Avaliação da influência do tratamento ortodôntico em sinais e sintomas de disfunção temporomandibular, no relato de bruxismo, na hipervigilância à dor e nos sintomas de ansiedade e depressão / Evaluation of orthodontic treatment on signs and symptoms of temporomandibular dysfunction, bruxism, pain hypervigilance, anxiety and depression

Novos estudos são necessários para elucidar com maior clareza o impacto da ortodontia na saúde dos músculos mastigatórios e das articulações temporomandibulares. A associação do estudo de sinais e sintomas de DTM com a investigação dos fatores psicossociais apresentam perspectivas promissoras, assim como o conhecimento da presença de hábitos parafuncionais. Entender como os fatores psicossociais interferem nos resultados dos tratamentos clínicos pode trazer contribuições enriquecedoras para a odontologia. Um modelo que tem sido aceito no entendimento da etiologia das DTM é o modelo biopsicossocial, que envolve uma combinação de fatores biológicos, psicológicos e sociais. Segundo essa perspectiva, entende-se que um problema biológico pode ter antecedentes psicológicos, assim como consequências comportamentais. O objetivo deste trabalho é avaliar a influência da ortodontia no desenvolvimento de sinais e sintomas de disfunção temporomandibular, no relato de bruxismo, na hipervigilância à dor e nos sintomas de depressão e ansiedade. 111 pacientes iniciando tratamento ortodôntico foram examinados em 3 sessões: t1 (no momento da instalação do aparelho), t2 (dois meses após a instalação), e t3 (seis meses após o início do tratamento). Nas 3 sessões os pacientes foram examinados clinicamente para avaliação oclusal, limiares de dor à pressão e aplicações de questionários de bruxismo, hipervigilância, depressão e ansiedade. Foram feitas comparações a respeito de cada variável quantitativa considerando os três tempos de avaliação através de Análise de variância (ANOVA) a um critério. O teste t foi utilizado para avaliar diferenças entre as médias das variáveis quantitativas no tempo inicial (t1) e tempo final (t3) de avaliação. Para avaliar o efeito da ortodontia sobre variáveis qualitativas oclusais foi utilizado o teste exato de Fisher. Foram considerados estatisticamente significantes aqueles resultados que apresentaram nível de significância igual ou menor que 0,05. O presente estudo demonstrou que a ortodontia não interfere no surgimento de sinais e sintomas de disfunção temporomandibular, sendo que não houve diferenças na presença de ruído articular e no LDP em nenhum dos sítios durante os períodos avaliados. Os resultados apontaram que nos grupos que não possuíam bruxismo do sono (controle), houve um aumento no relato de bruxismo em vigília após o início da ortodontia. Considerando o grupo de pacientes com maiores sintomas de ansiedade, encontrou-se maior presença de relato de bruxismo em vigília. Por último, os resultados demonstraram que a ortodontia não alterou os escores do questionário de hipervigilância à dor e os sintomas de ansiedade e depressão.(AU)

Further studies are needed to elucidate more clearly the impact of orthodontics on the health of the masticatory muscles and temporomandibular joints. The study of the association of signs and symptoms of TMD with psychosocial factors have promising prospects, as well as the presence of parafunctional habits. Understanding how psychosocial factors affect the results of clinical treatments can bring great contributions to dentistry. A model that has been accepted in the understanding of the etiology of TMD is the biopsychosocial model, which involves a combination of biological, psychological and social factors. From this perspective, it is understood that a biological problem may have psychological backgrounds, as well as behavioral consequences. The objective of this study is to evaluate the influence of orthodontics in the development of signs and symptoms of temporomandibular disorders, the report of bruxism, hypervigilance to pain, and symptoms of depression and anxiety. 111 patients initiating orthodontic treatment were examined in 3 sessions: t1 (at the time of orthodontic appliance installation), t2 (two months after installation), and t3 (six months after the start of the treatment). In the three sessions, patients were examined clinically for occlusal evaluation, pain pressure thresholds were measured, and bruxism, hypervigilance, depression and anxiety questionnaires were applied. Comparisons were made with respect to each quantitative variable considering the three phases of evaluation through a multi-way analysis of variance (ANOVA). The t test was used to assess differences between means of quantitative variables at the initial time (t1) and end time (t3) evaluation. To evaluate the effect of orthodontics on occlusal qualitative variables we used Fisher's exact test. This study showed that orthodontics does not interfere with the appearance of signs and symptoms of temporomandibular dysfunction, and there were no differences in the presence of articular noise and LDP on any of the sites during the evaluation period. The results showed that the group that did not reported sleep bruxism (control), showed an increase in the reporting of awake bruxism after the start of orthodontics. Considering the group of patients with higher anxiety symptoms, we found a greater presence of daytime bruxism report. Finally, the results showed that orthodontics did not alter the scores of pain hypervigilance questionnaire and symptoms of anxiety and depression.(AU)

Assessing changes in quality of life using the Oral Health Impact Profile (OHIP) in patients with different classifications of malocclusion during comprehensive orthodontic treatment.

BACKGROUND: The objectives of this study were to investigated changes in OHRQoL among patients with different classifications of malocclusion during comprehensive orthodontic treatment. METHODS: Clinical data were collected from 81 patients (aged 15 to 24) who had undergone comprehensive orthodontic treatment. Participants were classified 3 groups: Class I (n = 35), II (n = 32) and III (n = 14) by Angle classification. OHRQoL was assessed using the Oral Health Impact Profile (OHIP-14). All subjects were examined and interviewed at baseline (T0), after alignment and leveling (T1), after correction of molar relationship and space closure (T2), after finishing (T3). Friedman 2-way analysis of variance (ANOVA) and Wilcoxon signed rank tests were used to compare the relative changes of OHRQoL among the different time points. A Bonferroni correction with P < 0.005 was used to declare significance. RESULTS: Significant reductions were observed in all seven OHIP-14 domains of three groups except for social disability (P > 0.005) in class I and class II, Handicap in class II and class III (P > 0.005). Class I patients showed significant changes for psychological disability and psychological discomfort domain at T1, functional limitation, physical pain at T2. Class III patients showed a significant benefit in all domains except physical pain and functional limitation. Class II patients showed significant changes in the physical pain, functional disability, and physical disability domains at T1. CONCLUSIONS: The impact of comprehensive orthodontic treatment on patients' OHRQoL do not follow the same pattern among patients with different malocclusion. Class II patients benefits the most from the stage of space closure, while class I patients benefits the first stage (alignment and leveling) of treatment in psychological disability and psychological discomfort domains.

Braces versus Invisalign®: gingival parameters and patients' satisfaction during treatment: a cross-sectional study.

BACKGROUND: Fixed orthodontic appliances (FOA) temporarily interfere with periodontal health of patients, as the appliance complicates oral hygiene. The use of aligners in orthodontic therapy increased strongly during the last decade. In the literature, the reports about effects of aligner treatment on oral hygiene and gingival conditions are scarce. This cross-sectional study evaluated oral hygiene and patient's satisfaction during orthodontic treatment of patients with FOA or Invisalign®. METHODS: 100 patients (FOA = 50, Invisalign® = 50) were included who underwent orthodontic treatment for more than 6 months. Clinical examinations were performed to evaluate patients' periodontal condition and were compared with clinical data at the beginning of the orthodontic treatment. Oral hygiene, patients' satisfaction and dietary habits were documented by a detailed questionnaire. For statistical analysis, the Mann-Whitney U-Test and Fisher's Exact Test were used; as multiple testing was applied, a Bonferroni correction was performed. RESULTS: At the time of clinical examinations, patients with FOA were in orthodontic therapy for 12.9 ± 7.2 months, whereas patients with Invisalign® were in orthodontic therapy for 12.6 ± 7.4 months. Significantly better gingival health conditions were recorded in Invisalign® patients (GI: 0.54 ± 0.50 for FOA versus 0.35 ± 0.34 for Invisalign®; SBI: 15.2 ± 7.6 for FOA versus 7.6 ± 4.1 for Invisalign®), whereas the amount of dental plaque was also less but not significantly different (API: 37.7 % ± 21.9 for FOA versus 27.8 % ± 24.6 for Invisalign®). The evaluation of the questionnaire showed greater patients' satisfaction in patients treated with Invisalign® than with FOA. CONCLUSION: Patients treated with Invisalign® have a better periodontal health and greater satisfaction during orthodontic treatment than patients treated with FOA.

Differences in psychological traits between lingual and labial orthodontic patients: perfectionism, body image, and the impact of dental esthetics.

OBJECTIVE: To examine some of the patients' psychological traits in relation to their levels of perfectionism and their body image, and to discover whether these differ between lingual and labial orthodontic patients. MATERIALS AND METHODS: A cross-sectional study was designed with a consecutive sample of 80 patients attending a private orthodontic office. Three questionnaires were used to assess the patients' body image and level of perfectionism. The mean age was 33 years. The men numbered 32 and the women 48. The validated Spanish version of the Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ) was used to assess the psychosocial impact of their dental esthetics. The Multidimensional Perfectionism Scale (MPS) was used to assess how perfectionist the patients were. A version of the Multidimensional Body-Self Relations Questionnaire (MBSRQ) was used for assessment of their body image. Student's t-test was used to compare the means and 95% confidence intervals (P < .05), and a logistic regression model was used for multivariate analysis. RESULTS: The PIDAQ (55.4 vs 60, P  =  .218) and MBSRQ (128.7 vs 125.9, P  =  .523) results of the patients who chose lingual orthodontics did not differ significantly from those who opted for labial orthodontics. However, the MPS scores of the lingual orthodontic patients were significantly higher (95.9 vs 86.3, P  =  .044), and high social class, over 30 years of age, and perfectionist traits were significant independent variables in this group. CONCLUSIONS: This pilot study may indicate that lingual orthodontic patients are more perfectionists than labial orthodontic patients.

Smile attractiveness of patients treated for congenitally missing maxillary lateral incisors as rated by dentists, laypersons, and the patients themselves.

STATEMENT OF PROBLEM: Esthetic judgments can help dental professionals better understand how attentive people are to their own smiles and those of others. PURPOSE: The purpose of this study was to evaluate the smile attractiveness of patients treated for maxillary lateral incisor agenesis compared with that of individuals with a complete dentition. MATERIAL AND METHODS: Photographs were made of the smiles of patients with maxillary lateral incisor agenesis who were treated with space closure and teeth recontouring (n=26) or space opening and implants (n=20) and of a control group with a complete dentition (n=22). Both laypersons and dentists assessed smile attractiveness by using a visual analog scale. Patients and controls also assessed the level of satisfaction with their own smile. Assessments were performed twice, and the reliability of the method was determined with Cronbach α and intraclass correlation. Multifactorial and 1-way ANOVA were used to analyze smile attractiveness and participant satisfaction, followed by the Bonferroni post hoc test (α=.05). RESULTS: Attractiveness ratings by dentists and laypersons did not differ significantly among the study groups (P=.64). The ratings of male dentists and female laypersons differed significantly from those of other evaluators (P=.01). Patients with space closure and teeth recontouring were significantly more satisfied than controls (P=.002). No significant differences were found between the patients with implants and controls or between the patients with implants and those with space closure and teeth recontouring. CONCLUSIONS: The smiles of patients with maxillary lateral incisor agenesis were judged to be as attractive as those of the controls. Male dentists were the most critical raters, closely followed by female laypersons. All participants had high levels of satisfaction with their own smile; patients treated with space closure and teeth recontouring were the most satisfied.

Adolescent patients' experience with the Carriere distalizer appliance.

AIM: To examine adolescent patients' experience with the Carriere Distalizer Appliance (CDA) and compare it with that of the Forsus Fatigue Resistant Device (FFRD). MATERIALS AND METHODS: A survey was administered to 42 patients treated with the CDA and 70 patients treated with the FFRD. Amount of time required to become accustomed to the appliance, how many patients experienced side effects as well as the degree of discomfort were explored. RESULTS: The overall experience with the device was significantly better for the CDA group than for the FFRD group. Both groups felt that delivery and removal of the appliance was quick and easy, the appliance was noticeable to some extent, and the majority became accustomed to it within two weeks with a maximum of one month. In general, associated discomfort and effects on daily life and activities were less for the CDA group than for the FFRD group. Side effects decreased over time for both groups, often more so for the CDA group. The major side effects experienced by the CDA group were difficulty eating and sore teeth, and these improved significantly over time. Soreness from the appliance rubbing on the cheek or lip was significantly less for the CDA group. CONCLUSION: The CDA appears to be more comfortable, offers a more positive overall experience, and has fewer negative comfort-related side effects compared to FFRD.

Comparison of oral impacts experienced by patients treated with labial or customized lingual fixed orthodontic appliances.

INTRODUCTION: Our objective was to compare the oral impacts experienced by patients treated with labial or customized lingual fixed orthodontic appliances. METHODS: This was an age- and sex-matched prospective longitudinal study of 60 adult patients treated with either labial or customized lingual fixed orthodontic appliances over a 3-month period. Ratings of oral impacts experienced and satisfaction were made on visual analog scales at 3 time points after appliance fixation. Variations in oral impacts and satisfaction over the trajectory of treatment were assessed. Area-under-the-curve analyses were conducted to assess variations in oral impacts and satisfaction between the groups. RESULTS: All patients experienced oral impact disturbances, although these disturbances decreased over time (P < 0.001). Patients treated with customized lingual appliances reported more oral discomfort (P < 0.001), dietary changes (P < 0.001), swallowing difficulty (P < 0.001), speech disturbances (P < 0.001), and social problems (P < 0.001) than did those in the other group. There was no significant difference between the groups regarding ratings of oral self-care, mastication, and satisfaction level of treatment (P > 0.05). CONCLUSIONS: The findings indicate that oral impacts are commonly experienced during both labial and customized lingual fixed orthodontic therapies. However, the oral impacts decreased over the observational period. Patients treated with customized lingual appliances experienced more oral impacts. Both groups had similar levels of treatment satisfaction.

Psychosocial reward of orthodontic treatment in adult patients.

SUMMARY: The purpose of this study was to assess the short-term psychosocial impact of dental aesthetic improvement in adult subjects. Sixty-nine adult patients (61 females and 8 males, aged 21-59 years) requesting aesthetic dental improvement were prospectively and randomly recruited for the study in a private orthodontic office. A general interview included patient motivation and expectations from treatment. After clinical examination, discussion of the mode of treatment and the expected outcome, the patients were requested to complete the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) with several additions. The duration of their treatment was 6-14 months, and the main goals were tooth alignment, crowding alleviation, or space closure. After removal of the appliances, they completed an identical PIDAQ. Each patient served as his/her own control. Assessment of the impact of aesthetic improvement was based on the responses to the same questions relating to the patients' perceived dental aesthetics before and after treatment, their self-esteem, and changes in their social behaviour resulting from the treatment. The data were analysed using Cohen's and Pearson's correlation analyses and chi-square and Student's t-tests. A statistically significant improvement (P < 0.001) was found for all four factors: dental self-confidence (DSC), social impact (SI), psychological impact (PI), and aesthetic concern (AC). The reliability of the questionnaire, using Cronbach's alpha, was between 0.709 and 0.947. The degree of significance was not related to age, marital status, education, or gender. Dental aesthetics generated a significant improvement in adult patients' quality of life for the period examined (up to 6 months post-treatment).

Effects of preoperative ibuprofen on pain after separator placement.

INTRODUCTION: Many patients experience pain with orthodontics, but there is no widely accepted standard of care for controlling orthodontic pain. Previous studies were inconclusive as to the most effective way to manage orthodontic pain. The purpose of this study was to assess the effectiveness in reducing pain of preemptive ibuprofen added to an ibuprofen regimen administered after separator placement. We also examined the contributions of psychological factors and sex to the experience of pain. METHODS: The subjects were randomly assigned to group A, 400 mg of ibuprofen 1 hour before separator placement (D1), 3 hours after placement (D2), and 7 hours after placement (D3); group B, placebo at D1, 400 mg of ibuprofen at D2 and D3; or group C, placebo at D1, D2, and D3. Before separator placement, the subjects completed 2 psychological surveys, a masticatory efficiency test, and a visual analog scale for expected pain and experienced pain during the masticatory efficiency test. After placement, the subjects recorded their actual pain, kept a pain diary for 24 hours after separator placement, and performed a 24-hour follow-up masticatory efficiency test. RESULTS: Group A, receiving ibuprofen before and after separator placement, experienced significantly less pain (P <0.05) at 6 hours, at bedtime, and at awakening on the second day. No contributions to pain were found for psychological factors or sex. CONCLUSIONS: Preemptive administration of analgesics should be recommended to orthodontic patients before separator placement.

Emotional stress- and pain-related behaviors evoked by experimental tooth movement.

OBJECTIVE: To investigate by behavioral methods the relationship between emotional stress and pain during experimental tooth movement in rats. MATERIALS AND METHODS: Sixteen male Sprague-Dawley rats (210 to 250 g) were divided into two groups. The experimental group was treated with an active Ti-Ni appliance, and the control group received a passive appliance. A force of 20 gf was delivered by the active appliance between the maxillary first and second molars for 3 days. During this period the rat's behavior was evaluated eight times by means of open-field test and resistance-to-capture test. The specific parameters of animal activity were facial grooming, rearing, and locomotor activity, movement into the center of the open field, and response to capture. RESULTS: Parameters related to stress and pain were higher in the group carrying active appliance, compared to the group with a passive appliance. Statistically significant differences in stress-related behavior between control and experimental groups were found 8 hours after placing the appliance and were most evident on the second day. Pain-related behavior was significantly greater in the experimental group than in the control group at 24 hours. CONCLUSIONS: The increase in emotional stress evoked by orthodontic tooth movement may precede the appearance of periodontal pain.

Efecto del estrés sobre el movimiento dental / Effect of stress on dental movement

Introducción. Es bien conocido que la actividad remodeladora del hueso alveolar en los tejidos periodontales ocurre bajo ciertas circunstancias. Factores sistémicos pueden estar involucrados en la regulación de la actividad degradadora tisular. La reabsorción ósea es regulada por las citoquinas, que se encuentran dentro de las células medulares, que median la activación y formación de osteoclastos. Material y método. Veinticuatro ratas fueron asignadas al azar en cuatro grupos de seis ratas cada uno: grupo control, grupo estrés, grupo con movimiento dental y grupo de movimiento dental y estrés. Para ejercer la fuerza ortodóncica se utilizó un método modificado por Kohno et al. Las ratas fueron sometidas a una banda ancha de ruidos de 100 dB diarios por 5 segundos cada minuto durante períodos de 1 a 3 horas alrededor de la medianoche, en el pico de la actividad diurna. Se midió el movimiento dentario por un método modificado que fue descrito previamente por King et al (1991).Resultados. A los siete y catorce días se observó un aumento estadísticamente significativo del movimiento dental en animales sujetos a estrés comparados con aquellos no estresados. Discusión. Estudios recientes han sugerido que la regulación de la remodelación ósea puede estar influenciada por el sistema inmune a través de la producción de citoquinas por las células inflamatorias presentes tras la aplicación de fuerzas ortodóncicas. Numerosos estudios interdisciplinarios psicoinmunológicos han evidenciado que estímulos externos que generan repuestas de estrés emocional pueden influir y modular al sistema inmune por la vía del sistema nervioso y neuroendocrino (AU)

Introduction. The active remodeling of alveolar bone in periodontal tissues is well known to occur in various kinds of conditions. Systemic factors may be involved in the regulation of the tissue-degrading activity. Bone resorption is regulated by the cytokines within marrow cells that mediate osteoclast formation and activation. Psychological responses to stressors have been shown to modulate the immune system though the neural and endocrine system in at least three different pathways. Material and method. Twenty-four rats, were randomly assigned into four groups of six rats each, control, stress, dental movement, stress and dental movement. To exert orthodontic force we used a modified method described by Kohno et al. The rats were subjected to a broad band noise at 100 dB daily for 5 seconds every minute during a 1 or 3-h period around midnight, at the height of the diurnal activity cycle. Unstimulated rats were exposed only to the normal activity of the animal room. Tooth movement assessed by extra-oral cephalometric radiographic view from the superior, by a modified method that was previously described by King et al (1991).Results. At seven and fourteen days we observed a statistically significant increase of dental movement in the animals subject to stress compared to those not stressed. Discussion. Recent studies have suggested that the regulation of bone remodeling can be influenced by the immune system though cytokine production from inflammatory cells present after the application of orthodontic forces. Numerous interdisciplinary psychoimmunological studies have provided evidence that external stimuli generating emotional stress responses may influence and modulate the immune system via nervous and neuroendochrine system (AU)

The pain experience and psychological adjustment to orthodontic treatment of preadolescents, adolescents, and adults.

Age-related changes in psychological measurements of pain and well-being were studied in patients undergoing full fixed appliance orthodontic treatment. A longitudinal series of four questionnaires was used to obtain measurements of these factors after the separation phase of treatment, banding (2 to 7 days after separation), the first adjustment visit (3 to 4 weeks after placement of full fixed appliances), and the second adjustment visit (3-4 months after banding was completed). The results suggest an interaction between the phases of treatment and reported pain and psychological well-being and significant differences in the response profiles of the adolescent age group (14 to 17 years) compared to the preadolescent (11 to 13 years) and adult groups (18 years and older). These findings did not appear to be due simply to group differences in the use of analgesics, class of malocclusion, or type of full fixed appliance used. The profile comparisons indicated that the adolescent age group generally reported lower levels of psychological well-being and higher levels of pain during the phases of treatment examined. Consistent with these results was the finding that the adolescents differed from the preadolescents and adults in the quality of the pain experience reported during treatment. The results indicate an age difference in adjustment to fixed orthodontic therapy, which suggests that adolescents are more vulnerable to undesirable psychological effects of treatment.

Body image, self-concept, and the orthodontic patient.

Four major criterion groups--orthodontic retention patients, prospective orthodontic patients, a population sample, and mothers of prospective patients--were established. Appropriate relationships between groups and subgroups were studied with regard to body-image and self-concept satisfaction, to body-image and self-concept importance, and other factors. The findings include the following: 1. There was no significant difference in body-image and self-concept satisfaction of importance between prospective orthodontic patients and the population sample. 2. There was no significant difference in body-image and self-concept satisfaction or importance between prospective orthodontic patients and orthodontic patients in retention. 3. There was a significant difference between prospective orthodontic patients' self-concept importance and their mother's perception of self-concept importance. There teen-agers placed more emphasis on their self-concept than did their mothers. 4. There was no significant difference between any of the groups in body-image and self-concept satisfaction or importance with change in age (11 to 16 years). 5. Girls scored significantly lower in both body-image and self-concept satisfaction than did the boys at these ages (11 to 16 years). 6. Patients with Class III malocclusion scored significantly lower than the other malocclusion groups in all categories of body-image and self-concept satisfaction and importance.

Treatment of marked anteroposterior and transverse discrepancies in mandibular prognathism.

A case report of a patient with a severe skeletal Class III malocclusion has been presented. The patient's marked anteroposterior discrepancy was complicated by the fact that his buccolingual occlusion was normal. The solution to this case thus involved a correction of the transverse discrepancy in addition to the anteroposterior discrepancy, which required orthodontic and surgical solutions. A discussion of mandibular prognathism has also been presented.