RESUMO
Objective: The aim of this study was to analyze the intra- and inter-examiner reliability when using the DC/TMD axis 1 and verify the replicability and validity of the data obtained.Methods: The sample comprised 30 volunteers (students) of the Instituto Universitário de Ciências da Saúde Norte (Portugal). The calibration process consisted of a volunteer selection, theoretical and practical training, data collection, and agreement calculation. Examiners received proper previous training. Three dental practitioners applied the questionnaire (T1) and re-examined all the participants one week later (T2). To measure the degree of inter and intra-examiner agreement, multiple Kappa coefficients were obtained when nominal or ordinal variables were involved. When the correspondence between quantifiable variables was assessed, Pearson correlation coefficients and their statistical significance were replicated.Results: Regarding opening patterns, a strong overall agreement was obtained, only showing discrepancies in left-assisted and unassisted maximum openings (from -0.034 to -0.370 and -0.630 to -0.933, respectively). A high level of inter-examiner agreement during TMJ noise during the opening assessment was obtained, only displaying variations in clicks (Kappa -0.423 to 0.757). Protrusion movement showed negative kappa and weaker agreement of all measurements (Kappa between -0.034 and -0037). Small discrepancies were obtained from palpation assessment (left lateral pole- Kappa -0.034).Conclusion: There was no discernible and persistent difference in the amount of agreement among the three examiners, demonstrating that all three examiners were capable of participating in data collecting by employing the DC/TMD questionnaire. The findings indicated nearly perfect intra- and inter-examiner concordance scores.
Assuntos
Transtornos da Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/classificação , Diagnóstico Clínico , Coleta de Dados , OdontólogosRESUMO
OBJECTIVE: To describe postural alterations according to the type of temporomandibular disorder (TMD). METHODS: Prior informed consent, 30 patients were included in the study, with a mean age of 27.4 years; 80% women, diagnosed with TMD based on Diagnostic Criteria (DC/ TTM) by a trained researcher in the clinic of the Faculty of Stomatology of the BUAP. Subsequently, a postural analysis (three views) was carried out at the facilities of the School of Physiotherapy of the BUAP using an acetate grid. The results were analyzed with descriptive statistics in the SPSS v20 program. RESULTS: 16.7% of the patients presented muscular TMD, 36.7% joint TMD, and the rest combined TMD. The most common postural alterations were: high shoulder: 93.3%, pelvic tilt: 86.7%, and forward head posture: 83.3%. On average, the patients had between 4 and 5 postural changes. 100% of the patients ha alterations in the side view, while 50% of the patients with TMD of combined origin had alterations in the three views, as well as 45.5% of the patients with TMD of joint origin, and 60% of the patients with TMD of muscular origin. CONCLUSIONS: TMD patients present postural changes, mainly forward head posture, pelvic tilt and high shoulder, with special involvement related to muscle and combined diagnosis.
OBJETIVO: Describir las alteraciones posturales más frecuentes, de acuerdo al tipo de trastorno temporomandibular (TTM). METODOLOGÍA: Se analizaron 30 pacientes con edad media de 27,4 años; 80% mujeres, con diagnóstico de TTM confirmado con los Criterios Diagnósticos (CD/TTM) por investigador capacitado en la clínica de la Facultad de Estomatología de la BUAP. Posteriormente se realizó el análisis postural (tres vistas) con ayuda de una cuadrícula de acetato en las instalaciones de la Licenciatura de Fisioterapia de la BUAP. Se analizaron los resultados con estadística descriptiva en el programa SPSS v20. RESULTADOS: El 16,7% de los pacientes presentó TTM de origen muscular, el 36,7% articular y el resto combinado. Las alteraciones posturales más frecuentes fueron: hombro elevado: 93,3%, basculación pélvica: 86,7% y posición de cabeza adelantada: 83,3%. El mayor porcentaje de pacientes presentó cinco alteraciones posturales. El 100% presentó alteraciones en la vista lateral y el 50% de los pacientes con TTM de origen combinado presentaron alteraciones en las tres vistas, mientras en los de origen articular; el 45,5% y en los de origen muscular; el 60%. CONCLUSIONES: Los pacientes con TTM presentan alteraciones posturales; principalmente posición de cabeza adelantada, basculación pélvica y hombro elevado, con especial compromiso en los de diagnóstico muscular y combinado.
Assuntos
Postura , Transtornos da Articulação Temporomandibular/fisiopatologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos da Articulação Temporomandibular/classificaçãoRESUMO
A ressonância magnética é o exame de escolha para o estudo das desordens temporomandibulares de disco, considerando-se sua alta definição dos tecidos moles. O objetivo deste estudo foi avaliar a possível relação entre três parâmetros geométricos do músculo pterigóideo lateral (MPL) o ângulo entre seu longo eixo do e o plano sagital mediano (ANG), seu volume (VOL) e a intensidade do seu sinal (SIN) e a presença de desarranjos discais (posição e função do disco) em articulações temporomandibulares (ATM) e a presença de dor e ruído articulares, por meio de imagens de ressonância magnética (RM). Foram analisados 39 exames de (RM) (78 ATM) de indivíduos com idades entRe 16 a 71 anos, obtidos em protocolo específico para análise das ATM, pertencentes ao arquivo da disciplina de Radiologia. Foi utilizado o software OnDemand 3D (Cybermed, Seul, Coréia do Sul) para obtenção dos ANG e o software itkSNAP 4.3 (www.itksnap.org) para segmentação do MPL e obtenção de VOL e SIN. A angulação, volume e intensidade do sinal do MPL foram comparados com: posição e função do disco articular, dor articular e presença de ruídos articulares, por meio do teste t de Student, com nível de significância de 5%. Os resultados indicaram que foram encontradas diferenças significativas apenas entre a presença de dor no MPL e sua angulação (p<0,0001), para ambos os lados, não sendo encontradas diferenças significantes para todas as demais variáveis estudadas (p>0,05). Concluiu-se que, na amostra estudada, um valor maior do ângulo sagital do MPL relacionava-se com a presença de dor neste grupo muscular(AU)
Magnetic resonance imaging is the examination of choice for the study of temporomandibular disc disorders, considering its high definition of soft tissues. The objective of this study was to evaluate the possible relationship between three geometric parameters of the lateral pterygoid muscle (LPM) - angle between its long axis and median sagittal plane (ANG), its volume (VOL) and its signal intensity (SIN) and disc derangements (disc position and disc function) of the temporomandibular joint (TMJ), joint pain. A total of 39 magnetic resonance (MRI) exams (78 TMJ) were analyzed from individuals aged 16 to 71 years, obtained in a specific protocol for the analysis of TMJ, belonging to the archive of the discipline of Radiology. OnDemand 3D software (Cybermed, Seoul, South Korea) was used to obtain ANG and itkSNAP 4.3 software (www.itksnap.org) for LPM segmentation and obtaining VOL and SIN. The LPM angle, volume and signal intensity were compared to: position and function of the articular disc, articular pain and presence of articular noise, using Student's t test, with a level of significance of 5%. The results indicated that significant differences were found only between the presence of LPM pain and its angle (p <0.0001) for both sides, and no significant differences were found for all other variables studied (p> 0.05). It was concluded that, in this sample, a greater value of the sagittal angle of LPM was related to the presence of pain in this muscle group(AU)
Assuntos
Humanos , Imageamento por Ressonância Magnética , Transtornos da Articulação Temporomandibular/classificação , Disco da Articulação Temporomandibular/diagnóstico por imagemRESUMO
Los trastornos temporomandibulares (TTM) son alteraciones del funcionamiento del sistema estomatognático. Tienen etiologíamultifactorial y sintomatología variada. El objetivo del trabajo fue determinar la prevalencia de maloclusiones que se consideran asociadasal desarrollo de TTM en pacientes pre-ortodóncicos. Se analizaron 261 estudios fotográficos iníciales de pacientes entre 11 y 45 años, deambos sexos, que ingresaron a la Cátedra de Ortodoncia de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA). Se determinó la presencia o ausencia de las siguientes maloclusiones asociadas a TTM (MATTM): mordida invertida posteriorunilateral (MIPU), mordida invertida posterior bilateral (MIPB), mordida en tijera (MT), mordida invertida anterior (MIA), mordida abierta anterior (MAA) y mordida profunda (MP). De los 261 pacientes, se registraron 51(19,54 por ciento) sin MATTM, 154 pacientes(59 por ciento) presentaron al menos una MATTM, 52 pacientes (19,92 por ciento) presentaron dos MATTM, 3 pacientes (1,15 por ciento) presentaron tres MATTM y 1 paciente (0.39 por ciento) cuatro MATTM, 72 pacientes(27.58 por ciento) presentaron mordida invertida uni lateral (MIUL), 70 pacientes (26.82 por ciento) presentaron M.P, 46 pacientes (17.62 por ciento) presentaron MIA, 38 pacientes(14.55 por ciento) presentaron MAA, 33 pacientes (12.64 por ciento) presentaron MIBL y 12 pacientes (4.59 por ciento) presentaron MT. Se concluye que es importante realizar un minucioso examen clínico para evaluar la presencia de TTM previamente al tratamiento ortodóncico, ya que sólo el 19,54 por ciento de lospacientes evaluados no registró mal oclusiones asociadas a TTM, mientras que el 59 por ciento presentó al menos una. La maloclusión a pesar de que solo es uno de los factores etiológicos dentro de la etiología multifactorial del desarrollo de TTM, es importante tenerla en cuenta y darle una solución, idealmente de manera interdisciplinaria.
Temporomandibular disorders (TMD) are pathologies of the function of the stomatognathic system. They have a multifactorial etiologyand diverse symptomatology. The aim of the study was to determine the prevalence of malocclusions that are considered associated withTMD development in pre-orthodontic patients. A total of 261 initial photographic diagnostic studies were analyzed; these comprisedpatients between the ages of 11 and 45 from the Department of Orthodontics, FOUBA. The presence and absence of the followingTTM (MATTM) associated malocclusions was analyzed detected: unilateral posterior Crossbite (UPC), bilateral posterior Crossbite(BPC), scissor bite (SB), anterior Crossbite (AC), anterior open bite (AOB) and deep bite (DB). The findings in the 261 patientstreated were: 51 patients (19, 54%) presented MATMD, 154 patients (59%) presented at least one MATTM, 52 patients (19,92%)presented two MATTMs, 3 patients (1,15%) presented three MATTMs and 1 patient (0,39%) presented four MATTMs, 72patients (27,58%) presented IUPO, 70 patients (26,82%) presented DB, 46 patients (17,62%) presented (AC), 38 patients(14,55%) presented AOB, 33 patients (12,64%) presented BPC and 12 patients (4.59%) presented SB. It is concluded that it isimportant to carry out a thorough clinical examination to evaluate the presence of TMD prior to orthodontic treatment, as only 19,54%of the patients treated showed no malocclusions associated with TMD, while 59% presented at least one. Although malocclusions are onlysome of the etiological factors in the multifactorial etiology of TMD development, it is important to take them into account and provide asolution for them, ideally an interdisciplinary solution.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Criança , Adulto Jovem , Fotografia Dentária/métodos , Má Oclusão/classificação , Má Oclusão/epidemiologia , Transtornos da Articulação Temporomandibular/classificação , Transtornos da Articulação Temporomandibular/etiologia , Estudos Transversais , Fatores de Risco , Faculdades de Odontologia , Interpretação Estatística de DadosRESUMO
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation and synovial hyperplasia, which usually affects multiple joints. The temporomandibular joint (TMJ) becomes susceptible to the development of changes resulting from RA. The aim of this study was to evaluate the presence of TMD and degenerative bone changes in TMJ in patients diagnosed with RA (rheumatoid arthritis). The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/ TMD) questionnaire was used for clinical evaluation of the TMJ and for TMD classification of 49 patients of both sexes and all ages. Individuals who had already undergone prior treatment for TMD and/or with a history of craniofacial trauma were excluded. The participants underwent cone beam computed tomography (CBCT) exams to assess possible degenerative changes in the mandibular condyle and the articular eminence. The frequencies of the changes found are presented and the possible associations between clinical and CT findings analyzed using the chisquare test. It was found that 75% of the patients had complaints of pain in the orofacial region, including arthralgia, myalgia or both. As for the diagnoses, 100% of the sample was diagnosed as RDC/TMD Group III (arthralgia, osteoarthritis or osteoarthrosis). The presence of degenerative bone changes was found in 90% of the subjects, the most prevalent being flattening (78.7%) and osteophytes (39.3%).
A artrite reumatoide (AR) é uma doença sistêmica, autoimune, caracterizada por inflamação crônica e hiperplasia sinovial, que usualmente afeta múltiplas articulações. Dentre estas, a articulação temporomandibular (ATM), tornase susceptível ao desenvolvimento de alterações. O estudo objetiva avaliar a presença de desordem temporomandibular (DTM) e altera ções ósseas degenerativas da ATM (articulação temporo man di bu lar) de pacientes diagnosticados com AR (artrite reumatóide). Como metodologia, aplicouse o questionário Research Diagnostic Criteria for Temporomandibular Disorder (RDC/ TDM) em para avaliação clínica da ATM e classificação da desordem temporomandibular em 49 pacientes de ambos os sexos e idade variável. Foram excluídos os indivíduos que já haviam realizado tratamento prévio para DTM e/ou com histórico de traumatismo crâniofacial. Posteriormente os participantes foram submetidos a exames de tomografia computadorizada de feixe cônico (TCFC) para avaliação de possíveis alterações degenerativas no côndilo mandibular e na eminência articular. Foram apresentadas as frequências das alterações encontradas e verificouse a associação entre os achados clínicotomográficos por meio do teste do Quiquadrado. Após a avaliação clínica verificouse que 75% dos pacientes possuíam queixas de dor na região orofacial, variando entre a presença de artralgia, mialgia ou ambas. Quanto aos diagnósticos, 100% da amostra apresentou diagnóstico do Grupo III do RDC/TMD (artralgia, osteoartrite ou osteoartrose). A presença de alterações ósseas degenera tivas foi encontrada em 90% dos indivíduos avaliados, sendo que as mais prevalentes foram aplainamento (78,7%) e osteófito (39,3%).
Assuntos
Humanos , Adolescente , Adulto , Feminino , Criança , Adulto Jovem , Pessoa de Meia-Idade , Artrite Reumatoide , Artrite Reumatoide/diagnóstico , Transtornos da Articulação Temporomandibular/classificação , Transtornos da Articulação Temporomandibular/fisiopatologia , Brasil , Estudos Transversais , Diagnóstico Clínico/métodos , Epidemiologia Descritiva , Estudo Observacional , Interpretação Estatística de Dados , Tomografia Computadorizada de Feixe Cônico/métodosRESUMO
Objetivos: estimar la frecuencia y tipo de trastornos temporomandibulares (TTM) en niños y relacionarlos con edad, sexo, apretamiento dentario, bruxismo diurno y nocturno. Métodos: Pacientes de 10 a 15 años que concurrieron a la Cátedra Odontología Integral Niños, evaluados con el CDI/TTM por odontopediatras estandarizados (Kappa 0,88). Los registros fueron ingresados en una base de datos conformándose los siguientes grupos: sin TTM, con trastornos musculares (TM), con desplazamiento de discos (DD) y artralgias (A). Las variables analizadas fueron sexo, edad, apretamiento dentario, bruxismo diurno y nocturno, utilizando porcentajes y Odds ratio con intervalos de confianza (95%), medias, desvíos estándar y Test de Bonferroni. Resultados: Muestra constituida por 299 pacientes (12,65±1,74 años) correspondiendo el 54,51% al sexo femenino. Un 25,41% (20,56-30,76) presentaron TM (23,74%: dolor miofacial y 1,67% dolor miofacial con limitación de apertura); en el 21,07% (16.57- 26,15) se observó DD (15,71% con reducción, 5,01% sin reducción con apertura limitada y 0,33% sin reducción y sin limitación) y el 3,34% (1,6-6,07) reveló signos y síntomas de A. La edad mostró diferencias entre los grupos...
Objectives: to estimate the frequency and type of temporomandibular disorders (TMD) in children and determine their association with gender, age, teeth clenching, daytime and nocturnal bruxism. Methods: Standardized pediatric dentists (Kappa 0.88) evaluated with the RDC/TMD all patients aged 10 to 15 years who attended at the Pediatric Dentistry Department. Results of the questionnaire and clinical examination were loaded in a data base. Groups conformed were: without TMD, with muscle disorders (MD), displacement disk (DD), and arthralgia (A). Analyzed variables were: gender, age, teeth clenching, diurnal and nocturnal bruxism. Percentages and odds ratio with confidence interval (95%), means, standard deviation and Bonferroni Test were used for statistical analysis. Results: The sample was comprised of 299 patients (54.51% female) aged 12.65 ± 1.74. 25.41% (20.56-30.76) showed MD (23.74% myofacial pain and 1.67% myofacial pain with opening limitation); 21.07% (16.57-26.15) of children revealed DD, (15.71% displacement with reduction, 5.01% no reduction with limited opening and 0.33% no reduction and no limitation) and 3.34% (1.6-6.07) presented signs and symptoms of A. Age showed significant differences among the groups...
Assuntos
Humanos , Masculino , Adolescente , Feminino , Criança , Assistência Odontológica para Crianças/métodos , Faculdades de Odontologia , Transtornos da Articulação Temporomandibular/classificação , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/epidemiologia , Distribuição por Idade e Sexo , Argentina , Bruxismo/epidemiologia , Estudos Transversais , Epidemiologia Descritiva , Sintomas Gerais , Estudos Prospectivos , Fatores de Risco , Interpretação Estatística de DadosRESUMO
El objetivo del presente trabajo fue establecer valores de referencia de movimientos mandibulares en niños de 10-15 años sin disfunción; compararlos con los de pacientes de la misma edad con trastornos temporomandibulares (TTM) y con los hallados anteriormente en un grupo menor de 11 años sinTTM. Niños de ambos sexos que acudieron a la Cátedra Odontología Integral Niños de UBA en 2013 y cuyos responsables brindaron consentimiento fueron evaluados con CDI/TTM por odontopediatras estandarizados (Kappa 0.88) conformándose 3 grupos en función del resumen diagnóstico; C: sin TTM, Ia: con dolor miofacial e Ib: dolor con limitación de la apertura bucal, para el análisis de las siguientes variables: edad, sexo y movimientos mandibulares. La muestra quedó constituida por169 pacientes de 12.5±1.76 años. El 62.36 por ciento no presentó TTM (C) y en el 37.27 por ciento se estableció un diagnóstico de trastorno muscular (29.58 por ciento Ia y 7.69 por ciento Ib). En C se registraron lossiguientes valores en mm: Apertura máxima no asistida: 48.28±6.14; Lateralidad derecha 8.78±2.50; izquierda: 9.60±2.64; Protrusión: 4.94±2.58 y Sobremordida: 2.98 ± 2.5sin variaciones en relación al sexo, pero con diferencias en los registros de todos los movimientos comparados con losobtenidos en dentición mixta. (p=0.0001). El análisis de los valores medios de los movimientos mandibulares entre los 3 grupos sólo reveló diferencias para la apertura máxima no asistida (p= 0.0317). En relación al sexo, los TTM fueron másfrecuentes en niñas siendo significativa la diferencia entre C e Ia (p=0.019). En los niños sin disfunción se estableció unaapertura máxima promedio de 48.28±6.14mm, observándose valores inferiores en los pacientes con TTM. Los movimientos mandibulares en pacientes pediátricos sin TTM mostrarondiferencias significativas en función del tipo de dentición y la edad...
Assuntos
Humanos , Criança , Mandíbula/fisiologia , Transtornos da Articulação Temporomandibular/classificação , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/epidemiologia , Análise de Variância , Argentina , Estudos Transversais , Dor Facial/diagnóstico , Dor Facial/epidemiologia , Faculdades de Odontologia , Estudos Observacionais como Assunto , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Interpretação Estatística de DadosRESUMO
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 = 56.0%-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 (ß = -.008; P = .006), perception of oral health (ß = -.43; P < .001), and mandibular functional limitation (ß = .014; P = 014). CONCLUSION: The severity of TMD among Brazilian women was greater in nonusers of dental prostheses and was also associated with greater mandibular functional limitation and poor perception of oral health.
Assuntos
Transtornos da Articulação Temporomandibular/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Saúde , Brasil/epidemiologia , Estudos Transversais , Dentaduras/estatística & dados numéricos , Escolaridade , Estudos Epidemiológicos , Feminino , Humanos , Estado Civil , Pessoa de Meia-Idade , Saúde Bucal , Qualidade de Vida , Amplitude de Movimento Articular/fisiologia , Índice de Gravidade de Doença , Classe Social , Transtornos da Articulação Temporomandibular/classificação , Adulto JovemAssuntos
Ortodontia , Fenda Labial/terapia , Fissura Palatina/terapia , Criopreservação/métodos , Pesquisa em Odontologia/educação , Humanos , Intercâmbio Educacional Internacional , Japão , Células-Tronco Mesenquimais/fisiologia , Ortodontia/educação , Técnica de Expansão Palatina , Transtornos da Articulação Temporomandibular/classificação , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/terapia , Bancos de Tecidos , Engenharia Tecidual/métodos , Alicerces Teciduais , Dente , Reimplante Dentário/métodosAssuntos
Humanos , Ortodontia/educação , Bancos de Tecidos , Dente , Reimplante Dentário/métodos , Transtornos da Articulação Temporomandibular/classificação , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/terapia , Criopreservação/métodos , Técnica de Expansão Palatina , Fenda Labial/terapia , Fissura Palatina/terapia , Pesquisa em Odontologia/educação , Engenharia Tecidual/métodos , Alicerces Teciduais , Células-Tronco Mesenquimais/fisiologia , Intercâmbio Educacional Internacional , JapãoRESUMO
OBJECTIVE: The aim of this study was to evaluate the performance of research diagnostic criteria for temporomandibular disorders (RDC/TMD) as a diagnostic test for temporomandibular joint problems using magnetic resonance imaging (MRI) as the gold standard. STUDY DESIGN: Sixty-seven women were assessed with RDC/TMD (2 examiners) and underwent MRI examination (3.0 T). Images were evaluated by 2 independent radiologists blinded to the clinical diagnoses. Results were analyzed by the Catmaker system. RESULTS: Of the 67 patients, 44 were diagnosed with temporomandibular disorders (TMD) according to RDC/TMD, but 21 (32%) of the diagnoses were not confirmed by MRI. The RDC/TMD sensitivity was 83.0%, specificity was 53.0%, and the positive likelihood ratio was 1.77, whereas the negative likelihood ratio was 0.32 (P = 0.16). CONCLUSIONS: Our data suggest that RDC/TMD is a good research tool, but the high rate of false-positive results limits its use in clinical practice.
Assuntos
Imageamento por Ressonância Magnética/métodos , Transtornos da Articulação Temporomandibular/diagnóstico , Distribuição de Qui-Quadrado , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Funções Verossimilhança , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Transtornos da Articulação Temporomandibular/classificaçãoRESUMO
BACKGROUND: Temporomandibular disorder (TMD) patients might present a number of concurrent clinical diagnoses that may be clustered according to their similarity. Profiling patients' clinical presentations can be useful for better understanding the behavior of TMD and for providing appropriate treatment planning. The aim of this study was to simultaneously classify symptomatic patients diagnosed with a variety of subtypes of TMD into homogenous groups based on their clinical presentation and occurrence of comorbidities. METHODS: Clinical records of 357 consecutive TMD patients seeking treatment in a private specialized clinic were included in the study sample. Patients presenting multiple subtypes of TMD diagnosed simultaneously were categorized according to the AAOP criteria. Descriptive statistics and two-step cluster analysis were used to characterize the clinical presentation of these patients based on the primary and secondary clinical diagnoses. RESULTS: The most common diagnoses were localized masticatory muscle pain (n = 125) and disc displacement without reduction (n = 104). Comorbidity was identified in 288 patients. The automatic selection of an optimal number of clusters included 100% of cases, generating an initial 6-cluster solution and a final 4-cluster solution. The interpretation of within-group ranking of the importance of variables in the clustering solutions resulted in the following characterization of clusters: chronic facial pain (n = 36), acute muscle pain (n = 125), acute articular pain (n = 75) and chronic articular impairment (n = 121). CONCLUSION: Subgroups of acute and chronic TMD patients seeking treatment can be identified using clustering methods to provide a better understanding of the clinical presentation of TMD when multiple diagnosis are present. Classifying patients into identifiable symptomatic profiles would help clinicians to estimate how common a disorder is within a population of TMD patients and understand the probability of certain pattern of clinical complaints.
Assuntos
Transtornos da Articulação Temporomandibular/diagnóstico , Dor Aguda/classificação , Dor Aguda/fisiopatologia , Adolescente , Adulto , Idoso , Artralgia/classificação , Artralgia/fisiopatologia , Bruxismo/classificação , Bruxismo/fisiopatologia , Criança , Dor Crônica/classificação , Dor Crônica/fisiopatologia , Análise por Conglomerados , Grupos Diagnósticos Relacionados/classificação , Dor Facial/classificação , Dor Facial/fisiopatologia , Feminino , Humanos , Luxações Articulares/classificação , Luxações Articulares/fisiopatologia , Masculino , Músculos da Mastigação/fisiopatologia , Pessoa de Meia-Idade , Osteoartrite/classificação , Osteoartrite/fisiopatologia , Medição da Dor , Planejamento de Assistência ao Paciente , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Sinovite/classificação , Sinovite/fisiopatologia , Disco da Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/classificação , Transtornos da Articulação Temporomandibular/fisiopatologia , Adulto JovemRESUMO
OBJECTIVE: To verify a potential association between the presence of noncarious cervical lesions, parafunctional habits, and temporomandibular disorder (TMD) diagnosis. METHOD AND MATERIALS: Sample-size calculation provided a value of 130 participants with a confidence level of 95% and an error margin of 5%. A population of 132 volunteers (30 men: mean age, 23.7 ± 3.05 years; 102 women: mean age, 24.9 ± 5.86 years) underwent an oral examination and was interviewed by a trained dentist. The following parameters were registered: personal details, TMD diagnosis, parafunctional habits, and noncarious cervical lesion presence. The population was then divided into a noncarious cervical lesion group and a control group and subjected to the t test, chi-square test, Fisher exact test, and Spearman correlation (α = .05). RESULTS: Noncarious cervical lesions were present in 39% of the population, with the largest concentrations found in the maxillary premolars (32%). The data showed a significant association between noncarious cervical lesion presence, tooth clenching (P = .03), and nail biting (P = .02), as well as a relation with TMD diagnosis (Fonseca Index [P = .01] and Research Diagnostic Criteria for TMD (RDC/TMD) [P = .004] ). In the noncarious cervical lesion group, direct rank correlation was found between maxillary premolars and clenching (P = .03), mandibular canines and nail biting (P = .05), and mandibular incisors and parafunctional habits without dental contacts (P = .02). CONCLUSION: Parafunctional habits and TMD presence should be taken into account in the diagnosis and treatment plan of noncarious cervical lesions.
Assuntos
Bruxismo/complicações , Oclusão Dentária Traumática/complicações , Transtornos da Articulação Temporomandibular/complicações , Colo do Dente/patologia , Desgaste dos Dentes/complicações , Adulto , Dente Pré-Molar/patologia , Dente Canino/patologia , Feminino , Humanos , Incisivo/patologia , Masculino , Mandíbula , Maxila , Pessoa de Meia-Idade , Dente Molar/patologia , Hábito de Roer Unhas/efeitos adversos , Transtornos da Articulação Temporomandibular/classificação , Hábitos Linguais , Adulto JovemAssuntos
Bruxismo/complicações , Bruxismo/patologia , Dor Facial/patologia , Hábito de Roer Unhas , Transtornos da Articulação Temporomandibular/classificação , Transtornos da Articulação Temporomandibular/epidemiologia , Transtornos da Articulação Temporomandibular/etiologia , Transtornos da Articulação Temporomandibular/patologiaRESUMO
The aim of this pilot study was to evaluate the effectiveness of cognitive-behavioral therapy (CBT) and use of amitriptyline, a tricyclic antidepressant, in patients with chronic temporomandibular disorders (TMD). Forty-seven women (mean age = 35.4 years old) with chronic TMD were enrolled in the study and divided into 4 groups: amitriptyline; amitriptyline and CBT; placebo and CBT; and placebo only (control). Patients were managed for 7 consecutive weeks. Follow-up evaluations were done at the 1st, 7th and 11th weeks of treatment. The presence and severity of pain, levels of depression, and quality of life and sleep were measured. Data were analyzed using ANOVA, Chi-square and Cochran tests, considering a significance level of 5%. Improvements were found for all factors considered in the intragroup analysis, although no significant differences were detected among groups. However, at the end of the treatment (11 weeks of follow-up), these positive outcomes persisted only for the women treated with amitriptyline and CBT. The obtained results suggest that the combination of amitriptyline and CBT may be effective in reducing pain and depression levels as well as in improving the quality of life and sleep in patients with chronic TMD.
Assuntos
Amitriptilina/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Terapia Cognitivo-Comportamental , Transtornos da Articulação Temporomandibular/terapia , Adolescente , Adulto , Dor Crônica/classificação , Dor Crônica/tratamento farmacológico , Dor Crônica/terapia , Depressão/classificação , Depressão/tratamento farmacológico , Depressão/terapia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Medição da Dor , Projetos Piloto , Placebos , Qualidade de Vida , Sono/efeitos dos fármacos , Sono/fisiologia , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/terapia , Transtornos da Articulação Temporomandibular/classificação , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Resultado do Tratamento , Adulto JovemRESUMO
The aim of this pilot study was to evaluate the effectiveness of cognitive-behavioral therapy (CBT) and use of amitriptyline, a tricyclic antidepressant, in patients with chronic temporomandibular disorders (TMD). Forty-seven women (mean age = 35.4 years old) with chronic TMD were enrolled in the study and divided into 4 groups: amitriptyline; amitriptyline and CBT; placebo and CBT; and placebo only (control). Patients were managed for 7 consecutive weeks. Follow-up evaluations were done at the 1st, 7th and 11th weeks of treatment. The presence and severity of pain, levels of depression, and quality of life and sleep were measured. Data were analyzed using ANOVA, Chi-square and Cochran tests, considering a significance level of 5 percent. Improvements were found for all factors considered in the intragroup analysis, although no significant differences were detected among groups. However, at the end of the treatment (11 weeks of follow-up), these positive outcomes persisted only for the women treated with amitriptyline and CBT. The obtained results suggest that the combination of amitriptyline and CBT may be effective in reducing pain and depression levels as well as in improving the quality of life and sleep in patients with chronic TMD.
O objetivo deste estudo piloto foi avaliar a eficácia do uso de uma terapia cognitivo comportamental (TCC) e da amitriptilina, um antidepressivo tricíclico, no tratamento de pacientes portadores de disfunções temporomandibulares (DTM) crônicas. Quarenta e sete mulheres (com 35,4 anos em média) diagnosticadas com DTM crônica foram selecionadas e divididas em 4 grupos: amitriptilina; amitriptilina + TCC; placebo + TCC; e placebo (controle) e controle. As pacientes foram submetidas às terapias por 7 semanas consecutivas. As reavaliações aconteceram 1, 7 e 11 semanas após o início da terapia (11 semanas de avaliações). Foram avaliados a presença e severidade de dor, o nível de depressão, a qualidade de vida e do sono. Os dados foram avaliados através de ANOVA, Qui-quadrado e teste de Cochran, considerando um nível de significância de 5 por cento. Foram observadas melhoras significantes em todos os fatores avaliados para todos os grupos, porém não foram observadas diferenças entre os grupos. Após o final da terapia, os resultados positivos persistiram apenas para o grupo amitriptilina + TCC. Os resultados sugerem que o uso associado de amitriptilina e TCC no tratamento de pacientes portadores de DTM crônicas pode ser efetivo na melhora da dor, nível de depressão, qualidade de vida e do sono.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Amitriptilina/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Terapia Cognitivo-Comportamental , Transtornos da Articulação Temporomandibular/terapia , Dor Crônica/classificação , Dor Crônica/tratamento farmacológico , Dor Crônica/terapia , Depressão/classificação , Depressão/tratamento farmacológico , Depressão/terapia , Seguimentos , Medição da Dor , Projetos Piloto , Placebos , Qualidade de Vida , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/terapia , Sono/efeitos dos fármacos , Sono/fisiologia , Resultado do Tratamento , Transtornos da Articulação Temporomandibular/classificação , Transtornos da Articulação Temporomandibular/tratamento farmacológicoRESUMO
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.
Disfuncao temporomandibular e o termo usado para descrever uma serie de disturbios envolvendo as articulacoes temporomandibulares, musculos da mastigacao e oclusao, com sintomas comuns como dor, restricao de movimento, sensibilidade muscular e ruido articular intermitente. A etiologia da DTM e multifatorial e esta relacionada a tensao emocional, interferencias oclusais, perda de dentes, desvio postural, disfuncao muscular mastigatoria, mudancas internas e externas na estrutura da ATM, e a diferentes associacoes entre esses fatores. O objetivo deste estudo foi avaliar a relacao entre estresse psicologico e sinais de desordem temporomandibular em estudantes universitarios. Um total de 150 voluntarios participaram deste estudo sendo alunos de uma universidade publica e quatro universidades privadas de diferentes cursos da area de ciencias humanas. A avaliacao da DTM foi realizada por meio do questionario Research Diagnostic Criteria (RDC). Para a avaliacao da ansiedade foi aplicado o questionario Ansiedade Traco-Estado de Spielberger. Os resultados dos niveis de ansiedade e dos graus de DTM dos dois questionarios foram comparados pelo teste do qui-quadrado, com nivel de significancia de 5%. A analise estatistica mostrou que o grau de DTM tem relacao positiva para a Ansiedade-Estado (p = 0,008, p <0,05) e negativa para a ansiedade-traco (p = 0,619, p <0,05), alem disso, foi observado alto indice de DTM entre os estudantes (40%). Por meio dos resultados obtidos e analisados neste estudo, concluiuse que havia uma associacao positiva entre DTM e ansiedade.
Assuntos
Adolescente , Adulto , Humanos , Adulto Jovem , Estresse Psicológico/psicologia , Estudantes de Odontologia/psicologia , Transtornos da Articulação Temporomandibular/psicologia , Ansiedade/fisiopatologia , Ansiedade/psicologia , Som , Estresse Psicológico/fisiopatologia , Escala de Ansiedade Frente a Teste , Dor Facial/fisiopatologia , Dor Facial/psicologia , Transtornos da Articulação Temporomandibular/classificação , Transtornos da Articulação Temporomandibular/fisiopatologia , Doença Crônica , Amplitude de Movimento Articular/fisiologia , Músculos da Mastigação/fisiopatologiaRESUMO
The aim of this work was to describe the prevalence of signs and symptoms of temporomandibular disorders (TMD) in children of the State of Puebla, Mexico. A descriptive observational study was performed. After calculating sample size, children who met the following selection criteria were included: registered at an official elementary school, either sex, ages between 8 and 12 years, who accept to participate in the study and whose parents have signed the informed consent forms. The Research Diagnostic Criteria for Temporomandibular Disorders were used by calibrated researchers (Kappa.90) under the same conditions. Descriptive statistics were applied by using SPSSv15 software. The study included 235 children, 129 (54.9%) female and 106 (45.1%) male, of average age 9.31+1.2 years. Prevalence of signs and symptoms was 33.2%, and predominately muscular (82%), 48.1% showed signs of muscular pain and 19.1% joint pain. 63.4% showed signs of alteration in the mouth opening pattern, 39.1% presented joint sounds on opening or closing the mouth and 20.4% on mandibular excursions. The high prevalence of signs and symptoms related to temporomandibular disorders, in particular in children with mixed dentition, shows the importance of TMD evaluation during this period, when morphological changes associated to growth and craniofacial development prevail.
El objetivo del presente trabajo fue describir la prevalencia de signos y sintomas de los trastornos temporomandibulares (TTM) en ninos del estado de Puebla, Mexico. Se realizo un estudio observacional descriptivo. Previo calculo de tamano de muestra, se incluyeron ninos que cumplieron con criterios previos de seleccion: inscriptos en escuela primaria oficial, de cualquier sexo, en edades de 8 a 12 anos, que aceptaron participar en el estudio y cuyos padres firmaron el consentimiento informado. Se utilizaron los Criterios de Investigacion Diagnostica para los TTM, aplicados por investigador estandarizado (Kappa .90) bajo las mismas condiciones. Se calculo estadistica descriptiva con el programa SPSS v15. Se incluyeron 235 ninos, 129 (54.9%) mujeres y 106 (45.1%) varones con promedio de edad de 9.31}1.2 anos. La prevalencia de signos y sintomas de TTM fue del 33.2% predominantemente musculares (82%), 48.1% presentaron dolor muscular y 19.1% articular. El 63.4% presento alteraciones en el patron de apertura bucal, 39.1% presento ruidos articulares en apertura o cierre y 20.4% a las excursiones mandibulares. Las altas prevalencias de los signos y sintomas relacionadas con los Trastornos Temporomandibulares, particularmente en ninos con denticion mixta, demuestran la importancia de la evaluacion de los TTM durante este periodo, donde prevalecen los cambios morfologicos asociados al crecimiento y al desarrollo craneofacial.
Assuntos
Criança , Feminino , Humanos , Masculino , Transtornos da Articulação Temporomandibular/epidemiologia , Som , Zumbido/epidemiologia , Dor Facial/classificação , Dor Facial/epidemiologia , Transtornos da Articulação Temporomandibular/classificação , Prevalência , Amplitude de Movimento Articular/fisiologia , Dentição Mista , Cefaleia/epidemiologia , Mastigação/fisiologia , Músculos da Mastigação/fisiopatologia , México/epidemiologiaRESUMO
The objectives of the current study were to analyze the effects of orofacial myofunctional therapy (OMT) on the treatment of subjects with associated articular and muscular temporomandibular disorders (TMD). Thirty subjects with associated articular and muscular TMD, according to the Research Diagnostic Criteria (RDC/TMD), were randomly divided into groups: 10 were treated with OMT (T group), 10 with an occlusal splint (OS group), and 10 untreated control group with TMD (SC). Ten subjects without TMD represented the asymptomatic group (AC). All subjects had a clinical examination and were interviewed to determine Helkimo's Indexes (Di and Ai), the frequency and severity of signs and symptoms, and orofacial myofunctional evaluation. During the diagnostic phase, there were significant differences between groups T and AC. There were no significant differences between group T and OC and SC groups. During the final phase, groups T and OS presented significant improvement, however, the group T presented better results and differed significantly from group OS regarding the number of subjects classified as Aill; the severity of muscular pain and TMJ pain; the frequency of headache and the muscles and stomatognathic functions. The group T differed significantly from the SC group but no longer differed significantly from the AC group. OMT favored a significant reduction of pain sensitivity to palpation of all muscles studied but not for the TMJs; an increased measure of mandibular range of motion; reduced Helkimo's Di and Ai scores; reduced frequency and severity of signs and symptoms; and increased scores for orofacial myofunctional conditions.
Assuntos
Terapia Miofuncional , Transtornos da Articulação Temporomandibular/terapia , Adolescente , Adulto , Idoso , Deglutição/fisiologia , Músculos Faciais/fisiopatologia , Dor Facial/terapia , Feminino , Cefaleia/terapia , Humanos , Mastigação/fisiologia , Músculos da Mastigação/fisiopatologia , Pessoa de Meia-Idade , Placas Oclusais , Medição da Dor , Palpação , Amplitude de Movimento Articular/fisiologia , Transtornos da Articulação Temporomandibular/classificação , Transtornos da Articulação Temporomandibular/fisiopatologia , Adulto JovemRESUMO
AIMS: To assess the prevalence of primary headaches (HA) in adults with temporomandibular disorders (TMD) who were assessed in a specialty orofacial pain clinic, as well as in controls without TMD. METHODS: The sample consisted of 158 individuals with TMD seen at a university-based specialty clinic, as well as 68 controls. The Research Diagnostic Criteria for TMD were used to diagnose the TMD patients. HAs were assessed using a structured interview and classified according to the Second Edition of the International Classification for Headache Disorders. Data were analyzed by chi-square tests with a significance level of 5% and odds ratio (OR) tests with a 95% confidence interval (CI). RESULTS: HAs occurred in 45.6% of the control group (30.9% had migraine and 14.7% had tension-type headache [TTH]) and in 85.5% of individuals with TMD. Among individuals with TMD, migraine was the most prevalent primary HA (55.3%), followed by TTH (30.2%); 14.5% had no HA. In contrast to controls, the odds ratio (OR) for HA in those with TMD was 7.05 (95% confidence interval [CI] = 3.65-13.61; P = .000), for migraine, the OR was 2.76 (95% CI = 1.50-5.06; P = .001), and for TTH, the OR was 2.51 (95% CI = 1.18-5.35; P = .014). Myofascial pain/arthralgia was the most common TMD diagnosis (53.2%). The presence of HA or specific HAs was not associated with the time since the onset of TMD (P = .714). However, migraine frequency was positively associated with TMD pain severity (P = .000). CONCLUSION: TMD was associated with increased primary HA prevalence rates. Migraine was the most common primary HA diagnosis in individuals with TMD.