Célia Marisa Rizzatti Barbosa

Estrogen Receptor-α Polymorphisms and Predisposition to TMJ Disorder

UNLABELLED Temporomandibular joint disorders (TMJD) affect women with greater frequency than men, and sex hormones may contribute to this female predominance. Therefore, this study investigated whether estrogen receptor-alpha (XbaI/PvuII) single nucleotide polymorphisms (SNPs) are associated with TMJD in women. DNA was obtained from 200 women with TMJD (100 with chronic pain and 100 with signs of TMJD but no pain) diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD) and 100 control women without TMJD. Restriction fragment length polymorphisms of polymerase chain reaction products were used to analyze XbaI and PvuII SNPs in DNA fragments. A model directly characterizing specific DNA sequence variants based on the risk haplotypic structure implemented with the EM algorithm was used to analyze the data. The [GC] haplotype of the XbaI locus was significantly more prevalent in both TMJD groups when compared with the control group (P = .0012). Specifically, the [GC] haplotype was more prevalent within the painful TMJD group versus the control group (OR = 3.203, 95% CI = 1.633, 6.284) and in the TMJD no pain versus the control group (OR = 2.51, 95% CI = 1.267, 4.97). In conclusion, the presence of [GC] haplotype in the XbaI locus may increase the susceptibility of women to develop TMJD. PERSPECTIVE This study suggests that a polymorphism in the estrogen receptor may increase the risk of women developing temporomandibular joint disorder. This finding may elucidate the interindividual differences in the contribution of estrogen to TMJD, the genetic influences on TMJD predisposition, and may serve as the basis for future treatment tailoring, which could enhance outcomes for these patients.

Multidisciplinary approach to chronic pain from myofascial pain dysfunction syndrome: a four-year experience at a Brazilian center.

Chronic pain is the major complaint of myofascial pain dysfunction syndrome (MPDS) and is a complex problem which involves physical, psychological and social aspects. The etiology of MPDS is multifactorial and the multidisciplinary approach is essential for differential diagnosis and for comprehensive treatment planning. In 1993, the Dental School of Piracicaba-UNICAMP, Brazil, opened a Center for Pain Studies (CPS), staffed by health care providers including, dentists, psychologists, physicians, physiotherapists and phonoaudiologists. The major aims of the CPS are to provide clinical care and to develop basic and applied research. Sixty-two MPDS patients had been admitted to the CPS by 1997. There were 60 females and 2 males, mean age-32.5 years. The mean duration of chronic pain was 48 months. Pain intensity and unpleasantness were measured employing the Visual Analogue Scale. The tendency to develop stress-related diseases was assessed by the Social Readjustment Scale. There was a mean reduction of chronic pain of 69.89% and 71.78% relative to intensity and unpleasantness, respectively. The experience of clinical attendance at a multidisciplinary center showed the relevance of a team consisting of health care providers from different specialties with well-established aims, completely integrated and sensitive enough to understand the painful complaints of MPDS patients.

Could Acupuncture Be Useful in the Treatment of Temporomandibular Dysfunction

In this study, the effects of acupuncture in comparison with flat occlusal plane appliance were evaluated in patient with myogenic temporomandibular dysfunction (TMD). The sample consisted of 40 women with TMD and unbalanced energy predominance of Yang Liver Ascension, selected using the Renying and Cunkou pulses, randomly divided into two groups: acupuncture and splint. The effect of treatments on the masseter and anterior temporal muscles was evaluated after 4 weeks of treatment, by means of electromyographic activity (root mean square) and pain pressure threshold. Pain intensity was measured using the visual analog scale, and range of mouth opening was evaluated using a millimeter ruler. All evaluations were performed at the beginning and end of the treatment. Visual analog scale score was reduced equally in the two groups (p < 0001), and the increase in range of mouth opening was significant in both groups. A significant difference was detected only in pain pressure threshold of the left masseter in the acupuncture group (p < 0.05). Only root mean square in the at rest position of the right temporal muscle diminished in the final stage of the splint group (p < 0.05). Both treatments reduced the pain intensity of myogenic TMD in the short term and may be considered strategies for control of chronic pain related to TMD.

Prevalence of temporomandibular disorders in postmenopausal women and relationship with pain and HRT

The prevalence of temporomandibular disorders (TMD) is higher in females, reaching their high peak during reproductive years, probably because of the action of some female hormones, which alter pain threshold. This study aimed to investigate the prevalence of TMD in postmenopausal women and its relationship with pain and hormone replacement therapy (HRT). In total, 284 patients were evaluated and classified using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Pain was measured using the Visual Analogue Scale (VAS), and patients were also asked about the use of HRT. All data was analyzed using analysis of variance (ANOVA) and chi-square test. In total, 155 subjects did not have TMD and 129 had TMD; TMD group patients were classified according to RDC/TMD axis I classification as follows: muscle disorder group (1.6%), disk displacement group (72.87%), and arthralgia, osteoarthritis, and osteoarthrosis group (37.98%). Pain was registered in 35 patients who belonged to the TMD group, while 48 patients reported the use of HRT. There was a similar percentage of TMD and non TMD patients; moreover, the use of exogenous hormones was no associated with TMD, suggesting that there is no influence on the pain threshold.

Botulinum toxin type A reduces inflammatory hypernociception induced by arthritis in the temporomadibular joint of rats

Objective This study aimed to investigate the antinociceptive effects of Botulinum toxin type A (BoNT‐A) on persistent inflammatory hypernociception induced by arthritis in the temporomandibular joint (TMJ) of rats. Material and methods Wistar rats were induced to persistent inflammatory hypernociception in the left TMJ. Then, animals were treated with intra‐TMJ injections of BoNT‐A, using doses of 3.5, 7 and 14 U/kg. Saline was used as control group. Behavioral tests were applied to evaluated the effect of BoNT‐A in the inflammatory hypernociception. After that, animals were euthanized and samples from peri‐articular tissues and trigeminal ganglia were obtained for further analyses. Results BoNT‐A reduced the persistent inflammatory hypernociception induced by arthritis in the TMJ of rats. BoNT‐A significantly reduced the peripheral release of the neurotransmitters Substance P and Calcitonin gene related peptide; and the pro‐inflammatory cytokine IL‐1&bgr;. Otherwise, BoNT‐A had no effect in the peripheral release of glutamate and the cytokine TNF‐&agr;. Conclusion These results demonstrate that intra‐articular injection of BoNT‐A reduces the albumin‐induced arthritis persistent hypernociception in TMJ of rats by peripheral inhibition of neuropeptides release. HighlightsBotulinum toxin type A acts reduced behavioral nociceptive response in rats responses in nociceptive animals.Botulinum toxin type A reduces Interleukin 1 beta increasing its antinociceptive effect.Hypernociception is reduced by Botulinum toxin type A injections due to the inhibition of neuropeptides.

Therapeutic effectiveness of a combined counseling plus stabilization appliance treatment for myofascial pain of the jaw muscles: A pilot study

Objective: This study aims to assess changes over time in pain intensity (VAS) and in pressure pain threshold (PPT) of the anterior temporalis and masseter muscles with a treatment protocol combining counseling and stabilization appliance as well as its effects on psychosocial factors. Methods: Twenty individuals with myofascial pain of jaw muscles lasting from at least six months were selected for an uncontrolled before-after study. Counseling was performed by giving information on myofascial pain and advice on self-management. Stabilization appliances were delivered one week after the first counseling session. A number of outcome variables (i.e. visual analogue scale [VAS], pain pressure threshold [PPT] and Research Diagnostic Criteria for Temporomandibular Disorders axis II [RDC/TMD]) were assessed at different evaluation points during a six-month follow-up. ANOVA for repeated measures and Pearson’s correlation test were used to evaluate changes in the outcome variables over time. Results: Compared to baseline data, a significant positive change was found at the 1st week, 1st, 3rd, and 6th month evaluations for VAS values (P < 0.0001) and at the 1st week, 3rd, and 6th month evaluations for PPT values (P < 0.05). RDC/TMD axis II values were significantly different (P < 0.05) from baseline to all evaluations points. Conclusion: The association of counseling and stabilization appliance is effective in the management of chronic myofascial pain of jaw muscles. Future controlled studies are required to get deeper into the assessment of the relative effectiveness of counseling and stabilization appliances.

Counseling and oral splint for conservative treatment of temporomandibular dysfunction: preliminary study

Introduction Temporoamndiular Disorders (TMD) involve the masticatory muscles, temporomandibular joint (TMJ) or both. The most common symptom is pain, which is usually located in the muscles of mastication, pre-auricular region, and / or ATM, especially during mandibular function. The main treatment for TMD is related to pain relief. Objective The purpose of this case report was to evaluate the reduction of pain symptoms using Visual Analogue Scale (VAS) of patients with TMD treated with counseling and use of occlusal splint (OS). Material and method 16 subjects had participated in this study, that was composed by 4 appointment with 7-day interval between each (CEP FOP / Unicamp – 137/2009). In the first, an examiner used the Research Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD) to diagnose each patient and delivered a VAS to register the intensity of daily pain. In the second, counseling, molding of both dental arcs to fabricate the OS and the delivery of new VAS were performed. In the third, there was the installation and adjustment of the OS and the delivery of another scale, and in the last, possible adjustments on the OS were done. Data were analyzed by ANOVA two way and Tukey post-test at 5% significance level. Result There was significant difference when comparing the intensity of pain of individuals after installation of splint with the baseline data and after counseling (p = 0.05). Conclusion According to the result of this study, the treatment of TMD associating counseling occlusal splint is effective in reducing pain intensity.

Psychological aspects of temporomandibular disorder patients: evaluations after acupuncture treatment

BACKGROUND AND OBJECTIVES: Depression and somatization are emotional features present in chronic temporomandibular disorder pain patients. This study aimed at evaluating results after acupuncture on psychological aspects of females with chronic muscle temporomandibular disorder pain. METHODS: Sample was made up of 40 females, aged between 18 and 45 years, submitted to two procedures: acupuncture and splint. Patients were evaluated for one month by the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire Axis II before and after treatment. Treatment expectation before treatment was also evaluated by a visual analog scale with verbal anchors: negative expectation and positive expectation. RESULTS: There has been chronic pain improvement in 53.3% of acupuncture patients and in 60% of splint patients. For severe depression, 11.1% of acupuncture and 50% of splint patients have improved. Patients with severe somatization had 16.7% improvement with acupuncture and 44.4% with splint. There has been negative correlation (p<0.05) between treatment expectation and somatization (including and excluding pain items) for the acupuncture group. CONCLUSION: Both groups have improved some psychological aspects (depression and somatization) after a short period of treatment.