Promjene intenziteta boli i kvalitete života povezane s oralnim zdravljem u pacijenata s temporomandibularnim poremećajima tijekom terapije stabilizacijskom udlagom – probno ispitivanje

The aim of the study was to evaluate changes in pain intensity and self-perceived quality of life in patients with temporomandibular disorders (TMD ) during stabilization splint therapy. The hypothesis was that the clinical subtype of TMD , depending on whether pain is of muscular or temporomandibular joint origin, and pain chronicity (acute vs. chronic pain) differently affect treatment response. Thirty patients were included and treated with a stabilization splint in a 6-month clinical trial. Treatment outcomes included pain-free maximal mouth opening (MO), assisted maximal MO, path of MO, asymmetry in lateral excursions, spontaneous pain intensity (visual analog scale, VAS), and self-perceived quality of life (Oral Health Impact Profile, OHI P- 14). Overall, VAS and OHI P-14 scores changed significantly over time (VAS: F=80.85, p<0.001; OHI P-14: F=34.78, p<0.001). After 6 months, changes in pain intensity did not differ significantly between myofascial pain (MP) and disc displacement (DD ) groups (F=0.497, p=0.685, effect size = 0.018), or between acute pain (AP) and chronic pain (CP) patients (F=1.856, p=0.144, effect size = 0.064). Changes in self-perceived quality of life did not differ significantly between MP and D.D. groups (F=0.213, p=0.847, effect size = 0.008), or between AP and CP patients (F=0.816, p=0.489, effect size = 0.029). Linear regression analysis was used to assess the contribution of each predictor variable to the explanation of the OHI P summary score variance. Results showed pain reduction (coefficient = 0.303; 95% CI: 0.120 to 0.485) and MO increase (coefficient = 0.149; 95% CI: 0.037 to 0.260) to be independent predictors of the OHI P-14 summary score changes (R2=0.453), whereas other variables did not affect treatment outcome as assessed by OHI P-14. In conclusion, during 6-month stabilization splint therapy, significant changes in VAS and OHI P-14 summary scores were found. However, there were no significant differences in improvement rates between subjects with acute and chronic pain. Furthermore, no significant differences in improvement rates were found depending on whether pain was of muscular or temporomandibular joint origin.Cilj istraživanja bio je ispitati promjene intenziteta boli i kvalitete života u bolesnika s temporomandibularnim poremećajima (TM P) tijekom terapije stabilizacijskom udlagom. U istraživanju se vodilo hipotezom da klinički podtip TM P-a, ovisno o tome je li bol mišićnog ili zglobnog podrijetla, i kronicitet (akutna ili kronična bol) različito odgovaraju na liječenje. U istraživanje je uključeno tridesetoro pacijenata koji su tijekom šestomjesečnog kliničkog ispitivanja liječeni stabilizacijskom udlagom. Mjere ishoda uključivale su maksimalno otvaranje usta bez boli, asistirano maksimalno otvaranje usta (pasivno rastezanje), postojanje devijacije/defleksije pri otvaranju, asimetriju pri lateralnim kretnjama, bol prema vizualno analognoj skali (VAS) te samoprocjenu kvalitete života i njenu povezanost s oralnim problemima (upitnik OHI P-14). Tijekom šestomjesečnog liječenja udlagom iznos boli prema VAS te zbroj bodova upitnika OHI P-14 značajno su sniženi (VAS: F=80,85; p<0,001; OHI P-14: F=34,78; p<0,001 ). Između pacijenata s mišićnim (MP) ili zglobnim poremećajima (DD ) nisu pronađene značajne razlike u promjeni intenziteta boli nakon liječenja (F=0,497; p=0,685, veličina učinka = 0,018). Isto tako, nisu pronađene značajne razlike ni između pacijenata s akutnom (AP) ili kroničnom boli (CP) (F=1,856; p=0,144, veličina učinka = 0,064). Promjena u percepciji kvalitete života nije se bitno razlikovala između skupina MP i D.D. (F=0,213; p=0,847, veličina učinka = 0,008), kao ni između skupina AP i CP (F=0,816; p=0,489, veličina učinka = 0,029). Linearna regresija korištena je kako bi se procijenio doprinos svake prediktorske varijable u objašnjenju varijance ukupnog zbroja bodova upitnika OHI P-14. Rezultati su pokazali da su smanjenje boli (koeficijent = 0,303; 95% CI: 0,120-0,485 ) i povećanje iznosa maksimalog otvaranja usta (koeficijent = 0,149; 95% CI: 0,037-0,260 ) varijable najjače povezane s promjenom zbroja bodova upitnika OHI P-14 tijekom šestomjesečnog liječenja udlagom (R2=0,453), dok ostale varijable nisu imale utjecaj na ishod liječenja. U zaključku, tijekom šestomjesečne terapije stabilizacijskom udlagom došlo je do značajnog smanjenja boli prema VAS te do poboljšanja kvalitete života (OHI P-14). Nije, međutim, bilo značajnih razlika u iznosu napretka između ispitanika s akutnom i kroničnom boli. Nadalje, nije bilo značajnih razlika u iznosu poboljšanja ovisno o tome je li ta bol bila mišićnog ili zglobnog podrijetla

Mandibular Range of Movement and Pain Intensity in Patients with Anterior Disc Displacement without Reduction

Svrha: Temporomandibularni poremećaj (TMP) najčešći su orofacijalni bolni poremećaj nedentalnog podrijetla. Istraživanje je provedeno kako bi se ispitao učinak istodobne primjene okluzijske udlage i fizikalne terapije. Pritom je postavljena hipoteza da je istodobna primjena okluzijske udlage i fizikalne terapije učinkovita metoda za liječenje anteriornog pomaka zglobne pločice bez redukcije. Materijali i postupci: U istraživanje je bilo uključeno 12 pacijenata (srednja dob = 30,5 god.) s anteriornim pomakom zglobne pločice bez redukcije (prema DKI/TMP-u, potvrđeno magnetskom rezonancijom) nasumično podijeljenih u dvije skupine: šest pacijenata dobilo je stabilizacijsku udlagu (SU), a šest je liječeno stabilizacijskom udlagom i fizikalnom terapijom (SU-FT). Ishodi liječenja uključivali su maksimalno otvaranje usta bez boli (MO), maksimalno asistirano otvaranje usta (MAO), devijaciju/defleksiju pri otvaranju i bol prema vizualno analognoj ljestvici (VAS). Rezultati: Na početku nije bilo razlika između skupina u jakosti boli prema vizualno analognoj ljestvici i rasponu kretnji donje čeljusti. Tijekom liječenja bol je prema vizualno analognoj ljestvici značajno smanjena u obje skupine (SU-FT F = 28,964, p = 0,0001, veličina učinka = 0,853; SU: F = 8,794, p = 0,0011, veličina učinka = 0,638). Raspon otvaranja usta značajno se povećao samo u skupini SU-FT (MO: F = 20,971, p = 0,006; MAO: F = 24,014, p = 0,004). Skupine su se značajno razlikovale s obzirom na devijaciju/defleksiju pri otvaranju (p = 0,040). Nakon terapije, devijacija tijekom otvaranja usta i dalje se pojavljivala samo kod jednog pacijenta u skupini SUFT, prema njih pet u skupini SU. Zaključak: Unatoč ograničenjima ovog istraživanja pokazalo se da istodobna primjena stabilizacijske udlage i fizikalne terapije tijekom šestomjesečnog liječenja rezultira značajnijim povećanjem raspona otvaranja usta i značajnijim smanjenjem devijacija tijekom otvaranja od stabilizacijske udlage koja se upotrebljava bez fizikalne terapije. Obje terapijske opcije pokazale su se djelotvornima u smanjenju boli kod pacijenata s anteriornim pomakom zglobne pločice bez redukcije. Unatoč objektivno dijagnosticiranom poremećaju temporomandibularnog zgloba, fiziološka funkcija je obnovljena.Objective: Temporomandibular disorders (TMD) are the most common source of orofacial pain of a non-dental origin. The study was performed to investigate the therapeutic effect of the conventional occlusal splint therapy and the physical therapy. The hypothesis tested was that the simultaneous use of occlusal splint and physical therapy is an effective method for treatment of anterior disc displacement without reduction. Materials and Methods: Twelve patients (mean age =30.5 y) with anterior disc displacement without reduction (according to RDC/TMD and confirmed by magnetic resonance imaging) were randomly allocated into 2 groups: 6 received stabilization splint (SS) and 6 received both physical therapy and stabilization splint (SS&PT). Treatment outcomes included pain-free opening (MCO), maximum assisted opening (MAO), path of mouth opening and pain as reported on visual analogue scale (VAS). Results: At baseline of treatment there were no significant differences among the groups for VAS scores, as well as for the range of mandibular movement. VAS scores improved significantly over time for the SS&PT group (F=28.964, p=0.0001, effect size =0.853) and SS group (F=8.794, p=0.001, effect size =0.638). The range of mouth opening improved significantly only in the SS&PT group (MCO: F=20.971, p=0.006; MAO: F=24.014, p=0.004) (Figure 2). Changes in path of mouth opening differ significantly between the groups (p=0.040). Only 1 patient in SS&PT group still presented deviations in mouth opening after completed therapy while in the SS group deviations were present in 5 patients after completed therapy. Conclusion: This limited study gave evidence that during the treatment period lasting for 6 months, the simultaneous use of stabilization splint and physical therapy was more efficient in reducing deviations and improving range of mouth opening than the stabilization splint used alone. Both treatment options were efficient in reducing pain in patients with anterior disc displacement without reduction. Despite of objectively diagnosed disruption of temporomandibular joint anatomy, physiological function was regained

NeuroD1 Gene and Interleukin-18 Gene Polymorphisms in Type 1 Diabetes in the Dalmatian Population of Southern Croatia

Aim: To evaluate the frequency of known polymorphisms in the exon 2 of the NeuroD1 gene and in the interleukin (IL)-18 promoter region in patients with type 1 diabetes mellitus (T1DM) and in healthy control subjects in Dalmatia, Southern Croatia. Methods: A total of 134 unrelated patients (73 men and 61 women) and 132 consecutive unrelated healthy controls (61 men and 71 women) from the Dalmatian region of southern Croatia were recruited for the study. NeuroD1 genotypes (GG, GA, AA) were identified by means of polymerase chain reaction followed by restriction fragment length polymorphism (PCR/RFLP). IL-18 polymorphism in the position –137 of the promoter region was detected by using PCR sequence-specific primers. Results: Genotype distributions of both genes did not show significant difference between patients and controls. Conclusion: Our results suggest that NeuroD1 exon 2 and IL-18 promoter gene polymorphisms are not associated with development of T1DM susceptibility in the population of South Croatia. In addition to previously published positive correlations of these polymorphisms with development of T1DM among different world populations, our findings indicate the existence of ethnic variations in the association of these genes with disease development