M.Tech.

O presente estudo teve como objetivos testar a hipótese nula de que não há diferença entre o grupo com Disfunção Temporomandibular (DTM) e o grupo Controle, para as frequências genotípicas e de alelos dos SNPs candidatos COMT Val(158)Met (rs4680); TNFA-308 (rs1800629); IL6-174 (rs1800795); IL-1&#x3B2;-3954 (rs1143634); IL10-592 (rs1800872); MMP1-1607 (rs1799750) e TLR4-896 (rs4986790); e determinar, nos casos com DTM, a influência dos SNPs candidatos na sensibilidade dolorosa mecânica experimental, na intensidade e no tempo de dor. As frequências genotípicas e de alelos dos sete SNPs candidatos foram comparadas entre 152 indivíduos com DTM e 91 controles, por meio da técnica de PCR em tempo real. A sensibilidade dolorosa mecânica foi avaliada pelo limiar de dor à palpação (LDP) e a intensidade de dor, utilizando-se uma escala analógica visual. As diferenças entre as frequências dos polimorfismos estudados foram avaliadas por meio do teste qui-quadrado (x2) e os valores de LDP entre os grupos foram comparados pelo teste t. A análise de possíveis diferenças entre os subgrupos de genótipos, com relação aos valores de LDP, EAV e tempo de dor, foi feita pelo teste estatístico one-way ANOVA, seguido pelo teste de Tukey. A hipótese nula foi rejeitada, uma vez que houve diferença entre as frequências genotípicas do SNP TNFA-308 entre os grupos, estando o polimorfismo TNFA-308 (1800629) associado às DTMs (p<0,05). Além do TNFA-308, os SNPs COMT Val(158)Met, IL6-174, IL-1&#x3B2;-3954 e TLR4-896 foram capazes de influenciar a sensibilidade dolorosa mecânica em indivíduos doentes (p<0,05). O presente estudo apresenta associação inédita entre o polimorfismo TNFA-308 (1800629) e as DTMs. Encorajamos estudos futuros que elucidem a associação entre genótipos pró-inflamatórios e uma menor sensibilidade dolorosa mecânica. / This study aimed at testing the null hypothesis which claims that there is no difference between the group with temporomandibular joint disorder (TMD) and a control group regarding the genotypic and allelic frequencies of the candidate SNPs COMT Val(158)Met (rs4680); TNFA-308 (rs1800629); IL6-174 (rs1800795); IL-1&#x3B2;-3954 (rs1143634); IL10-592 (rs1800872); MMP1-1607 (rs1799750) and TLR4-896 (rs4986790). Additionally, it aimed at determining candidate SNPs influence on experimental mechanical pain sensitivity, intensity and duration of pain in the TMD cases. The genotypic and allelic frequencies of the seven candidate SNPs were compared among 152 individuals from the group with TMD and 91 individuals from the control group, by using the real-time PCR technique. Mechanical pain sensitivity was assessed through pressure pain threshold (PPT) and pain intensity was assessed using visual analogue scales (VAS). Differences between the frequencies regarding the studied polymorphisms were assessed through the chi-square test (x2) while the PPT values were compared through the t-test. Analysis of potential differences between the genotype subgroups with respect to the PPT, VAS and pain duration values was performed with ANOVA one-way test, followed by the Tukeys test. The null hypothesis was rejected, since there were differences among the genotypic frequencies of the TNFA-308 SNP between groups. The TNFA-308 (1800629) polymorphism is found to be associated with the TMDs (p<0.05). In addition to TNFA-308, the SNPs COMT Val(158)Met, IL6-174, IL-1&#x3B2;-3954 and TLR4-896 were capable of influencing mechanical pain sensitivity in individuals with TMD (p<0.05). This study presents an unprecedented association between the TNFA-308 (1800629) polymorphism and TMDs. We encourage future researches that enlighten the association between proinflammatory genotypes and lower mechanical pain sensitivity.

O presente estudo teve como objetivos testar a hipótese nula de que não há diferença entre o grupo com Disfunção Temporomandibular (DTM) e o grupo Controle, para as frequências genotípicas e de alelos dos SNPs candidatos COMT Val(158)Met (rs4680); TNFA-308 (rs1800629); IL6-174 (rs1800795); IL-1&#x3B2;-3954 (rs1143634); IL10-592 (rs1800872); MMP1-1607 (rs1799750) e TLR4-896 (rs4986790); e determinar, nos casos com DTM, a influência dos SNPs candidatos na sensibilidade dolorosa mecânica experimental, na intensidade e no tempo de dor. As frequências genotípicas e de alelos dos sete SNPs candidatos foram comparadas entre 152 indivíduos com DTM e 91 controles, por meio da técnica de PCR em tempo real. A sensibilidade dolorosa mecânica foi avaliada pelo limiar de dor à palpação (LDP) e a intensidade de dor, utilizando-se uma escala analógica visual. As diferenças entre as frequências dos polimorfismos estudados foram avaliadas por meio do teste qui-quadrado (x2) e os valores de LDP entre os grupos foram comparados pelo teste t. A análise de possíveis diferenças entre os subgrupos de genótipos, com relação aos valores de LDP, EAV e tempo de dor, foi feita pelo teste estatístico one-way ANOVA, seguido pelo teste de Tukey. A hipótese nula foi rejeitada, uma vez que houve diferença entre as frequências genotípicas do SNP TNFA-308 entre os grupos, estando o polimorfismo TNFA-308 (1800629) associado às DTMs (p<0,05). Além do TNFA-308, os SNPs COMT Val(158)Met, IL6-174, IL-1&#x3B2;-3954 e TLR4-896 foram capazes de influenciar a sensibilidade dolorosa mecânica em indivíduos doentes (p<0,05). O presente estudo apresenta associação inédita entre o polimorfismo TNFA-308 (1800629) e as DTMs. Encorajamos estudos futuros que elucidem a associação entre genótipos pró-inflamatórios e uma menor sensibilidade dolorosa mecânica. / This study aimed at testing the null hypothesis which claims that there is no difference between the group with temporomandibular joint disorder (TMD) and a control group regarding the genotypic and allelic frequencies of the candidate SNPs COMT Val(158)Met (rs4680); TNFA-308 (rs1800629); IL6-174 (rs1800795); IL-1&#x3B2;-3954 (rs1143634); IL10-592 (rs1800872); MMP1-1607 (rs1799750) and TLR4-896 (rs4986790). Additionally, it aimed at determining candidate SNPs influence on experimental mechanical pain sensitivity, intensity and duration of pain in the TMD cases. The genotypic and allelic frequencies of the seven candidate SNPs were compared among 152 individuals from the group with TMD and 91 individuals from the control group, by using the real-time PCR technique. Mechanical pain sensitivity was assessed through pressure pain threshold (PPT) and pain intensity was assessed using visual analogue scales (VAS). Differences between the frequencies regarding the studied polymorphisms were assessed through the chi-square test (x2) while the PPT values were compared through the t-test. Analysis of potential differences between the genotype subgroups with respect to the PPT, VAS and pain duration values was performed with ANOVA one-way test, followed by the Tukeys test. The null hypothesis was rejected, since there were differences among the genotypic frequencies of the TNFA-308 SNP between groups. The TNFA-308 (1800629) polymorphism is found to be associated with the TMDs (p<0.05). In addition to TNFA-308, the SNPs COMT Val(158)Met, IL6-174, IL-1&#x3B2;-3954 and TLR4-896 were capable of influencing mechanical pain sensitivity in individuals with TMD (p<0.05). This study presents an unprecedented association between the TNFA-308 (1800629) polymorphism and TMDs. We encourage future researches that enlighten the association between proinflammatory genotypes and lower mechanical pain sensitivity.

Orientador: Célia Marisa Rizzatti Barbosa / Texto em português e inglês / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-22T14:59:30Z (GMT). No. of bitstreams: 1 Stefanelli_ViniciusCobos_M.pdf: 4235468 bytes, checksum: ecfb59c5553ab09169e805022c5d6485 (MD5) Previous issue date: 2013 / Resumo: A técnica de strain-counterstrain (SCS) é uma das mais utilizadas no tratamento osteopático, proporcionando grande alívio dos sintomas desencadeados por pontos gatilhos miofasciais (PGM), porém poucas são as evidências científicas sobre seus efeitos imediatos e ao longo de um tratamento para pacientes sintomáticos. Este estudo objetivou avaliar os efeitos imediatos e tardios da SCS nos músculos mastigatórios de pacientes com disfunção temporomandibular (DTM). Para isso foram selecionadas 21 mulheres (25,52±4,11) diagnosticadas com DTM, as quais foram divididas aleatoriamente em dois grupos: grupo tratado (n=11) que recebeu a SCS para os PGMs dos músculos temporais, masseteres, pterigóideos mediais e digástricos; e grupo placebo (n=10) que recebeu uma técnica sem efeito terapêutico para os PGMs dos mesmos músculos. As voluntárias passaram por quatro sessões de tratamento, uma vez por semana e foram avaliadas antes (Pré), imediatamente após (Pós) a primeira sessão e de 48 a 72 horas após a quarta e última sessão (Final). Como método de avaliação utilizou-se o limiar de dor a pressão (LDP), amplitude de abertura bucal (AAB) e a eletromiografia de superfície (EMGs). O LDP foi coletado nos seguintes pontos: masseter, temporais e pólo lateral da articulação temporomandibular (ATM). A coleta do sinal eletromiográfico foi realizada nos seguintes músculos: masseteres, parte anterior dos temporais e supra-hioideos. Como resultado foi possível observar aumento do LDP entre as fases Pós e Final (p<0,05), e Pré e Final (p<0,05), e aumento da AAB entre as fases Pré e Pós (p<0,05), e Pré e Final (p<0,001) para o grupo tratado. Para o grupo placebo não foram observadas diferenças significativas, assim como para os resultados da EMGs em ambos os grupos / Abstract: Strain-counterstrain (SCS) is one of the most commonly technique used in osteopathic treatment, providing great relief of symptoms unleashed by myofascial trigger points (MTrPs). However there are few scientific evidence about its about its immediate effects and over a treatment for symptomatic patients. This study aimed to evaluate the effects of SCS in masticatory muscles of patients with temporomandibular disorders (TMD). Twenty one TMD women (mean age 25.52 ± 4.11) were randomly divided in two groups: treated group (n = 11) which received the SCS for MTrPs of temporal, masseter, medial pyterigoid and digastric muscles; and placebo group (n = 10) which received a non therapeutic technique for MTrPs of the same muscles. The volunteers underwent four treatment sessions, once a week and were evaluated before (Pre), immediately after the first session (Post), and 48 to 72 hours after the fourth session (Final). Outcomes measurement were pressure pain threshold (PPT), range of mouth opening (RMO) and electromyography (EMG). The LDP was collected at points painful in these types of patients: masseter, temporal, lateral pole temporomandibular joint (TMJ). The collect of the sEMG signal was conducted in the following muscles: masseter, anterior part of the temporal and supra-hyoid. It was observed an increase of PPT between Post and Final (p <0.05) and Pre and Final (p <0.05) phases for most points assessed, an increase of RMO between Pre and Post (p <0.05), and Pre and Final (p <0.001) phases in the treated group. In placebo group no significant differences were observed as well as the results of EMG in both groups / Mestrado / Anatomia / Mestre em Biologia Buco-Dental

Syfte Syftet med litteraturöversikten var att beskriva förekomst av whiplashtrauma hos TMD patienter. Metod En systematisk litteratursökning av PubMed, CochraneLibrary och Bandolier databaser genomfördes för artiklar publicerade från 1 januari 1966 till 11 november 2011. Den systematiska sökningen identifierade121 artiklar. Efter borttagning av brev till redaktion och författarinlägg, utfördes en initial screening av abstract på 108 artiklar. Efter den initiala screeningen lästes 32 artiklar i fulltext med tillämpning av inklusions- och exklusionskriterier. Två av författarna utvärderade den metodologiska kvaliteten på de inkluderade studierna. Resultat Sex studier mötte inklusionskriterierna och inkluderades i rapporten. Den rapporterade förekomsten av whiplashtrauma hos TMD populationerna varierade mellan 8,4 % och 70 % (median 35 %). Förekomst av whiplashtrauma hos kontrollgrupperna varierade mellan 1,7 % och 18 %. TMD patienter med historik av whiplashtrauma rapporterade gravare TMD symptom och mer smärta jämfört med TMD patienter utan nackskada.Konklusion Resultaten från denna litteraturöversikt visar en högre förekomst av whiplashtrauma hos TMD patienter vilket tyder på att whiplashtrauma kan vara en riskfaktor för TMD. Stora variationer sågs mellan de olika inkluderade studierna och i samtliga studier fanns också brister gällande diagnoskriterier. Sammantaget så gör dessa begränsningar det svårt att bedöma traumaförekomst hos TMD patienter och i vilken utsträckning whiplashskada kan bidra till utvecklingen av TMD. Fler väldesignade studier som använder tydligt definierade diagnostiska kriterier med hög reliabilitet och validitet som t.ex RDC/TMD behövs för att kunna dra en säkrare slutsats om TMD vid whiplashtrauma. / Aim The aim ofthis systemic literature review was to describe the prevalence of whiplash trauma in TMD populations. Method A systemic literature search of the PubMed, Cochrane Library and Bandolier databases was carried out for articles published from 1 January 1966 to 11 November 2011. This systemic search identified 121 articles. After exclusion of letters to editor and author replies, an initial screening of the abstracts of 108 articles was carried out. After the initial screening 32 articles were read in full text applying the inclusion and exclusion criteria. Two of the authors evaluated the methodological quality of the included studies. Result Six studies matched the inclusion criteria and were included in the review. The reported prevalence of whiplash trauma in the TMD populations varied from 8.4% to 70% (median 35%). The prevalence of whiplash trauma in the control groups varied from1.7% to 18%.TMD patients with a history of whiplash trauma reported more TMD symptom and more pain compared to TMD patient without a neck injury.Conclusion The results from this literature review show a higher prevalence of whiplash trauma in TMD patients which indicate that whiplash trauma could be risk factor for TMD. A large variation could be seen between the included studies and there were also weaknesses with regard to the diagnostic criteria. In summery we suggest that these limitations make it difficult to assess the prevalence of neck trauma in TMD patients and to which extent a whiplash injury can contribute to the development of TMD. More well designed studies using the RDC/TMD criteria and well-defined criteria with high reliability and validity for whiplash trauma are needed in order to make a more reliable conclusion.

A major physiological risk factor of temporomandibular disorders (TMD) is sensitization of peripheral and central nervous system pain processing pathways. Calcium channel, voltage-dependent, alpha-2/delta subunit-1 (CACNA2D1) has a crucial role in relaying nociceptive information in the spinal dorsal horn. Up-regulation of CACNA2D1 results in abnormal excitatory synapse formation and enhanced presynaptic excitatory neurotransmitter release. Blocking CACNA2D1 with gabapentinoid-class drugs relieves orofacial hypersensitivity. Drs. Foley, Horton, and Sciote previously reported that in a small sample group (n=12), CACNA2D1 expression was greater in males than females, but increased in women with TMD. The objectives of this study are to corroborate these data and investigate expression patterns of other ion channel and conducting system genes. Additionally, since the null polymorphism ACTN3-577XX associates with muscle fiber microdamage during eccentric contraction, we tested for possible gene associations with ACTN3-R577XX genotypes. Masseter muscle samples came from human subjects (n=23 male; 48 female) with malocclusions undergoing orthognathic surgery. This population had skeletal disharmony of the jaws and thus was prone to eccentric contraction. Three males and eighteen females were diagnosed with localized masticatory myalgia. Muscle total RNA was isolated and CACNA2D1, CACNA1S, GABARAP, and TRPM7 expression was quantified using RT-PCR. Expression of these genes were compared based on TMD status and various characteristics that may influence TMD including: sex, age, facial symmetry, sagittal dimension, vertical dimension, ACTN3-577 genotype and fiber type. CACNA2D1 expression differed significantly between sexes, overall (p&lt;0.02), and without TMD (p=0.001). Women with (n=13) and without (n=23) TMD differed significantly (p&lt;0.03). CACNA2D1 expression was also significantly higher (p=0.031) in subjects below age 25. Similarly, GABARAP expression was significantly higher (p=0.001) for patients younger than 25 and for patients less than or equal to age 18 (p=0.013). Otherwise, CACNA1S, TRPM7 and GABARAP differences were not significant. GABARAP expression differed, but not significantly by sex and for the ACTN3-577XX-null genotype. In a population of malocclusion patients, masseter muscle CACNA2D1 expression is significantly higher than CACNA1S, TRPM7, and GABARAP. CACNA2D1 expression is greater in males than females without TMD. However, CACNA2D1 expression increases significantly in females with TMD-associated myalgia. This may support evidence for calcium channel regulation of nociception differences seen between sexes in TMD. It was also found that expression of CACNA2D1 and GABARAP is significantly higher in younger subjects. Additionally, observations presented here suggest potential influence of ACTN3-null condition on function of GABARAP. / Oral Biology

Syfte. Att retrospektivt undersöka relationen mellan central sensitisering i det orofacialaområdet och refererad smärta, som kliniskt fynd, samt psykosociala faktorer hos patienter medDC/TMD-muskeldiagnosen myofasciell smärta med refererad smärta (MPR). Studien syftadeäven till att undersöka skillnader gällande psykosociala faktorer mellan patienter somdiagnostiserats med DC/TMD muskeldiagnoserna myofasciell smärta med refererad smärta(MPR), lokal myalgi (LM) och patienter med orofacial smärta eller käkdysfunktion men ejkäkmuskeldiagnos (WMD) som kontrollgrupper.Material och metod. Information från 85 patienters DC/TMD-undersökning utförd påOrofaciala smärtenheten vid Malmö högskola mellan september 2012 till årsslutet 2013insamlades retrospektivt. Undersökta variabler inkluderade smärtintensitet, smärt-relateraddysfunktion, psykosociala faktorer (depression, ångest och stress) samt refererad smärta.Patienterna indelades i grupper baserade på muskeldiagnos enligt DC/TMD samt utbredning avsmärta. Non-parametrisk statistik användes och P < 0,05 betraktades som signifikant.Resultat. Patienter med MPR uppvisade en signifikant korrelation mellan totala antaletrefererade smärtlokalisationer och smärt-relaterad dysfunktion (rs = 0,43, n = 49, p = 0,002),depression (rs = 0,32, n = 49, p = 0,023) och stress (rs = 0,39, n = 49, p = 0,006). Patienter meden generell smärtutbredning uppvisade en signifikant högre grad av stress (p = 0,020) samt flerantal refererade smärtlokalisationer (p = 0,019) jämfört med patienter med lokal och/ellerregional orofacial smärta.Konklusion. Studien indikerar att grad av central sensitisering kan bedömas med hjälp avutbredningen av refererad smärta, undersökt enligt DC/TMD, hos patienter med diagnosenmyofasciell smärta med refererad smärta i det orofaciala området. Studien kunde inte påvisaskillnader gällande psykosociala faktorer mellan de undersökta grupperna. / Objective. The aim of this study was to retrospectively investigate the relation between referredpain, as a clinical finding, and psychosocial factors versus central sensitization in patients withmyofascial pain with referral (MPR) as assessed according to DC/TMD. The study also aimedto investigate differences regarding psychosocial factors between patients demonstratingmyofascial pain with referral (MPR) and patients diagnosed with the DC/TMD muscle diagnoselocal myalgia (LM) as well as OFP/TMD patients without masticatory muscular diagnose(WMD) as control patients.Material and methods. Patients’ medical records of 85 patients examined at the Orofacial PainUnit at Malmö University during September 2012 till the end of 2013 were retrospectivelyexamined for DC/TMD data. Examined variables included pain intensity, pain-related disability,psychosocial factors (depression, anxiety and stress) and referred pain. The patients weredivided into groups based on DC/TMD muscle diagnosis as well as extension of pain. Nonparametricstatistics were used and a probability level of P < 0.05 was considered as significant.Results. Patients with MPR demonstrated significant correlations between the total number ofreferred pain sites and disability score (rs = 0.43, n = 49, p = 0.002), depression (rs = 0.32, n =49, p = 0.023) as well as stress (rs = 0.39, n = 49, p = 0.006). Patients with generalized paindistribution demonstrated a significantly higher degree of stress (p = 0.020) as well as highernumber of referred pain sites (p = 0.019) than patients with local and/or regional orofacial pain.Conclusion. This study indicates that the degree of central sensitization can be estimated bythe extent of referred pain, as assessed according to DC/TMD, in patients with myofascial painwith referred pain in the orofacial region. This study could not detect a difference inpsychosocial factors between the three groups, myofascial pain with referral (MPR), localmyalgia (LM) and no masticatory muscle diagnosis (WMD).

Made available in DSpace on 2015-05-14T12:56:00Z (GMT). No. of bitstreams: 1 Arquivototal.pdf: 12440507 bytes, checksum: 4c602610a4947af78ebd9048d453e0e8 (MD5) Previous issue date: 2004-09-20 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study had two objectives. The main objective was to evaluate the association of the impact of temporomandibular disorders (TMD) on oral health related quality of life to the psychosocial and psychological factors. The specific objective was to validate the Portuguese version of Axis II questionnaire to Research Diagnostic Criteria for TMD (RDC/TMD) as preconized by Dworkin and LeResche at 1992. The sample was compounded by 156 patients, with TMD, who attempted at Orofacial Pain Control Center School of Dentistry of Pernambuco University, from July 2003 to February 2004. Data collection was done by the author using the following instruments: Simplified Anamnesis Index DMF for screening patients with TMD; RDC/TMD Axis I to evaluated clinically and to classify TMD and Axis II to evaluate psychosocial and psychological factors; the specific questionnaires to evaluated oral health related to quality of life, OIDP and OHIP-14. Two different types of studies were conducted: validation study and cross sectional study. The validation study consisted on the evaluation of internal consistence by alpha Crombach reliability test; reliability and reproducibility estimated by Kappa statistics and by Spearman correlation and also concurrent validity (Spearman). For the transversal study, one has used Kruskall Wallis to test OIDP and ANOVA to test OHIP-14. The Portuguese version for Axis II of RDC/TMD was considered consistent (Crombach a=0,72), reliable (Kappa 0,73-0,91; p<0,01) and valid (p<0,01). According to transversal study, among the variables for sample characterization, the impact on oral health related qualify of life was statistical associated to sex and scholarship, this factor exclusively for OHIP-14. On Axis I, using OIDP, the impact was associated to groups I and II, muscle and joint disorders, respectively. While for OHIP-14, only for group I (muscle disorders) the association was detected. On Axis II, psychological factors, as depression and somatization (inespecific organic symptoms with or without pain) and psychosocial factor of disability and pain were statically associated to the impact of oral health related quality of life, according to evaluation with OIDP and OHIP-14. The validity of Axis II of RDC/TMD followed the methodology proposed at the literature and showed reproducbility and validity for brazilian population. Temporomandibular disorders and psychosocial and psychological factors produced an important impact on oral health related quality of life, associated to psychosocial and psychological factors associated and proportional to their intensity. / O presente estudo teve dois objetivos. O objetivo geral foi avaliar a associação entre o impacto da disfunção temporomandibular (DTM) na qualidade de vida relacionada à saúde bucal, e os fatores psicossocial e psicológicos. O objetivo específico foi realizar a validação da versão em português do questionário Eixo II dos Critérios Diagnósticos de Pesquisa em DTM (RDC/TMD), preconizado por Dworkin e LeResche, em 1992. A amostra foi composta por 155 pacientes portadores de DTM que procuraram atendimento no Centro de Controle da Dor Orofacial da Faculdade de Odontologia da Universidade de Pernambuco no período de Julho de 2003 a Fevereiro de 2004. Para a coleta de dados foram utilizados os seguintes instrumentos: Índice Anamnésico Simplificado DMF para a triagem dos pacientes com DTM; RDC/TMD: Eixo I para avaliação clínica e classificação da DTM, e Eixo II para avaliação psicossocial e psicológica e os questionários específicos para avaliação da qualidade de vida relacionada à saúde bucal OIDP e OHIP-14. Foram realizados dois tipos de estudo: estudo de validação e transversal. O estudo de validação constou da avaliação da consistência interna pelo teste de confiabilidade alfa Crombach; confiabilidade e reprodutibilidade, estimada pela estatística Kappa e correlação de Spearman e validação concorrente (Spearman). No estudo transversal, para o OIDP, utilizouse o teste Kruskal-Wallis e para o OHIP-14 o teste ANOVA. Os resultados revelaram que a versão em português Eixo II do RDC/TMD foi considerada consistente (Crombach=0,72); reprodutível (Kappa 0,73-0,91; p<0,01) e válida (p<0,01). No estudo transversal, dentre as variáveis de caracterização amostral, o impacto da qualidade de vida relacionado à saúde bucal foi estatisticamente associado com gênero e escolaridade, sendo este último fator apenas evidenciado quando da utilização do OHIP-14. No Eixo I, usando o OIDP, o impacto teve associação com os grupos I e III, de desordem muscular e articular, respectivamente; com o OHIP-14, teve associação apenas para o grupo I (desordem muscular). No Eixo II, os fatores psicológicos, como depressão e somatização (sintomas físicos não específicos, com e sem itens de dor), e o fator psicossocial de incapacidade e intensidade da dor, foram estatisticamente associados ao impacto da qualidade de vida relacionado à saúde bucal, quando avaliados pelo OIDP e OHIP-14. Conclui-se que a validação do Eixo II do RDC/TMD seguiu metodologia proposta na literatura e mostrou-se reprodutível e válida para a população brasileira. A disfunção temporomandibular e os fatores psicossocial e psicológicos produzem importante impacto nos portadores de DTM, interferindo negativamente na qualidade de vida relacionada à saúde bucal, e este impacto também foi associado ao grau de severidade dos fatores psicossocial e psicológicos.

No description available.

Made available in DSpace on 2014-07-29T15:22:00Z (GMT). No. of bitstreams: 1 Karlla Dias.pdf: 846498 bytes, checksum: b1d8bf8cb4afb64356d5ba064c943192 (MD5) Previous issue date: 2009-04-22 / Diagnosis of disorders affecting the temporomandibular joint (TMJ) is a difficult task for many reasons. These include the structural and functional complexity of this joint, the multifactorial origin of these disorders and limited knowledge of their natural course, the presence of common symptoms among its various subclasses and other craniofacial conditions. If the premise for effective treatment is a correct diagnosis, it is clear that the treatment of these disorders is not any less complex than their diagnosis. The aim of this study was to do a systematic analysis of the literature in relation to proof of the therapeutic efficacy of computed tomography (CT) and magnetic resonance imaging (MRI) in the treatment planning of TMJDs (disc displacement, inflammatory disorders without systemic involvement or osteoarthosis). This systematic review was comprised of three steps: (1) Specifying the problem and the inclusion/exclusion criteria used in the publications; (2) Formulation and detailing of a plan to conduct the literature search; (3) Interpretation and integration of the evidence in the studies and formulation of recommendations based on the quality of the evidence. The bibliographical search was undertaken in PubMed and Cochrane Library databases from January 1966 to July 2009, using specific indexed terms, selected according to the objectives. The titles and abstracts found were analyzed by three examiners and the publications fulfilling the inclusion criteria were selected. The same three examiners read the full texts of these selected publications, and extracted data with the help of a previously drawn up protocol. A publication was considered relevant and included in the review when its results expressed any type of impact of the information obtained with CT and MRI on the treatment of disc displacement, local inflammatory disorders or osteoarthosis therapeutic efficacy. Publications considered relevant were interpreted with the aid of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool and publications that critically evaluate systematic reviews. Results: The literature search yielded 584 titles and abstracts, of which 257 were selected and read in full text. One study was judged relevant. This study evaluated evidence of the efficacy of magnetic resonance imaging (MRI) in the diagnosis of disc position and configuration, disc perforation, joint effusion, and osseous and bone marrow changes in the temporomandibular joint, but no publication reported diagnostic thinking efficacy or therapeutic efficacy. The absence of studies on the therapeutic efficacy of CT and MRI on TMJD reinforces the need for investment in decision-making studies; meanwhile, sectional imaging tests should be prescribed with caution, especially when health budgets are limited. / O diagnóstico das desordens que afetam a articulação temporomandibular (ATM) tem sido uma tarefa difícil por inúmeras razões que incluem: a complexidade estrutural e funcional desta articulação, a origem multifatorial dessas desordens e o conhecimento limitado sobre a evolução natural das mesmas, presença de sintomas comuns entre as suas várias subclasses e em outros comprometimentos craniofaciais. Se a premissa do tratamento efetivo é o diagnóstico correto, fica claro que o tratamento dessas desordens não é menos complexo que o diagnóstico das mesmas. O objetivo deste estudo foi analisar sistematicamente a literatura sobre a evidência da eficácia terapêutica da tomografia computadorizada (TC) e ressonância magnética (RM) no plano de tratamento das desordens da ATM (DATM) (deslocamento do disco, desordens inflamatórias sem envolvimento sistêmico e osteoartrose). A realização desta revisão sistemática constituiu-se de 3 etapas: (1) especificação do problema e dos critérios de inclusão e exclusão das publicações; (2) formulação e detalhamento do plano de busca na literatura; (3) interpretação e integração das evidências dos estudos e formulação das recomendações baseada na qualidade das evidências. A busca bibliográfica foi realizada nas bases de dados PubMed e Biblioteca Cochrane no período de janeiro de 1966 a julho de 2009, utilizando-se de termos específicos indexados, selecionados de acordo com os objetivos. Os títulos e resumos assim encontrados foram analisados por três examinadores e as publicações que preencheram os critérios de inclusão foram selecionadas. Os mesmos três examinadores fizeram a leitura integral das publicações selecionadas e dados foram extraídos com o auxílio de um protocolo previamente elaborado. A publicação foi considerada relevante e incluída na revisão, quando seus resultados expressavam algum tipo de impacto das informações obtidas com TC e RM no tratamento do deslocamento do disco, desordens inflamatórias locais e osteoartrose eficácia terapêutica. Essas publicações relevantes foram interpretadas utilizando-se de um instrumento de análise da qualidade da publicação, desenvolvido especificamente para estudos que investigam métodos de diagnóstico QUADAS Quality Assessment of Diagnostic Accuracy Studies. A busca na literatura resultou em 584 títulos e resumos, dos quais 257 foram selecionados e lidos na íntegra. Somente 1 estudo foi considerado relevante. Este estudo avaliou a eficácia da RM no diagnóstico da posição, configuração e perfuração do disco, na efusão articular e nas alterações ósseas e medulares da ATM, mas nenhuma publicação reportou sobre eficácia dos achados de diagnóstico ou eficácia terapêutica. A ausência de estudos sobre a eficácia terapêutica da RM e TC nas DATM reforça a necessidade de investimentos em estudos sobre tomada de decisões, entretanto, exames de imagem seccionais devem ser prescritos com precaução, especialmente quando os orçamentos em saúde são limitados.