Oralne promjene kod pedijatrijskih bolesnika s poremećajima u jedenju

Numerous oral changes develop as a result of dysfunctional eating behavior in patients with eating disorders (ED). The aim of this study was to evaluate the correlation among oral manifestations, age, disease duration and nutritional status in pediatric patients with ED. The study included 50 female ED patients, median age 14 (range 10-18) years and median disease duration 9 (range 1-42) months. Nutritional status was expressed as z-score for body mass index (BMI). Mean BMI z-score was -2.10±1.64. The most commonly observed oral findings were dental plaque, marginal gingivitis, morsicatio, dental calculus, caries, pharyngeal erythema, exfoliative cheilitis and angular cheilitis. Dental plaque and pharyngeal erythema were correlated with shorter disease duration (p=0.048; p=0.040), while frictional keratosis of tongue was correlated with longer disease duration (0.011). Linea alba and pain in the temporomandibular joint were associated with younger age (p=0.012; p=0.024), and tooth impression on tongue with lower degree of nutrition (p=0.030). This study showed that there was a link among oral manifestations, age, disease duration and degree of nutritional disorder, although further investigations comparing the groups of ED patients with different age, disease duration and nutritional status would give better, concrete and precise conclusions.Poremećen odnos prema jelu u sklopu poremećaja u jedenju rezultira brojnim promjenama u usnoj šupljini. Cilj ovog istraživanja je bio utvrditi postoji li korelacija između pojavnosti promjena u usnoj šupljini, dobi, duljine trajanja poremećaja te stupnja uhranjenosti u pedijatrijskih bolesnika s poremećajima u jedenju. U istraživanju je sudjelovalo 50 bolesnica s poremećajem u jedenju prosječne dobi od 14 (raspon 10-18) godina i prosječnog trajanja bolesti od 9 (raspon 1-14) mjeseci. Stupanj uhranjenosti izražen je standardnom devijacijom indeksa tjelesne mase (ITM z-vrijednost). Srednja ITM z-vrijednost bila je -2,10±1,64. Najčešće promjene u usnoj šupljini bile su zubni plak, marginalni gingivitis, morsikacije, kamenac, karijes, eritem farinksa, eksfolijativni heilitis i angularni heilitis. Zubni plak i eritem farinksa bili su povezani s kraćim trajanjem poremećaja (p=0,048; p=0,040), a frikcijska keratoza jezika s duljim trajanjem poremećaja (0,011). Linea alba i bolovi u temporomandibularnom zglobu su bili povezani s mlađom dobi (p=0,012; p=0,024), a impresije zubi na jeziku s nižim stupnjem uhranjenosti (p=0,030). Ovo istraživanje je pokazalo da postoji povezanost između promjena u usnoj šupljini, dobi, trajanja poremećaja i stupnja uhranjenosti, no daljnja istraživanja koja će uspoređivati skupine bolesnika različite dobi, trajanja bolesti i različitog stupnja uhranjenosti dat će bolje, konkretnije i preciznije zaključke

Klinički pogled na poremećaj temporomandibularnog zgloba

Temporomandibular pain has a musculoskeletal origin because it occurs as a consequence of masticatory muscle function disorder and temporomandibular joint disorder. Most common diagnoses of disorders are disc displacement and osteoarthritis, but their comorbidity can also occur. Pain is the most common symptom, where chronic temporomandibular pain may contribute to the occurrence of psychological disorders in the patient population. Splint is the most widespread dental method of treatment but other, noninvasive methods of musculoskeletal pain treatment are also recommended. Electronic axiography is used for visualization of mandibular movements, in particular pathologic sounds in the joints. Mental health, although not so obvious in dental practice, can influence the need of a multidisciplinary approach to the patient with disorder of the temporomandibular joint.Temporomandibularna bol je muskuloskeletnog podrijetla, jer nastaje kao posljedica poremećaja funkcije žvačnih mišića i temporomandibularnih zglobova. Najčešće dijagnoze temporomandibularnih poremećaja su pomak diska i osteoartritis, ali je moguć i njihov komorbiditet. Bol je najčešća tegoba, a kronična temporomandibularna bol može dovesti i do pojave psiholoških poremećaja u populaciji pacijenata. Udlaga je najrašireniji stomatološki način liječenja, ali se preporučuju i ostale, neinvazivne metode liječenja muskuloskeletnih bolova. U svrhu vizualizacije kretnji donje čeljusti, a osobito patoloških zvukova u temporomandibularnom zglobu, koristi se elektronička aksiografija. Mentalno zdravlje, iako neprimjetno u stomatološkoj praksi, može utjecati na potrebu multidisciplinarnog pristupa bolesniku s poremećajem temporomandibularnog zgloba

Analiza kuta nagiba kondilne staze pomoću registracije definirane artikulatorom

The purpose of this investigation was to study sagittal condylar inclination values within a uniform sample (Angle class I occlusion) using ‘articulator-related registration’ and Camper’s plane as a reference plane. The study was performed on a sample of 58 Angle class I subjects (mean age 25.1, SD 3.1). Measurements were performed with an ultrasonic jaw tracking device with six degrees of freedom. After a paraocclusal tray was fixed in the mouth, each subject had to make three protrusive movements and three right and left laterotrusive movements. From protrusive movements the software of the device automatically calculated the left and the right sagittal condylar inclination values used for setting of the articulator. The mean sagittal condylar inclination value was 41.0° (SD 10.5) for the right joint and 40.7° (SD 9.8) for the left joint. The maximum value was 65.0° for the right and 68.6° for the left joint, and the minimum value was 13.7° for the right and 21.7° for the left joint. The results of this study suggested the average articulator setting for sagittal condylar inclination for fully dentate adult subjects to be 40° in relation to Camper’s plane. This is especially important for the articulators that are set up in relation to Camper’s plane.Cilj istraživanja bio je proučavanje vrijednosti kuta nagiba kondilne staze unutar jednoličnog uzorka (klasa I. po Angleu) koristeći registraciju definiranu artikulatorom i Camperovu ravninu kao referentnu ravninu. Istraživanje je provedeno na uzorku od 58 ispitanika (prosjek godina 25,1; SD 3,1). Mjerenja su izvedena pomoću ultrazvučnog uređaja za snimanje kretnji donje čeljusti na temelju šest stupnjeva slobode. Nakon što se pričvrstila paraokluzijska žlica svaki ispitanik je izveo po tri kretnje protruzije, lijeve i desne laterotruzije. Iz protruzijske kretnje program uređaja je automatski izračunao vrijednosti lijevog i desnog kuta nagiba kondilne staze koje se koriste za individualizaciju artikulatora. Prosječna vrijednost kuta nagiba kondilne staze iznosila je 41,0° (SD 10,5) za desni zglob i 40,7° (SD 9,8) za lijevi zglob. Maksimalna vrijednost iznosila je 65,0° za desni i 68,6° za lijevi zglob, dok je minimalna vrijednost iznosila 13,7° za desni i 21,7° za lijevi zglob. Rezultati ovoga istraživanja sugeriraju vrijednost kuta nagiba kondilne staze od 40° prema Camperovoj ravnini kod namještanja artikulatora prema prosječnim vrijednostima kod potpuno ozubljenih pacijenata. To pogotovo vrijedi za artikulatore vrijednosti kojih se postavljaju u odnosu na Camperovu ravninu

Influence of Occlusal Splint on Mandibular Movements in Patients with Bruxism: a Comparative Pilot Study

Svrha rada: Svrha ovog pilot-istraživanja bila je ispitati utjecaj terapije okluzijskom udlagom na granične kretnje donje čeljusti te položaj kondila kod ispitanika s bruksizmom. Materijal i postupci: U istraživanje je bilo uključeno 9 ispitanika s dijagnosticiranim bruksizmom (srednja dob 28,7 godina) i 9 ispitanika u kontrolnoj skupini (srednja dob 30,5 godina). Svi su bili punoljetni, eugnati s dentoalveolarnom klasom I prema Angleu, bez postojećih protetičkih radova, bez prijašnje ili sadašnje ortodontske terapije, prijašnjih kirurških zahvata u području temporomandibularnog zgloba te bez neke sistemske bolesti. Za sve ispitanike u objema skupinama izrađena je relaksacijska okluzijska udlaga standardiziranim postupkom koju su nosili 8 tjedana. Za to su vrijeme obavljena, uz inicijalno, još 3 mjerenja incizalnog otvaranja (IO), otvaranja lijevog kondila (OLC), otvaranja desnog kondila (ORC), lijeve laterotruzije (LLI) i desne laterotruzije (LRI) (nakon 2, 4 i 8 tjedana), koristeći se ultrazvučnim uređajem za snimanje kretnji donje čeljusti Arcus Digma II (Kavo). Istim uređajem ispitana je promjena položaja kondila pri protruziji, lijeve i desne laterotruzije te u položaju centrične relacije (CR) na početku istraživanja i zatim nakon 8 tjedana koristeći se položajem maksimalne interkuspidacije kao referentnim. Kontinuirane varijable opisane su s pomoću osnovnih statističkih parametara, a statistička značajnost razlika između varijabli provjerena je t-testom i χ2 testom (p < 0,05). Rezultati: Vrijednosti za IO, OLC, ORC, LLI LRI povećane su nakon 8-tjednog nošenja udlage te je najveće povećanje zabilježeno kod OLC-a –- za 13,8 %. Ni za jednu promjenu iznosa graničnih kretnji nije utvrđena statistički značajna razlika (p < 0,05). Promjene položaja kondila pri protruziji, lijeve i desne laterotruzije te u položaju centrične relacije (CR) bile su veće u ispitnoj skupini u 10 od 14 mjerenih parametara u odnosu prema kontrolnoj skupini te je u 5 od 14 mjernih parametara ustanovljena statistič-ki značajna razlika nakon terapije udlagom. Zaključak: U ovom pilot-istraživanju dokazan je utjecaj terapije udlagom na granične kretnje mandibule kod ispitanika s bruksizmom povećanjem raspona kretnji. Također je utvrđena veća promjena položaja kondila kod ispitanika s bruksizmom u odnosu prema zdravima.Objective: The objective of this pilot study was to examine the impact of occlusal splint treatment on mandibular border movements and the condyle position in subjects with bruxism. Material and methods: The study included 9 subjects diagnosed with bruxism (mean age 28.7) and 9 subjects in the control group (mean age 30.5). All subjects were adults, eugnathic, and with a dentoalveolar Angle Class I, without prosthetic restorations, previous or current orthodontic treatments, a systemic disease or previous surgical interventions in the temporomandibular joint. All experimental and con-trol group subjects were provided with a standardized relaxation occlusal splint, which they wore for 8 weeks. During this time, an initial and three additional measurements of incisal opening (IO), left condyle opening (OLC), right condyle opening (ORC), left laterotrusion (LLI) and right laterotrusion (LRI) (after 2, 4 and 8 weeks) were performed using an Arcus Digamma II (Kavo) ultrasound device for mandibular movements recording. Using the same instrument, the condylar position during protrusion, left and right laterotrusion, and in the centric relation position (CR) was analyzed initially and after 8 weeks using the maximum intercuspation as reference point. Continuous variables were described using basic statistical parameters, and the statistical significance of differences between the variables was checked by the t-test and χ2 test (p <0.05).Results: The values of IO, OLC, ORC, LLI and LRI increased after 8 weeks of wearing, with the highest increase for OLC, by 13.8%. No statistically significant difference (p <0.05) was found for any changes in movements. Changes in the condyle position during all movements and those in the CR were higher in the experimental group for 10 out of 14 measured parameters compared to the control group. A statistically significant difference was established for 5 out of 14 measured parameters after the occlusal splint treatment. Conclusions: The results of this pilot study have proven the influence of the occlusal splint treatment on mandibular border movements in subjects with bruxism by increasing the range of movements. Also the changes of the condyle position in subjects with bruxism were greater compared to those in healthy subjects

Radiological characteristics of osteoarthritis of temporomandibular joint without disc displacement

Background and Purpose: Radiological findings were compared between the patients with osteoarthritis (OA) of temporomandibular joint (TMJ) and asymptomatic volunteers. Materials and Methods: OA was diagnosed in 16 patients (mean age 46.9, 69% women) with disc displacement. A second group consisted of 20 selected dental school students without any clinical signs or history of temporomandibular joint disorders. The inclusion criteria for patients comprised pain referred to the TMJ and/or crepitation. Magnetic resonance imaging was used in this study for all subjects. Results: There is no statistical difference between degenerative changes of the condyle of TMJs with and without clinical signs of OA (p>0.05). In 30% of osteoarthritic joints, flattening of condylar joint surfaces was observed and 58.3% of the joints were without clinical signs ofOA. Sclerosis of the condyle was found in 30% of the joints and osteophyte formation in 15% of joints withOA. Moderate shape loss and severe sclerosation of the articular eminence were observed in two students in TMJs bilaterally – there is no difference between patients’ TMJs with and without OA (p>0.05). Pronounced shape loss and severe sclerosation of the articular eminence were found in 10 (50%) joints with OA. Conclusions: Scleroses of the condyle and osteophyte formation were the most common imaging findings of TMJs with OA. However, in asymptomatic volunteers only minimal bone changes were considered normal

Prevalence of Torus Palatinus and Torus Mandibularis in the Split-Dalmatian County, Croatia

Torus palatinus (TP) and torus mandibularis (TM) are non-pathological outgrowths of unclear etiology that develop from the jaw bone. The purpose of the present study was to report on the prevalence, shape and location of TP and TM in the population of the Central Dalmatian region, Croatia. The study comprised of 1679 subjects, 985 females and 694 males, age range from 9 to 99 years who were examined by clinical examination and analysis of the plaster casts. Torus palatinus was found in 42.9% subjects and torus mandibularis in 12.6% of the subjects. Spindle-shaped torus palatinus was the most frequent type (45.6%). The most frequent type of torus mandibularis was bilateral solitary torus mandibularis (35.4%). Furthermore, torus palatinus was found in 40.1% of the total number of females and in 46.8% of the total number of males, indicating a significantly higher prevalence in the male population (p=0.006). Torus mandibularis was found in 11.3% of the female population and in 14.6% of the male population, again indicating significantly higher prevalence in the male population (p=0.046). The results of this study show significantly higher prevalence of torus palatinus and torusmandibularis in themale subjects. Furthermore, no differences in the prevalence of either TM or TP regarding age were found

Movements of Temporomandibular Condyles during Swallowing

There have been studies that investigated mandibular movements and positioning during swallowing, but the results were inconsistent, and still the exact position of the condyles during swallowing is unknown. The purpose of this investigation was to study the kinematics of the mandible and the condyles, and to determine the actual movement paths and position of mandible and condyles during the process of swallowing. The study was performed on a sample of 44 dental students. Measurements were done with an electronic axiograph. After non-occlusing attachment was fi xed in the mouth, every subject swallowed for fi ve times from the rest position. The fi nal swallowing position of the left and the right condyles was measured in the sagittal plane. The fi nal swallowing position of the sagittal incisal point was measured in sagittal, frontal and horizontal plane, and data was statistically analyzed. The condyles showed average movement toward posterior (left 0.17 mm, SD 0.28, right 0.16 mm, SD 0.25) and superior (left 0.14 mm, SD 0.20, right 0.14 mm, SD 0.23). Anterior and/or inferior position had 20% of participants. The average sagittal incisal point movement during swallowing was toward anterior (0.30 mm, SD 0.53) and superior (0.81 mm, SD 0.84). The mean mandibular lateral movement was 0.1 mm (SD 0.1). The results of the study suggest that retrusion during swallowing is not the rule, although on average there is a slight tendency of condylar movement toward posterior. Swallowing can be used as auxiliary method for determining vertical dimension of occlusion