Assuntos
Má Oclusão/complicações , Transtornos da Articulação Temporomandibular/complicações , Adolescente , Adulto , Criança , Dor Facial/complicações , Dor Facial/terapia , Humanos , Má Oclusão/cirurgia , Má Oclusão/terapia , Avanço Mandibular , Ortodontia Corretiva , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Transtornos da Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/terapia , Adulto JovemRESUMO
BACKGROUND: Temporomandibular disorders are a group of orofacial pain conditions that are commonly identified in the general population. Like many other chronic pain conditions, they can be associated with anxiety/depression, which can be related to changes in the activity of the dorsolateral prefrontal cortex. Some studies have demonstrated clinical improvement in subjects with chronic pain who are given therapeutic neuromodulation. Transcranial direct current stimulation is a noninvasive brain stimulation technique that allows the modulation of neuronal membranes. This therapy can enhance or inhibit action potential generation in cortical neurons. In some instances, medications acting in the central nervous system may be helpful despite their adverse side effects. It is important to determine if cathodal transcranial direct current stimulation over the dorsolateral prefrontal cortex, an area that modulates emotion and motor cortex excitability, has an analgesic effect on chronic temporomandibular disorders pain. METHOD/DESIGN: The investigators will run a randomized, controlled crossover double blind study with 15 chronic muscular temporomandibular disorder subjects. Each subject will undergo active (1 mA and 2 mA) and sham transcranial direct current stimulation. Inclusion criteria will be determined by the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire, with subjects who have a pain visual analogic scale score of greater than 4/10 and whose pain has been present for the previous 6 months, and with a State-Trait Anxiety Inventory score of more than 42. The influence of transcranial direct current stimulation will be assessed through a visual analogic scale, quantitative sensory testing, quantitative electroencephalogram, and the State-Trait Anxiety Inventory score. DISCUSSION: Some studies have demonstrated a strong association between anxiety/depression and chronic pain, where one may be the cause of the other. This is especially true in chronic temporomandibular disorders, and breaking this cycle may have an effect over the symptoms and associated dysfunction. We believe that by inhibiting activity of the dorsolateral prefrontal cortex though cathodal transcranial direct current stimulation, there may be a change in both anxiety/depression and pain level. Transcranial direct current stimulation may emerge as a new tool to be considered for managing these patients. We envision that the information obtained from this study will provide a better understanding of the management of chronic temporomandibular disorders. TRIAL REGISTRATION: This trial was registered at clinicaltrials.gov on 24 May 2014 (Identifier: NCT02152267 ).
Assuntos
Músculos da Mastigação/inervação , Córtex Pré-Frontal/fisiopatologia , Transtornos da Articulação Temporomandibular/terapia , Estimulação Transcraniana por Corrente Contínua/métodos , Adolescente , Adulto , Brasil , Protocolos Clínicos , Estudos Cross-Over , Método Duplo-Cego , Eletroencefalografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Projetos de Pesquisa , Inquéritos e Questionários , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Antecedentes. El dolor craneofacial puede ser el único síntoma de una isquemia cardíaca. El fracaso en reconocer el origen cardíaco de dicho dolor puede poner en riesgo la vida del paciente. Los autores realizaron un estudio para revelar la prevalencia, la distribución y las diferencias entre sexos en lo que respecta al dolor craneofacial de origen cardíaco. Métodos. Los autores seleccionaron de forma prospectiva pacientes consecutivos (n=186) que habían presentado un episodio isquémico cardíaco verificado. Estudiaron en detalle la localización y distribución del dolor craneofacial e intraoral. Resultados: El dolor cráneofacial fue el único síntoma durante el episodio isquémico en 11 pacientes (6 por ciento), tres de los cuales presentaron un infarto agudo de miocardio (IAM). Otros 60 pacientes (32 por ciento) comunicaron dolor cráneofacial concomitantemente a dolor en otras regiones. Las localizaciones más frecuentes del dolor cráneofacial fueron la garganta, la región mandibular izquierda, la región mandibular derecha, la articulación temporomandibular izquierda / oído y dientes. El dolor cráneofacial se manifestó de forma predominante en mujeres (P=0.031) y fue el síntoma dominante en ambos sexos en ausencia de dolor torácico. Conclusiones: El dolor cráneofacial es inducido frecuentemente por isquemia cardíaca. Esta causa debe tenerse en cuenta en el diagnóstico diferencial del dolor dental y orofacial. Implicaciones clínicas: Debido a que los pacientes que tienen un IAM sin dolor torácico corren un mayor riesgo de no ser correctamente diagnosticados y de muerte, el alerta del clínico sobre esta sintomatología, puede ser crucial para el diagnóstico precoz y un rápido tratamiento.
Background. Craniofacial pain can be the only symptom of cardiac ischemia. Failure to recognize its cardiac source can put the patients life at risk. The authors conducted a study to reveal the prevalence of, the distribution of and sex differences regarding craniofacial pain of cardiac origin. Methods. The authors prospectively selected consecutivepatients (n = 186) with a verified cardiacischemic episode. They studied the location and distribution of craniofacial and intraoral pain in detail. Results. Craniofacial pain was the only complaintduring the ischemic episode in 11 patients (6 per cent), three of them who had acute myocardial infarction (AMI). Another 60 patients (32 per cent) reported craniofacial pain concomitant with pain in other regions. The most common craniofacial pain locations were the throat, left mandible, right mandible, left temporomandibular joint/ear regionand teeth. Craniofacial pain was preponderantly manifested in female subjects (P = 0.031) and was the dominating symptom in both sexes in theabsence of chest pain. Conclusions. Craniofacial pain commonly is induced by cardiac ischemia. This must beconsidered in differential diagnosis of toothache and orofacial pain. Clinical Implications. Because patients sufferingAMI without chest pain run a higher risk of missed diagnosis and death, the clinicians awareness of this symptomatology can be crucial for early diagnosis and timely treatment.
Assuntos
Angina Pectoris , Dor Facial , Infarto do Miocárdio , Neuralgia FacialRESUMO
The aim of this study was to observe the prevalence of diagnostic groups of temporomandibular disorders (TMD) in patients who were referred or sought treatment for TMD and/or orofacial pain in a private clinic. The clinical records of 357 patients were evaluated and selected based on inclusion/exclusion criteria; the mean age was 32 years. A clinical examination was performed and the diagnosis was based on the American Academy of Orofacial Pain criteria. Results showed that 86.8% of patients were women and 93.3% of the patients presented more than one diagnosis. The most frequent chief complaint (n = 216, chi2 = 30.68, p = 0.001) and total diagnosis realized (n = 748, chi2 = 14.14, p = 0.001) were muscle related. We concluded that women seek treatment for dysfunction/disorders of orofacial structures more than men do; patients seeking specialized treatment have more than one diagnosis and muscle dysfunction is more prevalent than intra-articular disorders.
Assuntos
Diagnóstico Bucal/estatística & dados numéricos , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Dor Facial/epidemiologia , Doenças Neuromusculares/epidemiologia , Transtornos da Articulação Temporomandibular/classificação , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Comorbidade , Diagnóstico Bucal/normas , Dor Facial/classificação , Feminino , Transtornos da Cefaleia/classificação , Transtornos da Cefaleia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Neuromusculares/classificação , Distribuição por Sexo , Transtornos da Articulação Temporomandibular/epidemiologia , Adulto JovemRESUMO
Head, neck, face, and ear pains are commonly associated with disorders of the temporomandibular joint (TMJ). Several theories have been proposed regarding the functional relationship of the TMJ and the associated structures, and how they might contribute to certain painful conditions. This study was conducted to determine the anatomic relationship of the auriculotemporal nerve to the middle meningeal artery and the mandibular condyle. Forty human cadaver temporomandibular joints were dissected to locate the precise position of the auriculotemporal nerve to the mandibular condyle. The study findings revealed a significant variation in the relationship of the auriculotemporal nerve to the middle meningeal artery. The auriculotemporal nerve was found to be between 10-13 mm inferior to the superior surface of the condyle and 1-2 mm posterior to the neck of the condyle. The nerve was not found to be in a position that would likely create an entrapment with adjacent tissues. These findings may assist the clinician to locate the most appropriate injection site for an auriculotemporal nerve block.