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

Can palpation-induced muscle pain pattern contribute to the differential diagnosis among temporomandibular disorders, primary headaches phenotypes and possible bruxism?

Background: The evaluation of possible differences in the distribution or characteristics of palpation-induced pain in the masticatory muscles could be valuable in terms of diagnostic assessment. The aim of this study was to evaluate the impact of different combinations of anterior temporalis (AT) and masseter palpation-induced pain in the diagnostic of temporomandibular disorder (TMD), primary headaches and bruxism. Material and Methods: A total of 1200 dental records of orofacial pain adult patients were analyzed. The outcomes were dichotomously classified (presence/absence) as following: a) AT and/or masseter palpation-induced pain; b) myogenous TMD; c) temporomandibular joint (TMJ) arthralgia (arthrogenous TMD); d) migraine; e) tension-type headache (TTH); f) self-reported bruxism. Binomial logistic regression model (α = 5%) was applied to the data considering the palpation-induced muscle pain as the dependent variable. Results: Mean age (SD) were 35.7 years (13.4) for 635 included dental records (83% females). Myogenous and arthrogenous TMD, migraine, TTH and bruxism were mainly associated with, respectively, masseter palpationinduced pain (p<0.001 - OR=5.77, 95%CI 3.86-8.62), AT or masseter palpation-induced pain (p<0.001 - OR=2.39, 95%CI 1.57-3.63), bilateral AT palpation-induced pain (p<0.001 - OR=2.67, 95%CI 1.64-4.32), masseter and AT palpation-induced pain (p=0.009 - OR=1.62, 95%CI 1.12-2.33) and bilateral masseter palpation-induced pain (p=0.01 - OR=1.74, 95%CI 1.13-2.69). Conclusions: Palpation-induced pain in the masticatory muscles may play a role in the differential diagnosis among painful TMD, primary headaches and bruxis

Deep pain sensitivity is correlated with oral-health-related quality of life but not with prosthetic factors in complete denture wearers

Low pressure Pain Threshold (PPT) is considered a risk factor for Temporomandibular Disorders (TMD) and is influenced by psychological variables. Objectives To correlate deep pain sensitivity of masticatory muscles with prosthetic factors and Oral-Health-Related Quality of Life (OHRQoL) in completely edentulous subjects. Material and Methods A total of 29 complete denture wearers were recruited. The variables were: a) Pressure Pain Threshold (PPT) of the masseter and temporalis; b) retention, stability, and tooth wear of dentures; c) Vertical Dimension of Occlusion (VDO); d) Oral Health Impact Profile (OHIP) adapted to orofacial pain. The Kolmogorov-Smirnov test, the Pearson Product-Moment correlation coefficient, the Spearman Rank correlation coefficient, the Point-Biserial correlation coefficient, and the Bonferroni correction (α=1%) were applied to the data. Results The mean age (standard deviation) of the participants was of 70.1 years (9.5) and 82% of them were females. There were no significant correlations with prosthetic factors, but significant negative correlations were found between the OHIP and the PPT of the anterior temporalis (r=-0.50, 95% CI-0.73 to 0.17, p=0.005). Discussion The deep pain sensitivity of masticatory muscles in complete dentures wearers is associated with OHRQoL, but not with prosthetic factors

Ultrasonographic evaluation of masticatory muscles and facial dimensions in children with unilateral posterior crossbite

PURPOSE: to evaluate the ultrasonographic thickness of masseter and anterior portion of the temporalis muscle and facial dimensions in children with normal occlusion and unilateral crossbite, in deciduous and early mixed dentition. METHODS: the sample comprised 49 children of both genders, divided into four groups: deciduous-normal occlusion, deciduous-crossbite, mixed_normal occlusion and mixed_crossbite. Muscle thickness was compared between the right and left sides (normal occlusion) and normal and crossbite-side (crossbite) (Student's t test) and related to facial dimensions and body variables (Pearson's and Spearman's correlation test). Facial dimensions were determined by measuring standardized frontal photographs: anterior facial height (AFH), bizygomatic (FWB) and intergonial width (FWI), and AFH/FWB and AFH/FWI ratios. RESULTS: the results showed that the anterior temporalis muscle at rest was significantly thicker in the crossbite side in the mixed-crossbite group (p=0.05). Masseter thickness did not show significant differences between the sides in all groups. Weight and height did not correlate with masticatory muscle thickness; but FWB and FWI showed being positive, and AFH/FWB and AFH/FWI ratios showed having negative correlation with masseter thickness, i.e. children with a long-face pattern showed smaller muscle thickness. CONCLUSION: in the sample studied, the influence of functional characteristics on craniofacial structures was observed in young children by masticatory muscles ultrasonography and facial dimensions exam.OBJETIVO: avaliar a espessura dos músculos masseter e porção anterior do temporal por meio da ultra-sonografia e as dimensões faciais de crianças com oclusão normal e mordida cruzada posterior unilateral, na dentição decídua e mista inicial. MÉTODOS: foram selecionadas 49 crianças, de ambos os gêneros, divididas em quatro grupos: decídua-oclusão normal, decídua-mordida cruzada, mista-oclusão normal e mista-mordida cruzada. A espessura muscular foi comparada entre os lados direito e esquerdo (oclusão normal); e normal e cruzado (mordida cruzada) (teste t Student), e relacionada às dimensões faciais e variáveis corporais (teste de correlação de Pearson e Spearman). As dimensões faciais foram mensuradas sobre fotografias frontais padronizadas: altura facial anterior (AFA), distância bizigomática (DB) e intergoniana (DI) e razões AFA/DB e AFA/DI. RESULTADOS: observou-se que o músculo temporal no repouso apresentou espessura maior no lado cruzado no grupo mista-cruzada (p=0,05). O masseter não apresentou diferença significativa entre os lados em todos os grupos. As variáveis peso e altura não apresentaram correlação com a espessura muscular; já DB e DI apresentaram correlação positiva e as razões AFA/DB e AFA/DI, correlação negativa, com a espessura do masseter em todos os grupos, indicando que crianças com faces mais longas possuem menor espessura deste músculo. CONCLUSÃO: na amostra estudada, os exames da espessura dos músculos mastigatórios e das dimensões faciais demonstraram que a influência das características funcionais sobre as estruturas craniofaciais pôde ser observada já em crianças de pouca idade.617

A rentabilidade das indústrias nacionais de cortiça: na ótica da gestão de tesouraria.

Dissertação de Mestrado Apresentado ao Instituto de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Contabilidade e Finanças, sob orientação de Mestre Adalmiro Álvaro Malheiro de Castro Andrade Pereira.A atual conjuntura económica tem vindo a exigir às empresas uma incessante eficiência quanto à gestão do fundo maneio. Assim, a gestão do fundo maneio constitui uma das funções mais importantes dentro de uma empresa, que visa financiar o ciclo de exploração da empresa sem comprometer o seu funcionamento normal e a sua atividade. Neste âmbito importa distinguir as indústrias das restantes empresas. As indústrias apresentam um prazo médio de existências bastante elevado, originando um montante elevado de ativos correntes. Porém, em contrapartida apresentam prazos médios de recebimento e pagamento mais curtos, que exigem das entidades organizacionais um esforço contínuo na gestão de liquidez que permita honrar os seus compromissos a curto prazo e com a maior rentabilidade possível. O objetivo deste estudo é analisar o impacto da gestão do fundo maneio na rentabilidade operacional das empresas, utilizando para o efeito uma amostra das indústrias do sector da cortiça em Portugal. Os dados obtidos reportam um painel de 987 observações respeitantes a 329 empresas para o período de tempo 2010-2012, isto é, são dados com periodicidade anual. Para tal para além de uma análise descritiva dos dados é estimado um modelo econométrico utilizando o método de efeitos fixos para estimação em dados em painel. Os resultados apontam que o cash conversion cycle (em dias) afeta de forma significativa a rentabilidade operacional da empresa. Os gestores poderão aumentar a rentabilidade da empresa através da redução do net trade cycle, do prazo médio de existências e do prazo médio de recebimentos. Ao contrário do prazo médio de recebimentos, a empresa deveria conseguir negociar com os seus fornecedores para alargar o prazo médio de pagamentos. Por outro lado, o crescimento das vendas juntamente com o grau de alavancagem operacional, apresentam um efeito positivo significativo sobre a rentabilidade operacional da empresa como um todo. Por último, relativamente ao nível de endividamento da empresa para assegurar a sua atividade normal, quanto menor o nível de endividamento maior a rentabilidade da entidade organizacional.The current economic environment has demanded that companies are run with relentless efficiency when managing their working capital. The management of working capital is one of the most important activities within a company, which aims to finance the operating cycle without compromising their normal activity. In industries it is known that the average inventory period is quite low, which justifies higher current assets. However, the average collection and payment periods are shorter, which requires an organisation ongoing effort managing the liquidity, to honour their commitments in the short term and maximize their profitability. The aim of this study is to analyse the impact of the working capital management within the profitability of a company using, as a case study, the Portuguese cork industry. The data includes 987 companies for the period between 2010 and 2012, using a fixed effect econometric model to estimate the hypothesis. The results shows that the cash conversion cycle significantly affects the company's profitability. Managers may increase this profitability by reducing net trade cycle, the average inventory period and average collection periods. Unlike the average collection period, the companies should also be able to negotiate with their suppliers to extend average payment periods. On the other hand, sales growth along with an increased operational leverage have a significant positive effect on the profitability of the companies. Finally, for the level of debt needed to ensure the normal activity of a company, we can conclude that, the lower the level of debt the greater the profitability. An efficient management of working capital implies an ongoing effort to guarantee the appropriate level of current financial assets and liabilities, leading to the increase of the profitability of companies

Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation

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Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation

Disc displacement with reduction (DDWR) is one of the most common intra-articular disorders of the temporomandibular joint (TMJ). Factors related to the etiology, progression and treatment of such condition is still a subject of discussion. This literature review aimed to address etiology, development, related factors, diagnosis, natural course, and treatment of DDWR. A non-systematic search was conducted within PubMed, Scopus, SciELO, Medline, LILACS and Science Direct using the Medical Subjective Headings (MeSH) terms "temporomandibular disorders", "temporomandibular joint", "disc displacement" and "disc displacement with reduction". No time restriction was applied. Literature reviews, systematic reviews, meta-analysis and clinical trials were included. DDWR is usually asymptomatic and requires no treatment, since the TMJ structures adapt very well and painlessly to different disc positions. Yet, long-term studies have shown the favorable progression of this condition, with no pain and/or jaw locking occurring in most of the patients27sem informaçãosem informaçã