323.01 - Stomatology: Summary of Doctor of Medical Sciences Thesis

The actuality of the subject. Temporomandibular disorders (TMD) are a collective term used for conditions characterized by pain and/or dysfunction of the masticatory muscles and/or the temporomandibular joint [1]. TMD have a significant economic impact – more frequent visits to medical service providers (on average 8.3±9.0 visits/6 months); high costs of medical care (in the USA – $4 billion annually) [2], significant impact on work capacity (annual losses of 17.8 million work-days/100 million people), as well as decrease in work quality (on average 12% decrease in productivity) [3]. Based on WHO data, TMD is the most common non-dental orofacial pain, the second most common musculoskeletal condition, and the third most common dental pathology [2]. In the general population, the prevalence of clinical forms of TMD is estimated to be between 7-31%, with the highest frequency of TMD occurring in women and in the 20-40 years age group [4]. Masticatory muscle dysfunctions remain an unsolved issue in terms of diagnosis and therapy, because it is based on multiple etiologies and multiple pathogenetic mechanisms, which interact in various ways, depending on the association of psychological disorders and the generalization of clinical manifestations. Currently, masticatory muscle dysfunctions are also approached within the concept of central sensitization, which opens up new possibilities in the diagnosis and interpretation of the etiopathogenesis of disorders in this category of patients. Some signs and symptoms may resolve spontaneously even without any intervention, while others may persist for years despite all management options being exhausted. Although for the standardization of the diagnostic process, the use of the DC/TMD protocol is currently recommended, the variety of clinical manifestations of the masticatory muscle dysfunctions requires the completion of diagnostic procedures both in the aspect of differentiating the clinical forms as well as taking into account the aspect of generalization and individualization. In the clinical approach to masticatory muscle dysfunctions, extensive and optimal criteria for diagnosing and monitoring the pathology have not yet been developed, attesting to a slow translation of scientific evidence into the clinical practice. [...

Etiopathogenetic aspects in the dysfunction of the masticatory muscles

Rezumat Disfuncţiile mușchilor masticatori reprezintă patologii clinice, caracterizate prin durere persistentă în mușchii masticatori. Incidenţa cea mai mare este între vârsta de 20 și 40 de ani, și se întâlnește preponderent la femei. Pe parcursul timpului, mai multe teorii etiologice au încercat să explice apariţia și dezvoltarea maladiei. Actualmente disfuncţia este privită prin prisma modelului integrat de adaptare la durere și a teoriei biopsihosociale. Sunt descriși numeroși factori și variabile, care își aduc aportul la apariţia, dezvoltarea și agravarea patologiei, printre care factori de mediu, psihologici, genetici, constituţionali, neurologici etc. Studierea pe larg a acestora va conduce la modificarea tratamentului acordat pacienţilor cu disfuncţii prin aplicarea abordărilor medicinii multidisciplinare, integrate și individualizate.Summary The masticatory muscles dysfunctions represent clinical pathologies, characterized by persistent pain in the masticatory muscles. The highest incidence is between the ages of 20 and 40, and is more prevalent in women. Over time, several etiological theories have tried to explain the occurrence and the development of the disease. Currently, the dysfunction is viewed through the integrated pain adaptation model and the biopsychosocial theory. Numerous factors and variables are described, which contribute to the onset, development and aggravation of the pathology, among which: environmental, psychological, genetic, constitutional, neurological factors etc. Their extensive study will lead to the modification of the treatment granted to patients with dysfunctions by applying the approaches of multidisciplinary, integrated and individualized medicine

323.01 - Stomatologie: Rezumat al tezei de doctor în științe medicale

Actualitatea temei. Dereglările temporomandibulare (DTM, engl. temporomandibular disorders) reprezintă un termen colectiv utilizat pentru patologiile, caracterizate prin durere și/sau disfuncție a mușchilor masticatori și/sau articulației temporomandibulare [1]. DTM au un impact economic semnificativ – vizite mai frecvente la prestatorii de servicii medicale (în medie 8.3±9,0 vizite/6 luni); costuri ridicate ale asistenței medicale (în SUA – 4 miliarde $ anual) [2], impact semnificativ asupra capacității de muncă (pierderi anuale de 17.8 milioane zile-lucru/100 milioane persoane), cât și a calității acesteia (în mediu 12% scăderea productivității) [3]. În baza datelor OMS, DTM reprezintă cea mai frecventă algie orofacială non-dentară, a doua cea mai frecventă afecțiune musculo-scheletică și a treia cea mai frecventă patologie stomatologică [2]. În populația generală, prevalența formelor clinice de DTM este estimată a fi între 7-31%, cu cea mai înaltă frecvență a DTM se observă la femei și în grupul de vârstă 20-40 de ani [4]. Disfuncțiile mușchilor masticatori rămân o problemă puțin soluționată în aspect diagnostic și terapeutic, deoarece la baza acesteia stau multiple etiologii și multiple mecanisme patogenetice, care interacționează variat, depinzând de asocierea dereglărilor psihologice și a generalizării manifestărilor clinice. Actualmente, disfuncțiile mușchilor masticatori sunt abordate și în cadrul conceptului de sensitizare centrală (central sensitization), ceea ce deschide noi posibilități în diagnosticul și interpretarea etiologiei ;i patogenezei dereglărilor la această categorie de pacienți. Unele semne și simptome se rezolvă spontan chiar și fără intervenție, în timp ce altele persistă ani de zile, în ciuda faptului că toate opțiunile de management sunt epuizate. Deși pentru standardizarea procesului diagnostic, este recomandată utilizarea protocolului DC/TMD, varietatea manifestărilor clinice ale disfuncțiilor mușchilor masticatori impune completarea procedurilor de diagnostic atât in aspectul diferențierii formelor cat si in aspectul de generalizare și focalizare a disfuncțiilor. În cadrul abordării clinice a disfuncțiilor mușchilor masticatori nu sunt încă elaborate criterii extensive și optime de diagnostic și monitorizare a patologiei, atestându-se o translare lentă a dovezilor științifice în activitatea practică a medicilor stomatologi. [...

323.01 – Stomatologie: Teză de doctor în științe medicale

Structura tezei. Textul tezei este expus pe 120 pagini text de bază, procesate la calculator, fiind constituită din: lista abrevierilor, introducere, 5 capitole, concluzii generale, recomandări practice, bibliografia din 288 surse și 4 anexe. Materialul ilustrativ include 23 tabele, 15 figuri și 7 formule. Cuvinte-cheie: dereglări temporomandibulare, disfuncții a mușchilor masticatori, indici clinico-fiziologici, diagnostic. Domeniul de studiu: 323.01 – Stomatologie. Scopul lucrării: Studierea particularităților disfuncțiilor mușchilor masticatori (varianta clinică, faza bolii) în baza suplinirii protocolului DC/TMD cu indici clinico-fiziologici locali, regionali și sistemici. Obiectivele cercetării: Studierea activității sistemului stomatognat la pacienți cu disfuncții a mușchilor masticatori în funcție de faza bolii și varianta clinică. Evidențierea în baza analizei matematico-statistice a tiparelor distincte ale dereglărilor mușchilor masticatori în baza indicilor clinico-fiziologici locali, regionali, sistemici și potențialul impact terapeutic al gutierelor ocluzale în reabilitarea funcționalității sistemului stomatognat. Studierea particularităților dereglărilor generalizate în cadrul subtipurilor clinice ale disfuncției mușchilor masticatori. Studierea performanței masticatorii în baza indicilor subiectivi și obiectivi în diferite subtipuri clinice ale disfuncției mușchilor masticatori. Elaborarea parametrilor integrali de apreciere a manifestărilor algice în sistemul stomatognat la pacienți cu disfuncții ale mușchilor masticatori. Noutatea și originalitatea științifică: În premieră, au fost evidențiați indicii activității sistemului stomatognat, statistic semnificativ asociați cu varianta clinică a disfuncției mușchilor masticatori, faza bolii și indicii comuni ambelor criterii. Pentru prima dată, în baza analizei matematico-statistice, au fost identificate manifestările clinice, care diferențiază pacienții cu disfuncții ale mușchilor masticatori în 2 tipare distincte (regională, regional-generalizată) în baza extinderii și severității dereglărilor. Structura și severitatea indicilor cantitativi și calitativi ai disfuncțiilor mușchilor masticatori sunt în dependență de fenomenul de fibromyalginess. Aprecierea funcției masticatorii necesită evaluarea concomitentă a indicilor obiectivi și subiectivi, care descriu aspecte diferite ale performanței masticatorii la pacienți cu disfuncții ale mușchilor masticatori. Pentru prima dată, a fost demonstrat că hipersensibilitatea senzorială este un criteriu informativ, caracteristic subtipurilor clinice de disfuncții ale mușchilor masticatori. Pentru prima dată, s-a propus metoda de cartografiere a mușchiului maseter cu aprecierea indicelui de heterogenitate relativă a hărții algice, care permite o abordare nouă și informativă a disfuncțiilor mușchilor masticatori. Pentru prima dată, s-a demonstrat că modelarea stresului operațional permite evidențierea modificării toleranței și rezistenței algice a mușchiului maseter, care nu se modifică esențial în condiții de confort relativ la pacienții cu disfuncții ale mușchilor masticatori, fapt care evidențiază anumite particularității ale conexiunii stresului și a manifestărilor locale ale durerii. Importanța practică: Structura tabloului clinic și expresia indicilor clinico-fiziologici a disfuncției mușchilor masticatori depinde de varianta clinică, faza bolii și prezența generalizării simptomelor. Aprecierea diferențiată a funcției masticatorii se poate realiza prin indici subiectivi și obiectivi la aplicarea testului de apreciere a abilității de mixare la pacienții cu disfuncții ale mușchilor masticatori. Personalizarea diagnosticului disfuncțiilor mușchilor masticatori în funcție de faza bolii, varianta clinică se poate realiza în baza indicilor hipersensibilității senzoriale. A fost determinată valoarea diagnostică a modelării experimentale a stresului operațional și impactul acestuia asupra indicilor cantitativ-senzoriali la pacienți cu disfuncții ale mușchilor masticatori. În premieră, a fost elaborată tehnologia de examinare loco-regională a durerii, prin analiza heterogenității distribuției spațiale a sensibilității mecanice algice a mușchiului maseter. Implementarea rezultatelor științifice. Rezultatele cercetărilor științifice au fost implementate în procesul de cercetare, activitate metodologică și clinică în Clinica stomatologică Fala Dental, Clinica stomatologică Megalux Dent, IM Centrul Stomatologic Municipal, în procesul didactic de instruire la Catedra de Stomatologie terapeutică a USMF ”Nicolae Testemițanu”. [...]Структура диссертации. Текст диссертации представлен на 120 основных текстовых страницах, обработанных на компьютере и состоящих из: списка сокращений, введения, 5 глав, общих выводов, практических рекомендаций, библиографии из 288 источников и 4 приложений. Иллюстративный материал включает 23 таблицы, 15 рисунков и 7 формул. Ключевые слова: височно-нижнечелюстные расстройства, дисфункции жевательных мышц, клинико-физиологические показатели, диагностика. Область изучения: 323.01 – Стоматология. Цель работы: Изучение особенностей дисфункций жевательных мышц (клинический вариант, фаза заболевания) на основе пополнения протокола DC/TMD с локальными, региональными и системными клинико-физиологическими показателями. Научно-исследовательские цели: Изучение активности стоматогнатической системы у больных с дисфункцией жевательных мышц в зависимости от фазы заболевания и клинического варианта. Выделение на основе математико-статистического анализа различных паттернов нарушений жевательной мускулатуры по локальным, региональным, системным клинико-физиологическим показателям и возможного лечебного воздействия окклюзионных сплинтов на восстановление функциональности стоматогнатической системы. Изучение особенностей генерализованных расстройств в рамках клинических подтипов дисфункции жевательных мышц. Изучение жевательной функции на основе субъективных и объективных показателей при различных клинических подтипах дисфункции жевательных мышц. Разработка интегральных показателей для оценки болевых проявлений в стоматогнатической системе у больных с дисфункцией жевательных мышц. Научная новизна и оригинальность. Впервые выделены показатели активности стоматогнатической системы, статистически значимо связанные с клиническим вариантом дисфункции жевательных мышц, фазой заболевания и показатели общими для обоих критериев. Впервые на основе математико-статистического анализа выделены клинические проявления, которые дифференцируют больных с дисфункцией жевательных мышц на 2 различных паттерна (региональный, регионально-генерализованный) в зависимости от протяженности и выраженности нарушений. Структура и выраженность количественных и качественных показателей дисфункции жевательных мышц зависят от явления фибромиалгизности. Оценка жевательной функции требует одновременной оценки объективных и субъективных показателей, которые описывают различные аспекты жевательной функции у пациентов с дисфункцией жевательных мышц. Впервые показано, что сенсорная гиперчувствительность является информативным критерием, характерным для клинических подтипов дисфункции жевательных мышц. Впервые предложен метод болевой картирования жевательных мышц с оценкой показателя относительной неоднородности болевой карты, что является новый и информативный подход к дисфункциям жевательных мышц. Впервые показано, что моделирования стрессовой нагрузки позволяет выделить изменение болевой толерантности и резистентности жевательной мышцы, существенно не меняющееся в условиях относительного комфорта у пациентов с дисфункцией жевательных мышц, что выявляет некоторые особенности связь стресса и его проявления в локализации боли. Практическая важность: Структура клинической картины и выраженность клинико-физиологических показателей дисфункции жевательных мышц зависят от клинического варианта, фазы заболевания и наличия генерализации симптомов. Дифференциальная оценка жевательной функции может быть достигнута по субъективным и объективным показателям при применении теста оценки жевательной способности к перемешиванию у пациентов с дисфункцией жевательных мышц. Персонализация диагностики дисфункций жевательных мышц в зависимости от фазы заболевания, клинического варианта может производиться на основании показателей сенсорной гиперчувствительности. Определена диагностическая ценность экспериментального моделирования стрессовой нагрузки и его влияния на количественно-сенсорные показатели у больных с дисфункцией жевательных мышц. Впервые разработана технология локо-регионального исследования боли путем анализа неоднородности пространственного распределения болевой механической чувствительности жевательной мышцы. Внедрение научных результатов. Результаты научных исследований были внедрены в исследовательский процесс, методологическую и клиническую деятельность в стоматологической клинике Fala Dental, Megalux Dent, в муниципальном стоматологическом центре, в дидактическом учебном процессе на кафедре терапевтической стоматологии ГУМФ «Николае Тестемицану». [...]Thesis structure. The text of the thesis is presented on 120 pages of basic text, processed on the computer, consisting of: list of abbreviations, introduction, 5 chapters, general conclusions, practical recommendations, bibliography from 288 sources and 4 appendices. The illustrative material includes 23 tables, 15 figures and 7 formulas. Keywords: temporomandibular disorders, masticatory muscle dysfunctions, clinical-physiological indices, diagnosis. Field of study: 323.01 – Stomatology. The purpose of the work: Studying the particularities of masticatory muscle dysfunctions (clinical variant, disease phase) based on the enhancement of the DC/TMD protocol with local, regional and systemic clinical-physiological indices. Research objectives: Study of the activity of the stomatognathic system in patients with dysfunctions of the masticatory muscles according to the phase of the disease and the clinical variant. Highlighting, based on the mathematical-statistical analysis, of the distinct clinical patterns of masticatory muscle disorders based on local, regional, systemic clinical-physiological indices and the potential therapeutic impact of occlusal splints in rehabilitating the functionality of the stomatognathic system. Studying the peculiarities of generalized disorders within the clinical subtypes of masticatory muscle dysfunction. Study of masticatory performance based on subjective and objective indices in different clinical subtypes of masticatory muscle dysfunction. Development of integral parameters for the assessment of pain manifestations in the stomatognathic system in patients with dysfunctions of the masticatory muscles. Scientific novelty and originality: For the first time, indices of the activity of the stomatognathic system were highlighted, that are statistically significantly associated with the clinical variant of masticatory muscle dysfunction, the phase of the disease and common indices for both criteria. For the first time, based on the mathematical-statistical analysis, the clinical manifestations were identified, which can differentiate patients with masticatory muscle dysfunctions into 2 distinct clinical patterns (regional, regional-generalized) based on the extent and severity of the disorders. The structure and severity of quantitative and qualitative indices of masticatory muscle dysfunctions are dependent on the phenomenon of fibromyalgianess. The assessment of masticatory function requires the simultaneous evaluation of objective and subjective indices, which describe different aspects of masticatory performance in patients with masticatory muscle dysfunction. For the first time, sensory hypersensitivity has been shown to be an informative criterion, characteristic of clinical subtypes of masticatory muscle dysfunction. For the first time, a masseter muscle pain mapping method was proposed with the assessment of the relative heterogeneity index of the pain map. For the first time, it has been shown that operational stress modeling allows highlighting the change in pain tolerance and resistance of the masseter muscle, which does not change essentially in relative comfort conditions in patients with masticatory muscle dysfunctions. Practical importance: The clinical structure and expression of masticatory muscle dysfunction depends on the clinical variant, the disease phase and the generalization of symptoms. Differentiated assessment of the masticatory function can be achieved by applying subjective and objective indices of the mixing ability assessment test in patients with masticatory muscle dysfunctions. Personalization of the diagnosis of masticatory muscle dysfunctions depending be made based on the indices of sensory hypersensitivity. The diagnostic value of experimental modeling of operational stress and its impact on quantitative-sensory indices in patients with masticatory muscle dysfunctions was determined. For the first time, a loco-regional pain examination technology was developed, by analyzing the heterogeneity of the spatial distribution of mechanical pain sensitivity of the masseter muscle. Implementation of scientific results. The results of scientific research were implemented in the research process, methodological and clinical activity at the Fala Dental Clinic, Megalux Dent Clinic, IM Municipal Dental Center, in the didactic training process at the Department of Therapeutic Dentistry of USMF "Nicolae Testemițanu". [...

Temporomandibular disorders: perspective clinical usage of acupuncture

Department of Alternative and Complementary Medicine, Department of Therapeutic Dentistry, Nicolae Testemițsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: One of the oldest medical practices is acupuncture, which was developed for about 3 thousand years. It includes also methods of treatment for various diseases and disorders of the stomatognathic region. Currently, there is an increased interest for the usage of these alternative methods of treatment. Acupuncture methods are widespread worldwide and are endorsed by WHO. The use of alternative medicine methods in dental practice has more positive aspects than negative ones, attracting the attention of patients and doctors and even of countries with different economic levels of development. The most important indications of acupuncture in dentistry are: 1) glossodynia; 2) stomatodynia; 3) primary trigeminal neuralgia; 4) spasm/contracture of the masticatory muscles; 5) myogenous dysfunction of the temporomandibular joint; 6) salivary disorders. For the treatment of various pathologies in dentistry, various stimulation of acupuncture points is being used (needling, electro-puncture, laser-puncture, pressopuncture, thermo-puncture, magneto-puncture, etc.). Currently, there is ongoing research on defining differential indications for these methods, based on the highest efficiency for particular pathologies. Conclusions: Currently, there is ongoing research on defining differential indications for these methods, based on the highest efficiency for particular pathologies. It is not concluded yet which acupuncture treatment is more efficient: the one based on the reflexogenic theory (local, regional, distal points) or the one based on Traditional Chinese Medicine (meridian theory, etc.). There are being developed complex treatment protocols for dental pathologies, with the inclusion of various acupuncture methods (magneto-puncture, laser-puncture, etc.)

Objective assesment of sympathetic electrodermal activity in patients with masticatory muscle pain

Background: Masticatory muscle pain is associated with autonomic disorders of different intensity; their identification leads to a more accurate diagnosis and a differentiated treatment. Currently, various scales and autonomic tests are used for this purpose, as well there are being developed neurophysiological diagnostic methods. For this purpose, electrodermal activity is being studied since the 1950s, which currently is further advancing due to modern recording and information processing technologies. The aim of the studywas objective assessment of sympathetic nervous system activity (tonus, provisioning) in patients with masticatory muscle pain, with the application of the spectral analysis of electrodermal activity. Material and methods: Thirty-four female patients with masticatory muscle pain were enrolled in the study. NeuroMEP (Neurosoft) diagnostic system was used to record electrodermal activity. For the assessment of the autonomic tone (rest) and autonomic provisioning (maxillary clenching test) there were used EDASymp, EDASympn, meanTVSymp, minTVSymp, maxTVSymp sympathetic indices, identified experimentally at the University of Connecticut (USA). Results: The comparative analysis of the indices has shown that EDASympn and meanTVSymp are reproducible and characterize the activity of the sympathetic system during the rest and maxillary clenching. The range of values of sympathetic indices at rest/maxillary clenching were: EDASympn (0.222 – 0.668/0.360 – 0.4872 u.n.) and meanTVSymp (0.883 – 1.015/1.055 – 1.245). Conclusions: EDASympn (normalized sympathetic component of the electrodermal activity) and meanTVSymp (index of sympathetic tone) sympathetic indices allow the objective assessment of the activity of the sympathetic nervous system, being reproducible in patients with myalgias

Anxiety and sympathetic skin responses in patients with masticatory muscle pain

Background: An important clinical aspect of masticatory muscle pain is its association with autonomic disorders and various mental states. Sympathetic skin response is a non-invasive approach for assessing sympathetic system function, allowing the determination of several autonomic indices (amplitudes), but their clinical interpretation is difficult. The aim of the study was to differentiate variants of sympathetic skin response and their correlations with the level of anxiety and pain intensity in patients with masticatory muscle pain. Material and methods: There were enrolled 46 patients with masticatory muscle pain who were examined in standardized conditions with NeuroMEP (Neurosoft) for assessing sympathetic skin responses (SSR) – sympathetic amplitude (A2). There were used cutoffs for different SSR variants: 1) V1 – optimal A2 = 3.34 – 3.5 mV; 2) V2 – amplified A2 ≥ 3.51 mV; 3) V3 – diminished A2 ≤ 3.33 mV. There were used clinical indices: GAD7 questionnaire (anxiety level), CPI index (Characteristic Pain Intensity). Results: There were observed the following variants in patients with masticatory muscle pain: V1 – 16 patients (34.78%); V2 – 25 patients (54.35%); V3 – 5 patients (10.87%). Patients with V2 variant had higher levels of anxiety (mean GAD7 score = 17.1): 1) severe anxiety – 17 patients (68%); 2) moderate anxiety – 7 patients (28%); 3) low anxiety – 1 patient (4%). V2 variant patients also had higher mean CPI values (54.1 – high intensity pain). Conclusions: There were observed different variants of sympathetic response in patients with masticatory muscle pain, the amplified variant correlated with more serious clinical indices (higher anxiety and pain intensity)

Bruxism and its cofactors: psychoemotional, vegetative and motor aspects

Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, Department of Alternative and Complementary Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Bruxism is a parafunctional activity, consisting of excessive teeth grinding and jaw clenching. It affects at least 15-20% of the general population, and it is estimated that 85-90% of people experience at least one episode of bruxism during their lifetime. Awake bruxism has a higher prevalence in women, in contrast to sleep bruxism, that is more prevalent in men. The objectives of our research are the following: analyzing the quantitative indices of awake bruxism under the influence of stress, nicotine, caffeine and alcohol; assessing the diagnostic possibilities for the fractal analysis of cardiac rhythm. Materials and methods: There were studied 19 patients with awake bruxism and 19 persons without bruxism. The influence of bruxism cofactors was quantified. There were analyzed the quantitative indices of bruxism, the EMG activity of the masseter muscle and the fractal analysis indices of the heart rate (sample entropy - SampEn, correlation dimension – D2). There were used the Polispectr- Ritm, Neuro-MVP diagnostic equipment and the Sleep Guard SG5 device (USA). Results: All the studied cofactors had a higher intensity in bruxers than in non-bruxers, with the highest statistical significant difference observed for emotional stress (p˂0,001) and alcohol consumption (p˂0,01). Bruxers are more likely to smoke more cigarettes than non-bruxers (p˂0,02). Caffeine consumption is two-fold higher for bruxers in comparison to non-bruxers (p˂0,03). The surface electromyography has shown changes under the influence of all cofactors, the highest Amax value was recorded under the influence of alcohol (p˂0,01). The lowest influence on the bioelectrical activity ofthe masseter muscle was observed for caffeine and nicotine. The most significant changes (p˂0,05) for SampEn index were observed under the influence of alcohol. For the D2 index, the influence of alcohol and stress are more significant (p˂0,001) in comparison to nicotine and caffeine (p˂0,05). Conclusion: In patients with awake bruxism, the intensity of factors increases in the following order: caffeine˂nicotine˂alcohol˂stress; the number of episodes, their total duration and the bioelectric activity of masseter muscle increases under the action of the cofactors in the following order: alcohol˂nicotine˂caffeine˂stress. Differentiated evaluation of the action of daily cofactors in patients with awake bruxism can be achieved based on the fractal analysis of the heart rate, which reflects the peculiarities of quantitative manifestation of awake bruxism episodes

Periodontitis - target organ (heart) concept - an integrative medicine paradigm in modern periodontology

Rezumat În baza paradigmei medicinii integrative, a fost descris sistemul patologic parodontita - organ(cord) - ţintă și căile de interacţiune caracteristice ale acestui sistem (infecţioase, neurogene, humoral-metabolice, genetice). Este prezentată valoarea diagnostică a probei de masticaţie și de igienizare profesională în procesul de identificare a dereglărilor ischemice preclinice în miocard la pacienţii cu parodontită cronică. Ca urmare, a fost propus un algoritm pentru managementul interdisciplinar al pacienţilor cu parodontită cronică, bazat pe conceptul de parodontită - cord - ţintă.Summary Following the integrative medicine paradigm, the pathological system periodontitis - organ (heart) - target and the characteristic interaction pathways of this system (infectious, neurogenic, humoral - metabolic, genetic pathways) were described. It is outlined the diagnostic value of the masticatory test and of the full mouth disinfectionprocedure in the process of identifying the preclinical ischemic myocardial disorders for patients with chronic periodontitis. As a result, it was proposed an algorithm for the interdisciplinary management of patients with chronic periodontitis, based upon the concept periodontitis - heart - arget

Evaluation of different instruments for quantifying pain in patients with masticatory muscle pain

State University of Medicine and Pharmacy „Nicolae Testemiţanu”, Department of therapeutic dentistry, Department of alternative and complementary medicine, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction. The clinical diagnosis of masticatory muscle pain is usually made based on manual palpation of muscles and on the subjective reactions of patients, which creates difficulties in standardization. For this reason, different quantitative methods are proposed (scales for assessing pain sensations, algometry, etc.). The evaluation of pain intensity and recording of these values serves as the basis for an efficient and adequate treatment. Purpose: to evaluate the correlation between instrumental and clinical algometric indices. in people with masticatory muscle pain. Material and methods The design of the study was analytical prospective. There were enrolled 30 patients diagnosed according to international DC/TMD criteria and based on the presence of pain in m. temporalis or m. masseter for not less than 3 months prior to examination. Exclusion criteria: TMJ arthrogenic pain, articular degenerative disorders, dental pain, chronic systemic disorders, fibromyalgia, self-reported psychogenic disorders, pregnant women. There were used GCPS (CPI index), VAS scales and instrumental algometric indices (PPT, PTT). The correlation coefficients of the obtained indices were calculated based on Spearman rank coefficient. Results. Algometric values (PPT, PTT) for both muscles reversely correlate with VAS: values for masseter (-0.51, -0.63) and for temporalis (respectively -0.39, - 0.36) (Table 1). The correlation coefficient was negative, significant and strong. Values at manual palpation were in a negative correlation with the algometric values and in a positive correlation with VAS values, but with no significance. CPI values significantly correlate with algometric values (from - 0.47 to -0.58) and VAS values (0.70). Manual palpation was negatively correlated with algometric values and positively correlated with VAS values, but insignificant. Palpation of the masseter was significantly correlated with CPI values (0.51), while for the temporalis muscle, they were not statistically significant (0.19). There was observed that in individuals with a significant impairment, a lower pressure value caused pain, therefore, there is a negative significant correlation with the values of algometric values for both muscles. Conclusions. There was observed a mutual link between VAS and algometry, and that these are more objective and accurate than manual palpation. The application of different instruments for quantifying pain allows highlighting the personalized sensory-pain pattern of the masseter and temporalis muscles with new perspectives in the diagnosis and monitoring of pain