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.

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.

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.

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.

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.

A Comparative Histomorphometric Analysis of Two Biomaterials for Maxillary Sinus Augmentation: A Randomized Clinical, Crossover, and Split-Mouth Study.

Introduction: Considering oral rehabilitation with dental implants, many studies have aimed at improving bone regeneration through the use of biomaterials. Objective: This study aimed at comparing bone neoformation in patients undergoing bilateral maxillary sinus surgery with two bovine biomaterials. Materials and Methods: This is a randomized, blinded, clinical crossover, and divided mouth study. Ten participants with an indication of maxillary sinus enlargement were selected and underwent surgical treatment with Bio-Oss® graft biomaterial (graft 1) on one side and Lumina-Porous® graft biomaterial (graft 2) on the other. The samples were collected after nine months and fixed and then decalcified in 10% ethylenediamine tetra-acetic acid (EDTA) solution for 30 days to process and make histological slides. Connective and bone tissue were further analyzed to identify the amount of newly formed bone. Results: The graft 1 group had a greater formation of vital mineralized tissue when compared to the graft 2 group (p = 0.01). For nonvital mineralized tissue and amount of connective tissue, there was no statistical difference (p = 0.21 and p = 0.09, respectively). The medullary spaces were larger in the graft 2 group. The group treated with graft 1 presented a higher percentage of osteoclasts and viable osteocytes compared to the graft 2 group (p = 0.014 and p = 0.027, respectively). Conclusion: Every day, new alternative biomaterials are offered as an option in oral rehabilitation. In this study, both treatments induced bone neoformation after 9 months; however, the group treated with Bio-Oss® showed a higher percentage of vital mineralized bone tissue.

The Impact of Temporomandibular Disorders on the Oral Health-Related Quality of Life of Brazilian Children: A Cross-Sectional Study.

Purpose: To evaluate the prevalence of signs and symptoms of temporomandibular disorders (TMD) in children and the impact on their oral health-related quality of life (OHRQoL).
Methods: Data were collected by means of a questionnaire to evaluate the presence of TMD symptoms in eight to 10-year-old children. For those who answered at least one of the four questions in a positive manner, a clinical exam was done to confirm the diagnosis. The Child Perceptions Questionnaire (CPQ8-10) was applied to evaluate the OHRQoL. Poisson regression was used to associate the total scores and individual domains of the CPQ8-10 with sociodemographic factors and clinical conditions.
Results: A total of 245 children participated in this cross-sectional study. One hundred and twenty-one (49.4 percent) were diagnosed with TMD; 57.9 percent were females and 42.1 percent were males. Children with a diagnosis of disc displacement with reduction had a negative impact on the domain of functional limitations (rate ratio=2.61, 95 percent confidence interval=1.19 to 5.75, P =0.017).
Conclusion: The prevalence of signs and symptoms of TMD was high in our sample, and signs and symptoms of TMD had a negative impact on children's OHRQoL in the domain of functional limitations.

Relationship between Expanded Disability Status Scale scores and the presence of temporomandibular disorders in patients with multiple sclerosis.

OBJECTIVES: The objectives of this study were to assess the prevalence of temporomandibular disorders (TMDs) in patients with relapsing-remitting multiple sclerosis (MS) and to investigate whether an association exists between the presence of TMD symptoms and the degree of MS-related disability. MATERIALS AND METHODS: In all, 120 individuals were evaluated: 60 patients with a diagnosis of relapsing-remitting MS and 60 age- and sex-matched controls without neurological impairments. A questionnaire recommended by the European Academy of Craniomandibular Disorders for the assessment of TMD symptoms was administered. For those who answered affirmatively to at least one of the questions, the RDC/TMD Axis I instrument was used for a possible classification of TMD subtypes. The Expanded Disability Status Scale (EDSS) was the measure of the degree of MS-related disability. STATISTICAL ANALYSIS USED: Fisher's exact test was used to analyze the data. ANOVA was used to detect significant differences between means and to assess whether the factors influenced any of the dependent variables by comparing means from the different groups. RESULTS: The prevalence of TMD symptoms in patients with MS was 61.7% versus 18.3% in the control group (CG). A diagnosis of TMD was established for 36.7% in the MS group and 3.3% in the CG (P = 0.0001). There were statistically significant differences between degrees of MS-related disability and the prevalence of TMD (P = 0.0288). CONCLUSIONS: The prevalence of both TMD and TMD symptoms was significantly greater in the MS group. EDSS scores and TMD prevalence rates were inversely related.

Relationship Between Orthodontics and Temporomandibular Disorders: A Prospective Study.

AIMS: To investigate the possible relationship between the orthodontic treatment of Class II malocclusion and the development of temporomandibular disorders (TMD). METHODS: A total of 40 patients was evaluated at four time points: the day before the start of treatment employing bilateral Class II elastics (baseline), as well as at 24 hours, 1 week, and 1 month after the start of treatment. The development of TMD pain complaints in the orofacial region and changes in the range of mouth opening were assessed at these times. Shapiro-Wilk, McNemar, and Friedman tests with 5% significance level were used to analyze the data. RESULTS: The treatment produced pain of a transitory, moderate intensity, but there was no significant change from baseline after 1 month. There were no restrictions in the range of jaw motion or any evidence of limitations in mouth opening. CONCLUSION: Orthodontic treatment with bilateral Class II elastics does not cause significant orofacial pain or undesirable changes in the range of mouth opening. Furthermore, this modality of orthodontic treatment was not responsible for inducing TMD.

Evaluation of body painful areas in patients with muscular temporomandibular disorder: a retrospective study / Avaliação das áreas de dor no corpo em pacientes com disfunção temporomandibular muscular: estudo retrospectivo

ABSTRACT BACKGROUND AND OBJECTIVES: Among temporomandibular disorder classifications, masticatory muscles myofascial pain is the most frequent. Its multifactorial etiology makes its treatment difficult. Identifying other painful sites related to temporomandibular disorders may help controlling comorbidities and, as a consequence, improving their symptoms. This study aimed at evaluating the presence of body pain in temporomandibular location. METHODS: We have evaluated 328 medical charts of the Dental Research Center São Leopoldo Mandic, with diagnosis of muscular temporomandibular disorder. Patients were evaluated by means of a body map to locate pain complaints. RESULTS: From 328 analyzed medical charts, 180 (55%) had body pain (160 females, 20 males), and 148 (45%) had facial pain only (116 females, 32 males). Areas with most frequent pain reports were cervical, lumbar and shoulders.Females had more body pain (with pain n=160, without pain n=116, p≤0.001) as compared to males (with pain n=20, without pain n=32) with statistical difference.In most cases pain has affected both body sides (bilateral face 67%, bilateral body 92%). CONCLUSION: Most patients with temporomandibular disorder had pain in body parts different from the face. Regions marked in human body drawings with more pain were cervical followed by lumbar and shoulders.

RESUMO JUSTIFICATIVA E OBJETIVOS: Dentre as classificações das disfunções temporomandibulares, as dores miofasciais nos músculos da mastigação são as mais frequentes. Sua etiologia multifatorial dificulta o tratamento. Reconhecer outros locais de dor relacionados à disfunção temporomandibular pode ajudar no controle das comorbidades e consequentemente melhorar o seu quadro. O objetivo deste estudo foi avaliar a presença de dor no corpo em pacientes com disfunção temporomandibular, a frequência desses relatos e sua localização. MÉTODOS: Foram avaliados 328 prontuários do Centro de Pesquisa Odontológica São Leopoldo Mandic, com diagnóstico de disfunção temporomandibular muscular. Os pacientes foram avaliados por meio de desenhos de mapa corporal para determinar a localização de queixas de dor. RESULTADOS: Dos 328 prontuários analisados, 180 (55%) apresentaram registro de dor pelo corpo (160 mulheres, 20 homens), e 148 (45%) apresentavam dor apenas na região da face (116 mulheres, 32 homens). As áreas com maior relato de dor foram: cervical, lombar e ombros. O gênero feminino apresentou maior frequência de dores no corpo (com dor n=160, sem dor n=116, p<0,001) que o gênero masculino (com dor n=20 e sem dor n=32) com diferença estatística. Na maior parte dos casos a dor acometeu os dois lados do corpo (face 67% bilateral e corpo 92% bilateral) CONCLUSÃO: A maioria dos pacientes com diagnóstico de disfunção temporomandibular apresentou dor em outras partes do corpo além da face. A região anotada nos desenhos do corpo humano com maior acometimento da dor foi a cervical seguida da lombar e ombros.

Varia��o da aplica��o da for�a de palpa��o digital utilizada no exame cl�nico de disfun��o temporomandibular e dor orofacial / Variation of digital palpation pressure used in the clinical examination of TMJ disorders and orofacial pain

Objective: The present research aims to evaluate the calibration of digital palpation pressure as well as to assess the inter-examiner variation and mean pressure used by a sample consisting of 56 professionals of the TMJ disorders and Orofacial Pain area. Methods: Each participant was asked to press a digital balance to approach 1.0 kg and subsequently 0.5 kg without seeing the display, in order to obtain a blind data. The values of 1.0 kg and 0.5 kg are recommended by the Research Diagnostic Criteria for Temporomandibular Disorder in the refined Axis I, the Physical Assessment. Participants were considered calibrated when they applied the correct pressure in at least 4 of the 5 measurement taken; within a 20% variation interval (pressures between 0.4 and 0.6 kg were acceptable for the reference value of 0.5 kg and between 0.8 and 1.2 kg for the reference value of 1.0kg). The t-student test was used to analyze data (p?0.05). Results: 70% of the sample was classified as non- calibrated for the 0.5 kg pressure while 57% were not calibrated for the 1.0 kg pressure. The mean inter-examiner variations, 0.3 kg for the pressure set at 0.5kg and 0.6 kg for the pressure set at 1.0 kg, were considered high. Conclusion: The mean pressures applied by participants (0.7 kg for joint palpation and 1.4 kg for muscle palpation) were also considered high in comparison with those recommended by the Research Diagnostic Criteria for Temporomandibular Disorder, but acceptable according to the tendency of applying higher values of 1.0 - 1.5 kg, as proven by recent study.

Objetivo: Avaliar a calibra��o da for�a de palpa��o digital, bem como determinar a varia��o intra-examinador e a for�a m�dia aplicada por uma amostra composta de 56 profissionais que atuam na especialidade de disfun��o temporomandibular e dor orofacial. M�todos: Foi solicitado a cada participante que pressionasse o centro de uma balan�a digital, sem visualizar o display, o valor que acreditasse ser correspondente � 1,0 kg e, posteriormente, a 0,5 kg, recomendados pelo protocolo de exame f�sico do Eixo I do Consortium, the Research Diagnostic Criteria for Temporomandibular Disorders. Foram considerados calibrados aqueles que aplicassem a for�a correta, aceitando-se uma varia��o de 20% (entre 0,4 e 0,6 kg para o menor valor e 0,8 a 1.2 kg para o maior valor), em 4 das 5 aferi��es realizadas. Na an�lise dos dados foi utilizado o teste t de Student (p?0,05). Resultados: 70% da amostra foi classificada como n�o calibrada para a for�a de 0,5 kg e 57% n�o calibrada para 1,0 kg. A varia��o m�dia intraexaminador de 0,3 kg para o peso de 0,5 kg e 0,6 kg para o de 1,0 kg foram consideradas altas. Conclus�o: A for�a m�dia aplicada pelos participantes (0,7 kg para palpa��o articular e 1.4 kg para palpa��o muscular) foi maior que o recomendado pelo Consortium, the Research Diagnostic Criteria for Temporomandibular Disorders, entretanto encontra-se de acordo com a tend�ncia em aplicar valores mais altos entre 1,0 e 1,5 kg, validado em estudo recente.

Cross-cultural adaptation and validation for Portuguese (Brazilian) of the pictorial representation of illness and self measure instrument in orofacial pain patients.

AIMS: To translate the Pictorial Representation of Illness and Self Measure (PRISM) instrument from German to Portuguese (Brazilian) and adapt it to the Brazilian cultural context, and then assess its reliability and validity in orofacial pain patients. METHODS: The PRISM was translated to Portuguese then back-translated to German. The translated PRISM was evaluated by a multidisciplinary committee and administered as a pre-test to 30 Portuguese-speaking orofacial pain patients. Psychometric properties were obtained after testing 116 orofacial pain patients. Validity was obtained through correlation analyses of scores obtained from PRISM and other psychometric tests, including the Numerical Pain Scale (NPS), Insomnia Severity Index (ISI), and Hospital Anxiety and Depression Scale (HAD). RESULTS: The adapted instrument showed high levels of reliability, proven by means of the test-retest procedure, and calculation of the Intraclass Correlation Coefficient (ICC = 0.991). Significant correlations were found between PRISM and the other tests. Correlation with NPS was moderate (-0.42), whereas correlations with ISI (-0.24), HAD-anxiety (-0.25), and HAD-depression (-0.22) were weak. CONCLUSION: The cross-cultural adaptation process of PRISM was successful and the adapted version offers reliable and valid psychometric properties in the Brazilian context.

Peripheral sympathetic component of the temporomandibular joint inflammatory pain in rats.

UNLABELLED: The aim of this study was to further validate our carrageenan-induced temporomandibular joint (TMJ) inflammatory hyperalgesia model in rats by showing that administration of indomethacin before the initiation of inflammation would diminish the TMJ hyperalgesia. Using this model, we investigated whether norepinephrine and local beta-adrenoceptors contribute to the development of inflammatory TMJ hyperalgesia. Carrageenan-induced TMJ hyperalgesia was assessed by measuring the behavioral nociceptive responses, such as rubbing the orofacial region and flinching the head, induced by the injection of a low dose of 5-hydroxytryptamine into the TMJ sensitized 1 h before by a TMJ injection of carrageenan. Blockade of prostaglandin synthesis by indomethacin prior to initiation of inflammation by carrageenan significantly attenuated the TMJ hyperalgesia. The guanethidine depletion of norepinephrine or the blockade of beta(2)but not the blockade of the beta(1)-adrenoceptor by the selective adrenoceptor antagonists ICI 118.55 and atenolol, respectively, significantly reduced carrageenan-induced TMJ hyperalgesia. In the present study, we further validated our carrageenan-induced TMJ hyperalgesia model to study the mechanisms involved in inflammatory TMJ hyperalgesia and to test the analgesic effect of different types of peripheral analgesics. We also demonstrated that norepinephrine released at the site of injury contributes to the development of the inflammatory TMJ hyperalgesia by the activation of beta(2)-adrenoceptors. PERSPECTIVE: The findings that local sympathomimetic amines contribute to the inflammatory TMJ hyperalgesia by activating beta(2)-adrenoceptors may be relevant to clinical TMJ inflammatory pain states less sensitive to nonsteroidal anti-inflammatory drugs.