Analysis of temporomandibular disfunction severity related to treatment and self medicine intake

Orientador: Marcio de MoraesTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: RESUMO O objetivo deste trabalho foi observar três diferentes aspectos relacionados a disfunção temporomandibular (DTM): o uso da automedicação, a correlação entre os instrumentos de avaliação da DTM, e os resultados funcionais com o uso da artroscopia. Foram realizados três estudos independentes: No primeiro estudo, foram selecionados prospectivamente 34 pacientes que responderam ao Índice Anamnésico de Fonseca (IAF) e a um questionário contendo questões relativas ao primeiro profissional procurado e ao uso de automedicação. No segundo estudo, foram incluídos 38 prontuários de pacientes. Foram utilizados os dados dos instrumentos de avaliação: IAF; Questionário dos Sintomas Mandibulares e Hábitos Orais (QSMHO), índice de Helkimo (IH) e o questionário de triagem para dor orofacial e desordens temporomandibulares recomendado pela Academia Americana de Dor (AAOPQ). No terceiro estudo, foi realizada uma revisão de 42 prontuários de pacientes que foram submetidos a artroscopia das articulação temporomandibular [operatória (AO) ou lise e lavagem (ALL)]. Os dados referentes à presença de dor e abertura interincisal máxima foram registrados para os períodos de acompanhamento de um mês e dois meses. Os dados foram analisados utilizando o programa SPSS versão 18.0. Em todos estudos foi observada a prevalência do gênero feminino (91,2%; 84,6%; 85,7%), com idade média próxima a metade da quarta década de vida. No primeiro estudo, 17 pacientes relataram ter utilizado medicação por conta própria, principalmente analgésicos, mais especificamente a dipirona sódica. O cirurgião dentista foi o profissional mais procurado (55,5%). Não foi observada a associação entre a automedicação e a severidade da DTM utilizando o IAF. No segundo estudo, os pacientes classificados como DTM severa no IAF apresentaram mais respostas positivas no AAOPQ, com diferença estatisticamente significativa quando comparados aos pacientes com DTM leve (p<0.01). Foi observada uma correlação positiva (r=0,78; p<0.01) entre o número de respostas positivas no AAOPQ e o somatório dos escores do QSMHO. Os pacientes classificados como DTM severa no IAF apresentaram maiores escores no QSMHO, com diferença estatisticamente significativa quando comparados aos pacientes com DTM moderada (p<0.01) e DTM leve (p<0.01). No terceiro estudo, 17 de pacientes foram submetidos a AO e 25 a ALL. Não foi observada diferença estatisticamente significativa quanto a melhora da abertura bucal máxima em relação aos procedimentos (AO=2.24 mm; ALL=1,92 mm). Em ambos os tratamentos, a abertura bucal pré-operatória foi menor que a pós-operatória de um e dois meses. Dois pacientes tratados com ALL permaneceram com dor depois de dois meses. A partir destes estudos é possível concluir que: a automedicação parece ter alta prevalência nos pacientes com DTM, porém esta prática parece não alterar a severidade da doença e o tempo até a consulta inicial; parece haver uma congruência entre resultados dos instrumentos de avaliação para DTM utilizados, de forma que a escolha deve ser baseada nos objetivos clínicos ou de pesquisa; A artroscopia representou melhora da dor nos pacientes refratários ao tratamento conservador, porém com pouco ganho de abertura bucal máxima independentemente da técnica utilizada (AO e ALL)Abstract: ABSTRACT The purpose of this study was to observe three different aspects related to temporomandibular disorders (TMD): The use of self-medication, the correlation between the instruments for assessing the TMD, and functional outcomes with the use of arthroscopy. In the first study, we prospectively selected 34 patients who responded to Fonseca Anamnesic Index (FAI) and a questionnaire containing questions regarding the sought professional and the use of self-medication. In the second study, 38 medical records of patients were included. The data used were from follow evaluation tools: FAI; Jaw Symptom & Oral Habit Questionnaire (JSOHQ), Helkimo index (HI) and American Association of Orofacial Pain Questionnaire (AAOPQ). In the third study, a review of 42 medical records of patients that underwent arthroscopy of the temporomandibular joint [operative (OA) or lysis and lavage (ALL)] was performed. The presence of pain and maximum interincisal opening were recorded for the follow-up periods of one month and two months. Data were analyzed using SPSS version 18.0. The prevalence of females were identified in all studies (91.2%; 84.6%; 85.7%) and an average age of half of the fourth decade of life. In the first study, 17 patients reported self-medication habit, especially painkillers, more specifically dipyrone. The dentist was the most sought professional (55.5%). There was no association between self-medication and the severity of TMD using the FAI. In the second study, patients classified having a severe TMD in FAI had more positive responses in AAOPQ, with a statistically significant difference when compared to mild TMD patients (p <0.01). A positive correlation was identified between the number of positive responses in AAOPQ and the sum of JSOHQ scores (p <0.01 r = 0.78). Patients classified having a severe TMD in FAI had higher scores in JSOHQ, with a statistically significant difference when compared to patients with moderate TMD (p <0.01) and mild TMD (p <0.01). In the third study, 17 patients underwent to ALL and 25 to OA. There was no statistically significant difference in the improvement of maximal mouth opening regarding the artroscopic procedure performed (OA = 2.24 mm; ALL = 1.92 mm). For both treatments, the preoperative maximal mouth opening is smaller than the postoperative in the one and two months of follow-up. Two patients that received ALL remained with pain after two months of follow-up. From the studies carried, it is possible conclude that: self-medication seems to have a high prevalence in patients with TMD, however this practice does not seem to change the severity of the disease at initial consultation; there was a congruence between the results of the assessment instruments used for DTM, then the choice should be based on the clinic and research purposes; Arthroscopy appears to alleviate the pain of patients unresponsive to conservative treatment, however the improvement of maximum mouth opening was small regardless of the technique used (AO and ALL)DoutoradoCirurgia e Traumatologia Buco-Maxilo-FaciaisDoutor em Clínica Odontológic

Concepts in Management of Advanced Craniomaxillofacial Injuries

The authors present a sequencing assessment of patients who were victims of traumatic deformities of the craniomaxillofacial complex. To that end, the authors highlight the eight steps worthy of particular attention, namely (1) clinical history and photographic documentation; (2) clinical assessment; (3) assessment through image and diagnostic exams; (4) planning of the treatment; (5) bases for the three-dimensional reconstruction of the face; (6) reconstruction sequence of multiple facial fractures; (7) support measures; and (8) complications. The proposed assessment sequence allows the oral and maxillofacial surgeon or craniomaxillofacial surgeon to assess the degree of impairment of traumatic deformity, which contributes in a significant way to the decision-making process of the treatment

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat