Silent Period of Masticatory Cycles in Dentate Subjects and Complete Denture Wearers

Purpose: The purpose of this study was to assess, through electromyographic activity (EMG), the silent period (SP) of masseter and anterior temporal muscles in dentate subjects (DS) and complete denture wearers (CDW).Materials and Methods: The evaluations were performed at the initial and final period of the mastication for the DS group. For the CDW group, the evaluations were performed at the initial period of mastication, with old complete dentures worn for more than 10 years (OCDW) and at the final period of the mastication with new complete dentures (NCDW), 5 months after rehabilitation. Twenty-four asymptomatic subjects (12 DS, 12 CDW) answered a questionnaire based on the Research Diagnostic Criteria for temporomandibular disorders. The CDW group answered the questionnaire before and after new denture insertion and after 5 months of rehabilitation. The SP of the muscles was recorded through EMG at the initial and final periods of mastication using artificial food (Optocal). The operator monitored 35 chewing cycles performed to grind the artificial food and selected eight open-close-clench-chewing cycles for the record.Results: The SP of the muscles analyzed with new complete dentures showed no statistical difference in comparison to the old dentures. There was a statistically significant difference in the SP between the CDW and DS groups for initial and final chewing.Conclusion: Lowered muscular capacity and ability reduced the SP of muscles after rehabilitation with NCDWs.

Evaluation of different occlusal splints and counselling in the management of myofascial pain dysfunction

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Treatment of snoring and sleep apnea syndrome with a removable mandibular advancement device in patients without TMD

INTRODUCTION: Among the sleep disorders reported by the American Academy of Sleep, the most common is obstructive sleep apnea-hypopnea syndrome (OSAHS), which is caused by difficulties in air passage and complete interruption of air flow in the airway. This syndrome is associated with increased morbidity and mortality in apneic individuals. OBJECTIVE: It was the objective of this paper to evaluate a removable mandibular advancement device as it provides a noninvasive, straightforward treatment readily accepted by patients. METHODS: In this study, 15 patients without temporomandibular disorders (TMD) and with excessive daytime sleepiness or snoring were evaluated. Data were collected by means of: Polysomnography before and after placement of an intraoral appliance, analysis of TMD signs and symptoms using a patient history questionnaire, muscle and TMJ palpation. RESULTS: After treatment, the statistical analysis (t-test, and the before and after test) showed a mean reduction of 77.6% (p=0.001) in the apnea-hypopnea index, an increase in lowest oxyhemoglobin saturation (p=0.05), decrease in desaturation (p=0.05), decrease in micro-awakenings or EEG arousals (p=0.05) and highly significant improvement in daytime sleepiness (p=0.005), measured by the Epworth Sleepiness Scale. No TMD appeared during the monitoring period. CONCLUSION: The oral device developed in this study was considered effective for mild to moderate OSAHS.

Bases epidemiológicas para análise das más oclusões morfológicas como fatores de risco no desenvolvimento das desordens temporomandibulares de origem articular

Dentre as pesquisas empreendidas no campo da epidemiologia, um grupo específico aborda patologias de etiologia desconhecida ou não totalmente compreendidas. É dentro deste grupo que estão situadas as desordens temporomandibulares (DTM). Três estratégias observacionais básicas têm sido utilizadas para abordar o papel etiológico da má oclusão no desenvolvimento das DTM, dentro do repertório epidemiológico. São elas: estudos do tipo transversal, estudos de caso controle e estudos de coorte. Alguns experimentos clínicos são realizados com base na remoção do fator etiológico suspeito. Com base em uma revisão estruturada da literatura, a partir da metodologia empregada nos estudos selecionados, podemos concluir que a definição dos possíveis fatores etiológicos relacionados a subgrupos específicos de DTM é fundamental para que o papel das más oclusões no desenvolvimento destas desordens, embora pareça pequeno quando baseado nas evidências disponíveis, não seja subestimado. Pode ser útil a caracterização de uma oclusão normal como aquela associada como o menor risco para o desenvolvimento de problemas de DTM, mas é provavelmente inapropriada a aplicação destes parâmetros para reverter um problema intra-capsular já estabelecido. O conceito de uma oclusão de baixo fator de risco implicaria em um pequeno desvio entre RC e MIH, pequeno transpasse horizontal, transpasse vertical positivo e ausência de mordida cruzada posterior. Este conceito é compatível com o conceito de oclusão normal defendido por décadas, embora uma variação do normal ao invés de um critério absoluto deva ser permitida. Embora provavelmente seja prudente estabelecer metas morfológicas terapêuticas que busquem o que é observado em oclusões não tratadas julgadas normais ou ideais, o estabelecimento de uma oclusão que alcance todos os critérios gnatológicos, por meio de tratamento ortodôntico, talvez seja impossível e provavelmente desnecessário.

Clinical evaluation of tinnitus in patients with sleep bruxism: prevalence and characteristics

Evaluation of the prevalence and characteristics of tinnitus in a Brazilian series of sleep bruxism patients. In this descriptive study, 100 patients (80 women and 20 men) were selected through the self-report of grinding teeth during sleep, confirmed by room mate or family member. They were evaluated according to a systematized approach: a questionnaire for orofacial pain and the Portuguese version of the Research Diagnostic Criteria for Temporomandibular Disorders. The patients were divided into two groups: group A, 54 patients with complaint of tinnitus and group B, 46 patients without tinnitus complaint. The mean age was 37.85 (13-66 years) and 34.02 years (20-59 years), respectively, for groups A and B (P = 0.1164). There was statistically significant difference between the two groups, with higher prevalence for the group A, in relation to: presence of chronic facial pain (P = 0.0007); number of areas painful to palpation in the masticatory and cervical muscles (P = 0.0032); myofascial pain in the masticatory muscles (P = 0.0003); absence of teeth without prosthetic replacement (P = 0.0145) and indices of depression (P = 0.0234). Structural alterations of the TMJ, like disc displacement and vertical dimension loss did not differ for the two groups. Tinnitus frequency was higher in patients with sleep bruxism and chronic facial pain. Myofascial pain, number of areas painful to palpation in the masticatory and cervical muscles, higher levels of depression and tooth absence without prosthetic replacement were more frequent in the group with tinnitus.

Joint Vibration Analysis in Patients with Articular Inflammation

The study of articular sounds using a computerized system (SonoPAK) in patients with temporomandibular disorders (TMD) of inflammatory origin revealed an increase of vibratory energy when compared to asymptomatic individuals. The following conclusions were reached: 1. The amount of vibratory energy registered in these patients ranged from 8.50 to 57.61 Hz. The major vibrations occurred in the middle of the mandibular opening cycle; 2. The mean vibratory energy measured at less than 300 Hz was between 5.70 and 48.64 Hz and at higher than 300 Hz was between 3.70 and 8.99 Hz; 3. The peak amplitude in the patients with inflammation ranged from 0.35 to 3.96 Pascal and the peak of frequency from 83.20 to 120.20 Hz.

Associação entre otalgia, zumbido, vertigem e hipoacusia com desordens temporomandibulares

Because nonespecific symptoms and signs are associated with others well-established in the temporomandibular disorders, it is difficult for the clinician to decide what symptoms and signs should be considered during the diagnosis and the treatment plan. Therefore, the aim of this literature review was to evaluate the prevalence of aural symptoms (otalgias, tinnitus, dizziness and deafness) in patients with orofacial pain. Although several hypotheses have been proposed to explain the association between aural symptoms and temporomandibular disorders, the results of the previous studies differed in magnitude. For this reason, it is difficult to establish the prevalence of these aural symptoms concomitantly with temporomandibular disorders. Moreover, such relationship does not necessarily imply a cause-effect relationship. Because of the diagnosis complexity, different treatments must be considered, so the nonespecific symptoms of temporomandibular disorders can be effectively controlled as well. It is crucial for the the clinician to be aware of the possible etiology of aural symptoms, so he should determine if such symptoms may be associated with temporomandibular disorders and thus include them in the treatment.

Relationship between psychological factors and symptoms of TMD in university undergraduate students.

Temporomandibular disorders is a collective term used to describe a number of related disorders involving the temporomandibular joints, masticatory muscles and occlusion with common symptoms such as pain, restricted movement, muscle tenderness and intermittent joint sounds. The multifactorial TMD etiology is related to emotional tension, occlusal interferences, tooth loss, postural deviation, masticatory muscular dysfunction, internal and external changes in TMJ structure and the various associations of these factors. The aim of this study was to evaluate the prevalence of the relationship between signs of psychological distress and temporomandibular disorder in university students. A total 150 volunteers participated in this study. They attended different courses in the field of human science at one public university and four private universities. TMD was assessed by the Research Diagnostic Criteria (RDC) questionnaire. Anxiety was measured by means of a self-evaluative questionnaire, Spielberger's Trait-State anxiety inventory, to evaluate students'state and trait anxiety. The results of the two questionnaires were compared to determine the relationship between anxiety levels and severity degrees of chronic TMD pain by means of the chi-square test. The significance level was set at 5%. The statistical analysis showed that the TMD degree has a positive association with state-anxiety (p = 0.008; p < 0.05) and negative with trait-anxiety (p = 0.619; p < 0.05). Moreover a high TMD rate was observed among the students (40%). This study concluded that there is a positive association between TMD and anxiety.

Sensibilidade dolorosa à palpação em pacientes con disfunção temporomandibularr crônica

The cephalalgias are frequently associated with the temporomandibular disorders being common to find an increase of pain sensitivity in these patients. Thus, the objective of present study was to assess the sensitivity to palpation in patients presenting with chronic temporomandibular disorders comparing two groups one with headache and other without it, respectively. The temporomandibular disorders and the primary cephalalgias were diagnosed according the Diagnostic Criteria for the Research of Temporomandibular Disorders and by a questionnaire based on the International Classification of the Cephalalgias (2004). Location, assessment and grouping of muscular and articular areas for palpation were carried out according to the Diagnostic Criteria for above mentioned disorders, considering bilaterally the masseter muscle, the temporalis muscle, the cervical region and the temporomandibular joint. Sample included 213 (88.0 %) of women and 29 (12.0 %) men with a mean age of 37.41 years. The mean of number of zones positive to palpation in the groups without headaches, tension headache, migraine and daily chronic headache were: 12.43, 14.38, 15.21 and 15.62 (p= 0.107) (min 2 max 22). The areas of temporalis muscle showed significant differences among groups (p= 0.007). The number of painful points was not statistically different among groups and only in the temporalis muscle there were differences with statistical significant to palpation.

Electromyographic analysis of masseter and anterior temporalis muscle in sleep bruxers after occlusal splint wearing

Bruxism is widely defined as an anxiety response to environmental stress. Occlusal splints are frequently used in sleep bruxism, to protect teeth from damage resulting from the contraction force of mandibular muscles, or to reduce the orofacial pain by relaxing masticatory muscles. Surface electromyography (EMG) of the right and left masseter and temporalis muscles was performed in 15 women presenting sleep bruxism and temporomandibular disorders related to occupational stress, after nocturnal use of the occlusal splint. The EMG signals were recorded twice per patient: After a work shift (pre-splint) and after a night of sleep with the occlusal splint (post-splint) before a new workday. The parametric t-paired test was used to compare differences of the RMS amplitude between pre and post-splint records, for resting and maximal clenching effort. The level of significance for each comparison was set to p < 0.05. The results of the study supports the premise that the use of occlusal splint reduces EMG activity in the masseter and anterior temporalis muscles, in patients who presented with sleep bruxism related to occupational stress. © 2011 Elsevier Ltd.

Facial pain associated with fibromyalgia can be marked by abnormal neuromuscular control: A cross-sectional study

Background. Temporomandibular disorder (TMD) development in fibromyalgia syndrome (FMS) is not yet fully understood, but altered neuromuscular control in FMS may play a role in triggering TMD. Objective. The purpose of this study was to verify the association between neuromuscular control and chronic facial pain in groups of patients with FMS and TMD. Design. A cross-sectional study was conducted. Methods. This study involved an analysis of facial pain and electromyographic activity of the masticatory muscles in patients with FMS (n=27) and TMD (n=28). All participants were evaluated according to Research Diagnostic Criteria for Temporomandibular Disorders and surface electromyography (SEMG). Myoelectric signal calculations were performed using the root mean square and median frequency of signals. Results. The data revealed premature interruption of masticatory muscle contraction in both patient groups, but a significant correlation also was found between higher median frequency values and increased facial pain. This correlation probably was related to FMS because it was not found in patients with TMD only. Facial pain and increased SEMG activity during mandibular rest also were positively correlated. Limitations. Temporal conclusions cannot be drawn from the study. Also, the study lacked a comparison group of patients with FMS without TMD as well as a control group of individuals who were healthy. Conclusions. Altered neuromuscular control in masticatory muscles may be correlated with perceived facial pain in patients with FMS. © 2013 American Physical Therapy Association.

Impacto da dor miofascial no hábito alimentar

Pós-graduação em Alimentos e Nutrição - FCFAR

Efeito das placas estabilizadora rígida, resiliente e não oclusiva na redução dos sinais e sintomas de pacientes com desordens de origem muscular

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Disfunção craniomandibular em pacientes desdentados totais com alteração da dimensão vertical. -

Pós-graduação em Reabilitação Oral - FOAR

Avaliação da atividade elétrica e limiar de dor à pressão dos músculos masseter e temporal anterior com placas de diferentes espessuras

Pós-graduação em Odontologia - FOA