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.

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.

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.

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.

Influence of tongue exercise and orofacial myofunctional status on the electromyographic activity and pain of chronic painful TMD.

Objective: To analyze the influence of tongue exercise and myofunctional status on the electromyographic activity (EMG) and pain perception in individuals with chronic painful TMDs.Methods: Twenty-four subjects diagnosed according to the DC/TMD (18-52 years old) were assessed: EMG on the masseter and anterior temporalis; myofunctional orofacial conditions underwent clinical assessment (OMES); and questionnaire for self-perception of TMD signs and symptoms (ProTMDMulti). The 50th percentile was calculated to establish a cutoff value based on OMES scores related to the functional variables of the tongue.Results: The compared groups showed no differences (p > 0.05) in self-perception of their TMD signs and symptoms or in the EMG activity during tongue exercises.Discussion: The myofunctional status of the tongue showed no impact on the painful TMD or on the activity of the masticatory muscles (captured during tongue exercise). The indication of tongue exercises in TMD cases is a safe and adequate possibility.

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.

Can the severity of orofacial myofunctional conditions interfere with the response of analgesia promoted by active or placebo low-level laser therapy?

OBJECTIVE: To analyze the influence of orofacial myofunctional condition (OMC) on pain perception, temporomandibular disorders (TMD) severity, and the response to low-level laser therapy (LLLT) in women with painful TMD. METHODS: Seventy-eight women, 59 with TMD, received active laser (30) or placebo (29), with 19 controls. OMC, TMD severity, pain intensity, and pressure pain threshold (PPT) were assessed at different times during the masticatory test: before treatment (LLLT dose: 780nm), during, and after 30 days. RESULTS: No correlation was found between OMC and pain perception or TMD severity (p > 0.05). The active and placebo LLLT showed reduction of pain during chewing and better recovery levels during the rest period (p > 0.05), without differences between OMC groups. DISCUSSION: The perception of pain and severity of TMD are not correlated with the OMC, and the response of analgesia promoted by active LLLT or placebo is not associated with OMC.

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.

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.

Low-level lasertherapy associated to occlusal splint to treat temporomandibular disorder: controlled clinical trial / Laserterapia de baixa intensidade associada ao uso de placa oclusal no tratamento de disfunção temporomandibular: estudo clínico controlado

ABSTRACT BACKROUND AND OBJECTIVES: Most widely used treatment modality for temporomandibular disorders is the occlusal splint. Low-level lasertherapy has been used as therapeutic agent, however as isolated treatment. So, this study aimed at evaluating the effect of the association of low-level lasertherapy and occlusal splint to treat temporomandibular disorders. METHODS: Participated in the study 25 selected patients according to the Research Diagnostic Criteria for Temporomandibular Disorders protocol. Control group (CG) was made up of 12 asymptomatic volunteers. Two groups were randomly formed: "splint-laser" (SLG), being treated with occlusal splint and associated low-level lasertherapy; "splint" (SG), treated with occlusal splint only. Jaw movements, pain at palpation and selfperception of signs and symptoms were investigated before and after treatment. RESULTS: There has been significant decrease in pain at palpation and reported pain according to self-perception of signs and symptoms for both groups, however more significant for SLG. There has been increased amplitude of jaw movements with significant difference after treatment for both groups. CONCLUSION: The association of low-level lasertherapy and occlusal splint to treat temporomandibular disorders has promoted more marked pain decrease as compared to occlusal splint alone. Placebo effect should not be discarded and should be tested in future studies.

RESUMO JUSTIFICATIVA E OBJETIVOS: A modalidade de tratamento mais empregada para disfunção temporomandibular é a placa oclusal. A laserterapia de baixa intensidade tem sido empregada como agente terapêutico, porém como tratamento isolado. Assim, o objetivo deste estudo foi analisar o efeito da associação da laserterapia de baixa intensidade ao uso da placa oclusal como tratamento para disfunção temporomandibular. MÉTODOS: Participaram do estudo 25 pacientes selecionados de acordo com o protocolo Research Diagnostic Criteria for Temporomandibular Disorders. O grupo controle (GC) foi formado por 12 voluntários assintomáticos. Dois grupos foram formados por sorteio: "placa-laser" (GPL), que recebeu tratamento com placa oclusal e laserterapia de baixa intensidade associada; "placa" (GP), que recebeu tratamento apenas com placa oclusal. Os movimentos mandibulares, a dor à palpação e autopercepção dos sinais e sintomas, foram investigados antes e após os tratamentos. RESULTADOS: Houve diminuição significativa da dor à palpação e da dor relatada de acordo com a autopercepção dos sinais e sintomas para ambos os grupos tratados, porém de forma mais acentuada para o GPL. Houve aumento da amplitude dos movimentos mandibulares com diferença significativa após os tratamentos para ambos os grupos. CONCLUSÃO: A associação da laserterapia de baixa intensidade ao tratamento da disfunção temporomandibular com placa oclusal promoveu diminuição mais acentuada do sintoma doloroso dolorosa quando comparado ao tratamento apenas com placa oclusal. O efeito placebo não deve ser descartado e deverá ser testado em estudos futuros

Effect of speech-language therapy after low-level laser therapy in patients with TMD: a descriptive study. / Efeito do tratamento fonoaudiológico após a laserterapia de baixa intensidade em pacientes com DTM: estudo descritivo.

Increased pain and/or discomfort during chewing, speaking, and swallowing have been commonly reported by patients with Temporomandibular Dysfunction (TMD). Speech-language pathology therapy (orofacial myofunctional therapy - OMT) has been proposed as part of the treatment for this condition; however, it is a modality that should be introduced when the TMD context and the pain are not accentuated, so that they do not prevent or hinder the performance of exercises. The aim of this study was to analyze the effect of OMT on the treatment of patients with TMD, according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), after analgesia with low-level laser therapy (LLLT), regarding orofacial myofunctional conditions (OMC) and the perception of TMD symptoms. Five patients aged 50 to 61 years were evaluated 30 days after completion of LLLT. An experienced speech-language pathologist conducted, pre- and post-OMT, the application of the ProDTM Multi-questionnaire - to investigate the self-perception of TMD symptomatology, and the Orofacial Myofunctional Evaluation with Scores (OMES) clinical examination - to confirm the orofacial myofunctional conditions. OMC presented increased OMT scores, indicating an increase in myofunctional orofacial balance. According to the patients' perception, TMD signs and symptoms were relieved after the application of OMT. According to the self-perception of the treated patients, introduction of OMT after LLLT analgesia promoted a balance of the orofacial functions of the sample studied, as well as a decrease in the remaining TMD signs and symptoms.

Efeito do tratamento fonoaudiológico após a laserterapia de baixa intensidade em pacientes com DTM: estudo descritivo / Effect of speech-language therapy after low-level laser therapy in patients with TMD: a descriptive study

RESUMO O aumento da dor/desconforto durante atividades como mastigar, falar e deglutir é comumente relatado por pacientes com Disfunção Temporomandibular (DTM) e a terapia fonoaudiológica miofuncional orofacial (TMO) tem sido proposta como parte do tratamento desta condição. Porém é uma modalidade que deve ser instituída quando o quadro de DTM e dor não está exacerbado a fim de não impedir ou dificultar a realização dos exercícios. Objetivo O objetivo deste estudo foi analisar o efeito da TMO no tratamento de pacientes com DTM, segundo o Research Diagnostic Criteria for temporomandibular disorders (RDC/TMD), após analgesia com laserterapia de baixa intensidade (LBI), quanto às condições miofuncionais orofaciais (CMO) e quanto à percepção dos sintomas de DTM. Método Transcorridos 30 dias após a finalização da LBI, cinco pacientes foram avaliados, com idades entre 50 e 61 anos. A aplicação do questionário ProDTMMulti para investigação da autopercepção da sintomatologia de DTM e do exame clínico AMIOFE (Avaliação Miofuncional Orofacial com Escores) para constatação das condições miofuncionais orofaciais foram realizados por fonoaudióloga experiente, antes e após a TMO. Resultados As CMO apresentaram aumento dos escores após TMO, indicando aumento do equilíbrio miofuncional orofacial. De acordo com a percepção das pacientes, após a TMO houve alívio dos sinais e sintomas de DTM. Conclusão A TMO instituída após a analgesia com LBI promoveu equilíbrio das funções orofaciais da amostra estudada e diminuição dos sinais e sintomas de DTM remanescentes, de acordo com a autopercepção dos indivíduos tratados.

ABSTRACT Increased pain and/or discomfort during chewing, speaking, and swallowing have been commonly reported by patients with Temporomandibular Dysfunction (TMD). Speech-language pathology therapy (orofacial myofunctional therapy - OMT) has been proposed as part of the treatment for this condition; however, it is a modality that should be introduced when the TMD context and the pain are not accentuated, so that they do not prevent or hinder the performance of exercises. The aim of this study was to analyze the effect of OMT on the treatment of patients with TMD, according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), after analgesia with low-level laser therapy (LLLT), regarding orofacial myofunctional conditions (OMC) and the perception of TMD symptoms. Five patients aged 50 to 61 years were evaluated 30 days after completion of LLLT. An experienced speech-language pathologist conducted, pre- and post-OMT, the application of the ProDTM Multi-questionnaire - to investigate the self-perception of TMD symptomatology, and the Orofacial Myofunctional Evaluation with Scores (OMES) clinical examination - to confirm the orofacial myofunctional conditions. OMC presented increased OMT scores, indicating an increase in myofunctional orofacial balance. According to the patients' perception, TMD signs and symptoms were relieved after the application of OMT. According to the self-perception of the treated patients, introduction of OMT after LLLT analgesia promoted a balance of the orofacial functions of the sample studied, as well as a decrease in the remaining TMD signs and symptoms.

Facial anthropometric analysis of a healthy group of young Brazilian adults by means of stereophotogrammetry technique / Análise antropométrica facial de um grupo de jovens adultos brasileiros saudáveis por meio da técnica da estereofotogrametria

Introduction: Anthropometry is the science responsible for measuring the weight, size, and proportions of the human body, providing valuable and objective insights into how to characterize phenotypic variation and dysmorphology. Among the newer methods for facial analysis, the stereophotogrammetry technique has shown excellent results given its use of a group of fast cameras that photograph subjects from multiple angles. Objective: The aims of the present study were: (1) to analyze the facial profile of a group of healthy young Brazilian adults, between 18 and 30 years of age, (2) to define common facial values among the subjects, (3) to create a database of facial measurements of a portion of this young healthy Brazilian population to be used in future works, and (4) to test the precision and repeatability of the Vectra M3® equipment. Material and method: Sixty healthy young Brazilian adults participated in the study, 30 males and 30 females. Temporary craniometrical landmarks were performed in soft tissue, and those subjects underwent image capturing by the stereophotogrammetry technique. Thirty landmarks were used to take the measurements (in mm) of 35 distances. The equipment repeatability was tested in 20% of the sample (i.e., 12 subjects). Result: The values between the first and second acquisitions were statistically (p<0.05) similar for all 35 distances analyzed. The findings allowed the creation of a reliable database containing facial distances of a portion of the young healthy Brazilian population. In addition, the distances Tr-N, N-Sn, Ls-Sto, Sto-Li, En[r]-En[l] and Prn-Sn were not statistically different for the group of men (GM) and the group of women (GW), while the other 29 distances were significantly greater in GM. Conclusion: The technique and methods employed in the study yielded objective analyses of the facial profile of this group of healthy young Brazilian adults, and the equipment Vectra M3® showed a high level of precision and repeatability.

Introdução: Antropometria é a ciência responsável por medir o peso, tamanho e proporções do corpo humano, fornecendo informações objetivas e confiáveis para caracterizar variações e dismorfismos fenotípicos. Entre os novos métodos de análise facial, a técnica da estereofotogrametria tem mostrado excelentes resultados devido o uso de um grupo de câmeras capazes de fotografar sujeitos em múltiplos ângulos. Objetivo: Os objetivos deste estudo foram: (1) analisar o perfil facial de um grupo de jovens adultos saudáveis brasileiros, entre 18 e 30 anos, (2) definir valores comuns entre os sujeitos, (3) criar uma base de dados de medidas faciais de uma porção desta população jovem adulta de brasileiros para ser utilizada em trabalhos futuros, e (4) testar a precisão e repetibilidade do equipamento Vectra M3®. Material e método: Sessenta jovens adultos brasileiros participaram deste estudo, 30 homens e 30 mulheres. Pontos de referência craniométricos temporários foram realizados em tecido mole, e estes sujeitos foram fotografados pela técnica da estereofotogrametria. Trinta pontos de referência foram usados para realizar as medições (em mm) de 35 distâncias. A repetibilidade do equipamento foi testada em 20% da amostra (12 sujeitos). Resultado: Os valores entre a primeira e a segunda aquisição foram estatisticamente (p<0,05) similares para todas as 35 distancias analisadas. Os achados possibilitaram a criação de um banco de dados confiável contendo distâncias de uma porção da população jovem adulta saudável brasileira. Além disso, as distâncias Tr-N, N-Sn, Ls-Sto, Sto-Li, En[r]-En[l] e Prn-Sn não foram estatisticamente diferentes entre o grupo de homens (GM) e o grupo de mulheres (GW), enquanto as outras 29 distâncias foram significativamente maiores em GM. Conclusão: A técnica e os métodos empregados neste estudo possibilitaram análise objetiva do perfil facial de um grupo de jovens adultos saudáveis brasileiros, e o equipamento Vectra M3® mostrou alto nível de precisão e reprodutibilidade.

Evaluation of the impact on quality of life of patients with temporomandibular disorders / Avaliação do impacto na qualidade de vida de pacientes com disfunção temporomandibular

ABSTRACTBACKGROUND AND OBJECTIVES:Chronic pain, such as temporomandibular disorder, often leads to significant changes in quality of life. This study aimed at evaluating the influence of temporomandibular disorders in the subjective perception of quality of life by means of the Oral Health Impact Profile-14.METHODS:Participated in the study 80 patients diagnosed with temporomandibular disorders by means of the Research Diagnostic Criteria for Temporomandibular Disorders, aged between 18 and 60 years (32.71±1.1), who were submitted to the Oral Health Impact Profile-14 questionnaire. Non parametric Mann-Whitney statistics, Pearson Correlation test, Analysis of Variance and Tukey test were used with significance level of 5%.RESULTS:There has been no statistically significant difference in the perception of the impact on quality of life between genders; patients with association of signs and symptoms of the three groups of the Research Diagnostic Criteria for Temporomandibular Disorders had further impact on quality of life, as well as the most severe the temporomandibular disorder the highest the reported impact (p=0.05), and the age group with the highest impact on quality of life was between 18 and 30 years (p<0.01).CONCLUSION:Increased age, severity and the association of diagnoses have exacerbated the impact of temporomandibular disorders on quality of life. Variables analyzed in this study were related to temporomandibular disorder chronicity, stressing the importance of early intervention strategies to minimize the impact on quality of life.

RESUMOJUSTIFICATIVA E OBJETIVOS:Dores crônicas, como as disfunções temporomandibulares, levam com frequência a alterações significativas na qualidade de vida. O objetivo deste estudo foi avaliar a influência da disfunção temporomandibular na percepção subjetiva da qualidade de vida, obtida por meio do Oral Health Impact Profile-14.MÉTODOS:Oitenta pacientes diagnosticados com disfunção temporomandibular por meio dos critérios do Research Diagnostic Criteria for Temporomandibular Disorders, com idade entre 18 e 60 anos (32,71±11,1), foram submetidos ao questionário Oral Health Impact Profile-14. Empregaram-se a estatística não paramétrica de Mann-Whitney, teste de Correlação de Pearson e Análise de Variância e teste de Tukey, adotando-se 5% como nível de significância.RESULTADOS:Não houve diferença estatisticamente significativa quanto à percepção do impacto na qualidade de vida entre os gêneros; pacientes com associação de sinais e sintomas dos três grupos do Research Diagnostic Criteria for Temporomandibular Disorders apresentaram maior impacto na qualidade de vida, assim como, quanto maior a gravidade da disfunção temporomandibular maior é o impacto relatado (p=0,05) e a faixa etária com maior impacto na qualidade de vida encontrava-se entre 18 e 30 anos (p<0,01).CONCLUSÃO:O aumento da idade, a gravidade e a associação de diagnósticos exacerbaram o impacto da disfunção temporomandibular na qualidade de vida. As variáveis analisadas neste estudo relacionam-se com a cronicidade da disfunção temporomandibular, ressaltando a importância de estratégias de intervenção precoce para minimizar o comprometimento da qualidade de vida.

Is the masticatory function changed in patients with temporomandibular disorder?

Patients with temporomandibular disorders (TMD) often complain and have limitation in masticatory function, which can be affected by a complex interaction of factors. The aim of this study was analyze the masticatory function in patients with TMD using surface electromyography (EMG) and masticatory efficiency (ME). Twenty-seven patients with TMD and 25 considered control (n), aged between 18 and 60 years, paired by age and gender, were evaluated according to RDC/TMD. In both groups were performed: EMG with chewing gum, clinical evaluation of habitual chewing with stuffed cookie (CE) (number of chewing strokes and time) and analysis of ME with fuchsin beads. Nonparametric statistical analyses were used (Mann-Whitney) for comparisons between groups, with 5% significance level. For all variables, the TMD group showed higher values than the control, with statistical significance for ME (p<0.0001), number of chewing strokes (p=0.04), chewing time (p=0.009), right masseter EMG activity (p=0.05), left masseter (p=0.005), right anterior temporal (p=0.05) and left anterior temporal (p=0.001). The conclusion is that patients with TMD showed changed chewing pattern, but without impairment of masticatory function.

Is the Masticatory Function Changed in Patients with Temporomandibular Disorder?

Patients with temporomandibular disorders (TMD) often complain and have limitation in masticatory function, which can be affected by a complex interaction of factors. The aim of this study was analyze the masticatory function in patients with TMD using surface electromyography (EMG) and masticatory efficiency (ME). Twenty-seven patients with TMD and 25 considered control (n), aged between 18 and 60 years, paired by age and gender, were evaluated according to RDC/TMD. In both groups were performed: EMG with chewing gum, clinical evaluation of habitual chewing with stuffed cookie (CE) (number of chewing strokes and time) and analysis of ME with fuchsin beads. Nonparametric statistical analyses were used (Mann-Whitney) for comparisons between groups, with 5% significance level. For all variables, the TMD group showed higher values than the control, with statistical significance for ME (p<0.0001), number of chewing strokes (p=0.04), chewing time (p=0.009), right masseter EMG activity (p=0.05), left masseter (p=0.005), right anterior temporal (p=0.05) and left anterior temporal (p=0.001). The conclusion is that patients with TMD showed changed chewing pattern, but without impairment of masticatory function.

Pacientes com disfunção temporomandibular (DTM) frequentemente se queixam e apresentam limitação na função mastigatória, a qual pode ser afetada por uma complexa interação de fatores. O objetivo deste estudo foi analisar a função mastigatória de pacientes com DTM em comparação a sujeitos controle por meio das técnicas de eletromiografia de superfície e eficiência mastigatória (EM). 27 pacientes com DTM e 25 considerados controle (n), com idade entre 18 e 60 anos, pareados por idade e gênero, foram avaliados segundo o RDC/TMD. Em ambos os grupos foram realizados: exame de eletromiografia de superfície da mastigação habitual com goma de mascar (EMG), avaliação fonoaudiológica da mastigação habitual com biscoito recheado (AF) (número total de golpes mastigatórios e tempo) e análise da eficiência mastigatória com o sistema de cápsulas compostas por beads de fucsina (EM). Foi empregada estatística não paramétrica (Mann-Whitney) para a comparação intergrupos, adotando-se 5% como nível de significância. Para todas as variáveis estudadas o grupo DTM apresentou valores superiores em relação ao grupo controle, com significância estatística: EM (p<0,0001), número total de golpes (p=0,04), tempo de mastigação (p=0,009), atividade eletromiográfica masseter direito (p=0,05), masseter esquerdo (p=0,005), temporal anterior direito (0,05) e temporal anterior esquerdo (p=0,001). Conclui-se que pacientes com DTM apresentam um padrão mastigatório alterado porém, sem comprometimento da função mastigatória.

Frequency of electromyographic indices alterations in temporomandibular disorders and their correlation with pain intensity / Frequência de alterações dos índices eletromiográficos na disfunção temporomandibular e sua correlação com o nível de dor

BACKGROUND AND OBJECTIVES: Understanding the importance of surface electromyography as a complementary method to understand the myofunctional status of the stomatognathic system, this study aimed at analyzing the frequency of altered and normal electromyographic indices in a sample of subjects with temporomandibular disorders, in addition to their relation with pain complaint. METHODS: Participated in the study 44 individuals with temporomandibular disorder signs and symptoms (11 males and 33 females), with mean age of 39 years, who were submitted to surface electromyography. Pain intensity was measured by the visual analog scale. Total Asymmetry Index (AStotal), Masseter Asymmetry Index (ASMM), Temporal Asymmetry Index (ASTA), Activation Index (ACtotal) and Torque Index (TOtotal) were calculated. Correlation between pain intensity and electromyographic indices was checked by Pearson correlation test and sample characterization with regard to investigated indices was done by descriptive analysis. RESULTS: Means of all indices were within previously established normality patterns. The frequency of altered electromyographic indices in our sample was high (ASMM=68%; ASTA=64%; TOtotal=64%; AStotal=55%). With regard to ACtotal, there has been predominance of masseter activity as compared to temporal activity, both for normal and altered values. Among individuals with altered indices, the left side had superior activity. No correlation was found between pain intensity and the level of electromyographic indices alterations (p>0.05). CONCLUSION: The frequency of electromyographic indices alterations in individuals with temporomandibular disorders is high, pointing to the possible presence of myofunctional disorders of the stomatognathic system. These indices have no direct relation with pain complaint but show muscular activity imbalance, which may not be useful to diagnose pain, but may help the correct referral to relevant muscle therapies. .

JUSTIFICATIVA E OBJETIVOS: Compreendendo a importância da eletromiografia de superfície como método complementar para o entendimento do estado miofuncional do sistema estomatognático, o objetivo deste estudo foi analisar a frequência de índices eletromiográficos alterados e normais em uma amostra de sujeitos com disfunção temporomandibular, bem como sua relação com a queixa de dor. MÉTODOS: Foram avaliados 44 sujeitos com sinais e sintomas de disfunção temporomandibular, (11 homens/33 mulheres), com média de idade de 39 anos, os quais foram submetidos à eletromiografia de superfície. O nível de dor foi investigado por meio de escala analógica visual. Foram calculados o Índice de Assimetria Total (AStotal), Índice de Assimetria do Masseter (ASMM), Índice de Assimetria do Temporal (ASTA), Índice de Ativação (ACtotal) e Índice de Torque (TOtotal). A correlação entre o nível de dor e os índices eletromiográficos foi verificada pelo teste de correlação de Pearson e a caracterização da amostra quanto aos índices investigados foi feita por meio de análise estatística descritiva. RESULTADOS: As médias de todos os índices encontraram-se dentro dos padrões de normalidade, estabelecidos previamente. A frequência de índices eletromiográficos alterados na amostra estudada foi alta (ASMM=68%; ASTA=64%; TOtotal=64%; AStotal=55%). Em relação ao ACtotal houve predomínio de atividade do masseter em relação ao temporal, tanto para os valores normais quanto para os alterados. Dentre os sujeitos com índices alterados, o lado esquerdo apresentou atividade superior. Não foi encontrada correlação entre o nível de dor e o nível de alteração dos índices eletromiográficos ...