RESUMO
Diabetes mellitus (DM) is one of the most common metabolic disorders. DM is characterized by hyperglycaemia, resulting in wound healing difficulties and systemic and oral manifestations, which have a direct effect on dental pulp integrity. Experimental and clinical studies have demonstrated a higher prevalence of periapical lesions in patients with uncontrolled diabetes. The influence of DM on periapical bone resorption and its impact on dental intervention of such patients are reviewed, and its aetiology and pathogenesis are analysed at molecular level. Pulps from patients with diabetes have the tendency to present limited dental collateral circulation, impaired immune response, increased risk of acquiring pulp infection (especially anaerobic ones) or necrosis, besides toothache and occasional tendency towards pulp necrosis caused by ischaemia. In regard to molecular pathology, hyperglycaemia is a stimulus for bone resorption, inhibiting osteoblastic differentiation and reducing bone recovery. The relationship between poorly controlled diabetes and bone metabolism is not clearly understood. Molecular knowledge about pulp alterations in patients with diabetes could offer new therapeutic directions. Knowledge about how diabetes affects systemic and oral health has an enduring importance, because it may imply not only systemic complications but also a higher risk of oral diseases with a significant effect on pulp and periapical tissue.
Assuntos
Complicações do Diabetes , Periodontite Periapical/complicações , Pulpite/complicações , Perda do Osso Alveolar/complicações , Complicações do Diabetes/sangue , Complicações do Diabetes/fisiopatologia , Humanos , Hiperglicemia/complicações , Fatores de Risco , Tratamento do Canal RadicularRESUMO
Minimum interdental threshold is the smallest thickness that can be detected between teeth during an occlusion and has an influence on the occlusal force and on the control of mandibular movements. The aim of this study was to assess the possible association of the signs and symptoms of temporomandibular disorders (TMD) with the ability to detect a minimum interdental threshold. Two hundred women were equally divided into four groups: asymptomatic (control), subjects with masticatory muscle pain, with articular [temporomandibular joint (TMJ)] pain and mixed (muscular and articular pain). Evaluation of the ability to detect a minimum interdental threshold was performed using aluminium foils with 0.010, 0.024, 0.030, 0.050, 0.080 and 0.094 mm of thickness in the premolar region. A total of 20 tests with each thickness for each patient were performed, starting with the thickest foil (0.094 mm) and ending with the thinnest one. The myogenic pain and articular groups presented significantly higher threshold values (0.020 and 0.022 mm, respectively), when compared to the control. Both groups reached the level of certain perceptiveness only at 0.030 mm. No significant correlation was found between minimum interdental threshold and age. These results suggest that discrimination of thicknesses can be disturbed as a consequence of TMD manifestations and not the cause of it. Clinicians should, therefore, be aware that changes on muscles and TMJ can secondarily lead to occlusion changes. The mechanisms involved in this process, however, are not well understood and warrant further investigation.
Assuntos
Força de Mordida , Dor Facial/fisiopatologia , Gengiva/fisiopatologia , Limiar Sensorial , Transtornos da Articulação Temporomandibular/fisiopatologia , Adolescente , Adulto , Estudos de Casos e Controles , Análise do Estresse Dentário , Discriminação Psicológica , Feminino , Humanos , Músculos da Mastigação/fisiopatologia , Pessoa de Meia-Idade , Medição da Dor , Amplitude de Movimento Articular , Estatísticas não Paramétricas , Adulto JovemRESUMO
The aim of this study was to evaluate the maximum bite force in temporomandibular disorders (TMD) patients. Two hundred women were equally divided into four groups: myogenic TMD, articular TMD, mixed TMD and control. The maximum bite force was measured in the first molar area, on both sides, in two sessions, using an IDDK (Kratos) Model digital dynamometer, adapted to oral conditions. Three-way anova, Tukey and Pearson correlation tests were used for the statistical analysis. The level of statistical significance was given when P < or = 0.05. The maximal bite force values were significantly higher in the control group than in the experimental ones (P = 0.00), with no significant differences between sides. Higher values were obtained in the second session (P = 0.001). Indeed, moderate negative correlation was found between age and bite force, when articular, mixed groups and all groups together were evaluated. A moderate negative correlation was also detected between TMD severity and the maximal bite force values for myogenic, mixed and all groups together. Authors concluded that the presence of masticatory muscle pain and/or TMJ inflammation can play a role in maximum bite force. The mechanisms involved in this process, however, are not well understood and deserve further investigation.