Rodrigo Lorenzi Poluha

Single-Needle Arthrocentesis with Upper Compartment Distension versus Conventional Two-Needle Arthrocentesis: Randomized Clinical Trial

The objective of this study was to compare single-needle arthrocentesis with distension of the upper compartment of the temporomandibular joint (TMJ) with the conventional two-needle arthrocentesis. Twenty-six patients with articular disc displacement without reduction (DDWOR) were included in the study and assigned to two groups (n = 13): single-needle arthrocentesis with distension of the upper compartment of the TMJ (1N) and conventional two-needle arthrocentesis (2N). The maximum interincisal distance (MID) and TMJ pain as measured by the visual analog scale (VAS) were compared. MID and VAS data were obtained: before (T1), seven days after (T2), fifteen days after (T3), one month after (T4), three months after (T5), six months after (T6), nine months after (T7), and one year after the arthrocentesis procedures (T8). Considering each group individually, results of the VAS scores and MID measurements showed a significant difference between T1 and T2–T8 (p < 0.001) in both groups. Between two groups, results show no significant differences (p > 0.05). Both techniques tested were effective in reducing pain and increasing MID. Due to the advantages over the conventional two-needle arthrocentesis, single-needle arthrocentesis with distension of the upper compartment should be considered as the first treatment option for patients with painful hypomobilized TMJ of DDWOR.

Inflammatory mediators related to arthrogenic temporomandibular dysfunctions

BACKGROUND AND OBJECTIVES: Inflammatory disorders of the temporomandibular joint present a high prevalence in the population. The knowledge about inflammatory mediators, such as histamine, serotonin, kinins, eicosanoids, platelet-activating factor, nitric oxide, tumor necrosis factor and interleukins, may contribute to a better understanding of these disorders. The objective of this study was to review the literature on the major inflammatory mediators involved in temporomandibular arthralgia. CONTENTS: A search was made in the LILACS, Pubmed/ Medline, Scielo and Science direct databases, crossing the following descriptors in the English and Portuguese language: inflammation, temporomandibular joint, inflammatory mediators, inflammation, temporomandibular joint and inflammatory mediators. Articles of literature review, systematic review, meta-analysis and randomized clinical trials, as well as books with compatible themes, published between September 1990 and June 2017 were included. Clinical reports, open label studies, animal model studies, were excluded. CONCLUSION: The knowledge of the inflammatory process, with the different mediators and mechanisms, can contribute to a better understanding, allowing the selection of the best therapy to be used clinically in cases of arthrogenic temporomandibular joint disorders.

Predictors of ARTHROCENTESIS outcome on JOINT effusion in PATIENTS with DISC displacement without REDUCTION

OBJECTIVES The aim of this study was to investigate the preoperative variables in patients with articular disk displacement without reduction that may influence the results of arthrocentesis on joint effusion (JE). STUDY DESIGN The records of 203 patients with clinical signs and symptoms of unilateral painful disk displacement without reduction and JE, confirmed by magnetic resonance imaging (MRI), and treated with arthrocentesis were selected. The following preoperative data were recorded: sex; age; joint side; pain duration; pain intensity, measurement with the visual analogue scale; and maximum interincisal distance (MID). All patients underwent a second MRI examination 3 to 4 months postoperatively to assess JE. The sample was then divided into 2 groups: group 1 (n = 160) comprised patients with no signs of JE; and group 2 (n = 43) comprised patients still showing signs of JE. Univariate and multivariate analyses were used to compare the groups. RESULTS Among the studied variables, pain duration (P = .0175), pain intensity (P < .0001), and MID (P = .0085) were shown to affect arthrocentesis outcomes. The longer the pain duration (odds ratio [OR] = 0.930), the more intense was the pain (OR = 0.346), and the smaller the MID (OR = 0.562), the less were the chances of arthrocentesis completely eliminating JE. CONCLUSIONS Pain duration, pain intensity, and MID can be used as predictors for the effect of arthrocentesis on JE outcomes and considered during treatment planning.

Myofascial trigger points in patients with temporomandibular joint disc displacement with reduction: a cross-sectional study

Abstract Objective The objective of this retrospective study was to evaluate the impact of myofascial trigger points (MTrPs) in patients with articular disc displacement with reduction (DDWR) and to identify which clinical variables are associated with the concomitant presence of DDWR and MTrPs. Material and Methods 130 patients were selected that sought treatment due to joint pain, with ages ≥18 years, of both genders, with DDWR confirmed by magnetic resonance imaging. The sample was divided into two groups: Group 1, patients with DDWR and MTrPs (N=101); and Group 2, patients with DDWR and no MTrPs (N=29). Information on gender, age, pain duration, pain scores, and maximal interincisal distance (MID) were collected. The logistic regression model was used and the odds ratios (OR) was calculated (p<0.05). Results Group 1 presented statistically significant higher mean pain scores (p=0.007), and smaller MID (p=0.0268) than Group 2. OR were significant for the pain scores (1.429), MID (0.937) and gender (women) (2.810). Conclusions Patients with DDWR and MTrPs had increased pain scores and a MID decrease compared to patients with DDWR and no MTrPs. The variables pain scores, MID, and gender (women) showed a significant association with the concomitant presence of DDWR and MTrPs.

Evaluation of effusion and articular disc positioning after two different arthrocentesis techniques in patients with temporomandibular joint disc displacement without reduction

ABSTRACT Objective To evaluate joint effusion and positioning of the articular disc through magnetic resonance imaging (MRI) before and after two different arthrocentesis techniques. Methods Twenty-six patients with dislocation of the articular disc without reduction (ADDwoR) were included and randomly divided into two groups: single needle arthrocentesis with distention of the upper compartment of the TMJ (A1) and conventional arthrocentesis with 2 needles (A2). Results A statistically significant difference was observed between the different effusion categories (p = 0.009). No differences were found comparing both treatment modalities concerning the position of the mandibular condyle and the articular disc. Conclusion Conventional arthrocentesis was able to change the effusion variable, whereas the single needle arthrocentesis was not. Both techniques were responsible for altering the position of the mandibular head or the disc-head complex, projecting them to a more anterior position related to the increase in the final maximum interincisal distance.

Does pregabalin improve sleep disorders in fibromyalgia

BACKGROUND AND OBJECTIVES: Fibromyalgia is a chronic generalized pain syndrome accompanied by somatic symptoms, mainly represented by sleep disorders. Pregabalin is the main agent among pharmacological treatments. CONTENTS: An electronic search was performed in the databases Lilacs, Pubmed/Medline, Scielo and ScienceDirect. The keywords used in English and Portuguese were “fibromyalgia”; “sleep disorder”, “treatment”; “pregabalin”; “medicine”; “fibromialgia”; “distúrbios do sono”, “tratamento”; “pregabalina”; “fármacos”. Only articles of literature review, systematic review, meta-analysis and randomized clinical studies published between October 1992 and May 2018 were included. CONCLUSION: Pregabalin is efficient and safe in the management of sleep disorders in patients with fibromyalgia because it reduces the number of awakenings and increases sleep duration.

Indexes of anxiety, depression and disability in patients with myofascial pain, with and without the additional diagnosis of migraine

BACKGROUND AND OBJECTIVES: The aim of this study was to compare anxiety, depression and disability indexes in patients with myofascial pain with and without additional diagnosis of migraine. METHODS: We included 203 patients of the Orofacial Pain Clinic of the University of California, Los Angeles, USA. Patients were over 18 years of age, both genders, with a primary diagnosis of myofascial pain. The patients were also evaluated for the presence of migraine according to the criteria of the International Headache Society. The sample was divided into two groups: 120 patients with only myofascial pain (Group 1) and 83 patients with myofascial pain and with an additional diagnosis of migraine (Group 2). The Beck Anxiety Inventory, Beck Depression Inventory and Migraine Disability Assessment questionnaires were applied. The Mann-Whitney test was used to compare the groups at a significance level of 5%. RESULTS: Patients in group 1 presented significantly higher indexes in the Beck Anxiety Inventory (p=0.005), Beck Depression Inventory (p=0.025) and number of days lost and/or impaired (56.4 days) than those in group 2. The Migraine Disability Assessment Questionnaire scores for groups 1 and 2 were, respectively, 48% and 24.1% for grade I; 9.2% and 3.6% for grade II; 8.2% and 22.9% for grade III; and, 34.7% and 49.4% for grade IV. CONCLUSION: Patients with myofascial pain and migraine had significantly higher anxiety, depression and disability inIndexes of anxiety, depression and disability in patients with myofascial pain, with and without the additional diagnosis of migraine

Avaliação nutricional de refeições e análise de estrutura física em restaurante popular de Sorocaba-SP

O presente trabalho objetiva avaliar o valor nutricional de macro e micronutrientes, servidos durante almoco em um restaurante popular de Sorocaba-SP e analisar a estrutura fisica do estabelecimento. A coleta de dados foi realizada atraves de pesagem dos alimentos durante o almoco, seguindo como referencia os valores da Dietary Reference Intakes e para a analise da estrutura utilizou-se o check-list da Agencia Nacional de Vigilância Sanitaria. Para obtencao dos resultados utilizou-se o software DietWin® e o software SPSS versao 18.0. Obtiveram-se valores superiores a recomendacao para: consumo energetico (1.354,80±158,79 kcal); carboidratos (217,82±21,23g); fibra alimentar (25,17±11,14g); proteinas (54,89±13,84g); vitamina C (124,66±51,86mg); ferro (9,50±4,44mg) e sodio (1.870,76±757,75mg). Houve valores inadequados e inferiores para: lipideos (29,32±5,18g); vitamina A (134,85±69,39 mcg) e calcio (213,06±118,12mg). Com diferencas estatisticamente significativas (p<0,05) para fibras, vitamina A, vitamina C, ferro e calcio. Quanto a estrutura fisica, 96,8% dos itens encontravam-se em conformidade. Observou-se inadequacao nos nutrientes. Sao fundamentais a adequacao e o balanceamento da comida, principalmente em um restaurante popular devido ao grande numero de refeicoes servidas e pessoas atendidas diariamente. Descritores: Avaliacao Nutricional; Macronutrientes; Micronutrientes.

Influência ambiental do chumbo usado em radiografias odontológicas

Lead foil it’s a component of intra oral x-ray film, and, although the advent of digital radiographic exams, is an artifact that still remain in the reality of brazilian dental offices. This review aimed to raise awareness the professional about effects from such component, both for those who use it also for the environment Descriptors: Radiography, Dental; Lead; Toxicity.