Gustavo Hauber Gameiro

How may stressful experiences contribute to the development of temporomandibular disorders

Temporomandibular disorders (TMD) comprise the most common cause of chronic facial pain conditions, and they are often associated with somatic and psychological complaints including fatigue, sleep disturbances, anxiety, and depression. For many health professionals, the subjectivity of pain experience is frequently neglected even when the clinic does not find any plausible biologic explanation for the pain. This strictly biomedical vision of pain cannot be justified scientifically. The purpose of this study is to demonstrate, by original articles from the literature and recent studies conducted in our own laboratory, the biological processes by which psychological stress can be translated into the sensation of pain and contribute to the development of TMD. The role of the hypothalamic–pituitary–adrenal axis, the serotoninergic and opioid systems in the pathogenesis of facial pain is exposed, including possible future therapeutic approaches. It is hoped that knowledge from apparently disparate fields of dentistry, integrated into a multidisciplinary clinical approach to TMD, will improve diagnosis and treatment for this condition through a clinical practice supported by scientific knowledge.

The effects of restraint stress on nociceptive responses induced by formalin injected in rat's TMJ

It has been reported that stress can alter nociception from superficial tissues, such as skin and subcutaneous region. However, the influence of stress on an experimental deep nociception model is not understood. In this study, the temporomandibular joint (TMJ) formalin test was used to evaluate the effects of acute and chronic restraint stress on nociceptive responses in rats. Animals were initially submitted to one session of acute restraint stress (1 h) or exposed to chronic stress (40 days-1 h/day). Then, animals were killed immediately to collect blood for hormonal determinations by radioimmunoassay, or submitted to the TMJ formalin test to evaluate nociception. Rats submitted to acute restraint presented a performance similar to unstressed controls in the TMJ formalin test, whereas chronically stressed rats showed an increase in nociceptive responses. After 40 days of restraint, morphine was injected i.p. (1, 5 mg/kg or saline). The stressed rats displayed decreased morphine effects on nociception compared to unstressed controls. These findings suggest that repeated stress can produce hyperalgesia, which is, at least in part, due to alterations in the activity of opioid systems. This model may help elucidate the underlying neural mechanisms that mediate the effects of repeated stress on orofacial pain.

Posterior crossbite and functional changes. A systematic review.

OBJECTIVE To assess, by systematically reviewing the literature, the functional changes of the masticatory muscles associated with posterior crossbite in the primary and mixed dentition. MATERIALS AND METHODS A literature survey from the Medline database covering the period from January 1965 to February 2008 was performed. Randomized controlled trials, controlled clinical trials, and clinical trials that evaluated bite force, surface electromyography, and signs and symptoms of temporomandibular disorders (TMD) were included. Two reviewers extracted the data independently and assessed the quality of the studies. RESULTS The search strategy resulted in 494 articles, of which 8 met the inclusion criteria. Children with posterior crossbite can have reduced bite force and asymmetrical muscle function during chewing or clenching, in which the anterior temporalis is more active and the masseter less active on the crossbite side than the noncrossbite side. Moreover, there is a significant association between posterior crossbite and TMD symptomatology. CONCLUSION The consequences of the functional changes for the growth and development of the stomatognathic system deserves further investigation.

Effects of Short- and Long-Term Celecoxib on Orthodontic Tooth Movement

OBJECTIVE To test the hypothesis that short- and long-term celecoxib administration has no effect on orthodontic tooth movement. MATERIALS AND METHODS Male Wistar rats were submitted to short- (3 days) and long-term (14 days) celecoxib administration, while the respective control groups received equivolumetric saline intraperitoneal injections. The upper left first molars of all rats were moved mesially for 14 days by a fixed orthodontic appliance exerting 50 g force upon insertion. After the experimental period, tooth movement was quantified and tissues around the first molar were processed for tartrate-resistant acid phosphatase (TRAP) histochemistry. The amount of tooth movement and the number of TRAP-positive cells on the alveolar bone surface were evaluated. RESULTS The amount of tooth movement was significantly reduced in rats submitted to short- and long-term celecoxib administration, while the number of osteoclasts on the alveolar bone did not differ between the four groups studied. CONCLUSIONS The hypothesis is rejected. Although celecoxib administration did not affect the number of osteoclasts, the osteoclast activity might be reduced, which could explain the inhibition of tooth movement observed in the celecoxib-treated animals. These results indicate that orthodontists should be aware of patients under short- and long-term therapy with celecoxib.

Treatment of Chronic Periodontitis and Its Impact on Mastication

BACKGROUND The aim of the present study is to assess the impact of conventional periodontal treatment of chronic periodontitis on the perception of mastication. METHODS The patients (n = 28; age range: 23 to 56 years, mean age: 37.9 years) were evaluated on two occasions (before and after treatment) with a 45-day interval using the Oral Impact on Daily Performance questionnaire. An electromyography system was used for the determination of activity in muscles of mastication and bite force. Masticatory performance was assessed using a test material. The median particle size of the masticated material was determined using a sieve method and the Rosin-Rammler equation. The clinical criteria were the number of teeth and probing depth, both determined by a single calibrated observer masked to the treatment phase. The data were analyzed in the pretreatment and post-treatment periods using Wilcoxon test; Spearman correlation coefficient; and two multiple linear regression models (backward stepwise procedure). RESULTS There was a significant negative correlation between the number of teeth (number of mastication units) and difficulty eating (P <0.05) before and after treatment. Probing depth had a positive relationship with the total Oral Impact on Daily Performance score before treatment (P <0.01). CONCLUSIONS The subjective perception of the impact of oral health on mastication diminished after periodontal treatment. The number of teeth had considerable importance in the perception of impact on mastication in the sample studied.

Histological analysis of orthodontic root resorption in rats treated with the cyclooxygenase-2 (COX-2) inhibitor celecoxib

INTRODUCTION It has been reported that anti-inflammatory drugs used for treatment of pain and discomfort related to orthodontic treatment could slow down tooth movement. However, the effect of these drugs on orthodontic root resorption is not well understood. OBJECTIVES The aim of this study was to investigate whether the COX-2 inhibitor celecoxib offers some protection against orthodontically induced root resorption. DESIGN Male Wistar rats were divided into four groups: Groups I and II were treated with saline and celecoxib (10 mg / kg), respectively for 3 days. Groups III and IV were treated with saline and celecoxib for 14 days. The upper left first molars of all rats were moved mesially for 14 days with 50 g of force. An area including the disto-apical aspect of the mesial root of the first molar was processed for histological and histochemical techniques with tartarate-resistant acid phosphatase (TRAP). OUTCOME MEASURE The degree of root resorption was measured using an image analysis system with a grid-sheet superimposed in the root were resorption lacunae were counted. The number of TRAP-positive cells on the tooth root surface defined as odontoclasts were also evaluated. RESULTS The results revealed that there were no significant differences in the degree of root resorption and in the number of odontoclasts on the root between the four groups studied. CONCLUSION The short and long-term celecoxib administration did not suppress the root resorption in case of experimental orthodontic force application.

Nociceptive behavior induced by mustard oil injection into the temporomandibular joint is blocked by a peripheral non-opioid analgesic and a central opioid analgesic

The aim of this study was to improve the mustard oil (MO) induced temporomandibular joint (TMJ) nociception model and to investigate the potential analgesic activity of systemic dipyrone and tramadol on the nociceptive behavioral responses induced by injection of low concentrations of the MO into the rat TMJ region. TMJ injection of 2.5% MO produced a significant nociceptive behavior expressed by head flinching and orofacial rubbing. This activity was related to the MO injection since mineral oil (vehicle) did not elicit response. Local application of the lidocaine N-ethyl bromide quaternary salt, QX-314 (2%) and systemic administration of morphine (4 mg/kg) significantly reduced the MO-induced nociceptive responses, validating the nociceptive character of the behaviors. The pretreatment with systemic dipyrone (19, 57 or 95 mg/kg) as well as tramadol (5, 7.5 or 10 mg/kg) was effective in decreasing the nociceptive behavioral responses induced by the injection of MO into the rat TMJ. In conclusion, TMJ injection of low concentrations of MO in rats produces well defined and quantifiable nociceptive behaviors constituting a reliable behavioral model for studying TMJ pain mechanisms and testing analgesic drugs. The results also suggest that dipyrone and tramadol could be effective analgesic options in the management of TMJ pain.

Pain, masticatory performance and swallowing threshold in orthodontic patients

OBJECTIVE The aim of this study was to assess pain, masticatory performance and swallowing threshold of patients undergoing orthodontic treatment. METHODS Ten patients of both genders (mean age of 17.25 ± 5.21 years), with complete permanent dentition, who underwent orthodontic treatment with fixed appliances were evaluated. The masticatory performance and the swallowing threshold were assessed by patients individual capacity of fragmenting an artificial test food (Optocal) which was chewed and had the resulting particles processed by a standardized sieving method, presenting the median particle size (MPS) of crushed units. The intensity of pain / discomfort during chewing was evaluated by means of a visual analog scale. All tests were performed at the following times: T0 - before activating the orthodontic appliance; T1 - 24 hours after activation, and T2 - 30 days after activation. RESULTS The results showed a significant increase in pain at T1 (T0 = 0.60 ± 0.70 mm; T1 = 66.2 ± 34.5 mm), returning to baseline values at T2 (3.20 ± 3.82 mm). Masticatory performance was also reduced in T1 (MPS = 10.15 ± 1.1 mm2) in comparison to T0 (MPS 7.01 ± 2.9 mm2) and T2 (MPS 6.76 ± 1.3 mm2). However, particle size was not affected in the swallowing threshold test (T0 = 5.47 ± 2.37 mm2; T1 = 6.19 ± 2.05 mm2; T2 = 5.94 ± 2.36 mm2). CONCLUSIONS The orthodontic appliances did not interfere in the size of the particles that would be swallowed, even in the presence of pain.

Influence of ethanol and morphine on pain perception evoked by deep tissue injury

The aim of this study was to evaluate the effect of ethanol and morphine on nociceptive behavioral responses evoked by the injection of formalin into the temporomandibular joint region of rats (the TMJ formalin test). In experiment 1, animals were given an ethanol solution (6.5%) or tap water to drink for 4 and 10 days, before the procedure for TMJ pain. In the group treated for 4 days, significant analgesia was observed in the TMJ formalin test, whereas the group treated for 10 days did not show this effect, revealing the development of tolerance to ethanol antinociceptive effects. In experiment 2, animals were submitted to chronic regimen of ethanol (6.5% for 10 days) and the control group was given tap water to drink. After this period, morphine (10 mg/kg i.p.) was administrated 30 minutes before the TMJ formalin test. Morphine had the same analgesic effect in both groups, showing that the treatment with ethanol was not able to alter the analgesic potency of morphine. The results showed that ethanol can affect nociceptive behavioral responses related to pain from deep tissues, like the TMJ, and the absence of interaction between ethanol and morphine suggest that ethanol-induced analgesia was mediated by nonopiate mechanisms.

Quantification of the force systems delivered by transpalatal arches activated in the six Burstone geometries

OBJECTIVE To evaluate the force systems produced by transpalatal arches (TPAs) activated according to the six classes of geometries described by Burstone and Koenig. MATERIALS AND METHODS Sixty appliances were tested for first-order activations using a mechanical force testing system. The TPAs were first checked for passivity in sagittal, transverse, and vertical planes at the measuring machine. Then 10 appliances per group were activated using a millimeter template to obtain the six classes of geometries, and the activated appliances were inserted into lingual tubes of the Force System Identification machine that recorded the deactivation forces and moments delivered by both terminal ends of the TPAs. RESULTS The overall force system with the actual values of forces and moments recorded by each type of activation was illustrated and compared with the mathematical model reported by Burstone and Koenig. Although a great consistency of the direction of forces and moments were observed, the theoretically feasible force systems could not be fully accomplished by the TPA activated for the six classes of geometries. CONCLUSION The first-order activations of the TPA can deliver predictable force systems in respect to the direction of forces and moments attainable, but some unexpected forces and moments are also produced. Careful clinical monitoring is, therefore, strongly recommended when using this statically indeterminate system.