Melissa de Oliveira Melchior

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.

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.

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.

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.

Treatment for TMD with Occlusal Splint and Electromyographic Control: Application of the FARC Protocol in a Brazilian Population

Abstract The purpose of this study was to apply Functional Anatomy Research Center (FARC) Protocol of TMD treatment, which includes the use of a specific type of mandibular occlusal splint, adjusted based on the electromyographic index, in a group of 15 patients with disc displacement, classified according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and then analyzing the results compared with the control group. The clinical evaluations were completed both before and after the treatment. Electromyographic (EMG) data was collected and recorded on the day the splint was inserted (visit 1), after one week (visit 2) and after five weeks of treatment (visit 3). The control group consisted of 15 asymptomatic subjects, according to the same diagnostic criteria (RDC/TMD), who were submitted to the same evaluations with the same interval periods as the treatment group. Immediately after splint adjustment, masseter muscle symmetry and total muscular activity were significantly different with than without the splint (p<0.05), showing an increased neuromuscular coordination. After treatment, significant variations (p<0.05) were found in mouth opening and in pain remission. There were no significant differences among the three sessions, either with or without the splint. There were significant differences between the TMD and control groups for all analyzed indices of muscular symmetry, activity and torque, with the exception of total muscular activity. The use of the splint promoted balance of the EMG activities during its use, relieving symptoms. EMG parameters identified neuromuscular imbalance, and allowed an objective analysis of different phases of TMD treatment, differentiating individuals with TMD from the asymptomatic subjects.

Electromyographic Evaluation of Neuromuscular Coordination of Subject After Orthodontic Intervention

Abstract The aim of this work was to investigate the neuromuscular changes associated with the orthodontic post-treatment using surface electromyography. One hundred (100) young, healthy adults without signs and symptoms of temporomandibular dysfunction (TMD) were divided into two groups: 60 subjects who were undergoing orthodontic intervention (Ortho Group) and 40 subjects who had no orthodontic intervention (Control Group), aged 18-25 years. EMG activity of masseter and temporalis anterior muscle was recorded during two different tests: 1. maximum voluntary clench (MVC) with cotton rolls; and 2. MVC in intercuspal position. In all subjects, both tests were performed with symmetric muscular patterns (more than 85%) and with insignificant latero-deviating of the mandible (lower than 10%). There are no statistically significant differences between the subjects of both groups evaluated. Both groups showed medium index values calculated according to the normal standards established previously.

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.

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.

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.

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.