Laís Valencise Magri

Severity of TMD Related to Age, Sex and Electromyographic Analysis

Temporomandibular disorders (TMD) are manifested as a group of signs and symptoms that affect a particular population profile. Some variables such as sex and age influence the clinical expression of this condition. This observational descriptive cross-sectional study aimed to correlate the severity of TMD established by the craniomandibular index (CMI) with the variables: age, sex and electromyographic activity of the masseter and anterior temporal muscles. Fifty-four subjects (15 males/39 females) aged between 16 to 65 years (mean age = 41 years) and diagnosed with TMD were evaluated. Severity was determined by the CMI. These subjects also underwent examination by surface electromyography of the masseter and anterior temporal muscles. No correlation was found between age and severity of TMD (p=0.19/r=0.16), however there was a trend of greater severity in young adults (25-50 years). The sex variable in the correlation was positive with the CMI (p=0.03/r=-0.96) and superior to women. A greater EMG activity of the anterior temporal in relation to masseter (p=0.01) was found and the left temporal activity had the highest average (161.5 ± 44.6 Hz). The electromyographic activity of the anterior temporal and right masseter muscles was positively correlated with the Dysfunction Index CMI (p=0.01). The use of CMI to quantify the severity of TMD and of EMG to assess the functionality of the masticatory muscles can be important allies to direct the treatment.

Is the Masticatory Function Changed in Patients with Temporomandibular Disorder

Patients with temporomandibular disorders (TMD) often complain and have limitation in masticatory function, which can be affected by a complex interaction of factors. The aim of this study was analyze the masticatory function in patients with TMD using surface electromyography (EMG) and masticatory efficiency (ME). Twenty-seven patients with TMD and 25 considered control (n), aged between 18 and 60 years, paired by age and gender, were evaluated according to RDC/TMD. In both groups were performed: EMG with chewing gum, clinical evaluation of habitual chewing with stuffed cookie (CE) (number of chewing strokes and time) and analysis of ME with fuchsin beads. Nonparametric statistical analyses were used (Mann-Whitney) for comparisons between groups, with 5% significance level. For all variables, the TMD group showed higher values than the control, with statistical significance for ME (p<0.0001), number of chewing strokes (p=0.04), chewing time (p=0.009), right masseter EMG activity (p=0.05), left masseter (p=0.005), right anterior temporal (p=0.05) and left anterior temporal (p=0.001). The conclusion is that patients with TMD showed changed chewing pattern, but without impairment of masticatory function.

Perception of the signs and symptoms of temporomandibular disorder in females by using the ProTMDMulti protocol and the visual analog scale before and after acupuncture treatment

OBJECTIVE To evaluate the perceptions of patients with TMD in relation to the signs and symptoms before and after acupuncture treatment, according to the ProTMDMulti and the VAS. METHOD 68 patients were divided into groups: muscle TMD treated with acupuncture at local points (MUS-LP), muscle TMD with acupuncture at distant points (MUS-DP), joint and muscle treated with LP (JOI-LP) and joint and muscle treated with DP (JOI-DP). The evaluations were performed at four times: initial, control, final and follow-up. RESULTS The best results were seen in the JOI-LP and the MUS-DP groups, in which the perceptions of the signs and symptoms were statistically lower in the final assessment than in the initial (P<0.05). In all groups, the final and the follow-up evaluations were similar. CONCLUSIONS For TMDs with joint components, the best acupuncture treatment involves local points and for the TMDs with muscle components, points at a distance.Objective: To evaluate the perceptions of patients with TMD in relation to the signs and symptoms before and after acupuncture treatment, according to the ProTMDMulti and the VAS. Method: 68 patients were divided into groups: muscle TMD treated with acupuncture at local points (MUS-LP), muscle TMD with acupuncture at distant points (MUS-DP), joint and muscle treated with LP (JOI-LP) and joint and muscle treated with DP (JOI-DP). The evaluations were performed at four times: initial, control, final and follow-up. Results: The best results were seen in the JOI-LP and the MUS-DP groups, in which the perceptions of the signs and symptoms were statistically lower in the final assessment than in the initial (P<0.05). In all groups, the final and the follow-up evaluations were similar. Conclusions: For TMDs with joint components, the best acupuncture treatment involves local points and for the TMDs with muscle components, points at a distance.

Evaluation of the impact on quality of life of patients with temporomandibular disorders

BACKGROUND AND OBJECTIVES: Chronic pain, such as temporomandibular disorder, often leads to significant changes in quality of life. This study aimed at evaluating the influence of temporomandibular disorders in the subjective perception of quality of life by means of the Oral Health Impact Profile-14. METHODS: Participated in the study 80 patients diagnosed with temporomandibular disorders by means of the Research Diagnostic Criteria for Temporomandibular Disorders, aged between 18 and 60 years (32.71±1.1), who were submitted to the Oral Health Impact Profile-14 questionnaire. Non parametric Mann-Whitney statistics, Pearson Correlation test, Analysis of Variance and Tukey test were used with significance level of 5%. RESULTS: There has been no statistically significant difference in the perception of the impact on quality of life between genders; patients with association of signs and symptoms of the three groups of the Research Diagnostic Criteria for Temporomandibular Disorders had further impact on quality of life, as well as the most severe the temporomandibular disorder the highest the reported impact (p=0.05), and the age group with the highest impact on quality of life was between 18 and 30 years (p<0.01). CONCLUSION: Increased age, severity and the association of diagnoses have exacerbated the impact of temporomandibular disorders on quality of life. Variables analyzed in this study were related to temporomandibular disorder chronicity, stressing the importance of early intervention strategies to minimize the impact on quality of life.

Anterior and medial angulations of the styloid process in subjects with TMD: clinical and radiographic findings

This study investigated the existence of association between the angulation of the styloid process on the anterior and medial directions with the intensity of temporomandibular dysfunction (TMD) symptoms. Fifty patients (8 men and 42 women) aged 25 to 70 years, with relevant TMD symptoms were evaluated. Clinical examinations were performed to determine the severity of TMD symptoms (orofacial pain, headache, tinnitus and dizziness) based on the RDC/TMD criteria and the visual analogue scale (VAS), and digital radiographic images of the styloid process were obtained: lateral cephalometric skull radiograph (analysis of anterior angulation) and posteroanterior skull radiograph (reverse Townes projection) (analysis of medial angulation). The anterior angulation average of the styloid process was 20.89° while the medial angulation average was 19.1° in the right side and 19.04° in the left side. There was no statistically significant difference among the patient groups (severe, moderate and mild symptoms) associating the TMD symptoms and the anterior or medial angulation of the styloid process (p>0.05). There was no correlation between the intensity of the TMD symptoms and the measurements of anterior and medial angulation of the styloid process using either lateral cephalometric or posteroanterior radiographs (reverse Townes projection).

Ultra-low frequency transcutaneous electric nerve stimulation does not affect the centric relation registration.

Abstract Objective: To evaluate the influence of ULF-TENS on the displacement of the mandibular condyle and on the repeatability of centric relation (CR) registration of three different techniques: bimanual manipulation (BM), long strip technique, and harmonic centric occlusal relationship (R.O.C.A. wires). Methods: Twenty-five participants without temporomandibular disorder (TMD) underwent two study stages conducted via electronic position analysis: (1) three CR records were made, one for each manipulation technique; (2) the ULF-TENS was applied for 30 min, and after that the same CR records were repeated. Statistical analyses: Mann–Whitney, ICC, and one-tailed F test. Results: The ULF-TENS did not influence the condyle total displacement, regardless of CR recording technique used (p > 0.05). BM showed an improvement in repeatability after ULF-TENS. Discussion: Concerning the variance, BM showed less variation at the X-axis. Long strip technique and R.O.C.A. wires varied less at the Y-axis. Long strip technique was again less variable at the Z-axis.

Repeatability Study of Angular and Linear Measurements on Facial Morphology Analysis by Means of Stereophotogrammetry

Abstract The aim of this study was to analyze the repeatability in a stereophotogrammetry digital system used for the evaluation of facial morphology. Thirty healthy Brazilian, 18 to 45 years old (26.71 ± 6.53), had 11 reference landmarks marked on their faces by the same examiner and were photographed with an interval of 1 week by the VECTRA M3. Nine angular measurements (nasolabial, mentolabial, nasofrontal, maxillofacial, nasal, maxillary, mandibular, facial convexity, full facial convexity) and 2 linear measurements (middle facial height and lower facial height) were taken. Repeatability was analyzed by the mean absolute differences, relative error of magnitude, technical error of measurement, intraclass correlation coefficient, and Bland–Altman analysis. Paired t test sought any systematic errors between the acquisitions. Associations among body mass index, age, and the error in the measurements were made using the Pearson correlation coefficient. For the technical error of measurement, the nasolabial and mentolabial angles showed values >2° (clinical limit set for this study). For the relative error of measurement, most of the measures were rated between good and excellent. The maxillofacial angle was only moderate. There was a systematic error for middle facial height. The nasolabial, mentolabial, facial convexity, full facial convexity, maxillofacial, and nasofrontal angles presented intraclass correlation coefficient values rated as excellent. The relationship between age/body mass index and the error found between measurements was not confirmed. The nasolabial and mentolabial angles should be interpreted with caution due to the variability showed. The results found stereophotogrammetry to be repeatable, giving accurate measures within the references established for this study.

Are the bite force and electromyographic activity altered in muscle TMD patients with abfraction lesions

Abstract Objective: To verify if the maximal molar bite force (BF) and the electromyographic activity (EMG) are altered in TMD patients with abfraction lesions (AL) when compared to those without AL. Methods: The sample was composed of 45 patients (18–60 years old), 30 diagnosed with TMD (RDC/TMD) (15 with AL and 15 without AL) and 15 controls. The BF and the EMG of the masticatory muscles (maximal voluntary contraction (MVC) and chewing gum) were measured. Results: TMD patients showed decreased BF (p < 0.001), without differences between patients with and without AL. The electromyographic activity during MVC was similar among all groups (p > 0.05), although there was a greater trend of muscular balance for the control group (percentage overlapping coefficient and electromyographic indexes). The TMD group without AL showed a lower number of cycles and masticatory frequency. Discussion: TMD patients with and without AL exhibited similar results in the analysis of the BF and EMG, without differences.

Facial anthropometric analysis of a healthy group of young Brazilian adults by means of stereophotogrammetry technique

Introduction: Anthropometry is the science responsible for measuring the weight, size, and proportions of the human body, providing valuable and objective insights into how to characterize phenotypic variation and dysmorphology. Among the newer methods for facial analysis, the stereophotogrammetry technique has shown excellent results given its use of a group of fast cameras that photograph subjects from multiple angles. Objective: The aims of the present study were: (1) to analyze the facial profile of a group of healthy young Brazilian adults, between 18 and 30 years of age, (2) to define common facial values among the subjects, (3) to create a database of facial measurements of a portion of this young healthy Brazilian population to be used in future works, and (4) to test the precision and repeatability of the Vectra M3® equipment. Material and method: Sixty healthy young Brazilian adults participated in the study, 30 males and 30 females. Temporary craniometrical landmarks were performed in soft tissue, and those subjects underwent image capturing by the stereophotogrammetry technique. Thirty landmarks were used to take the measurements (in mm) of 35 distances. The equipment repeatability was tested in 20% of the sample (i.e., 12 subjects). Result: The values between the first and second acquisitions were statistically (p<0.05) similar for all 35 distances analyzed. The findings allowed the creation of a reliable database containing facial distances of a portion of the young healthy Brazilian population. In addition, the distances Tr-N, N-Sn, Ls-Sto, Sto-Li, En[r]-En[l] and Prn-Sn were not statistically different for the group of men (GM) and the group of women (GW), while the other 29 distances were significantly greater in GM. Conclusion: The technique and methods employed in the study yielded objective analyses of the facial profile of this group of healthy young Brazilian adults, and the equipment Vectra M3® showed a high level of precision and repeatability.

Relationship between temporomandibular disorder symptoms signs and Burnout syndrome among dentistry students

JUSTIFICATIVA E OBJETIVOS: A disfuncao temporomandibular e a sindrome de Burnout sao influenciadas por fatores emocionais. O objetivo deste estudo foi analisar de forma prospectiva as dimensoes da sindrome de Burnout, e sua relacao com a percepcao dos sinais e sintomas de disfuncao temporomandibular em uma amostra de estudantes de graduacao em Odontologia. METODOS: A amostra foi composta por alunos de graduacao em odontologia (23±2.5 anos), os quais responderam aos questionarios Inventario de Burnout de Maslach - versao estudantes e o ProDTMMulti. Os questionarios foram respondidos anualmente, considerando-se o primeiro, segundo e terceiro ano do curso (2013/2014/2015). A analise estatistica comparou as dimensoes da sindrome de Burnout entre os generos e testou a sua correlacao com o escore total do ProDTMMulti, bem como a variacao entre os escores das dimensoes dessa sindrome ao longo dos anos por genero. RESULTADOS: Considerando a amostra total houve aumento na frequencia da zona de risco para a sindrome de Burnout com o passar dos anos. Observou-se diferenca significativa entre homens e mulheres para exaustao emocional nos tres anos avaliados (p=0,002, p=0,003, p=0,01, respectivamente) e ainda para a descrenca no ultimo ano (p=0,02), sendo mais altos para as mulheres. Houve correlacao significativa dos escores do ProDTMMulti com a exaustao emocional nas mulheres no primeiro e segundo ano avaliados (p=0,0004, p=0,04). CONCLUSAO: Parece existir uma correlacao entre a exaustao emocional e a percepcao de sinais e sintomas de disfuncao temporomandibular no genero feminino e uma tendencia de aumento dos escores das dimensoes da sindrome de Burnout com a progressao do curso.