Orientador: Maria Beatriz Duarte Gavião / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-11T16:25:27Z (GMT). No. of bitstreams: 1 Pizolato_RaquelAparecida_M.pdf: 3072009 bytes, checksum: d1e15093f6467696643da37de1e480d4 (MD5) Previous issue date: 2008 / Resumo: O objetivo deste estudo foi avaliar as funções de deglutição e fala em crianças na faixa etária de 8 a 12 anos com diagnóstico de desordem temporomandibular (DTM) e presença ou ausência de sinais ou sintomas de DTM. A amostra foi composta por 152 crianças (78 meninos e 74 meninas, idade média 10,05± 1,39 anos) de duas escolas públicas de Piracicaba. Os sinais clínicos foram avaliados através do Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) (eixo I) e os sintomas subjetivos por um questionário. Os seguintes grupos foram formados: Grupo DTM (n=40), Grupo sinais e sintomas de DTM (S e S, n=68), Grupo sinais ou sintomas de DTM (S ou S, n= 33) e Grupo sem sinais e sintomas de DTM (N, n=11). Foram realizados exames intra-oral e extra-oral das estruturas orofaciais, verificando dentes, língua, frênulo lingual, lábio e músculo mentual. Para a avaliação da deglutição foi utilizado alimento líquido (água) e sólido (pão francês padronizado tamanho 2 cm de largura e 2 cm de altura), observando-se as seguintes alterações: participação da musculatura perioral, contração do músculo mentual, interposição de lábio inferior, interposição de língua anteriormente e lateralmente aos arcos dentários, pressionamento lingual e movimento de cabeça. Para a avaliação da fala, em situação espontânea, foram utilizadas as 5 figuras temáticas do protocolo de avaliação fonológica de Yavas. Utilizou-se uma lista de 40 palavras foneticamentebalanceadas para avaliação da fala pela repetição. Os movimentos mandibulares durante a fala foram avaliados visualmente. A fala foi gravada em áudio para análise da transcrição fonética e fonológica. Os dados foram analisados pela estatística descritiva, teste do Quiquadrado e Exato de Fischer com nível de significância de 5%. A análise dos resultados mostrou que não houve diferença estatisticamente significante na proporção de crianças com deglutição alterada entre os grupos. As crianças com deglutição normal não apresentaram alteração das estruturas orofaciais. Na amostra com deglutição anormal, a proporção de crianças com tônus de lábios flácidos, tônus do mentual rígido e hipofunção de língua foi estatisticamente menor no grupo sem sinal e sintoma de DTM em relação aos outros grupos. Em relação às características da oclusão, somente a sobressaliência excessiva (=4 mm) esteve presente em proporção significantemente maior em crianças dos grupos DTM e S e S com padrão de deglutição anormal. As alterações na fala foram mínimas entre os grupos e não estiveram associadas com DTM e sinais e/ou sintomas de DTM. Na avaliação dos movimentos mandibulares durante a fala não foram observados desvios de lateralidade e somente 4 crianças apresentaram redução de amplitude vertical. Concluiu-se que na amostra estudada não houve associação entre alteração da deglutição e fala com DTM e sinais e/ou sintomas de DTM / Abstract: The aim of this study was to evaluate the functions of swallowing and speech in children aged from 8 to 12 years old with temporomandibular disorders (TMD) and presence or absence of the signs and/or symptoms of TMD. The sample comprised 152 children (78 boys and 74 girls, mean age 10.05±1.39 years). The clinical signs were evaluated using the RDC/TMD (axis I) and the symptoms, using a questionnaire. The following groups were formed: Group TMD (n=40), signs and symptoms of TMD (Group S and S, n=68), signs or symptoms of TMD (Group S or S, n=33) and without signs and symptoms (Group N, n=11). Intra- and extra-oral exams of the orofacial structures were performed: teeth, tongue, lingual frenum, lips, mentalis muscle. For the swallowing assessment, solid and liquid foods were used, observing the following alterations: orbicularis oris muscle contraction, mentalis muscle contraction, lower lip thrust, anterior and lateral tongue thrust, tongue pressure and head movements. For speech evaluation in spontaneous situations, 5 pictures of the Yavas¿ protocol were used. A list of 40 phonetically balanced words was also applied to evaluate speech repetition. The mandibular movements during the speech were visually evaluated. Speech was recorded in audio to analyze the transcribed phonetic and phonological emissions. The data were analyzed by descriptive statistics, Fisher exact or Qui- square test (a=0.05). Analyses of the results showed no statistically significant difference in the proportion of children with abnormal swallowing pattern among groups. The children with normal swallowing did not show alterations of the orofacial structures. In the sample with abnormal swallowing there was a statistically significant lower proportion of children with weak lip tonus, strong mentalis muscle tonus and hypofunction of the tongue in the group without signs and symptoms of TMD, than there was in the other groups. With regard to the characteristics of occlusion, excessive overjet (=4mm) was present in a significantly higher proportion in children of the groups TMD and S and S with abnormal swallowing. The few alterations in speech showed no association with TMD and signs and/or symptoms of the TMD. In evaluation of the mandibular movements during speech, no lateral deviations were observed and only 4 children showed reduction of vertical amplitude. It was concluded that in the studied sample there were no associations between swallowing or speech alterations and TMD and signs and/or symptoms of TMD / Mestrado / Fisiologia Oral / Mestre em Odontologia

Abstract The study was undertaken to determine the prevalence of facial pain and the association of facial pain with temporomandibular disorders (TMD) as well as with other factors, in a geographically defined population-based sample consisting of subjects born in 1966 in northern Finland, and in a case-control study including subjects with facial pain and their healthy controls. In addition, the influence of conservative stomatognathic and necessary prosthetic treatment on facial pain and TMD was evaluated in a sample of patients with facial pain. In the age group of 31-32-year-olds, facial pain was reported by 12 % of men and 18 % of women. Reported facial pain was strongly associated with TMD symptoms, and a relation was also seen with other factors, i.e. certain occlusal factors, previous traumas, other pain conditions in the body, clinically assessed tenderness in the neck muscles, and psychological problems, such as depressiveness and alexithymia. Conservative treatment of TMD seemed to be effective in relieving facial pain in a one-year follow-up. It can be concluded that facial pain is quite a common symptom with several both localized and generalized associated factors. Conservative stomatognathic treatment is recommended in the case of TMD-related facial pain. The possibility of psychological problems should be taken into account, especially in complex and chronic cases. When no response to conservative stomatognathic treatment is achieved, a multidisciplinary team, including mental health professionals, will be needed in both diagnosis and treatment. This study provides support for the suggestion that in future individualizing treatment of the patients with facial pain should be based on patient characteristics, which may improve treatment efficacy.

>Magister Scientiae - MSc / Aim: To compare osseous changes in the mandibular condyles in patients presenting to the Oral Health Center, Tygerburg Campus, with and without clicking of the temporomandibular joint. Background: Clicking of the temporomandibular joint (TMJ) is not a normal occurrence in its form or function. A chronic click may lead to the development of osteoarthritis. A clinical finding of clicking of the joint can reflect osseous changes of the bony structures and form part of the early signs of degenerative joint diseases. These osseous changes can be detected on Cone Beam Computed Tomography (CBCT) images. The purpose of this study is to confirm the presence osseous changes of the joint and institute the early management of these patients. Failure to intervene in the early stages could result in disease progression to possible osteoarthritis. CBCT imaging will be used to assess osseous changes in the temporomandibular joints with reference to erosions, flattening, lipping, sclerosis and osteophyte formation. Materials and methods: 25 patient records were selected for a control group and 25 patients that attended the Oral Health center were screened for asymptomatic clicking of the temporomandibular joints. Osseous changes of the 100 condyles were examined by the author and a senior member of the department. Changes were recorded when consensus was reached on the presence of any changes. Cone Beam Computed Tomography was used to assess the joints in both groups. Results: Age and gender showed no statistical significance between the 2 groups. The proportion of ‘yes’ for the variables showed that sclerosis (right) was statistically significant when comparing case versus control groups (P = 0.002). A chi-squared test applied to the data resulted in observed chi-square = 15.68, df = 1, p-value = 7.501e-05, (<0.0001) confirming that the discrimination is statistically significant. Conclusion: Osseous changes were found in both the control and case group. The case group exhibited equal or greater prevalence of osseous changes. Patients with asymptomatic click of the temporomandibular joints demonstrate osseous changes.

Indiana University-Purdue University Indianapolis (IUPUI) / Orthodontics has been suggested as a form of treatment for temporomandibular (TM) disorders, while at the same time orthodontic treatment accompanied by premolar extraction has been blamed for producing iatrogenic internal derangement of the TM joint. Signs and symptoms of TM disorders were evaluated by a clinical history questionnaire and a thorough clinical examination. The clinical examination entailed TMJ manipulation, palpation of muscles and TM joints, and recording the active range of motion. The 45 patients in each pre-treatment and post-treatment group were obtained from the Orthodontic Clinic at the Indiana University School of Dentistry. With the exception of age, there was no statistically significant difference between the two groups.

published_or_final_version / abstract / Dentistry / Master / Master of Dental Surgery

As disfunções temporomandibulares (DTM) compreendem uma série de alterações funcionais que podem acometer a articulação temporomandibular (ATM), a musculatura mastigatória ou ambas simultaneamente. Os distúrbios internos da ATM são modalidades específicas de DTM que se manifestam clinicamente por ruídos articulares associados a movimentos mandibulares desarmônicos ou limitados e, freqüentemente, dor. Sua etiologia e fisiopatologia ainda são desconhecidas, mas sugere-se a participação de fatores de postura de cabeça e corporal em sua gênese e perpetuação. A pesquisa aqui relatada, com o objetivo de verificar possíveis relações entre postura corporal global e distúrbios internos da ATM, procedeu à comparação entre 30 indivíduos portadores de sintomatologia característica de distúrbios da ATM (grupo teste) e 20 indivíduos saudáveis (grupo controle). Os métodos utilizados foram: o clínico, que constou de anamnese e fichas padronizadas para avaliação de características do sistema estomatognático; traçados e análise por cadeias musculares em fotografias de postura corporal; e análise de radiografia de coluna cervical em perfil. A comparação entre os grupos teste e controle revelou maior curvatura lordótica da coluna cervical no grupo teste, pelo método de diagnóstico clínico. No grupo controle, 79% dos indivíduos apresentaram diagnóstico clínico de retificação de coluna cervical e em apenas 10,5% a curvatura de coluna cervical foi considerada hiperlordótica, ao passo que, no grupo teste, somente 41,4% dos indivíduos apresentaram diagnóstico clínico de retificação, 37,9% apresentaram curvatura lordótica fisiológica e 20,7% obtiveram diagnóstico de hiperlordose (p=0,03). O grupo teste apresentou ainda maior prevalência de elevação de ombros: 63,3% versus 30,0% (p=0,04). Nenhuma outra relação estatisticamente significante foi encontrada na comparação dos grupos teste e controle. Em um segundo momento, o grupo teste foi dividido em três subgrupos, de acordo com a gravidade da DTM, avaliada pelo Índice Disfuncional de Helkimo. Nessa análise de subgrupos nenhuma correlação estatística foi demonstrada; no entanto, o grupo com maior gravidade de DTM apresentou tendência, embora não significante estatisticamente, à maior prevalência de hiperlordose de coluna cervical (50%) observada em radiografia, bem como algumas discrepâncias posturais, como protrusão de cabeça (100%) e de ombros (100%) e aumento de lordose lombar (83,3%). Os resultados sugerem que a coluna cervical e ombros, possivelmente por estarem localizados nas adjacências do sistema temporomandibular, estão intimamente relacionados aos distúrbios internos da ATM. Por outro lado, as poucas associações estatísticas entre o grupo teste e o controle, aliadas à tendência a desarmonias posturais encontrada no grupo de maior grau de disfunção, levam a concluir que o papel da postura corporal na fisiopatologia desta seria de baixa relevância, podendo inclusive não constituir fator etiológico, mas uma decorrência da DTM. / The temporomandibular joint dysfunctions (TMD) embrace a variety of functional disturbances that may affect the temporomandibular joint (TMJ), masticatory musculature, or both simultaneously. TMJ internal derangements are a specific case of TMD, clinically presented by articular sounds associated to jerk or limited mandibular movements, and often pain. Its etiology and physiopathology are broadly unknown, but it has been suggested that head-neck and body posture factors take part in its genesis and perpetuation. This study aimed at verifying possible relationships between body posture and TMJ internal disarrangements, by comparing 30 subjects presenting typical TMJ internal disarrangement signs (test group) to 20 healthy subjects (control group). Methods used included: 1) clinical, by means of anamnesis and standard files for stomatognatic system characteristics evaluation; 2) plotting and muscular chain analysis on body posture photographs; and 3) lateral cervical spine radiographic analysis. The comparison between the test and control groups has shown sharp lordosis on test group subjects cervical spine, through clinical diagnostic methods; 79% of control group subjects were clinically diagnosed as having cervical spine rectification, and only 10.5% presented hiperlordosis; whereas in the test group 41.4% of subjects had clinically diagnosed cervical spine rectification, 37.9% had physiological cervical spine curvature and 20.7%, hiperlordosis (p=0.03). The test group presented an even higher prevalence of elevated shoulders: 63.3%, against 30% of control group (p=0.04). No other significant statistical relationship was found when comparing both groups. Later the test group was divided into three subgroups according to TMD degree of severity, evaluated by the Helkimo Dysfunctional Index, but the comparative analysis has shown no statistical correlations; nevertheless, the subgroup with most severe dysfunction presented a tendency, though not statistically significant, to higher cervical spine hiperlordosis prevalence (50%) observed on radiography, as well as some body postural alterations, such as head protrusion (100%), shoulder protrusion (100%), and increased lumbar lordosis (83.3%). These findings suggest that cervical spine and shoulders, possibly due to their position close to the temporomandibular system, are intimately related to TMJ internal disarrangement. On the other hand, the scarce statistical relationships between the test and control groups, allied to a tendency to certain body alterations found in the most severed-dysfunction group, lead to concluding that the role of body posture on TMD physiopathology would be of low importance, and would possibly not constitute a TMD etiological factor, but a consequence of it.

Diss. (sammanfattning) Stockholm : Karol inst., 2004. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Michigan, 1984.

Thesis (M.S.)--University of Michigan, 1976.

Thesis (M.S.)--University of Michigan, 1986.