Daniel Bonotto

Intra-articular injections with corticosteroids and sodium hyaluronate for treating temporomandibular joint disorders: a systematic review

INTRODUCTION In some cases, conservative treatment of internal derangements of the Temporomandibular Joint (TMJ) is considered little responsive. Thus, it is necessary to accomplish treatments that aim at reducing pain and improve function in patients who present arthrogenic temporomandibular disorders. OBJECTIVE This study, by means of a systematic review of the literature, aimed to analyze the effectiveness of intra-articular injections with corticosteroids and sodium hyaluronate for treating internal derangements of the TMJ. METHODS Carry out a research in the following databases: MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs, and BBO, considering publications issued between 1966 and October 2010, focusing on randomized or quasi-randomized controlled clinical trials, single or double-blind. RESULTS After applying the inclusion criteria we collected 9 articles, 7 of which were randomized controlled double-blind clinical trials and 2 randomized controlled single-blind clinical trials. CONCLUSION After analyzing the literature, it was found that intra-articular injection with corticosteroids and sodium hyaluronate seems to be an effective method for treating internal derangements of the TMJ. However, further randomized controlled clinical trials, with representative samples and longer follow-up time must be carried out in order to assess the real effectiveness of this technique.

Influence of orthognathic surgery for symptoms of temporomandibular dysfunction

OBJECTIVE To evaluate the influence of orthognathic surgery on the clinical signs and symptoms of temporomandibular disorders (TMDs). STUDY DESIGN In a cohort study, 54 patients undergoing orthognathic surgery were evaluated with regard to the signs and symptoms of TMDs through subjective and objective assessments. These evaluations were performed 1 week preoperatively (T1), 1 month postoperatively (T2), and 6 months postoperatively (T3). The evaluations included patient variables and surgery. Univariate analyzes were performed to verify the association of the variables (P < .05). RESULTS The incidence of TMD 6 months after orthognathic surgery was significantly lower (P < .001). TMD intensity decreases significantly in the postoperative period. Females had a higher prevalence of TMD (P = .003) and muscular disorders preoperatively (P = .001). There was a decrease in clicks between T1 and T3 (P = .013). Mouth opening without pain worsened from T1 to T2 (P < .001) and improved from T1 to T3 (P = .015) and T2 to T3 (P < .001). The results were similar for mouth opening with pain (P < .001). In patients undergoing jaw fixation with bicortical screws, mouth opening without pain was significantly less in T3 patients than in patients undergoing fixation with plate and monocortical screws (P = .048). CONCLUSIONS Orthognathic surgery reduces the clinical signs and symptoms of TMD.

Professional karate-do and mixed martial arts fighters present with a high prevalence of temporomandibular disorders

BACKGROUND/AIM Facial trauma in sports has been associated with temporomandibular disorders. Because of the intensity and duration of training needed for elite-level competitions, high-performance athletes can have two to five times more traumatic injuries than recreational athletes. This study aimed to investigate the prevalence of temporomandibular disorders in high-performance martial arts fighters and compare it with the prevalence in recreational athletes and non-athletes. MATERIAL AND METHODS The Research Diagnostic Criteria for Temporomandibular Disorders was used to diagnose and classify professional karate-do practitioners (group I; n = 24), amateur karate-do practitioners (group II; n = 17), high-performance mixed martial arts fighters (group III; n = 13), and non-athletes (n = 28). The groups were compared with the chi-square test and tested for the difference between two proportions using a significance level of 5% (P < 0.05). RESULTS The prevalence of temporomandibular disorders in groups I (54.2%; P = 0.003) and III (61.5%; P = 0.002) was significantly higher than in group IV (14.3%). The prevalence in group II was similar to that in group IV (P > 0.05). A diagnosis of arthralgia from disk displacement was made more frequently in groups I (45.8%; P = 0.013) and III (38.5%; P = 0.012) than in group IV (7.1%). The chronic pain associated with TMD was low intensity and low disability. CONCLUSIONS While there was a high prevalence of temporomandibular disorders in the professional athletes in our study, the prevalence of the condition in recreational athletes was similar to that in individuals who did not practice martial arts.

Eletromiografia de superfície em disfunção temporomandibular: revisão sistemática

JUSTIFICATIVA E OBJETIVOS: A eletromiografia de superficie (ES) permite uma avaliacao nao invasiva do fenomeno bioeletrico durante o estado de repouso do musculo avaliado bem como a comparacao com sua atividade durante a contracao muscular. O objetivo deste estudo foi avaliar a efetividade do uso de ES em pacientes diagnosticados com disfuncao temporomandibular segundo os criterios Research Diagnostic Criteria for Temporomandiublar Disorders (RDC/TMD) eixo I. CONTEUDO: A revisao de literatura foi realizada a partir das bases de dados LILACS, Medline e Scielo, cobrindo o periodo de janeiro de 1987 a fevereiro de 2012. Ensaios clinicos randomizados e controlados, ensaios clinicos e testes clinicos que avaliaram ES, sinais e sintomas de desordens temporomandibulares (DTM) diagnosticados pelo criterio RDC/TMD foram incluidos. A estrategia de busca resultou em 182 artigos, dos quais oito preencheram os criterios de inclusao, sendo que um caracterizava um estudo clinico randomizado e sete eram estudos longitudinais sem criterios de randomizacao. Em todos os estudos, o metodo utilizado para detectar e analisar a atividade eletrica dos musculos da mastigacao (corpo do masseter e feixe anterior do temporal) foi a ES, sendo empregada com certa facilidade e seguindo os padroes para o exame. No entanto, foram utilizados diferentes modelos experimentais e selecao das amostras, causando dificuldades na comparacao dos resultados. CONCLUSAO: Dentro das limitacoes deste estudo, foi possivel constatar que embora a ES em DTM nao deva ser utilizada para diagnostico, ela pode auxiliar no acompanhamento da evolucao dos tratamentos de DTM.

Viscosupplementation as a treatment of internal derangements of the temporomandibular joint: retrospective study

BACKGROUND AND OBJECTIVES: There are many non invasive treatment modalities for internal temporomandibular joint derangements described in the literature, including counseling, drug therapy, physical therapy and interocclusal devices. However, some patients become refractory to conservative treatments and procedures such as arthrocentesis, arthroscopy and temporomandibular joint surgery are indicated. Viscosupplementation is a less invasive, low cost approach with good short and long term results. This study aimed at discussing viscosupplementation to treat internal temporomandibular joint alterations with results after four months of follow-up.METHODS: Participated in the study 55 patients with reducing and non reducing disc displacement and osteoarthritis refractory to conservative treatments who were submitted to sodium hyaluronate infiltrations. There has been statistically significant pain improvement for all groups.RESULTS: Patients with non reducing disc displacement and osteoarthritis had significant mouth opening improvement. Such results were constant along the four months of follow-up.CONCLUSION: Viscosupplementation with sodium hyaluronate may be considered a good alternative to functionally reestablish temporomandibular joint in the short term in patients with internal alterations refractory to conservative treatments.

Does orthognathic surgery improve myofacial pain in individuals with skeletal class III? One-year follow-up

OBJECTIVE The objective of the study was to evaluate the effect of orthognathic surgery on temporomandibular disorder (TMD) in patients with skeletal class III malocclusion. STUDY DESIGN Forty-seven patients undergoing surgery were evaluated by a trained examiner using Axis I of the Research Diagnostic Criteria/TMD index, consecutively, at 3 different periods: 1 week before operation (T0), 6 months after operation (T1), and 1 year after operation (T2). Bivariate analyses were performed to compare the evaluation periods (P < .05). RESULTS The prevalence of TMD in the sampled patients from T0 to T1 decreased from 30 (63.8%) to 22 (46.8%) (P = .021). Even in T2, the prevalence of TMD remained lower than that in T0, at 21 (44.7%) diagnosed patients (P = .049). The reported frequencies of myofascial pain and headache were lower in T1 and T2 than in T0 (P < .001). Decrease in the frequency of joint pain and joint sounds was observed only from T0 to T1 (P = .039 and P = .021, respectively). The mean maximum of mouth opening decreased from T0 to T1 (P < .001) and increased again at T2 (P < .001). CONCLUSIONS Orthognathic surgery promoted reduction in the frequencies of myofascial pain and headache reported by patients with skeletal class III malocclusion.

Glossopharyngeal neuralgia of tumor origin diagnosed in dental care. Case report

BACKGROUND AND OBJECTIVES: The glossopharyngeal neuralgia is a neuropathy considered rare that manifests itself in the IX cranial nerve distribution characterized by an electric shock-like pain, often associated with hyperalgesia and allodynia. The etiology may be related to vascular changes, brain tumor, or even idiopathic. The aim of this study was to report a case of glossopharyngeal neuralgia secondary to a brain tumor diagnosed in a dental clinic, highlighting its clinical manifestations and discussing its nosological limit with other orofacial pain. CASE REPORT: Female patient, 63 years old, sought care at a dental outpatient clinic of Orofacial Pain complaining about an intense electric shock and jumping pain of sudden onset on the lower right edge region and right tongue base. She reported that the events were triggered and exacerbated when chewing, opening the mouth, laughing and talking. The diagnostic hypothesis of glossopharyngeal neuralgia was tested by momentary depletion to the application of benzocaine 20% and pain remission with the administration of carbamazepine (400mg/ day) for 20 days. The patient was referred to the Neurology service of the hospital, where the magnetic resonance imaging presented an expansive, solid, extra-axial lesion in the right prepontine cistern, suggesting meningioma. CONCLUSION: The professional should be aware of the differential diagnosis of orofacial pains, especially in episodic neuropathies, to rule out the tumor etiology. In these cases, the quick referral to tertiary centers is fundamental for the good prognosis.