56 research outputs found
Temporomandibularni poremeÄaji ā uloga neuromuskularne stomatologije
Masticatory system function disorders, known as temporomandibular disorders (TMD) represent frequently encountered problem in daily practice. Clinicians generally agree that psychosocial factors (stress), trauma (macrotrauma - any sudden force to the joint resulting in structural alteration, or microtrauma - functional overloading associated with muscular hyperactivity (bruxism) or occlusal instability), and occlusal conditions have the important role in the onset of TMD.
Neuromuscular dentistry is modern approach in diagnosis and treatment of TMD. It objectively evaluates the complex relationship between teeth, masticatory muscles, temporomandibular joints and cranial nerves in order to achieve an occlusion that is based on the optimal relationship between the mandible and the skull ā a neuromuscular occlusion. Neuromuscular dentistry uses computerized instrumentation to measure the patientās jaw movements via Computerized Mandibular Scanning (CMS) or Jaw Motion Analysis (JMA), muscle activity via electromyography (EMG) and temporomandibular joint sounds via Electro-Sonography (ESG) or Joint Vibration Analysis (JVA).
The fact is, however, that to date there is still no sufficient number of randomized double-blind clinical studies that could objectively help in choosing the appropriate method of diagnosis and treatment of TMD, and that in the future those studies certainly might contribute to resolving the enigma of temporomandibular disorders.PoremeÄaji funkcije žvaÄnog sustava (tzv. temporomandibularni poremeÄaji) problem su s kojim se sve ÄeÅ”Äe susreÄemo u svakodnevnoj praksi. KliniÄari se uglavnom slažu u tome da najvažniju ulogu u njihovu nastanku imaju psihosocijalni Äimbenici (stres), trauma ā koja može biti makrotrauma, kao Å”to je npr. udarac u Äeljust, ili mikrotrauma, ona povezana s kroniÄnom miÅ”iÄnom hiperaktivnoÅ”Äu (bruksizmom) ili okluzijskom nestabilnoÅ”Äu ā te okluzijski uvjeti.
Neuromuskularna stomatologija moderan je oblik dijagnostike i lijeÄenja tih poremeÄaja. Ona objektivno procjenjuje kompleksan odnos izmeÄu zubi, žvaÄnih miÅ”iÄa, temporomandibularnih zglobova i kranijalnih živaca kako bi meÄu njima postigla sklad. Za razliku od standardnih dijagnostiÄkih metoda kliniÄke funkcijske analize kojima se koristi tradicionalna stomatologija, neuromuskularna stomatologija u tu se svrhu koristi razliÄitim kompjutoriziranim suvremenim tehnikama kojima se bilježi pomicanje donje Äeljusti (analiza kretnji donje Äeljusti), registriraju miÅ”iÄnu aktivnost (elektromiografija) i identificiraju zvukove zgloba (elektrosonografija i analiza zglobnih vibracija).
Äinjenica je ipak da do danas joÅ” uvijek ne postoji dovoljan broj randomiziranih dvostruko slijepih kliniÄkih studija koje bi nam mogle objektivno pomoÄi u odabiranju odgovarajuÄeg naÄina dijagnostike i lijeÄenja, a koje Äe u buduÄnosti zasigurno doprinijeti rjeÅ”avanju enigmi temporomandibularnih poremeÄaja
Pilocarpine-Hydrocloride Has a Short-Time Effect on Reducing Xerostomia
Kserostomija, tj. suhoÄa usta jest stanje uglavnom uzrokovano uzimanjem lijekova, imunoloÅ”kim bolestima (Sy. Sjoegren) ili radioterapijom tumora usta i glave. Postoje mnogi ali ne dovoljno uÄinkoviti terapijski postupci, ukljuÄujuÄi i uporabu agonista muskarinskih receptora pilokarpin- hidroklorida. U Hrvatskoj lijeÄenje salivarne hipofunkcije polikarpin-hidrokloridom joÅ” nije uvedeno.
U ovome istraživanju cilj je bio ocijeniti uÄinak peroralne uporabe pilokarpina na male žlijezde slinovnice i ukupnu salivaciju te nadzirati moguÄe neželjene pojave i subjektivni odgovor bolesnika na terapiju. Bio je to jednostruko slijepi placebo pokus. Deset bolesnika s kserostomijom sudjelovalo je u pokusu. IskljuÄeni su bolesnici sa srÄanim i pluÄnim bolestima te oni kojima se tijekom ukljuÄenog ispitivanja 7 dana prije pokusa kemijskom stimulacijom C-vitaminom nije poveÄao salivarni tok. Pokus je obuhvaÄao 7 uzastopnih mjerenja koliÄine sline u vremenskim razmacima od 15 do 30 min, od vremena neposredno prije i nakon jedinstvene doze 5 mg pilokarpin- hidroklorida (5 kapi otopine, Pilokarpin 2%, Pliva, hrvatska). Sekrecija malih slinovnica mjerena je na donjoj usni i nepcu s pomoÄu Periotrona (Oraflow, Plainview, SAD), a ukupna salivacija mjerna je s piomoÄu graduiranih epruveta. Svaki je ispitanik ispunio jednostavan upitnik o subjektivnoj percepciji lijeÄenja i o možebitnim nuspojavama. SljedeÄi je tjedan procedura ponovljena, ali tada je umjesto pilokarpina upotrebljena dekspantenolna otopina (D-panthenol, Ljekarne Zagreb, Hrvatska) kao placebo.
Pilokarpin je poveÄao slivaciju i poboljÅ”ao simptome u svakog bolesnika. Razlike u sekreciji sline bile su statistiÄki znatne i u usporedbi sa stanjem prije ordiniranja pilokarpina i u usporedbi s placebom (p = 0,01). Nije bilo zabilježenih nepoželjnih pojava ni nakon ordiniranja pilokarpina ni nakon placeba. Nakon poboljÅ”anja salivacije uÄinak pilokarpina se vremenom smanjuje, Å”to je zabilježeno tijekom promatranja bolesnika.
UzimajuÄi u obzir kontraindikacije i neželjene uÄinke, rezultati naÅ”eg ispitivanja upuÄuju da bi se pilokarpin trebao redovito upotrebljavati u lijeÄenju kserostomije.Xerostomia, i.e. oral dryness, is mainly caused by side effects of medications, immunologic diseases, e.g. Sy. Sjoegren, and radiation treatment for oral and neck cancer. There are variable, although far from satisfactory, treatment options, including that of muscarinic receptor agonist pilocarpine-hydrochloride. Pilocarpine treatment of salivary hypofunction is not yet an established method in croatia.
The aim of this preliminary study was to assess the autcome of oral administration of pilocarpin on minor salivary glands and whole saliva production, as well as to monitor possible side effects and patients subjective responses to treatment.
Is was a single blind-placebo controlled trial. Ten patients suffering from xerostomia underwent this trial. Patients with cardiac or pulmonary diseases were excludet, as well as those that did not show any increase in salivary flow rate after administration of ascorbic acid solution (chemical stimulant) at inclusion testing one week prior to the experiment. The experiment comprised 7 repeated measurements in time intervals of 15-30 min., from the baseline up to 2 h after single oral administration of 5 mg of pilocarpine hydrochloride ( 5 drops of slution, Pilokarpin 2%, pliva, Croatia). The flow rate of minor salivary glands was measured on the lower lip and palate by means of Periotron (Oraflow Inc., Plainview, USA) and whole saliva was collected in calibrated test tubes . A simple questionnaire was filled in to record patients subjective perception of treatment. The same procedure was repeated one week later, when dexpanthenol drops (DPanthenol, Ljekarne Zagreb, Croatia) were used as placebo instead of pilocarpine.
Pilocarpine increased salivary output and gave symptomatic relief in every patient. The differences in salivary output were significant both compared to baseline and to placebo controls (p = 0,01). There were no side effects during the trial, either after administration of pilocarpine; or placebo. After increasing salivary flow rate the action of pilocarpine decrease in time, which was recordable during the observation session.
Respecting possible contraindications and side effects, according to our finding pilocarpine should be regulary used in treatment of xerostomia
ADHERENCE TO Ā»AMERICAN EUROPEAN CONSENSUS GROUPĀ« CLASSIFICATION CRITERIA FOR SJĆGRENāS SYNDROME IN DIFFERENTIAL DIAGNOSIS OF XEROSTOMIA
Svrhe rada su dobiti epidemioloÅ”ke i etioloÅ”ke podatke o problemu kserostomije u dijelu hrvatske populacije i utvrditi dosljednost pridržavanja klasifikacijskih kriterija American European Consensus Group (AECG) za Sjƶgrenov sindrom (SSj), s ciljem identificiranja moguÄe potrebe za poboljÅ”anjem dijagnostiÄkog postupka u diferencijalnoj dijagnostici kserostomije. Retrospektivno istraživanje provedeno je u Zavodu za oralnu medicinu meÄu bolesnicima primljenima zbog osjeÄaja suhih usta. UkljuÄne kriterije zadovoljilo je 395 bolesnika. Napravljena je baza epidemioloÅ”kih, kliniÄkih i sijalometrijskih podataka, nalaza seroloÅ”kih, scintigrafskih, ultrazvuÄnih i patohistoloÅ”kih pretraga žlijezda slinovnica te podataka o farmakoterapiji. Rabili su se deskriptivni statistiÄki postupci. Salivarna hipofunkcija dokazana je u 74% bolesnika. NajÄeÅ”Äi vjerojatni uzrok kserostomije bila je farmakoterapija. SSj je dokazan u 6,7% ispitanika sa kserostomijom, dok u 8% postoji visoka sumnja, ali biopsija labijalnih slinovnica nije uÄinjena, Å”to upuÄuje na nepridržavanje kriterija AECG za dijagnostiku SSj-a. Nužno je provoditi kriterije AECG u obradi bolesnika sa suhim ustima i provesti edukaciju lijeÄnika opÄe prakse, stomatologa i bolesnika o kserogenim nuspojavama farmakoterapije.The aims were to obtain epidemiological and etiological data on xerostomia in cross section of Croatian population, and to evaluate adherence to Ā»American European Consensus GroupĀ« (AECG) classification criteria for Sjƶgrenās syndrome (SSj), in order to identify possible need for improvements in differential diagnosis of xerostomia. A retrospective study among patients seen at the Department of oral medicine for complaints of dry mouth was performed. Three hundred and ninety-five patients met inclusion criteria. A data base was formed, comprising epidemiological, clinical and sialometric data, immunological, scintigraphic, ultrasonographic and histopathological findings of salivary glands, coupled with drug intake listings. Descriptive statistics were used for data analysis. Objective salivary hypofunction was found in 74% of our patients. The most common probable cause of xerostomia was side effect of pharmacotherapy. SSj was diagnosed in 6.7% of patients with xerostomia, whereas in another 8% of patients Sjƶgrenās syndrome was strongly suspected, but labial gland biopsy wasnāt performed, indicating a lack of adherence to AECG criteria for SSj diagnosis. Application of AECG criteria in differential diagnosis of patients with dry mouth is mandatory, as well as educating general practitioners, dentists and patients on xerogenic side effects of pharmacotherapy
Temporomandibular Dysfunctions (TMD) in Contemporary Practice
Temporomandibularne disfunkcije u svim svojim patoloÅ”kim oblicima Äine sve ÄeÅ”Äi problem u suvremenoj stomatoloÅ”koj praksi. Sustavan pristup dijagnostici s obzirom na prikupljanje i interpretaciju podataka o pacijentu jedan je od primarnih ciljeva u tretmanu znakova i simptoma TMD-a.
Prema W. Bellu dijagnoza TMD-a mora obuhvatiti:
ā¢ pravilnu identifikaciju i klasifikaciju poremeÄaja
ā¢ razumijevanje mehanizma nastanka i mjesta boli
ā¢ utvrÄivanje etioloÅ”kih Äimbenika, ako je moguÄe
ā¢ bazirati prognozu s obzirom na djelotvornost terapije.
Temeljem navedenih naÄela temporomandibularna disfunkcija ne može se smatrati jedinstvenim patoloÅ”kim entitetom veÄ skupinom bolesti koja se javlja sliÄnim preklapajuÄim simptomima. PosljediÄno, terapija svih oblika TMD-a nikako ne može biti ista.
Osim uobiÄajenih kliniÄkih postupaka u dijagnostici TMD-a upotrebljavaju se i raÄunalni postupci poput elektromiografije,
elektrosonografije elektrokinetiÄka i aksiografska mjerenja koja omoguÄuju da se lakÅ”e postavi pravilna dijagnoza i izabere prikladna terapija.Temporomandibular dysfunction in al its variety tends to present a problem with high morbidity and increasing prevalence in the dental office. A systematic approach to gathering and interpreting clinical evidence must be the primary goal when dealing with patients who suffer from TMD signs and symptoms.
According to W. Bell diagnosis of TMD must:
ā¢ Properly identify and classify the disorder.
ā¢ Establish the mechanism of dysfunction and the source of pain.
ā¢ Determine the etiology, if possible.
ā¢ Provide a basis prognosis in the light of effective therapy.
As a result of these principles we can canclude that TMD is not an acceptable diagnosis. It refers to a group of diseases with overlapping and similar signs and symptomatologies and cannot be solely used to determine appropriate therapy.
Apart from good clinical judgement the patient can benefit from any inanimate objective measuring device which improves the clinicianās sensory acuity. Information obtained from electomyography, electrosonography, electrokinetic and axiographic tracings analyzed properly can aid in assessing what a specific TM disorder does to
a patient and the effect treatment has on that disorder
Electromyographic Evaluation of Masticatory Muscle Activity in Patients with Temporomandibular Dysfunction
Pojam temporomandibularna disfunkcija (TMD) obuhvaÄa mnoge poremeÄaje u vezi sa žvaÄnim miÅ”iÄima i temporomandibularnim zglobovima. U vezu s nastankom TMD-a najÄeÅ”Äe se dovode okluzalni, traumatski, psihosocijalni i sustavski Äimbenici. Svrha ovoga istraživanja bila je ustanoviti postoji li promijenjena aktivnost žvaÄnih miÅ”iÄa u ispitanika s poremeÄajem te utvrditi moguÄnosti dijagnostike temporomandibularnih poremeÄaja metodom elektromiografije. U ispitivanju je sudjelovalo 40 ispitanika: 13 ispitanika sa simptomima temporomandibularne disfunkcije i 27 asimptomatskih ispitanika, usporedivih po spolu i dobi. Elektromiografska mjerenja provedena su na Å”est miÅ”iÄa (desni i lijevi prednji temporalis, maseter i digastrikus) u osam referentnih položaja.
Ispitivanje odnosa vrijednosti mioelektriÄkih signala pojedinog miÅ”iÄa desne i lijeve strane u skupini zdravih ispitanika u lateralnim okluzijskim položajima i u maksimalnim lateralnim položajima pokazalo je znatno veÄu aktivnost temporalnoga miÅ”iÄa radne strane (p0,05). Razlika u vrijednosti mioelektriÄkih signala izmeÄu asimptomatske i simptomatske skupine pronaÄena je za desni i lijevi maseter u maksimalnoj interkuspidaciji s 50% MVC (p<0,05), kod kojih su veÄe vrijednosti naÄene u simptomatskoj skupini.
Rezultati ovoga istraživanja pokazali su postojanje promjena aktivnosti žvaÄnih miÅ”iÄa u ispitanika s TMD-om te potvrdili moguÄnost uporabe elektromiografije u dijagnostici temporomandibularnih poremeÄaja.The term temporomandibular dysfunction (TMD) encompasses a group of disorders of the masticatory muscles and temporomandibular joints. Major precipitating factors are occlusal, traumatic, psychosocial and systemic factors. The aim of this investigation was to determine possible altered muscular function in patients with TMD, as well as to determine the need for EMG application in TMD diagnosis. Forty young adults participated in this study: 13 subjects with signs and symptoms of TMD and 27 asymptomatic subjects, sex and age matched. Surface EMG recordings were obtained from left and right anterior temporal muscle, left and right masseter muscle and from left and right digastric muscle in eight mandibular positions. Right side to left side ratio of examined muscles myoelectrical signals in lateral occlusal and maximal lateral positions for the asymptomatic group showed significantly higher activity of the working side anterior temporal muscle (p0.05). Comparison of myoelectrical signals in the position of maximal intercuspation of teeth between the patients and the controls, showed significantly higher activity in right and left masseter muscle at 50% MVC (p<0.05) in the symptomatic group.
Results of this investigation showed the presence of altered masticatory muscle activity in TMD patients and confirmed the use of electromyography in TMD diagnosis
The Effect of Nonaromatic Naphthalane on Mice Oral Planocellular Carcinoma - a Pilot Study
Nearomatski visokosteranski naftalan (NAVS) posebna je frakcija hrvatske nafte, iznimno bogata steranima, iz koje je odstranjen aromatski sastav. Steranima se pripisuje bioaktivnost sliÄna steroidnim hormonima, modulatorima tumorskoga rasta. Potaknuti rezultatima prijaÅ”njih in vitro i in vivo studija o inhibitornom efektu NAVS-a na rast planocelularnog karcinoma, proveli smo studiju o njegovu uÄinku na oralni planocelularni karcinom (OPCC) u miÅ”eva.
Ciljevi: 1) ispitati valjanost jednostavnog eksperimentalnog modela OPCC-a; 2) ispitati moguÄi antiproliferativni uÄinak NAVS-a na postavljenome modelu praÄenjem tumorskoga rasta; 3) ispitati antineoangiogeni uÄinak NAVS-a kao objaÅ”njenje moguÄeg antiproliferativnog uÄinka, te za tu prigodu procijeniti moguÄnost križne reaktivnosti anti-humanih imunohistokemijskih markera s miÅ”jim tkivom. Suspenzija od 100 Ī¼l s 105 SCC VII stanica inokulirana je intraoralnim putem pod bukalnu sluznicu u 48 singeniÄnih C3H miÅ”eva. Sedam dana nakon inokulacije životinje su podijeljene u 6 jednakih skupina, te se miÅ”evima, ovisno o skupini, intratumorski injiciralo po 100 Ī¼l sljedeÄih tvari: parafinsko ulje (PO) kao negativna kontrola, NAVS (u jednoj skupini 7 dana, a u drugoj skupini 14 dana nakon inokulacije tumora), 1, 25 dihidroksiergotamin (1,25-D3) kao pozitivna kontrola, te kombinacije NAVS s 1,25-D3 i PO s 1,25-D3. Rast tumora praÄen je tjednim mjerenjem s pomoÄu kalipera. Životinje su žrtvovane 1., 2., 3. i 4. tjedna nakon aplikacije ispitivanoga sredstva. HistoloÅ”ki pripravci eksplantiranih tumora bojeni su hematoksilin-eozinom te imunohistokemijski s anti-CD34 protutijelima radi procjene tumorske neoangiogeneze. U usporedbi s PO skupinom, tumorski rast i angiogeneza bili su sniženi u 1,25-D3 i NAVS skupinama. NAVS vjerojatno smanjuje rast OPCC-a inhibicijom vaskularne proliferacije potrebne za tumorski rast.Nonaromatic naphthalane (NAVS) is a specific fraction of Croatian oil, extremely rich in steranes from which the aromatic system is removed. Steranes are attributed with bioactivity similar to steroid hormones, modulators of tumour growth. Encouraged by the results of earlier in vitro and in vivo studies on the inhibitory effect of NAVS on the growth of planocellular carcinoma, we carried out a study on its effect on oral planocellular carcinoma (OPCC) in mice.
Aims: 1) To test the validity of the simple experimental model OPCC, 2) to test possible antiproliferative effect of NAVS on the above model by monitoring tumour growth, 3) to test the antineoangiogenic effect of NAVS to explain the possible antiproliferative effect, and to estimate the possibility of crisis reactivity of anti-human immunohistochemical markers with mice tissue. A suspension of 100 Ī¼l s 105 SCC VII cell was inoculated intraorally under the buccal mucous membrane in 48 syngeneic C3H mice. Seven days after inoculation the animals were divided in six equal groups and the mice, depending on the group, were intratumorously injected with 100 Ī¼l of the following substances: paraffin oil (PO) as a negative control, NAVS (in one group 7 days, and in the second group 14 days, after inoculation of the tumour), 1.25 dihydroxyergotamine (1.25-D3) as a positive control, and a combination of NAVS with 1.25 D3 and PO with 1.25- D3. Tumour growth was monitored weekly by measuring with callipers. The animals were sacrificed 1, 2, 3 and 4 week after application of the tested substance. Histological specimens of explanted tumours were stained with hematoxylin-eozine, and immunohistochemically with anti-CD34 antibodies for estimation of tumour neoangiogenesis. Compared with the PO group, tumour growth and angiogenesis were decreased in the 1.25-D3 and NAVS groups. NAVS probably reduced growth by OPCC inhibition of vascular proliferation, needed for tumour growth
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