How do the mindfulness and sensory-behavioural-emotional aspects influence the painful experience related to temporomandibular disorder?

BACKGROUND: Chronic pain is persistent or recurrent pain lasting longer than 3 months. The experience of temporomandibular disorder (TMD)-related pain is modulated by emotional and social factors, with mindfulness encapsulating these aspects. OBJECTIVE: To investigate the association between cognitive-behavioural-emotional characteristics, mindfulness and the painful experience in women with chronic pain-related TMD. METHODS: A cross-sectional study was conducted, including 90 women aged between 18 and 61 years old, diagnosed with chronic pain-related TMD according to the Diagnostic Criteria for Temporomandibular Disorder, considering both temporomandibular joint and muscle pain. Specific instruments were employed to assess cognitive-behavioural-emotional aspects. The Mindful Attention Awareness Scale and the Five Facets of Mindfulness Questionnaire scales evaluated the level and construct of mindfulness. The relationship between variables was analysed using bivariate association tests (.05 > p < .20), followed by multiple regression tests (p < .05). RESULTS: The heightened experience of pain correlated with increasing age, a low level of education, the attribution of the locus of control by chance, and lower levels of mindfulness (p < .05). The heightened experience of pain was negatively influenced by mindfulness levels (p < .05). On the other hand, the painful experience was mainly influenced by facets describing negative formulation, distraction, non-reactivity and non-judgement (p < .05). CONCLUSION: Demographic, cognitive-behavioural-emotional data and levels of mindfulness and its facets presented different influence weights on the painful experience. These findings provide support for future studies focusing on mindfulness strategies, education and pain management in women with chronic pain-related TMD.

The bruxism paradigm in the absence of teeth: observational cross-sectional study in full denture users / O paradigma do bruxismo na ausência de dentes: estudo observacional de corte transversal em usuários de próteses totais

ABSTRACT BACKGROUND AND OBJECTIVES: Bruxism is defined as an activity of the masticatory muscles, which is independent of the teeth presence, so it can occur in total edentulous patients and users of dental prostheses. In this sense, It is therefore necessary to know the clinical manifestations of bruxism in this population. The objective of this study was to evaluate the clinical manifestation and the presence of probable sleep and awake bruxism in a sample of users of full dentures treated at a teaching dental clinic in the city of Ribeirão Preto/SP. METHODS: The adopted sample consisted of 30 patients (mean age 72 years, 18 women/12 men). The following questionnaires were used to assess probable bruxism: Oral Behavior Checklist (OBC), Questionnaire of the American Academy of Orofacial Pain (AADO) and the Depression Anxiety and Stress Scale (DASS-21). The clinical assessment included the identification of wear on the prostheses, tongue indentations, bitten cheek and sensitivity in the masticatory muscles and temporomandibular joints. The data was analyzed using descriptive statistics. RESULTS: The average of use of the dentures were nine years. Six patients (20%) reported self-perceived sleep bruxism, and 11 (36%) reported self-perceived awake bruxism. OBC showed an average total score of 9.8 ± 6.2, with "teeth clenching" being the most described symptom. DASS-21 presented an average of 16.5, and stress, anxiety and depression were within normal limits. The most commonly reported symptoms in the AADO were headache, neck pain, pain and/or difficulty during jaw function and recent trauma to the head, neck or jaws. In the clinical evaluation, 15 (50%) patients had wear on prosthesis, only 2 (6%) had bitten cheek, none had tongue indentations, 4 (13%) had pain during palpation. CONCLUSION: Despite the limitations of the study (cross-sectional, small sample and absence of instrumental evaluation of bruxism), it is possible to conclude that a significant portion of users of total dentures presented probable bruxism, with tooth clenching being the main report and wear on the prosthesis the main clinical manifestation.

RESUMO JUSTIFICATIVA E OBJETIVOS: O bruxismo é definido como uma atividade da musculatura mastigatória, que independe da presença de dentes, portanto pode ocorrer em pacientes desdentados totais e usuários de próteses dentárias. Assim, é preciso conhecer como o bruxismo se manifesta clinicamente nessa população. O objetivo deste estudo foi investigar a presença do provável bruxismo de sono e de vigília em usuários de prótese total atendidos em uma clínica odontológica de ensino em Ribeirão Preto/SP. MÉTODOS: Uma amostra de conveniência foi composta por 30 pacientes (média de 72 anos, 18 mulheres e 12 homens). Os seguintes questionários foram utilizados para avaliar o provável bruxismo: Oral Behavior Checklist (OBC), Questionário da Academia Americana de Dor Orofacial (AADO) e o Depression Anxiety and Stress Scale (DASS-21). A avaliação clínica incluiu a identificação de desgastes nas próteses, língua dentada, bochecha mordiscada e sensibilidade nos músculos mastigatórios e nas articulações temporomandibulares. Os dados foram analisados por meio de estatística descritiva. RESULTADOS: A média de uso das próteses foi de nove anos. Seis indivíduos (20%) relataram bruxismo do sono e 11 (36%) relataram bruxismo de vigília. O OBC apresentou média de escore total de 9,8 ± 6,2, sendo "apertar de dentes" o sintoma mais descrito. O DASS-21 apresentou média total de 16,5, com valores de estresse, ansiedade e depressão dentro da normalidade. Os sintomas mais relatados no AADO foram cefaleia, dores no pescoço, dor e/ou dificuldade durante a função mandibular e trauma recente na cabeça, pescoço ou maxilares. Na avaliação clínica, 15 (50%) dos pacientes apresentaram desgastes na prótese, 4 (13%) dor por palpação, 2 (6%) bochecha mordiscada e nenhum (0%) língua dentada. CONCLUSÃO: Apesar das limitações deste estudo (corte transversal, amostra reduzida e ausência de avaliação instrumental do bruxismo) foi possível concluir que uma parcela significativa de usuários de próteses totais apresentou provável bruxismo, sendo o apertamento dentário o principal relato e desgastes na prótese a principal manifestação clínica.

Can high pain intensity and catastrophizing interfere with the cognitive performance of women with chronic pain related TMD? A cross-sectional study.

OBJECTIVE: Interventions based on pain education and self-management are dependent on factors such as attention, memory, concentration, and executive function. To explore the relationship between cognitive performance and the variables pain intensity, central sensitization, catastrophizing, and hypervigilance in women diagnosed with chronic pain-related TMD. METHODOLOGY: This is a cross-sectional study. A total of 33 women (mean age: 38±4.6 years; range: 18 to 66 years) with chronic pain-related TMD (myalgia and/or arthralgia) diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Specific questionnaires were used to evaluate cognitive performance, overall pain intensity, central sensitization, hypervigilance, and pain catastrophizing. The data were analyzed using Pearson's correlation coefficient and backward stepwise multiple linear regression (statistical significance at 5% alpha). RESULTS: Approximately 53% of the study sample showed decreased cognitive performance. High central sensitization, hypervigilance, and pain catastrophizing were observed. A significant negative correlation was observed between cognitive performance and hypervigilance (p=.003, r=-.49), cognitive performance and catastrophizing (p<.001, r=-.58), and cognitive performance and pain intensity (p<.001, r=-.58). Regarding the partial regression coefficients, only catastrophizing and pain intensity showed statistical significance (t=-2.12, p=.043; t=-2.64, p=.014, respectively), indicating a significant role in explaining cognitive performance at the sample. CONCLUSION: High pain intensity and the presence of catastrophic thoughts regarding pain can predict impaired cognitive performance in women with chronic pain-related TMD. Management strategies addressing psychosocial dimensions such as reducing catastrophizing and ensuring complete understanding of the condition are important.

Application of photobiomodulation for chronic pain-related TMD on pain points versus pre-established points: Randomized clinical trial.

Photobiomodulation therapy (PTB) is a therapeutic possibility for temporomandibular disorders (TMD), but its effectiveness and protocols for use remain controversial. This study is a RCT that compared the effectiveness of PTB on pain points of the masticatory muscles and TMJs, located through palpation versus application of pre-established points in women with painful TMD, diagnosis by DC/TMD (Diagnostic Criteria for Temporomandibular Disorders - Brazilian Portuguese version). Therefore, a total sample of 54 women, aged between 18 and 60 years, was investigated. Volunteers were randomly randomized and PTB was applied in four different groups with a dose of 4 J and 6 J divided into pre-established application points (PE - G1) and pain points (PD - G2) - Groups 4PE, 4PD, 6PE and 6PD. Four laser applications were performed with a wavelength of 780 nm, one session per week, totaling one month of therapy. The following assessments were performed: DC/TMD, Brief Pain Inventory (BPI), McGill Questionnaire - Short Version (SF-MPQ) and Pain Intensity, Visual Analogue Scale (VAS). Friedman's test was used for within-group comparisons, while the Mann-Whitney test was used for between-group comparisons (p < 0.05). According to the results, laser application on pain points (G2) was more effective. McGill's results showed that regardless of dose, the pain point application group had better outcomes (p = 0.004). Pain intensity evaluation (last days) also showed that application at the pain points was more effective regardless of dose (p = 0.0002). Medians and interquartile deviations showed overall that PTB was more effective at pain points, with a trend towards better outcomes at the 6 J dose. Therefore, it can be concluded that in women with chronic painful TMD, the application of PTB at pain points is more effective than the application at pre-established points. Therefore, individualized PTB protocols are proposed, based on examination palpation of the masticatory structures.

Atenção integral à população trans: panorama da atuação do cirurgião-dentista na atenção primária à saúde / Comprehensive care for the trans population: importance of the dentist's role in primary health care

A sigla LGBTQIA+ engloba identidades relacionadas à orientação sexual e de gênero, representando aqueles que se desviam dos padrões cis heteronormativos e binários. Esta população, em especial a trans, enfrenta silenciamento e estigmatização no acesso aos serviços de saúde, incluindo a saúde bucal, devido à discriminação e à falta de conhecimento dos profissionais. Estudos apontam que a saúde bucal dessa população é pior do que a média da população em geral e transtornos mentais são mais comuns nessa população, afetando os cuidados com a higiene bucal e se relaciona a condições como disfunção temporomandibular (DTM) e dor orofacial. Além disso, a população trans apresenta taxas mais altas de abuso de substâncias nocivas à saúde bucal, como álcool, tabaco e drogas ilícitas, que estão associados ao desenvolvimento de neoplasias orais. A terapia hormonal de afirmação de gênero (THAG), utilizada por trans, pode afetar a saúde bucal, levando à inflamação gengival e dor. A adoção de abordagem multidisciplinar é fundamental para fornecer cuidados adequados e inclusivos, sendo essencial considerar também os impactos psicossociais na saúde bucal. Na busca por cuidados de saúde, é crucial a abordagem do risco de infecções sexualmente transmissíveis (ISTs) e da violência interpessoal. É fundamental que os cirurgiões-dentistas estejam preparados para o acolhimento e tratamento dessa população de forma inclusiva, oferecendo cuidados preventivos, diagnóstico precoce e encaminhamento adequado. Ainda, um olhar sensível deve ser voltado às questões de identidade de gênero, uso correto de pronomes e nome social e a criação de ambiente seguro e livre de discriminação

The acronym LGBTQIA+ encompasses identities related to sexual orientation and gender, representing those who deviate from cis-heteronormative and binary standards. The LGBTQIA+ population, especially the transgender persons, faces silencing and stigmatization in accessing health services, including oral health, due to discrimination and a lack of knowledge of professionals. Studies indicate that the oral health of this population is worse than the average of the general population and mental disorders are more common in this population, affecting oral hygiene care and being related to conditions such as temporomandibular disorders (TMD) and orofacial pain. In addition, transgender persons have higher rates of substance abuse that are harmful to oral health, such as alcohol, tobacco, and illicit drugs, which are associated with the development of oral neoplasms. Gender-affirming hormone therapy (GAHT), used by transgender person, can affect oral health, leading to gum inflammation and pain. The adoption of a multidisciplinary approach is essential to provide adequate and inclusive care, and it is essential to consider the psychosocial impacts on oral health. In seeking healthcare, addressing the risk of sexually transmitted infections (STIs) and interpersonal violence is crucial. It is essential that dentists are prepared to receive and treat this population in an inclusive way, offering preventive care, early diagnosis, and appropriate referral. In addition, a sensitive look must be turned to questions of gender identity, social names, correct pronouns, and creating a safe and discrimination-free environment

Can high pain intensity and catastrophizing interfere with the cognitive performance of women with chronic pain related TMD? A cross-sectional study

Abstract Interventions based on pain education and self-management are dependent on factors such as attention, memory, concentration, and executive function. Objective To explore the relationship between cognitive performance and the variables pain intensity, central sensitization, catastrophizing, and hypervigilance in women diagnosed with chronic pain-related TMD. Methodology This is a cross-sectional study. A total of 33 women (mean age: 38±4.6 years; range: 18 to 66 years) with chronic pain-related TMD (myalgia and/or arthralgia) diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Specific questionnaires were used to evaluate cognitive performance, overall pain intensity, central sensitization, hypervigilance, and pain catastrophizing. The data were analyzed using Pearson's correlation coefficient and backward stepwise multiple linear regression (statistical significance at 5% alpha). Results Approximately 53% of the study sample showed decreased cognitive performance. High central sensitization, hypervigilance, and pain catastrophizing were observed. A significant negative correlation was observed between cognitive performance and hypervigilance (p=.003, r=−.49), cognitive performance and catastrophizing (p<.001, r=−.58), and cognitive performance and pain intensity (p<.001, r=−.58). Regarding the partial regression coefficients, only catastrophizing and pain intensity showed statistical significance (t=−2.12, p=.043; t=−2.64, p=.014, respectively), indicating a significant role in explaining cognitive performance at the sample. Conclusion High pain intensity and the presence of catastrophic thoughts regarding pain can predict impaired cognitive performance in women with chronic pain-related TMD. Management strategies addressing psychosocial dimensions such as reducing catastrophizing and ensuring complete understanding of the condition are important.

Analysis of the anthropometric measurements of the smile using 3D stereophotogrammetry / Análise das medidas antropométricas do sorriso utilizando a estereofotogrametria 3D

3D stereophotogrammetry makes the analysis of facial soft tissues possible, and has the potential to contribute to human identification processes. Nowadays, the images available through social networks are composed of a significant amount of smile photos, making techniques such as 3D stereophotogrammetry relevant. The objective of the present study was to quantitatively analyze the anthropometric measurements of the smile through 3D stereophotogrammetry, including area, angular, and linear measurements. Anatomical landmarks were used to make possible the area, angular, and linear measurements. The sample consisted of 25 volunteers, 13 female and 12 male, both in the 19-25 age group, resulting in a mean age of 22.31.9 and 23.31.5, respectively. The anatomical landmarks were marked on the face of the volunteers using a black eyeliner, and the photographs were taken using the 3D stereophotogrammetry technique (Vectra H1, Canfield, NY, USA), being 3 photographs with a spontaneous smile and 3 at rest, right lateral, left lateral and frontal of each. Among the results of the comparison between genders and the photo/smile relation of the statistical analysis, variables such as the mentolabial angle and the vermilion height of the upper lip showed significant p-values of 0.046 and 0.014, respectively. It can be concluded that anthropometric measurements of three-dimensional smile images can be performed with the use of 3D stereophotogrammetry, with the purpose of contributing to facial identification methods

A estereofotogrametria 3D possibilita a análise dos tecidos moles faciais e tem o potencial de contribuir para os processos de identificação humana. Atualmente, as imagens disponíveis nas redes sociais são compostas por uma quantidade significativa de fotos de sorrisos, tornando relevante técnicas como a estereofotogrametria 3D. O objetivo do presente estudo foi analisar quantitativamente as medidas antropométricas do sorriso por meio da estereofotogrametria 3D, incluindo medidas de área, angulares e lineares. Referenciais anatômicos foram utilizados para possibilitar as medidas de área, angulares e lineares. A amostra foi composta por 25 voluntários, sendo 13 do sexo feminino e 12 do sexo masculino, ambos na faixa etária de 19 a 25 anos, resultando em média de idade de 22,3±1,9 e 23,3±1,5, respectivamente. Os referenciais anatômicos foram marcados na face dos voluntários com delineador preto e as fotografias foram realizadas pela técnica de estereofotogrametria 3D (Vectra H1, Canfield, NY, EUA), sendo 3 fotografias com sorriso espontâneo e 3 em repouso, direita lateral, esquerda lateral e frontal de cada um. Dentre os resultados da comparação entre gêneros e relação foto/sorriso da análise estatística, variáveis como o ângulo mentolabial e a altura do vermelhão do lábio superior apresentaram valores de p significativos de 0,046 e 0,014, respectivamente. Pode-se concluir que medidas antropométricas de imagens tridimensionais do sorriso podem ser realizadas com o uso da estereofotogrametria 3D, com a finalidade de contribuir com os métodos de identificação facial

Influence of cognitive performance on the response to pain education guidelines in patients with chronic painful temporomandibular disorders / Influência do desempenho cognitivo na resposta às orientações de educação sobre a dor em pacientes com disfunção temporomandibular dolorosa crônica

ABSTRACT BACKGROUND AND OBJECTIVES: Patients with painful temporomandibular disorders (TMD) may present cognitive performance alterations, making it difficult to understand and adhering to self-management strategies offered in pain education interventions. The aim of this study was to analyze the response to self-management guidelines in patients with chronic painful TMD due to cognitive performance. METHODS: Sample of 45 patients (35.5 years) with chronic painful TMD according to Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) test. The Brazilian Portuguese Central Sensitization Inventory (CSI- -BP) was also applied to measure central sensitization and numerical rating scale to assess the perception of pain intensity. The intervention consisted of self-care guidelines for pain management with homemade methods, through a video and a printed tutorial. After an interval of 15 days, a new evaluation was made to verify whether the self-management guidelines promoted pain-related changes in the sample studied and whether there were differences between participants with adequate and altered cognitive performance (groups obtained after the application of the test). RESULTS: The mean MoCA for the sample was 23.3±2.5 (lower than expected cognitive performance). A strong inverse correlation was found between the cognitive performance and pain intensity scores, indicating the tendency to have lower cognitive performance when there is greater intensity of pain (r=-0.77 and p=0.03). There was no correlation between cognitive performance and central sensitization (p>0.05). The group with better cognitive performance presented better response to pain education strategies. CONCLUSION: There is a trend towards worse cognitive performance according to the increase in perception of painful intensity. In addition, low cognitive performance seems to impair the use and efficacy of pain education-based intervention for patients with painful TMD, which is considered an important strategy for its management.

RESUMO JUSTIFICATIVA E OBJETIVOS: Pacientes com disfunção temporomandibular (DTM) dolorosa podem apresentar alterações de desempenho cognitivo dificultando a compreensão e adesão às estratégias de automanejo oferecidas em intervenções de educação sobre dor. O objetivo deste estudo foi analisar a resposta às orientações de automanejo em pacientes com DTM dolorosa crônica em função do desempenho cognitivo. MÉTODOS: Amostra de 45 pacientes, com idade média de 35,5 anos, com DTM dolorosa crônica segundo o Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). O desempenho cognitivo foi avaliado por meio do teste Montreal Cognitive Assessment (MoCA). Foi também aplicado o Brazilian Portuguese Central Sensitization Inventory (CSI-BP) para mensuração da sensibilização central e a escala numérica para avaliar a percepção de intensidade dolorosa. A intervenção consistiu em orientações de autocuidado para o manejo da dor com métodos caseiros, por meio de um vídeo e de um tutorial impresso. Após um intervalo de 15 dias, foi feita nova avaliação para verificar se as orientações de automanejo promoveram mudanças relacionadas à dor na amostra estudada e se houve diferenças entre os participantes com desempenho cognitivo adequado e alterado (grupos obtidos após a aplicação do teste). RESULTADOS: A média do MoCA para a amostra foi de 23,3 ± 2,5 (desempenho cognitivo abaixo do esperado). Foi encontrada forte correlação inversa entre os escores do desempenho cognitivo e da intensidade de dor, indicando a tendência de haver menor desempenho cognitivo ao passo que há maior intensidade de dor (r=-0,77 e p=0,03). Não houve correlação entre o desempenho cognitivo e a sensibilização central (p>0,05). O grupo com melhor desempenho cognitivo apresentou melhor resposta às estratégias de educação sobre a dor. CONCLUSÃO: Há uma tendência de pior desempenho cognitivo de acordo com o aumento na percepção de intensidade dolorosa. Além disso, o baixo desempenho cognitivo parece prejudicar o aproveitamento e eficácia da intervenção baseada em educação sobre a dor para pacientes com DTM dolorosa, a qual é considerada importante estratégia para seu manejo.

Mindfulness and pain catastrophization: how are they associated in women with chronic painful temporomandibular disorder (TMD)?

OBJECTIVE: Pain catastrophizing has dimensions of magnification, rumination, and helplessness, being an important evaluator of chronic pain. Studies with mindfulness intervention point to a possible modulation of chronic pain catastrophizing behavior. However, how these facets of mindfulness are associated with the catastrophizing subscales is uncertain. The scope of this study is to verify how the association of mindfulness facets and catastrophizing subdimensions occurs. METHODS: Women with chronic TMD answered the Pain Catastrophizing Scale (PCS) and Five Facets of Mindfulness Questionnaire (FFMQ). RESULTS: Magnification was inversely correlated with "not reacting," "not judging," and the total FFMQ score. Total PCS was also inversely correlated with "not reacting." CONCLUSION: It is necessary to consider such possible correlations between mindfulness facets and the catastrophizing subdimensions in mindfulness-based interventions for this population.

Phenotypic analysis of discordant monozygotic twins for pain-related temporomandibular joint disorder. Case report / Análise fenotípica de gêmeas monozigóticas discordantes para disfunção temporomandibular dolorosa. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: The design of research with monozygotic twins discordant for the disease has emerged as a powerful tool for the detection of phenotypic risk factors. The aim of this study is to report a clinical case of monozygotic twins discordant for pain-related temporomandibular joint disorder (TMD) from a cognitive-behavioral-emotional phenotypic analysis, from the comparison of clinical variables of pain, history of exposure to painful procedures in early childhood, and coping with pain. CASE REPORT: TMD-Twin presented a diagnosis of painful (myofascial pain with referral) and joint (disk displacement with reduction) TMD according to the criteria of the DC/TMD. Control-Twin did not show TMD, however she presented other chronic pains. TMD-Twin showed reduced pressure pain threshold, hyperalgesia in trigeminal and extra-trigeminal regions compared to the Control-Twin. TMD-Twin was more exposed to painful procedures and emotional events due to congenital heart problems. Both had central sensitization based on the Central Sensitization Inventory, although TMD-Twin had more catastrophic thoughts about pain. TMD-Twin presented an internal locus of control. CONCLUSION: Both monozygotic twins presented a chronic pain phenotype, although they were discordant with the TMD-related pain. The main differences were the lower pressure pain threshold and higher hyperalgesia locally presented by TMD-Twin. The internal locus of control indicates greater pain sensitivity, with better coping of the painful experience for the TMD-Twin. One possible explanation for this clinical condition can be that painful experiences in early childhood have shaped a phenotype of greater sensitivity with better coping and resilience to the painful condition.

RESUMO JUSTIFICATIVA E OBJETIVOS: O desenho da pesquisa com gêmeos monozigóticos discordantes para a doença surgiu como uma ferramenta poderosa para a detecção de fatores de risco fenotípicos. O objetivo deste estudo foi relatar um caso clínico de gêmeas monozigóticas discordantes para disfunção temporomandibular (DTM) dolorosa a partir de análise fenotípica cognitivo-comportamental-emocional entre elas, por meio de comparação de variáveis clínicas de dor, histórico de exposição a procedimentos dolorosos na primeira infância e enfrentamento de dor (autoeficácia e lócus de controle). RELATO DO CASO: A gêmea-DTM apresentou diagnóstico de DTM dolorosa (dor miofascial com referência) e articular (deslocamento do disco com redução) segundo os critérios do Critérios de Diagnóstico para Distúrbios Temporomandibulares. A gêmea--controle não apresentou DTM, contudo apresentou manifestação clínica de outras dores crônicas. A gêmea-DTM apresentou limiar de dor à pressão reduzido, hiperalgesia em regiões trigeminais/extra-trigeminais quando comparados à gêmea-controle, que na primeira infância foi mais exposta a procedimentos dolorosos devido a problemas cardíacos congênitos. Ambas apresentaram sensibilização central de acordo com o Inventário de Sensibilização Central, embora a gêmea-DTM apresentou mais pensamentos catastróficos sobre a dor. A gêmea-DTM apresentou lócus de controle interno. CONCLUSÃO: Ambas as gêmeas apresentaram fenótipo de dor crônica, apesar do fato de serem discordantes para a DTM. Dentre as avaliações, as que mais diferiram entre o par foram o baixo limiar de dor à pressão e hiperalgesia local presentes na gêmea com DTM. O lócus de controle interno associado à maior sensibilidade indicou melhor enfrentamento da experiência dolorosa para a gêmea-DTM. Uma possível explicação para esta manifestação clínica está pautada na hipótese de que experiências dolorosas na primeira infância vivenciadas por ela tenham moldado um fenótipo de maior sensibilidade com melhor enfrentamento e resiliência frente à condição dolorosa.

Análise quali-quantitativa do conhecimento dos cirurgiões-dentistas acerca da temática violência contra a mulher / Quali-quantitative analysis of the knowledge's dentists about the theme of violence against women

Introdução: A violência contra a mulher é entendida como qualquer forma de violência com base no gênero, e afeta de forma subjetiva e objetiva a vida de inúmeras vítimas. A vigilância epidemiológica aponta que é dever a notificação da suspeita ou confirmação dos casos de qualquer tipo de violência. Objetivo: Investigar o conhecimento dos cirurgiões-dentistas que atuam nas Unidades de Saúde da Atenção Básica (USAB) de Ribeirão Preto/SP sobre tópicos relacionados com a temática "violência contra a mulher". Material e métodos: Este estudo contou com uma amostra de 33 cirurgiões-dentistas que atuam nas USAB de Ribeirão Preto/SP, que responderam um questionário enviado por e-mail (Google Forms), composto por 8 questões objetivas e 2 dissertativas. O questionário foi elaborado para identificar o conhecimento desses profissionais quanto aos sinais que indiquem esse tipo de violência, bem quanto às redes de suporte municipais, experiências prévias e os aspectos legais. Resultados: Verificou-se que 48,5% dos participantes se sentem capacitados para identificar os indícios físicos e 36,4% os emocionais da violência. 90,9% já suspeitaram de que alguma paciente tenha sido vítima de violência, e julgam ser um dever a notificação, porém apenas 27,3% já notificou a alguma autoridade. 54,5% apontaram nunca terem recebido nenhuma capacitação para identificação de casos. Os profissionais não detinham um conhecimento das redes. Conclusão: Embora haja entendimento do importante papel do dentista na identificação e notificação, o conhecimento demonstrado sobre o assunto não é aprofundado, em especial no que se diz respeito ao processo de notificação e redes de suporte

Introduction: Violence against women is understood as any form of gender-based violence, and it affects the lives of countless victims in a subjective and objective way. Epidemiological surveillance points out that it is a duty to report suspected or confirmed cases of any type of violence. Objectives: To investigate the knowledge of dentists who work in Primary Care Health Units (USAB) in Ribeirão Preto / SP on topics related to the theme "violence against women". Material and methods: This study had a sample of 33 dentists that work in the USAB of Ribeirão Preto / SP, each of whom answered a questionnaire sent by email (Google® Forms), composed of 8 objective questions and 2 dissertation-type questions. The questionnaire was designed to identify the knowledge of these professionals regarding the signs that indicate this type of violence, as well as the municipal support networks, previous experiences and legal aspects. Results: It was found that 48.5% of the participants felt able to identify the physical evidence and 36.4% the emotional evidence of violence. 90.9% of them have already suspected that at least one of their patients has been a victim of violence, and they believe that notification is a duty, but only 27.3% have already notified some authority. 54.5% said they had never received any training to identify cases. The professionals did not have knowledge of the networks. Conclusion: Although there is an understanding of the important role of the dentist in the identification and notification, the knowledge demonstrated on the subject is not deepened, especially with regard to the notification process and support networks

Follow-up results of a randomized clinical trial for low-level laser therapy in painful TMD of muscular origins.

Objective: To characterize short- and long-term assessment of the low-intensity laser therapy (LLLT) effectiveness in women with TMD of muscular origins and to evaluate whether the information about the treatment received (active or placebo) modifies the pain intensity.Methods: Forty-one women with painful TMD (31.7 ± 5.2 years) were divided into laser (n = 20) and placebo (n = 21) groups. The pain intensity was measured at the baseline, after the LLLT (T8), 6 and 12 months. At the 6-month follow-up, the groups received information about the active or placebo treatment.Results: At T8 and 6-month, both active and placebo LLLT were effective in reducing pain (p < .05). After one year, the groups showed similar pain. Active LLLT was more effective in reducing pain palpation (p = .001) and referred pain (p = .04) in the region of the TMJs. The information about the treatment modified the perceived pain intensity.Conclusion: Active and placebo LLLT are effective for painful TMD of muscular origins in the short-term. Information about the treatment impairs the subjective perception of pain.

Intervenção baseada em mindfulness reduz parâmetros de sensibilidade em mulheres com DTM dolorosa crônica / Mindfulness-based intervention reduces sensitivity parameters in women with chronic painful TMD / La intervención basada en la atención plena reduce los parámetros de sensibilidad en mujeres con TMD dolorosa crónica

OBJETIVO: analisar parâmetros clínicos sugestivos de sensibilização central em mulheres com disfunção temporomandibular dolorosa crônica antes e após uma intervenção baseada em mindfulness. MÉTODO: onze mulheres com idade entre 27 e 44 anos (36,36 ± 5,61), com diagnóstico de disfunções temporomandibulares dolorosa crônica (Diagnostic Criteria for Temporomandibular Disorders), participaram do estudo. A hiperalgesia, a alodinia e o limiar de dor à pressão foram avaliados em pontos trigeminais e extra-trigeminais antes e após a intervenção baseada em mindfulness, bem como a aplicação do questionário Mindful Attention Awareness Scale. O programa de mindfulness de 8 semanas foi oferecido às participantes do estudo, com base no protocolo Mindfulness Trainings International, em sessões semanais de 2 horas e uma sessão de 4 horas. RESULTADOS: houve redução significativa da alodinia, da hiperalgesia e aumento do limiar de dor à pressão, além de aumento significativo do nível de atenção plena (p < 0,05) enquanto marcador de efetividade da intervenção baseada em mindfulness oferecida. CONCLUSÃO: índices mais saudáveis nos parâmetros clínicos sugestivos de sensibilização central investigados após a intervenção, representam melhora significativa na relação da pessoa com quadro de enfermidade crônica geradora de experiências desagradáveis contínuas como a disfunções temporomandibulares.

OBJECTIVE: manifestations of allodynia and hyperalgesia are commonly present in chronic painful temporomandibular disorder. Studies point to the benefits of people with chronic pain undergoing mindfulness-based interventions, by demonstrating brain, hormonal, and clinical changes. This study aimed to analyze clinical parameters suggestive of central sensitization (pressure pain threshold, allodynia, and hyperalgesia) in women with chronic painful temporomandibular disorder before and after a mindfulness-based intervention, through a before-and-after intervention study, longitudinal, uncontrolled. METHOD: the analysis included 11 women chosen at random from a total of 20, aged between 27 and 44 years (36.36 ± 5.61), diagnosed with chronic painful temporomandibular disorder according to the Diagnostic Criteria for Temporomandibular Disorders protocol and who completed the 8-week mindfulness-based intervention program. Hyperalgesia, allodynia, and pressure pain threshold were tested at trigeminal and extra-trigeminal points before and after the intervention as well as the application of the questionnaire to measure the level of mindfulness (Mindful Attention Awareness Scale). The 8-week mindfulness program was offered to the study participants, based on the Mindfulness Trainings International - protocol, in weekly 2-hour sessions and a 4-hour session (immersion). RESULTS: the results pointed to a reduction in allodynia, hyperalgesia and an increase in pressure pain threshold, with significant differences in several tested points (p <0.05). The changes identified were accompanied by a significant increase in the level of mindfulness (p < 0.05). CONCLUSION: healthier indexes in clinical parameters suggestive of central sensitization investigated after the intervention represent a significant improvement in the person's relationship with a chronic illness that generates continuous unpleasant experiences such as temporomandibular disorder. Thus, the practice of mindfulness represents an appropriate and particularly interesting care because it is a low-cost, non-invasive intervention with low evidence of adverse effects.

OBJETIVO: las manifestaciones de alodinia y hiperalgesia y están comúnmente presentes en lo trastorno temporomandibular doloroso crónico. Los estudios señalan los beneficios de las personas con dolor crónico que se someten a intervenciones basadas en la atención plena, al demostrar cambios cerebrales, hormonales y clínicos. El objetivo de este estudio fue analizar parámetros clínicos sugestivos de sensibilización central (umbral de dolor por presión, alodinia e hiperalgesia) en mujeres con trastorno temporomandibular doloroso crónico antes y después de una intervención basada en la atención plena, a través de un estudio de intervención antes y después, longitudinal, sin control. MÉTODO: el análisis incluyó a 11 mujeres elegidas al azar de un total de 20, con edades entre 27 y 44 años (36.36 ± 5.61), diagnosticadas con trastorno temporomandibular doloroso crónico de acuerdo con protocolo Criterios de diagnóstico para trastornos temporomandibulares y que completaron el 8- programa de intervención basado en mindfulness de una semana. La hiperalgesia, la alodinia y el umbral de dolor por presión se probaron en los puntos trigémino y extra-trigémino antes y después de la intervención, así como también en la aplicación del cuestionario para medir el nivel de atención plena (Escala de conciencia de atención plena). El programa de atención plena de 8 semanas se ofreció a los participantes del estudio, basado en el protocolo Mindfulness Trainings International, en sesiones semanales de 2 horas y una sesión de 4 horas (inmersión). RESULTADOS: los resultados apuntaron a una reducción en la alodinia, hiperalgesia y un aumento en la umbral de dolor por presión, con diferencias significativas en varios puntos probados (p <0.05). Los cambios identificados fueron acompañados por un aumento significativo en el nivel de atención plena (p <0.05), como un marcador de la efectividad de la capacitación ofrecida para la práctica de la atención plena. CONCLUSIÓN: los índices más saludables en los parámetros clínicos sugestivos de sensibilización central investigados después de la intervención, representan una mejora significativa en la relación de la persona con una enfermedad crónica que genera experiencias continuas desagradables como trastorno temporomandibular doloroso crónico. Por lo tanto, la práctica de la atención plena representa una atención aplicable y particularmente interesante porque es una intervención no invasiva de bajo costo con poca evidencia de efectos adversos.

Relation of painful TMD with the speech function: What are the possible characteristics of mandibular movements and the main symptoms reported? / Relação da DTM dolorosa com a função de fala: Quais as possíveis características de movimentos mandibulares e os principais sintomas relatados?

OBJECTIVE: To analyze the mandibular movements of patients with painful TMD during the speech function in order to understand possible alterations and which subgroups of patients may present them. In addition to identifying which signs and symptoms related to painful TMD are perceived in the performance of this function. METHODS: Thirty-two subjects aged between 18-60 years old (35.1 ± 8.9), 23 with TMD ( DC/TMD; eight men and 15 women) and nine controls were evaluated regarding: self-perception of TMD signs and symptoms during speech (ProTMDMulti); range of mandibular movements during the reading of a word list (electrognatography, Jaw Motion Analyzes). The percentage of movement usage during the speech performance as a function of maximum individual amplitude was calculated, and groups of patients with painful TMD (TMD-D) and painful/joint (TMD-D/A) were subdivided. RESULTS: The TMD-D/A group presented a higher percentage of use of lateral movement during speech than the other groups. Pain, joint noise, and difficulty in speaking were the most commonly reported signs/symptoms of speech performance. The perception of joint noises and the presence of lateral deviations were significantly higher in the TMD-D/A group (p<0.05). CONCLUSION: The lateral deviations are the main alteration of the mandibular movement during the speech performance in painful TMD. Such deviations are more expected in joint TMD (disc displacement and degenerative diseases). The perception of pain and joint noise are the main complaints related to the orofacial speech function in individuals with painful TMD.

OBJETIVO: Analisar os movimentos mandibulares de pacientes com DTM dolorosa durante a função de fala, a fim de compreender possíveis alterações e quais subgrupos de pacientes podem apresentá-las. Além de identificar quais sinais e sintomas relacionados com a DTM dolorosa são percebidos no desempenho desta função. MÉTODO: Trinta e dois sujeitos com idade entre 18 e 60 anos (35,1 ± 8,9), 23 com DTM ( DC/TMD; oito homens e 15 mulheres) e nove controles foram avaliados quanto à: autopercepção de sinais e sintomas de DTM durante a fala (ProDTMMulti); amplitude de movimentos mandibulares durante a leitura de lista de palavras (eletrognatografia, Jaw Motion Analyses). Foi calculada a porcentagem de utilização de movimento durante o desempenho da fala em função da amplitude máxima individual, e foram subdivididos grupos de pacientes com DTM dolorosa (DTM-D) e dolorosa/articular (DTM-D/A). RESULTADOS: O grupo DTM-D/A apresentou maior porcentagem de utilização de movimento na lateralidade durante a fala que os demais grupos. A dor, os ruídos articulares e a dificuldade para falar foram os sinais/sintomas mais relatados no desempenho da fala. A percepção de ruídos articulares e a presença de desvios laterais foram significativamente superiores no grupo DTM-D/A (p<0,05). CONCLUSÃO: Os desvios laterais são a principal alteração de movimento mandibular durante o desempenho da fala na DTM dolorosa. Tais desvios são mais esperados nos quadros de DTM articular (deslocamentos de disco e doenças degenerativas). A percepção de dor e de ruídos articulares são as principais queixas relacionadas à função orofacial de fala em indivíduos com DTM dolorosa.

Three-Dimensional Nasal Alterations in Le Fort I Advancement: Linear Measurements, Angles, Nasal Indices, and Volume Differences.

The maxillary advancement obtained by the Le Fort I osteotomy can also generate significant changes in the soft tissue of the nose and lips. The aim of this study was to compare the alterations in the soft tissue of the nose following the Le Fort I osteotomy maxillary advancement technique in a population of young adults submitted to orthognathic surgery. Seven men and 8 women aged between 23 and 45 underwent orthognathic surgery using the Le Fort I osteotomy and bilateral mandibular sagittal osteotomy. Sixty 3-dimensional images were analyzed (Vectra M3, Canfield, NJ) after labeling landmarks on the face and determining linear and angular measurements, proportion, and volume difference indices at the following intervals: preoperatively (baseline), then 2 months, 6 months, and 1 year after surgery. Following Le Fort I, there was an increase in the alar base, and reduction of nasal tip protrusion, nasal angles, and the nasal tip protrusion index (P < 0.05). There were no differences in the facial thirds, the nasal index, and angles of nasal and mentolabial convexity (P > 0.05). There was a difference in the volume of the nose only 2 months after surgery. The Le Fort I osteotomy caused significant alterations in linear, angular, and nasal proportion measurements. The volume differences were reversible in the early postoperative period and probably associated with edema. The possibility of variations in the size and shape of the nose should be presented to prospective patients preoperatively.

Accuracy evaluation of tridimensional images performed by portable stereophotogrammetric system / Avaliação da acurácia de imagens tridimensionais realizadas em sistema de estereofotogrametria portátil

Abstract Introduction Human facial characteristics vary according to individual dental occlusion, facial harmony, orofacial musculature and the format and configuration of craniofacial structures. Traditionally, anthropometric measurements have been acquired through direct evaluation of subjects in a clinical environment using calipers and metric tapes to measure distances between arches and landmarks. Scientific breakthroughs have enabled the digitization of data and introduced the possibility of quick, precise, radiation-free acquisitions; details can be archived for future analysis and easily shared with patients and colleagues. Among new facial analysis methods, the stereophotogrammetry technique has emerged, which uses a group of cameras to take many photographs of a subject in rapid succession from multiple angles. Nowadays, portable stereophotogrammetric systems are being proposed, as they are more practical and easier to use. Objective The aim of this work was to analyze the accuracy and reproducibility of a portable 3D stereophotogrammetric system (Vectra H1, Canfield, Fairfield, NJ, USA) in measuring soft facial tissues of 30 participants, defining measures of a cube and comparing these measurements with those obtained by a set 3D stereophotogrammetric system (Vectra M3, Canfield, Fairfield, NJ, USA) with previously validated accuracy and reproducibility through quantitative analysis of possible errors. Material and method Thirty temporary landmarks were used to measure (in mm) 34 distances in 30 participants (n = 30). Regarding the cube, 12 angles and 9 linear distances were evaluated. Result The results obtained by the established methodology indicated that the Vectra H1 portable system has shown accuracy and reproducibility equal to that of the Vectra M3 set system. Conclusion Data analysis and correlation to literature findings show Vectra H1's capability to reliably capture tridimensional images, which makes it practical for use in diverse clinical applications.

Resumo Introdução A configuração e o formato das estruturas craniofaciais, a oclusão dentária, a musculatura orofacial bem como a harmonia facial são determinantes para as características próprias da face humana. Instrumentos manuais como paquímetro e fitas métricas têm sido tradicionalmente utilizados para realizar as medidas antropométricas, diretamente de um sujeito em ambiente clínico. O avanço tecnológico possibilitou transformar a aquisição destas medidas analógicas em medições digitais, tornando possível aquisições rápidas, precisas e sem radiação. Tais informações podem, ainda, ser arquivadas para futuras análises e compartilhamento de informações com colegas e pacientes. A estereofotogrametria tem se destacado dentre as novas técnicas de captação de imagens tridimensionais, onde um grupo de câmeras de rápida captura fotografam a imagem do indivíduo a partir de variadas angulações. Atualmente, sistemas portáteis de estereofotogrametria vêm sendo propostos no mercado por apresentarem maior praticidade e simplicidade no manuseio. Objetivo A proposta do presente estudo foi avaliar a precisão e a reprodutibilidade de um sistema de estereofotogrametria 3D portátil (Vectra H1, Canfield Scientific, Fairfield, NJ, EUA) em medições dos tecidos moles faciais de 30 participantes e de um cubo de medidas definidas, comparando tais medidas com as obtidas por um sistema de estereofotogrametria 3D fixo (Vectra M3, Canfield Scientific, Fairfield, NJ, EUA), de precisão e reprodutibilidade estabelecidas e validadas, através de análise quantitativa dos possíveis erros. Material e método Foram realizadas marcações craniométricas transitórias em tecido mole da face nos 30 participantes do estudo (n=30), sendo estes submetidos à aquisição de imagens pela técnica da estereofotogrametria, tanto pelo sistema fixo Vectra M3, quanto pelo sistema portátil Vectra H1. Trinta pontos de referência (landmarks) foram utilizados para realizar as medidas (em mm) de 34 distâncias. Quanto ao cubo, foram avaliados, no total, 20 ângulos, 20 áreas e 9 distâncias lineares. Resultado Os resultados obtidos pela metodologia estabelecida mostraram que o sistema portátil Vectra H1 apresentou precisão e repetibilidade comparáveis com o sistema fixo Vectra M3. Conclusão A análise dos dados, juntamente com a correlação aos achados da literatura, evidenciam a capacidade do Vectra H1 de capturar imagens tridimensionais de modo eficaz, o que torna viável seu uso nas mais diversas aplicações clínicas.

Relação da DTM dolorosa com a função de fala: Quais as possíveis características de movimentos mandibulares e os principais sintomas relatados? / Relation of painful TMD with the speech function: What are the possible characteristics of mandibular movements and the main symptoms reported?

RESUMO Objetivo Analisar os movimentos mandibulares de pacientes com DTM dolorosa durante a função de fala, a fim de compreender possíveis alterações e quais subgrupos de pacientes podem apresentá-las. Além de identificar quais sinais e sintomas relacionados com a DTM dolorosa são percebidos no desempenho desta função. Método Trinta e dois sujeitos com idade entre 18 e 60 anos (35,1 ± 8,9), 23 com DTM ( DC/TMD; oito homens e 15 mulheres) e nove controles foram avaliados quanto à: autopercepção de sinais e sintomas de DTM durante a fala (ProDTMMulti); amplitude de movimentos mandibulares durante a leitura de lista de palavras (eletrognatografia, Jaw Motion Analyses). Foi calculada a porcentagem de utilização de movimento durante o desempenho da fala em função da amplitude máxima individual, e foram subdivididos grupos de pacientes com DTM dolorosa (DTM-D) e dolorosa/articular (DTM-D/A). Resultados O grupo DTM-D/A apresentou maior porcentagem de utilização de movimento na lateralidade durante a fala que os demais grupos. A dor, os ruídos articulares e a dificuldade para falar foram os sinais/sintomas mais relatados no desempenho da fala. A percepção de ruídos articulares e a presença de desvios laterais foram significativamente superiores no grupo DTM-D/A (p<0,05). Conclusão Os desvios laterais são a principal alteração de movimento mandibular durante o desempenho da fala na DTM dolorosa. Tais desvios são mais esperados nos quadros de DTM articular (deslocamentos de disco e doenças degenerativas). A percepção de dor e de ruídos articulares são as principais queixas relacionadas à função orofacial de fala em indivíduos com DTM dolorosa.

ABSTRACT Objective To analyze the mandibular movements of patients with painful TMD during the speech function in order to understand possible alterations and which subgroups of patients may present them. In addition to identifying which signs and symptoms related to painful TMD are perceived in the performance of this function. Methods Thirty-two subjects aged between 18-60 years old (35.1 ± 8.9), 23 with TMD ( DC/TMD; eight men and 15 women) and nine controls were evaluated regarding: self-perception of TMD signs and symptoms during speech (ProTMDMulti); range of mandibular movements during the reading of a word list (electrognatography, Jaw Motion Analyzes). The percentage of movement usage during the speech performance as a function of maximum individual amplitude was calculated, and groups of patients with painful TMD (TMD-D) and painful/joint (TMD-D/A) were subdivided. Results The TMD-D/A group presented a higher percentage of use of lateral movement during speech than the other groups. Pain, joint noise, and difficulty in speaking were the most commonly reported signs/symptoms of speech performance. The perception of joint noises and the presence of lateral deviations were significantly higher in the TMD-D/A group (p<0.05). Conclusion The lateral deviations are the main alteration of the mandibular movement during the speech performance in painful TMD. Such deviations are more expected in joint TMD (disc displacement and degenerative diseases). The perception of pain and joint noise are the main complaints related to the orofacial speech function in individuals with painful TMD.

Rapid maxillary expansion in the treatment of the functional posterior crossbite: joint noise and electromyographic activity analysis / Expansão rápida da maxila no tratamento da mordida cruzada posterior: análise de ruídos articulares e atividade eletromiográfica

Abstract Introduction The rapid maxillary expansion (RME) reduces the risk of developing structural and functional disorders in the stomatognathic system. Objective To examine the effects of the RME as a treatment for the posterior crossbite, related with the electromyographic activity of the masticatory muscles and the TMJ noises in a population of children. Material and method 13 girls and 7 boys, regardless of the type of malocclusion, with a mean age of 9 years old (± 3), were treated with RME. The electrovibratography analyzed the TMJ noise, and the electromyography analyzed the masticatory muscles before treatment (T0) and after three months of a short-term follow-up (T1). The comparisons of the affected and unaffected sides by the crossbite were performed using Mann-Whitney's test, and to compare data before and after treatment the Wilcoxon's test was used (level of significance: 5%). Result No significant differences were found in the parameters of joint noise in comparison to the sides affected and unaffected by the crossbite, in both T0 and T1 (p>0.05); only the side without the crossbite observed decrease in the peak amplitude of the joint noises after treatment. In the static electromyographic analysis, inter-side differences were observed before and after treatment, since the deliberate unilateral chewing showed greater asymmetry activity in T0 for both sides, which has been corrected after treatment, improving the functional chewing. Conclusion The proposed treatment did not lead to the occurrence of joint noises and improved the functional pattern of electromyographic activity during chewing at the end of treatment.

Resumo Introdução A expansão rápida da maxila (RME) reduz o risco de desenvolvimento de distúrbios estruturais e funcionais no sistema estomatognático. Objetivo Analisar os efeitos desta intervenção como tratamento para a mordida cruzada posterior, relacionados à ocorrência de ruídos nas articulações temporomandibulares e à atividade eletromiográfica dos músculos masseter e temporal anterior. Material e método 13 meninas e 7 meninos, independentemente do tipo de maloclusão, com idade média de 9 anos (±3), foram tratadas com RME. Por meio de eletrovibratografia analisou-se ruídos nas articulações temporomandibulares, e de eletromiografia de superfície a atividade dos músculos mastigatórios antes (T0) e após 3 meses do final do tratamento proposto (T1). As comparações entre os lados afetado e não afetado pela mordida cruzada foram realizadas utilizando-se o teste de Mann-Withney. As comparações de antes e após o tratamento foram realizadas pelo teste de Wilcoxon (nível de significância: 5%). Resultado Não houve diferença significativa na eletrovibratografia entre os lados afetado e não afetado pela mordida cruzada, tanto em T0 como em T1 (p>0.05); do lado sem mordida cruzada observou-se diminuição do pico de amplitude dos ruídos articulares após a expansão rápida da maxila (p<0.05). Na análise da eletromiografia estática foram observadas diferenças inter-lados antes e após o tratamento, uma vez que a mastigação deliberada unilateral apresentou maior atividade de assimetria em T0 para ambos os lados, o que foi corrigido após o tratamento (p<0.05), melhorando a mastigação funcional padrão. Conclusão O tratamento proposto para mordida cruzada posterior funcional não levou à ocorrência de ruídos articulares e melhorou o padrão funcional da atividade eletromiográfica durante a mastigação ao final do tratamento.

Non-specific effects and clusters of women with painful TMD responders and non-responders to LLLT: double-blind randomized clinical trial.

The aim was to analyze the non-specific effects (placebo, spontaneous remission, and regression to the mean) of the low-level laser therapy (LLLT) in women with myofascial pain (painful temporomandibular disorder (TMD)), as well as to differentiate between responders and non-responder clusters to active and placebo LLLT according to the anxiety levels, salivary cortisol, use of oral contraceptives, and premenstrual period. Sixty-four women diagnosed with myofascial pain (Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD)) were included, divided into laser (n = 20), placebo group (n = 21), and 23 controls (without treatment (WT)). The LLLT applied was 780 nm, masseter and temporal = 5 J/cm2 (20 mW-0.5 W/cm2), and TMJ area = 7.5 J/cm2 (30 mW-0.8 W/cm2), eight sessions, twice a week. The pain intensity (visual analogue scale (VAS)), anxiety (Beck Anxiety Inventory), salivary cortisol, and menstrual cycle's data at the baseline, T1-T8, and 30 days after LLLT (follow-up) were evaluated. The laser group showed 80% of pain reduction, placebo 85%, and WT 43% in T8. Women with severe anxiety and at the premenstrual period did not reduce pain with any LLLT. Active and placebo LLLT had similar effectiveness during the treatment period; however, women with moderate anxiety, cortisol levels above 10 ng/ml, and without contraceptive use maintain analgesia longer with active LLLT than placebo (follow-up 30 days). Women with low levels of anxiety, salivary cortisol below 10 ng/ml, and with contraceptive use showed the higher pain reduction. The analgesia promoted by LLLT in women with myofascial pain is a result of non-specific effects during the treatment period, although active LLLT is more effective in maintaining the analgesia after treatment (30 days) for the cluster of women with moderate anxiety, salivary cortisol above 10 ng/ml, and without contraceptive use.

Ultra-low frequency transcutaneous electric nerve stimulation does not affect the centric relation registration.

OBJECTIVE: To evaluate the influence of ULF-TENS on the displacement of the mandibular condyle and on the repeatability of centric relation (CR) registration of three different techniques: bimanual manipulation (BM), long strip technique, and harmonic centric occlusal relationship (R.O.C.A. wires). METHODS: Twenty-five participants without temporomandibular disorder (TMD) underwent two study stages conducted via electronic position analysis: (1) three CR records were made, one for each manipulation technique; (2) the ULF-TENS was applied for 30 min, and after that the same CR records were repeated. STATISTICAL ANALYSES: Mann-Whitney, ICC, and one-tailed F test. RESULTS: The ULF-TENS did not influence the condyle total displacement, regardless of CR recording technique used (p > 0.05). BM showed an improvement in repeatability after ULF-TENS. DISCUSSION: Concerning the variance, BM showed less variation at the X-axis. Long strip technique and R.O.C.A. wires varied less at the Y-axis. Long strip technique was again less variable at the Z-axis.