Headache Associated With Temporomandibular Disorders Among Young Brazilian Adolescents

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Epidemiology of Severity of Temporomandibular Disorders in Brazilian Women

Aims: To evaluate the severity of temporomandibular disorders (TMD) of women in the municipality of Araraquara (Brazil) as well as the contribution of the perception of oral health, mandibular functional limitation, and sociodemographic variables on the severity of TMD. Methods: The participants were interviewed by telephone. Information regarding age, marital status, economic level, education, and use and type of dental prostheses was surveyed. To evaluate TMD severity, mandibular functional limitation and perception of oral health, Fonseca's Anamnesic Index (IAF), the Mandibular Function Impairment Questionnaire (MFIQ), and the General Oral Health Assessment Index (GOHAI) were used. To evaluate the contribution of these variables on TMD severity, a structural equation model (SEM) was fitted to the data and assessed by usual goodness-of-fit indices. Results: A total of 701 women with a mean age of 44.36 years (SD = 16.31) participated. According to the IAF, 59.6% (95% confidence interval = 56.00%-63.2%) of the women were classified as having TMD, of which 63.9% presented light, 26.8% moderate, and 9.3% severe TMD. Mandibular functional limitation was low in 91.0% of the women, moderate in 7.1%, and severe in 1.9%. Goodness-of-fit for the structural model was adequate. The predictors explained 43% of the variation in the TMD severity, with significant contributions of the variables dental prostheses (beta = -.008; P = .006), perception of oral health (beta = -.43; P < .001), and mandibular functional limitation (beta = .014; P = 014). Conclusion: The severity of TMD among Brazilian women was greater in non-users of dental prostheses and was also associated with greater mandibular functional limitation and poor perception of oral health.

Factors associated with temporomandibular disorders pain in adolescents

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A survey of the management of patients with temporomandibular disorders by general dental practitioners in southern Brazil

Purpose: Temporomandibular disorders (TMD) are recognized as one of the mostcontroversial topics in dentistry, despite the fact that both basic science and clinicalresearchers have currently reached some degree of consensus. This study aimed toconduct a questionnaire-based survey about the management of TMD patients bygeneral dental practitioners (GDPs).Materials and Methods: One hundred fifty-one GDPs with a private practice in a cityof southern Brazil were included, independent of school of origin, gender, graduationyear, and curriculum content. All participants were administered a questionnaire aboutthe management of patients with TMD, and the responses were analyzed by binomialand chi-square tests (α = 0.05).Results: Of the GDPs, 88.7% received TMD patients, who were primarily diagnosedon the basis of medical history (36.6%) or physical examination (30.4%). Of these,65.4% referred the patients elsewhere, primarily to specialists in occlusion (36.1%) ororthodontics (29.7%). Occlusal splinting was the most commonly used managementmodality (20.8%), followed by occlusal adjustment (18.1%) and pharmacotherapy(16.6%). Splints were fabricated in maximum habitual intercuspation or centric re-lation depending on individual patient (54.8%). The hard stabilization form was themost common type of appliance used (35.0%). Moreover, 73.8% of the GDPs didnot employ semi-adjustable articulators, and 69.5% adjusted the appliances at thetime of fixing. The duration of splint use and the frequency of follow-up were con-sidered patient dependent by 62.1% and 72.8%, respectively. GDPs considered thetwo major TMD etiologic categories as multifactorial (20.8%) and occlusion (19.9%).Multidisciplinary medical and dental treatment was considered necessary by 97.9%.Conclusions: The evaluated general dental practitioners manage TMD patients ac-cording to international guidelines.

Association between painful temporomandibular disorders, sleep bruxism and tinnitus

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Temporomandibular disorders among Brazilian adolescents: reliability and validity of a screening questionnaire

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Lateral pterygoid muscle volume and migraine in patients with temporomandibular disorders

Lateral pterygoid muscle (LPM) plays an important role in jaw movement and has been implicated in Temporomandibular disorders (TMDs). Migraine has been described as a common symptom in patients with TMDs and may be related to muscle hyperactivity. This study aimed to compare LPM volume in individuals with and without migraine, using segmentation of the LPM in magnetic resonance (MR) imaging of the TMJ. Twenty patients with migraine and 20 volunteers without migraine underwent a clinical examination of the TMJ, according to the Research Diagnostic Criteria for TMDs. MR imaging was performed and the LPM was segmented using the ITK-SNAP 1.4.1 software, which calculates the volume of each segmented structure in voxels per cubic millimeter. The chi-squared test and the Fisher's exact test were used to relate the TMD variables obtained from the MR images and clinical examinations to the presence of migraine. Logistic binary regression was used to determine the importance of each factor for predicting the presence of a migraine headache. Patients with TMDs and migraine tended to have hypertrophy of the LPM (58.7%). In addition, abnormal mandibular movements (61.2%) and disc displacement (70.0%) were found to be the most common signs in patients with TMDs and migraine. In patients with TMDs and simultaneous migraine, the LPM tends to be hypertrophic. LPM segmentation on MR imaging may be an alternative method to study this muscle in such patients because the hypertrophic LPM is not always palpable.

Temporomandibular disorders in females: acupuncture compared to occlusal splint

To compare the effect of acupuncture and occlusal splint in the treatment of temporomandibular disorders (TMD) in female patients.Method: Forty-eight female patients (mean age of 39.3±6.8 years) with diagnosed pain in muscles or joint according to RDC/TMD criteria were attended at UNESP - Aracatuba Dental School. Including criteria were reported pain in the chewing muscles and/or in the temporomandibular joint measured by a visual analogue scale (range from 0 to 10) and a reported reduction of the maximum mouth opening. Excluding factors were major occlusal problems, systemic diseases, pregnancy and age below 18 years. After randomization, the first group was treated with acupuncture performed by instructed dentist. The second group was treated with occlusal splint. The outcome variables were assessed at baseline (prior to the first treatment session) and after 1, 3 and 6 months. Primary criteria of success were improvement of mouth opening and pain reduction.Result: Acupuncture group exhibited chewing pain decrease from 5 (at baseline) to 1, 2 and 1 after 1, 3 and 6 months, respectively. In the splint group, chewing pain decreased from 4 to 2, 1 and 2 after 1, 3 and 6 months, respectively. The mouth opening (in mm) increased from 28 (at baseline) to 42, 44 and 46 after 1, 3 and 6 months, respectively in the acupuncture group. In the splint group, mouth opening improved from 29 to 40 after 1 month, and to 43 and 42 after 3 and 6 months. A significant pain reduction was noted for both groups when compared to the baseline (p<.001; Wilcoxon test). Acupuncture group had a significant clinical improvement of opening mouth (Mann-Whitney). Conclusion: The present outcomes suggest a positive association among acupuncture and occlusal splint on the reduction of chewing pain. Acupuncture was more effective in the mouth opening increase.

Temporomandibular Joint Vibration Before and After Exercises and Occlusal Splints

Temporomandibular joint (TMJ) sounds are frequent in patients. The aim of this study was to analyze patients with clicking at the end of opening and at the beginning of closing their mouths treated by muscular exercises through chewing and by occlusal splints. Fifteen patients with clinically verified clicking and TMJ and 15 patients without sounds were selected by the Research Diagnostic Criteria for Temporomandibular Disorders. They were submitted to electrovibratography at consultation and 60 and 120 days of treatment by occlusal splints and exercises. Patients demonstrated significant reduction of TMJ sounds after treatment, but vibration intensity was not similar with that of the control group after 120 days.

Headache and Symptoms of Temporomandibular Disorder: An Epidemiological Study

Objectives.-A population-based cross-sectional study was conducted to estimate the prevalence of migraine, episodic tension-type headaches (ETTH), and chronic daily headaches (CDH), as well as the presence of symptoms of temporomandibular disorders (TMD) in the adult population.Background.-The potential comorbidity of headache syndromes and TMD has been established mostly based on clinic-based studies.Methods.-A representative sample of 1230 inhabitants (51.5% women) was interviewed by a validated phone survey. TMD symptoms were assessed through 5 questions, as recommended by the American Academy of Orofacial Pain, in an attempt to classify possible TMD. Primary headaches were diagnosed based on the International Classification of Headache Disorders.Results.-When at least 1 TMD symptom was reported, any headache happened in 56.5% vs 31.9% (P < .0001) in those with no symptoms. For 2 symptoms, figures were 65.1% vs 36.3% (P < .0001); for 3 or more symptoms, the difference was even more pronounced: 72.8% vs 37.9%. (P < .0001). Taking individuals without headache as the reference, the prevalence of at least 1 TMD symptom was increased in ETTH (prevalence ratio = 1.48, 95% confidence interval = 1.20-1.79), migraine (2.10, 1.80-2.47) and CDH (2.41, 1.84-3.17). At least 2 TMD symptoms also happened more frequently in migraine (4.4, 3.0-6.3), CDH (3.4; 1.5-7.6), and ETTH (2.1; 1.3-3.2), relative to individuals with no headaches. Finally, 3 or more TMD symptoms were also more common in migraine (6.2; 3.8-10.2) than in no headaches. Differences were significant for ETTH (2.7 1.5-4.8), and were numerically but not significant for CDH (2.3; 0.66-8.04).Conclusions.-Temporomandibular disorder symptoms are more common in migraine, ETTH, and CDH relative to individuals without headache. Magnitude of association is higher for migraine. Future studies should clarify the nature of the relationship.

Sleep bruxism increases the risk for painful temporomandibular disorder, depression and non-specific physical symptoms

To explore the relationship between sleep bruxism (SB), painful temporomandibular disorders (TMD) and psychologic status in a cross-sectional study. The sample consisted of 272 individuals. The Research Diagnostic Criteria for TMD (RDC/TMD) was used to diagnose TMD; SB was diagnosed by clinical criteria proposed by The American Academy of Sleep Medicine. The sample was divided into four groups: (1) patients without painful TMD and without SB, (2) patients without painful TMD and with SB, (3) patients with painful TMD and without SB and (4) patients with painful TMD and with SB. Data were analysed by Odds Ratio test with a 95% confidence interval. Patients with SB had an increased risk for the occurrence of myofascial pain (OR = 5.93, 95% CI: 3.1911.02) and arthralgia (2.34, 1.583.46). Group 3 had an increased risk for moderate/severe depression and non-specific physical symptoms (10.1, 3.6727.79; 14.7, 5.3939.92, respectively), and this risk increased in the presence of SB (25.0, 9.6564.77; 35.8, 13.9491.90, respectively). SB seems to be a risk factor for painful TMD, and this in turn is a risk factor for the occurrence of higher depression and non-specific physical symptoms levels, but a causeeffect relationship could not be established.

Clinical and MRI investigation of temporomandibular joint in major depressed patients

Objective: The aim of the present study was to describe the clinical and MRI findings of the temporomandibular joint (TMJ) in patients with major depressive disorders (MDDs) of the non-psychotic type.Methods: 40 patients (80 TMJs) who were diagnosed as having MDDs were selected for this study. The clinical examination of the TMJs was conducted according to the research diagnostic criteria and temporomandibular disorders (TMDs). The MRIs were obtained bilaterally in each patient with axial, parasagittal and paracoronal sections within a real-time dynamic sequence. Two trained oral radiologists assessed all images. For statistical analyses, Fisher's exact test and chi(2) test were applied (alpha = 0.05).Results: Migraine was reported in 52.5% of subjects. Considering disc position, statistically significant differences between opening patterns with and without alteration (p = 0.00) and between present and absent joint noises (p = 0.00) were found. Regarding muscular pain, patients with and without abnormalities in disc function and patients with and without abnormalities in disc position were not statistically significant (p = 0.42 and p = 0.40, respectively). Significant differences between mandibular pathway with and without abnormalities (p=0.00) and between present and absent joint noises (p=0.00) were observed.Conclusion: Based on the preliminary results observed by clinical and MRI examination of the TMJ, no direct relationship could be determined between MDDs and TMDs. Dentomaxillofacial Radiology (2012) 41, 316-322. doi: 10.1259/dmfr/27328352

The treatment of painful temporomandibular joint clicking with oral splints: A randomized clinical trial

Background. The authors compared the efficacy of bilateral balanced and canine guidance (occlusal) splints in the treatment of temporomandibular joint (TMJ) pain in subjects who experienced joint clicking with a nonoccluding splint in a double-blind, controlled randomized clinical trial.Methods. The authors randomly assigned 57 people with signs of disk displacement and TMJ pain into three groups according to the type of splint: bilateral balanced, canine guidance and nonoccluding. The authors followed the groups for six months using analysis of a visual analog scale (VAS), palpation of the TMJ and masticatory muscles, mandibular movements and joint sounds. They used repeated analysis of variance and a XI test to test the hypothesis.Results. The type of guidance used did not influence the pain reduction; yet both occlusal splints were superior to the nonoccluding splint, on the basis of the VAS. Despite similar outcomes in relation to opening, left; lateral and protrusive movements, TMJ and muscle pain on palpation, subjects who used the occlusal splints had improved clinical outcomes. The frequency of joint noises decreased over time, with no significant differences among groups. Subjects in the groups using the occlusal splints reported more comfort.Conclusion. The type of lateral guidance did not influence the subjects'; improvement: All of the subjects had a general improvement on the VAS, though subjects in the occlusal splint groups had better results that did subjects in the nonoccluding splint group.

Chewing in temporomandibular disorder patients: an exploratory study of an association with some psychological variables

Aims: To compare kinematic parameters (ie, amplitude, velocity, cycle frequency) of chewing and pain characteristics in a group of female myofascial temporomandibular disorder (TMD) patients with an age-matched control female group, and to study correlations between psychological variables and kinematic variables of chewing. Methods: Twenty-nine female participants were recruited. All participants were categorized according to the Research Diagnostic Criteria for TMD (RDC/TMD) into control (n = 14, mean age 28.9 years, SD 5.0 years) or TMD (n = 15, mean age 31.3 years, SD 10.7) groups. Jaw movements were recorded during free gum chewing and chewing standardized for timing. Patients completed the Depression, Anxiety, and Stress Scales (DASS-42), the Pain Catastrophizing Scale (PCS), the Fear of Pain Questionnaire-III (FPQ-III), and the Pain Self-Efficacy Questionnaire (PSEQ). Statistical analyses involved evaluation for group differences, and correlations between kinematic variables and psychological questionnaire scores (eg, depression, anxiety, stress) and pain intensity ratings. Results: Velocity and amplitude of standardized (but not free) chewing were significantly greater (P < .05) in the TMD group than the control group. There were significant (P < .05) positive correlations between pain intensity ratings and velocity and amplitude of standardized chewing but not free chewing. There were significant (P < .05) positive correlations between depression and jaw amplitude and stress and jaw velocity for standardized but not free chewing. Conclusion: This exploratory study has provided data suggesting that psychological factors, manifesting in depression and stress, play a role in influencing the association between pain and motor activity. J OROFAC PAIN 2011;25:56-67

15d-PGJ2-loaded in nanocapsules enhance the antinociceptive properties into rat temporomandibular hypernociception

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)