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1.
J Oral Facial Pain Headache ; 35(2): 150-156, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34129660

RESUMO

AIMS: To investigate the sensitivity and specificity of the TMD pain screener in a headache population. METHODS: A cross-sectional study was conducted at the Danish Headache Center (DHC). Patients were included if they had primary or secondary headache, trigeminal neuralgia, or facial pain. The pain screener was compared to the outcome of a full Diagnostic Criteria for TMD (DC/TMD) examination. RESULTS: A total of 62 headache patients were included (77% women). The sensitivity of the pain screener short version (three questions) was 85% (95% CI: 70% to 94%), and the specificity was 64% (95% CI: 41% to 83%). In the full version (six questions), the sensitivity was 83% (95% CI: 67% to 93%), and the specificity was 82% (95% CI: 60% to 95%). CONCLUSION: The TMD pain screener seems to be a valid tool to accurately screen for the presence of TMD to provide the most optimal treatment for headache patients. These findings should however be confirmed in a larger sample with migraine, tension-type headache, and trigeminal neuralgia.


Assuntos
Transtornos da Articulação Temporomandibular , Cefaleia do Tipo Tensional , Estudos Transversais , Dor Facial/diagnóstico , Feminino , Cefaleia/diagnóstico , Humanos , Masculino , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/diagnóstico
2.
J Oral Rehabil ; 48(9): 1035-1043, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34129743

RESUMO

BACKGROUND: Parkinson's disease (PD) has a negative effect on oral health and orofacial function, but the subjective experience of orofacial symptoms and their impact on the quality of life is not fully investigated. In addition, knowledge of how to improve the subjective oral symptoms is lacking. OBJECTIVES: To assess the self-reported orofacial function and oral health in patients with PD. Furthermore, to investigate the effect of interventions for improvement of oral hygiene and function on oral health-related quality of life (OHRQoL). METHODS: A randomised controlled study with delayed intervention was conducted in 29 patients with moderate to advanced PD. Patients were instructed in a standardised exercise programme for the jaw and orofacial muscles and given an individualised oral hygiene programme. The effect on self-reported orofacial function and OHRQoL was measured after 2 and 4 months using the Nordic Orofacial Test-Screening (NOT-S), the oral health impact profile (OHIP-14), self-reported drooling score and subjective mastication ability. RESULTS: Self-reported oral health and function before the intervention was significantly correlated to the severity and duration of PD. The NOT-S and drooling score were significantly improved by the interventions after 2 months and the OHIP-14 after 4 months. CONCLUSION: The interventions improve the self-reported orofacial function and OHRQoL. These simple interventions can be implemented in the allied multidisciplinary health care surrounding the PD patient.


Assuntos
Doença de Parkinson , Qualidade de Vida , Humanos , Saúde Bucal , Higiene Bucal , Doença de Parkinson/complicações , Inquéritos e Questionários
3.
J Oral Rehabil ; 47(3): 370-376, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31837276

RESUMO

BACKGROUND: Parkinson's disease (PD) is a progressive neurodegenerative disorder. It is associated with reduced oral health and impaired oro-facial function, but besides recommendations of dental visits and drooling treatment, there are little documented odontological treatment options. OBJECTIVES: To evaluate the effect of standardised home exercise jaw opening and chewing programmes, as well as home oral hygiene measures instructed and controlled by a trained dentist. METHODS: Twenty-nine patients (median 65 years) with moderate to advanced PD participated in the project after informed consent. They were followed at a Neurology Department, were able to cooperate, and had stable medical treatment and nine also deep brain stimulation. The interventions were individual dental hygiene instruction, training of jaw opening (JawTrainer), and lip and chewing exercises (Ulmer Oral Screen and Proxident Fluoride Gum). The study was performed as a randomised controlled study. The treatment effect was evaluated after 2 and 4 months. The primary outcome was maximum unassisted jaw opening capacity, chewing time of a standardised apple slice, and the Simplified Debris Index. Results were analysed with Wilcoxon matched pairs test and Mann-Whitney U test (significance level P < .05). RESULTS: Jaw opening, chewing time and hygiene were significantly improved 2 months from the start of the invention, respectively, 6%, 49%, and 25%, and the improvement was still significant after 4 months. No significant changes were found after the 2-month control period without intervention. CONCLUSION: The simple measures had a substantial and significant clinical effect which is promising despite the progressive nature of the PD.


Assuntos
Doença de Parkinson , Sialorreia , Humanos , Mastigação , Saúde Bucal , Higiene Bucal
4.
J Oral Facial Pain Headache ; 33(4): 389­398, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31247061

RESUMO

AIMS: To investigate whether an international consensus exists among TMD experts regarding indications, performance, follow-up, and effectiveness of jaw exercises. METHODS: A questionnaire with 31 statements regarding jaw exercises was constructed. Fourteen international experts with some geographic dispersion were asked to participate in this Delphi study, and all accepted. The experts were asked to respond to the statements according to a 5-item verbal Likert scale that ranged from "strongly agree" to "strongly disagree." The experts could also leave free-text comments, which was encouraged. After the first round, the experts received a compilation of the other experts' earlier responses. Some statements were then rephrased and divided to clarify the essence of the statement. Subsequently, the experts were then asked to answer the questionnaire (32 statements) again for the second round. Consensus was set to 80% agreement or disagreement. RESULTS: There is consensus among TMD experts that jaw exercises are effective and can be recommended to patients with myalgia in the jaw muscles, restricted mouth opening capacity due to hyperactivity in the jaw closing muscles, and disc displacement without reduction. The patients should always be instructed in an individualized jaw exercise program and also receive both verbal advice and written information about the treatment modality. CONCLUSION: This Delphi study showed that there is an international consensus among TMD experts that jaw exercises are an effective treatment and can be recommended to patients with TMD pain and disturbed jaw function.


Assuntos
Transtornos da Articulação Temporomandibular , Consenso , Técnica Delfos , Terapia por Exercício , Humanos , Mialgia
5.
J Oral Rehabil ; 46(5): 441-449, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30664806

RESUMO

BACKGROUND: Oromandibular dystonia (OMD) with involuntary jaw and tongue movements may be misdiagnosed as temporomandibular disorders (TMD) and because of the complex muscle activity and involvement of several small muscles, OMD is also considered difficult to treat. OBJECTIVES: The aim was to evaluate OMD in patients 8-10 years after start of treatment with botulinum toxin (BoNT) by self-reported and standardised global scales and questionnaires. METHODS: Of 21 previously reported patients with OMD, 14 responded to a mail health questionnaire to describe the disease course and treatment effect as well as the overall impact of OMD by a visual analogue scale (VAS), the Patient Health Questionnaire (PHQ) for depression and anxiety, and the Jaw Functional Limitation Scale (JFLS). The results were analysed with non-parametric statistical analysis (Wilcoxon matched-pairs test and Spearman's rank-order correlations). RESULTS: The OMD was still present in 13 patients. In nine patients, the BoNT treatment had continued as monotherapy or combined with oral medication. VAS for OMD was significantly reduced (P < 0.04) over the years, and most patients felt improvement from the treatment. However, the patients had still some functional limitations, typically regarding jaw mobility and communication, and both JFLS and mental distress (PHQ) were significantly correlated with the OMD VAS (rS 0.77 and 0.74). CONCLUSION: The results showed marked reduction of the experienced OMD with treatment and over time, and also stressed similarities between OMD and TMD. Both dentists and neurologists should be aware of this overlap and reduce misdiagnosis by applying an interdisciplinary approach.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Distonia/tratamento farmacológico , Músculos da Mastigação/efeitos dos fármacos , Fármacos Neuromusculares/uso terapêutico , Adulto , Idoso , Progressão da Doença , Distonia/diagnóstico , Distonia/fisiopatologia , Distonia/psicologia , Feminino , Seguimentos , Humanos , Masculino , Músculos da Mastigação/fisiopatologia , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Estresse Psicológico/complicações , Estresse Psicológico/fisiopatologia , Resultado do Tratamento
6.
Clin Case Rep ; 6(11): 2150-2155, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30455910

RESUMO

Tardive dystonia is a risk factor in medical antipsychotic treatment. It often begins with repetitive involuntary jaw and tongue movements resulting in impaired chewing and detrimental effect on the dentition. The orofacial dysfunction may go unrecognized in a neurological setting. The diagnosis may be difficult so we suggest interdisciplinary collaboration.

7.
Artigo em Inglês | MEDLINE | ID: mdl-27989706

RESUMO

OBJECTIVES: To compare 1) temporomandibular joint (TMJ) mobility between patients with and without reduced upper cervical spine (UCS) mobility and with and without TMJ osseous osteoarthritic-like changes, and 2) UCS osseous changes between patients with and without TMJ osseous osteoarthritic-like changes and with and without reduced UCS mobility. STUDY DESIGN: The study comprised 39 patients without pain from TMJ or UCS and with obstructive sleep apnea, 15 women (age range 26-72 years, mean 56.0) and 24 men (age range 27-71 years, mean 49.8). The range of motion (ROM) of the mandible and UCS was assessed clinically. Osseous changes of the TMJ and UCS were assessed by cone beam computed tomography. Differences were tested and adjusted for age and gender by multiple linear and logistic regression analyses. RESULTS: The mandibular ROM was within normal range (45-64 mm) but the UCS ROM was reduced in 15 patients. Osseous TMJ and UCS changes were both found in 38.5% of the patients. Osseous UCS changes were found more frequently in patients with than without TMJ changes (P = .0003; odds ratio 21.9). No other significant results were found. CONCLUSIONS: The present findings of comorbid osseous changes in patients with obstructive sleep apnea support a possible biomechanical relationship between the TMJ and the UCS.


Assuntos
Vértebras Cervicais/fisiopatologia , Osteoartrite/fisiopatologia , Articulação Temporomandibular/fisiopatologia , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Amplitude de Movimento Articular , Articulação Temporomandibular/diagnóstico por imagem
8.
Toxins (Basel) ; 7(7): 2481-93, 2015 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-26134257

RESUMO

The aim of this prospective open-label study was to treat disabling drooling in children with cerebral palsy (CP) with onabotulinumtoxin A (A/Ona, Botox®) into submandibular and parotid glands and find the lowest effective dosage and least invasive method. A/Ona was injected in 14 children, Mean age 9 years, SD 3 years, under ultrasonic guidance in six successive Series, with at least six months between injections. Doses and gland involvement increased from Series A to F (units (U) per submandibular/parotid gland: A, 10/0; B, 15/0; C, 20/0; D, 20/20; E, 30/20; and F, 30/30). The effect was assessed 2, 4, 8, 12, and 20 weeks after A/Ona (drooling problems (VAS), impact (0-7), treatment effect (0-5), unstimulated whole saliva (UWS) flow and composition)) and analyzed by two-way ANOVA. The effect was unchanged-moderate in A to moderate-marked in F. Changes in all parameters were significant in E and F, but with swallowing problems ≤5 weeks in 3 of 28 treatments. F had largest VAS and UWS reduction (64% and 49%). We recommend: Start with dose D A/Ona (both submandibular and parotid glands and a total of 80 U) and increase to E and eventually F (total 120 U) without sufficient response.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Paralisia Cerebral/tratamento farmacológico , Sialorreia/prevenção & controle , Adolescente , Toxinas Botulínicas Tipo A/administração & dosagem , Toxinas Botulínicas Tipo A/efeitos adversos , Paralisia Cerebral/complicações , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Feminino , Humanos , Estudos Longitudinais , Masculino , Glândula Parótida/efeitos dos fármacos , Estudos Prospectivos , Sialorreia/etiologia , Glândula Submandibular/efeitos dos fármacos , Resultado do Tratamento
9.
J Oral Facial Pain Headache ; 28(4): 331-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25347168

RESUMO

AIMS: To assess the prevalence of temporomandibular joint (TMJ) bony changes in cone beam computed tomography (CBCT) images of adult subjects without ongoing orofacial pain or complaints from the TMJ. METHODS: The study included 84 TMJs from 28 men and 14 women (mean age [± SD]: 51 ± 11 years) without orofacial pain or TMJ complaints who were participants in a study of patients with obstructive sleep apnea. They were examined before any treatment with the Research Diagnostic Criteria for Temporomandibular Disorders and with CBCT (NewTom VGi; 15 × 15 cm, exposure time 18 seconds, axial thickness 0.3 mm). Osseous TMJ deviations were assessed blindly and classified. RESULTS: Degenerative changes were noted in the CBCT images of 33 (39.3%) of the TMJs, of which 21 were classified as osteoarthritic alterations and 12 as indeterminate changes of osteoarthritis. Two TMJs were clinically classified as osteoarthrosis and 6 as disc displacement with reduction. The CBCT images of the 2 TMJs with a clinical diagnosis of osteoarthrosis showed also bony changes, but the CBCT images also revealed osteoarthritic bony changes in the 18 TMJs without any clinical diagnosis. CONCLUSION: CBCT images of asymptomatic adult TMJs commonly show degenerative bony alterations. Accordingly, such radiographic findings should be used with care and only as a supplement to clinical assessment.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/diagnóstico por imagem , Adulto , Idoso , Doenças Assintomáticas , Cartilagem Articular/diagnóstico por imagem , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Côndilo Mandibular/diagnóstico por imagem , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteófito/diagnóstico por imagem , Apneia Obstrutiva do Sono/diagnóstico por imagem , Disco da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/diagnóstico
10.
Acta Odontol Scand ; 72(8): 578-84, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25155559

RESUMO

OBJECTIVE: The Nordic Orofacial Test-Screening (NOT-S) was developed as a comprehensive method to assess orofacial function. Results from the screening protocol have been presented in 11 international publications to date. This study reviewed these publications in order to compile NOT-S screening data and create profiles of orofacial dysfunction that characterize various age groups and disorders. MATERIALS AND METHODS: NOT-S results of nine reports meeting the inclusion criteria were reviewed. Seven of these studies not only provided data on the mean and range of total NOT-S scores, but also on the most common domains of orofacial dysfunction (highest rate of individuals with dysfunction scores), allowing the construction of orofacial dysfunction profiles based on the prevalence of dysfunction in each domain of NOT-S. RESULTS: The compiled data comprised 669 individuals, which included healthy control subjects (n = 333) and various patient groups (n = 336). All studies reported differences between individuals with diagnosed disorders and healthy control subjects. The NOT-S data could measure treatment effects and provided dysfunction profiles characterizing the patterns of orofacial dysfunction in various diagnoses. CONCLUSIONS: This review corroborates previous results that the NOT-S differentiates well between patients and healthy controls and can also show changes in individuals after treatment. NOT-S could be used as a standard instrument to assess orofacial dysfunction, evaluate the outcomes of oral habilitation and rehabilitation and improve comparability in clinical practice and research.


Assuntos
Transtornos de Deglutição/diagnóstico , Programas de Rastreamento/métodos , Mastigação/fisiologia , Distúrbios da Fala/diagnóstico , Expressão Facial , Humanos , Músculos da Mastigação/fisiologia , Respiração , Sensação/fisiologia , Sialorreia/diagnóstico , Xerostomia/diagnóstico
11.
Artigo em Inglês | MEDLINE | ID: mdl-22999966

RESUMO

OBJECTIVES: The objectives of this study were to describe subtypes, characteristics, and orofacial function of patients with oromandibular dystonia and report results of special dental importance. STUDY DESIGN: Symptoms, signs, and function were evaluated by questionnaires, video, and clinical and physiological examinations in 21 patients with primary and secondary dystonia (13 focal, 7 segmental, 1 multifocal). RESULTS: A mixture of 2 or more subtypes of jaw movements was most common (43%), and the dystonic electromyographic activity was frequent in the anterior digastric (62%) and temporal and lateral pterygoid (48%) muscles. The impact from the oromandibular dystonia was marked. The prevalence of problems with mastication and swallowing was high, as well as with hyposalivation, dental attrition, and other dental problems. CONCLUSIONS: Patients with oromandibular dystonia may present to dentists with involuntary jaw movements and other severe functional problems. Care must be adapted to the neurological disorder and may be complicated by the condition itself.


Assuntos
Distonia/fisiopatologia , Músculos Faciais/fisiopatologia , Adulto , Idoso , Índice CPO , Diagnóstico Diferencial , Distonia/diagnóstico , Eletromiografia , Feminino , Humanos , Masculino , Mastigação/fisiologia , Pessoa de Meia-Idade , Exame Físico , Amplitude de Movimento Articular/fisiologia , Saliva/metabolismo , Inquéritos e Questionários , Gravação em Vídeo
12.
J Orofac Pain ; 25(3): 223-31, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21837289

RESUMO

AIM: To assess whether changes in diagnoses and management of temporomandibular joint disorder (TMJD) patients are influenced by radiographic findings and if there is an association between specific radiologic alterations and management strategy changes. METHODS: A total of 204 patients with TMJ symptoms were examined using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Diagnoses and management were first decided without the aid of radiographs. Management categories were: pharmacology, physiotherapy, counseling and behavioral treatment, occlusal stabilization, surgery, additional examinations, and referrals, each with subcategories. Sagittal TMJ tomograms were assessed for the presence of flattening, erosion, osteophyte, and sclerosis in the TMJ components. Diagnoses and management were reevaluated after gaining access to the radiographs and radiographic classifications. Logistic regression analyses were performed with changes in management as the dependent variable and age and radiographic findings as the independent variables. RESULTS: Diagnosis was changed for 56 patients, mainly from arthralgia to osteoarthritis. Management was changed for 55 patients. Most changes occurred in pharmacology and physiotherapy followed by counseling and behavioral treatment, occlusal stabilization, referrals, additional examinations, and surgery. Changes were mostly within the categories, and the highest number of changes was seen in pharmacology, physiotherapy, and counseling and behavioral treatment. Radiographic degenerative findings increased the chance of change (any change) (odds ratio [OR] ⋝ 2.03) and the chance of change in pharmacology (OR ⋝ 2.56) and physiotherapy (OR = 2.48) separately. No other significant associations were found. CONCLUSION: Radiographic degenerative findings increased the chance of changes in management strategy. However, 73% of the TMJD patients had no changes in management after radiographic examination. In cases with changes, these were mainly adjustments within management categories.


Assuntos
Tomada de Decisões , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/terapia , Articulação Temporomandibular/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Anatomia Transversal , Artralgia/diagnóstico por imagem , Distribuição de Qui-Quadrado , Diagnóstico Diferencial , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/patologia , Adulto Jovem
13.
Anesth Analg ; 112(6): 1330-8, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21467556

RESUMO

BACKGROUND: We performed this study to quantify the detrimental effect of intraneural injection of 50 µL of saline, articaine 2%, or articaine 4% in the rat sciatic nerve. METHODS: Lumbar-evoked electrospinograms from stimulation of the sciatic nerve were recorded before and immediately after injection and again after 3 weeks. Test substance was injected into the right sciatic nerve, and the untreated left sciatic nerve served as control. The animals were killed after the 3-week follow-up, and cross-sections of the sciatic nerve were examined stereologically. RESULTS: The evoked spinal cord field potential in the articaine groups faded away immediately after injection and was concentration-dependently, significantly more reduced at the 3-week follow-up in comparison with the saline group. The response from the control sides was unaffected in all groups. The number of myelinated axons was unaffected by the treatment. The mean cross-sectional axon area and the mean myelin sheath thickness were significantly reduced in animals injected with articaine 4%. CONCLUSIONS: These observations indicate concentration-dependent neurotoxic injuries after injection of articaine with a significant difference between 2% and 4% formulations. The mechanical injury of needle penetration with saline injection had no significant effect on nerve conduction or histomorphology.


Assuntos
Carticaína/farmacologia , Eletrofisiologia/métodos , Nervo Isquiático/patologia , Animais , Axônios/metabolismo , Relação Dose-Resposta a Droga , Feminino , Vértebras Lombares/patologia , Modelos Estatísticos , Bainha de Mielina/química , Condução Nervosa , Ratos , Ratos Wistar , Nervo Isquiático/efeitos dos fármacos , Fatores de Tempo
14.
Eur J Oral Sci ; 119(1): 27-32, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21244508

RESUMO

No comprehensive study has previously been published on orofacial function in patients with well-defined Parkinson's disease (PD). Therefore, the aim of this study was to perform an overall assessment of orofacial function and oral health in patients, and to compare the findings with matched control subjects. Fifteen outpatients (nine women and six men, 61-82 yr of age; Hoehn & Yahr Stages 2-4; and with motor impairment ranging from 17 to 61 according to the Unified Parkinson's Disease Rating Scale, Objective Motor Part III) were examined in their 'on' state together with 15 age- and gender-matched controls. Orofacial function and oral health were assessed using the Nordic Orofacial Test, masticatory ability, performance and efficiency, oral stereognosis, jaw opening, jaw muscle tenderness, the Oral Health Impact Profile-49, number of natural teeth, and oral hygiene. Orofacial dysfunction was more prevalent, mastication and jaw opening poorer, and impact of oral health on daily life more negative, in patients with PD than in controls. The results indicate that mastication and orofacial function are impaired in moderate to advanced PD, and with progression of the disease both orofacial and dental problems become more marked. It is suggested that greater awareness of the special needs in PD patients and frequent dental visits are desirable to prevent dental diseases and decay and to support masticatory function.


Assuntos
Arcada Osseodentária/fisiopatologia , Mastigação , Músculos da Mastigação/fisiopatologia , Saúde Bucal , Doença de Parkinson/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Força de Mordida , Estudos de Casos e Controles , Transtornos de Deglutição/etiologia , Expressão Facial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Higiene Bucal , Doença de Parkinson/complicações , Sialorreia/etiologia , Perfil de Impacto da Doença , Distúrbios da Fala/etiologia , Estatísticas não Paramétricas , Estereognose , Inquéritos e Questionários , Xerostomia/etiologia
15.
Acta Odontol Scand ; 69(3): 151-7, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21198339

RESUMO

OBJECTIVE: Drooling in neurodegenerative diseases is associated with social impediment. Previous treatments of drooling have little effect or are effective but with severe side effects. Therefore, there is a need to test new methods such as the use of botulinum toxin type A (BTX-A). MATERIAL AND METHODS: This open, prospective study deals with treatment of drooling in 12 patients with amyotrophic lateral sclerosis and three with Parkinson's disease. Injections of BTX-A (Botox) were given into the parotid (25-40 units) and submandibular (15-30 units) glands with ultrasonographic guidance. After BTX-A treatment, the patients were followed for 2 months with evaluations every second week by means of self-assessed rating scales for drooling intensity, discomfort and treatment effect, and determination of unstimulated whole saliva (UWS) flow rate, and inorganic and organic UWS composition. The treatment was repeated up to four times, but seven patients dropped out shortly after the first treatment due to marked worsening of their disease-related condition. RESULTS: Drooling and flow were reduced (P < 0.05) 2 weeks after treatment, without side-effects. The maximal reductions during the observation period were 40% for drooling and 30% for flow. There was a systematic variation in flow during the observation period, with an initial decrease and then an increase followed by a second decrease. Amylase activity and total protein concentration generally increased with decreasing flow (P ≤ 0.03). CONCLUSION: Inhibition of acetylcholine release from postganglionic parasympathetic nerve endings by injection of BTX-A into salivary glands seemed useful for secondary sialorrhoea, although cyclic variations in flow may occur, possibly due to transitory sprouting and regeneration.


Assuntos
Esclerose Amiotrófica Lateral/complicações , Toxinas Botulínicas Tipo A/uso terapêutico , Fármacos Neuromusculares/uso terapêutico , Doença de Parkinson/complicações , Sialorreia/tratamento farmacológico , Acetilcolina/metabolismo , Idoso , Algoritmos , Toxinas Botulínicas Tipo A/administração & dosagem , Toxinas Botulínicas Tipo A/farmacologia , Feminino , Humanos , Injeções , Masculino , Fármacos Neuromusculares/administração & dosagem , Fármacos Neuromusculares/farmacologia , Glândula Parótida/efeitos dos fármacos , Estudos Prospectivos , Saliva/química , Saliva/metabolismo , Salivação/efeitos dos fármacos , Taxa Secretória/efeitos dos fármacos , Sialorreia/etiologia , Glândula Submandibular/efeitos dos fármacos , Ultrassonografia de Intervenção
16.
Ugeskr Laeger ; 172(44): 3037-9, 2010 Nov 01.
Artigo em Dinamarquês | MEDLINE | ID: mdl-21044561

RESUMO

Temporomandibular disorders (TMD) are the most common cause of chronic orofacial pain. They are characterized by painful and hampered jaw function. Especially disc displacements, osteoarthritis of the temporomandibular joint and masticatory muscle problems are frequent. The pain is localized in the jaws, face and temples, and jaw opening may be reduced, asymmetrical or irregular with noises from the temporomandibular joints. In cases with restricted jaw mobility or when the pain is provoked or aggravated by jaw function, referral to odontological examination is indicated. The prognosis is good, but full recovery may take years.


Assuntos
Síndrome da Disfunção da Articulação Temporomandibular , Adulto , Criança , Dor Facial/diagnóstico , Feminino , Humanos , Masculino , Músculos da Mastigação/fisiopatologia , Osteoartrite/diagnóstico , Prognóstico , Encaminhamento e Consulta , Síndrome da Disfunção da Articulação Temporomandibular/diagnóstico , Síndrome da Disfunção da Articulação Temporomandibular/fisiopatologia , Síndrome da Disfunção da Articulação Temporomandibular/terapia
17.
Clin Oral Implants Res ; 21(1): 108-14, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19845708

RESUMO

BACKGROUND: No comprehensive patient-centered and clinical evaluations of the functional effect of treatment with implant-supported single crowns (ISSC) have been reported previously. OBJECTIVE: To investigate whether and how treatment with ISSC affects masticatory function and Oral Health-Related Quality of Life (OHRQoL) in subjects with tooth agenesis. MATERIAL AND METHODS: In nine females and nine males (32 + or - 10 years) with agenesis treated with one to four ISSC (68% in the premolar region), the treatment effect and masticatory function were assessed. The evaluation was performed first after implant placement shortly before crown cementation, and again 1 month after cementation. It consisted of questionnaires [including Oral Health Impact Profile (OHIP-49)] and functional examination with plastic strips, the Dental Prescale Film and the Occluzer system, Xylitol color-changeable gum and slices of Granny Smith apple. RESULTS: The patients' satisfaction with treatment was high and they experienced a significant overall improvement in their OHRQoL (on average 13% reduction in the total OHIP scores). The cementation of the crowns was associated with a significant increase in the number of near occlusal tooth contacts, contact area, bite force, and masticatory ability and performance. Correspondingly, there was a significant, positive correlation between the number of tooth contacts and (1) occlusal contact area, (2) bite force, and (3) masticatory performance. CONCLUSION: Treatment with ISSCs in subjects with tooth agenesis significantly increased masticatory function subjectively and clinically as well as OHRQoL. However, as the functional parameters before replacement of the teeth corresponded to values in subjects with complete dentitions, the functional importance of the increase may be questioned.


Assuntos
Anodontia/cirurgia , Coroas , Prótese Dentária Fixada por Implante , Adulto , Força de Mordida , Oclusão Dentária , Feminino , Humanos , Masculino , Mastigação , Pessoa de Meia-Idade , Satisfação do Paciente , Qualidade de Vida , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Resultado do Tratamento
18.
J Orofac Pain ; 22(3): 239-51, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18780537

RESUMO

AIM: To identify associations between clinical symptoms of temporomandibular joint disorders and radiographic findings. METHODS: Two hundred four adult patients (156 women, 48 men, mean age 40 years) with temporomandibular joint (TMJ) pain/sounds or changes in mandibular motion were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Bilateral sagittal corrected TMJ tomograms in closed and open positions were assessed for the presence of flattening, erosion, osteophytes, and sclerosis in the joint components and the range of mandibular motion. Logistic regression analyses were performed with the radiographic findings as the dependent variables and the following clinical variables as independent variables: opening pattern, maximal jaw opening, TMJ sounds, number of painful muscle/TMJ sites, duration of pain, presence of arthritic disease, depression and somatization scores, graded chronic pain, and age and gender. RESULTS: Coarse crepitus on opening/closing (odds ratio [OR] > or = 3.12), on lateral excursions (odds ratio > or = 4.06), and on protrusion (OR > or = 5.30) was associated with increased risk of degenerative findings in tomograms. A clinical diagnosis of osteoarthritis increased the risk of radiographic findings (OR > or = 2.95) and so did increasing age (OR > or = 1.03 per year) and the female gender (OR > or = 2.36). Maximal assisted opening and maximal opening without pain (< 40 mm) was associated with a posterior condyle-to-articular tubercle position (OR > or = 2.60). No other significant associations were observed. CONCLUSION: Age, gender, and coarse crepitus, but no pain-related variables, were associated with increased risk of degenerative findings in TMJ tomograms. Maximal opening < 40 mm was associated with a posterior condyle-to-articular tubercle relation on opening.


Assuntos
Transtornos da Articulação Temporomandibular/diagnóstico , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artrite/diagnóstico , Depressão/diagnóstico , Dor Facial/diagnóstico , Dor Facial/diagnóstico por imagem , Feminino , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/diagnóstico por imagem , Masculino , Côndilo Mandibular/diagnóstico por imagem , Músculos da Mastigação/diagnóstico por imagem , Músculos da Mastigação/patologia , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Osteoartrite/diagnóstico por imagem , Osteófito/diagnóstico , Osteófito/diagnóstico por imagem , Osteosclerose/diagnóstico , Osteosclerose/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Fatores Sexuais , Transtornos Somatoformes/diagnóstico , Articulação Temporomandibular/diagnóstico por imagem , Disco da Articulação Temporomandibular/diagnóstico por imagem , Disco da Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Síndrome da Disfunção da Articulação Temporomandibular/diagnóstico , Síndrome da Disfunção da Articulação Temporomandibular/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos
19.
Artigo em Inglês | MEDLINE | ID: mdl-18547834

RESUMO

OBJECTIVE: The objective of this study was to evaluate the impact of clinical TMJ diagnosis, gender, and age on the agreement between expected and actual radiographic findings. STUDY DESIGN: A total of 204 patients with TMJ symptoms were examined using the Research Diagnostic Criteria (RDC/TMD). Expected radiographic findings were recorded. TMJ tomograms in closed and open mouth position were assessed for osseous changes and condyle position. Expected and actual findings were compared. Logistic regression analyses were performed with agreement on radiographic findings as the dependent variable and with clinical RDC/TMD diagnoses, gender and age as the independent variables. RESULTS: The number of radiographic findings was mostly underestimated. A clinical diagnosis of osteoarthritis and age increased the chance of overestimating osseous changes. Disc displacement and age decreased the chance of agreement on certain condyle positions. CONCLUSION: Tomography often revealed unexpected findings. It was not possible to select particular patient groups who would benefit more or less from a radiographic examination.


Assuntos
Côndilo Mandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/diagnóstico , Articulação Temporomandibular/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artralgia/diagnóstico , Artralgia/diagnóstico por imagem , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/diagnóstico por imagem , Diagnóstico Diferencial , Dor Facial/fisiopatologia , Feminino , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/diagnóstico por imagem , Masculino , Côndilo Mandibular/patologia , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Osteoartrite/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Fatores Sexuais , Som , Articulação Temporomandibular/patologia , Disco da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Síndrome da Disfunção da Articulação Temporomandibular/diagnóstico , Síndrome da Disfunção da Articulação Temporomandibular/diagnóstico por imagem
20.
Artigo em Inglês | MEDLINE | ID: mdl-18547838

RESUMO

OBJECTIVE: The present follow-up study in 20 women with TMJ pain and reduced mandibular function associated with disc derangement, osteoarthritis, or inflammatory disorders aimed at investigating whether pain reduction was reflected in function. STUDY DESIGN: After 3 years and conventional therapy, 19 of the patients and 15 of the original 20 matched controls completed a questionnaire, including RDC/TMD Jaw Disability Scale and TMJ chewing pain (VAS). Fourteen patients also accepted reexamination comprising TMJ pressure-pain thresholds (PPT), jaw opening, bite force, and jaw kinematics during chewing. RESULTS: VAS was significantly reduced in patients at the follow-up, but PPT was unchanged, and Jaw Disability ratings were significantly higher than in controls. However, the patients' jaw opening, chewing speed, and bite force had increased significantly. CONCLUSION: With reduction of TMJ pain, function improved in patients to a level that approached reference levels, indicating a marked ability of the nervous system in restoring motor activity.


Assuntos
Mandíbula/fisiopatologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Adulto , Artrite/fisiopatologia , Artrite/terapia , Atitude Frente a Saúde , Força de Mordida , Estudos de Casos e Controles , Dor Facial/fisiopatologia , Dor Facial/terapia , Feminino , Seguimentos , Humanos , Luxações Articulares/fisiopatologia , Luxações Articulares/terapia , Mastigação/fisiologia , Pessoa de Meia-Idade , Movimento , Osteoartrite/fisiopatologia , Osteoartrite/terapia , Limiar da Dor/fisiologia , Exame Físico , Amplitude de Movimento Articular/fisiologia , Disco da Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/terapia
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