Daniela Aparecida Biasotto-Gonzalez

Craniocervical posture and bruxism in children.

AIM  The aim of this study was to investigate, using photogrammetry, the relationship between head posture and bruxism in children with complete deciduous dentition. MATERIAL AND METHODS  Forty-two children aged between 3 and 6 years, with complete deciduous dentition, participated in the study. Twenty-one children diagnosed with bruxism according to the diagnostic criteria of the American Academy of Sleep Medicine were selected for the bruxism group, and 21 children without bruxism were selected for the control group. Markers were placed on three anatomical landmarks (spinous process of the seventh cervical vertebra, manubrium of the sternum and mental protuberance) and photographic measurements were made to evaluate head posture. Angles between markers were determined using the ALCimagem® software for quantitative image analysis. The Students t-test was used at a significance level of 0.05 for the comparison of head posture (mean cervical angle) between the bruxism and control groups. RESULT  There was a significant difference (p < 0.005) in the mean cervical angle between the control (89.58° ± 8.03°) and bruxism (98.99° ± 8.15°) groups. CONCLUSION  In the present study, children with bruxism showed greater alterations in head posture than controls.

Effects of Massage Therapy and Occlusal Splint Therapy on Mandibular Range of Motion in Individuals With Temporomandibular Disorder: A Randomized Clinical Trial

OBJECTIVE The purpose of this study was to investigate the effects of massage therapy compared with occlusal splint therapy on mandibular range of motion (ROM) in individuals with temporomandibular disorder (TMD) and compare the results with ROM obtained in a group of individuals without this disorder. METHODS A blinded randomized clinical trial was conducted. Twenty-eight volunteers with TMD were randomly distributed into either a massage therapy group or an occlusal splint group. Both treatments were provided for 4 weeks. Fourteen individuals without TMD were consecutively allocated to a comparison group. Fonseca anamnestic index was used to characterize TMD and allocate the volunteers to either of the intervention groups or asymptomatic comparison group. Mandibular ROM was evaluated before and after treatment using a digital caliper. Two-way repeated-measures analysis of variance with a post hoc Bonferroni testing was used for intergroup and intragroup comparisons (level of significance was set to 5%). Cohen d was used to calculate the effect size. RESULTS In the intragroup analysis, significant increases in ROM were found for all measures in both the massage and occlusal splint groups (P < .05). A small to moderate clinical effect of treatment with the occlusal splint was found regarding right and left lateral excursion in comparison with the massage therapy and asymptomatic comparison groups (0.2 <d < 0.5). CONCLUSION Massage therapy on the masticatory muscles and the use of an occlusal splint lead to an increase in mandibular ROM similar to that of the asymptomatic comparison group with regard to maximum active mouth opening and both right and left excursion in individuals with TMD.

Relação da postura cervical e oclusão dentária em crianças respiradoras orais

PURPOSE: to evaluate and compare head and neck posture, and the relationship between occlusal class, among mouth and nasal breathing children. METHODS: an observational, cross-sectional study was carried out, in which 110 children took part. These were divided into Group I: nasal breathers, and Group II: mouth breathers. For evaluating the respiration, we used mirror clouding and filling the mouth with water tests, with intrabuccal clinical exam for the Angle occlusal classification. Posture analysis was carried out by means of photogrammetry, and the software Alcimagem® was used to measure the predefined angle by the protuberances of the Spinous Process of the 7th Cervical Vertebra, Manubrium of the sternum and Mentum Vertex. The obtained data were tabulated and submitted to a statistical analysis, using the program SPSS 12.0 with a 95% confidence interval. RESULTS: a larger cervical angle was observed for Group II (96.59o±8.79) than for Group I (86.60o±8.53), showing statistically significant differences (p<0.001). The majority (68.5%) of the mouth breathing individuals presented class II occlusion Angle, and this relationship was significant (p<0.05). The class II individuals showed a larger cervical angle, differing statistically from the class I patients (p<0.05). CONCLUSION: it may be concluded that there is a connection between mouth breathing, alteration in head and neck posture and class II occlusal Angle in the studied children. In mouth breathing subjects, forward inclination of the head is predominant.

Analysis of laser therapy and assessment methods in the rehabilitation of temporomandibular disorder: a systematic review of the literature

The aim of the present study was to perform a systematic review of the literature on the effects of low-level laser therapy in the treatment of TMD, and to analyze the use of different assessment tools. [Subjects and Methods] Searches were carried out of the BIREME, MEDLINE, PubMed and SciELO electronic databases by two independent researchers for papers published in English and Portuguese using the terms: “temporomandibular joint laser therapy” and “TMJ laser treatment”. [Results] Following the application of the eligibility criteria, 11 papers were selected for in-depth analysis. The papers analyzed exhibited considerable methodological differences, especially with regard to the number of sessions, anatomic site and duration of low-level laser therapy irradiation, as well as irradiation parameters, diagnostic criteria and assessment tools. [Conclusion] Further studies are needed, especially randomized clinical trials, to establish the exact dose and ideal parameters for low-level laser therapy and define the best assessment tools in this promising field of research that may benefit individuals with signs and symptoms of TMD.

Pattern of Electromyographic Activity in Mastication Muscles of Adolescents with Temporomandibular Disorder

[Purpose] The aim of the present study was to assess the behavior of the mean and median frequencies of the electromyography signal of the mastication muscles of adolescents with different degrees of TMD severity. [Subjects] Forty-two adolescents aged 14 to 18 years. [Methods] The adolescents were classified according to severity using the Helkimo Index. The control group consisted of 14 subjects with no signs or symptoms of TMD. Three readings were taken in during maximum intercuspation and mandibular rest, with each reading lasting 10 seconds. [Results] Significant differences (p=0.0001) were found in the mean frequency (Hz) between the control group (CG), mild TMD group (MG) and moderate/severe TMD group (MSG), especially during mandibular rest, for all muscles evaluated: right temporal: CG (137.5), MG (194.2), MSG (291.7); left temporal: CG (106.9), MG (200.6), MSG (294.2); right masseter: CG (155.7), MG (242.8), MSG (278.3); left masseter: CG (125.0), MG (214.6), MSG (316.7). Greater differences among groups were found under the condition of mandibular rest. Conclusions: Adolescents with TMD especially those with more severe symptoms exhibit hyperactivity of the mastication muscles.

Jaw Dysfunction Is Associated with Neck Disability and Muscle Tenderness in Subjects with and without Chronic Temporomandibular Disorders

Purpose. Tender points in the neck are common in patients with temporomandibular disorders (TMD). However, the correlation among neck disability, jaw dysfunction, and muscle tenderness in subjects with TMD still needs further investigation. This study investigated the correlation among neck disability, jaw dysfunction, and muscle tenderness in subjects with and without chronic TMD. Participants. Forty females between 19 and 49 years old were included in this study. There were 20 healthy controls and 20 subjects who had chronic TMD and neck disability. Methods. Subjects completed the neck disability index and the limitations of daily functions in TMD questionnaires. Tenderness of the masticatory and cervical muscles was measured using an algometer. Results. The correlation between jaw disability and neck disability was significantly high (r = 0.915, P < 0.05). The correlation between level of muscle tenderness in the masticatory and cervical muscles with jaw dysfunction and neck disability showed fair to moderate correlations (r = 0.32–0.65). Conclusion. High levels of muscle tenderness in upper trapezius and temporalis muscles correlated with high levels of jaw and neck dysfunction. Moreover, high levels of neck disability correlated with high levels of jaw disability. These findings emphasize the importance of considering the neck and its structures when evaluating and treating patients with TMD.

Presença de desconforto na articulação temporomandibular relacionada ao uso da chupeta

AIM: The goal of the present study was to analyze if the duration of pacifier use influenced the stomatognathic system in children that did not present any other parafunctional habits. STUDY DESIGN: Transversal cohort study. MATERIAL AND METHOD: To collect data, a questionnaire was used and answered by the mothers of 90 children aged three to seven years old. RESULTS: The children were divided into three groups: did not use pacifier; used pacifier until 2 years old; and used pacifier for more than 2 years. Greater prevalence of pain or discomfort in the stomatognathic system was observed among the children who had not used pacifier and the children who had used it for more than 2 years. The prevalence was smaller among the children who used pacifier until 2 years of age. CONCLUSION: Thus, it is concluded that pacifier is important to induce children to perform suction movements, preparing them to the introduction of solid foods. However, if used for a prolonged period of time, it may damage the joint and consequently the childs quality of life.

Accuracy study of the main screening tools for temporomandibular disorder in children and adolescents

The aims of the present study were to assess the degree of sensitivity and specificity of the screening questionnaire recommended by the American Academy of Orofacial Pain (AAOP) and the patient-history index proposed by Helkimo (modified by Fonseca) and correlate the findings with a clinical exam. All participants answered the questionnaires and were submitted to a clinical exam by a dentist who had undergone calibration training. Both the AAOP questionnaire and Helkimo index achieved low degrees of sensitivity for the detection of temporomandibular disorder (TMD), but exhibited a high degree of specificity. With regard to concordance, the AAOP questionnaire and Helkimo index both achieved low levels of agreement with the clinical exam. The different instruments available in the literature for the assessment of TMD and examined herein exhibit low sensitivity and high specificity when administered to children and adolescents stemming from difficulties in comprehension due to the age group studied and the language used in the self-explanatory questions.

Signs and symptoms of temporomandibular disorders and their impact on psychosocial status in non-patient university student's population

BACKGROUND AND PURPOSE  Temporomandibular disorders (TMD) exhibit a combination of signs and symptoms, mainly characterized by pain and dysfunction, which impairs the functional capacity of the mastication system. These symptoms may produce a negative impact on social activities, employment and leisure. The aim of this study was to early identify the signs and symptoms of TMD and their impact on daily life of non-patient university students.  METHODS  Data were collected from 183 students of the dentistry course. The Axis II of the Research Diagnostic Criteria for Temporomandibular Disorders was administered and analyzed using Spearman test at a significance level of 0.05.  RESULTS  Among the 183 participants, 107 were women (58.47%) and 76 were men (41.53%). Age ranged from 18 to 47, with a mean age of 25.35 years. In relation to pain intensity and disability, 129 participants (70.88%) reported no pain in the previous 6 months. An analysis of depression revealed that 35 (19.67%) had moderate and 7 (3.83%) had severe depression. The assessment of nonspecific physical symptoms including pain revealed that nine (4.92%) exhibited moderate symptoms, and one (0.55%) exhibited severe symptoms. The nonspecific physical symptoms excluding items of pain analysis revealed that 44 (24.04%) exhibited moderate symptoms, and 91 (49.73%) exhibited severe. The functions reported as most adversely affected by jaw disability were yawning, eating hard foods, chewing, smiling and laughing. Regarding the habit, 64 (35%) confirmed having the nighttime and 59 daytime (32.3%) teeth grinding with a significant correlation with the four domains analyzed. A significant correlation was observed among all domains.  CONCLUSION  This study analyzed a young population that exhibited para-functional habits and nonspecific physical symptoms excluding pain that need some intervention since they could progress to a symptomatic TMD in future.

Influence of temporomandibular disorder on temporal and masseter muscles and occlusal contacts in adolescents: an electromyographic study

BackgroundThe aim of the present study was to analyse the influence of temporomandibular disorder (TMD) on electromyographic activity in the masseter and temporal muscles of adolescents and investigate a possible association with the number of occlusal contacts.MethodsThe Helkimo Index was administered for the diagnosis of TMD and classification of the adolescents into three groups: without TMD; with mild TMD; and with moderate/severe TMD. Carbon paper was used for the determination of occlusal contact points. A standardised electromyographic evaluation was performed on the masticatory muscles at rest, during habitual chewing and during maximum voluntary clenching. The readings were normalised to maximum voluntary clenching. Statistical analysis involved the chi-squared test and Fisher’s exact test. The Kruskal-Wallis test and one-way analysis of variance with Dunn’s post hoc test were used to compare differences between groups. Pearson’s correlation coefficients (r) were calculated for the determination of correlations between the number of occlusal contacts and RMS values.ResultsElectromyography revealed significant differences in the right and left masseter and temporal muscles at rest and during chewing among the three groups. These differences were not observed during maximum voluntary clenching. No statistically significant differences were found between the groups with and without TMD regarding the number of occlusal contacts.ConclusionElectromyographic activity in the masseter and temporal muscles was greater among adolescents with moderate to severe TMD.