Josemar Parreira Guimarães

Palpation and pressure pain threshold: reliability and validity in patients with temporomandibular disorders.

Abstract This study assessed the interexaminer reliability and validity of palpation (PA) and pressure pain threshold (PPT) of the temporomandibular joint (TMJ) and the masseter and temporalis muscles in patients with temporomandibular disorders (TMD) and asymptomatic controls. Eighty (80) subjects were distributed into two groups: Group 1 consisted of 40 TMD patients with muscular and joint pain selected by RDC/TMD Axis I; and Group 2 (control) with 40 asymptomatic individuals. Training and calibration of examiners was undertaken prior to testing. Mean reliability values were 0.64 and 0.78 (PPT), and 0.59 and 0.75 (PA), for patients and controls, respectively. Results showed statistically significant differences (p<0.001), for PA and PPT among TMD patients compared with the control. The results also showed acceptable specificity values (above 0.90), although sensitivity had low values. The tests had low diagnostic validity to discriminate between patients and controls, with low positive predictive values (PPV).

Prevalência de alteração morfológica do processo estilóide em pacientes com desordem temporomandibular

OBJETIVO: Avaliar, radiograficamente, a prevalencia de alteracoes morfologicas do processo estiloide em pacientes com desordens temporomandibulares. MATERIAIS E METODOS: Foram analisadas 1.500 radiografias panorâmicas da articulacao temporomandibular de pacientes de ambos os sexos e sem limitacao de idade, que foram atendidos pelo Servico de Desordem Temporomandibular da Faculdade de Odontologia da Universidade Federal de Juiz de Fora, MG, no periodo de 1997 a 2003. RESULTADOS: Oitenta e tres (5,53%) dos pacientes da amostra apresentaram pelo menos um dos lados da articulacao com alteracao morfologica do processo estiloide, sendo 74 do sexo feminino e 9 do sexo masculino, concentrados na faixa dos 41 a 50 anos de idade (32,5%). Com relacao ao tipo morfologico do processo estiloide, verificaram-se 113 alongados, 21 pseudo-articulados e 19 segmentados. Constatou-se, tambem, que as alteracoes morfologicas do processo estiloide desenvolvem-se de forma simetrica. CONCLUSAO: Em pacientes com desordem temporomandibular as alteracoes do processo estiloide ocorrem de forma diferenciada e de maneira simetrica em cada paciente, independentemente do sexo e da idade.

Temporomandibular disorder in patients with juvenile idiopathic arthritis: clinical evaluation and correlation with the findings of cone beam computed tomography

OBJECTIVE The objective of this study was to assess the presence of temporomandibular disorder (TMD) in patients with juvenile idiopathic arthritis (JIA), and correlate with tomographic findings and clinical aspects. STUDY DESIGN Fifteen patients with JIA were evaluated by means of RDC/TMD, and submitted to a cone beam computerized tomography (CBCT) examination, then correlated with the clinical diagnosis of TMD with tomographic findings, gender, age at the time of evaluation, time elapsed since the onset of symptoms, and time of treatment of JIA. RESULTS In the 30 temporomandibular joints evaluated, 25 (83.3%) were clinically diagnosed with TMD. Although tomographic alterations have frequently been found (83.3%), only 5 (16.7%) were clinically diagnosed with osteoarthritis/arthrosis. There was a difference in the degree of TMD when evaluated, the time elapsed since the onset of symptoms, and the time of treatment of JIA. CONCLUSIONS Diagnosis based on physical examination and complementary evaluation is necessary to provide early therapeutic procedures so that possible functional and/or anatomical problems do not develop.

A Study of the Association Between Sleep Bruxism, Low Quality of Sleep, and Degenerative Changes of the Temporomandibular Joint.

AbstractThe aim of this study was to evaluate the presence of degenerative bone changes of the temporomandibular joint (TMJ) in individuals suffering from sleep bruxism (SB), associating these characteristics with the quality of sleep. For this, we followed the International Classification of Sleep Disorders for the diagnosis of SB, in addition to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the classification of TMD and cone beam computed tomography. It was found that 97.7% of the individuals with bruxism had at least 1 RDC/TMD group III diagnosis, 75.6% of the subjects considered their sleep quality as poor, and the largest group (23%) had centric bruxism. There was no significant association between the pattern of sleep quality (P = 0.36), the type of SB (P = 0.277), and the presence of degenerative changes of the TMJ. Regardless of the quality of sleep and the type of bruxism presented, the prevalence of degenerative bone disorders was high (67%) among women with a mean age of 46 years and a clinical diagnosis of SB.

Chronic myalgia centrally mediated

The clinical case report of a 50-year-old patient who presented to the Diagnostic and Guidance Service for Patients with Temporomandibular Disorders, at the School of Dentistry, Federal University of Juiz de Fora, with complaint of pain in the facial muscles in a continuous, throbbing manner that was paroxysmal at times, with severe intensity and of a chronic nature. After semiological interdisciplinary examination (dental, speech and physical therapy), the diagnosis suggestive of temporomandibular disorder was reached, characterized by centrally mediated chronic myalgia, associated with articular structures, parafunctional habits, malocclusion and emotional factors. Supportive dental treatment consisted of guidance throughout treatment and use of occlusal splints. After a three-and-a-half-month period of interdisciplinary therapy the patient was discharged with an 80% improvement in pain and increase in mouth opening amplitude. Episodes of pain were related only to moments of stress. The patient was instructed about the need for orthodontic treatment and psycho therapy.

Associação Entre os Hábitos Bucais Deletérios e as Desordens Temporomandibulares: Os Filhos Imitam os Pais na Adoção Destes Costumes?

Objetivo: analisar uma possivel associacao entre a existencia de habitos bucais deleterios nos pais e existencia de habitos bucais deleterios nos filhos, observando o habito de maior frequencia nestes grupos. Pretende-se, ainda, verificar a correlacao entre a ocorrencia de DTM e a presenca de habitos bucais deleterios nestas criancas. Metodos: aplicou-se um questionario a 50 criancas e seus respectivos pais na Clinica de Odontopediatria da FO/UFJF, abordando a presenca e frequencia de habitos bucais deleterios de succao (chupeta e digital) e mastigatorio (onicofagia, morder objetos, morder a mucosa oral, bruxismo e apertamento dentario), bem como a presenca de quadros de desordens temporomandibulares nas criancas. Os dados coletados foram submetidos a analise estatistica, sendo o qui-quadrado o teste escolhido.Resultados: Os resultados nao demonstraram associacao entre a existencia dos habitos bucais deleterios nos pais e a existencia de habitos bucais deleterios nos filhos, considerando o nivel de 5% de significância (p>0,05). O habito de morder objetos 74% (n=23) foi o habito mais frequente entre as criancas, enquanto que o habito de apertamento dentario 46% (n=37) foi o de maior ocorrencia entre os pais. Os resultados nao demonstraram associacao entre a presenca dehabitos bucais deleterios e desordens temporomandibulares, independente do tipo de habito.Conclusao: Os habitos bucais deleterios sao frequentes na populacao infantil. Orientacoes e esclarecimentos sao fundamentais nestes casos e capacitam os pais a se tornarem agentes estimuladores para o melhor desenvolvimento dos seus filhos Purpose: To examine a possible association between the presence of oral habits in parents and the presence of oral habits in children, observing the habit of a higher frequency in these groups. The aim is also to investigate the correlation between the occurrence of TMD and the presence of oral habits in these children.Methods: A questionnaire was given out to 50 children and their parents at the Clinic of Pediatric Dentistry of FO/UFJF addressing the presence and frequency of oral habits of sucking (pacifier and digital) and chewing (biting nails, biting objects, biting the oral mucosa, bruxism and clenching), and the presence of tables of temporomandibular disorders in children. The data collected were subjected to statistical analysis, and chi-square test chosen.Results: The results showed no association between the presence of oral habits in parents and the presence of oral habits in children, considering the 5% level of significance (p>0.05). The habit of biting objects 74% (n=23) was the most common habit among children. While the habit of clenching 46% (n=37) was the most frequent among the parents. The results showed no association between the presence of oral habits and temporomandibular disorders, regardless of the type of habit.Conclusion: The oral habits are common in children. Guidance and clarification are essential in these cases and empower mothers to become agents for stimulating the better development of their children