Taís de Souza Barbosa

Temporomandibular disorders and bruxism in childhood and adolescence: Review of the literature

OBJECTIVE The aim of this article was to review the literature about temporomandibular disorders and bruxism and their relationships in children and adolescents. METHODS The literature was searched using Medline, ISI, Cochrane Library, Scielo and the Internet, from March 1970 to the end of June 2007. The inclusion criteria were: they evaluated a possible association between TMD and bruxism, and they dealt with child and/or adolescent samples. Furthermore, interim reports, related Internet sites and chapters in textbooks were considered. From 64 records found, 30 fulfilled the inclusion criteria. RESULTS The prevalence of temporomandibular disorders in children and adolescent varies widely in the literature. Temporomandibular disorders are often defined on the basis of signs and symptoms, of which the most common are: temporomandibular joint sounds, impaired movement of the mandible, limitation in mouth opening, preauricular pain, facial pain, headaches and jaw tenderness on function, having mainly a mild character, fluctuation and progression to severe pain and dysfunction is rare. One of the possible causal factors suggested that temporomandibular disorders in children is a functional mandibular overload variable, mainly bruxism. Bruxism, defined as the habitual nonfunctional forceful contact between occlusal tooth surfaces, is involuntary, excessive grinding, clenching or rubbing of teeth during nonfunctional movements of the masticatory system. Its etiology is still controversial but the multifactorial cause has been attributed, including pathophysiologic, psychologic and morphologic factors. Moreover, in younger children, bruxism may be a consequence of the masticatory neuromuscular system immaturity. Complications include dental attrition, headaches, temporomandibular disorders and masticatory muscle soreness. Some studies have linked oral parafunctional habits to disturbances and diseases of the temporomandibular joint, mainly bruxism, suggesting its association with temporomandibular disorders in the primary and mixed dentition, whereas other authors did not observed respective relationship in primary dentition. The unreliability for the clinical assessment of bruxism also reduces confidence in conclusions about the relationship with temporomandibular disorders. CONCLUSIONS Taken all evidence together, the relationship between bruxism and temporomandibular disorders, if it exists, seems to be controversial and unclear.

Validity and reliability of the Child Perceptions Questionnaires applied in Brazilian children

BackgroundThe Child Perceptions Questionnaires (CPQ8–10 and CPQ11–14) are indicators of child oral health-related quality of life. The aim of this study was to assess the validity and reliability of the self-applied CPQ8–10 and CPQ11–14 in Brazilian children, after translations and cultural adaptations in the Brazilian Portuguese language.MethodsSchoolchildren were recruited from general populations for pre-testing (n = 80), validity (n = 210), and test-retest reliability (n = 50) studies. They were also examined for dental caries, gingivitis, fluorosis, and malocclusion.ResultsChildren with greater dental caries experience in primary dentition had higher impacts on CPQ domains. Girls had higher scores for CPQ8–10 domains than boys. Mean CPQ11–14 scores were highest for 11-year-old children and lowest for 14-year-old children. Construct validity was supported by significant associations between the CPQ8–10 and CPQ11–14 scores and the global rating of oral health (r = 0.38, r = 0.43) and overall well-being (r = 0.39, r = 0.60), respectively. The Cronbachs alpha was 0.95 for both questionnaires. The test-retest reliabilities of the overall CPQ8–10 and CPQ11–14 scores were both excellent (ICC = 0.96, ICC = 0.92).ConclusionThe Brazilian Portuguese version of CPQ8–10 and CPQ11–14 was valuable and reliable for use in the Brazilian child population, although discriminant validity was sporadic due to the fact that impacts are mediated by others factors, such personal, social, and environmental variables.

Evaluating oral health-related quality of life measure for children and preadolescents with temporomandibular disorder.

BackgroundOral health-related quality of life (OHRQoL) in children and adolescents with signs and symptoms of temporomandibular disorder (TMD) has not yet been measured. This study aimed to evaluate the validity and reliability of OHRQoL measure for use in children and preadolescents with signs and symptoms of TMD.MethodsFive hundred and forty-seven students aged 8-14 years were recruited from public schools in Piracicaba, Brazil. Self-perceptions of QoL were measured using the Brazilian Portuguese versions of Child Perceptions Questionnaires (CPQ)8-10 (n = 247) and CPQ11-14 (n = 300). A single examiner, trained and calibrated for diagnosis according to the Axis I of the Research Diagnostic Criteria for TMD (RDC/TMD), examined the participants. A self-report questionnaire assessed subjective symptoms of TMD. Intraexaminer reliability was assessed for the RDC/TMD clinical examinations using Cohens Kappa (κ) and intraclass correlation coefficient (ICC). Criterion validity was calculated using the Spearmans correlation, construct validity using the Spearmans correlation and the Mann-Whitney test, and the magnitude of the difference between groups using effect size (ES). Reliability was determined using Cronbachs alpha, alpha if the item was deleted and corrected item-total correlation.ResultsIntraexaminer reliability values ranged from regular (κ = 0.30) to excellent (κ = 0.96) for the categorical variables and from moderate (ICC = 0.49) to substantial (ICC = 0.74) for the continuous variables. Criterion validity was supported by significant associations between both CPQ scores and pain-related questions for the TMD groups. Mean CPQ8-10 scores were slightly higher for TMD children than control children (ES = 0.43). Preadolescents with TMD had moderately higher scores than the control ones (ES = 0.62; p < 0.0001). Significant correlation between the CPQ scores and global oral health, as well as overall well-being ratings (p < 0.001) occurred, supporting the construct validity. The Cronbachs alphas were 0.93 for CPQ8-10 and 0.94 for CPQ11-14. For the overall CPQ8-10 and CPQ11-14 scales, the corrected item-total correlation coefficients ranged from 0.39-0.76 and from 0.28-0.73, respectively. The alpha coefficients did not increase when any of the items were deleted in either CPQ samples.ConclusionsThe questionnaires are valid and reliable for use in children and preadolescents with signs and symptoms of temporomandibular disorder.

Assessment of thickness and function of masticatory and cervical muscles in adults with and without temporomandibular disorders

OBJECTIVE The aim of this study was to evaluate the maximal bite force (MBF), electromyographic (EMG) activity and thickness of the masseter, anterior part of the temporalis and sternocleidomastoid (SCM) muscles in a group of young adults with and without temporomandibular disorders (TMDs). DESIGN Nineteen individuals comprised the TMD group (6 males/13 females, aged 25.4±3.8 years), classified based on the Research Diagnostic Criteria for TMD (RDC/TMD), and 19 comprised the control group (6 males/13 females, aged 24.1±3.6 years). The MBF was determined with a transducer placed between the dental arches at the first molars level (N). The muscles were evaluated bilaterally at rest and during maximal voluntary clenching (MVC) by assessing EMG activity and performing ultrasonography (USG). The mean values of these measures for both sides of the mouth were used. The normality of the distributions was assessed by the Shapiro-Wilks test. Variables between groups and genders were compared using two-way factorial ANOVA test and correlated using the Spearman coefficient (α=0.05). Unpaired t test was used to compare variables between TMD subgroups. Logistic regression analysis was used to identify the variables associated with the presence of TMD. RESULTS MBF, EMG and USG data were similar among clinical groups and among TMD subgroups. The thickness of masseter and SCM muscles in the relaxed and clenching states were significantly higher in males than females. On the other hand, the EMG of the temporalis muscle in the rest state was significantly higher in females than males. Additionally, the MBF was positively correlated with the USG characteristics of masseter and SCM muscles, as well as with the EMG activity of masseter and temporalis muscles in the TMD group. In this group, there was also a positive correlation between the thickness of the masseter muscle and its activity. On the other hand, the thickness of the SCM muscle was negatively correlated with its activity. A lower MBF was independently associated with the presence of TMD. CONCLUSIONS Subjects with TMD exhibited similar values of MBF, thickness and electrical activity of masticatory and cervical muscles when compared with controls; positive correlations observed between these variables may suggest a muscular alteration in TMD patients and a co-activation of masticatory and cervical muscles during mandibular movement. This fact may also be confirmed by the negative association between bite forces and presence of TMD.

Oral infection by Diptera larvae in children: a case report

Background  Oral myiasis is usually caused by flies of the order Diptera. One of the causes of human myiasis is Cochliomyia hominivorax, which is a true obligate parasite of mammals.

Associations between oral health-related quality of life and emotional statuses in children and preadolescents.

OBJECTIVES To evaluate the associations between oral health-related quality of life (OHRQoL) and emotional statuses in children and preadolescents. METHODS One hundred and forty-five Brazilian students (8-14 years) were clinically examined for caries, gingivitis, fluorosis, malocclusions, and temporomandibular disorders (TMD). OHRQoL was measured using two global ratings of oral health (OH) and overall well-being (OWB). The Revised Childrens Manifest Anxiety Scale (R-CMAS) and Childrens Depression Inventory (CDI) were used to assess anxiety and depression, respectively. Saliva was collected 30 min after waking and at night to determine the diurnal decline in salivary cortisol (DDSC). The results were analyzed using non-paired t test/one-way ANOVA, Pearsons correlation test, and multiple linear regression analyses. RESULTS 11-14-year-old participants had higher CDI scores (P < 0.01) and DDSC concentrations (P < 0.001). Participants with fewer caries and without gingivitis had higher DDSC concentrations (P < 0.05). TMD patients had higher DDSC concentrations and OWB ratings (P < 0.001). Girls had higher Revised Childrens Manifest Anxiety Scale (RCMAS) scores (P < 0.01). There was positive correlation between RCMAS and CDI scores and OWB ratings (P < 0.05). The OH model retained age (β =0.312; P < 0.001) and the OWB model retained TMD (β = 0.271; P < 0.001) and CDI scores (β=0.175; P < 0.05). CONCLUSIONS Children and preadolescents with poor emotional well-being are more sensitive to the impacts of OH and its effects on OWB.

Relationship among oral habits, orofacial function and oral health-related quality of life in children

The objective was to evaluate the relationship among oral habits, oral function and oral health-related quality of life (OHRQoL) in children. Three hundred and twenty-eight subjects (8-14 years old) were assessed for orofacial function using the Brazilian version of the Nordic Orofacial Test-Screening (NOT-S). OHRQoL was assessed using the Child Perceptions Questionnaires (Brazilian versions) for the 8-10 (CPQ(8-10)) and 11-14 (CPQ(11-14)) year age groups. The subjects were distributed into a Habit group and a Habit-free group according to domain III (Habits) of the NOT-S. Oral habits were present in 71.3% of the sample (p = .0001), with a higher prevalence in females (62.8%, p = .001). The NOT-S, CPQ(8-10) and CPQ(11-14) scores were higher in the Habit group (P = .0001, P = .009 and p = .001, respectively). Domain I (Sensory Function) was significantly more affected in Habit group subjects (p = .001). The NOT-S scores were positively correlated with the CPQ(8-10) and CPQ(11-14) scores only in the Habit group (r = .32, p = .0003 and r = .30, p = .001, respectively). These results indicate that oral habits can impact OHRQoL. Moreover, orofacial dysfunctions were associated with worse OHRQoL in subjects with oral habits.

Evaluation of masticatory performance and bite force in children with sleep bruxism.

The aim of this study was to evaluate the association between masticatory performance (MP) and bite force (BF) in children with sleep bruxism (SB) during the mixed dentition stage, considering also the occlusal characteristics. The sample was composed by 52 healthy children of both genders, aged 6-10 years. From those, 22 presented signs and symptoms of SB and 30 were the controls. SB diagnosis consisted of both parental report and presence of tooth wear. MP was evaluated by the individuals ability to communicate an artificial chewable test material for determining the median particle size (X50) and distribution of particles in the different sieves (b). BF was measured using a digital gnathodynamometer with fork strength of 8 mm. The results were submitted to descriptive statistics, Mann-Whitney and chi-square tests, Spearmans correlation and multiple logistic regression. Mean BF and X50 did not differ between groups with and without SB. A significant negative correlation was observed between BF and X50 only in the group of children with SB. Moreover, the logistic regression model showed an association between the presence of SB and higher b index. The other independent variables included in the model showed no association with SB. BF did not differ between children with and without SB. Besides, higher BFs in children with SB meant better MP; however, they were more likely to present chewed particles retained in the larger aperture sieves, consequently requiring more chewing cycles to break down the test material in smaller particles.

Awakening salivary cortisol levels of children with sleep bruxism.

UNLABELLED The study of factors potentially associated with sleep bruxism (SB) may contribute to a better understanding of its nature and etiology. OBJECTIVES In this way, this cross-sectional study aimed to evaluate the association between SB and salivary cortisol levels, heart rate, and other parafunctional habits. DESIGN AND METHODS Data were collected in 100 healthy caries-free children of both genders, aged 7.23 ± 0.60 years, with (n=27) and without (n=73) signs and symptoms of SB by interview with the parents and clinical and physical examination. Salivary cortisol was measured immediately after waking up and 30min after awakening for the determination of the area under the response curve (AURC). Data were analyzed by descriptive statistics, normality test, and Spearman correlation test; a stepwise logistic regression model was used to verify the association between SB, as the dependent variable, and age, gender, body mass index (BMI), heart rate, presence of sucking habit, nail biting, enuresis, and AURC (α=0.05). RESULTS AURC did not correlate with BMI and heart rate. Only AURC showed a significant negative association with SB, while age, gender, BMI, heart rate and other parafunctional habits did not associate with SB. CONCLUSION In the studied sample, children with SB were more likely to present low concentrations of awakening salivary cortisol.

Qualidade de vida e saúde bucal em crianças - parte II: versão brasileira do Child Perceptions Questionnaire

O Child Perceptions Questionnaire (CPQ11-14) e um instrumento auto-aplicavel para avaliacao da qualidade de vida relacionada a saude bucal em criancas. O objetivo do estudo foi de traduzir e adaptar o questionario para seu uso no Brasil. O questionario foi traduzido do original em ingles ao portugues, utilizando o processo de traducao reversa (ingles/portugues/ingles), seguido de avaliacao pelo comite revisor e pela adaptacao cultural em um grupo de 20 criancas. As criancas de 11 a 14 anos nao compreenderam algumas questoes do questionario. Inicialmente, as questoes 4 e 11 apresentaram nivel de incompreensao superior a 15%. Foram feitas as adaptacoes necessarias e a terceira versao em portugues foi auto-aplicada em uma nova amostra de 20 criancas. Nesta etapa, somente a questao 40 foi incompreendida e modificada. Q quarta versao em portugues foi considerada adequada para mais de 95% das criancas avaliadas. A versao para o portugues do instrumento CPQ11-14 e um instrumento util para avaliacao da qualidade de vida relacionada a saude bucal em criancas brasileiras.