadas serão necessárias para avaliar a contribuição dessa ferramenta na Atenção Primária à Saúde.

This report describes the use of electronic mail by a primary health care team (PHT) in order to communicate with patients and aid in scheduling. Such use has emerged as a result of a process of facilitating access, both electronically and face-to-face. During a 25-month study period, users sent a total of 1437 messages with the purpose of scheduling appointments (61.5%), asking health-related questions (27.8%), and inquiring about services offered (7.6%). Women submitted 87% of the messages (63.3% of them were 20­40 years of age), with 60% of these messages concerning themselves and over 30% of them concerning their families. The team responded to 83% of messages within 8 business hours. According to the team, the use of electronic mail has improved communication and access, and has been well received by users without harming the most vulnerable groups. Further investigation is needed to assess the full contribution of this tool to primary health care.

Este texto describe la utilización del correo electronico por un equipo de salud de la familia para comunicación con los pacientes y marcación de citas. El correo surgió como consecuencia de un proceso para facilitar el acceso presencial y no presencial. En el periodo de 25 meses hubo crecimiento en el numero de mensajes y de remitentes. De las 1.437 mensajes recibidas, el 61,5% fueron para la marcación de citas, el 27,8% solicitaban informaciones de salud y el 7,6% eran sobre servicios ofrecidos. Las mujeres enviaron el 87% de los correos (el 63,3% de ellas tenían entre 20 y 40 años). En el 60% de las veces, el contacto se refería a la demanda del remitente y más del 30% a las de sus familiares. El equipo contestó al 83% de los mensajes dentro de 8 horas útiles. Según el equipo, el uso del correo electrónico mejoró la comunicación y el acceso y fue bien acepto por los usuarios, sin perjudicar a los grupos más vulnerables. Investigaciones más profundas serán necesarias para evaluar la contribución de esta herramienta en la Atención Primaria a la Salud

Prevalência de disfunção temporomandibular e associação com fatores psicológicos em estudantes de Odontologia / Prevalencia de trastornos temporomandibulares y su asociación con factores psicológicos en los estudiantes de Odontología / Prevalence of temporomandibular dsorders and association with psychological factors in students of undergraduate Dentistry students

Introdução: a abordagem dos fatores biopsicossociais tem ganhado destaque quando se analisa a natureza multifatorial da Disfunção Temporomandibular, mas alguns estudos trazem resultados conflitantes quanto à sua relação com fatores psicológicos. Objetivo: determinar a prevalência de sinais e sintomas desta disfunção e sua associação com a tensão emocional, ansiedade e depressão em estudantes universitários do curso de Odontologia. Métodos: do universo de acadêmicos de odontologia de uma universidade pública do nordeste brasileiro (344 estudantes), foram selecionados aleatoriamente 135 voluntários. Os critérios de exclusão foram: ausência de dois ou mais dentes (exceto os terceiros molares); uso de prótese removível; uso de aparelhos ortodônticos (fixo ou móvel), no momento do estudo; participantes em tratamento para disfunção ou outras dores orofaciais; não assinatura do termo de consentimento livre e esclarecido. Os sinais e sintomas de Disfunção Temporomandibular foram coletados através de uma ficha contendo um questionário anamnésico adaptado e de um protocolo de exame clínico. Para estimar a presença de fatores psicológicos foi utilizada a escala Hospital Anxiety and Depression, traduzida e validada para o português. Os dados foram tabulados e analisados descritiva e estatisticamente. Associações entre as variáveis, tensão emocional, ansiedade, depressão e disfunção foram verificadas pelos testes estatísticos Qui-quadrado (x2) e Exato de Fisher, com p< 0,05. Resultados: 76,3 porcento da amostra apresentaram disfunção, sendo que em 54,1 porcento esta foi considerada de grau leve, enquanto que em 22,2 porcento foi verificada necessidade ativa de tratamento. 34,1 porcento da amostra afetada apresentaram apenas sinais clínicos articulares. Tensão emocional foi estaticamente associada à presença de disfunção e a necessidade de tratamento. Ansiedade e depressão foram associadas apenas a necessidade de tratamento. Conclusão: a prevalência de Disfunção Temporomandibular na amostra de estudantes universitários foi elevada, com maior frequência de sinais clínicos articulares e associação com gênero feminino, tensão emocional, ansiedade e depressão(AU)

Introducción: el enfoque de los factores biopsicosociales tiene gran importancia en la naturaleza multifactorial de los trastornos temporomandibulares, pero algunos estudios presentan resultados contradictorios en cuanto a su relación con los factores psicológicos. Objetivo: determinar la prevalencia de signos y síntomas de este trastorno y su asociación con el estrés emocional, la ansiedad y la depresión en estudiantes de Odontología. Métodos: del universo de estudiantes de Odontología de una universidad pública en el noreste de Brasil (344 estudiantes) se seleccionaron 135 alumnos. Los criterios de exclusión fueron: ausencia de dos o más dientes (excluyendo los terceros molares); uso de prótesis desmontable; uso de aparatos de ortodoncia (fijo o móvil), en el momento del estudio; participantes en tratamiento para trastorno u otro dolor orofacial; no firmar el consentimiento informado. Los signos y síntomas del trastorno fueron recolectados a través de cuestionario y examen clínico. Para estimar la presencia de factores psicológicos se utilizó la escala Hospital Anxiety and Depression, traducida y validada para el portugués. Los datos fueron tabulados y analizados de forma descriptiva y estadística. Las asociaciones entre las variables, el estrés emocional, la ansiedad, la depresión y trastorno fueron verificadas por las pruebas estadísticas Chi Cuadrado (x2) y Exacta de Fisher (p< 0,05). Resultados: el transtorno se presentó em 76,3 por ciento de la muestra; en 54,1 por ciento fue considerado como leve, mientras que en 22,2 % fue verificada la necesidad de tratamiento. En 34,1 por ciento de la muestra afectada, solamente se presentaron signos clínicos articulares. El estrés emocional se asoció estadísticamente con el trastorno y la necesidad de tratamiento. La ansiedad y la depresión están asociados solo con la necesidad de tratamiento. Conclusión: la prevalencia de trastornos temporomandibulares en la muestra de estudiantes universitarios fue alta, con mayor frecuencia de signos clínicos articulares y asociados con el sexo femenino, el estrés emocional, la ansiedad y la depresión(AU)

Introduction: the approach of biopsychosocial factors have gained prominence when considering the multifactorial nature of Temporomandibular Disorders but some studies present conflicting results as to its relationship with psychological factors. Objective: to determine the prevalence of signs and symptoms of this disorder and its association with emotional stress, anxiety and depression in college students of Dentistry course. Methods: therefore, we randomly selected 135 volunteers from a Brazilian public university, from a total of 344 undergratuate dental students. Exclusion criteria were: absence of two or more teeth (excluding third molars); use of a removable prosthesis; use of orthodontic appliances (fixed or mobile), at the time of the study; participants treated for orofacial pain or dysfunction; not signing the free and informed consent. The signs and symptoms of temporomandibular dysfunction were collected through a form with an appropriate history questionnaire and a clinical examination protocol. To estimate the presence of psychological factors we used the scale Hospital Anxiety and Depression, translated and validated to Portuguese. Data were tabulated and analyzed descriptively and statistically. Associations between variables, emotional stress, anxiety, depression and dysfunction were verified by statistical tests chi-square (x2) and Fisher's exact, with p< 0.05. Results: 76.3 percent had dysfunction, and in 54.1 percent it was considered mild, while in 22.2 percent were observed active treatment needs. 34.1 percent of the sample had only affected joint clinical signs. Emotional tension is statically associated with the presence of disorder and need of treatment. Anxiety and depression are associated only with the need for treatment. Conclusion: the prevalence of Temporomandibular Disorders in the sample of college students was high, with higher frequency of joint clinical signs and associated with the female gender, emotional stress, anxiety and depression(AU)

Correlação entre sinais e sintomas da Disfunção Temporomandibular (DTM) e severidade da má oclusão / Correlation between signs and symptoms of Temporomandibular Disorders (TMD) and severity of malocclusion

Introdução: O papel da oclusão como fator etiológico das disfunções temporomandibulares (DTMs) tem sido um assunto polêmico e ainda controverso. Objetivo: Avaliar a correlação entre sinais e sintomas da disfunção temporomandibular e a severidade da má oclusão. Método: Foram avaliados 135 estudantes de Odontologia da UFPB. A presença de DTM foi estimada através do Índice Anamnésico de Fonseca (DMF) e de questões objetivas sobre seus sintomas. Os estudantes também foram submetidos a um protocolo resumido de avaliação clínica de DTM. A avaliação dos fatores oclusais foi realizada através do Índice de Prioridade de Tratamento (IPT) aplicado a modelos de gesso dos arcos dentários superior e inferior. As diferenças entre as médias do IPT relacionadas aos sinais e sintomas de DTM foram determinadas por meio dos testes t e One-way ANOVA. As correlações entre os fatores oclusais e a DTM foram determinadas a partir de correlação de Pearson. Resultado: A severidade da má oclusão, segundo o IPT, não influenciou no surgimento de DTM e de sinais clínicos musculares ou articulares, e na necessidade de tratamento. A má oclusão de classe II, trespasse vertical acentuado e dentes girados foram estatisticamente correlacionados à necessidade de tratamento e aos sinais clínicos de DTM. Conclusão: Em modelos multifatoriais, como na fisiopatologia da DTM, a oclusão pode desempenhar um papel de cofator na predisposição ou perpetuar as diferentes formas de DTM, não devendo ser considerada fator principal. .

Introduction: The role of occlusion as an etiologic factor of temporomandibular disorders (TMD) has been polemic and still controversial. Objective: To evaluate the correlation between signs and symptoms of temporomandibular disorders and severity of malocclusion. Method: A total of 135 undergraduate dental students from Federal University of Paraíba were evaluated. The presence of TMD was estimated by Fonseca's Anamnestic Index and objective questions about symptoms were addressed. Students were also submitted to a summarized protocol for clinical evaluation of TMD. The evaluation of occlusal factors was performed using the Treatment Priority Index (TPI) applied to plaster casts corresponding to upper and lower dental arches. The differences between the means of IPT related to signs and symptoms of TMD were determined by t tests and One-way ANOVA. Correlations between occlusal factors and TMD were determined by Pearson correlation. Result: According to the TPI, the severity of the malocclusion did not influence the onset of TMD, muscle or joint clinical signs and need for treatment. Class II malocclusion, marked overbite and rotated teeth were statistically correlated with the need for treatment and clinical signs of TMD. Conclusion: In multifactor models as in the pathophysiology of TMD, occlusion can play a role as a co-factor in predisposing or perpetuating the different forms of TMD. As such, it should not be considered a major factor. .

Effects of high molecular weight hyaluronic acid on induced arthritis of the temporomandibular joint in rats.

High molecular weight hyaluronic acid (HMWHA) has been used to treat temporomandibular joint (TMJ) disorders, but controversial results have been described. This study aimed to characterize the morphological and biochemical actions of HMWHA on induced arthritis of the TMJ. Twenty-four male Wistar rats were used, and arthritis of the TMJ was induced through an intra-articular injection of Complete Freund's Adjuvant (CFA) (50 µl). One week after arthritis induction, the animals were treated with HMWHA (once per week for three weeks). Histological analyses were performed using sections stained with hematoxylin-eosin, toluidine blue and Picrosirius. Were also performed histomorphometric analysis and birefringence of collagenous fibers (polarization microscopy). Biochemical analyses of TMJ tissues were carried out through measurements of sulfated glycosaminoglycans and zymography for evaluation of metalloproteinase-2 and -9 (MMP-2 and -9). Data were analyzed using paired t-test and unpaired t-test, with a 5% significance level. HMWHA reduced histologic changes and thickness of the articular disc, led to a greater arrangement of collagenous fibers, lower concentration of sulfated glycosaminoglycans and lower activity in all isoforms of MMP-2 and -9 in TMJs with induced arthritis. These findings suggest that HMWHA may exert a protective effect on the TMJ.

Influence of temporomandibular disorder presence and severity on oral health-related quality of life / Influência da presença e gravidade da disfunção temporomandibular na qualidade de vida relacionada com a saúde oral

BACKGROUND AND OBJECTIVES: Temporomandibular disorders are highly prevalent and may impair several oral function- related aspects. This study aimed at evaluating the impact of the presence and severity of temporomandibular disorder signs and symptoms on oral health-related quality of life. METHODS: Participated in the study 135 dentistry students of the Federal University of Paraiba. The presence of temporomandibular disorder was determined by means of an anamnesis questionnaire and a summarized clinical evaluation protocol. Oral health-related quality of life was determined by the summarized Oral Health Impact Profile version translated and validated for the Portuguese language. Statistical comparisons between Oral Health Impact Profile-14 means related to the presence of temporomandibular disorder signs and symptoms were achieved with Mann-Whitney and Kruskal-Wallis tests. RESULTS: Volunteers with temporomandibular disorder (p<0.001), needing treatment (p<0.001) and higher severity (p<0.001) had higher impact on oral health-related quality of life. Volunteers with clinical temporomandibular disorder signs had further quality of life impairment, being that individuals with simultaneous muscle and joint temporomandibular disorders (p=0.034) had higher Oral Health Impact Profile-14 scores. Most impaired domains were physical pain (p=0.045), functional limitation (p=0.007) and psychological discomfort (p=0.045). CONCLUSION: Temporomandibular disorder severity has negative impact on quality of life, especially in volunteers with simultaneous joint and muscle clinical signs. .

JUSTIFICATIVA E OBJETIVOS: As disfunções temporomandibulares são altamente prevalentes e podem comprometer diversos aspectos relacionados à função oral. O objetivo deste estudo foi avaliar o impacto da presença e gravidade dos sinais e sintomas de disfunção temporomandibular na qualidade de vida relacionada com a saúde oral. MÉTODOS: Cento e trinta e cinco estudantes de odontologia da Universidade Federal da Paraíba foram avaliados. A presença de disfunção temporomandibular foi determinada por meio de questionário anamnésico e por um protocolo resumido de avaliação clínica. A qualidade de vida relacionada com a saúde oral foi determinada por meio da versão resumida do Oral Health Impact Profile em sua versão traduzida e validada para o português. Comparações estatísticas entre as médias do Oral Health Impact Profile-14 relacionadas à presença de sinais e sintomas de disfunções temporomandibulares foram realizadas por meio dos testes de Mann-Whitney e Kruskal-Wallis. RESULTADOS: Os voluntários com disfunção temporomandibular (p<0,001), necessidade de tratamento (p<0,001) e maior gravidade (p<0,001) exibiram maior impacto na qualidade de vida relacionada com a saúde oral. Os voluntários com sinais clínicos de disfunção temporomandibular apresentaram maior comprometimento da qualidade de vida, sendo que os indivíduos com sinais de disfunção temporomandibular muscular e articular simultaneamente (p=0,034) apresentaram os maiores escores do Oral Health Impact Profile-14. Os domínios mais comprometidos foram dor física (p=0,045), limitação funcional (p=0,007) e desconforto psicológico (p=0,045). CONCLUSÃO: A gravidade da disfunção temporomandibular representa impacto negativo na qualidade de vida, especialmente em voluntários com sinais clínicos articulares e musculares simultâneos. .