Temporomandibular disorders : studies on pain, mastication and diagnostic

Orientador: Renata Cunha Matheus Rodrigues GarciaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Disfunções temporomandibulares (DTM) são condições orofaciais patológicas comuns caracterizadas por dor na articulação temporomandibular e/ou nos músculos da mastigação. A DTM é uma condição comum de dor, especialmente em mulheres durante a fase reprodutiva. Desta maneira os objetivos dessa tese foram (1) avaliar se as flutuações hormonais ocorridas durante o ciclo menstrual alteram a sensibilidade dolorosa (SD), força máxima de mordida (FMM) e performance mastigatória (PM) de voluntárias com DTM, (2) avaliar se os movimentos mandibulares e a qualidade do sono alterariam com o tratamento com placas oclusais estabilizadoras e (3) comparar o diagnóstico baseado no Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) avaliando a confiabilidade e calibração entre o treinamento formal em relação a autoinstrução com documentos e filme. Para tanto, cinquenta voluntárias foram selecionadas e divididas em dois grupos de 25 participantes: (1) voluntárias com DTM e ciclos menstruais regulares e (2) voluntárias com DTM e utilizando contraceptivos orais. Foram analisados a sensibilidade dolorosa (SD) por meio da escala visual analógica, força máxima de mordida (FMM) por meio de sensores e performance mastigatória (PM) por meio do peneiramento. Essas variáveis foram avaliadas durante o período de quatro fases de um ciclo menstrual completo. As mesmas 50 voluntárias diagnosticados com SD participaram do segundo estudo, que foram analisadas a intensidade da dor (escala visual analógica), qualidade do sono (Escala de Sonolência Epworth (ESS) e Índice de Qualidade de Sono de Pittsburgh (PSQI), e movimentos mandibulares ¿ amplitude de movimento e movimentos mastigatórios (cinesiografia) antes e depois de dois meses do tratamento com placa estabilizadora. Medidas repetidas GLIMMIX foram utilizados para a análise de dados seguido pelo teste de Tukey (P ? 0,05). Para o terceiro estudo foi utilizada uma amostra diferente, um total de 32 indivíduos (27 pacientes com DTM e 9 assintomáticos) foram examinados por meio do DC/TMD. Seis examinadores foram divididos em dois grupos com diferentes tipos de treinamento, (1) treinamento formal e de calibração em um centro de treinamento para o DC/TMD e (2) autoinstrução com o uso de documentos e vídeo. Após a primeira avaliação o segundo grupo passou pelo treinamento formal, sendo considerado o grupo (3) Autoinstrução + curso. A avaliação da confiabilidade foi realizada ao longo de um dia inteiro compreendendo em um exame clínico em 16 pacientes para cada um dos três grupos. O coeficiente kappa foi utilizado para calcular a confiabilidade dos diagnósticos do DC/TMD. Em relação aos resultados, foram encontradas diferenças na SD entre a fase lútea (quarta avaliação) e ovulatória (terceira avaliação) (p = 0,01), de ambos os grupos. Não foram encontradas diferenças em FMM (P = 0,34) ou PM (P = 0,43), entre os grupos experimental e controle. Sensibilidade à dor foi reduzido após o tratamento (P = 0,0001). O tratamento melhorou a amplitude de movimento, aumentando a abertura bucal (P = 0,0001) e movimento ântero-posterior (P = 0,01), bem como a velocidade de abertura máxima (P = 0,0001) e de fechamento (P = 0,04) durante a mastigação, após o tratamento. Houve diferenças nos índices de qualidade de sono para PSQI (P = 0,0001) e ESS (P = 0,04) após o tratamento da dor miofacial. No terceiro estudo, a confiabilidade foi boa em todos os três grupos de examinadores para todos os diagnósticos, exceto para a mialgia local e dor miofascial com referência no grupo Autoinstrução + curso. O curso melhorou a confiabilidade para a mialgia e artralgia quando comparado com a auto-instrução. Desta maneira, flutuações de estrogênio pode influenciar a sensibilidade à dor de pacientes com DTM, mas não afeta a função mastigatória. O tratamento de indivíduos com dor miofascial com placas estabilizadoras foi eficaz reduzindo a dor, e esta opção de tratamento melhora a qualidade do sono e movimentação mandibular. A confiabilidade da calibração do DC/TMD por meio do treinamento formal e da auto-instrução são semelhantes, exceto para os subgrupos de Mialgia. A auto-instrução seguida de treinamento formal melhora a confiabilidade da calibração do DC/TMDAbstract: Temporomandibular disorders (TMD) are common chronic orofacial pathology conditions characterized by pain in the temporomandibular joint and/or muscles of mastication. The TMD is a common pain condition, especially in women during their reproductive phase. Thus the objectives of this thesis were (1) to evaluate whether the hormonal fluctuations that occur during the menstrual cycle alter pain sensitivity (PS), maximum bite force (MBF) and masticatory performance (MP) to volunteers with TMD, (2) evaluate if jaw movements and sleep quality would change with treatment with stabilizing occlusal splint and (3) compare the diagnosis based on the Diagnostic Criteria for Temporomandibular Disorders (DC / TMD) to evaluate the reliability and calibration between formal training in relation to self-instruction with documents and film. For this purpose, fifty volunteers were selected and divided into two groups of 25 participants: (1) volunteers with regular menstrual cycles and TMD, and (2) voluntary with TMD and using oral contraceptives. Pain sensitivity (PS) by using a visual analog scale, maximum bite force (MBF) using sensors and masticatory performance (MP) through screening were analyzed. These variables were measured for a period of four phases of a complete menstrual cycle. The same 50 volunteers diagnosed with PS participated in the second study, pain intensity (visual analogue scale), quality of sleep (Epworth Sleep Scale (ESS) and Index of Pittsburgh Sleep Quality (PSQI) were analyzed, and mandibular movements - range of motion and chewing movements (kinesiography) before and after two months of treatment with stabilizing splints. Repeated measures GLIMMIX were used for data analysis followed by Tukey¿s test (P ? .05). For the third study a different sample was used, a total of 32 patients (27 patients with TMD and 9 asymptomatic) were examined using DC/TMD. Six examiners were divided into two groups with different training, (1) formal training and calibration at a DC/TMD training center and (2) self-instruction with the use of documents and video. After the first evaluation, the second group went through the formal training, considered the group (3) self-instruction + course. The reliability assessment was performed over a full day comprising in a clinical examination of 16 patients for each of the three groups. The Cohen's kappa coefficient was used to calculate the reliability of the DC/TMD diagnoses. Regarding the results, differences between the PS in luteal phase (Fourth evaluation) and ovulatory phase (third evaluation) were found (p = 0.01) in both groups. No differences in MBF (P = 0.34) or MP (P = 0.43) were found between the experimental and control groups. Sensitivity to pain was reduced after treatment (P = 0.0001). The treatment improved range of motion, increasing mouth opening (P = 0.0001) and anterior-posterior movement (P = 0.01) and the maximum opening speed (P = 0.0001) and closing (P = 0.04) during mastication after treatment. There were differences in the sleep quality scores for PSQI (P = 0.0001) and ESS (P = 0.04) after the treatment of myofascial pain. On the third study, the reliability was good in all three groups of examiners for all diagnoses, except for Myofascial pain with referral in the Self + course group. The course group improved reliability for myalgia and arthralgia compared to self-instruction. Thus, estrogen fluctuations may influence the pain sensitivity of TMD patients, but does not affect masticatory function. Treatment of MFP subjects with stabilized splints was effective reducing pain, and this treatment option improves sleep quality and jaw motion. The reliability of the calibration of DC / TMD through formal training and self-education are similar, except for subgroups of Myalgia. The self-instruction followed by formal training improves the reliability of the calibration of DC / TMDDoutoradoProtese DentalDoutora em Clínica Odontológic

Diagnostic Criteria For Temporomandibular Disorders: Self-instruction Or Formal Training And Calibration?

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Background: To investigate the difference in diagnostic reliability between self-instructed examiners and examiners taught in a Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) course and if the reliability of self-instructed examiners improves after the course. Methods: Six examiners were divided into three groups: (1) formal two-day training and calibration course at a DC/TMD training center (Course group), (2) self-teaching through documents and movie (Self group) with three examiners on each and the Self group later participated in the course (Self + course group). Each group examined sixteen subjects, total of 48 volunteers (36 patients with TMD and 12 asymptomatic) and the reliabilities in relation to the diagnoses derived by a Reference Standard Examiner were compared by Cohen's Kappa coefficient. Results: The reliability was good to excellent in all three groups of examiners for all DC/TMD diagnoses, except for Myofascial pain with referral in the Self + course group. The course seemed to improve the reliability regarding Myalgia and Arthralgia at the same time as the examiners experienced the course to be valuable for self-perceived ability and confidence. Conclusions: This study shows that the diagnostic reliability of formal DC/TMD training and calibration and DC/TMD self-instruction are similar, except for subgroups of Myalgia. Thus, self-instruction seems to be possible to use to diagnose the most common TMDs in general dental practice. The course further improves the reliability regarding Myalgia and Arthralgia at the same time as the examiners experienced the course to be valuable for self-perceived ability and confidence.16Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)CAPES [10225/13-7

Patologias atuais: a compulsão e a sociedade dos excessos: Current pathologies: compulsion and the society of excesses

O artigo em tela tem por objetivo analisar os aspectos biopsicossociais da conduta compulsiva de consumo. Propõe-se a apresentar os elementos psicológicos contidos nesse comportamento, além de verificar quais são os resultados decorrentes dessa compulsão. O consumo compulsivo, também chamado de oniomania, é um transtorno causado pela ansiedade despertada pela necessidade de comprar e saciada, somente, quando é materializada a aquisição daquilo que se deseja comprar. O estudo em questão pode ser classificado como sendo de cunho bibliográfico, a partir da análise de documentos publicados em forma de artigos científicos e livros em formato digital

Aplicações clínicas do enceramento diagnóstico na reabilitação oral – uma revisão de literatura

O Enceramento de diagnóstico consiste no planejamento de um caso clínico, apresentando soluções customizadas para cada caso. O objetivo do presente trabalho é apresentar uma revisão crítica da literatura científica, apresentando os conceitos, definições, empregos e limitações do enceramento de diagnóstico. Entre os objetivos desta técnica está o de oferecer, através de estudo prévio, uma resolução clínica efetiva ao paciente. Os desfechos clínicos proporcionados por esta ferramenta são: à devolução da anatomia oclusal e; os determinantes da oclusão, para que haja uma perfeita harmonia entre os elementos dentários com os movimentos mandibulares. Sendo de fundamental importância para as reabilitações bucais, esta técnica apresenta diferentes metodologias que buscam um objetivo final único, a devolução do equilíbrio do sistema estomatognático. Desta forma, o enceramento de diagnóstico possibilita o planejamento personalizado para cada caso clínico e integração entre profissionais da área, resultando em uma perfeita função e estética da prótese dental, e consequentemente harmonia do sistema estomatognático

Hormonal Fluctuations Intensify Temporomandibular Disorder Pain Without Impairing Masticatory Function

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Purpose: The influence of hormonal fluctuations on pain and mastication was evaluated in patients with painful temporomandibular disorder (TMD) symptoms. Materials and Methods: Fifty women were assigned to menstrual cycle and oral contraceptive groups (n = 25). Their TMD was diagnosed by Research Diagnostic Criteria for Temporomandibular Disorders. Pain levels, maximum oclusal force (MOF), and masticatory performance (MP) were measured in all menstrual cycle phases. Results: A lower pain level was observed in the ovulatory phase when compared to menstrual and luteal phases (P = .02). No differences were found regarding MOF (P = .20) or MP (P = .94). Conclusions: Hormonal fluctuations intensify pain in women with symptomatic TMD without impairing mastication.2817274Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP [2011/09551-4

Reproducibility of a silicone-based test food to masticatory performance evaluation by different sieve methods

The aim of this study was to evaluate the reproducibility of the condensation silicone Optosil Comfort® as an artificial test food for masticatory performance evaluation. Twenty dentate subjects with mean age of 23.3 ± 0.7 years were selected. Masticatory performance was evaluated using the simple (MPI), the double (IME) and the multiple sieve methods. Trials were carried out five times by three examiners: three times by the first, and once by the second and third examiners. Friedman’s test was used to find the differences among time trials. Reproducibility was determined by the intra-class correlation (ICC) test (α = 0.05). No differences among time trials were found, except for MPI-4 mm (p = 0.022) from the first examiner results. The intra-examiner reproducibility (ICC) of almost all data was high (ICC ≥ 0.92, p < 0.001), being moderate only for MPI-0.50 mm (ICC = 0.89, p < 0.001). The inter-examiner reproducibility was high (ICC > 0.93, p < 0.001) for all results. For the multiple sieve method, the average mean of absolute difference from repeated measurements were lower than 1 mm. This trend was observed only from MPI-0.50 to MPI-1.4 for the single sieve method, and from IME-0.71/0.50 to IME-1.40/1.00 for the double sieve method. The results suggest that regardless of the method used, the reproducibility of Optosil Comfort® is high.010

Apexification of an Immature Permanent Incisor with the Use of Calcium Hydroxide: 16-Year Follow-Up of a Case

Apexification is a process of forming a mineralized apical barrier and had been performed by using calcium hydroxide paste, due to its biological and healing performances in cases of existent trauma. This clinical report aims to report the results of a 16-year follow-up study of an apexification treatment applied to nonvital tooth 22 of a healthy 8-year-old male after a trauma. Clinical inspection of the tooth showed fractures of the incisal edge and mesial angle, absence of coronal mobility, and negative pulp vitality under cold testing. Radiographic analysis of the root revealed incomplete apex formation. The possibility of fracture into the root or luxation injury was rejected, and the diagnosis of pulp necrosis was verified. Apexification by calcium hydroxide and subsequent endodontic treatment were planned. Initial formation of the mineralized apical barrier was observed after 3 months, and the barrier was considered to be completed after 8 months. Clinical, radiographic, and CBCT examinations after 16 years verified the success of the treatment, although the choice of calcium hydroxide for apexification treatment is discussed