Luciano Ambrosio Ferreira

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.

Review articleDiagnosis of temporomandibular joint disorders: indication of imaging examsDiagnóstico das disfunções da articulação temporomandibular: indicação dos exames por imagem☆

Introduction Knowledge of the different imaging tests and their appropriate indications is crucial to establish the diagnosis of temporomandibular disorders, especially in patients with overlapping signs and symptoms.INTRODUCTION Knowledge of the different imaging tests and their appropriate indications is crucial to establish the diagnosis of temporomandibular disorders, especially in patients with overlapping signs and symptoms. OBJECTIVE To present and assess the main diagnostic imaging tests for temporomandibular disorders and rationally discuss their indication criteria, advantages, and disadvantages. METHODS Literature review in the Web of Knowledge, PubMed and SciELO databases, as well as manual search for relevant publications in reference lists of the selected articles. RESULTS Computed tomography and magnetic resonance imaging were considered the gold standard assessments for the temporomandibular joint to evaluate hard and soft tissues, respectively. Each diagnostic method exhibited distinct sensitivity and specificity for the different subtypes of joint dysfunction. CONCLUSION Selecting an evaluation examination based on its accuracy, safety, and clinical relevance is a rational decision that can help lead to an accurate diagnosis and an optimum treatment plan.

Diagnosis of temporomandibular joint disorders: indication of imaging exams

Introduction Knowledge of the different imaging tests and their appropriate indications is crucial to establish the diagnosis of temporomandibular disorders, especially in patients with overlapping signs and symptoms.INTRODUCTION Knowledge of the different imaging tests and their appropriate indications is crucial to establish the diagnosis of temporomandibular disorders, especially in patients with overlapping signs and symptoms. OBJECTIVE To present and assess the main diagnostic imaging tests for temporomandibular disorders and rationally discuss their indication criteria, advantages, and disadvantages. METHODS Literature review in the Web of Knowledge, PubMed and SciELO databases, as well as manual search for relevant publications in reference lists of the selected articles. RESULTS Computed tomography and magnetic resonance imaging were considered the gold standard assessments for the temporomandibular joint to evaluate hard and soft tissues, respectively. Each diagnostic method exhibited distinct sensitivity and specificity for the different subtypes of joint dysfunction. CONCLUSION Selecting an evaluation examination based on its accuracy, safety, and clinical relevance is a rational decision that can help lead to an accurate diagnosis and an optimum treatment plan.

Ear Acupuncture Therapy for Masticatory Myofascial and Temporomandibular Pain: A Controlled Clinical Trial

Ear acupuncture works by reducing painful sensations with analgesic effect through microsystem therapy and has been demonstrated to be as effective as conventional therapies in the control of facial pain. This clinical trial aimed to evaluate the adjuvant action of auricular acupuncture through an observation of the evolution of temporomandibular and masticatory myofascial symptoms in two groups defined by the therapies elected: auricular acupuncture associated with occlusal splint (study) and the use of the occlusal splint plate alone (control). We have selected 20 patients, who were randomly allocated into two groups of ten individuals. Symptoms were evaluated in five different moments, every seven days. We analyzed the orofacial muscle and joint palpation in order to measure the intensity of the experienced pain. Both groups showed a statistically significant decrease in muscle and joint symptoms (p < 0.05). However, comparisons between the groups showed an expressive and significant reduction of symptomatology in the study group (p < 0.05) already on the first week of therapy. According to the results, to the methodological criteria developed and statistical analysis applied, the conclusion is that auricular acupuncture therapy has synergistic action on conventional occlusal splint treatment. It was demonstrated to be effective in the reduction of symptoms in the short term.

Magnetic Resonance Image Evaluation of Temporomandibular Joint Osteophytes: Influence of Clinical Factors and Artrogenics Changes.

AbstractThis research aims to examine the presence of osteophyte in patients with arthrogenic temporomandibular disorders through magnetic resonance imaging (MRI); to investigate the influence of sex and clinical symptoms in its prevalence; and the position of the osteophytes in the condyle. The study was based on 100 MRI and on reports of patients, which corresponded to the evaluation of 200 joints. Patients of both sexes were aged from 18 to 82 years (average = 49.48) and were subjected to the aforementioned examination from January 2006 to March 2009. The assessment considered the type of disc displacement, the presence of effusion, bone marrow edema, condyle changes, joint noise and pain. The MRI machine used was the GE Signa HDX (General Electric, Milwaukee, WI), with T1 and T2-weighted, 1.5 T magnetic field, sagittal oblique (mouth closed, mouth open) and coronal (mouth closed) imaging, with spherical surface coil and an asymmetric matrix. All images were interpreted by an experienced radiologist. A total of 28% (n = 56) of the temporomandibular joints showed osteophytes on the anterior surface of the mandible. No relationship was found between sex and osteophytes. The authors found a statistically significant difference between osteophytes and disc displacement without reduction (P < 0.001). The presence of osteophytes suggested a possible cause and effect relationship between osteoarthritis and disc displacement without reduction; the osteophyte was always located in the anterior surface of condyle, regardless of the sex variable; no significant difference was found between osteophytes and the main complaints of the patient.

Surgical treatment of projectile in the infratemporal fossa. Case report

BACKGROUND AND OBJECTIVES: Gunshot wounds may have fatal results. Even when not causing major injuries to soft and hard tissues, there may be other severe problems. This study aimed at reporting the case of a projectile located in the left infratemporal fossa and at discussing treatment, risks and complications. CASE REPORT: Male patient, 18 years old, suffered a gunshot wound which has penetrated the face by the left zygomatic region, and was lodged in the homolateral infratemporal fossa. This has caused jaw function impairment and pain. Foreign body was surgically removed by preauricular access and patient was then submitted to physiotherapy. After treatment, temporomandibular joint function was reestablished and esthetic results were considered excellent without sequelae. CONCLUSION: Management of patients hit by projectiles is more complex when these are located in an area of difficult access and close to noble structures. Radiographic techniques obtained by means of different planes allow the accurate location of the object. There may be major deformity and functional incapacity, especially if the facial nerve is affected during bullet trauma or during surgery. Although there were no nervous injuries, functional impairment of orofacial structures was decisive to indicate the surgical procedure. Surgical removal of the projectile from the infratemporal fossa, combined with postoperative physiotherapy, has shown to be an effective treatment.

A Rare Case of Surgical Treatment of Projectile in the Infratemporal Fossa

Grossmann Eduardo1*, Bruno Primo2, Luciano Ambrosio Ferreira3 and Antônio Carlos Pires Carvalho4 1Craniofacial Pain Applied to Dentistry Discipline, Federal University of Rio Grande do Sul and Pain and Orofacial Deformity Center, CENDDOR, Porto Alegre, Brazil 2Department of Oral and Maxillofacial Surgery, School of Dentistry, ULBRA, Canoas, RS, Brazil 3Maternity Hospital Therezinha Jesus-HMTJ/JF and Supreme-Faculty Medical and Health Sciences. Juiz de Fora, MG, Brazil 4Department of Radiology, Postgraduate Program in Medicine, Federal University of Rio de Janeiro

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.

Indication Criteria of Imaging Exams for Diagnosing of Temporomandibular Joint Disorders

The various subtypes of temporomandibular disorders and different imaging exams available for diagnosis and indication influence the choice of the most appropriate examination front of clinical symptoms of the patient. This review aims to provide an indication of imaging tests for the diagnosis of pathological changes of the temporomandibular joint, discussing its accuracy and criteria for the prescription. The indication is considered appropriate when based on safety and clinical relevance of the examination requested. This sets the correct diagnosis and influences on the most appropriate treatment plan. We proposed that each of the imaging tests has its own sensitivity and specificity to subtypes and different manifestations of temporomandibular joint disorders.