Orientador: Paulo Roberto de Madureira / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T14:00:59Z (GMT). No. of bitstreams: 1 Bortolleto_PaulaProsperoBorelli_M.pdf: 1662347 bytes, checksum: 9d735ee0a2d4610a16474d3bdada78e7 (MD5) Previous issue date: 2011 / Resumo: Os hábitos parafuncionais são um dos fatores etiológicos associados às disfunções temporomandibulares (DTM). O objetivo deste estudo foi verificar a prevalência dos hábitos parafuncionais mais encontrados em alunos e servidores da Universidade Estadual de Campinas (Unicamp), São Paulo, Brasil, e analisar sua associação com as DTM. Trata-se de um estudo transversal, que se originou a partir de um projeto odontológico preventivo oferecido pela Coordenadoria de Serviço Social/Centro de Saúde da Comunidade (CSS/Cecom) da Unicamp. Dentre as 859 pessoas que participaram desse projeto no período entre 2005 e 2010, 274 foram selecionadas através de questionário com mensuração para as DTM e dores orofaciais (DOF). Após a aplicação dos critérios de escolha, 172 sujeitos preencheram uma anamnese específica para DTM e dores orofaciais, com perguntas e avaliação através do exame físico e clínico. Entre os participantes selecionados, 31% eram do gênero masculino e 69%, do feminino, com idade entre 17 e 78 anos. Os hábitos parafuncionais mais frequentemente relatados foram o bruxismo (ranger e/ou apertar os dentes) durante o dia (61%), seguido pelo bruxismo durante a noite (47%) e o de morder unhas e/ou cutículas (37,2%). A dor facial foi encontrada em 58,72% dos pacientes e, em 89% dos casos foi relacionada aos músculos masseteres, e, em 11%, às articulações temporomandibulares (ATM). A prevalência das DTM foi de 75% na população estudada. Destes 129 pacientes com DTM estudados 74,4% relataram bruxismo durante o dia, à noite ou a associação de ambos. Os ruídos nas ATM foram observados em 20% dos casos. Encontramos associação estatística entre DTM e o bruxismo durante a noite e durante o dia. Não houve a mesma associação em relação aos outros hábitos como o de morder unhas, cutículas, objetos, lábios e mascar chicletes. Através da análise de regressão logística, observamos associação entre a variável desgaste dental e o bruxismo noturno / Abstract: The parafunctional habits are one of the etiological factors associated with temporomandibular disorders (TMD). The main objective of this study was to determine the prevalence of these habits among students and staves of the Universidade Estadual de Campinas (Unicamp), São Paulo, Brazil and to analyze the association with the TMD in this population. This is a transversal study, which originated from a dentistry preventive project offered by the Coordination of Social Services/Community Health Center (CSS/Cecom)-Unicamp. Among the 859 people who were a part of this project, in the period between 2005 and 2010, 274 were selected through a questionnaire to measure the TMD and orofacial pain. After the application of the selection criteria, data analysis was performed with 172 subjects, through a specific interview consisting of questions and evaluation involving physical and clinical examination. Among the selected participants, 31% were male and 69% female, between the age of 17 to 78 years old. The most frequently parafunctional habits reported was bruxism (grinding and/or clenching teeth) during the day (61%), followed by bruxism during the night (47%) and biting nail/cuticle (37,2%). Facial pain was presented in 58,72% of patients, in which 89% were related to masseter muscle and 11% to the TMJ. The TMD prevalence was 75% in this population. Of these 129 studied patients with TMD 74,4% reported bruxism during the day, night and a combination of both. The click or noise in the TMJ was presented in 20% of cases. We discovered a statistical association between TMD and bruxism during the night and day. The association wasn't the same in relation to other habits such as chewing gum and nail, cuticle, objects and lips biting. By logistic regression analysis, we observed an association between teeth wear and the variable bruxism at night / Mestrado / Epidemiologia / Mestre em Saude Coletiva

Orientador: Wilkens Aurelio Buarque e Silva / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-04T00:58:55Z (GMT). No. of bitstreams: 1 Santos_SidneySaint'Clair_D.pdf: 775564 bytes, checksum: 3773083a765391d32e47600112182852 (MD5) Previous issue date: 2004 / Resumo: O objetivo deste trabalho foi avaliar o espaço funcional livre e as modificações na posição da mandíbula, no plano sagital (ântero-posterior) e no plano frontal látero-lateral), utilizando a eletrognatografia computadorizada (K6-I Diagnostic System, Myotronics Co, U.S.A.), em pacientes portadores de alterações funcionais do sistema estomatognático, tratados com aparelhos de superfície oclusal plana modificados (com guias em incisivos e caninos). A amostra aleatória foi composta por 15 pacientes submetidos aos exames previstos na ficha clínica do CETASE (Centro de Estudos e Tratamento das Alterações do Sistema Estomatognático) para a confirmação das variáveis para inclusão e para exclusão na amostra, dentre elas os portadores de alterações degenerativas. As avaliações foram realizadas antes da instalação dos aparelhos, com 30, 60, 90 e 120 dias após a instalação dos mesmos. Os resultados mostraram que o espaço funcional livre teve aumento significativo em função do tempo de tratamento / Abstract: The aim of this research was to evaluate changes in the mandible position, in sagittal plane (anteroposterior) and in frontal plane, using computerized electrognathography (K6-I Diagnostic System, Myotronics Co, U.S.A.) in patients who suffer from functional changes in the stomatognathic system, treated with modified flat occlusal surface appliances (guidances on incisors and canines). The random sample was composed of 15 patients submitted to examinations foreseen on the CETASE (Center of Studies and Treatment of stomatognathic System Alterations) history chart, to confirm variables for inclusion and for exclusion on the sample, including patients suffering from degenerative changes. The evaluations were taken before the appliances were set and within 30,60,90 and 120 days after. The results showed that the free-way space had an statistically significant difference higher on behalf of time treatment / Doutorado / Protese Dental / Doutor em Clínica Odontológica

Introduktion: Mikrodialys används för att studera metabola förändringar i olika vävnader. Vid mikrodialys sätts en kateter i muskeln vilket inducerar en traumafas, som kan påverka frisläpp av substanser. En 120 minuters stabiliseringstid har föreslagits så att metabola förändringar p.g.a. traumat ska normaliseras och ej påverka resultatet. En lång stabiliseringstid leder dock till att dessa studier är tidskrävande och därför även dyra och svårgenomförda. Syfte: Att undersöka och fastställa lämplig stabiliseringsperiod för mikrodialys av serotonin och glutamat i massetermuskeln hos friska individer samt hos patienter med myofascial TMD. Material och metod: Intramuskulär mikrodialys utfördes och dialysat samlades in på 15 friska kontroller samt 15 patienter med myofascial TMD för analys av serotonin och glutamat. För att tillåta vävnaden återhämta sig från traumafasen utvärderades en 120-minuters stabiliseringsperiod, där de första 20 minuterna utgjorde ursprunglig baseline och de sista 20 minuterna stabiliserad baseline. Resultat: Ingen signifikant förändring av serotonin och glutamat observerades över tid för kontroll-gruppen (P>0,05). För TMD-gruppen sågs däremot såg en signifikant sänkning av serotoninhalten over tid (P<0,001) följt av en signifikant ökning mellan tidpunkten T100-120 och T120-140 (P<0,001). För glutamat sågs en reduktion vid tidpunkten T20-40 jämför med det ursprungliga baselinevärdet (P<0,05). Konklusion: Resultaten antyder att 20 minuters stabiliseringsperiod är tillräcklig för friska individer vid mikrodialys av serotonin och glutamat i masseter muskeln. Hos patienter med myofacial TMD är glutamat-nivåerna stabiliserade efter 40 minuter. Serotonin nivåerna är däremot inte stabiliserade efter 120 minuter, vilket tyder på en spontan ökning av intramuskulär serotonin 2 timmar efter införandet av katetern. / Introduction: Microdialysis is a technique used to study metabolic changes in tissues. When performing microdialysis, a catheter is inserted into the muscle inducing a trauma phase, which may affect the release of substances. A 2-hour stabilization period has been suggested to allow tissues to recover from metabolic changes following the trauma. A long stabilization period however, makes these studies time-consuming and thus expensive.Aim: To investigate the necessary stabilization period for microdialysis of serotonin and glutamate in the masseter muscle in healthy subjects and in patients with myofascial TMD.Material and Methods: Intramuscular microdialysis was carried out in 15 patients with myofascial TMD and 15 healthy controls to collect serotonin and glutamate. To allow the tissue to recover following the probe insertion, a 120-min stabilization period was evaluated where the first 20 min served as the zero baseline and the last 20 min as the stabilized baseline. Results: No significant alterations of serotonin or glutamate were observed over the 2-hour period for the controls (P>0.05). For the TMD group, a significant decrease of serotonin was observed over time (P<0.001) followed by a significant increase between T100-120 and T120-140 (P<0.001). For glutamate, a significant reduction was observed at T20-40 compared with the zero baseline (P<0.05). Conclusion: A 20-min stabilization period is sufficient for healthy subjects for microdialysis of serotonin and glutamate in the masseter muscle. In patients with myofascial TMD, glutamate levels are stabilized after 40 minutes. Serotonin levels are not stabilized after 2 hours indicating a spontaneous increase of serotonin.

Psychosocial functioning is a key component of screening and treatment of Temporomandibular Disorders (TMD) in adults; however, psychosocial functioning in adolescents with TMD has received little empirical attention. The present study aims to examine group difference between adolescents and adults with TMD on pain and prominent psychosocial factors, such as anxiety, depression, and somatization, as well as to explore additional developmentally sensitive psychosocial factors that may be associated more with the adolescent TMD pain. Participants included 35 adolescents aged 12-17 (M=14.89 years, SD=1.84) with TMD muscle pain who completed pain questionnaires and a comprehensive dental examination. Patients and their primary caregivers completed behavioral questionnaires to examine psychosocial functioning. Thirty-five adults matched on gender, diagnosis, and duration of pain were selected from a large pre-existing database of previous orofacial pain patients. Adolescents and adults reported descriptively similar TMD pain and equivalent rates of anxiety, depression, and somatization; however, the relationship between these psychosocial factors and TMD pain appear to be more salient for adults compared to adolescents. In adolescents, increased pain-related interference was significantly associated with positive attitudes toward school, better anger control, and deficits in functional communication; whereas, more frequent TMD pain was significantly associated with sense of inadequacy and parent-reported withdrawal, though not in the expected direction. Screening for TMD in adults typically focuses on anxiety, depression, and somatization; however, these psychosocial factors overall did not appear as salient in adolescents as attitude toward school, anger control, sense of inadequacy, withdrawal, and functional communication, suggesting that adult psychosocial screen may need to be revised to include developmentally sensitive targets that may be particularly important for screening of TMD in adolescents.

Background Pain and dysfunction in the temporomandibular region (Temporomandibular Disorders, TMD) are common conditions in the general population with an estimated treatment need of 5-15% in the general population. However, in Sweden, traceable performed treatments are significantly lower. The reasons for this indicated under-treatment are not known. To easily detect patients with a potential TMD related condition, three screening questions, 3Q/TMD, have been introduced. The aim with this project was to evaluate the validity and outcome of the 3Q/TMD with the objective to recognize individuals with TMD and potential treatment need in the Public Dental Health service (PDHS). Methods The thesis is based on four study samples; three from the PDHS in the county of Västerbotten, Sweden and one sample from the specialized orofacial pain clinic at the Academic Centre for Dentistry, ACTA, Amsterdam, the Netherlands. The bases for all studies are individuals’ answers to the 3Q/TMD and quantitative approaches were used in the analyses. The prevalence of affirmative answers was evaluated in a large cross-sectional study over the lifespan. The validity of the 3Q/TMD in relation to the Diagnostic Criteria for TMD (DC/TMD) as reference standard was established in two case-control studies. The outcome of the 3Q/TMD on TMD treatment within general practice was evaluated in a cohort study. Results Affirmative answers to the 3Q/TMD increased during adolescence. Women answered affirmatively to the 3Q/TMD significantly more often compared to men for all age groups expect for the first and last parts of a one hundred-year lifespan. The highest prevalence was reported by women during their fertile period in life. In a general population sample, 74% of individuals with an affirmative answer qualified for a DC/TMD pain or dysfunctional diagnosis, as compared to 64% in a specialist patient sample. In the general population sample, for the individual 3Q/TMD questions, as well as combinations of questions, the negative predictive values were high (0.92-0.99). For the specialist sample, when at least one question was answered affirmatively the negative predictive value was high (0.90). The positive predictive value was high (0.89) when all three questions were positive. There was significantly more treatment performed or recommended for 3Q-positives (21.5%) compared to 3Q-negatives (2.2%) (P&lt;0.001). The odds ratio for TMD-related treatment for 3Q-positives versus 3Q-negatives was 12.1 (95% CI: 6.3-23.4). Conclusion The 3Q/TMD is a convenient and valid tool to recognize individuals who would benefit from a further TMD examination within an adult, general population. Within specialized orofacial pain clinics, the questions are useful as guidance for further diagnostics. Although the 3Q/TMD was a factor related to TMD treatment, the majority of individuals with self-reported symptoms of TMD still did not receive traceable assessment or treatment. Factors associated with dentists’ clinical decision-making in relation to TMD warrants further research. The utilization of the 3Q/TMD as a part of a decision tree for the clinician can improve the health care for patients with TMD and is therefore recommended within dentistry. / Bakgrund Smärta och funktionsstörningar i käksystemet (TMD) är vanligt förekommande och de flesta av dessa patienter kan behandlas framgångsrikt i tandvården. Tidigare studier har visat att det kan finnas en skillnad mellan det skattade vårdbehovet och utförd behandling för patienter med TMD i tandvården. Anledningen till detta är inte känt och har identifierats som en kunskapslucka av Socialstyrelsen. Den vanligaste orsaken till akut smärta i ansiktsregion är tandvärk medan kronisk smärta oftast är relaterat till smärttillstånd i muskulatur och käkled (TMD). Att leva med smärta har en negativ påverkan på livskvaliteten oavsett om smärtan är orsakad av tandvärk eller TMD. Kvinnor uppger symtom på TMD ungefär två gånger så ofta som män och förekomsten är som högst bland kvinnor i arbetsför ålder. Smärtan är ofta relaterad till stress och långvarig smärta ökar risken för såväl spridning till andra lokalisationer som till sömnbesvär och nedstämdhet. Tidig intervention har visat sig betydelsefull för att minska risken för negativa konsekvenser relaterat till kroniska besvär. Sammantaget visar detta på vikten av ett system inom tandvården för att tidigt identifiera patienter som är i möjligt behov av fördjupad utredning och eventuellt behandling. Därför har tre screeningfrågor för TMD, 3Q/TMD införts inom tandvården. I Folktandvården i Västerbotten infördes frågorna i maj 2010 som en obligatorisk del av den digitala hälsodeklarationen för samtliga patienter. Syfte Syftet med avhandlingen har varit att synliggöra patienter med smärta och käkfunktionsstörning i befolkningen och att därmed förbättra omhändertagandet av patienter med TMD inom Folktandvården. De specifika målen var att: i) beskriva förekomst av frekvent smärta och dysfunktion i ansikte, käke och käkled för män och kvinnor för olika åldersgrupper baserat på tre screeningfrågor ii) bedöma de tre screeningfrågornas validitet i förhållande till en diagnos enligt Diagnostic Criteria for TMD, DC/TMD i två olika populationer iii) utvärdera utfallet av 3Q/TMD på klinisk beslutsprocess inom Folktandvården i Västerbotten, Sverige. Studiepopulation och metod Avhandlingen baserades på fyra olika urval av patientpopulationer, tre från Folktandvården i Västerbotten, Sverige och en från Specialistkliniken från Academish Centrum Tandheelkunde Amsterdam, ACTA, Amsterdam, Nederländerna. Underlaget för samtliga studier var baserade på individuella svar på de tre screeningfrågorna. Förekomsten av de som svarat ja på någon av frågorna utvärderades i en tvärsnittsstudie bland nästan 140 000 individer och över ett helt livsspann. Validiteten för 3Q/TMD i relation till en diagnos enligt DC/TMD utvärderades i två fall-kontroll studier. Först undersöktes en studiepopulation från Folktandvården i Västerbotten, Sverige för att representera allmän befolkningen. Därefter utvärderades screeningfrågorna bland de patienter som remitterats till en specialistklinik i Amsterdam, Nederländerna på grund av TMD relaterade besvär. Dessa representerar remitterade patienter. Utfallet av 3Q/TMD på TMD behandling i Folktandvården utvärderades i en prospektiv kohort studie. Resultat Förekomsten av de som svarat ja på någon av frågorna ökar under tonåren. Kvinnor svarar ja på någon av frågorna signifikant oftare än män i alla åldrar, utom i början och slutet av livsspannet. Den högsta prevalensen noterades för kvinnor i fertil ålder. I allmänbefolkningen kvalificerar 74% av de som svarat ja på någon av frågorna även för en DC/TMD diagnos. Motsvarande siffra för urvalet från specialistkliniken var 64%. I urvalet från allmänbefolkningen var det negativa prediktiva värdet högt för såväl alla enskilda frågor som för kombinationer av frågor (0.92-0.99). Bland de remitterade patienterna, var negativt prediktivt värde högt när individen svarade ja på minst en fråga (0.90). Positivt prediktivt värde var högt när individen svarat ja på alla tre frågorna (0.89). Behandling hade utförts eller rekommenderats signifikant oftare till de som svarat ja på någon av frågorna (21.5%) jämfört med de som svarat nej på alla tre frågor (2.2%) (P&lt;0.001). Odds ratio för TMD behandling för 3Q-positiva jämfört med 3Q-negativa var 12.1 (95% CI:6.3-23.4). Slutsats Sammanfattningsvis visar resultaten att en betydande andel av befolkningen, framför allt kvinnor i arbetsför ålder, har smärta och/eller funktionsstörningar i käksystemet. Frågorna är lämpliga för att screena patienter i behov av en fördjupad utredning. De som svarat nej kommer med stor sannolikhet inte att kvalificera för en diagnos enligt DC/TMD. Bland remitterade patienter kommer majoriteten att svara ja på någon av frågorna. I allmäntandvården får två tredjedelar av det som svarat ja på minst en fråga, inte ett synliggjort omhändertagande baserat på vad som är angivet i deras tandvårdsjournal. Detta kan tyda på brister bland allmäntandläkare och tandhygienister i kliniskt beslutsfattande för patienter med TMD.

The current study examined the ability of pain-related catastrophizing to predict outcomes following non-surgical and surgical intervention for temporomandibular disorders (TMDs). The interpersonal context of pain-related catastrophizing, referred to as the communal coping model, was also examined to determine if patient perceptions of punishing and solicitous responses from significant others would moderate or mediate relations between pain catastrophizing and outcomes. The role of pain duration as a moderator of the relation between pain-related catastrophizing and perceived significant other responding was also examined. A total of 94 patients were identified for which 65 had follow-up outcomes that could be examined. Patient follow-up data were obtained at approximately two to three weeks, two to three months, and six months post-intervention. Results showed that pain-related catastrophizing was predictive of greater pain severity at all three follow-up time points after controlling for baseline levels of pain severity, depressive symptoms, sleep disturbance, and pain duration. Pain-related catastrophizing was predictive of poorer range of motion (ROM) at the initial follow-up after controlling for baseline levels of ROM, gender, and form of intervention. Pain-related catastrophizing was not associated with ROM at the second and third post-intervention follow-ups. There was no interaction between pain-related catastrophizing and perceptions of either solicitous or punishing responses in predicting post-intervention pain severity or ROM and any time point. Perceptions of significant other responses also did not mediate the relation between pain-related catastrophizing and post-intervention outcomes at any time point. Additionally, the interaction between pain duration and pain-related catastrophizing in the prediction of post-intervention pain severity or ROM was not significant at any follow-up time point. The findings indicate that pain related catastrophizing is an important predictor of pain severity following non-surgical and surgical interventions for TMDs both initially and in the long-term. Pain-related catastrophizing is related to ROM outcomes only in the short term. Perceptions of punishing and solicitous responses from significant others do not appear to play a role in these associations. The results suggest that patients with high levels of pre-intervention catastrophizing may benefit from adjunctive cognitive-behavioral intervention to attenuate post-intervention pain severity.

Este trabalho teve por objetivo avaliar os efeitos da acupuntura em dois diferentes grupos de pacientes portadores de Disfunções Temporomandibulares (DTM), um deles com DTM de característica apenas muscular (MUSC), e o outro com DTM muscular associada a desordem articular (ART). Participaram dessa pesquisa 68 pacientes, 32 no grupo MUSC e 36 no grupo ART. Os pacientes de cada grupo foram aleatoriamente subdivididos em dois grupos, que receberam diferentes tratamentos por acupuntura. Um grupo foi tratado com pontos próximos ao local da dor (VG20, VB20, TA21, E6 e E7), e o outro, com pontos à distância (IG4 e YinTang). Foram 6 sessões semanais, cada uma com duração de 20 minutos. Os pacientes foram avaliados por meio de escala visual analógica (VAS), limiar de dor à pressão por algômetro, sensibilidade dolorosa à palpação digital, extensão de movimentos mandibulares, questionário para medir o impacto da dor na qualidade de vida (OHIP-14), questionário de qualidade do sono (SAQ) e questionário para avaliar a percepção dos sinais e sintomas pelo paciente (ProDTMmulti). As avaliações foram feitas em 4 momentos diferentes, o inicial, no primeiro contato com o paciente após o período de triagem, o controle, após 4 semanas sem qualquer intervenção terapêutica, o final, após 6 sessões semanais de acupuntura, e o de acompanhamento, 4 semana após o fim do tratamento, sem que nenhum intervenção fosse feita. Os resultados demonstraram que as melhorias estatisticamente significativas para os grupos experimentais foram observadas de maneira generalizada para a avaliação subjetiva da dor, em que todos os grupos de comportaram de maneira semelhante, apesar de os melhores resultados terem sido observados em ART-PD. Em todos os outros parâmetros de avaliação foi possível observar aspectos de melhoria dos grupos com significância estatística (p<0,05), mas não de maneira generalizada como na VAS. Parâmetros objetivos, como extensão de movimentos mandibulares e algometria, mostraram uma tendência para melhoria, embora sem significância estatística para todos os grupos. A acupuntura foi um tratamento considerado eficiente no controle da dor e dos outros aspectos avaliados em pacientes com DTM muscular associada ou não a alterações articulares. / This study aimed to evaluate the effect of acupuncture treatment in two diferent types of temporo-mandibular disorder (TMD) pacients: muscular TMD (MUSC) and a muscular plus articular TMD (ART). Out of 68 patientes, 32 were classified to the MUSC group and the other 36 ones for the ART group. Patientes of each group were randomly assigned into two subgroups according to type of practiced acupuncture. One subgroup were treated with local acupuncture, next (PL) to the pain location (VG20, VB20, TA21, E6 e E7), and the other one were treated with needles inserted distant (PD) to the pain location (IG4 e YinTang). Six weekly 20min treatment sections were performed. The patients were evaluated according to Visual Analogic Scale (VAS), pressure pain thresold by algometer, digital pressure pain sensation, mandibular movements extension, quality of life questionaire (OHIP-14), sleep quality questionaire (SAQ), and signals and simptoms questionaire (ProDTMmulti). Evaluations were performed at for different moments: initially, at the first meeting; control, four weeks after the initial meeting; end, after six acupunture meetings; and follow-up, four weeks after treatment end, without any additional intervention. Results showed that statistical significant better observations for subjective pain evaluation were noted for all groups, in spite of the best results were noted in ART-PD. According to all evaluation methods it was possible to note better results for all groups (p<0,05), but this was not so noticiable as on VAS evaluation. Direct objective parameters, i.e., mandibular movements extension or algomenter measurements, showed a tendecy for better results, but no statistical significant results were found. Acupuncture could be considered an effective treament option for pain relief and also for the other evaluated aspects for patients with muscular TMD with or without articular association.

O objetivo deste estudo foi avaliar o efeito de placas oclusais com guias anteriores de desoclusão e placas oclusais com contatos bilaterais e anteriores simultâneos durante os movimentos excursivos da mandíbula em pacientes com disfunção temporomandibular (DTM) e zumbido subjetivo. Foram avaliados 264 pacientes encaminhados para tratamento da DTM na FORP/USP e selecionados 32 mulheres com DTM muscular, associada ou não a DTM articular, e zumbido subjetivo que preencheram os critérios de inclusão. O diagnóstico da DTM foi realizado com o Research Diagnostic Criteria for Temporomadibular Disorders (RDC/TMD). As pacientes foram divididas randomicamente em dois grupos para utilizarem um dos dois tipos de placas. As avaliações incluíram dor à palpação, limiar de dor a pressão com algômetro, medidas da amplitude dos movimentos mandibulares, eletromiografia de superfície, relato da intensidade da dor e da loudness do zumbido em escala visual analógica (EVA) e das características do zumbido. Os pacientes também responderam a um questionário para quantificação da frequência e severidade dos sinais e sintomas de DTM (ProDTMMulti) e para a avaliação do impacto do zumbido no dia-a-dia (Tinnitus Handicap Inventory - THI). A avaliação eletromiográfica foi realizada em várias atividades com e sem placa oclusal (apertamento máximo voluntário, movimentos excursivos mandibulares, repouso e mastigação habitual) e comparada com um grupo de 13 mulheres assintomáticas. As avaliações foram realizadas inicialmente (A1), no dia de instalação das placas oclusais, após 60 dias da avaliação inicial (A2) e após 90 dias de uso da placa oclusal (A3). O período entre as avaliações A1 e A2 foi considerado um período controle. Os resultados mostraram uma significante melhora da dor relatada pelo pacientes e aumento da amplitude da abertura bucal sem dor nos dois grupos, sem diferença entre eles. A atividade eletromiográfica foi significativamente reduzida durante apertamento máximo voluntário com a placa oclusal em comparação com o apertamento em máxima intercuspidação habitual, para as demais atividades realizadas durante o exame não houve diferença significante. A avaliação do zumbido mostrou que em muitos pacientes houve remissão do sintoma após o tratamento com placa oclusal. Não houve diferença entre os grupos para todas as avaliações realizadas. Baseados nesses achados, pode-se concluir que o tratamento com ambas as placas promoveu melhora na sintomatologia dos pacientes, sem diferenças entre elas, e houve em muitos pacientes uma remissão do zumbido relatado durante o tratamento. / The aim of this study was to assess the effect of anterior guidance and bilateral balanced splints in patients with temporomandibular disorders (TMD) and subjective tinnitus. A total of 264 subjects referred for treatment of TMD in FORP/USP were evaluated and 32 women with muscular TMD with or without the diagnosis of articular TMD, who met the inclusion criteria, were selected. TMD diagnosis was performed according to Research Diagnostic Criteria for Temporomadibular Disorders (RDC/TMD). The patients were randomly divided into two groups: anterior guidance splint group and bilateral balanced splints group. The assessments included pain to palpation, pressure pain threshold with algometer, measurement of amplitude of mandibular movements, surface electromyography, pain intensity and loudness of tinnitus reports in visual analogue scale (VAS) and characteristics of tinnitus. The patients also answered a questionnaire to quantify the frequency and severity of signs and symptoms of TMD (ProDTMMulti) and to assess the impact of tinnitus on a day-to-day (Tinnitus Handicap Inventory - THI). The electromyography evaluation was performed in different activities with and without occlusal splint (maximum voluntary clenching, excursive jaw movements, resting and habitual chewing) and compared to a group of 13 asymptomatic women. The assessments were performed initially (A1), at the day of installation of the occlusal splints, after 60 days of the initial assessment (A2) and after 90 days of occlusal splint therapy (A3). The period between A1 and A2 assessments was considered a control period. The results showed a significant improvement in pain reported by patients and an increase in the amplitude of mouth opening without pain in both groups, without difference between them. The electromyographic activity was significantly reduced during maximum voluntary clenching with occlusal splint compared to clenching in maximal habitual intercuspation, to the other activities performed during the examination there was no significant difference. The tinnitus evaluation showed that in many patients there was remission of symptom after treatment with occlusal splint. There was no difference among groups for all assessments. Based on these findings it is possible to conclude that treatment with both splints promoted improvement in symptoms of patients, without differences among them, and many patients had a remission of reported tinnitus during the treatment.

A incapacidade de produzir repetidamente no tempo um determinado nível de força ou potência muscular designa-se por fadiga neuromuscular. A etiologia da fadiga muscular tem atraído o interesse de pesquisadores há mais de um século. Contudo, os seus agentes e locais definitivos permanecem ainda por serem identificados. Este trabalho teve por objetivo avaliar a fadiga neuromuscular por meio da análise de frequência do sinal eletromiográfico dos músculos masseter e temporal anterior de ambos os lados em 3 grupos distintos: sujeitos saudáveis assintomáticos para disfunção temporomandibular (DTM), pacientes acometidos por DTM tratados com placa oclusal resiliente e pacientes acometidos por DTM tratados com placa oclusal rígida. Para isso, participaram da pesquisa 100 sujeitos assintomáticos para DTM e 30 pacientes com DTM subdivididos em 2 grupos: tratados com placa rígida tipo FARC; e tratados com placa resiliente. Todos realizaram exame eletromiográfico antes e após o tratamento com placa oclusal. Os resultados demonstraram que houve diferenças estatisticamente significantes na comparação da taxa de fadiga avaliada antes e após o tratamento com placa oclusal, tanto para o grupo Placa FARC como para o grupo Placa Soft. Houve diminuição da taxa de fadiga após o tratamento com placa para os músculos masseter esquerdo e temporal anterior direito para o grupo Placa Soft; e diminuição da taxa de fadiga após o tratamento para o músculo temporal anterior esquerdo para o grupo Placa FARC. Pode-se concluir que o tratamento com ambos tipos de placa oclusal foi eficiente na redução da taxa de fadiga neuromuscular em pacientes acometidos por DTM. / The repeated failure to produce in time a certain level of strength or muscle power is called neuromuscular fatigue. The etiology of muscle fatigue has attracted the interest of researchers for over a century. However, their agents and local definitive remain yet to be identified. This work aimed to evaluate neuromuscular fatigue by frequency analysis of the electromyographic signal of the masseter and anterior temporal muscles of both sides in three different groups: healthy subjects asymptomatic for temporomandibular disorders (TMD), patients suffering from TMD treated with resilient occlusal splint and patients suffering from TMD treated with rigid occlusal splint. For this, 100 subjects asymptomatic for TMD participated in the survey and 30 patients with TMD subdivided into 2 groups: treated with rigid splint type FARC, and treated with resilient splint. All electromyographic examinations performed before and after treatment with occlusal splint. The results showed that statistically significant differences when comparing the rate of fatigue assessed before and after treatment with occlusal appliance, for both groups. There was a decrease in the rate of fatigue after treatment with occlusal splint to the left masseter and right anterior temporal in the group Soft Splint; and decrease in the rate of fatigue after treatment for left anterior temporal muscle to the group FARC Splint. It can be concluded that treatment with both types of occlusal splint was effective in reducing the rate of neuromuscular fatigue in patients affected by TMD.

A radioterapia de cabeça e pescoço quando direcionada às glândulas salivares, articulação temporomandibular e músculos da mastigação, provoca sequelas na cavidade oral muitas vezes irreversíveis. Objetivo: Comparar a saúde oral, condição periodontal e função mandibular, antes e após a radioterapia da região de cabeça e pescoço. Métodos: Vinte e seis pacientes com diagnóstico de tumores malignos de cabeça e pescoço foram avaliados 30 dias antes, 30 e 90 dias após a radioterapia. A avaliação orofacial incluiu: avaliação dentária, periodontal e função mandibular. Também foram observadas as características gerais como tipo histológico do tumor e dose de radioterapia. Resultados: A idade média da amostra foi de 58 anos, sendo que 21 indivíduos (80,76%) eram do gênero masculino. Observamos um aumento do número de dentes cariados, entre a primeira e terceira avaliação (2,08±2,31 vs 4,19±3,41, p0,001) e um aumento do número de dentes perdidos (14±6,34 vs 14,46±6,23, p=0,006) e obturados (2,04±3,38 vs 2,73±3,54, p=0,004) a partir da segunda avaliação, provavelmente pelo preparo oral da radioterapia. Noventa dias após o término do tratamento radioterápico, observamos diminuição da inserção clínica periodontal (3,65±1,37 vs 4,10±2,08, p=0,001), pelo aumento de limite esmalte-cemento/margem gengival (1,67±1,13 vs 2,15±1,63, p=0,001). Os pacientes apresentaram prejuízo da mobilidade mandibular com diminuição de protrusão (7,88±3,59 vs 6,38±3,69, p=0,009) e da abertura bucal forçada (37,42±9,88 vs 34,12±10,51, p=0,007), além de um aumento de sinais e sintomas de disfunção temporomandibular. Conclusão: Os resultados mostram que a radioterapia provoca efeitos deletérios na região orofacial, que tendem a acentuar com o passar do tempo, ainda que o tratamento odontológico prévio seja realizado. Entretanto, o preparo de boca é relevante para minimizar os problemas decorrentes da radioterapia. / When salivary glands, temporomandibular joint and muscles of mastication are in the field of radiation, radiotherapy for head and neck cancer causes sequelae in the oral cavity often irreversible. Objective: Compare oral health, periodontal condition and jaw function before and after radiotherapy of head and neck. Method: Twenty-six patients with head and neck malignant tumors were evaluated 30 days before and 30 and 90 days after radiotherapy. The orofacial evaluation included: dental, periodontal and jaw function. General characteristics as histological type of the tumor and radiotherapy´s dose were also evaluated. Results: The mean age of the sample was 58 years and 21 (80.76%) were male. We observed an increase in the number of decayed teeth, between the first and third evaluations (2.08 ± 2.31 vs. 4.19 ± 3.41, p 0.001) and an increased number of missing teeth (14 ± 6.34 vs 14.46 ± 6.23, p = 0.006) and filled (2.04 ± 3.38 vs 2.73 ± 3.54, p = 0.004) in the second assessment, probably caused by dental preparation for radiotherapy. Ninety days after the radiotherapy treatment, we observed reduction in clinical attachment (3.65 ± 1.37 vs. 4.10 ± 2.08, p = 0.001) and increased cemento-enamel / gingival margin limit (1.67 ± 1.13 vs. 2.15 ± 1.63, p = 0.001). Patients had impaired mandibular mobility in protrusion (7.88 ± 3.59 vs. 6.38 ± 3.69, p = 0.009) and forced mouth opening (37.42 ± 9.88 vs 34.12 ± 10.51, p = 0.007), and an increase in signs and symptoms of temporomandibular disorders. Conclusion: The results show that radiotherapy may have adverse effects in orofacial region and that these effects tend to worsen over time, even if orofacial treatment is realized before radiation therapy. However, orofacial pre radiotherapy treatment is relevant to minimize the problems due radiotherapy.