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.)

Variabilitatea ritmului cardiac la pacienţii cu migrenă cronică

A fost studiată variabilitatea ritmului cardiac (VRC) la 109 pacienţi cu migrenă cronică (MC) și 61 de pacienţi cu migrenă frecventă (MF), prin 3 metode: analiza spectrală, time domain și pulsometria variaţională. Raportul activităţii sistemului nervos vegetativ (SNV) simpatic și celui parasimpatic – indicele LF/HF a fost statistic semnificativ mai înalt la pacienţii cu MC în raport cu MF (1,50±0,36 vs. 0,63±0,09,

Neuropatia cu implicarea fibrelor mici: Studiu clinico-electrofiziologic

Neuropatia cu implicarea fi brelor mici este un subtip al neuropatiei senzoriale cu care debutează orice neuropatie senzorială sau senzorimotorie. Este importantă stabilirea factorului etiologic al neuropatiei, fapt ce ar putea preveni evoluţia progresivă a neuropatiei și implicarea ulterioară a fibrelor groase în procesul patologic. La un lot de 56 de pacienţi cu polineuropatie cu afectarea fibrelor mici a fost studiat posibilul factor etiologic care a declanșat polineuropatia. Implicarea fi brelor mici a fost demonstrată prin răspuns simpatic cutanat și prin teste vegetative periferice. Cercetările au relevat că la 16 bolnavi (28,57%) era patologic modificată toleranţa la glucoză. La 4 pacienţi (7,14%) primar am depistat diabetul zaharat. În 8 cazuri (14,29%) neuropatia putea fi asociată cu abuzul de alcool. În alte 8 cazuri polineuropatia putea fi indusă de acţiunea substanţelor toxice. 4 pacienţi (7,14%) au dezvoltat sindromul algic polineuropatic după suportarea unei infecţii virale acute. În 2 cazuri (3,57%) declanșarea neuropatiei putea fi asociată cu carenţele datorate dietelor specifice, indicate în pancreatitele cronice. Neuropatia cu afectarea fi brelor mici este datorată influenţei mai multor factori patologici, rolul principal atribuindu-i-se diabetului zaharat. Este necesară efectuarea testului de toleranţă a glucozei la fi ecare pacient cu polineuropatie

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)

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

The dynamic transcranial micropolarisation – a new alternative method of treatment of psycho-vegetative disturbances

Catedra Medicina Alternativă şi Complementară USMF “Nicolae Testemiţanu”It is for the first time represented the information about a new method of correction of the psyho - vegetative disturbances of different etiology – dynamic transcranial micropolarisation. It was analyzed the differentiated application of this method in correlation with clinical manifestations and coherent analysis of the alpha-rythm of the different regions of the brain. It were proposed electro-physiological criteria for individual treatment (deviation grade, intrahemispheric/interhemispheric asymmetry level). The efficiency of the proposed method is illustrated by clinical case. În lucrare, în premieră, este expusă informaţia referitor la o metodă nouă de corecţie a dereglărilor psihovegetative de diferită etiologie – micropolarizarea transcraniană dinamică şi se analizează aplicarea diferenţiată a acestei metode în baza manifestărilor clinice şi analizei de coerenţă a alfa-ritmului în diferite regiuni ale creierului. Se propun criteriile electrofiziologice pentru individualizarea tratamentului (gradul de deviere de la normă, nivelul de asimetrie intraemisferică/interemisferică). Eficienţa metodei elaborate este ilustrată prin caz clinic

Auricular acupuncture and the neurochemical indexes of convulsive activity

State University of Medicine and Pharmacy „Nicolae Testemiţanu”, 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 Auricular acupuncture (AA) is applied in the complex treatment of convulsive syndrome. Currently there are multiple hypotheses that propose the involvement of neurochemical cerebral mechanisms in the anti-convulsive actions of AA. Purpose The study of AA’s influence on monoamine concentrations in different cerebral structures in animals with experimental convulsive activity. Material and methods The study was conducted on white rats from the Wistar line (n=100) where the syndrome of tabagic abstinence was modelled, and the cerebral convulsive activity was monitored through EEG. Monoamines were determined via the CLIR method in the hypothalamus, midbrain and the spinal bulb. The ear acupuncture points with a decreased skin electrical resistance were stimulated. Results After performing AA a noradrenaline (NA) drop (compared to initial indexes), was registered in the: hypothalamus by 32% (p<0,01); midbrain by 49% (p<0,001) and the spinal bulb by 27% (p<0,001). Dopamine (DA) levels had risen in the hypothalamus by 49% (p<0,001) and in the spinal bulb by 55% (p<0,001). Serotonin (5-HT) had no significant changes in the studied cerebral structures (p>0,05). After AA stimulation, a tendency to normalize the EEG picture was registered, with a significant reduction of the paroxysmal index (p<0,05). Conclusions In the experimental animals, AA had reduced convulsive activity in parallel with the differentiated activity of the neurochemical indexes: NA – decreased, DA – increased, 5-HT – no significant changes

Acupunctura auriculară la pacienții cu astm bronșic și dereglări anxioase

Background. Anxiety disorders in patients with bronchial asthma have a negative impact on their quality of life and create difficulties in treatment. Currently, for this category of patients, different variations of acupuncture are indicated, along with the application of psychotropic remedies. Objective of the study. The study of auricular acupuncture’s anxiolytic effect in patients with bronchial asthma, depending on the predominance of sympathetic / parasympathetic autonomic tonus. Material and Methods. Vein’s diagnostic tables (autonomic disorders), Spielberger-Hanin questionnaire (anxiety levels), spectral analysis of cardiac rhythm (autonomic tonus) were applied. Patients were divided into 2 groups: I – sympathetic (n=24), II – parasympathetic (n=24). These acupoints were stimulated: Lung, Sympathetic Nervous System, Shenmen, Zero. The Student’s t-test was applied for coherent selections. Results. Anxiety levels before treatment: group I – 51,13±2,19 points, group II – 48,8±3,15 points. After applying AA, anxiety levels had significantly dropped (p<0,01) compared to indexes before treatment (group I - Δ1, group II - Δ2), at all stages of the investigation: after the first procedure Δ1 = –8,58, Δ2 = –6,0; after a 10-day treatment Δ1 = –15,5, Δ2 = –18,17; over 30 days after completing the treatment Δ1 = –15,25, Δ2 = –18,42. The autonomic equilibrium indexes (LF/HF) at each phases of investigation had pronounced tendencies of normalization at the end of the treatment (10 days), being statistically significant (p<0,05). Conclusion. In patients with bronchial asthma, AA had a moderate effect on autonomic system and a pronounced anxiolytic effect indifferent of the predominance of the autonomic tonus (sympathetic / parasympathetic). The obtained effects were maintained in the following 3-4 weeks. Introducere. Tulburările anxioase la pacienții cu astm bronșic au un impact negativ asupra calității vieții, crează dificultăți în tratamentul maladiei. Actualmente, la această categorie de pacienți, de rând cu aplicarea remediilor psihotrope, se indică diferite variante de acupunctură. Scopul lucrării. Studierea efectului anxiolitic al acupuncturii auriculare (AA) la pacienţii cu astm bronşic în funcție de predominarea tonusului autonom simpatic/parasimpatic. Material și Metode. S-au aplicat tabele diagnostice Vein (dereglăti autonome), chestionarul Spilbergher-Hanin (nivelul anxietății), analiza spectrală a ritmului cardiac (tonusul autonom). Pacienţii au fost divizați în 2 loturi: I – simpaticotonic (n=24), II – vagotonic (n=24). S-au stimulat acupunctele: plămân, sistem nervos simpatic, Shenmen, Zero. S-a aplicat criteriul T (Student) pentru selecţii coerente. Rezultate. Expresia anxietății până la tratament: lotul I – 51,13±2,19 puncte, lotul II – 48,8±3,15 puncte. După aplicarea AA, anxietatea în comparație cu indicii până la tratament (lotul I – Δ1, lotul II – Δ2), a diminuat semnificativ (p<0,01) la toate etapele de investigație: după prima procedură Δ1 = –8,58, Δ2 = –6,0; după 10 zile tratament Δ1 = –15,5, Δ2 = –18,17; peste 30 zile după finisarea tratamentului Δ1 = –15,25, Δ2 = –18,42. Indicele echilibrului autonom (LF/HF) la toate etapele de investigație a avut tendințe pronunțate de normalizare, fiind statistic semnificativ (p<0,05) la finele curei de tratament (10 zile). Concluzii. La pacienții cu astm bronșic, AA a avut acțiune vegetotropă moderată și anxiolitică pronunțată indiferent de predominarea tonusului autonom (simpatic/parasimpatic) cu menținerea efectelor obținute în următoarele 3-4 săptămâni