Fernanda Pasinato

Temporomandibular disorder and generalized joint hypermobility: application of diagnostic criteria

UNLABELLED Generalized joint hypermobility (GJH) has been considered a predisposing factor for the development of temporomandibular disorder (TMD). AIM To evaluate clinical and psychosocial aspects in individuals diagnosed with TMD with or without GJH. MATERIALS AND METHODS Clinical and experimental study, which enrolled 34 women, from 18 to 35 years of age with TMD diagnosed by RDC/TMD. The GJH was assessed by the Beighton score and volunteers were broken down into 2 groups: with GJH (n = 22) and without GJH (n = 12). RESULTS We found a high percentage of GJH (64. 71%). All participants had myofascial pain; 79. 41% had arthralgia and 41% had disk displacement. There was a correlation between higher GJH scores and higher passive mouth opening amplitude (p = 0.0034), with pain (p = 0.0029) and without pain (p = 0.0081). Greater mandibular range of motion was observed in the group with GJH, except for protrusion. Painful mouth opening was statistically higher in the GJH group (p = 0.0279). CONCLUSIONS Individuals with TMD associated or not to GJH do not differ significantly regarding clinical and psychosocial aspects, except in the mandibular opening range of motion, which if kept at physiological levels can lead to a late diagnosis of TMD in these individuals.Generalized joint hypermobility (GJH) has been considered a predisposing factor for the development of temporomandibular disorder (TMD). Aim: To evaluate cli...

Global body posture and plantar pressure distribution in individuals with and without temporomandibular disorder: a preliminary study.

OBJECTIVE The aim of this study was to evaluate body posture and the distribution of plantar pressure at physiologic rest of the mandible and during maximal intercuspal positions in subjects with and without temporomandibular disorder (TMD). METHODS Fifty-one subjects were assessed by the Diagnostic Criteria for Research on Temporomandibular Disorders and divided into a symptomatic group (21) and an asymptomatic group (30). Postural analysis for both groups was conducted using photogrammetry (SAPo version 0.68; University of São Paulo, São Paulo, Brazil). The distribution of plantar pressures was evaluated by means of baropodometry (Footwork software), at physiologic rest and maximal intercuspal positions. RESULTS Of 18 angular measurements, 3 (17%) were statistically different between the groups in photogrammetric evaluation. The symptomatic group showed more pronounced cervical distance (P = .0002), valgus of the right calcaneus (P = .0122), and lower pelvic tilt (P = .0124). The baropodometry results showed the TMD subjects presented significantly higher rearfoot and lower forefoot distribution than those in the asymptomatic group. No differences were verified in maximal intercuspal position in the between-group analysis and between the 2 mandibular positions in the within-group analysis. CONCLUSIONS Subjects with and without TMD presented with global body posture misalignment. Postural changes were more pronounced in the subjects with TMD. In addition, symptomatic subjects presented with abnormal plantar pressure distribution, suggesting that TMD may have an influence on the postural system.

ESTUDO DA POSTURA CORPORAL EM CRIANÇAS COM RESPIRAÇÃO PREDOMINANTEMENTE ORAL E ESCOLARES EM GERAL

Objetivo: avaliar a postura de respiradores predominantemente orais e comparar com achados, descritos na literatura, de escolares em geral. Metodos: a amostra foi composta por 30 escolares, respiradores orais, que foram submetidos a avaliacao postural subjetiva com analise da simetria e do posicionamento das estruturas, nas vistas anterior, posterior e lateral. Os achados obtidos foram comparados aos descritos na literatura sobre a postura corporal de escolares em geral. Resultados: na vista anterior predominou a elevacao do ombro direito, flexao de cotovelo e dedos. Na vista posterior, observou-se abducao e elevacao das escapulas e rotacao dos joelhos. E, na vista lateral, anteriorizacao da cabeca, protrusao e rotacao interna de ombros. Na literatura revisada predominaram: semiflexao de joelhos, protrusao de ombros, hiperlordose lombar. Conclusao: o modo respiratorio e essencial no equilibrio postural de criancas em idade escolar. Algumas alteracoes sao proprias do desenvolvimento postural normal, pois apareceram em ambos os grupos.

Multimodal physiotherapeutic approach: effects on the temporomandibular disorder diagnosis and severity

Introduction The temporomandibular disorder (TMD) consists of a set of signs and symptoms that affect the masticatory structures, which may cause joint and/or muscular pain. The physiotherapy approach aims at the pain relief and the functional recovery by means of several modalities.Objective To investigate the effects, short and medium-term, of a multimodal physiotherapeutic approach on TMD diagnosis and severity.Methodology Individuals with diagnosis of TMD, confirmed by the Axis I of the RDC/TMD, took part in the study. From this evaluation, the Temporomandibular Index (TMI) and its sub-indices were calculated. The participants were treated during ten sessions of physiotherapy, which included therapeutic ultrasound, thermotherapy, manual therapy, stretching and neuromuscular exercises, as well as self-care and home exercises instructions. Assessments were carried out before treatment (AV1), immediately after treatment (AV2) and two months after the end of the treatment (AV3). The values of indices and the diagnosis prevalence were compared between the different periods by the t paired test (p < 0.05).Results The number of diagnoses reduced in all the subgroups and 41.7% of the 24 participants presented no diagnosis after the treatment. A significant decrease in the TMI was observed between AV1 and AV2 (p = 0.000). There was no difference between AV2 and AV3 (p = 0.204) in 13 participants assessed two months after the end of the treatment.Conclusion The multimodal physiotherapeutic approach resulted in positive effects, short and medium-term, on the symptoms and clinical signs, with deletion of the dysfunction or reduction of its severity in treated patients.

Aspectos clínicos e psicossociais avaliados por critérios de diagnóstico para disfunção temporomandibular

Purpose: to analyze the association between the classification of clinical diagnoses (myofascial pain, disk displacement and joint disorder) and chronic pain grade, depression and non-specific physical symptoms in subjects with temporomandibular disorder. Methods: 32 patients, mean age 28.71±4.66 years, were included. The assessment tool used was the Research Diagnostic Criteria for Temporomandibular Disorders - Axis I and II. Regarding the diagnostic group, 88.13% of patients showed mixed conditions, with 43.75% from groups I and III (muscle and joint disorders) and 34.38% from groups I, II and III (muscle and joint disorders, and disk displacement). Results: according to Axis II, 96.88% the participants were classified as having chronic pain, grade I and II (low disability and low intensity; low disability and high intensity). Moderate and severe degrees of depression were observed in 84.38% of the participants. In the assessment of non-specific physical symptoms including and excluding pain, respectively, 59.38% showed severe symptoms and 71.88% had moderate and severe symptoms. There was a significant relationship between the clinical diagnosis of temporomandibular disorder and the degree of non-specific physical symptoms including pain. Conclusion: some clinical and psychosocial factors are associated in patients with temporomandibular disorder, observing a variety of clinical diagnoses with a significant relationship between clinical diagnoses and the presence of non-specific physical symptoms with pain. Complaints of greater severity of physical symptoms were found in patients with multiple clinical diagnoses.

Severidade da desordem temporomandibular e sua relação com medidas cefalométricas craniocervicais

Abstract Introduction : It is known that there is a relationship between the Temporomandibular Disorder (TMD) and craniocervical posture, but, besides the studies showed inconclusive results, the severity of signs and symp-toms of TMD is not considered. Objective : To correlate the severity of TMD index to craniocervical cephalo-metric measurements. Materials and methods : Thirty-two women, from 19 to 35 years old with a diagnosis of TMD (RDC/TMD), took part in the study. The severity of signs and symptoms of TMD was assessed by the Temoromandibular Index proposed by Pehling and calculated according to the physical examination findings of the RDC/TMD (Axis I). The craniocervical posture was evaluated by cephalometry through 11 measures related to the head, cervical spine, jaw and the hyoid bone position. Data normality was tested by Lilliefors test and correlations were performed by Spearman coefficient. Results : Moderate negative correlation was found between the CVT/Hor angle and Muscular (p = 0.0288) and Temporomandibular (p = 0.0394) Indices; between the CPL/Hor angle (anterior) when correlated with Functional (p = 0.0482) and Muscle indices (p = 0.0086) and between distance from the hyoid to the third cervical vertebra (Hy/C3) and Functional Index (p = 0.0155).

Atividade elétrica dos músculos cervicais e amplitude de movimento da coluna cervical em indivíduos com e sem DTM

O objetivo da pesquisa foi avaliar a atividade eletrica e a dor a palpacao dos musculos cervicais, a amplitude de movimento (ADM) da coluna cervical e a relacao entre atividade eletrica e ADM cervical em individuos com e sem desordem temporomandibular (DTM). Participaram do estudo 53 voluntarios, sendo 24 com DTM e 29 sem, de ambos os generos, com 18 a 32 anos de idade. A DTM foi diagnosticada pelo criterio de diagnostico em pesquisa para DTM (Research Diagnostic Criteria for Temporomandibular Disorders). A eletromiografia dos musculos esternocleidomastoideo (ECOM) e trapezio superior foi realizada bilateralmente, na situacao de repouso, com frequencia de 2 KHz e filtro passa-faixa de 10-1000 Hz. As medidas de ADM de flexao, extensao, lateroflexao e rotacao foram realizadas com um fleximetro e a comparacao entre os grupos contou com o teste de Mann Whitney. O teste de Spearman foi aplicado para a correlacao entre as variaveis, com nivel de significância de 5%. Nao foi verificada nenhuma diferenca na ADM cervical entre os grupos. A atividade eletrica demonstrou-se significativamente maior nos musculos ECOM direito (p=0,0130), trapezio superior direito (p=0,0334) e esquerdo (p=0,0335) no grupo DTM em relacao ao grupo controle. Nao houve correlacao significante entre atividade eletrica e ADM cervical. A dor nos musculos cervicais apresentou-se significativamente maior apenas no musculo ECOM direito (p=0,0055). Conclui-se que os grupos estudados registraram diferenca na atividade eletrica dos musculos cervicais, sendo esta maior em individuos com DTM.

AVALIAÇÃO DO ESTADOETRAÇODEANSIEDADEEMINDIVÍDUOS COMDISFUNÇÃO TEMPOROMANDIBULARE ASSINTOMÁTICOS

Diversos disturbios psicologicos, principalmente o estresse, ansiedade e depressao, podem estar associados com a disfuncao temporomandibular (DTM), agindo como importantes colaboradores para a instalacao e manutencao desta disfuncao. Estados e/ou tracos emocionais aliados a fatores estressores de vida podem levar a habitos disfuncionais orais e consequentemente a hiperatividade da musculatura mastigatoria, constituindo fatores desencadeantes de dor orofacial. O objetivo deste estudo foi avaliar a presenca do estado e traco de ansiedade em individuos assintomaticos e com disfuncao temporomandibular. Participaram do estudo 35 voluntarios, sendo 20 individuos com DTM e 15 assintomat icos. Os participantes foram avaliados para verificacao da presenca e grau de disfuncao temporomandibular (Indice Anamnesico de Fonseca e Indice Anamnesico e Clinico de Disfuncao e Estado Oclusal). Apos, realizou-se a avaliacao do estado e traco de ansiedade por meio do Inventario de Ansiedade Traco-Estado. Observou-se incidencia significativamente maior tanto do estado de ansiedade (43,3 versus 35,7) como do traco (48,1 versus 36,73) de personalidade ansiosa em individuos com DTM, quando comparados aos assintomaticos para esta disfuncao. Os resultados sugerem que estado e traco de ansiedade podem contribuir para a genese e perpetuacao das disfuncoes temporomandibulares.