Measurement of Spee curve in individuals with temporomandibular disorders: a cross-sectional study

Several factors are cited as capable to influence the development of Temporomandibular Disorders (TMD), among them, the psychological, systemic, genetic, and occlusal factors. The curve of Spee is the factor directly related to the TMJ. However, the combination of variations in amplitude, and the presence of signs and symptoms of TMD have not been investigated. Objective: The aim of this study was to measure the curve of Spee in patients with TMD, through the use of study models, comparing these values with the different clinical and symptomatic presentations of such individuals. We evaluated 198 models of patients treated at the care service for patients with TMD at UFJF. The maximum depth of the curve was determined by the sum of the distances between the lowest part of the buccal cusp of the posterior teeth of each hemiarch to a reference plane, using a caliper to measure. The following factors were considered: gender, presence of myalgia (temporal, masseter, medial pterygoid, lateral and sternocleidomastoid muscles) and TMJ arthralgia, and the presence of occlusal interferences and parafunctional habit of bruxism. For statistical analysis, we used T-test and ANOVA test with a significance level of 5%. Conclusion: There was a statistically significant association between the presence of occlusal interferences and changes in the curve (p = 0.01). There was no association between the following factors: the presence of myalgia and/or arthralgia, gender, achievement of bruxism, and the type of TMD presented with changes in the Spee curve

Micropapillary carcinoma in a dog: case report

Mammary neoplasms in female dogs present a high incidence. Several histological types are observed, among them, micropapillary carcinoma is considered one of the most aggressive because it is related to vascular invasion, metastases and low survival time. Aimed to describe a case of micropapillary breast carcinoma, with cutaneous metastasis, in a dog. A canine, female, 14 years old, 8kg, not defined breed, uncastrated, nulliparous, with pseudocyesis and no contraceptives administration history was attended at the Veterinary Reproduction and Obstetrics Service from "Governador Laudo Natel” Hospital, FCAV, UNESP, Jaboticabal, presenting a breast ulcerated nodule, with one month estimated evolution. After stabilization and preoperative exams, radical unilateral mastectomy and ipsilateral axillary and inguinal lymphadenectomy were performed. Histopathologic diagnosis revealed micropapillary carcinoma and free surgical margins from neoplasm, however, there were metastasis in both lymph nodes. The tutors did not adhere to antineoplastic chemotherapy. In 60th post-surgical day, there was inflammatory reaction in the surgical scar region, with small cutaneous ulceration, where the elastogram  revealed  rigidity and shear velocity of 7.84m/s. Skin biopsy revealed metastasis of micropapillary breast carcinoma. There was progression of ulcerations, compromising animal’s welfare and its physiological activities, when on the 110th post-surgical day, it was decided to euthanize the patient.  The correct diagnosis and knowledge of tumor biological behavior are importants points to choose the correct treatment. The adjuvant chemotherapy treatment can impact on average survival time and ARFI elastography is an accurate predictor of rapid and non-invasive diagnosis of micropapillary carcinoma recurrence.Mammary neoplasms in female dogs have a high incidence. Among the several histological types observed, micropapillary carcinoma is considered one of the most aggressive due to vascular invasion, metastases, and short survival time. The present objective was to describe a case of mammary gland micropapillary carcinoma, with cutaneous metastasis, in a dog. A 14-year-old intact nulliparous mixed-breed bitch, weighing 8kg, with a history of pseudocyesis and no history of contraceptive administration, presented to the Veterinary Reproduction and Obstetrics Service from "Governador Laudo Natel” Hospital, FCAV, UNESP, Jaboticabal, with an ulcerated nodule in the mammary gland for approximately one month. After stabilization of clinical parameters and preoperative exams, a radical unilateral mastectomy and ipsilateral axillary and inguinal lymphadenectomy were performed. Histopathology revealed micropapillary carcinoma with clear surgical margins, however, there were metastases in both lymph nodes. Antineoplastic chemotherapy was refused by the owners. On the 60th day after surgery, there was an inflammatory reaction in the surgical scar region, with a small cutaneous ulceration, where elastography showed rigidity and shear velocity of 7.84m/s. Skin biopsy revealed metastasis of the micropapillary carcinoma. Even with continued treatment since the patient was first examined, the ulcerations progressed, compromising the animal’s welfare and physiological activities, and on the 110th day after surgery, euthanasia was decided on. A correct diagnosis and knowledge of tumor biological behavior are important points for choosing the correct treatment. Acoustic Radiation Force Image (ARFI) elastography has been shown to be a fast and non-invasive diagnostic method for detection of recurrent micropapillary carcinoma

Ações estratégicas de educação em saúde em ambientes de espera: abordagem da temática “higienização de próteses dentárias” / Strategic actions on health education in waiting environments: approach of the theme “hygienization of dental prostheses” in focus

Trata-se de um relato de experiência, que descreve, sob estratégia narrativo-argumentativa, as significâncias político-pedagógicas atreladas ao planejamento estratégico de ações de educação em saúde vivenciadas em salas de espera e experimentadas por acadêmicos estagiários de um curso de Odontologia. Após análise detalhada, algumas inferências se destacaram: o reconhecimento dos ambientes de espera como território fértil para o desenvolvimento de ações promotoras de saúde; a efetividade do instrumento “TPC” (Teorizar-Praticar-Criticar) no direcionamento dos acadêmicos estagiários no planejamento estratégico de atividades de educação em saúde; a importância de se disseminar, em espaços científicos, os aprendizados advindos de experimentações práticas de estágios. 

ESRRB polymorphisms are associated with comorbid temporomandibular disorders and rotator cuff disease

Os diversos sintomas físicos presentes nas Desordens Temporomandibulares (DTM) estão associados frequentemente à presença de doenças comórbidas. A dor no ombro é uma das principais queixas dos pacientes com DTM. O objetivo deste estudo foi investigar a base biomecânica da associação entre DTM e lesão do manguito rotador (LMR). Neste estudo transversal, foram avaliados fatores etiológicos comuns à DTM e LMR, a fim de elucidar a interação DTM/LMR. A avaliação das estruturas orofaciais (RDC-Eixo I) e da região do ombro foram realizadas em 108 indivíduos. O grupo controle consistiu de 30 integrantes sem queixas de dor. Setenta e oito indivíduos foram divididos em 3 grupos: com LMR (sem DTM, n=16), com DTM (sem LMR, n=13) e com ambas as lesões (com DTM+LMR, n=49). Um total de 8 polimorfismos do gene ESRRB envolvido na via do estrogênio foram investigados. Os níveis de estradiol foram mensurados por imunoensaio quimioluminescente. A atividade muscular dos músculos cervicais e faciais foi avaliada através de eletromiografia de superfície (EMG). A significância das variáveis nominais e contínuas foi analisada através dos testes do qui-quadrado, T-Student / Mann-Whitney, respectivamente Valores de p<0.05 foram considerados significantes. A regressão logística multivariada explorou múltiplas variáveis simultaneamente. Indivíduos com DTM apresentaram 7 vezes mais chances de desenvolver LMR (OR 7.0; 95% CI, 2.7-18.4). O risco de desenvolver ambas as lesões foi 6 vezes maior em caucasianos (OR, 5,9 ; IC 95 % , 1,9-18,5 ). Os genótipos TT rs1676303 (p=0.02) e GG rs6574293 (p=0.04) foram associadas à LMR. Indivíduos com ambas as lesões apresentaram maior frequência dos genótipos polimórficos para o rs4903399 (p = 0,02) e rs10132091 (p = 0,02). Os haplótipos CTTCTTAG (p = 0,01) e CCTCTCAG (p = 0,01) foram associados com DTM+LMR. A regressão logística multivariada afirmou caucasianos (p = 0,001) como um fator de risco para DTM+LMR. Os níveis de estradiol foram semelhantes entre os grupos. Os músculos masseter e temporal anterior apresentaram menor atividade em pacientes com as duas doenças em posição de repouso (p=0,03 / p=0,02, respectivamente) e na posição de máxima intercuspidação habitual (p= 0,01 / p=0,03, respectivamente). Os músculos esternocleidomastóideo e trapézio apresentaram menor atividade em indivíduos com DTM+LMR (p = 0,03). Este presente trabalho sugere ser a DTM um fator de risco para a LMR. Etnia branca, haplótipos do gene ESRRB e baixa atividade eletromiográfica foram identificadas como características biomecânicas comuns nos indivíduos com ambas as lesões.Temporomadibular disorder’s (TMD) physical symptoms are associated with comorbid disorders. Shoulder pain is one of the main complaints of TMD patients. The purpose of this study was to investigate the association between TMD and rotator cuff disease (RCD) comorbid symptoms and its biomechanical basis. In this cross-sectional study, we assessed for common etiology factors of TMD and RCD in order to elucidate the TMD/RCD interaction. Orofacial (RDC-Axis I) and shoulder examinations were performed in 108 subjects. The control group consisted of 30 subjects without pain. Seventy-eight committed subjects were divided into the following groups: RCD subjects (TMD free, n=16), TMD (RCD free, n=13) and TMD/RCD affected (with RCD + TMD, n=49). A total of 8 SNPs within the ESRRB gene involved in the estrogen pathway were investigated. Estradiol levels were measured by chemiluminescent immunoassay. The head and cervical muscle activity was recorded with surface electromyography (EMG). Significance of nominal and continuous variables was assessed by the chi-square test and Student t-/ MannWhitney tests. Values of p<0.05 were considered significant. Multivariate logistic regression permitted the exploration of covariates simultaneously. Subjects with TMD were seven times more susceptible to RCD (OR 7.0; 95% CI, 2.7-18.4) than subjects with healthy TMJ. The risk associated with having both diseases was 6 times higher in Whites (OR, 5.9; 95% CI, 1.9-18.5) than in the control. The rs1676303 TT genotype (p=0.02) and rs6574293 GG genotype (p=0.04) are associated with RCD. TMD/RCD affected subjects showed higher association with rs4903399 (p=0.02) and rs10132091 (p=0.02). Haplotype CTTCTTAG (p=0.01) and CCTCTCAG (p=0.01) were associated with TMD/RCD. Multivariate logistic regression affirmed being White (p=0.001) as a risk factor for TMD/RCD. Estradiol levels were similar among groups. Masseter and Temporalis muscles showed lower activity in patients with both diseases in rest position (p=0.03/ p=0.02, respectively) and in the maximum clenching effort (p=0.01/ p=0.03, respectively). Sternocleidomastoid and trapezius showed lower activity in TMD/RCD affected subjects (p=0.03). Our work supported TMD as a risk factor for RCD. White ethnicity, ESRRB haplotypes, and low muscle surface EMG activity were identified as common biolmechanical characteristics in subjects with both diseases.47f

Clinical and genetic evaluation of systemic chronic joint pain in patients with temporomandibular disorders

A dor presente nas desordens temporomandibulares (DTM) está com frequência sobreposta à sintomas físicos associados à outras desordens dolorosas crônicas e comorbidades, como dores musculares e articulares generalizadas. Contudo, a possível associação entre a presença conjunta da dor orofacial com outros tipos de artralgia é pouco explorada. O objetivo deste estudo foi determinar a possível associação entre a presença conjunta de dores crônicas articulares na ATM, e em outras articulações do corpo, com polimorfismos em genes relacionados à: (a) sensibilidade dolorosa, (b) metabolismo de osteoblastos e condroblastos, e (c) alterações hormonais. Trezentos e trinta e sete voluntários foram avaliados clinicamente, através da aplicação da ferramenta Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), para avaliação quanto à presença das DTM, sendo questionados sobre a presença de dores articulares crônicas sistêmicas, sendo divididos nos seguintes grupos: indivíduos com artralgias crônicas e DTM muscular; artralgias crônicas e DTM articular; artralgias crônicas e DTM muscular e articular; indivíduos sem DTM e com artralgias crônicas e; grupo controle. Trinta polimorfismos nos genes COMT (rs165774, rs6269, rs9332377), ADRB2 (rs2053044, rs1042713, rs1042714), HTR1A (rs1364043, rs13361335), OPG (rs11573919, rs11573875, rs11573854, rs11573838, rs11573817 e rs11573816), RANK (rs474369, rs9498322, rs504762, rs6920383, rs237033), RANKL (rs492956,rs13215304 e rs12660731), ESR1 (rs12154178, rs1884051, rs2273206, rs7774230) e ESRRB (rs1676303, rs4903399, rs10132091, rs7151924) foram avaliados. A significância das variáveis nominais e contínuas foi analisada através dos testes do qui-quadrado, T-Student / Mann-Whitney, respectivamente. Valores de p<0.05 foram considerados estatisticamente significantes. Os principais resultados encontrados foram: (a) Polimorfismos no gene COMT possuem relação com a presença de DTM de origem muscular associada a artralgias crônicas. Neste mesmo grupo de indivíduos, alterações nos genes ADRB2 associaram-se com a proteção ao desenvolvimento de DTM muscular. (b) Haplótipos nos genes OPG e RANK encontram-se associados ao risco de desenvolvimento de artralgias crônicas, mesmo na ausência de DTM; e (c) Polimorfismo no gene ESR1 possuem relação com a presença de DTM de origem muscular associada a artralgias crônicas. Alterações no gene ESRRB associaram-se com a presença de DTM articular. O presente trabalho sugere haver base genética e clínica para o desenvolvimento comórbido de artralgias crônicas em indivíduos com DTM.Pain from temporomandibular disorder (TMD) is often associated with physical symptoms and other chronic pain disorders and comorbidities, such as generalized muscle and joint pain. However, the association between the presence of orofacial pain and other types of arthralgia is not widely studied. The aim of this study was to determine the association between the presence of chronic temporomandibular joint (TMJ) pain, and other body joints, with polymorphisms in genes related to: (a) pain sensitivity, (b) osteoblast and chondroblasts metabolism and (c) hormonal changes. Three hundred and thirty-seven volunteers were clinically evaluated by applying the Research Diagnostic Criteria tool for Temporomandibular Disorders (RDC / TMD) in order to evaluate the presence of TMD. In addition, volunteers were questioned about the presence of systemic chronic joint pain. Based on these information, volunteers were divided into the following groups: individuals with chronic joint pain and muscle TMD; arthralgia and chronic articular TMD; arthralgia and chronic muscle and joint TMD; individuals without TMD and chronic joint pain and; control group . Thirty polymorphisms in the genes COMT (rs165774, rs6269, rs9332377), ADRB2 (rs2053044, rs1042713, rs1042714), HTR1A (rs1364043, rs13361335), OPG (rs11573919, rs11573875, rs11573854, rs11573838, rs11573817 and rs11573816), RANK (rs474369, rs9498322, rs504762, rs6920383, rs237033), RANKL (rs492956, rs13215304 and rs12660731) ESR1 (rs12154178, rs1884051, rs2273206, rs7774230) and ESRRB (rs1676303, rs4903399, rs10132091, rs7151924) were evaluated. The chi-square test and the Student's t-test / Mann-Whitney test were used to assess the significance of the nominal and continuous variables, respectively. A p-value <0.05 was considered significant. The main findings were: (a) polymorphisms in the COMT gene are related to the presence of myogenic TMD associated with chronic arthralgia. In this same group of individuals, alterations in the ADRB2 gene were associated with the protection against the development of muscular TMD. (B) haplotypes in the OPG and RANK genes are associated with the risk of developing chronic arthralgia, even in the absence of TMD; and (c) Polymorphisms in the ESR1 gene are related to the presence of myogenic TMD associated with chronic arthralgia. Alterations in the ESRRB gene were associated with the presence of articular TMD. This study suggests that there is a clinical and genetic basis for comorbid chronic joint pain in individuals with TM

Phylogeny of the species Trichosporon asahii by multilocus sequence analysis

Nas últimas décadas observou-se um número crescente de relatos de infecções invasivas por Trichosporon em ambientes hospitalares, devido ao aumento da população suscetível e a melhoria dos métodos diagnósticos. Leveduras do gênero Trichosporon, depois de Candida, são as mais relacionadas à infecção fúngica invasiva em pacientes hematológicos, sendo Trichosporon asahii responsável por 90% dos casos. A identificação de espécies de Trichosporon é realizada através do sequenciamento da região IGS1 do DNA ribossomal, técnica considerada padrão-ouro. Através do estudo dos polimorfismos da região IGS1 do DNA ribossomal, diversos genótipos de T. asahii têm sido descritos, entretanto sem relação com a distribuição geográfica, perfil de suscetibilidade aos antifúngicos ou patogenicidade. O presente estudo teve como objetivo padronizar um método de análise por sequenciamento multilocus para a espécie T. asahii, definindo novos genes (loci) para melhor descrever a filogenia da espécie. Foram analisadas 21 cepas de T. asahii de diferentes origens (Brasil, Europa, Ásia) e genótipos (1,3,4,5,6,7). As sequências de genes estruturais (housekeeping genes) dos genomas de T. asahii (CBS2479 e CBS8904) disponíveis no GenBank foram alinhadas e analisadas in silico para o delineamento e avaliação dos novos primers. Após as reações de PCR e análise das sequências de DNA, quatro novos loci foram selecionados para a análise filogenética multilocus: phosphate carrier protein, topoisomerase 1 (TOP1), beta-1-tubulin, copper-exporting ATPase. As árvores filogenéticas demonstraram dois clados bem distintos, com altos valores de bootstraps. Além disso, os genótipos 1 e 3 foram alocados em clados diferentes. Nossos resultados sugerem uma reclassificação genética para a espécie T. asahii. Novos estudos, incluindo um maior número de cepas e outros marcadores genéticos, são necessários para melhor abordar a filogenia atual de T. asahiiIn the last decades there has been a significant increase of the reported cases of invasive fungal infections by Trichosporon in hospital settings, related to the increase of the susceptible population and to the improvement of diagnostic methods. Trichosporon are the most frequent yeast related to invasive fungal infection in hematological patients after Candida, with Trichosporon asahii accounting for 90% of the cases. The gold standard method for Trichosporon species identification is the sequence analysis of the intergenic spacer region 1 (IGS1) from the ribosomal DNA. Based on the polymorphisms of the IGS region of ribosomal DNA, several T. asahii genotypes have been described, without relation with geographical distribution, antifungal susceptibility profile or pathogenicity. The objective of the study was to evaluate a multilocus sequencing method for the T. asahii species, defining new loci to better describe the phylogeny of the species. Twenty-one strains of T. asahii from different origins (Brazil, Europe, Asia) and genotypes (1,3,4,5,6,7) were analyzed. Housekeeping genes from T. asahii genomes (CBS2479 and CBS8904) available in GenBank were aligned and in silico analyses were carried out to design and evaluate the new primers. After PCR reactions and DNA sequence analysis, four new loci were selected for the multilocus plylogenetic analysis along with the IGS1 region from the rDNA: topoisomerase 1 (TOP1), phosphate carrier protein, beta-1-tubulin, copper-exporting ATPase. Phylogenetic trees revealed two well-distinct clades, with high bootstraps values. Moreover, IGS genotypes 1 and 3 strains were split into the different clades. Our results suggest a different genetic background for the species T. asahii. Further studies including more T. asahii strains and other genetic markers are necessary to better address the current phylogeny of T. asahi

Phylogeny of the species Trichosporon asahii by multilocus sequence analysis

Nas últimas décadas observou-se um número crescente de relatos de infecções invasivas por Trichosporon em ambientes hospitalares, devido ao aumento da população suscetível e a melhoria dos métodos diagnósticos. Leveduras do gênero Trichosporon, depois de Candida, são as mais relacionadas à infecção fúngica invasiva em pacientes hematológicos, sendo Trichosporon asahii responsável por 90% dos casos. A identificação de espécies de Trichosporon é realizada através do sequenciamento da região IGS1 do DNA ribossomal, técnica considerada padrão-ouro. Através do estudo dos polimorfismos da região IGS1 do DNA ribossomal, diversos genótipos de T. asahii têm sido descritos, entretanto sem relação com a distribuição geográfica, perfil de suscetibilidade aos antifúngicos ou patogenicidade. O presente estudo teve como objetivo padronizar um método de análise por sequenciamento multilocus para a espécie T. asahii, definindo novos genes (loci) para melhor descrever a filogenia da espécie. Foram analisadas 21 cepas de T. asahii de diferentes origens (Brasil, Europa, Ásia) e genótipos (1,3,4,5,6,7). As sequências de genes estruturais (housekeeping genes) dos genomas de T. asahii (CBS2479 e CBS8904) disponíveis no GenBank foram alinhadas e analisadas in silico para o delineamento e avaliação dos novos primers. Após as reações de PCR e análise das sequências de DNA, quatro novos loci foram selecionados para a análise filogenética multilocus: phosphate carrier protein, topoisomerase 1 (TOP1), beta-1-tubulin, copper-exporting ATPase. As árvores filogenéticas demonstraram dois clados bem distintos, com altos valores de bootstraps. Além disso, os genótipos 1 e 3 foram alocados em clados diferentes. Nossos resultados sugerem uma reclassificação genética para a espécie T. asahii. Novos estudos, incluindo um maior número de cepas e outros marcadores genéticos, são necessários para melhor abordar a filogenia atual de T. asahiiIn the last decades there has been a significant increase of the reported cases of invasive fungal infections by Trichosporon in hospital settings, related to the increase of the susceptible population and to the improvement of diagnostic methods. Trichosporon are the most frequent yeast related to invasive fungal infection in hematological patients after Candida, with Trichosporon asahii accounting for 90% of the cases. The gold standard method for Trichosporon species identification is the sequence analysis of the intergenic spacer region 1 (IGS1) from the ribosomal DNA. Based on the polymorphisms of the IGS region of ribosomal DNA, several T. asahii genotypes have been described, without relation with geographical distribution, antifungal susceptibility profile or pathogenicity. The objective of the study was to evaluate a multilocus sequencing method for the T. asahii species, defining new loci to better describe the phylogeny of the species. Twenty-one strains of T. asahii from different origins (Brazil, Europe, Asia) and genotypes (1,3,4,5,6,7) were analyzed. Housekeeping genes from T. asahii genomes (CBS2479 and CBS8904) available in GenBank were aligned and in silico analyses were carried out to design and evaluate the new primers. After PCR reactions and DNA sequence analysis, four new loci were selected for the multilocus plylogenetic analysis along with the IGS1 region from the rDNA: topoisomerase 1 (TOP1), phosphate carrier protein, beta-1-tubulin, copper-exporting ATPase. Phylogenetic trees revealed two well-distinct clades, with high bootstraps values. Moreover, IGS genotypes 1 and 3 strains were split into the different clades. Our results suggest a different genetic background for the species T. asahii. Further studies including more T. asahii strains and other genetic markers are necessary to better address the current phylogeny of T. asahi

COVID-19 and Painful Temporomandibular Disorders: what does the dentist need to know?

ABSTRACT COVID-19 outbreak may lead to major impacts in applied oral sciences. Remarkably, it could be expected that factors associated to pandemic may lead to a greater risk of developing, worsening and perpetuating TMD and its associated risk factors. This non systematic literature review aims to discuss how the COVID-19 pandemic can influence the emergence, maintenance or worsening of TMD worldwide. During epidemics: the number of people whose mental health is affected tends to be greater than the number affected by the infection, and fear increases anxiety and stress levels in healthy individuals; chronic pain patients probably not receipt important treatments; overuse of medications becomes frequent; there are manifestation of unconscious oral parafunctional habits and poor sleep quality. All these facts represent risk factors common to TMD. Dentists should be aware of these issues and adapt their practices to properly diagnose and treat these patients within a multifactorial approach, increasing the quality of life of these individuals