Association of sleep quality and psychological aspects with reports of bruxism and TMD in Brazilian dentists during the COVID-19 pandemic

Dentists are exposed to contamination by SARS-CoV-2 due to dental interventions, leading to a state of alert and potential risk of negative impact in mental health and sleep quality, associated with Temporomandibular Disorder (TMD) and bruxism. Objective: to evaluate the psychosocial status, sleep quality, symptoms of TMD, and bruxism in Brazilian dentists (DSs) during the COVID-19 pandemic. Methodology: The sample (n=641 DSs) was divided into three groups (quarantined DSs; DSs in outpatient care; and frontline professionals), which answered an electronic form containing the TMD Pain Screening Questionnaire (Diagnostic Criteria for Temporomandibular Disorders – DC/TMD), the Pittsburgh Sleep Quality Index (PSQI), the Depression, Anxiety and Stress Scale (DASS-21), and the sleep and awake bruxism questionnaire. ANOVA test and Mann Whitney post-test were used, with Bonferroni adjustment (p<0.016) and a 95% confidence level. Results: Probable TMD was found in 24.3% (n=156) of the participants, while possible sleep and awake bruxism were diagnosed in 58% (n=372) and 53.8% (n=345) of them, respectively. Among all variables evaluated, only symptoms of depression were significantly greater in the quarantined DSs group when compared to those who were working at the clinical care (p=0.002). Working DSs were significantly less likely (OR=0.630, p=0.001) to have depressive symptoms. Those who were not worried or less worried about the pandemic were less likely to experience stress (OR=0.360), anxiety (OR=0.255), and poor sleep quality (OR=0.256). Sleep had a strong positive and moderate correlation with psychological factors on frontline workers and DSs in outpatient care, respectively. Conclusion: The results suggest confinement may have a more negative impact on the life of DSs than the act of being actively working. The concern about Covid-19 and poor sleep quality was significantly prevalent and may negatively affect the quality of life of DSs. Thus, further research on the topic is needed

Dental wear caused by association between bruxism and gastroesophageal reflux disease: a rehabilitation report

Bruxism is a pathological activity of the stomatognathic system that involves tooth grinding and clenching during parafunctional jaw movements. Clinical signs of bruxism are mostly related to dental wear and muscular and joint discomforts, but a large number of etiological factors can be listed, as local, systemic, psychological and hereditary factors. The association between bruxism, feeding and smoking habits and digestive disorders may lead to serious consequences to dental and related structures, involving dental alterations (wear, fractures and cracks), periodontal signs (gingival recession and tooth mobility) and muscle-joint sensivity, demanding a multidisciplinary treatment plan. This paper presents a case report in which bruxism associated with acid feeding, smoking habit and episodes of gastric reflow caused severe tooth wear and great muscular discomfort with daily headache episodes. From the diagnosis, a multidisciplinary treatment plan was established. The initial treatment approach consisted of medical follow up with counseling on diet and smoking habits and management of the gastric disorders. This was followed by the installation of an interocclusal acrylic device in centric relation of occlusion (CRO) for reestablishment of the occlusal stability, vertical dimension of occlusion, anterior guides and return to normal muscle activity (90-day use approximately). After remission of initial symptoms, oral rehabilitation was implemented in CRO by means of full resin composite restorations and new interocclusal device for protection of restorations. Satisfactory esthetics, improved function and occlusal stability were obtained after oral rehabilitation. The patient has attended annual follow-ups for the past 2 years. The multidisciplinary treatment seems to be the key for a successful rehabilitation of severe cases of dental wear involving the association of different health disorders

Evaluation of screw loosening on new abutment screws and after successive tightening

This study evaluated the loss of the torque applied after use of new screws and after successive tightening. Four infrastructures (IE), using UCLA castable abutment type, were cast in cobalt-chromium alloy and new abutment screws (G1) were used in a first moment. Subsequently, the same abutment screws were used a second time (G2) and more than two times (G3). The values of the torques applied and detorques were measured with a digital torque wrench to obtain the values of initial tightening loss (%). Data were analyzed by ANOVA and Tukey's test (?=0.05). Significant differences were observed between the G1 (50.71% ± 11.36) and G2 (24.01% ± 3.33) (p=0.000) and between G1 (50.71% ± 11.36) and G3 (25.60% ± 4.64) (p=0.000). There was no significant difference between G2 and G3 (p=0.774). Within the limitations of the study, it may be concluded that the percentage of the initial torque loss is lower when screws that already suffered the application of an initial torque were used, remaining stable after application of successive torques.O objetivo deste estudo foi avaliar a perda do torque inicial, quando usados novos parafusos de pilares e após sucessivos apertos. Quatro infra-estruturas (IE), utilizando pilares calcináveis tipo UCLA, foram fundidas em liga de cobalto-cromo, onde novos parafusos de pilares foram utilizados (G1) em um primeiro momento. Posteriormente os mesmos parafusos de pilares foram utilizados em um segundo momento (G2), e depois por mais duas vezes (G3). Os valores de torque e detorque aplicados foram mensurados a partir de um torquímetro digital para obtenção dos valores de perda do torque inicial (%). Os dados foram coletados e submetidos à análise de variância e teste de Tukey (p<0,05). Foram observadas diferenças estatisticamente significantes entre os grupos G1 (50,71% ± 11,36) and G2 (24,01% ± 3,33) (p=0,000) and the groups G1 (50,71% ± 11,36) and G3 (25,60% ± 4,64) (p=0,000). Os maiores valores foram encontrados para o grupo G1. Não houve diferença estaticamente significante entre os grupos G2 e G3 (p=0,774). Dentro das limitações deste estudo, pôde-se observar que a porcentagem de perda de torque inicial foi menor quando os parafusos já haviam sofrido a aplicação do primeiro torque, se mantendo estáveis após os demais torques

Influence of maxillomandibular relationship, vertical dimension and posterior retainer in temporomandibular disorders / Influência da relação maxilomandibular, dimensão vertical e retentor posterior nas desordens temporomandibulares

Introduction: There are professionals who believe in the relation between occlusal parameters and the presence of temporomandibular disorders (TMD) in the face of the controversy among the findings of numerous studies about this topic. Objective: to evaluate the association between maxillomandibular relationship (MMR), vertical dimension (VD) and posterior retainer (PR) with the presence of TMD. Methods: Of the 148 patients in the sample, 78 presented a diagnosis of TMD and 70 comprised the control group, from an examination with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD - Axis I). The MMR relationship was evaluated by the frontal manipulation method of Ramfjord associated with swallowing and it was verified with carbon paper if they presented occlusion in centric relation (CR) or maximal habitual intercuspation (MHI); for the VD was used the metric method associated to phonetic; for PR, individuals with 0 to 2 occlusal units (OU), 3 to 5 OU (reduced dental arch) and 6 or more OU were categorized. Results: the majority of patients with altered Vertical Dimension of Occlusion (VDO) presented TMD (52.5%); there was no statistically significant association (p=0.495). Regarding MMR, 100% of patients with TMD occluded in MHI, while 95.7% of patients without TMD presented occlusion in MIH. The PR variable and the presence of TMD also had no association (p=0726 and p=0.054). Conclusion: In this way, there was no association between the occlusal parameters evaluated and the presence of TMD, although it was observed that the prevalence of TMD increased as the occlusal support was reduced

The role of occlusion and occlusal adjustment on temporomandibular dysfuction

s a great controversy related to the role of occlusion and its usage on occlusal adjustment as a treatment of temporomandibular disorders. Occlusal adjustment is a clinical procedure in which modifications are done on teeth surfaces, restorations or prostheses, through selective wear or restorative materials addition, seeking to harmonize maxillo-mandibular functional aspects in centric occlusion and eccentric movements. The adjustment aims to obtain appropriate jaw stability free from premature contacts and occlusal interferences. The aim of this paper is to elucidate the role of occlusion and occlusal adjustment in Temporomandibular Dysfunction and to guide the professional when indicating it

The role of occlusion and occlusal adjustment on temporomandibular dysfunction Flávio Domingues das Neves Correspondence to

Abstract There is a great controversy related to the role of occlusion and its usage on occlusal adjustment as a treatment of temporomandibular disorders. Occlusal adjustment is a clinical procedure in which modifications are done on teeth surfaces, restorations or prostheses, through selective wear or restorative materials addition, seeking to harmonize maxillo-mandibular functional aspects in centric occlusion and eccentric movements. The adjustment aims to obtain appropriate jaw stability free from premature contacts and occlusal interferences. The aim of this paper is to elucidate the role of occlusion and occlusal adjustment in Temporomandibular Dysfunction and to guide the professional when indicating it

Differential diagnosis between post-polio syndrome symptoms and temporomandibular disorder - Clinical case

Post-poliomyelitis syndrome (PPS) is characterized by the delayed appearance of new neuromuscular symptoms in patients several years after their acute poliomyelitis paralysis. Clinical features of PPS include fatigue, joint and muscle pain, new muscular weakness and bulbar symptoms. The diagnosis is essentially clinical after excluding other neurological, orthopedic or rheumatologic problems. Temporomandibular disorders (TMD) are usually diagnosed by means of comprehensive review of patient history and clinical examination and the symptoms are pain/discomfort in the jaw, mainly in the region of the temporomandibular joints (TMJs) and/or masticatory muscles, limitation of mandibular function and/or TMJ sounds. In the same way as PPS, the diagnosis of TMD is challenging. This study reports the case of a patient that presented the symptoms of both conditions in the stomatognathic system, and discusses how to achieve the differential diagnosis for proper management of the cases

Differential diagnosis between post-polio syndrome symptoms and temporomandibular disorder Clinical case

liomyelitis syndrome (PPS) is characterized by the delayed appearance of new neuromuscular symptoms in patients several years after their acute poliomyelitis paralysis. Clinical features of PPS include fatigue, joint and muscle pain, new muscular weakness and bulbar symptoms. The diagnosis is essentially clinical after excluding other neurological, orthopedic or rheumatologic problems. Temporomandibular disorders (TMD) are usually diagnosed by means of comprehensive review of patient history and clinical examination and the symptoms are pain/discomfort in the jaw, mainly in the region of the temporomandibular joints (TMJs) and/or masticatory muscles, limitation of mandibular function and/or TMJ sounds. In the same way as PPS, the diagnosis of TMD is challenging. This study reports the case of a patient that presented the symptoms of both conditions in the stomatognathic system, and discusses how to achieve the differential diagnosis for proper management of the cases