Carolina Almeida Rodrigues

Styloid process elongation and calcification in subjects with tmd: clinical and radiographic aspects

Knowledge of the Eagles syndrome shows that its symptoms can be very easily confused with other types of craniomandibular disorders, especially temporomandibular disorders (TMD). The aim of this study was to find a possible correlation between the presence of TMD and elongation of the styloid process as well relate to presence of calcification of the stilohyoid chain. Fifty patients with TMD, confirmed from the RDC/TMD, were examined clinically and radiographically. Radiographic documentation consisted of digital panoramic radiograph and digital lateral cephalometric radiograph. Radiocef software (Radiomemory) was used for the analysis of radiographs by means of specific cephalometric tracing and linear measurements of the styloid process. Each radiograph was traced and measured three times with intervals of 1 month to spread the error. Statistical analysis was performed by Pearsons test (p=0.001) using Biostat 4.0 statistical software. Result showed an incidence of 76% elongation of the styloid process in the sample. There was a correlation between the bilateral measures taken in panoramic radiographs (?<0.001) and also for measures of styloid process length carried out in different panoramic radiographs and lateral cephalometric radiographs (?<0.001). It was concluded that there is prevalence of elongated styloid process in patients with TMD. However, no relationship was found between measurements on the stylohyoid chain and symptoms of headache, orofacial pain, tinnitus and vertigo.

Severity of TMD Related to Age, Sex and Electromyographic Analysis

Temporomandibular disorders (TMD) are manifested as a group of signs and symptoms that affect a particular population profile. Some variables such as sex and age influence the clinical expression of this condition. This observational descriptive cross-sectional study aimed to correlate the severity of TMD established by the craniomandibular index (CMI) with the variables: age, sex and electromyographic activity of the masseter and anterior temporal muscles. Fifty-four subjects (15 males/39 females) aged between 16 to 65 years (mean age = 41 years) and diagnosed with TMD were evaluated. Severity was determined by the CMI. These subjects also underwent examination by surface electromyography of the masseter and anterior temporal muscles. No correlation was found between age and severity of TMD (p=0.19/r=0.16), however there was a trend of greater severity in young adults (25-50 years). The sex variable in the correlation was positive with the CMI (p=0.03/r=-0.96) and superior to women. A greater EMG activity of the anterior temporal in relation to masseter (p=0.01) was found and the left temporal activity had the highest average (161.5 ± 44.6 Hz). The electromyographic activity of the anterior temporal and right masseter muscles was positively correlated with the Dysfunction Index CMI (p=0.01). The use of CMI to quantify the severity of TMD and of EMG to assess the functionality of the masticatory muscles can be important allies to direct the treatment.

Is the Masticatory Function Changed in Patients with Temporomandibular Disorder

Patients with temporomandibular disorders (TMD) often complain and have limitation in masticatory function, which can be affected by a complex interaction of factors. The aim of this study was analyze the masticatory function in patients with TMD using surface electromyography (EMG) and masticatory efficiency (ME). Twenty-seven patients with TMD and 25 considered control (n), aged between 18 and 60 years, paired by age and gender, were evaluated according to RDC/TMD. In both groups were performed: EMG with chewing gum, clinical evaluation of habitual chewing with stuffed cookie (CE) (number of chewing strokes and time) and analysis of ME with fuchsin beads. Nonparametric statistical analyses were used (Mann-Whitney) for comparisons between groups, with 5% significance level. For all variables, the TMD group showed higher values than the control, with statistical significance for ME (p<0.0001), number of chewing strokes (p=0.04), chewing time (p=0.009), right masseter EMG activity (p=0.05), left masseter (p=0.005), right anterior temporal (p=0.05) and left anterior temporal (p=0.001). The conclusion is that patients with TMD showed changed chewing pattern, but without impairment of masticatory function.

Evaluation of the impact on quality of life of patients with temporomandibular disorders

BACKGROUND AND OBJECTIVES: Chronic pain, such as temporomandibular disorder, often leads to significant changes in quality of life. This study aimed at evaluating the influence of temporomandibular disorders in the subjective perception of quality of life by means of the Oral Health Impact Profile-14. METHODS: Participated in the study 80 patients diagnosed with temporomandibular disorders by means of the Research Diagnostic Criteria for Temporomandibular Disorders, aged between 18 and 60 years (32.71±1.1), who were submitted to the Oral Health Impact Profile-14 questionnaire. Non parametric Mann-Whitney statistics, Pearson Correlation test, Analysis of Variance and Tukey test were used with significance level of 5%. RESULTS: There has been no statistically significant difference in the perception of the impact on quality of life between genders; patients with association of signs and symptoms of the three groups of the Research Diagnostic Criteria for Temporomandibular Disorders had further impact on quality of life, as well as the most severe the temporomandibular disorder the highest the reported impact (p=0.05), and the age group with the highest impact on quality of life was between 18 and 30 years (p<0.01). CONCLUSION: Increased age, severity and the association of diagnoses have exacerbated the impact of temporomandibular disorders on quality of life. Variables analyzed in this study were related to temporomandibular disorder chronicity, stressing the importance of early intervention strategies to minimize the impact on quality of life.

Anterior and medial angulations of the styloid process in subjects with TMD: clinical and radiographic findings

This study investigated the existence of association between the angulation of the styloid process on the anterior and medial directions with the intensity of temporomandibular dysfunction (TMD) symptoms. Fifty patients (8 men and 42 women) aged 25 to 70 years, with relevant TMD symptoms were evaluated. Clinical examinations were performed to determine the severity of TMD symptoms (orofacial pain, headache, tinnitus and dizziness) based on the RDC/TMD criteria and the visual analogue scale (VAS), and digital radiographic images of the styloid process were obtained: lateral cephalometric skull radiograph (analysis of anterior angulation) and posteroanterior skull radiograph (reverse Townes projection) (analysis of medial angulation). The anterior angulation average of the styloid process was 20.89° while the medial angulation average was 19.1° in the right side and 19.04° in the left side. There was no statistically significant difference among the patient groups (severe, moderate and mild symptoms) associating the TMD symptoms and the anterior or medial angulation of the styloid process (p>0.05). There was no correlation between the intensity of the TMD symptoms and the measurements of anterior and medial angulation of the styloid process using either lateral cephalometric or posteroanterior radiographs (reverse Townes projection).

Ultra-low frequency transcutaneous electric nerve stimulation does not affect the centric relation registration.

Abstract Objective: To evaluate the influence of ULF-TENS on the displacement of the mandibular condyle and on the repeatability of centric relation (CR) registration of three different techniques: bimanual manipulation (BM), long strip technique, and harmonic centric occlusal relationship (R.O.C.A. wires). Methods: Twenty-five participants without temporomandibular disorder (TMD) underwent two study stages conducted via electronic position analysis: (1) three CR records were made, one for each manipulation technique; (2) the ULF-TENS was applied for 30 min, and after that the same CR records were repeated. Statistical analyses: Mann–Whitney, ICC, and one-tailed F test. Results: The ULF-TENS did not influence the condyle total displacement, regardless of CR recording technique used (p > 0.05). BM showed an improvement in repeatability after ULF-TENS. Discussion: Concerning the variance, BM showed less variation at the X-axis. Long strip technique and R.O.C.A. wires varied less at the Y-axis. Long strip technique was again less variable at the Z-axis.

Frequency of electromyographic indices alterations in temporomandibular disorders and their correlation with pain intensity

BACKGROUND AND OBJECTIVES:Understanding the importance of surface electromyography as a complementary method to understand the myofunctional status of the stomatognathic system, this study aimed at analyzing the frequency of altered and normal electromyographic indices in a sample of subjects with temporomandibular disorders, in addition to their relation with pain complaint.METHODS:Participated in the study 44 individuals with temporomandibular disorder signs and symptoms (11 males and 33 females), with mean age of 39 years, who were submitted to surface electromyography. Pain intensity was measured by the visual analog scale. Total Asymmetry Index (AStotal), Masseter Asymmetry Index (ASMM), Temporal Asymmetry Index (ASTA), Activation Index (ACtotal) and Torque Index (TOtotal) were calculated. Correlation between pain intensity and electromyographic indices was checked by Pearson correlation test and sample characterization with regard to investigated indices was done by descriptive analysis.RESULTS:Means of all indices were within previously established normality patterns. The frequency of altered electromyographic indices in our sample was high (ASMM=68%; ASTA=64%; TOtotal=64%; AStotal=55%). With regard to ACtotal, there has been predominance of masseter activity as compared to temporal activity, both for normal and altered values. Among individuals with altered indices, the left side had superior activity. No correlation was found between pain intensity and the level of electromyographic indices alterations (p>0.05).CONCLUSION:The frequency of electromyographic indices alterations in individuals with temporomandibular disorders is high, pointing to the possible presence of myofunctional disorders of the stomatognathic system. These indices have no direct relation with pain complaint but show muscular activity imbalance, which may not be useful to diagnose pain, but may help the correct referral to relevant muscle therapies.