Paulo Afonso Cunali

Prevalence of sleep bruxism in children: A systematic review

INTRODUCTION: Prevalence of sleep bruxism (SB) in children is subject to discussions in the literature. OBJECTIVE: This study is a systematic literature review aiming to critically assess the prevalence of SB in children. METHODS: Survey using the following research databases: MEDLINE, Cochrane, EMBASE, PubMed, Lilacs and BBO, from January 2000 to February 2013, focusing on studies specifically assessing the prevalence of SB in children. RESULTS: After applying the inclusion criteria, four studies were retrieved. Among the selected articles, the prevalence rates of SB ranged from 5.9% to 49.6%, and these variations showed possible associations with the diagnostic criteria used for SB. CONCLUSION: There is a small number of studies with the primary objective of assessing SB in children. Additionally, there was a wide variation in the prevalence of SB in children. Thus, further, evidence-based studies with standardized and validated diagnostic criteria are necessary to assess the prevalence of SB in children more accurately.

Intra-articular injections with corticosteroids and sodium hyaluronate for treating temporomandibular joint disorders: a systematic review

INTRODUCTION In some cases, conservative treatment of internal derangements of the Temporomandibular Joint (TMJ) is considered little responsive. Thus, it is necessary to accomplish treatments that aim at reducing pain and improve function in patients who present arthrogenic temporomandibular disorders. OBJECTIVE This study, by means of a systematic review of the literature, aimed to analyze the effectiveness of intra-articular injections with corticosteroids and sodium hyaluronate for treating internal derangements of the TMJ. METHODS Carry out a research in the following databases: MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs, and BBO, considering publications issued between 1966 and October 2010, focusing on randomized or quasi-randomized controlled clinical trials, single or double-blind. RESULTS After applying the inclusion criteria we collected 9 articles, 7 of which were randomized controlled double-blind clinical trials and 2 randomized controlled single-blind clinical trials. CONCLUSION After analyzing the literature, it was found that intra-articular injection with corticosteroids and sodium hyaluronate seems to be an effective method for treating internal derangements of the TMJ. However, further randomized controlled clinical trials, with representative samples and longer follow-up time must be carried out in order to assess the real effectiveness of this technique.

Professional karate-do and mixed martial arts fighters present with a high prevalence of temporomandibular disorders

BACKGROUND/AIM Facial trauma in sports has been associated with temporomandibular disorders. Because of the intensity and duration of training needed for elite-level competitions, high-performance athletes can have two to five times more traumatic injuries than recreational athletes. This study aimed to investigate the prevalence of temporomandibular disorders in high-performance martial arts fighters and compare it with the prevalence in recreational athletes and non-athletes. MATERIAL AND METHODS The Research Diagnostic Criteria for Temporomandibular Disorders was used to diagnose and classify professional karate-do practitioners (group I; n = 24), amateur karate-do practitioners (group II; n = 17), high-performance mixed martial arts fighters (group III; n = 13), and non-athletes (n = 28). The groups were compared with the chi-square test and tested for the difference between two proportions using a significance level of 5% (P < 0.05). RESULTS The prevalence of temporomandibular disorders in groups I (54.2%; P = 0.003) and III (61.5%; P = 0.002) was significantly higher than in group IV (14.3%). The prevalence in group II was similar to that in group IV (P > 0.05). A diagnosis of arthralgia from disk displacement was made more frequently in groups I (45.8%; P = 0.013) and III (38.5%; P = 0.012) than in group IV (7.1%). The chronic pain associated with TMD was low intensity and low disability. CONCLUSIONS While there was a high prevalence of temporomandibular disorders in the professional athletes in our study, the prevalence of the condition in recreational athletes was similar to that in individuals who did not practice martial arts.

Total temporomandibular joint alloplastic reconstruction

BACKGROUND AND OBJECTIVES:Temporomandibular disorders are made up of a variety of diseases involving masticatory muscles, temporomandibular joint or both. With clinical treatment, most patients improve function and pain, however when this therapy has unfavorable results, surgical treatment should be considered. Total joint reconstruction with joint prosthesis is a type of surgical procedure. This study aimed at evaluating current status of temporomandibular joint reconstructions with total prostheses.CONTENTS:A review was carried out by crossing selected descriptors in the last 25 years about prosthetic reconstruction of joint structures of the temporomandibular joint.CONCLUSION:The scarcity of highly relevant scientific studies on temporomandibular joint reconstruction with prosthesis makes impossible a systematic review, leading the procedure to be still seen and indicated with caution.

Eletromiografia de superfície em disfunção temporomandibular: revisão sistemática

JUSTIFICATIVA E OBJETIVOS: A eletromiografia de superficie (ES) permite uma avaliacao nao invasiva do fenomeno bioeletrico durante o estado de repouso do musculo avaliado bem como a comparacao com sua atividade durante a contracao muscular. O objetivo deste estudo foi avaliar a efetividade do uso de ES em pacientes diagnosticados com disfuncao temporomandibular segundo os criterios Research Diagnostic Criteria for Temporomandiublar Disorders (RDC/TMD) eixo I. CONTEUDO: A revisao de literatura foi realizada a partir das bases de dados LILACS, Medline e Scielo, cobrindo o periodo de janeiro de 1987 a fevereiro de 2012. Ensaios clinicos randomizados e controlados, ensaios clinicos e testes clinicos que avaliaram ES, sinais e sintomas de desordens temporomandibulares (DTM) diagnosticados pelo criterio RDC/TMD foram incluidos. A estrategia de busca resultou em 182 artigos, dos quais oito preencheram os criterios de inclusao, sendo que um caracterizava um estudo clinico randomizado e sete eram estudos longitudinais sem criterios de randomizacao. Em todos os estudos, o metodo utilizado para detectar e analisar a atividade eletrica dos musculos da mastigacao (corpo do masseter e feixe anterior do temporal) foi a ES, sendo empregada com certa facilidade e seguindo os padroes para o exame. No entanto, foram utilizados diferentes modelos experimentais e selecao das amostras, causando dificuldades na comparacao dos resultados. CONCLUSAO: Dentro das limitacoes deste estudo, foi possivel constatar que embora a ES em DTM nao deva ser utilizada para diagnostico, ela pode auxiliar no acompanhamento da evolucao dos tratamentos de DTM.

Use of chondroitin sulphate and glucosamine sulphate in degenerative changes in TMJ: a systematic review

Introduction: Degenerative changes in Temporomandibular Joint (TMJ) have increased in prevalence and severity over the years. Within this context, it’s necessary to obtain safe and effective therapies for control and management of the patient in cases of osteoarthritis and osteoarthrosis of the TMJ. Therapeutic options range from intra-articular infiltration protocols, occlusal splints, pharmacological therapies and physiotherapy and educational measures. The alternative treatment with structure-modifying agents, like as chondroitin and glucosamine sulphates, showed promising results, and especially safety. Thus, through a systematic literature review, this study aimed to analyze and discuss effectiveness and safety of chondroitin and glucosamine in degenerative changes of the TMJ.

Imaginologia da articulação temporomandibular durante o tratamento ortodôntico: uma revisão sistemática

INTRODUCTION: The evolution of imaging in dentistry has provided several advantages for the diagnosis and development of treatment plans in various dental specialties. Examinations as nuclear magnetic resonance, computed tomography and Cone Beam volumetric tomography, as well as 3D reconstruction methods, have enabled a precise analysis of orofacial structures. Allied to this fact, the effects of orthodontic treatment on temporomandibular joint (TMJ) could be evaluated with the accomplishment of clinical studies with appropriate designs and methodologies. OBJECTIVE: This study, a systematic literature review, had the objective of analyzing the interrelation between orthodontic treatment and TMJ, verifying if orthodontic treatment causes changes in the internal structures of TMJ. METHODS: Survey in research bases MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs and BBO, between the years of 1966 and 2009, with focus in randomized clinical trials, longitudinal prospective nonrandomized studies, systematic reviews and metaanalysis. RESULTS: After application of the inclusion criteria 14 articles were selected, 2 were randomized clinical trials and 12 longitudinal nonrandomized studies. CONCLUSIONS: According to the literature analysis, the data concludes that orthodontic treatment does not occur at the expense of unphysiological disc-condyle position. Some orthodontic mechanics may cause remodeling of articular bone components.

Ortodontia como fator de risco para disfunções temporomandibulares: uma revisão sistemática

INTRODUCTION: The interrelationship between Orthodontics and temporomandibular disorders (TMD) has attracted an increasing interest in Dentistry in the last years, becoming subject of discussion and controversy. In a recent past, occlusion was considered the main etiological factor of TMD and orthodontic treatment a primary therapeutical measure for a physiological reestablishment of the stomatognathic system. Thus, the role of Orthodontics in the prevention, development and treatment of TMD started to be investigated. With the accomplishment of scientific studies with more rigorous and precise methodology, the relationship between orthodontic treatment and TMD could be evaluated and questioned in a context based on scientific evidences. OBJECTIVES: This study, through a systematic literature review had the purpose of analyzing the interrelationship between Orthodontics and TMD, verifying if the orthodontic treatment is a contributing factor for TMD development. METHODS: It was conducted a survey in research bases (MED-LINE, Cochrane, EMBASE, Pubmed, Lilacs and BBO) between the years of 1966 and 2009, with focus in randomized clinical trials, longitudinal prospective non-randomized studies, systematic reviews and meta-analysis. RESULTS: After application of the inclusion criteria 18 articles were used, which were 12 longitudinal prospective non-randomized studies, 4 systematic reviews, 1 randomized clinical trial and 1 meta-analysis, which evaluated the relationship between orthodontic treatment and TMD. CONCLUSIONS: According to the literature, the data concludes that orthodontic treatment cannot be considered a contributing factor for the development of temporomandibular disorders.

Botulinum toxin for treating muscular temporomandibular disorders: a systematic review

OBJECTIVE: This study, through a systematic literature review, aims to analyze the effectiveness of Botulinum Toxin as a treatment for masticatory myofascial pain and muscles temporomandibular disorders (TMD). METHODS: Survey in research bases: MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs and BBO, between the years of 1966 and April 2011, with focus in randomized or quasi-randomized controlled clinical trials, blind or double-blind. RESULTS: After applying the inclusion criteria, 4 articles comprised the final sample: 3 were double-blind randomized controlled clinical trials and 1 was single-blind randomized controlled clinical trial. CONCLUSIONS: According to the literature, there is lack of evidence about the real effectiveness of botulinum toxin in the treatment of masticatory myofascial pain and muscular TMD. Thus, further randomized controlled clinical trials, with representative samples and longer follow-up time, to assess the real effectiveness of the technique are needed.

Mandibular Exercises For The Prevention Of Temporomandibular Disorder During Mandibular Advancement Device Therapy In Obstructive Sleep Apnea Patients: A Randomized Controlled Trial

Objective: This study aimed to evaluate the efficacy of mandibular exercises for the prevention of temporomandibular disorder (TMD) during Obstructive Sleep Apnea (OSA) treatment with mandibular advancement device (MAD) in patients without TMD symptoms.Material and methods: Nineteen subjects with mild to moderate OSA were included. Patients were randomized into two groups: a control group and a support therapy group. Both groups received the MAD at 75% of their maximum protrusion. The support therapy group was instructed to perform mandibular exercises two times per day. Pain was assessed by an analogical pain scale during progressive protrusion at the 4th, 12th and 16th week. The Research Diagnostic Criteria for Temporomandibular disorders (RDC-TMD) were applied at the initial evaluation and at 16th week. Student’s t-test, paired t-test, ANOVA, Friedman’s ANOVA and chi-square were performed for statistics analyses.Results: A total of 19 subjects, 10 in the support therapy group and 9 in the control group completed the protocol. According to the analogical pain scale and the RDC-TMD, none of the patients from either group experienced temporomandibular pain.Conclusion: Both groups did not develop TMD symptoms, mandible exercise as support therapy did not influence the prevention of TMD.