Chemotherapy-related trigeminal and glossopharyngeal nerves neurotoxicity: a cohort study.

BACKGROUND AND OBJECTIVES: The association between orofacial neurotoxicity and chemotherapy treatment is still unclear. In this context, the purpose of this study is to relate the orofacial alterations that manifest during antineoplastic pharmacological treatment, highlighting the drugs commonly related to orofacial neuropathy and the adequate instrument to verify the alterations at clinical levels. METHODS: This prospective cohort study, addressed patients who would start therapy with taxanes, platinum, or related therapy. The collection of signs and symptoms was divided into 3 different times (baseline, second or third cycle of antineoplastic chemotherapy treatment, and sixth cycle). A total of 40 patients were submitted to the application of the Short McGill pain questionnaire and Neutoxicity Induced by Antineoplastics questionnaire (QNIA). To verify sensory alterations in the face, a clinical evaluation was performed with the help of Semmes-Weinstein monofilaments. RESULTS: Taxanes show greater orofacial neurotoxic potential, being associated with sensory alterations assessed by monofilaments (P = .003) and the presence of orofacial pain analyzed by the Short McGill pain questionnaire (P = .001). These medications related to neuropathy in the orofacial region measured through the QNIA, demonstrating a predominantly acute nature (P < .001). CONCLUSION: It is suggested that chemotherapy may induce neurotoxicity in the orofacial region.

Subtypes of temporomandibular disorders in patients diagnosed with otalgia: observational study / Subtipos de desordem temporomandibular em pacientes diagnosticados com otalgia: estudo observacional

ABSTRACT BACKGROUND AND OBJECTIVES: Temporomandibular disorder (TMD) has complex symptoms that involve the orofacial region, such as otalgia. Considering the difficult differential diagnoses for associating otological symptoms with TMD. The aim of this study was to verify the diagnosis of TMD in patients with otalgia. METHODS: This is a cross-sectional and descriptive study, where 75 patients diagnosed with otalgia were evaluated. The European Academy of Craniomandibular Disorders's (EACD) screening questionnaire was initially applied, and those who answered affirmatively to at least one question were evaluated by the Research Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), with a final sample of 50 patients. Data were tabulated and ANOVA verified whether there was a statistical difference between TMD subtypes classified by DC/TMD, considering confidence intervals with 95% significance. RESULTS: The mean age of the participants was 39.9±14.1 years, with a predominance of females (76%) (p<0.0001). Among those diagnosed with TMD, females also predominated, with a higher percentage in all evaluated subtypes, with emphasis on arthralgia (82%) and myofascial pain with limited opening (81.8%), followed by myofascial pain (74%) and disc displacement with reduction (72.7%). When observing the distribution of TMD subtypes between genders, there was a predominance of myofascial pain in males (75%) and females (68%), but no statistical significance was observed in this variable and in the others studied. CONCLUSION: Patients with otalgia had one or more TMD subtypes, and the myofascial subtype TMD was the most prevalent among study participants.

RESUMO JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibular (DTM) possui sintomas complexos que envolvem a região orofacial, como a otalgia. Considerando os difíceis diagnósticos diferenciais para associar sintomas otológicos com DTM. O objetivo deste estudo foi verificar o diagnóstico de DTM em pacientes com otalgia. MÉTODOS: Este é um estudo transversal e descritivo, com uma avaliação de 75 pacientes diagnosticados com otalgia. O questionário de triagem da Academia Europeia de Disfunções Craniomandibulares (EACD) foi aplicado inicialmente, e aqueles que responderam afirmativamente a pelo menos uma questão foram avaliados pelo Critério Diagnóstico de Pesquisa para Disfunções Temporomandibulares (DC/TMD), com amostra final de 50 pacientes. Os dados foram tabulados e por meio da ANOVA foi verificado se havia diferença estatística entre os subtipos de DTM classificados pelo DC/TMD, considerando intervalos de confiança com 95% de significância. RESULTADOS: A idade média dos participantes foi de 39,9±14,1 anos. Além disso, predominou-se o sexo feminino (76%) (p<0,0001), com maior percentual em todos os subtipos avaliados, destacando-se a artralgia (82%) e a dor miofascial com limitação de abertura (81,8%), seguida da dor miofascial (74%) e deslocamento de disco com redução (72,7%). Quando observada a distribuição dos subtipos de DTM entre os sexos, notou-se predominância de dor miofascial no sexo masculino (75%) e feminino (68%), mas não foi observada significância estatística nessa variável e nas demais estudadas. CONCLUSÃO: Os pacientes com otalgia manifestaram mais de um dos subtipos de DTM, sendo o subtipo de dor miofascial o mais prevalente entre os participantes do estudo.

Functional literacy and the assessment process as a diagnostic instrument for temporomandibular disorders: observational study / Alfabetismo funcional e o processo de avaliação como instrumento diagnóstico das disfunções temporomandibulares: estudo observacional

ABSTRACT BACKGROUND AND OBJECTIVES: Health literacy is a topic that has been gaining traction in recent years, both on the policy and research agendas of many countries, however there is no evidence about temporomandibular disorders (TMD) and this topic. The objective was to evaluate the association between the level of functional literacy and the understanding of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) through self-report and to associate the time of TMD complaint with the levels of functional literacy. METHODS: This is an observational, cross-sectional study, comprising 56 patients from the Temporomandibular Disorders (TMD) clinic at São Leopoldo Mandic College. The DC/TMD questionnaire - axis I, a sociodemographic questionnaire, and tests of the Indicador de Alfabetismo Funcional (Functional Literacy Indicator - INAF) were applied. RESULTS: The outcomes showed that 85.7% of the sample were females and 14.3% males, mainly white (60.7%), with a schooling degree, predominantly from the 3rd grade of high school and professionally active. It was found that 22.5% of the sample were functionally illiterate and 77.5% were functionally literate, 30.6% of whom had elementary level schooling. There was a significant association between the schooling level and combined INAF (p=0.005), as well as between combined INAF and duration of complaint in intervals for jaw pain (p=0.037) when Chi-square tests were used. There is evidence to establish that the mean duration of headache complaints (in months) between literacy groups are different (p=0.001) when using the Student´s t-test. With these results, it is possible to suggest that lower levels of functional literacy are related to a poorly detailed perception of TMD complaints regarding the duration of the complaint and, mainly, to the association of headache with a complaint of TMD. CONCLUSION: Lower levels of functional literacy are related to a poorly detailed perception of TMD complaints regarding the duration of the complaint and, mainly, to the association of headache with a complaint of temporomandibular disorders.

RESUMO JUSTIFICATIVA E OBJETIVOS: O letramento em saúde é um tema que vem ganhando força nos últimos anos, tanto nas agendas políticas como de investigação de muitos países, no entanto não existem evidências sobre as disfunções temporomandibulares e este tema. O objetivo foi avaliar a associação entre o nível de alfabetismo funcional e a compreensão dos Critérios Diagnósticos para Disfunção Temporomandibular (DC/DTM) por meio do autorrelato e associar o tempo de queixa de DTM com os níveis de letramento funcional. MÉTODOS: Trata-se de um estudo observacional, transversal, realizado com 56 pacientes do ambulatório de Disfunções Temporomandibulares (DTM) da Faculdade São Leopoldo Mandic. Para isso foram aplicados o questionário DC/DTM - eixo I, questionário sociodemográfico e testes do Indicador de Alfabetismo Funcional (INAF). RESULTADOS: Mostraram que 85,7% da amostra era do sexo feminino e 14,3% do sexo masculino, predominantemente brancos (60,7%), com escolaridade superior, predominantemente do 3º ano do ensino médio e profissionalmente ativos (57,1%). Verificou-se que 22,5% da amostra eram analfabetos funcionais e 77,5% eram alfabetizados funcionalmente, sendo que 30,6% possuíam nível fundamental. Houve associação significativa entre escolaridade e INAF combinado (p=0,005), bem como entre INAF combinado e tempo de queixa nos intervalos de dor mandibular (p=0,037) quando foram utilizados testes Qui-quadrado. Há evidências que estabelecem que a duração média das queixas de cefaleia (em meses) entre os grupos de alfabetismo é diferente (p=0,001) quando utilizado o teste t de Student. Com base nesses resultados, é possível sugerir que níveis mais baixos de alfabetismo funcional estariam relacionados a uma percepção pouco detalhada das queixas de DTM quanto à duração da queixa e à associação de cefaleia com queixa de DTM. CONCLUSÃO: Níveis mais baixos de alfabetismo funcional foram relacionados à percepção pouco detalhada das queixas de DTM quanto à duração e, principalmente, à associação de cefaleia com queixa de disfunção temporomandibular.

Manejo das disfunções temporomandibulares. Parte I: tratamento conservador / Management of temporomandibular joint disorders. Part I: conservative treatment

Objetivo: Apresentar as modalidades de tratamentos conservadoras e minimamente invasivas mais usadas disponíveis no arsenal terapêutico das desordens temporomandibulares (DTM). Revisão da literatura: Os objetivos do tratamento invariavelmente incluem redução da dor, diminuição das atividades parafuncionais e restauração da função. Dentre as alternativas conservadoras e minimamente invasivas, podemos citar os dispositivos interoclusais, exercícios terapêuticos, eletrofototermoterapia, agulhamento seco e infiltração de anestésicos locais em pontos gatilho, injeção de sangue autógeno para controle da luxação mandibular, terapia cognitivo comportamental, toxina botulínica, viscossuplementação, controle farmacológico da dor aguda e crônica. As DTMs afetam uma proporção significativa da população. Somente após o fracasso das opções não invasivas é que devem ser iniciados tratamentos mais invasivos e irreversíveis. No entanto, algumas condições, como a anquilose e neoplasias, por exemplo, são essencialmente tratadas cirurgicamente e tentativas de tratamentos conservadores podem trazer piora na qualidade de vida ou risco de morte. Considerações finais: Uma abordagem de equipe multidisciplinar para o manejo é essencial no cuidado fundamental de todos os pacientes com DTM, para que o tratamento possa ser especificamente adaptado às necessidades individuais do paciente.

Aim: To present the most widely used conservative and minimally invasive treatment modalities available in the therapeutic arsenal for temporomandibular disorders (TMD). Literature review: Treatment goals invariably include pain reduction, reduction of parafunctional activities and restoration of function. Among the conservative and minimally invasive alternatives, we can mention interocclusal devices, therapeutic exercises, electrophototherapy, dry needling and infiltration of local anesthetics in trigger points, autogenous blood injection to control mandibular dislocation, cognitive behavioral therapy, botulinum toxin, viscosupplementation, pharmacological control of acute and chronic pain. TMD affects a considerable proportion of the population. Only after non-invasive options have failed should more invasive and irreversible treatments be initiated. However, some conditions, such as ankylosis and neoplasms, for example, are treated surgically and attempts at conservative treatments can lead to worsening quality of life or risk of death. Conclusions: A multidisciplinary team approach to management is essential in the fundamental care of all TMD patients, so that treatment can be specifically tailored to the patient's individual needs.

Occlusal Changes with Clear Aligners and the Case Complexity Influence: A Longitudinal Cohort Clinical Study.

BACKGROUND: Clear aligners (CA) are used 22 h daily, creating a bite-block effect. This work aims to (i) analyze occlusal changes before the beginning of treatment, after the first set of CA and after the use of additional aligners; (ii) compare planned occlusal contacts with the ones obtained after the first set of CA; (iii) analyze the occlusal changes occurred after reaching the orthodontic goals after 3 months of using CA only at night; (iv) evaluate and characterize which tooth movements did not allow the treatment to be completed at the end of the first set of aligners, and finally (v) verify the possible relation between the changes in occlusal contact and areas and parameters such as case complexity and facial biotype. MATERIALS AND METHODS: A quantitative, comparative, and observational longitudinal cohort study design was implemented to evaluate the clinical data and the complexity levels of cases receiving CA. A non-probabilistic and convenience sample of 82 individuals was recruited. The orthodontic malocclusion traits were classified as simple, moderate, or complex corrections based on the basis of the Align® recommendations with the Invisalign® evaluation tool. According to the Invisalign® criteria, patients need only one complex problem for their case to be classified as complex. Meshlab® v. 2022.02, ClinCheck® version Pro 6.0, My-Itero® version 2.7.9.601 5d plus, and IBM® SPSS Statistics software (Statistical Program for Social Sciences), version 27.0 for Windows were the software® used. RESULTS: A statistically significant decrease in area and occlusal contacts number were observed from before the start of orthodontic treatment (T0) to the end of treatment (T1). The changes in the occlusal area (from T0 to T1) were statistically different between hyperdivergent (28.24 [15.51-40.91]) and hypodivergent (16.23 [8.11-24.97]) biotypes (p = 0.031). A significant difference between the hyperdivergent (4.0 [2.0-5.0]) and normodivergent (5.5 [4.0-8.0]) group was found in T1 for the anterior contacts (p = 0.044). Anterior contacts obtained were significantly higher than the planned (p = 0.037) Between T1 and T2 statistically significant increases of occlusal areas, posterior and total contacts were observed. CONCLUSIONS: Occlusal contact and area were decreased, either at the end of the first set or after the use of additional aligners. Anterior occlusal contacts obtained were higher than planned as opposed to posterior occlusal contacts obtained. The hardest tooth movements to achieve to complete the treatment were distalization, rotation, and posterior extrusion. After completing orthodontic treatment (T1) to 3 months after (T2) using additional aligners only at night, posterior occlusal contacts were significantly increased, which could be due to the natural settling of the teeth in this period.

Self-ligating brackets do not reduce discomfort or pain when compared to conventional orthodontic appliances in Class I patients: a clinical study.

OBJECTIVES: To compare the intensity, location, and short-term impact of the periodontal discomfort/pain, as well as the related functional parameters of bite force and masticatory efficiency, between self-ligating and conventional orthodontic appliances. MATERIALS AND METHODS: In 20 patients referred for orthodontic treatment, samples were collected from the gingival sulcus to evaluate the level of substance P using enzyme-linked immunosorbent assay. Orthodontic devices were randomly bonded, with self-ligating appliances on one side and conventional brackets on the contralateral side. Pain threshold (PT), maximal bite force (MBF), and masticatory efficiency (ME) were assessed using standard validated techniques at the beginning of the treatment and 24 hours post-orthodontic activation with an 0.016-inch nickel-titanium wire. RESULTS: There were no significant differences (P > .05) in the substance P levels, PT, MBF, and ME between the self-ligating and conventional orthodontic appliances. CONCLUSIONS: There was no difference between conventional and self-ligating appliances in the parameters of pain: substance P and pressure. Functional aspects, such as pain, discomfort, and masticatory efficiency, should not be considered when making a therapeutic decision regarding the use of self-ligating vs conventional orthodontic appliances.

Masticatory Function in Individuals with Temporomandibular Disorders: A Systematic Review and Meta-Analysis.

The literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol in the PubMed, Cochrane Library, LILACS, EBSCO, Scielo, between 2012 and 2022. The methodological quality was assessed by using the Newcastle-Ottawa Study Quality Assessment Scale. Mean differences and 95% confidence intervals were calculated and combined in meta-analyses. A total of 1202 participants were included in this systematic review (690 with TMD; 512 without TMD), with 22 articles being included in the qualitative analysis. Only three studies enabled the comparative analysis of the results. Ten articles showed a high methodological quality and a low risk of bias, and twelve had a low methodological quality and an increased risk of bias. The meta-analysis showed that the differences between the intervention and control groups were not statistically significant for the percentage overlapping coefficient of the anterior temporal muscle, for the masseter, and for the torque coefficient. The parameters analyzed with the compound technique for chewing showed altered mandibular functions in individuals with TMD. With the EMG method, it was possible to suggest that TMD in adult individuals causes compensatory muscle behaviors, and several changes in the masticatory function were found.

Diagnosis of temporomandibular dysfunction subtypes in a population seeking specialized care / Diagnóstico dos subtipos de disfunção temporomandibular em uma população que busca atendimento especializado

ABSTRACT BACKGROUND AND OBJECTIVES: The goal of the present study was to assess the frequency of temporomandibular disorders (TMD) subtypes in individuals that search for specialized care, identifying the subtypes of TMD, muscular and/or articular, in addition to relating each subtype with variables such as gender and age. METHODS: In this context, after a screening, 270 individuals, aged between 18 and 70 years, were selected. All data were acquired using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) instrument. RESULTS: Among the 267 patients, 88.7% (n = 237) were female and 11.3% (n = 30) were male, with a mean age of 42±11.8 years. In this study, the predominance of joint/muscle TMD was evidenced (51.7%; n = 138), followed by only muscle TMD (47.5%; n = 127) and lastly, joint TMD (0.8%; n = 2). Important correlations (p>0.05) were not identified when comparing TMD subtypes with the variables gender and age, according to chi-square test. By relating the diagnosis to the TMD subtype, it was evidenced that bilateral myalgia was the most prevalent in muscle TMD (n = 100; 37.4%) and articular/muscular (n = 112; 41.9%). The other variables did not show significant statistics, neither moderate nor strong correlation. CONCLUSION: In this research, all TMD subtypes were found, with a clear predominance of joint/muscle type of TMD, followed by muscle only, especially in females aged between 39 and 48 years.

RESUMO JUSTIFICATIVA E OBJETIVOS: O objetivo do presente estudo foi avaliar a frequência dos subtipos de disfunção temporomandibular (DTM) em indivíduos que buscaram atendimento especializado, identificando os subtipos da DTM, se muscular e/ou articular, além de relacionar cada subtipo com variáveis como sexo e faixa etária. MÉTODOS: Neste contexto, após uma triagem, foram selecionados 270 indivíduos na cidade de Fortaleza/CE, com faixa etária entre 18 anos e 70 anos de idade. Todos os indivíduos foram avaliados por meio do instrumento Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). RESULTADOS: Entre os 267 pacientes, 88,7% (n = 237) foram do sexo feminino e 11,3% (n = 30) do masculino, com média de idade de 42 ± 11,8 anos. Neste estudo evidenciou-se a predominância de DTM articular/muscular (51,7%; n = 138), seguida de indivíduos com DTM somente muscular (47,5%; n = 127) e por último a articular (0,8%; n = 2). Não foram identificadas correlações importantes (p > 0,05), segundo o teste qui-quadrado, quando comparados os subtipos de DTM com as variáveis gênero e idade. Ao relacionar o diagnóstico com o subtipo de DTM, evidenciou-se que a mialgia bilateral foi a mais prevalente na DTM muscular (n = 100; 37,4%) e articular/muscular (n = 112; 41,9%). As demais variáveis não apontaram significância estatística nem correlação moderada ou forte. CONCLUSÃO: Nesta pesquisa, foram encontrados todos os tipos de DTM, havendo um claro predomínio da DTM do tipo articular/muscular, seguida da somente muscular, especialmente em indivíduos do gênero feminino e de idade entre 39 e 48 anos.

Frequency of symptoms of temporomandibular dysfunction in homeless people: cross-sectional study / Frequência de sintomas de disfunção temporomandibular em pessoas em situação de rua: estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Homeless people live a reality of social vulnerability, poverty and exclusion and are considerably more affected by long-term pain (chronic pain) than the general population. The objective of this study was to evaluate the presence of symptoms of temporomandibular disorder (TMD) in homeless people who attended a reception center for this population (POP Center) in the city of Juazeiro do Norte-CE. METHODS: This is an observational, cross-sectional, descriptive-exploratory study, whit a quantitative approach and a convenience sample. For this, the TMD-Pain Screener was applied to measure TMD frequency in 100 individuals who were divided into two groups, group 1 (G1, n=50) composed of residents who were assisted by the center and group 2 (G2, n=50) individuals who worked in the center. The TMD Pain Screener instrument was used and the data were paired according to gender and age group. The Qui-square test was applied to verify associations between the variables, considering a level of significance of 5% (p≤0.05). RESULTS: It was observed that homeless people had fewer TMD symptoms than the control group and this difference was statistically significant (p=0,045). The symptom of pain in the lateral region of the head was the most commonly found, being reported by 20% of the homeless population and by 48% of the control group 48% (p=0.03). CONCLUSION: The homeless population presented TMD symptoms, which should be taken into account by the health authorities, however, in a smaller proportion than the control group, requiring further studies to identify these differences.

RESUMO JUSTIFICATIVA E OBJETIVOS: As pessoas em situação de rua vivem uma realidade de vulnerabilidade social, pobreza e exclusão e são consideravelmente mais afetadas pela dor de longa duração (dor crônica) do que a população em geral. O objetivo deste estudo foi avaliar a presença de sintomas de disfunção temporomandibular (DTM) em moradores de rua que frequentam o centro especializado de assistência à população de rua (Centro POP) da cidade de Juazeiro do Norte-CE. MÉTODOS: Este é um estudo observacional do tipo transversal, descritivo-exploratório, com abordagem quantitativa e amostra por conveniência. Para isso, foi aplicado o TMD-Pain Screener para medir a frequência de DTM em 100 indivíduos que foram divididos em dois grupos, grupo 1 (G1, n=50) composto de residentes que foram assistidos pelo centro e grupo 2 (G2, n=50) indivíduos que trabalhavam no mesmo local. O instrumento TMD Pain Screener foi utilizado e os dados foram emparelhados de acordo com o sexo e a faixa etária. O teste Qui-quadrado foi aplicado para verificar associações entre as variáveis, considerando um nível de significância de 5% (p≤0.05). RESULTADOS: Foi observado que as pessoas em situação de rua apresentaram menos sintomas de DTM do que o grupo controle (p=0,045). O sintoma de dor na região lateral da cabeça foi o mais relatado, sendo reportado por 20% da população em situação de rua e por 48% dos indivíduos do grupo controle 48% (p=0,03). CONCLUSÃO: A população em situação de rua apresenta sintomas de DTM, o que deve ser levado em consideração pelas autoridades sanitárias, contudo, em menor proporção do que a população em geral, sendo necessários mais estudos para a elucidação dessa desproporcionalidade.

Development and application of a questionnaire to evaluate signs of temporomandibular disorder observed by caregivers of children with autism spectrum disorder.

OBJECTIVE: This study aimed to develop and validate a questionnaire to detect signs of temporomandibular disorders (TMD), verifying whether the perception of signs observed by caregivers of non-verbal autistic children are the same as those observed by caregivers of verbal ones. METHODS: This is a cross-sectional, exploratory and analytical study. The sample consisted of forty individuals with Autism Spectrum Disorders (ASD), thirty non-verbal and ten verbal, besides their respective caregivers. For this, an experimental questionnaire was applied and compared to the European Academy of Orofacial Pain (EAOP) questionnaire, which is already validated and widely used throughout the world. All responses were compared using the chi-square test and the questionnaires were compared with the McNemar test, considering p < .05. RESULTS: When comparing the number of coincident responses to the questionnaire between caregivers and children, the mean was 8.2 ± 1.61 responses. After performing the binomial test, no statistically significant discrepancy was found between the results of the two tests adopted when the questionnaires were compared (Mc Nemar test, p > .05) CONCLUSION: The development of this questionnaire and its validation serve as a support for health professionals in the TMD area, for the detection of TMD in non-verbal autistic children, providing them and their caregivers, who are faced with several difficulties in their day-by-day, a facilitating instrument.

Relationship between myofascial pain and facial types: an observational study / Relação entre dor miofascial e tipos faciais: um estudo observacional

Temporomandibular disorder (TMD) is a term that covers a number of clinical problems involving the masticatory muscles, TMJ and all associated structures leading to signs and symptoms such as jaw pain, otalgia, headaches and limitation of function. In this context, TMD has been related to facial type and there are three distinct facial types (euryprosopic, mesoprosopic, and leptoprosopic). Objective: The aim of this study was to investigate the correlation between myofascial pain and facial types classified by the RDC/TMD Axis I. Material and Methods: this study was composed of 64 women aged between 12 and 49 years, using data obtained from two institutions. We used the anthropometric methodology, which meets the criteria of simplicity and reliability. We also applied the Brugsh Facial Index. The individuals were classified as euryprosopic (51.56%), mesoprosopic (12.50%) and leptoprosopic (35.94%), without statistical significance among the groups (p=0,3492). Results: there is no statistical difference between the age groups (p=0.2976) and no association between facial type and age range. Conclusion: this study found that there was a correlation between myofascial pain and facial types, with the predominance of euryprosopic faced women aged between 20 and 29 years when compared with other facial types and other age groups. (AU)

A Disfunção Temporomandibular é um termo que cobre uma série de problemas clínicos envolvendo os músculos mastigatórios, ATM e todas as estruturas associadas que levam a sinais e sintomas como dor na mandíbula, otalgia, dores de cabeça e limitação de função. Nesse contexto, a DTM tem sido relacionada ao tipo facial que são classificados em três tipos distintos (euryprosopo, mesoprosopo e leptoprosopo). Objetivo: O objetivo deste estudo foi investigar a correlação entre a dor miofascial e os tipos faciais classificados pelo RDC/TMD Eixo I. Material e Métodos: este estudo foi composto por 64 mulheres com idade entre 12 e 49 anos, utilizando dados obtidos em duas instituições. Utilizou-se a metodologia antropométrica, que atende aos critérios de simplicidade e de confiabilidade. Também foi utilizado o Índice Facial de Brugsh. Os indivíduos foram classificados em euriprosopo (51,56%), mesoprosopo (12,50%) e leptoprosopo (35, 94%), sem significância estatística entre os grupos (p = 0,3492). Resultados: não houve diferença estatística entre as faixas etárias (p = 0,2976) e nenhuma associação entre tipo facial e faixa etária. Conclusão: este estudo constatou que houve correlação entre dor miofascial e tipos faciais, com predomínio de mulheres euriprosopo com idade entre 20 a 29 anos quando comparadas com outros tipos faciais e outras faixas etárias.(AU)

Related factors for indication of temporomandibular joint surgery in a supplementary health operator: retrospective and cross-sectional study / Fatores relacionados a indicação de cirurgia da articulação temporomandibular em uma operadora de saúde suplementar: estudo retrospectivo e transversal

ABSTRACT BACKGROUND AND OBJECTIVES: The number of temporomandibular joint (TMJ) surgeries has been growing in recent years. The objective of this study was to evaluate the factors measured for the indication of TMJ surgery. METHODS: This is an observational, quantitative, retrospective, cross-sectional study. A total of 99 surgical requests for TMJ surgery, assigned to a supplementary health operator, were analyzed. Information regarding age, gender, the patients' main complaint, movement alteration, magnetic resonance results, diagnostic tests used, and previous therapy performed were collected. The T-test and the Chi-squared test were used (α=5%). RESULTS: 85% of patients were female, and the mean age among women (27.07±6.33) was lower when compared to men (31.98±9.55) (p=0.03). Almost half of patients did not receive any therapeutic approach prior to the surgery indication. Less than 10% of the requests described the Wilkes classification. Among the symptoms considered for the indication of surgery. pain report in the TMJ region (63.64%) stands out. The clicking and mouth opening limitation were among the highest prevalence as 52.5% and 67.7%. respectively. CONCLUSION: The factors evaluated for the indication of TMJ surgery by oral and maxillofacial surgeons in the present study do not match the recommendations of the Colégio Brasileiro de Cirurgia e Traumatologia Buco-Maxilo-Facial (CTBMF - Brazilian College of Oral and Maxillofacial Surgery and Traumatology). Few conservative treatments were previously recommended. Where the majority was decided without any diagnostic criteria.

RESUMO JUSTIFICATIVA E OBJETIVOS: O número de cirurgias da articulação temporomandibular (ATM) vem crescendo nos últimos anos. O objetivo deste estudo foi avaliar os fatores relacionados à indicação de cirurgia da ATM. MÉTODOS: Trata-se de um estudo observacional, quantitativo, retrospectivo e transversal. Foram analisadas 99 solicitações cirúrgicas para a realização da cirurgia de ATM, destinadas a uma operadora de saúde suplementar. Foram coletadas informações sobre idade, sexo, queixa principal do paciente, alteração de movimento, resultados de ressonância magnética, teste diagnóstico utilizado e terapia prévia realizada. Foram utilizados os testes T e Qui-quadrado (α=5%). RESULTADOS: 85% dos pacientes avaliados eram do sexo feminino, e a média de idade entre as mulheres (27,07±6,33) foi menor quando comparada à dos homens (31,98±9,55) (p=0,03). Quase metade dos pacientes não recebeu nenhuma abordagem terapêutica antes da indicação da cirurgia. Menos de 10% das solicitações descreveram a classificação de Wilkes. Dentre os sintomas considerados para a indicação da cirurgia, destaca-se a dor na região da ATM (63,64%). A limitação do clique e da abertura da boca estiveram entre as maiores prevalências: 52,5% e 67,7%, respectivamente. CONCLUSÃO: Os fatores relacionados às indicações de cirurgia da ATM pelos cirurgiões bucomaxilofaciais no presente estudo não condizem com as recomendações do Colégio Brasileiro de Cirurgia e Traumatologia Buco-Maxilo-Facial (CTBMF). Poucos tratamentos conservadores foram recomendados anteriormente, sendo que a maioria foi decidida sem a utilização de nenhum critério diagnóstico.

Painful and non-painful comorbidities associated with short- and long-term painful temporomandibular disorders: A cross-sectional study among adolescents from Brazil, Canada and France.

BACKGROUND: Temporomandibular disorder (TMD) pain is common among adolescents. The association between painful TMD and other comorbidities has been demonstrated. However, the difference between short-term (<6 months) and long-term (≥ 6 months) painful TMD is not yet clear. OBJECTIVE: The aim of this study was to assess the association between comorbidities and short- and long-term painful TMD among adolescents. METHODS: In this cross-sectional study, adolescents were recruited from Montreal (Canada), Nice (France) and Arceburgo (Brazil). Self-reported painful TMD, comorbidities, school absence and analgesic intake were assessed using reliable instruments. Multivariable logistic regression analyses were conducted to assess the study aims. RESULTS: The prevalence of short- and long-term painful TMD was estimated at 22.29% and 9.93% respectively. The number of comorbidities was associated with short- (OR = 1.71, 95%CI = 1.53-1.90) and long-term painful TMD (OR = 1.79, 95%CI = 1.55-2.08) compared to controls. Frequent headaches (ORshort-term  = 4.39, 95%CI = 3.23-5.98, ORlong-term  = 3.69, 95%CI = 2.45-5.57) and back pain (ORshort-term  = 1.46, 95%CI = 1.06-2.03, ORlong-term  = 1.69, 95%CI = 1.11-2.59) were associated with both painful TMD groups. Frequent neck pain (OR = 2.23, 95%CI = 1.53-3.26) and allergies were only associated with short-term painful TMD (OR = 1.54, 95%CI = 1.13-2.10). Frequent stomach pain was related to long-term (OR = 2.01, 95%CI = 1.35-3.26), and it was the only comorbidity significantly more frequent among the long than short-term TMD (OR = 1.82, 95%CI: 1.14-2.90). These analyses were adjusted by sex, age and city. CONCLUSION: In this multi-centre study, both short- and long-term painful TMD are associated with frequent headaches and back pain, whereas frequent neck pain and allergies are related to only short-term and frequent stomach pain with long-term painful TMD.

Temporomandibular disorders in patients with polysomnographic diagnosis of sleep bruxism: a case-control study.

BACKGROUND: Temporomandibular disorders (TMD) is a collective term that refers to complaints of temporomandibular joint (TMJ) pain, fatigue and/or pain of the craniocervical muscles, limitation of movement of the mandible, and TMJ noises. Sleep bruxism (SB) is a disorder involving rhythmic (phasic) or non-rhythmic (tonic) masticatory muscle activity during sleep and is not a movement disorder or a sleep disorder in otherwise healthy individuals. The present study aimed to support or reject the null hypothesis that there is no association between SB and TMD. METHODS: The study population was recruited from patients who visited the Artmedica Clinic, Mossoro city, Rio Grande do Norte, Brazil. Patients who underwent polysomnography received information about the research and were invited to participate following the inclusion and exclusion criteria. The study sample consisted of 40 individuals with age ranging from 19 to 76 years. The subjects were administered the questionnaire of the European Academy of Craniomandibular Disorders (AEDC). Those who answered affirmatively to at least one question of the questionnaire were recommended to visit the primary researcher's dental clinic for examination; those who met the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were evaluated, and their condition was classified into one or more subtypes of TMD. The subjects were divided into 4 groups according to the polysomnographic findings and the responses to the AEDC questionnaire. Of the 40 individuals who answered the AEDC questionnaire and underwent polysomnography, 28 presented with TMD symptoms. The data were expressed as simple frequency and percentage values using statistical software. Values of p < 0.05 were considered to be significant. RESULTS: The results showed that the frequency of TMD in individuals diagnosed to have SB was 46.4%. According to the DC/TMD of the 28 individuals, the most prevalent TMD subtype was local myalgia (85.7%). Of the total subjects, 32.5% had TMD and SB, 36.4% were males, and in the age range of 31 to 40 years (40%). CONCLUSION: In this study sample, there was no association between SB as currently defined and TMD, thus confirming previous findings on this topic.

Prevalence of morphological and structural changes in the stylohyoid chain.

BACKGROUND: Total or partial calcification of the stylohyoid chain, elongation of the stylohyoid process of the temporal bone and/or calcification of the stylohyoid ligament are usually incidental radiographic findings. The purpose of this study was to evaluate the prevalence of morphological and structural changes within the stylohyoid chain in 4413 digital panoramic radiographs. MATERIAL AND METHODS: The images were evaluated for the presence or absence of changes in the stylohyoid chain by a specialist in dentofacial radiology and the information collected comprised gender, age, side, right and left measurements and classification of the chain side elongated or calcified stylohyoid process, as well as type and pattern of right or left calcification. RESULTS: 275 (6.2%) subjects presented alterations, mostly bilateral, in the stylohyoid chain, being 186 females (67.6%) and 89 males (32.4%), with a higher proportion elongation. Partial calcification was more prevalent than total calcification. The right side was most affected and the frequency of events increased with age. CONCLUSIONS: The findings of the present study demonstrate that the commonest alterations in the stylohyoid chain are bilateral, mainly elongation, with a clear trend to increased prevalence with increasing age, presenting a low incidence. Noneless, the clinicians must be aware of these alterations in the routinely radiographic examination. Key words:Stylohyoid process, Stylohyoid ligament calcification, Stylohyoid chain, Eagle's syndrome.

The effect of biofeedback on pain and sleep in a patient with temporomandibular disorder. Case report / Efeito do biofeedback na dor e no sono de paciente com disfunção temporomandibular. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Literature has shown that behavioral and educational modalities are effective options in the treatment of chronic pain, including temporomandibular disorder, and techniques such as biofeedback have been used for single therapy or in combination for effective pain control in these individuals. Furthermore, the severity of symptoms is related to relevant prognostic factors, such as quality of life, emotional states and sleep quality. The aim of the present study was to evaluate the effect of the biofeedback audiovisual technique on pain control and sleep quality in a patient with temporomandibular disorder. CASE REPORT: Female patient, 34 years old, with Temporomandibular Disorder. The DC/TMD (Diagnostic Criteria for Temporomandibular Disorders) Axis I, diagnostic was applied, and the patient was classified with more than one subtype of temporomandibular disorders: local myalgia and myofascial pain with reference, in addition to neck pain as a comorbidity. CONCLUSION: In this case, the biofeedback treatment was effective both in reducing pain intensity and improving sleep quality.

RESUMO JUSTIFICATIVA E OBJETIVOS: A literatura tem demonstrado que as modalidades comportamentais e educacionais são opções efetivas no tratamento da dor crônica, inclusive da disfunção temporomandibular, e técnicas como o biofeedback vêm sendo utilizadas como terapia isolada ou em combinação para um controle efetivo da dor nesses indivíduos. Além disso, a gravidade dos sintomas tem correlação com fatores de relevância para o prognóstico, como a qualidade de vida, estados emocionais e qualidade do sono. O objetivo deste estudo foi avaliar o efeito da técnica do biofeedback audiovisual no controle da dor e na qualidade do sono em paciente com disfunção temporomandibular muscular. RELATO DO CASO: Paciente do sexo feminino, 34 anos, com disfunção temporomandibular. O critério diagnóstico DC/TMD (Diagnostic Criteria for Temporomandibular Disorders) Eixo I foi aplicado, sendo a paciente classificada com mais de um subtipo de disfunção temporomandibular: mialgia local e dor miofascial com referência, além de cervicalgia como comorbidade. CONCLUSÃO: No caso clínico apresentado a terapia com biofeedback foi efetiva na redução da intensidade da dor e melhoria da qualidade do sono.

Correlation between patient complaint, temporomandibular disorder diagnosis and mandible head morphology

The aim of this study was to evaluate the correlation between patient complaints, clinical diagnosis of temporomandibular disorder (TMD) based on the diagnostic criteria for TMD, and morphology of the mandibular condyle obtained by cone-beam computed tomography (CB-CT). Data were collected from 40 patients. The anatomy of the mandibular condyle was assessed using CB-CT, the diagnosis of TMD according to diagnostic criteria for TMD, and patients' complaints was registered at the appointment. Data were explored and all statistical references were completed in bicaudal tests, with 95% confidence level (α=0.05). The Chisquared test was used with Bonferroni correction (z-tests). Main complaints found were grouped as muscular, articular, muscular and articular, or headache and articular symptoms. Clinical diagnosis of TMD involved myalgia, local myalgia, myofascial pain, myofascial pain with reference, myofascial pain with arthralgia, arthralgia, or disc displacement with reduction. At least one joint showed condylar flattening, erosion, sclerosis, or osteophytes. No correlation was observed between main complaints, clinical diagnosis, and morphology of the mandibular condyle in all comparisons. The findings suggest that due to the absence of clinical and morphological correlation, CB-CTs should be requested only in specific cases, when doubt remain after careful TMD diagnosis, to avoid their over-indication(AU)

Pain perception and quality of life in burning mouth syndrome / Percepção da dor e qualidade de vida na síndrome da boca ardente

ABSTRACT BACKGROUND AND OBJECTIVES: Burning mouth syndrome is a dysfunctional state affecting physical, mental and social welfare, often contributing to chronic stress conditions. Despite the lack of objective data, patients experience pain-related discomfort with impact in their daily life. The objective of this study was to assess the impact of burning mouth syndrome on pain perception and quality of life. METHODS: A cross-sectional, observational, case-controlled study was performed on 76 individuals (38 in each group). The groups were sex- and age-matched. The Oral Health Impact Profile (OHIP-14) questionnaire was used to assess any changes in the quality of life. The visual analog scale was used to assess pain impact and intensity, as well as the Pain Catastrophizing Scale (PCS). The effect of sex and other risk factors associated with burning mouth syndrome were also associated. RESULTS: The age of participants was 41 to 85 years. The patients had a negative impact on quality of life with respect to all dimensions of OHIP-14 and PCS domains. Burning mouth syndrome patients complained about moderate (58%) or intense (42%) pain, while the control group participants experienced only mild pain by visual analog scale. The prevalence was predominant in females (a ratio of 3:1), and the most site involved was the tongue. Menopause, hormonal changes, and gastritis were identified as major risk factors. CONCLUSION: Burning mouth syndrome patients had significantly higher PCS and OHIP-14 scores for all domains, indicating an interaction between a higher burden of pain perception and worse quality of life which should therefore be adequately assessed, characterized and managed.

RESUMO JUSTIFICATIVA E OBJETIVOS: A síndrome de ardência bucal é um estado disfuncional que afeta o bem-estar físico, mental e social, contribuindo para condições de estresse crônico. Apesar da ausência de dados objetivos, os pacientes experimentam desconforto relacionado à dor com impacto na vida diária. O objetivo deste estudo foi avaliar o impacto da síndrome da boca ardente na percepção da dor e na qualidade de vida. MÉTODOS: Foi realizado um estudo transversal, observacional e caso-controle em 76 indivíduos, 38 em cada grupo, pareados por gênero e idade. Foram utilizados o questionário Oral Health Impact Profile (OHIP-14) para avaliar mudanças na qualidade de vida, a escala analógica visual para o impacto e intensidade da dor e a Pain Catastrophizing Scale (PCS). Foi avaliado também o efeito do sexo, idade e outros fatores de risco associados à síndrome de ardência bucal. RESULTADOS: A idade dos participantes foi de 41 a 85 anos. A síndrome de ardência bucal teve um impacto negativo na qualidade de vida em todas as dimensões dos domínios OHIP-14 e PCS. Cinquenta e oito por cento dos pacientes se queixaram de dor moderada e 42% de dor intensa, enquanto os controles experimentaram apenas dor leve pela escala analógica visual. A prevalência foi predominante no sexo feminino (3:1), e a língua foi o local envolvido mais comum. Menopausa, alterações hormonais e gastrite foram os maiores fatores de risco. CONCLUSÃO: Os pacientes com síndrome de ardência bucal apresentaram escores PCS e OHIP-14 mais altos para todos os domínios, indicando uma interação entre maior carga de percepção da dor e pior qualidade de vida, o que deve ser mais bem avaliado, caracterizado e gerenciado.

Comorbid conditions associated with painful temporomandibular disorders in adolescents from Brazil, Canada and France: A cross-sectional study.

BACKGROUND: Painful temporomandibular disorder (TMD) is common among adolescents. Presence of painful comorbidities may worsen painful TMD and impact treatment effectiveness. OBJECTIVE: The aim of this study was to assess the association between painful TMD and comorbidities. METHODOLOGY: In this cross-sectional study, adolescents were recruited in Montreal (Canada), Nice (France) and Arceburgo (Brazil). Reliable instruments were used to assess painful TMD and comorbidities. Multivariable logistic and linear regression analyses were conducted to assess the study aims. RESULTS: The prevalence of self-reported painful TMD was estimated at 31.6%; Arceburgo (31.6%), Montreal (23.4%) and Nice (31.8%). Painful TMD was more common among girls than boys (OR = 1.96). Painful TMD was associated with a higher number of comorbidities (OR = 1.77); Arceburgo (OR = 1.81), Montreal (OR = 1.80) and Nice (OR = 1.72). A stronger association was found between painful TMD and headaches (OR = 4.09) and a weaker one with stomach pain (OR = 1.40). Allergies were also related to painful TMD (OR = 1.43). CONCLUSION: Painful TMD was associated with comorbidities. Headaches were consistently associated with painful TMD. Other associations were modified by sex and/or covariates related to the cities where participants were recruited.

Jaw Exercises in the Treatment of Temporomandibular Disorders-An International Modified Delphi Study.

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.