Temporomandibular joint findings in CBCT images: A retrospective study.

OBJECTIVE: To evaluate radiological characteristics of the temporomandibular joint. METHODS: Retrospective study of images of 20-80 year-old patients. Two independent clinicians analyzed the images, and a radiological score was obtained, considering sclerosis, osteophites, cysts, and erosion. RESULTS: Seventy eight percent of the joints belonged to females. The main complaints were pain and headache (54.5%) and reduced motion (21.2%). The most common diagnoses were disc dislocation with reduction (35.9%), myofascial pain (20.7%), and osteoarthritis (15.2%). The majority of the joints (96.5%) showed degeneration, with an average radiological score of 3.86 ± 1.47 (0-8). Non-parametric tests showed that females had significantly higher radiological scores (p = 0.014), and TMD-joint patients had higher scores than TMD-muscle patients (p = 0.013). No statistically significant association between radiological scores and chief complaint. CONCLUSION: There were differences among the radiological findings between genders and joint/ muscle TMD, as well as across diagnoses, as expected.

Efficacy of cannabis-based medications compared to placebo for the treatment of chronic neuropathic pain: a systematic review with meta-analysis.

BACKGROUND: Chronic neuropathic pain (NP) presents therapeutic challenges. Interest in the use of cannabis-based medications has outpaced the knowledge of its efficacy and safety in treating NP. The objective of this review was to evaluate the effectiveness of cannabis-based medications in individuals with chronic NP. METHODS: Randomized placebo-controlled trials using tetrahydrocannabinol (THC), cannabidiol (CBD), cannabidivarin (CBDV), or synthetic cannabinoids for NP treatment were included. The MEDLINE, Cochrane Library, EMBASE, and Web of Science databases were examined. The primary outcome was the NP intensity. The risk of bias analysis was based on the Cochrane handbook. RESULTS: The search of databases up to 2/1/2021 yielded 379 records with 17 RCTs included (861 patients with NP). Meta-analysis showed that there was a significant reduction in pain intensity for THC/CBD by -6.624 units (P < .001), THC by -8.681 units (P < .001), and dronabinol by -6.0 units (P = .008) compared to placebo on a 0-100 scale. CBD, CBDV, and CT-3 showed no significant differences. Patients taking THC/CBD were 1.756 times more likely to achieve a 30% reduction in pain (P = .008) and 1.422 times more likely to achieve a 50% reduction (P = .37) than placebo. Patients receiving THC had a 21% higher improvement in pain intensity (P = .005) and were 1.855 times more likely to achieve a 30% reduction in pain than placebo (P < .001). CONCLUSION: Although THC and THC/CBD interventions provided a significant improvement in pain intensity and were more likely to provide a 30% reduction in pain, the evidence was of moderate-to-low quality. Further research is needed for CBD, dronabinol, CT-3, and CBDV.

Efficacy of medications in adult patients with trigeminal neuralgia compared to placebo intervention: a systematic review with meta-analyses.

BACKGROUND: Trigeminal neuralgia (TN) is characterized by brief, unilateral, sharp, stabbing, and shooting pain of the fifth cranial nerve. The objective of this systematic review with meta-analysis was to determine the effect of medications compared to placebo in adult patients with TN. METHODS: Review authors identified randomized placebo-controlled trials (RCTs) from PubMed, Web of Science, Cochrane, and EMBASE up to February 2021. We assessed the inclusion and exclusion criteria as well as the risk of bias of the studies based on the Cochrane Handbook. A total of 324 unduplicated references were scanned independently and reduced to eight relevant RCTs, with 89 patients included. Medications investigated included oral carbamazepine, subcutaneous sumatriptan, lidocaine (intranasal, 8% spray on the oral mucosa or intravenous), buprenorphine (ganglionic local opioid analgesia), and oral Nav1.7, a selective sodium channel blocker. RESULTS: Meta-analyses showed that overall patients receiving lidocaine reported a significantly lower post-treatment intensity of pain -3.8 points on a 0-10 scale (95% Cl = -4.653 to -2.873; P < 0.001). Patients who received lidocaine were 8.62 times more likely to have pain improvement than patients on placebo (P < 0.001). In one RCT, patients receiving oral carbamazepine showed a significant improvement in pain intensity of -32% compared to the placebo (P < 0.001). In one trial, patients receiving 3 mg subcutaneous sumatriptan had a significantly lower intensity of pain on average -6.1 points on a scale of 0-10 compared to placebo (P < 0.001) and a significant improvement in pain intensity of -75% compared to the improvement in the placebo group (P < 0.001). Patients who received subcutaneous sumatriptan were 10 times more likely to have pain improvement than those who received placebo (P = 0.001) in one study. Due to the unclear/high risk of bias and small sample size, the quality of the evidence for lidocaine in the treatment of TN was low. CONCLUSION: Further studies are needed for carbamazepine, sumatriptan, buprenorphine, and oral Nav1.7 sodium channel blockers, as only one study reported outcomes.

Effects of respiratory muscle therapy on obstructive sleep apnea: a systematic review and meta-analysis.

STUDY OBJECTIVES: The purpose of this study is to conduct a systematic review and meta-analysis evaluating the effects of respiratory muscle therapy (ie, oropharyngeal exercises, speech therapy, breathing exercises, wind musical instruments) compared with control therapy or no treatment in improving apnea-hypopnea index ([AHI] primary outcome), sleepiness, and other polysomnographic outcomes for patients diagnosed with obstructive sleep apnea (OSA). METHODS: Only randomized controlled trials with a placebo therapy or no treatment searched using PubMed, EMBASE, Cochrane, and Web of Science up to November 2018 were included, and assessment of risk of bias was completed using the Cochrane Handbook. RESULTS: Nine studies with 394 adults and children diagnosed with mild to severe OSA were included, all assessed at high risk of bias. Eight of the 9 studies measured AHI and showed a weighted average overall AHI improvement of 39.5% versus baselines after respiratory muscle therapy. Based on our meta-analyses in adult studies, respiratory muscle therapy yielded an improvement in AHI of -7.6 events/h (95% confidence interval [CI] = -11.7 to -3.5; P ≤ .001), apnea index of -4.2 events/h (95% CI = -7.7 to -0.8; P ≤ .016), Epworth Sleepiness Scale of -2.5 of 24 (95% CI= -5.1 to -0.1; P ≤ .066), Pittsburgh Sleep Quality Index of -1.3 of 21 (95% CI= -2.4 to -0.2; P ≤ .026), snoring frequency (P = .044) in intervention groups compared with controls. CONCLUSIONS: This systematic review highlights respiratory muscle therapy as an adjunct management for OSA but further studies are needed due to limitations including the nature and small number of studies, heterogeneity of the interventions, and high risk of bias with low quality of evidence.

Efficacy of Antidepressants in the Treatment of Obstructive Sleep Apnea Compared to Placebo. A Systematic Review with Meta-Analyses.

PURPOSE: To establish the efficacy of oral antidepressants compared to placebo in improving obstructive sleep apnea (OSA) as measured on a polysomnography study. Secondary outcomes included self-reported sleepiness. METHODS: Authors identified prospective randomized placebo-controlled studies from MEDLINE through PubMed, Web of Science, the Cochrane Library and EMBASE up to February 2019 in English language. Antidepressants included tricyclic antidepressants (TCA), tetracyclic antidepressants (TeCA), selective serotonin reuptake inhibitors (SSRI), and serotonin receptor modulators (SRM). Studies were assessed for inclusion and exclusion criteria, as well as risk of bias based on the Cochrane handbook. RESULTS: The initial search yielded 254 unduplicated references ultimately reduced to 8 relevant studies, in which 198 OSA participants were included. Patients with an average baseline AHI of 26.7 events/hour taking 15-45mg mirtazapine had a statistically significant reduction in apnea-hypopnea index compared to placebo by -10.5 events/hour (p<0.001), apnea index by -3.6 events/hour (p=0.001) and hypopnea index by -5.9 events/hour (p=0.037). In one study, patients taking 100mg trazodone 1 night improved significantly in AHI compared to placebo group (p<0.001). Arousal index, sleepiness, and sleep efficiency were not statistically significantly reduced with any antidepressant medication compared to placebo (p>0.05). CONCLUSIONS: Of the five antidepressant medications studied, only mirtazapine and trazadone showed a statistically significant reduction in AHI in the treated groups but not in sleepiness scale nor an increase in sleep efficiency. In this review, the total sample sizes were small, adverse side effects of some of the antidepressant medications were clinically significant, overall risk of bias of the studies was high or unclear, and overall quality of the evidence was low. Based on the evidence available at this time, we cannot recommend the antidepressants studied in the treatment of OSA.

Efficacy of topical interventions for temporomandibular disorders compared to placebo or control therapy: a systematic review with meta-analysis.

This systematic review focused on the efficacy of topical products in reducing temporomandibular joint disorder (TMD)-associated pain, in comparison to placebo or control interventions. The EMBASE, Web of Science, Cochrane Library, and MEDLINE via PubMed databases were searched for randomized controlled trials (RCTs) using topical interventions in adults diagnosed with TMD. The pain intensity was the primary outcome, and other clinical findings were the secondary outcomes. The risk of bias was evaluated according to the Cochrane's handbook. The search up to February 7, 2020 identified a total of 496 unduplicated references. Nine RCTs with 355 adult patients diagnosed with TMD were included. The meta-analysis did not show a significant reduction in baseline pain intensity in the nonsteroidal anti-inflammatory drug (NSAIDs) group, when compared to the placebo group (P = 0.288). One study demonstrated a statistically significant pain score decrease for Theraflex-TMJ compared to placebo after 10 d of treatment (P = 0.003) and follow-up, 5 d after the last application (P = 0.027). Ping On reduced pain at 4 weeks of application (P < 0.001) but not after 7 d of application (P = 0.136). In one study, cannabidiol (CBD) significantly improved the pain intensity compared to placebo (P < 0.001). However, no differences were found with capsaicin in the two studies (P = 0.465). Evidence was of low quality because the studies were considered as having an unclear or a high risk of bias and a small number of studies were analyzed. The evidence is not sufficient to support the use of topical NSAIDs and capsaicin, and limited evidence was found for Threraflex-TMJ, bee venom, Ping On, and CBD, with only one study reporting for each. Additional studies are recommended to validate these results.

Trigeminal neuralgia management after microvascular decompression surgery: two case reports.

Trigeminal neuralgia (TN) involves chronic neuropathic pain, characterized by attacks of repeating short episodes of unilateral shock-like pain, which are abrupt in onset and termination. Anticonvulsants, such as carbamazepine, are the gold standard first-line drugs for pharmacological treatment. Microvascular decompression (MVD) surgery is often the course of action if pharmacological management with anticonvulsants is unsuccessful. MVD surgery is an effective therapy in approximately 83% of cases. However, persistent neuropathic pain after MVD surgery may require reintroduction of pharmacotherapy. This case report presents two patients with persistent pain after MVD requiring reintroduction of pharmacological therapy. Although MVD is successful for patients with failed pharmacological management, it is an invasive procedure and requires hospitalization of the patient. About one-third of patients suffer from recurrent TN after MVD. Often, alternative treatment protocols, including the reintroduction of medications, may be necessary to achieve improvement. This case report presents two cases of post-MVD recurrent pain. Further research is lacking on the success rates of subsequent medication therapy after MVD has proven less effective in managing TN.

Prevalence of trismus in patients with head and neck cancer: A systematic review with meta-analysis.

BACKGROUND: The purpose of this systematic review and meta-analysis was to determine the prevalence of trismus in patients with head and neck cancer. METHODS: Four electronic databases were searched: Cochrane Library, MEDLINE, EMBASE, and Web of Science up to April 2018. Level of evidence was assessed based on Oxford Centre for Evidence-based Medicine. Publications were restricted to prospective cohort studies (n = 15), randomized clinical trials (n = 3), and cross-sectional studies (n = 5) reporting on trismus as mouth maximum opening less than or equal to 35 mm in the English language. RESULTS: A total of 636 abstracts were reviewed for inclusion. Twenty-three studies were included in qualitative analysis and 15 studies in meta-analysis. The results included 2786 patients with head and neck cancer treated with surgery, radiotherapy, and/or chemotherapy either alone or in combination. Based on meta-analyses, the weighted average prevalence of trismus increased from 17.3% at baseline (95% confidence interval [CI], 10.8%-26.5%) to a peak of 44.1% at 6 months (95% CI, 36.7%-51.8%) and decreased to 32.1% at 12 months (95% CI, 27.2%-37.4%) and continued in average 32.6% at 3-10 years (95% CI, 22.0%-45.3%). CONCLUSIONS: Having a primary site of the oral cavity or oropharynx was associated with a higher risk for developing trismus based on individual studies. Prospective cohort studies or randomized controlled trials with multiple objective trismus measurements, evaluation of disease characteristics, and treatment variables are needed to further investigate the prevalence of trismus secondary to head and neck cancer treatment.

Empathy Levels of Dental Faculty and Students: A Survey Study at an Academic Dental Institution in Chile.

A successful health care provider may be described as a clinician capable of establishing a comprehensive diagnosis including identifying related risk factors. However, an equally important quality a clinician should possess is the ability to understand the experiences and feelings of others to allow better communication for better outcomes. It is likely that faculty empathy levels influence students' ability to demonstrate this attribute. The aim of this study was to assess the levels of empathy of dental faculty members relative to dental students at the Universidad San Sebastian in Chile. Using a cross-sectional design of survey-collected data collected with the Jefferson Scale of Empathy, the authors compared the perceptions of the dental faculty involved in teaching fourth- and fifth-year dental students (n=116) to the perceptions of basic and preclinical students (n=346) and clinical students (n=189). The data were collected in 2016-17. The results showed that the mean faculty scores were higher than that of the students in compassionate care (90.1%) and perspective adoption (89.7%); however, for putting oneself in the other's shoes, the faculty had a lower score (57.8%) than the clinical students (58.2%). Future investigations are needed to understand the impact of faculty empathy scores on students and whether pedagogical interventions can increase empathy scores.

Local Anesthetic Injections for the Short-Term Treatment of Head and Neck Myofascial Pain Syndrome: A Systematic Review with Meta-Analysis.

AIMS: To evaluate the effectiveness of local anesthetic trigger point injections in adults with myofascial pain syndrome (MPS) in the head, neck, and shoulder regions compared to dry needling, placebo, and other interventions. METHODS: Randomized controlled trials using local anesthetic injections in adults diagnosed with MPS were included. The Cochrane Library, MEDLINE via PubMed, Web of Science, and EMBASE libraries were searched. The primary outcome was pain measured with a 0 to 10 visual analog scale (VAS). Secondary outcomes included pain threshold, range of cervical motion, depression scale, and pressure pain intensity (PPI) score. Risk of bias was analyzed based on Cochrane's handbook. RESULTS: The initial search strategy yielded 324 unduplicated references up to April 1, 2018. A total of 15 RCTs were included, with 884 adult patients diagnosed with MPS. Meta-analysis showed a significant improvement in VAS pain scale of 1.585 units at 1 to 4 weeks in the local anesthetic group compared to the dry needling group (95% confidence interval -2.926 to -.245; P = .020). However, when only including double-blinded studies, the effect was not statistically significant (P = .331). There was also a significant improvement in pain of 0.767 units with local anesthetic at 2 to 8 weeks compared to placebo (95% confidence interval -1.324 to -0.210; P = .007). No statistically significant differences were found in other secondary outcomes between local anesthetic and all other interventions. CONCLUSION: Though local anesthetics provided a significant improvement in pain compared to dry needling, evidence was of low quality, and sensitivity analyses including only double-blinded studies provided no statistically significant difference. Additional studies are needed to confirm these results.

Declinación en el género y la empatía en alumnos de la Facultad de Odontología de la Universidad Central (Ecuador): estudio transversal. Género y declinación empática: un estudio transversal / Decline in gender and empathy in students of the Faculty of Dentistry of the Central University (Ecuador): cross-sectional study. Gender and empathic decline: a cross-sectional study

Objetivo: Diagnosticar el comportamiento empático en general y de cada uno de sus componentes en los estudiantes de la Facultad de Odontología de la Universidad Central de Quito, Ecuador. Material y Métodos: Este trabajoes de tipo exploratorio y transversal. A los participantes se les aplicó la Escala de Empatía Médica de Jefferson sometida a criterio de jueces para verificar la validez cultural y de contenido y adaptarla para estudiantes de odontología.Se estimó el alpha de Cronbach, el coeficiente de correlación intraclase y T2 de Hotelling. Se estimaron la mediay desviación estandar. Se aplicó un análisis de varianza (ANOVA multivariado) bifactorial (modelo III) Se estimóel potencial total de crecimiento posible. Se utilizaron gráficos de cajas aritméticos simples y procesados con SPSS22.0. El nivel de significación fue de α ≤ 0,05 y ß ≥ 0,80. Resultados: Se encontraron bajos niveles de empatía enrelación a otras facultades de América Latina y un alto desarrollo relativo de los niveles del componente cuidado concompasión. Los componentes restantes se mantuvieron con valores de crecimiento bajos y, en algunos casos, negativos; no se cumple el modelo de erosión empática, y en general, no existen diferencias estadísticas entre los géneros.Conclusiones: El diagnóstico realizado permite crear las condiciones para construir una estrategia de intervenciónmás específica(AU)

Objective:To make a diagnosis of empathic behaviour as a whole and in each of its components in the students of Facultadde Odontologia de la Universidad Central de Quito, Ecuador. Materials and methods: This is an exploratory and crosssectional research. Jefferson Medical Empathy Scale was applied to the participants. It was submited to judges to verify thecultural and content validity and to adapt it to dentistry students. Cronbach's alpha, intraclass correlation coefficient andHotelling's T2 were estimated, as well as the mean and standard deviation. A bifactorial (model III) analysis of variance(multivariate ANOVA) was applied. Total possible growth potential was estimated. Simple and SSPSS22.0 processedarithmetic box graphs were used. The level of significance was α ≤ 0.05 and ß ≥ 0.90. Results:We found low levelsof empathy in comparison with other faculties from Latin America and a high relative development of the levels of thecompassionate component, with the remaining components with low, and in some cases negative growth values. The modelof empathic decline is not fulfilled and, generally, there are no statistical differences between genders. Conclusions: Theresults presented here may create conditions to build a more specific intervention strategy(AU)

Chilean Dentistry students, levels of empathy and empathic erosion: Necessary evaluation before a planned intervention: Levels of empathy, evaluation and intervention.

OBJECTIVES: To estimate the general empathy levels and the potential for empathic growth in Dentistry students and demonstrate that the empathic erosion model is not med. MATERIAL AND METHODS: Exploratory and cross-sectional study. Population: First- to fifth-year Dentistry students at Universidad San Sebastián, Santiago Campus (Chile). The total student population (N) was 800. The participants completed the Jefferson Scale of Empathy in its Spanish version for medical students, validated and adapted in Chile. A two-factor analysis of variance (model III) was applied to find differences in the means between academic years, between genders, and in the interaction between these two factors. The data were described using simple arithmetic graphs and then processed with SPSS 22.0. The total growth potential was estimated. RESULTS: The Sample (n) consisted of 534 students (66.88% of the population studied, 2016). Differences were found between academic years and genders in general empathy and some of its components. CONCLUSION: The behavior of empathy levels is not in line with the concept of empathic erosion. This suggests that empathic erosion is a particular and not a general phenomenon. There exists a considerable growth potential for empathy and its components.

Effectiveness of Intra-Articular Injections of Sodium Hyaluronate or Corticosteroids for Intracapsular Temporomandibular Disorders: A Systematic Review and Meta-Analysis.

AIMS: To assess the effectiveness of intra-articular injections of sodium hyaluronate (NaH) or corticosteroids (CS) for treatment of intracapsular temporomandibular disorders (TMD). METHODS: Single- or double-blinded randomized controlled trials (RCTs) on the effectiveness of NaH or CS injections, compared to each other or to placebo, for the treatment of intracapsular TMD due to osteoarthritis and/or internal joint derangement were analyzed in this systematic review and meta-analysis. Electronic searches of MEDLINE through the PubMed, Web of Science, and Cochrane Library databases were conducted on March 17, 2015, and an updated search was conducted on June 7, 2017. Three reviewers independently extracted the data and assessed the risk of bias of included studies. RESULTS: An initial search yielded 245 studies, and 5 additional studies were identified through cross referencing. A total of 22 studies were identified as relevant based on the abstracts, but only 7 RCTs met the inclusion criteria. Six of the included studies had unclear risk of bias, and one had high risk of bias. Four studies were eligible for meta-analysis. Pooled results showed no significant difference in short- or long-term pain improvement with NaH compared to CS. The number of responders to NaH was significantly more than placebo in one study, but not significantly higher than CS in another study. CONCLUSION: Although there was no significant difference between the effectiveness of NaH and CS intra-articular injections, there was some evidence that NaH was better than placebo. Further research is needed to determine the minimum effective dose and long-term side effects of both injections.

Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis.

The purpose of this review is to conduct a systematic review and meta-analysis comparing the effects of continuous positive airway pressure (CPAP) with a mandibular advancement device (MAD) in improving the quality of life (sleepiness, cognitive, and functional outcomes) in patients diagnosed with obstructive sleep apnea (OSA). Authors identified randomized, placebo-controlled studies from MEDLINE through PubMed, Web of Science, and the Cochrane Library. Studies were assessed for inclusion and exclusion criteria, as well as risk of bias. Initial search yielded 240 unduplicated references, which the authors reduced to 12 relevant studies. Patients with CPAP therapy showed no statistically significant difference in the post-treatment quality of life measured with the SF-36 mental health component (p = .994), or the SF-36 physical functioning component (p = .827). There was no significant improvement in neither Functional Outcomes of Sleep Questionnaire (p = .788) nor cognitive performance (p = .395) compared to patients treated with oral appliances. However, the meta-analyses' overall results showed a significant improvement in the post-treatment apnea-hypopnea index (AHI) in favor of CPAP therapy as compared with the oral appliance group (p < .001). Meta-analyses showed unclear results for sleepiness with no significant differences in average post-treatment Epworth Sleepiness Scale [ESS] (p = .203), but significant differences in change in ESS from baseline favorable to CPAP treatment (p = .047). Further studies are needed. Compliance with treatment was 1.1 h per night significantly lower with CPAP than MAD (p = .004), which could explain why though efficacy (AHI) is better with CPAP, no significant results are shown for quality of life, cognitive, and functional outcomes. Though CPAP is significantly more efficient in reducing AHI (moderate quality of evidence), it has a significantly lower compliance resulting in no differences with MAD in quality of life, cognitive, or functional outcomes. Sleep medicine professionals should monitor treatment compliance and offer patients non-compliant with CPAP an oral appliance for treatment of OSA.

Use of platelet-rich plasma, platelet-rich growth factor with arthrocentesis or arthroscopy to treat temporomandibular joint osteoarthritis: Systematic review with meta-analyses.

BACKGROUND: The authors conducted a systematic review and meta-analysis to determine whether arthrocentesis or arthroscopy combined with platelet-rich plasma (PRP) or platelet-rich growth factor (PRGF) injection compared with no injection or saline injection (control group) or hyaluronic acid (HA) injection reduced pain and increased maximum mouth opening (MMO) in patients with temporomandibular joint (TMJ) osteoarthritis (OA). TYPES OF STUDIES REVIEWED: The authors used the Cochrane Library, Embase, PubMed, Web of Science, Google Scholar databases and hand searched reference lists through May 4, 2018, to identify randomized controlled trials and controlled trials including patients with TMJ OA receiving injections (PRP or PRGF versus other). The authors assessed the risk of bias according to the Cochrane guidelines. RESULTS: The authors screened 36 abstracts. They included 5 studies (3 randomized controlled trials and 2 controlled trials) with a total of 285 patients with TMJ OA in this review. The authors assessed all 5 studies as being at high risk of bias. The quality of evidence was very low owing to statistical heterogeneity, small sample size, or high risk of bias. Meta-analyses with 2 studies showed a visual analog scale pain improvement from baseline of -2.778 units (0-10 scale, 0 = no pain, 10 = worst pain) favorable to PRP or PRGF compared with findings in control groups (95% confidence interval [CI], -3.504 to -2.052; P < .001) and an improvement of -0.968 favorable to PRP or PRGF compared with findings in HA groups (95% CI, -1.854 to -0.082; P = .032). The authors found no significant increase in MMO in those receiving PRP or PRGF compared with that in the control or HA groups. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Although the results of the included studies showed that arthrocentesis or arthroscopy with PRP or PRGF, saline, or HA injections all reduced pain and increased mouth opening, the evidence was of very low quality. Further studies are needed to confirm these preliminary results showing that PRP or PRGF with arthrocentesis or arthroscopy significantly improved pain but did not increase MMO compared with findings in the control or HA groups.

Reconsidering the 'Decline' of Dental Student Empathy within the Course in Latin America.

INTRODUCTION: The controversy over the presence of empathic decline within the course in students of medicine, dentistry and health sciences in general, has not fully been studied. This controversy could be partially solved if massive studies of empathy levels are made in similar cultural, social and economic contexts. MATERIAL AND METHODS: Empathy levels within the course were studied in eighteen dental schools from six countries in Latin America (2013). The mean of the empathy levels were used to study the behavior between first and fifth academic years. The values of empathy levels within the course were observed by applying the Jefferson Scale of Physician Empathy, the Spanish version. All these studies were cross-sectional. The value of means observed, were subjected to regression studies and further adjustment curves were obtained and the coefficient of determination were calculated. RESULTS: Six different models of behavior were observed, which found that five of them suffer empathic decline within the course, but with different final results: in some the decline persists until the fifth academic year and in others, this decline 'recovers' persistently until the fifth academic year. The sixth model is characterized by a constant and persistent increase of levels of empathy within the course until the last academic year. DISCUSSION: There are six different models for the behavior of means of levels of empathy within the course evaluated by a common methodology in eighteen dental schools from six countries of Latin America. These findings support the existence of variability of empathic response and a comprehensive approach is needed to find the causes that give rise to this variability. CONCLUSION: In dental students of Latin America, there is variability in the behavior of the distribution in means between the academic years of the dentistry schools examined in this study.

Introdução: A controvérsia sobre o declínio da empatia relativamente ao curso em estudantes de Medicina, Odontologia e Ciências da Saúde em geral ainda não foi completamente elucidada. Esta controvérsia poderia ser parcialmente solucionada se fossem realizados estudos significativos sobre os níveis de empatia em contextos culturais, sociais e económicos similares. Material e Métodos: Foram estudados os níveis de empatia com o curso em dezoito escolas de Odontologia de seis países na América Latina (2013). As médias dos níveis de empatia foram usadas para estudar o comportamento entre académicos do primeiro e quinto anos. Os valores de níveis de empatia para com o curso foram observados aplicando a versão em espanhol da escala Jefferson de Empatia Médica. Todos estes estudos foram transversais. O valor das médias observadas sujeito a tratamento estatístico de regressão, obtendo-se as subsequentes curvas de ajustes e calculado o coeficiente de determinação. Resultados: Foram observados seis diferentes modelos de comportamento, sendo que em cinco deles se verificou declínio da empatia, com diferentes resultados finais: em alguns, o declínio persistiu até o quinto ano académico e, em outros, o declínio 'recuperou-se' persistentemente até ao quinto ano académico. O sexto modelo caracterizou-se por um constante e persistente aumento nos níveis de empatia com o curso até o último ano académico. Discussão: Existem seis modelos diferentes para o comportamento das médias dos níveis de empatia para com o curso, avaliados por uma metodologia comum em dezoito escolas de Odontologia de seis países na América Latina. Estes resultados suportam a existência de variabilidade de resposta empática, sendo necessária uma abordagem compreensiva para encontrar as suas causas. Conclusão: Em estudantes de Odontologia da América Latina verifica-se variabilidade no comportamento da distribuição de meios entre os anos acadêmicos das escolas de odontologia examinadas neste trabalho.