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J Dent Res ; : 220345221128226, 2022 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-36314491


Patients with persistent orofacial pain (POFP) can go through complex care pathways to receive a diagnosis and management, which can negatively affect their pain. This study aimed to describe 44-y trends in attendances at Welsh medical practices for POFP and establish the number of attendances per patient and referrals associated with orofacial pain and factors that may predict whether a patient is referred. A retrospective observational study was completed using the nationwide Secure Anonymised Information Linkage Databank of visits to general medical practices in Wales (UK). Data were extracted using diagnostic codes ("Read codes"). Orofacial and migraine Read codes were extracted between 1974 and 2017. Data were analyzed using descriptive statistics and univariate and multivariable logistic regression. Over the 44-y period, there were 468,827 POFP and migraine diagnostic codes, accounting for 468,137 patient attendances, or 301,832 patients. The overall attendance rate was 4.22 attendances per 1,000 patient-years (95% confidence interval [CI], 4.21-4.23). The attendance rate increased over the study period. Almost one-third of patients (n = 92,192, 30.54%) attended more than once over the study period, and 15.83% attended more than once within a 12-mo period. There were 20,103 referral codes that were associated with 8,183 patients, with over half these patients being referred more than once. Odds of receiving a referral were highest in females (odds ratio [OR], 1.23; 95% CI, 1.17-1.29), in those living in rural locations (OR, 1.17; 95% CI, 1.12-1.22), and in the least deprived quintile (OR, 1.39; 95% CI, 1.29-1.48). Odds also increased with increasing age (OR, 1.03; 95% CI, 1.03-1.03). The increasing attendance may be explained by the increasing incidence of POFP within the population. These patients can attend on a repeated basis, and very few are referred, but when they are, this may occur multiple times; therefore, current care pathways could be improved.

Artigo em Inglês | MEDLINE | ID: mdl-36018357


PURPOSE: To assess the effect of oral splint therapy on audio-vestibular symptoms in patients with Menière's disease (MD) and temporomandibular disorder (TMD). METHODS: Retrospective case-control study. Treatment group: 37 patients with MD and TMD who received gnatological treatment. CONTROL GROUP: 26 patients with MD and TMD who had never received gnatological treatment. The number of vertigo spells in 6 months (primary endpoint), pure-tone audiometry average (PTA), MD stage, functional level, Dizziness handicap Index (DHI), Tinnitus handicap Index (THI) and Aural Fullness Scale (AFS) were compared at baseline and after 24 months according to groups. Analysis of Covariance was used to determine the treatment effect. RESULTS: Groups were comparable for demographic, clinical data, baseline PTAs and the number of vertigo spells. Analysis of covariance showed a significant effect of gnathological treatment on number of vertigo spells ([Formula: see text] = 0.258, p < 0.001), PTA ([Formula: see text] = 0.201, p < 0.001), MD stage ([Formula: see text] = 0.224, p < 0.001), functional level ([Formula: see text] = 0.424, p < 0.001), DHI ([Formula: see text] = 0.421, p < 0.001), THI ([Formula: see text] = 0.183, p < 0.001), but not for AFS ([Formula: see text] = 0.005, p = 0.582). The treatment group showed vertigo control of class A in 86.5% and class B in 13.5% of patients. In the control group, vertigo control was of class A in 19.2% of patients and class B in 11.5%, class C in 30.8%, class D in 11.5%, class E in 19.2% and class F in 7.7%. Classes of vertigo control differed significantly (X2 test, p < 0.001). CONCLUSIONS: Oral splint therapy could represent a viable treatment in patients with TMD and uncontrolled MD disease. The effects are maintained at least after 2 years.

Cranio ; : 1-10, 2022 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-35588467


OBJECTIVE: To evaluate the efficacy of chondroitin sulfate (CS) and glucosamine (GS), the most relevant drugs of "Symptomatic Slow Acting Drug for Osteoarthritis" (SYSADOA), in the functional and symptomatic improvement of temporomandibular dysfunction. Although, controversy exists regarding their benefit. METHODS: An electronic search was conducted to retrieve randomized controlled clinical trials (RCTs). The risk of bias assessment was evaluated using the Cochrane Collaboration's tool. Data were meta-analyzed with a random effect model whenever possible. RESULTS: Three RCTs were included. Qualitative results showed a decrease in pain, joint noise, and inflammatory biomarkers in synovial fluid and an improvement in maximum mouth opening without significant adverse effects. Meta-analysis showed a significant increase in maximum mouth opening with the use of CS-GS (p = 0.19). No statistically significant differences were found in pain reduction compared to tramadol. CONCLUSION: CS-GS is effective and safe in the symptomatic and functional improvement of patients with TMD.

Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1385873


RESUMEN: El objetivo de este estudio fue determinar los factores asociados a Trastornos Temporomandibulares (TTM) en pacientes del servicio de Estomatología Quirúrgica de un Hospital Peruano. La muestra del estudio estuvo conformado por 132 pacientes diagnosticados con Trastornos Temporomandibulares por cirujanos dentistas especialistas en Cirugía Bucal y Maxilofacial del servicio de Estomatología Quirúrgica. Se realizó una anamnesis complementaria y una evaluación clínica. Del total de pacientes evaluados, se encontró que el 84,09 % pertenecía al sexo femenino y el 20,45 % tenía entre 50-59 años. Además, el 72,73 % refirieron haber recibido atención previa por otro servicio, el 52,27 % presentaron hábito parafuncional de bruxismo, el 58,33 % presentaron patrón oclusal alterado, el 25,76 % presentaron pérdida de 5 dientes o más por arcada con prevalencia en ambas arcadas y el 54,55 % presentaron atrición. Se concluyó que el sexo predominante fue el femenino y el grupo etario prevalente en pacientes con diagnóstico de TTM, se ubicó en el rango de edad de 50-59 años. Respecto a la sintomatología dolorosa en pacientes con diagnóstico de TTM del servicio de Estomatología Quirúrgica del HNAL fue prevalente el dolor al masticar o hablar.

ABSTRACT: The objective of this study was to determine the factors associated with Temporomandibular Disorders (TMD) in patients of the Surgical Stomatology service of a Peruvian Hospital. The study sample consisted of 132 patients diagnosed with Temporomandibular Disorders by dental surgeons specializing in Oral and Maxillofacial Surgery of the Surgical Stomatology service. A complementary anamnesis and a clinical evaluation were carried out. Of the total of patients evaluated, it was found that 84.09 % belonged to the females and 20.45 % were between 50-59 years old. In addition, 72.73 % reported having received prior care from another service, 52.27 % had a parafunctional habit of bruxism, 58.33 % had an altered occlusal pattern, 25.76 % had loss of 5 or more teeth due to arch with prevalence in both arches and 54.55 % presented attrition. It was concluded that the predominant sex was female and the prevalent age group in patients diagnosed with TMD was in the age range of 50-59 years. Regarding the painful symptoms in patients with a diagnosis of TMD from the Surgical Stomatology Service of the HNAL, pain when chewing or speaking was prevalent.

Int J Oral Maxillofac Surg ; 51(9): 1211-1225, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35339331


Temporomandibular disorders (TMD) impact a significant proportion of the population. Given the range of management strategies, contemporary care should be evidence-informed for different TMD types. A knowledge-to-action rapid review of systematic reviews published in the past 5 years and guidelines published in the past 10 years concerning the management of TMD was conducted. The Cochrane, Embase, MEDLINE, PEDro, and PubMed databases were searched. A qualitative data analysis was undertaken, with quality assessment completed using the AMSTAR 2 checklist. In total, 62 systematic reviews and nine guidelines considering a range of treatment modalities were included. In concordance with current guidelines, moderate evidence supports a multi-modal conservative approach towards initial management. Contrary to existing guidelines, occlusal splint therapy is not recommended due to a lack of supporting evidence. The evidence surrounding oral and topical pharmacotherapeutics for chronic TMD is low, whilst the evidence supporting injected pharmacotherapeutics is low to moderate. In concordance with current guidelines, moderate quality evidence supports the use of arthrocentesis or arthroscopy for arthrogenous TMD insufficiently managed by conservative measures, and open joint surgery for severe arthrogenous disease. Based on this, a management pathway showing escalation of treatment from conservative to invasive is proposed.

Transtornos da Articulação Temporomandibular , Artrocentese , Humanos , Placas Oclusais , Revisões Sistemáticas como Assunto , Transtornos da Articulação Temporomandibular/terapia
Odontol. sanmarquina (Impr.) ; 25(1): e22075, ene.-mar. 2022.
Artigo em Espanhol, Inglês | LILACS-Express | LILACS | ID: biblio-1358541


Los trastornos temporomandibulares (TTM) tienen consecuencias funcionales importantes, que no distinguen edad ni sexo, los esquemas de tratamiento están enfocados al mejoramiento de la función y alivio de los síntomas, basándose principalmente en terapias conservadoras, evitando el sobretratamiento y atendiendo de forma oportuna a los casos que lo requieran, con la finalidad de evitar tratamientos invasivos. Los estudios controlados sobre la eficacia de la terapia manual para el tratamiento de los TTM son escasos, y la evidencia existente tiene claras limitaciones en su metodología, a pesar de ello, es la terapia más segura, aunque sus resultados son controversiales. Por tanto, el objetivo de este trabajo fue realizar una revisión de literatura sobre la eficacia de la terapia manual en el tratamiento de algunos de los trastornos temporomandibulares. En la mayoría de los estudios se observó la influencia que tiene el asesoramiento profesional y las charlas para el control de hábitos en el tratamiento con terapia manual. Así también, la constancia de los pacientes en sus citas, y la realización de los ejercicios en casa. La terapia demostró ser efectiva en algunos de los TTM, debido a que en casos crónicos no se evidenció mejora significativa.

TMDs have important functional consequences, which do not distinguish age or gender. Treatment schemes are focused on improving function and relieving symptoms, they are mainly based on conservative therapies, avoiding over-treatment and at the same time, opportunely treating cases that require it, hence, avoiding more invasive treatments. Controlled studies on the efficacy of manual therapy for the treatment of TMDs are scarce, and the existing evidence has clear limitations in its methodology, despite this, it is the safest therapy although its results are controversial. Therefore, the aim of this work was to perform a literature review on the efficacy of manual therapy in the treatment of some temporomandibular disorders. In most of the studies it was noticed, the influence of professional advice and habit control talks in the treatment with manual therapy, as well as the consistency of the patients with their appointments, and the practice of at home exercises. The therapy proved to be effective in some of the TMDs, since in chronic cases, no significant improvement was evidenced.

Cranio ; 40(3): 199-206, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-31900091


Objective: The present study aimed to compare the clinical characteristics of volunteers with temporomandibular dysfunction before and after performing exercises with those of volunteers who only followed self-care guidelines.Methods: A parallel randomized controlled trial was performed. Individuals included underwent the intervention twice a week for one month, while the control group only followed self-care guidelines.Results: Twenty-three volunteers participated; however, during the study, four dropped out. At the end of the study, the degree of depression decreased in the volunteers in the intervention group.Conclusion: The level of pain decreased, but the improvement was not statistically significant and, therefore, could not be attributed to the intervention. It can be concluded that the strategies used to reduce pain in this study were not sufficient for clinical improvement in volunteers with temporomandibular dysfunction.

Síndrome da Disfunção da Articulação Temporomandibular , Terapia por Exercício/métodos , Humanos , Dor , Medição da Dor , Síndrome da Disfunção da Articulação Temporomandibular/terapia , Resultado do Tratamento
RGO (Porto Alegre) ; 70: e20220007, 2022. graf
Artigo em Inglês | LILACS-Express | LILACS, BBO - Odontologia | ID: biblio-1365290


ABSTRACT Studies have found the association between episodes of bruxism and the presence of signs and symptoms of temporomandibular disorder (TMD). The aim of the present study was to report the diagnosis and palliative therapy of bruxism associated with TMD. Patient, 23 years old, male gender, presented at dental clinic, complaining of pain in the temporomandibular joint on the left side and alteration of the form of the anterior teeth. During the anamnesis it was documented that this symptom was recurrent and reported the habit of grinding teeth. The clinical examination observed discrepancy between the centric relation and the maximum habitual intercuspation, unsatisfactory protrusive guide, presence of wear facets, clicking and mandibular deviation during mouth opening. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD) questionnaire was applied to diagnose TMD. By means of specific algorithms this disorder was classified as myofascial pain, disc displacement with reduction and osteoarthritis, all affecting the left side. Thus, it was proposed the assembly of the models in semi-adjustable articulator for occlusal mapping and waxing diagnosis, then the occlusal adjustment by selective wear and material addition was executed. After this procedure, the occlusal splint was installed as a palliative therapy for bruxism. This case report suggests that the dental approach by means of occlusal adjustment and occlusal splint, in a patient diagnosed with bruxism and temporomandibular disorder, reduces the signs and symptoms that affect the components of the Stomatognathic System.

RESUMO Estudos tem encontrado a associação entre os episódios de bruxismo e a presença dos sinais e sintomas de disfunção temporomandibular (DTM). O objetivo do presente trabalho foi relatar o diagnóstico e terapia paliativa do bruxismo associado à DTM. Paciente, 23 anos, gênero masculino, apresentou-se à clínica odontológica, queixando-se de dor na articulação temporomandibular do lado esquerdo e alteração da forma dos dentes anteriores. Durante a anamnese foi documentado que esse sintoma era recorrente e relatado o hábito de ranger os elementos dentais. No exame clínico observou-se discrepância entre relação cêntrica e máxima intercuspidação habitual, guia protrusiva insatisfatória, presença de facetas de desgaste, estalido e desvio mandibular durante o movimento de abertura bucal. O questionário Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) foi aplicado para diagnosticar a DTM. Por meio de algoritmos específicos essa desordem foi classificada como dor miofascial, deslocamento de disco com redução e osteoartrite, todos acometendo o lado esquerdo. Desta forma, foi proposto a montagem dos modelos em articulador semi-ajustável para mapeamento oclusal e enceramento diagnóstico. Em seguida o ajuste oclusal por desgaste seletivo e acréscimo de material foi executado. Finalizado esse procedimento, a placa estabilizadora da oclusão foi instalada como terapia paliativa para o bruxismo. Esse relato de caso sugere que a abordagem odontológica por meio do ajuste oclusal e placa oclusal, em paciente diagnosticado com bruxismo e disfunção temporomandibular, reduz os sinais e sintomas que afetam os componentes do Aparelho Estomatognático.

CoDAS ; 34(3): e20210138, 2022. tab, graf
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1360362


RESUMO Objetivo Revisar os efeitos da Fotobiomodulação com Laser de Baixa Potência na função mastigatória e nos movimentos mandibulares, em adultos com Disfunção Temporomandibular. Estratégia de pesquisa Busca nas bases de dados PubMed, Web of Science, Scopus, Embase, Cochrane, Lilacs, Science Direct e Google Scholar, utilizando os descritores: "temporomandibular joint disorders", "low level light therapy", "low level laser therapy", "mastication" e "mandible". Critérios de seleção Ensaios clínicos randomizados envolvendo adultos com Disfunção Temporomandibular, que utilizaram laser de baixa potência e avaliaram a mastigação e os movimentos mandibulares. Análise dos dados Inicialmente realizou-se a leitura dos títulos e resumos de todos os estudos encontrados. Em seguida, apenas os estudos selecionados na primeira etapa foram lidos na íntegra e avaliados quanto à elegibilidade. Após a seleção, foram analisadas as características dos estudos incluídos, bem como a sua qualidade metodológica e da evidência. Na metanálise, a média da amplitude de abertura de boca foi considerada como medida de efeito da intervenção. Resultados Verificou-se que os dez artigos incluídos apresentaram resultados muito distintos entre si, principalmente com relação à amplitude de abertura de boca, sendo a mastigação avaliada em apenas um deles. A maioria dos estudos apresentou alto risco de viés, demonstrando uma baixa qualidade metodológica. Considerando os seis estudos incluídos na metanálise, foram identificados resultados significativamente superiores para a fotobiomodulação. Conclusão Devido à escassez na literatura, não há evidências suficientes para os efeitos da fotobiomodulação com laser de baixa potência na mastigação. Já nos movimentos mandibulares, notou-se que essa intervenção apresentou resultados significativos, principalmente para o desfecho de amplitude de abertura de boca.

ABSTRACT Purpose To review the effects of low-level laser photobiomodulation on masticatory function and mandibular movements in adults with temporomandibular disorder. Research strategies Search in PubMed, Web of Science, Scopus, EMBASE, Cochrane, LILACS, ScienceDirect, and Google Scholar, using the following descriptors: "temporomandibular joint disorders", "low-level light therapy", "low-level laser therapy", "mastication", and "mandible". Selection criteria Randomized clinical trials in adults with temporomandibular disorder, using low-level laser and assessing the mastication and mandibular movements. Data analysis Firstly, the titles and abstracts of all retrieved studies were read. Then, only the studies selected in the first stage were read in full and assessed regarding eligibility. After the selection, the characteristics, methodological quality, and quality of evidence of the studies included in the review were analyzed. In the meta-analysis, the mean amplitude of mouth opening was considered as a measure of intervention effect. Results The 10 articles included in the review had quite different results one from the other, especially regarding the amplitude of mouth opening, while the mastication was assessed in only one of them. Most studies had a high risk of bias, demonstrating a low methodological quality. Significantly higher results for photobiomodulation were identified in the six studies included in the meta-analysis. Conclusion Due to the scarcity in the literature, there is not enough evidence of the effects of low-level laser photobiomodulation on mastication. As for the mandibular movements, this intervention presented significant results, particularly in the amplitude of mouth opening.

Audiol., Commun. res ; 27: e2669, 2022. tab, graf
Artigo em Português | LILACS | ID: biblio-1393979


RESUMO Objetivo identificar e sintetizar evidências sobre estratégias utilizadas no treino da mastigação e deglutição em indivíduos com disfunção temporomandibular e dor orofacial. Estratégia de pesquisa revisão de escopo desenvolvida com consulta nas bases de dados MEDLINE, LILACS, BBO, IBECS, BINACIS, CUMED, SOF, DeCS, Index Psi, LIPECS e ColecionaSUS (via BVS), Scopus, CINAHL, Embase, Web of Science, Cochrane e na literatura cinzenta: Biblioteca Digital Brasileira de Teses e Dissertações (BDTD), OpenGrey e Google Acadêmico. Critérios de seleção estudos quantitativos ou qualitativos, sem limite temporal e sem restrição de idioma, que continham os seguintes descritores ou palavras-chave: Articulação Temporomandibular, Síndrome da Disfunção da Articulação Temporomandibular, Transtornos da Articulação Temporomandibular, Dor Facial, Mastigação, Deglutição, Terapêutica, Terapia Miofuncional e Fonoaudiologia. Na primeira etapa, dois revisores fizeram a triagem independente dos estudos, por meio da leitura dos títulos e resumos. Na segunda etapa, os revisores leram, independentemente, os documentos pré-selecionados na íntegra. Em caso de divergência, um terceiro pesquisador foi consultado. Resultados as 11 publicações incluídas foram publicadas entre 2000 e 2018. As estratégias mais utilizadas foram o treino da mastigação bilateral simultânea, seguido da mastigação bilateral alternada. Na deglutição, foi proposto aumento do tempo mastigatório para reduzir o alimento em partículas menores e lubrificar melhor o bolo alimentar e treinos com apoio superior de língua. Conclusão o treinamento funcional demonstrou efetividade na reabilitação dos pacientes, embora não siga uma padronização e não seja realizado de forma isolada. Os estudos encontrados apresentam baixo nível de evidência. Considera-se fundamental a realização de estudos mais abrangentes e padronizados, como ensaios clínicos randomizados.

ABSTRACT Purpose To identify and synthesize evidence on strategies used to train chewing and swallowing in individuals with temporomandibular disorder and orofacial pain. Research strategy Scoping review conducted by search in MEDLINE, LILACS, BBO, IBECS, BINACIS, CUMED, SOF, DeCS, Index Psi, LIPECS, and ColecionaSUS (via VHL), Scopus, CINAHL, Embase, Web of Science, Cochrane, and the grey literature: Brazilian Digital Theses and Dissertations Library (BDTD), OpenGrey, and Google Scholar. Selection criteria Quantitative or qualitative studies, with no restriction on time or language of publication, with the following descriptors or keywords: Temporomandibular Joint; Temporomandibular Joint Dysfunction Syndrome; Temporomandibular Joint Disorders; Facial Pain; chewing (Mastication); swallowing (Deglutition); Therapeutics; Myofunctional Therapy; Speech, Language and Hearing Sciences. In the first stage, two reviewers independently screened the studies by title and abstract reading. In the second stage, the reviewers independently read the preselected documents in full text. In case of divergences, a third researcher was consulted. Results The 11 documents included in the review were published between 2000 and 2018. The mostly used training strategies were simultaneous bilateral mastication/chewing, followed by alternating bilateral mastication. In swallowing, increased mastication time was proposed to break food into smaller bits and better lubricate the bolus; training with upper tongue support was also indicated. Conclusion Functional training proved to be effective in rehabilitation, although it was not standardized or performed alone. The studies had low levels of evidence. It is essential to conduct more encompassing and standardized studies, such as randomized clinical trials.

Dor Facial/terapia , Síndrome da Disfunção da Articulação Temporomandibular/terapia , Terapia Miofuncional , Deglutição , Mastigação
Odontol. vital ; (35)dic. 2021.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1386452


Resumen Objetivo. Comparar posición condilar y espacio articular en articulación témporo-mandibular, en pacientes con y sin disfunción témporo-mandibular mediante tomografía Cone Beam. Métodos. Criterios diagnósticos de investigación para trastornos témporo-mandibulares Eje II, n=50 pacientes ambos sexos, edad comprendida 18 - 27 años. Muestra aleatoria n= 50 pacientes equivalente a 100 articulaciones, se obtuvo: n=25 pacientes sin disfunción témporo-mandibular, considerados asintomáticos 25 con y sin disfunción témporo-mandibulares, considerados sintomáticos. Mediante tomografía Cone Beam de articulación témporo-mandibular boca abierta - boca cerrada se avaluó de forma manual los espacios interarticulares. Resultados. El espacio condilar anterior en pacientes con y sin disfunción témporo-mandibular no presentó diferencia significativa, p=0,30. La posición condilar tampoco mostró diferencia significativa p=0,58. En pacientes con y sin disfunción témporo-mandibular (sintomáticos) la posición central y posterior del cóndilo (35,2%), pacientes con y sin disfunción témporo-mandibular (asintomáticos) la posición anterior y central fue más significativa (37,0%); seguido de la posición posterior del cóndilo (26,1%). Conclusión. No existe diferencia significativa en la posición condilar y el espacio interarticular en pacientes sintomáticos y asintomáticos.

Abstract Aim. To compare the condylar position and joint space of the temporomandibular join in individuals with and without temporomandibular dysfunction, using cone beam computed tomography (CBCT). Methods. Research Diagnostic Criteria for Temporomandibular Disorders Axis II (n= 50) patients both sexes, age 18 - 27 years. Random sample (n=50) patients equivalent to 100 joints, obtaining: n-25 patients without temporomandibular dysfunction, considered asymptomatic and 25 patients with and without temporomandibular dysfunction, considered symptomatic. By tomography Cone Beam of open mouth temporomandibular joint - closed mouth was manually evaluated the interarticular spaces. Results. The anterior condylar position space and condylar position not significantly different in induvials with and without temporomandibular dysfunction temporomandibular disorders p=0,30 and p=0,58, respectively. Conclusions. There is no significant difference in the condylar position and intraarticular.

Rev. ABENO ; 21(1): 1253, dez. 2021. tab
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1371268


Casos de bruxismo e disfunção temporomandibular (DTM) têm se tornado cada vez mais frequentes na prática clínica. Reconhecer seus mecanismos é necessário para o sucesso do controle e tratamento. O objetivo deste estudo piloto foi investigar o conhecimento e a percepção sobre DTM e bruxismo dos estudantesde Odontologia da Universidade Federal de Santa Maria (UFSM). Para isso um questionário com 15 questões foi aplicado a20 estudantes dessa instituição, sendo 10 do 7º e 10 do 10º semestre. Todos os estudantes avaliados relataram ouvir sobre DTM durante a graduação, mas 70% consideraram que possuíam pouca ou nenhuma base de conhecimento sobre o assunto. Noventa por cento dos estudantes relatou não conhecer a ferramenta utilizada em pesquisas para diagnóstico das DTM. Não houve diferença estatística entre os grupos avaliados e a média geral de acertos foi de 54%. Os dados evidenciam o pouco conhecimento sobre os assuntos abordados e a fragilidade do ensino destas alterações, especialmente pela não evolução do conhecimento sobre DTM e bruxismo ao longo do curso avaliado, pois o grupo de estudantes do 10º semestre apresentou resultados inferiores quando comparados ao do 7º semestre, que passaram recentemente pela Clínica de Oclusão, na qual os temas são abordados (AU).

Bruxism and temporomandibular disorders (TMD) have become increasingly frequent in clinical practice. Recognizing its mechanisms is necessary for successful management and treatment. The aim of this pilot study was to investigate the knowledge and perception about TMD and bruxism of dental undergraduate students from the Federal University of Santa Maria (UFSM). A questionnaire with 15 questions was applied to 20 students from this institution, 10 from the 7th and 10 from the 10th semester. All evaluated students reported hearing about TMD during the Dentistry course, but 70% considered that they had little or no knowledge on the subject. Ninety percent of students reported not knowing the instrument used in research to diagnose TMD. There was no statisticaldifference between the evaluated groups, and the overall average of correct answers was 54%. Data show little knowledge about the subjects and fragility regarding the teaching-learning process of these topics. Moreover, the non-evolution of knowledge about TMD and bruxism throughout the evaluated course is evident, as the group of students in the 10th semester showed poorer results when compared to the 7th semester, which have recently finished the discipline in which these themes are addressed (AU).

Humanos , Masculino , Feminino , Adulto , Estudantes de Odontologia/psicologia , Bruxismo/diagnóstico , Transtornos da Articulação Temporomandibular/patologia , Conhecimentos, Atitudes e Prática em Saúde , Avaliação Educacional/métodos , Percepção Social , Brasil , Distribuição de Qui-Quadrado , Inquéritos e Questionários , Pesquisa Qualitativa
BMC Musculoskelet Disord ; 22(1): 959, 2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34789211


BACKGROUND: Temporomandibular disorders (TMD) are a group of painful and debilitating disorders, involving the masticatory muscles and/or the temporomandibular joint (TMJ). Chronic TMD pain can be associated with genetic changes in the key muscle development genes. OBJECTIVE: To evaluate the association between polymorphisms in the PAX7 (paired box 7) gene and masticatory myalgia in patients with temporomandibular disorders (TMD). MATERIALS AND METHODS: This is a case-control study. Patients with TMD were divided into two groups: (a) presence of muscular TMD (n = 122) and (b) absence of muscular TMD (n = 49). Genomic DNA was obtained from saliva samples from all participants to allow for genotyping single nucleotide polymorphisms in PAX7 (rs766325 and rs6659735). Over-representation of alleles was tested using chi-square or Fisher's exact tests. Values of p < 0.05 were considered to be statistically significant. RESULTS: Individuals without muscular TMD were less likely to have the PAX7 rs6659735 GG genotype (p = 0.03). No associations were found for PAX7 rs766325. CONCLUSIONS: Alterations in PAX7 may influence muscular pathophysiology and individuals with TMD and the rs6659735 homozygous genotype (GG) are seemingly associated with muscular involvement of the disorder. No associations were found in the region rs766325.

Dor Crônica , Transtornos da Articulação Temporomandibular , Estudos de Casos e Controles , Humanos , Músculos , Fator de Transcrição PAX7/genética , Polimorfismo de Nucleotídeo Único , Células-Tronco , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/epidemiologia , Transtornos da Articulação Temporomandibular/genética
Fisioter. Pesqui. (Online) ; 28(4): 408-415, out.-dez. 2021. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1364873


ABSTRACT This study aims to validate the Brazilian version of World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with temporomandibular disorders (TMD), assessing its psychometric properties, including internal consistency, construct validity, and discriminant validity. In total, 100 female and male patients with TMD were included. Participants were assessed based on the Research Diagnostic Criteria for TMD (RDC/TMD). For statistical analyses, McDonald's omega coefficient was used to assess internal consistency; Spearman correlation, for construct validity; Kruskal-Wallis test and multiple comparisons (Dunn method), for discriminant validity. The results of internal consistency for the WHODAS 2.0 domains ranged from 0.70 to 0.94. The WHODAS 2.0 showed a moderate and significant correlation with the disability points of the RDC/TMD and with the WHOQOL-BREF domains. In the discriminant validity, significant differences were found in all domains of WHODAS 2.0 between grade 0 and grade III, between grade I and grade III, and between grade II and grade III from the chronic pain grading of the RDC/TMD. The results demonstrate that the instrument is reliable and valid for measuring the functioning of individuals with TMD, presenting acceptable psychometric properties for internal consistency, as well as for construct validity and discriminant validity.

RESUMO Este estudo metodológico teve como objetivo validar a versão brasileira do World Health Organization Disability Assessment Schedule (WHODAS 2.0) para indivíduos com desordem temporomandibular (DTM), avaliando suas propriedades psicométricas, incluindo consistência interna, validade de construto e validade discriminante. Um total de 100 pacientes do sexo feminino e masculino com DTM participaram do estudo e foram avaliados com base no Research Diagnostic Criteria for TMD (RDC/TMD). Para as análises estatísticas, o coeficiente ômega de McDonald foi usado para avaliar a consistência interna, a correlação de Spearman para a validade de construto, o teste de Kruskal-Wallis e comparações múltiplas (método de Dunn) para a validade discriminante. Os resultados de consistência interna para os domínios do WHODAS 2.0 variaram de 0,70 a 0,94. O WHODAS 2.0 apresentou correlação moderada e significativa com os pontos de incapacidade do RDC/TMD e com os domínios do WHOQOL-bref. Na validade discriminante, foram encontradas diferenças significativas em todos os domínios do WHODAS 2.0 entre os graus 0 e III, entre os graus I e III, e entre os graus II e III dos graus de dor crônica do RDC/TMD. Os resultados obtidos demonstram que o WHODAS 2.0 é um instrumento confiável e válido para mensurar a funcionalidade em indivíduos com DTM, apresentando propriedades psicométricas aceitáveis para consistência interna, bem como para validade de construto e validade discriminante.

RESUMEN Este estudio metodológico tuvo como objetivo validar la versión brasileña del Cuestionario para la Evaluación de la Discapacidad de la Organización Mundial de la Salud (WHODAS 2.0) para personas con trastorno temporomandibular (TTM), así como evaluar sus propiedades psicométricas, incluidas la consistencia interna, la validez de constructo y la validez discriminante. Participaron en el estudio un total de 100 pacientes de ambos sexos con TTM, quienes fueron evaluados con base en Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). En los análisis estadísticos, se utilizó el coeficiente omega de McDonald para evaluar la consistencia interna; la correlación de Spearman para la validez de constructo; y la prueba de Kruskal-Wallis y comparaciones múltiples (método de Dunn) para la validez discriminante. Los resultados de consistencia interna para los dominios de WHODAS 2.0 variaron de 0,70 a 0,94. El WHODAS 2.0 tuvo una correlación moderada y significativa con los puntos de incapacidad del RDC/TMD y con los dominios del WHOQOL-bref. En la validez discriminante, se encontraron diferencias significativas en todos los dominios de WHODAS 2.0 entre los grados 0 y 3, entre los grados 1 y 3 y entre los grados 2 y 3 de los grados de dolor crónico del RDC/TMD. Los resultados apuntan que el WHODAS 2.0 es fiable y válido para medir la funcionalidad de personas con TTM, presentando propiedades psicométricas aceptables para la consistencia interna, así como para la validez de constructo y la validez discriminante.

J Oral Rehabil ; 48(8): 955-967, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33966292


BACKGROUND: Our aim was to assess the diagnostic correlation between clinical protocols and magnetic resonance (MRI) findings in temporomandibular disorders (TMDs), including disc displacement with and without reduction (DDwR; DDwoR) and arthralgia. METHODS: A systematic review performed in two phases according to the PRISMA checklist. Specific indexing terms were used for search of studies assessing TMDs through clinical diagnostic protocols with the aid of Research Diagnostic Criteria for TMDs or Diagnostic Criteria for TMDs. Quality assessment performed using QUADAS-2. Heterogeneity was assessed using I2 . Publication bias was assessed using funnel plots. For meta-analysis, we used random effect model or fixed effect. The main outcomes were sensitivity and specificity of clinical protocols. RESULTS: Fourteen studies included in the qualitative analysis and 11 studies in the meta-analysis. None of the studies fulfilled all criteria of QUADAS-2. High heterogeneity and high publication bias were found among the studies. Clinical protocols for assessing DDwR compared with MRI showed pooled sensitivity of 66% and specificity of 72%. For DDwoR, sensitivity was 61% and specificity 98%. For arthralgia, sensitivity was 43% and specificity 68% for the presence of effusion. CONCLUSIONS: This review reveals the need for studies with improved quality. Clinical protocols show poor to moderate validity in diagnosis of DDwR and DDwoR compared with MRI. No correlation was found between a clinical diagnosis of arthralgia and MRI effusion. Clinical diagnostic protocols can be used as screening tools, reserving the use of MRI for a more accurate diagnosis in patients with symptoms or dysfunction.

Luxações Articulares , Transtornos da Articulação Temporomandibular , Protocolos Clínicos , Humanos , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Transtornos da Articulação Temporomandibular/diagnóstico por imagem
J Family Med Prim Care ; 10(1): 254-258, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34017736


CONTEXT: Internal derangements of temporomandibular joint (TMJ) with associated symptoms which do not respond to conservative therapies are refractory cases of temporomandibular joint dysfunction syndrome (TMD). Minimally invasive techniques like arthrocentesis and platelet rich plasma (PRP) injections are usually employed to improve TMJ symptoms and function in these cases. AIMS: To compare PRP with arthrocentesis for evaluating the effectiveness of PRP in relieving symptoms of refractory TMJ pain dysfunction syndrome. SETTING AND DESIGN: A clinical study was carried out on 52 patients of refractory Temporomandibular joint dysfunction syndrome. The patients were divided in two groups that is Group A - test group and Group B -control Group. METHODS AND MATERIAL: Group A consisted of 26 patients who underwent intraarticular PRP injection in TMJ and Arthrocentesis of TMJ was done in 26 patients of Group B. TMJ pain, Maximium Interincisal opening and TMJ clicking were assessed among the group as well as between the groups over a period of 6 months. STATISTICAL ANALYSIS USED: Repeated Measure ANOVA was used to compare the parameters within the groups and T test was used for group comparison at 0.05 level of significance. RESULT: There was statistically significant difference in pain intensity improvement 1 ± 0.75 versus 3.17 ± 2.13, maximum interincisal opening 39.86 ± 2.86 versus 37.59 ± 4.03 and clicking 6 versus 16 between the PRP group and arthrocentesis group at P < 0.05. CONCLUSIONS: Intraarticular PRP injection for the management of refractory TMD is more effective than arthrocentesis in reducing symptoms and functional improvement.

Odontol. Clín.-Cient ; 20(3): 36-40, jul.-set. 2021. ilus, tab
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1372314


Disfunção Temporomandibular (DTM) apresenta-se como principal causa de dores orofaciais de origem não dentária. A acupuntura é indicada para o alívio de da dor em casos de DTM muscular, baseada em propriedades anti-inflamatórias com efeitos neuro-hormonais. Objetivou-se nesta pesquisa a avaliação da eficácia da acupuntura como um método válido para redução imediata da sintomatologia dolorosa e limitação de abertura bucal nos casos de DTM. Realizou-se terapia acupuntural em 30 pacientes com DTM, avaliando-se a dor, a partir da Escala Verbal (EV) e da Escala Analógica Visual (EAV) e a limitação de abertura bucal com o auxílio de paquímetro digital antes e após a terapia para registro da análise. O aumento da média de abertura bucal foi de 9,2% no total de participantes. Quanto à sintomatologia dolorosa, apresentou redução média em 63%. Na EV, 27 dos pacientes tiveram resposta "moderada" e "intensa" para sensação dolorosa. Contudo, após a terapia, observou-se ausência de sensação dolorosa intensa. Os dados apontaram significância da terapia acupuntural para redução dor e limitação de abertura bucal, de forma imediata, em pacientes com DTM... (AU)

Temporomandibular Disorder (TMD) is the main cause of orofacial pain of non-dental origin. Acupuncture is indicated for pain relief in cases of muscle TMD, based on anti-inflammatory properties with neuro hormonal effects. The aim of this research was to evaluate the effectiveness of the acupuncture as a valid method for immediate reduction of painful symptoms and mouth opening limitation in TMD cases. Acupuncture therapy was performed in 30 patients with TMD, evaluating pain from the Verbal Scale (VE) and Visual Analog Scale (VAS) and mouth opening limitation with the aid of a digital caliper before and after therapy to record the analysis. The increase in the average mouth opening was 9.2% in the total number of participants. As for painful symptoms, an average reduction of 63%. In IV, 27 of the patients had "moderate" and "intense" responses to painful sensation. However, after therapy, the absence of intense painful sensation was observed. The data showed the significance of acupuncture therapy for immediate pain reduction and mouth opening limitation in patients with TMD... (AU)

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Dor Facial , Transtornos da Articulação Temporomandibular , Síndrome da Disfunção da Articulação Temporomandibular , Analgesia por Acupuntura , Terapia por Acupuntura , Acupuntura , Medicina Tradicional Chinesa , Boca , Músculos
BJA Educ ; 21(2): 44-50, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33889429
J Oral Rehabil ; 48(6): 643-653, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33710632


BACKGROUND: Pain catastrophising is a maladaptive cognitive response characterised by an exaggerated negative interpretation of pain experiences. It has been associated with greater disability and poorer outcomes in chronic pain, to include several specific oro-facial pain conditions. The goal of this study was to examine pain catastrophising at a military oro-facial pain specialty clinic. METHODS: This retrospective chart review (RCR) examined information collected at initial examination from 699 new patients seen between September 2016 and August 2019 at the Orofacial Pain Center at the Naval Postgraduate Dental School (Bethesda, MD). Pain catastrophising, pain characteristics, psychosocial factors and sleep were assessed using standardised scales. Linear regression was used to evaluate associations of patient characteristics and pain intensity with pain catastrophising. Mediation analyses were done to characterise the extent to which the relationship between pain intensity and pain catastrophising may be explained by anxiety, depression and insomnia. RESULTS: Higher pain intensity, depression, anxiety, insomnia and younger age were each associated with higher pain catastrophising (all p < .05). A primary diagnosis of neuropathic pain was the strongest independent predictor of higher pain catastrophising. The relationship between pain intensity and pain catastrophising was partially mediated by anxiety, depression and insomnia. CONCLUSIONS: In this RCR of a population of oro-facial pain patients, those diagnosed with neuropathic pain were most likely to display high levels of pain catastrophising, a characteristic which is associated with poor long-term pain outcomes. This is the first study to show that, independent of other patient characteristics, those suffering from neuropathic pains displayed the highest levels of pain catastrophising. This highlights the importance of also addressing psychosocial factors in the treatment of neuropathic pain conditions, which are commonly treated using a predominantly biomedical approach. Additionally, anxiety, depression and insomnia each partially explains the relationship between pain intensity and pain catastrophising.

Dor Crônica , Dor Facial , Ansiedade , Dor Facial/epidemiologia , Humanos , Medição da Dor , Estudos Retrospectivos
Syst Rev ; 10(1): 70, 2021 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-33685496


BACKGROUND: The term temporomandibular disorder (TMD) includes disorders of the temporomandibular joints (TMJ), masticatory muscles and adjacent tissues. Several studies have examined the effectiveness of manual therapy (MT) for TMDs by evaluating changes in pain and maximum mouth opening (MMO). Nevertheless, the effectiveness of MT exclusively applied to the craniomandibular structures (craniomandibular manual therapy (CMMT)) on pain and TMJ range of motion remains unclear. This review aims to evaluate the effectiveness of CMMT on pain and TMJ range of motion in people with TMDs. METHODS: This protocol is reported in line with the preferred reporting items for systematic reviews and meta-analysis protocols (PRISMA-P). Databases including MEDLINE, Embase, CINAHL, ZETOC, Web of Science, SCOPUS, PEDro, PubMed, Cochrane Library and Best Evidence, EBM reviews-Cochrane Central Register of Controlled Trials, Index to Chiropractic Literature ChiroAccess and Google Scholar will be searched from inception as well as key journals and grey literature. Randomised controlled trials involving adults with TMD that compare the effect of any type of CMMT (e.g. mobilisation) on pain and range of motion with a placebo intervention, controlled care intervention or other types of treatment will be included. Two reviewers will independently screen articles for inclusion, extract data, assess risk of bias (revised Cochrane risk of bias tool) for included studies and evaluate overall quality of evidence (Grading of Recommendations Assessment, Development and Evaluation). A meta-analysis will be conducted if possible. If not, a narrative synthesis will be conducted reporting the effectiveness of CMMT according to disorder type (TMJ disorders, masticatory muscle disorders and mixed disorders). DISCUSSION: In this review, the effectiveness of MT applied to craniomandibular structures for the treatment of TMD will be evaluated. Results will be submitted for publication in a peer-reviewed journal and presented at conferences. We expect our findings will facilitate treatment planning for manual therapists managing patients with TMD and provide future clinical research implications. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019160213.

Manipulações Musculoesqueléticas , Transtornos da Articulação Temporomandibular , Adulto , Humanos , Metanálise como Assunto , Dor , Modalidades de Fisioterapia , Amplitude de Movimento Articular , Literatura de Revisão como Assunto , Transtornos da Articulação Temporomandibular/terapia