Marco Antonio Moreira Rodrigues da Silva

Otologic Symptoms of Temporomandibular Disorder and Effect of Orofacial Myofunctional Therapy

Abstract The aim of this study was to investigate the frequency of otologic symptoms and their relationship to orofacial signs and symptoms of temporomandibular disorder (TMD), and the effect of orofacial myofunctional therapy. The study was conducted on eight asymptomatic subjects (Group C) and 20 subjects with articular TMD, randomly distributed over two groups: one treated using orofacial myofunctional therapy (OMT Group) and a control group with TMD (Group CTMD). Patient selection was based upon the Research Diagnostic Criteria for TMD (RDC/TMD). All subjects submitted to a clinical examination with self-reporting of symptom severity, and to orofacial myofunctional and electromyographic evaluation at diagnosis and again, at the end of the study. Correlations were calculated using the Pearson test and inter- and intragroup comparisons were made (p<0.05). In the diagnosis phase, subjects with TMD reported earache (65%), tinnitus (60%), ear fullness (90%), and 25% of the asymptomatic subjects reported tinnitus. The otologic symptoms were correlated with tenderness to palpation of the temporomandibular muscles and joints and with orofacial symptoms. Only the OMT group showed a reduction of otologic and orofacial symptoms, of tenderness to palpation and of the asymmetric index between muscles. OMT may help with muscle coordination and a remission of TMD symptoms.

Low Level Laser Effects On Pain to Palpation and Electromyographic Activity in TMD Patients: A Double-Blind, Randomized, Placebo-Controlled Study

Abstract The purpose of this study was to evaluate the effect of diode laser (GaAlAs – 780 nm) on pain to palpation and electromyographic (EMG) activity of the masseter and anterior temporalis muscles. The laser was applied on the temporalis and masseter muscles twice a week (four weeks). Forty-eight (48) patients with myofascial pain were randomly assigned between actual and placebo treatments and between the energetic doses of 25 J/cm2 and 60 J/cm2, and were evaluated using VAS before, immediately after the final application, and 30 days after the laser treatment. Surface electromyography was performed with maximum dental clenching before and after laser therapy. The results show there were no significant statistical differences in the EMG activity between the groups before and after laser treatment. With regard to the pain at palpation, although both groups presented a significant difference in the symptoms before and after the treatment, only the active doses showed statistically significant reductions in pain level in all the regions of the palpated muscles. However, there was no significant statistical difference between groups (experimental and placebo). In conclusion, low level laser did not promote any changes in EMG activity. The treatment did, however, lessen the pain symptoms in the experimental groups.

Electromyographic indices, orofacial myofunctional status and temporomandibular disorders severity: A correlation study.

This study examined whether there is an association between surface electromyography (EMG) of masticatory muscles, orofacial myofunction status and temporomandibular disorder (TMD) severity scores. Forty-two women with TMD (mean 30 years, SD 8) and 18 healthy women (mean 26 years, SD 6) were examined. According to the Research Diagnostic Criteria for TMD (RDC/TMD), all patients had myogenous disorders plus disk displacements with reduction. Surface EMG of masseter and temporal muscles was performed during maximum teeth clenching either on cotton rolls or in intercuspal position. Standardized EMG indices were obtained. Validated protocols were used to determine the perception severity of TMD and to assess orofacial myofunctional status. TMD patients showed more asymmetry between right and left muscle pairs, and more unbalanced contractile activities of contralateral masseter and temporal muscles (p<0.05, t-test), worse orofacial myofunction status and higher TMD severity scores (p<0.05, Mann-Whitney test) than healthy subjects. Spearman coefficient revealed significant correlations between EMG indices, orofacial myofunctional status and TMD severity (p<0.05). In conclusion, these methods will provide useful information for TMD diagnosis and future therapeutic planning.

Desempenho mastigatório em adultos relacionado com a desordem temporomandibular e com a oclusão

BACKGROUND Temporomandibular disorder and mastication. AIM To compare subjects who present temporomandibular disorders to a control group considering mastication and to analyze the related variables. METHOD 20 subjects with temporomandibular disorder (TMD group) and 10 controls--selection based on clinical examination and anamnesis--responded to a questionnaire on the self-perception of pain severity and presence of noise in the temporomandibular joints, muscle pain, otologic symptoms, headaches, and jaw opening difficulties. The subjects were also submitted to a clinical examination regarding the number of teeth and functional occlusion--measurements of jaw opening and jaw lateral excursions, occlusal interferences, occlusal contacts of the working and non-working-side, and mastication evaluation. Mastication was evaluated in terms of time needed to eat a stuffed cookie, number of chewing strokes and type (unilateral or bilateral). The maximum force needed at first to break the cookie, verified with a TA-XT2 Texture Analyzer (Stable Micro Systems), was of 4341.8 g. The groups were compared using variance analysis and the correlations between variables were calculated using the Pearson product-moment test. RESULTS Most of the control subjects presented bilateral pattern of mastication, whereas the TMD group tended to present the unilateral pattern. Masticatory type scores and laterality measurements were significantly higher in the control group. The TMD group presented higher means in terms of: age, time of chewing, number of chewing strokes and TMD severity. Chewing time and type were positively correlated with TMD severity and negatively correlated with number of occlusal interferences. CONCLUSION In the TMD group, chewing differed from the normal physiological standard. The number of occlusal interferences and the severity of TMD were variables correlated to chewing.

Effects of Orofacial Myofunctional Therapy on Temporomandibular Disorders

Abstract The objectives of the current study were to analyze the effects of orofacial myofunctional therapy (OMT) on the treatment of subjects with associated articular and muscular temporomandibular disorders (TMD). Thirty subjects with associated articular and muscular TMD, according to the Research Diagnostic Criteria (RDC/TMD), were randomly divided into groups: 10 were treated with OMT (T group), 10 with an occlusal splint (OS group), and 10 untreated control group with TMD (SC). Ten subjects without TMD represented the asymptomatic group (AC). All subjects had a clinical examination and were interviewed to determine Helkimo’s Indexes (Di and Ai), the frequency and severity of signs and symptoms, and orofacial myofunctional evaluation. During the diagnostic phase, there were significant differences between groups T and AC. There were no significant differences between group T and OC and SC groups. During the final phase, groups T and OS presented significant improvement, however, the group T presented better results and differed significantly from group OS regarding the number of subjects classified as AiII; the severity of muscular pain and TMJ pain; the frequency of headache and the muscles and stomatognathic functions. The group T differed significantly from the SC group but no longer differed significantly from the AC group. OMT favored a significant reduction of pain sensitivity to palpation of all muscles studied but not for the TMJs; an increased measure of mandibular range of motion; reduced Helkimo’s Di and Ai scores; reduced frequency and severity of signs and symptoms; and increased scores for orofacial myofunctional conditions.

Desordem Temporomandibular: relações entre sintomas otológicos e orofaciais

Os sintomas otologicos sao frequentes em pacientes com desordem temporomandibular, e estudos sao necessarios para elucidar os mecanismos envolvidos. OBJETIVO: O objetivo desse estudo clinico foi investigar a associacao de sintomas otologicos (otalgia, zumbido e plenitude auricular) com os achados audiologicos, os outros sinais/sintomas relacionados a desordem temporomandibular, e os habitos parafuncionais orais. FORMA DE ESTUDO: Prospectivo clinico. MATERIAL E METODO: 27 pacientes com desordem temporomandibular, da Clinica de Oclusao da Faculdade de Odontologia de Ribeirao Preto da Universidade de Sao Paulo, responderam um questionario sobre sinais, sintomas e habitos orais, e passaram por avaliacoes otorrinolaringologica e audiologica. Os dados foram analisados pelos testes Binomial, Exato de Fisher e correlacao produto-momento de Pearson. O indice de significância adotado foi p<0,05. RESULTADOS: Os sintomas otologicos foram presentes em 88,88% dos pacientes (59,26% apresentavam otalgia, 74,07% zumbido e 74,07% plenitude auricular). Nao houve associacao significante entre os sintomas otologicos e os achados audiologicos. Houve associacao significante entre os sintomas otologicos e os movimentos mandibulares e funcoes (falar, abrir e fechar a boca). Houve tambem correlacoes significantes entre o grau de severidade dos sintomas otologicos e o grau de outros sinais/sintomas de desordem temporomandibular; e entre o sintoma plenitude auricular e numero de habitos parafuncionais. CONCLUSAO: Este estudo fornece sustentacao adicional a nocao de que ha relacao entre desordem temporomandibular e sintomas otologicos. Nos pacientes com desordem temporomandibular as alteracoes do sistema estomatognatico, como a dor orofacial e a dificuldade nas atividades funcionais, foi associada de modo significante aos sintomas otologicos.

Orofacial Myofunctional Disorder In Subjects with Temporomandibular Disorder

Abstract To determine the frequency and degree of orofacial myofunctional disorder (OMD) in a sample of patients with temporomandibular disorder (TMD), the dental records of 240 patients with a diagnosis of TMD were reviewed. Mean patient age and mean TMD duration, gender frequency, complaints, and signs and symptoms were calculated. The results showed that the sample studied was quite characteristic of a TMD group. The presence of the following signs/symptoms was significant: muscular pain, TMJ pain, joint noise, at least one otologic symptom, headache, and neck and shoulder pain. Most subjects presented some degree of OMD, with grade high prevailing over grade low. The importance of evaluating the stomatognathic structures and functions during the clinical examination of patients with TMD is emphasized.

Impaired orofacial motor functions on chronic temporomandibular disorders

Because temporomandibular disorders (TMDs) rehabilitation continues to be a challenge, a more comprehensive picture of the orofacial functions in patients with chronic pain is required. This study assessed the orofacial functions, including surface electromyography (EMG) of dynamic rhythmic activities, in patients with moderate-severe signs and symptoms of chronic TMD. It was hypothesized that orofacial motor control differs between patients with moderate-severe chronic TMD and healthy subjects. Seventy-six subjects (46 with TMD and 30 control) answered questionnaires of severity of TMD and chewing difficulties. Orofacial functions and EMG during chewing were assessed. Standardized EMG indices were obtained by quantitative analysis of the differential EMG signals of the paired masseter and temporal muscles, and used to describe muscular action during chewing. TMD patients showed significant greater difficulty in chewing; worse orofacial scores; longer time for free mastication; a less accurate recruitment of the muscles on the working and balancing sides, reduced symmetrical mastication index (SMI) and increased standardized activity during EMG test than healthy subjects. SMI, TMD severity and orofacial myofunctional scores were correlated (P<0.01). Impaired orofacial functions and increased activity of the muscles of balancing sides during unilateral chewing characterized the altered orofacial motor control in patients with moderate-severe chronic TMD. Implications for rehabilitation are discussed.

Clinical Validity of the Protocol for Multi-Professional Centers for the Determination of Signs and Symptoms of Temporomandibular Disorders. Part II

Abstract The aims of this study were to analyze the criterion and construct validity of Part II of the protocol for multi-professional centers for the determination of signs and symptoms of temporomandibular disorders (ProTMDMulti) as a measure of TMD severity. The study was conducted on eight asymptomatic subjects (CG) and 30 subjects with articular TMD (TMDG), according to the Research Diagnostic Criteria for TMD (RDC/TMD). The ProTMDMulti-Part II was validated using the Helkimo Clinical Dysfunction Index (Di). The construct validity was tested using the analysis of the ability of ProTMDMulti-part II to differentiate the CG from the TMDG and to measure the changes that occurred in the TMDG between the period before and after TMD treatment. Correlations between the Di and the ProTMDMulti-Part II scores were calculated using the Spearman test. Inter- and intragroup comparisons were made (p<0.05). There was a statistically significant correlation between the Helkimo Clinical Dysfunction Index (Di) and the severity scores of the ProTMDMulti-Part II. There was a significant difference between TMDG and CG regarding the severity of signs and symptoms. The present study provides statistical evidence of the clinical validity of the ProTMDmulti-Part II as a measure of the severity of TMD symptoms.

Immediate Effect of the Resilient Splint Evaluated Using Surface Electromyography in Patients with TMD

Abstract The aim of this study was to analyze the immediate effect of resilient splints through surface electromyography testing and to compare the findings with the electromyographic profiles of asymptomatic subjects. The participants were 30 subjects, 15 patients with TMD (TMD Group) and 15 healthy subjects (Control Group), classified according to Research Diagnostic Criteria (RDC/TMD) Axis I. A resilient occlusal splint was made for each patient in the TMD Group from two mm thick silicon to cover all teeth. The EMG examination was performed before and immediately after installing the splint. Three tests were performed as follows: 1. Maximum Voluntary Contraction (MVC) using cotton rolls (standards test); 2. MVC in maximal intercuspation position; and 3. MVC with the splint in position. The EMG signal was recorded for five seconds. EMG indices were calculated to assess muscle symmetry, jaw torque, and impact. There was a statistically significant difference when comparing the results among the study groups. The symmetry index values in the Control Group were higher than the TMD Initial Group and similar to the TMD Group after the installation of the splint. The index values of torque were higher in TMD Initial Group when compared with the Controls. Impact values were lower than normal values in the TMD Initial Group and restored upon installation of the splint. The resilient occlusal splints may be used as complementary or adjunctive treatment of temporomandibular disorders.