How psychosocial and economic impacts of COVID-19 pandemic can interfere on bruxism and temporomandibular disorders?

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Occlusal changes secondary to temporomandibular joint conditions: a critical review and implications for clinical practice

The relationship between Temporomandibular Disorders (TMD) and malocclusion is an extremely critical issue in dentistry. Contrary to the old concept that malocclusion causes TMD, occlusal changes, especially those observed as sudden, may be secondary and reflect joint or muscle disorders due to the obvious connection between these structures and the dental occlusion. Objectives The aim of this article is to present the most commonly occlusal changes secondary to TMD. Methods The clinical presentation of these conditions is discussed. Details regarding diagnosis, treatment, and follow-up of patients presenting TMD prior or during treatment are also presented. Conclusions All plans for irreversible therapy should be preceded by a meticulous analysis of TMD signs and symptoms in such a way that patients are not submitted to irreversible treatment, based on an untrue occlusal relationship, secondary to articular and/or muscular disorders. When present, TMD symptoms must always be controlled to reestablish a “normal” occlusion and allow proper treatment strategy

Current panorama of temporomandibular disorders' field in Brazil

In 2012, the recognition of the specialty of Temporomandibular Disorders and Orofacial Pain completed ten years. Given this scenario, it is extremely important to track the current situation of this field of knowledge in Brazil, specifically in the area of research and training. We hope to discuss the importance of the recognition of this specialty and the inclusion of these subjects in undergraduate programs in Dentistry. Objective: The objective of this study is to perform a bibliometric survey of researches regarding Temporomandibular Disorders and Orofacial Pain conducted in the country, determine the number of specialization courses in Orofacial Pain and the number of specialists in the field. Methods: The bibliometric survey was conducted based on the Dissertations Portal of Coordination for the Improvement of Higher education Personnel (CAPES) and on PubMed. The panorama of the field of Orofacial Pain and Temporomandibular disorders in Brazil was determined by searching on the website of the Brazilian Council of Dentistry. Results: We found 731 theses and dissertations with Temporomandibular Disorders and Orofacial Pain as the main subjects; 81 accredited/recognized Courses on Orofacial Pain and Temporomandibular Dysfunction completed; 8 accredited/recognized Specialization Courses on Orofacial Pain and Temporomandibular Dysfunction still in progress, and 1,064 registered specialists in Orofacial Pain and Temporomandibular Dysfunction in the Brazilian Council of Dentistry. Search in the PUBMED database yielded 576 articles published with the participation of Brazilian researchers as first authors and/or co-authors in the period from 2000 to 2013. From this amount, only 5 were published in Portuguese, while all the others were published in english. We can also notice that the number of published articles increases over time. Conclusion: The number of researches related to temporomandibular disorders has increased over the last ten years, as well as the number of specialization courses and the number of specialists, which represents a major breakthrough for this field of knowledge

Evaluation of the efficacy of low-level laser therapy (LLLT) and the microelectric neurostimulation (MENS) in the treatment of myogenic temporomandibular disorders: a randomized clinical trial

OBJETIVO: Avaliar a efetividade do laser de baixa freqüência e do estímulo muscular microelétrico (MENS) no tratamento de pacientes com disfunções temporomandibulares (DTM). MATERIAL E MÉTODOS: Uma amostra de 19 indivíduos com sinais e sintomas de DTM de origem muscular, foi dividida em dois grupos (I -laser e II - MENS). O tratamento consistiu de 10 sessões, três vezes por semana, durante um mês. Os critérios de avaliação dos pacientes foram: escala de análise visual (EAV), mensuração de abertura máxima bucal e palpação muscular, estes foram avaliados imediatamente antes e 5 minutos após cada sessão terapêutica, num estudo do tipo controlado. Para análise estatística, foram aplicados ANOVA para mensurações repetidas e Mann-Whitney. RESULTADOS: Os resultados demonstraram aumento da abertura bucal máxima e diminuição na sensibilidade à palpação em ambos os grupos e, em relação à EAV, ambos os grupos demonstraram decréscimo, mas houve uma diferença estatisticamente significante entre os grupos, já que o grupo laser apresentou os melhores resultados pOBJECTIVE: The aim of the present study was to evaluate the efficacy of low-level laser therapy (LLLT) and the microelectric neurostimulation (MENS) in the treatment of patients with temporomandibular disorders (TMD). MATERIAL AND METHODS: A sample of 19 individuals presenting with signs and symptoms of myogenic TMD was randomly divided into two groups (I - LLLT and II - MENS). Therapy was done in 10 sessions, three times a week, for one month. Patients were evaluated by the Visual Analogue Scale (VAS), measurement of active range of motion (AROM) and muscle palpation, performed immediately before and 5 minutes after each therapeutic session by a blinded TMD specialist. The ANOVA for repeated measurements and Mann-Whitney tests were used for the statistical analysis. RESULTS: The results showed an increase in maximum mouth opening and a decrease in tenderness to palpation for both groups. The VAS reduced for both groups, although more evident for the laser group (

Aplicação de TENS e laser de baixa freqüência no tratamento das disfunções temporomandibulares

Pain relief and reestablishment of normal jaw function are the main goals of conservative management of Temporomandibular Disorders (TMD). Transcutaneous electrical nerve stimulation (TENS) and laser therapy are part of these modalities, although little is known about their real efficacy in controlled studies. This research compared these two treatments in a sample of 18 patients with chronic TMD of muscular origin, divided into two groups (LASER and TENS). Treatment consisted of ten sessions, in a period of 30 days. Active range of motion (AROM), visual analogue scale (VAS) of pain and muscle (masseter and anterior temporalis) palpation were used for follow-up analysis. Data were analyzed by Friedman test and ANOVA for repeated measurements. Results showed decrease in pain and increase in AROM for both groups (pO tratamento das Disfunções Temporomandibulares (DTM) objetiva ser conservador e reversível para alívio da dor e restauração da função normal. Sendo assim, tratamentos como a estimulação neural elétrica transcutânea (TENS) e o laser de baixa freqüência têm sido utilizados. Portanto, foi premissa deste trabalho a comparação do TENS com o a terapia com laser de baixa freqüência no tratamento de pacientes com DTM. Foram selecionados dezoito pacientes com sinais e sintomas de DTM crônica de origem muscular. O grupo LASER recebeu aplicação de laser e o grupo TENS, estimulação elétrica, totalizando 10 sessões, três vezes por semana, durante um mês. A avaliação foi feita imediatamente antes e 5 minutos após cada sessão terapêutica, por meio da escala de análise visual (EAV) para o registro da sensação de dor mensuração de abertura máxima e palpação muscular ( masseter e temporal anterior). Para análise estatística foram utilizados o teste de Friedman e ANOVA para mensurações repetidas. Os resultados demonstraram decréscimo na EAV e aumento da abertura bucal máxima de ambos os grupos (

Avaliação das condutas adotadas por profissionais na utilização de coroas metalo-cerâmicas

The current features of ceramic fused to metal crowns were evaluated by means of a questionnaire composed by 20 questions concerning the use of this type of restoration in the daily dental practice of professionals from Aracaju, Bauru and post-graduation students in the area of dental prosthesis. The conclusions were as follows: 1. Ceramic fused to metal crowns are the most employed restorations in Dentistry. 2. Most dentists regard ceramic fused to metal crowns as successful restorations, indicating ceramic occlusal surfaces for most of the patients. 3. Even though most professionals use nickel-chromium alloys in ceramic fused to metal crowns for their patients, they prefer the use of noble and semi-noble alloys for restorations in their own mouths. 4. The majority of the interviewees employ ceramic fused to metal crowns for rehabilitation of anterior teeth (57.23%). Nevertheless, this was due to the fact that 78% of the dentists from Aracaju preferred this type of restoration, whereas in Bauru most professionals and students make use of ceramic crowns. 5. Most professionals apply zinc phosphate cement for the placement of ceramic fused to metal crowns. Most of them prefer to use Vita porcelain (34.34%), compared to 13.86% for the Noritake and Dulceram Plus porcelains. 6. The most desired improvement for ceramic fused to metal crowns was the possibility of easy repair.A fim de avaliar a opinião da classe odontológica sobre a utilização das coroas metalo-cerâmicas na prática odontológica, aplicou-se um questionário de 20 questões a cirurgiões-dentistas da cidade de Aracaju - SE, e a cirurgiões-dentistas e estudantes de pós-graduação em odontologia, na área de prótese dental, da cidade de Bauru-SP. Concluiu-se que: 1. As coroas metalo-cerâmicas são o tipo de restauração protética mais empregado em Odontologia. 2. A maioria dos dentistas refere-se às coroas metalo-cerâmicas como restaurações bem sucedidas, indicando superfícies oclusais metálicas para a maioria dos pacientes. 3. Apesar da maior parte dos profissionais utilizar as ligas de níquel-cromo nas coroas metalo-cerâmicas de seus pacientes, os mesmos prefeririam que ligas nobres ou semi-nobres fossem empregadas em suas próprias restaurações. 4. A maioria dos entrevistados emprega as coroas metalo-cerâmicas na restauração de dentes anteriores (57,23%). Entretanto, esse valor se deve à preferência dos dentistas de Aracaju (78%) por esse tipo de restauração, ao passo que, em Bauru, prevaleceu o número de respostas favoráveis às coroas de porcelana pura. 5. O cimento de fosfato de zinco foi o cimento de escolha da maioria dos profissionais. 6. A preferência da maior parte dos entrevistados, com relação à porcelana utilizada foi pela porcelana Vita (34,34%), em comparação às porcelanas Noritake e Dulceram Plus (13,86%). 6. Ficou evidente o desejo dos entrevistados quanto ao desenvolvimento de mecanismos que facilitem o reparo das coroas metalo-cerâmicas

Effects of acute mental stress on conditioned pain modulation in temporomandibular disorders patients and healthy individuals

Stress is a contributing factor to painful temporomandibular disorders (TMD). Nevertheless, the underpinnings of this relationship are not fully understood. Objective: To investigate the effects of acute mental stress on conditioned pain modulation (CPM) in TMD patients compared with healthy individuals. Methodology: Twenty women with chronic myofascial TMD diagnosed according to the RDC/TMD and 20 age-matched healthy women had the CPM assessed before and after a stressful task using the Paced Auditory Serial Addition Task (PASAT) in a single session. Subjective stress response was assessed with the aid of visual analog scale (VAS). Pressure pain threshold (PPT) on masseter muscle was the test stimulus (TS) and immersion of the participant’s hand on hot water was the conditioning stimulus (CS) - CPM-sequential paradigm. Results: Healthy individuals reported PASAT are more stressful when compared with TMD patients and the stress task did not affect the CPM in neither group. Nonetheless, a negative correlation was observed between change in CPM and change in TS from baseline to post-stress session, which indicates that the greater the increase in PPT after the stress task, the greater was the decrease in CPM magnitude. The correlation was strong for healthy controls (r=- 0.72, p<0.001) and moderate for TMD patients (r=- 0.44, p=0.047). Conclusions: The correlation between the change in CPM and the TS change following the stress task may possibly indicate an overlapping pathway between stress-induced analgesia/hyperalgesia and descending pain inhibition

Avaliação da influência do gênero e do bruxismo na força máxima de mordida

The objective of this research was to evaluate the influence of gender and bruxism on the maximum bite force. The concordance for the physical examination of bruxism between examiners was also evaluated. One hundred and eighteen individuals, from both genders, bruxists and non-bruxists, with an average age of 24 years, were selected for this purpose. For group establishment, every individual was submitted to a specific physical examination for bruxism (performed by three different examiners). Subjects were then divided into four groups according to gender and the presence of bruxism. The maximum bite force was measured using a gnathodynamometer at the first molar area, three times on each side, performed twice. The two measurements were made with a 10-day interval. The highest value was recorded. The mean maximum bite force was statistically higher for males (587.2 N) when compared to females (424.9 N) (p;0.05). The concordance between examiners for physical examination of bruxism was considered optimal.O objetivo dessa pesquisa foi avaliar a influência do gênero e do bruxismo na força máxima de mordida. A concordância interexaminadores para o exame físico de bruxismo também foi avaliada. Cento e dezoito voluntários, com idade média de 24 anos, divididos por gênero e pela presença de bruxismo, foram selecionados. Para o estabelecimento da amostra todos os voluntários foram submetidos a um exame físico específico para bruxismo (realizado por três examinadores). Então, os voluntários foram divididos em quarto grupos de acordo com o gênero e a presença de bruxismo. A força máxima de mordida foi mensurada, com o auxílio de um gnatodinamômetro, na região de primeiro molar, três vezes de cada lado, em duas sessões distintas. As sessões foram separadas por um intervalo de 10 dias. O maior valor dentre os doze obtidos, foi utilizado como sendo a força máxima. A força máxima de mordida foi estatisticamente maior para o gênero masculino (587.2 N) quando comparado com o gênero feminino (424.9 N) (p;0.05). A concordância entre os examinadores para o exame físico de bruxismo foi considerada favorável

Validation of an experimental polyurethane model for biomechanical studies on implant-supported prosthesis: compression tests

OBJECTIVES: The complexity and heterogeneity of human bone, as well as ethical issues, most always hinder the performance of clinical trials. Thus, in vitro studies become an important source of information for the understanding of biomechanical events on implant-supported prostheses, although study results cannot be considered reliable unless validation studies are conducted. The purpose of this work was to validate an artificial experimental model based on its modulus of elasticity, to simulate the performance of human bone in vivo in biomechanical studies of implant-supported prostheses. MATERIAL AND METHODS: In this study, fast-curing polyurethane (F16 polyurethane, Axson) was used to build 40 specimens that were divided into five groups. The following reagent ratios (part A/part B) were used: Group A (0.5/1.0), Group B (0.8/1.0), Group C (1.0/1.0), Group D (1.2/1.0), and Group E (1.5/1.0). A universal testing machine (Kratos model K - 2000 MP) was used to measure modulus of elasticity values by compression. RESULTS: Mean modulus of elasticity values were: Group A - 389.72 MPa, Group B - 529.19 MPa, Group C - 571.11 MPa, Group D - 470.35 MPa, Group E - 437.36 MPa. CONCLUSION: The best mechanical characteristics and modulus of elasticity value comparable to that of human trabecular bone were obtained when A/B ratio was 1:1.(FAPESP) São Paulo Research Foundatio

Ruídos articulares e sinais de disfunção temporomandibular: um estudo comparativo por meio de palpação manual e vibratografia computadorizada da ATM

Esta pesquisa teve como finalidade estimar a validade interexaminadores, em detectar sons articulares e comparar os resultados com um sistema computadorizado (SONOPAK). Para isto, uma amostra de 45 indivíduos foi selecionada aleatoriamente e dividida em dois grupos. O grupo experimental foi formado por 24 pacientes, que apresentavam problemas articulares, e o grupo controle por 19 pacientes com ausência de qualquer relato ou queixa, compatível com DTM. Sessenta e sete por cento dos pacientes eram mulheres, com médias de idade de 36 anos. Os resultados da eletrovibratografia (EVG) foram comparados com os obtidos pela palpação manual. Todos os examinadores desconheciam o grupo ao qual pertencia o paciente examinado. Para análise dos resultados de concordância, foi utilizado o teste de Cohens kappa e o percentual de concordância. Os resultados mostraram uma prevalência de 62,5% e 42,1% dos sons articulares, apresentados pelo grupo experimental e grupo controle, respectivamente. Pela análise dos resultados, concluiu-se que os sons articulares são comumente apresentados em ambos os grupos, porém sua identificação e classificação são difíceis, mesmo quando obtidos por aparelhos computadorizados. Embora a amostra deste estudo seja pequena, os resultados indicam que a EVG deve ser utilizada com cautela, e a calibração dos examinadores pode melhorar a identificação dos sons articulares.Both vibrational analysis and clinical examination have been claimed to identify intracapsular temporomandibular joint (TMJ) disorders, particularly disc displacements. The purpose of this study was to evaluate the interexaminer consensus on detecting TMJ sounds and to compare this with the results obtained through a computerized system (SONOPAK). The sample was composed of 45 people and it was divided in 2 groups: an experimental group of 24 patients presenting with TMJ complaints (sounds and/or pain), and a control group of 19 individuals with no obvious signs or symptoms of temporomandibular disorders. Sixty-seven percent of the patients were females with a mean age of 36 years. The control group was gender- and age-matched with the test group. Temporomandibular joint electrovibratography (JVA) was performed on the whole sample by one examiner. This was followed by light manual palpation of the TMJs by 2 examiners, who were not calibrated and were not aware of the results of the previous vibratographic (EAV) examination. Both examiners were unaware of which group was being examined. Indices of agreement and the Cohens kappa test were used to analyze the data. A prevalence of 62.5% and 42.1% of TMJ sounds was found for the experimental and control groups, respectively. Indices of agreement ranged from 32% to 100% and kappa index ranged from 0 to 0.4 for all conditions investigated (opening and reciprocal clicking, crepitation, and terminal thud). Although acceptable agreement was achieved, the values for kappa index were considered poor for all variables (fair agreement is considered between 0.4 and 0.75). Temporomandibular joint sounds are commonly found in both patients and nonpatients, but their detection and classification are difficult, even when an electronic device is employed. Although the sample in this study was small, the results indicate that electrovibratography (JVA) should be used with caution, and that interexaminer calibration may improve the identification of joint sounds