Thaís Cristina Chaves

Use of the Fonseca's questionnaire to assess the prevalence and severity of temporomandibular disorders in brazilian dental undergraduates

This study to assessed the prevalence of signs and symptoms of temporomandibular disorders (TMD) by means of the frequency distribution of data for 218 dentistry students from a Brazilian public university using the Fonsecas questionnaire. The group consisted of 96 men and 122 women, with an average age of 20 years. Of the students, 53.21% showed some level of TMD: 35.78% mild TMD 11.93% moderate and 5.5% severe. Women were the most affected group, with 63.11% showing some level of TMD, against 40.62% of men. When considering only severe TMD, women are approximately 9 times more affected than men. Students with any level of TMD showed marked characteristics: 76.72% considered themselves tense people; 71.55% reported to clench or grind their teeth; 65.52% reported clicking of the temporomandibular joint; 64.66% reported frequent headache and 61.21% neck pain. In conclusion, clinical signs and symptoms of TMD can occur in young population and this information is of great importance for the early diagnosis of the dysfunction.

Principais instrumentos para avaliação da disfunção temporomandibular, parte I: índices e questionários; uma contribuição para a prática clínica e de pesquisa

Na literatura especializada, encontram-se variados instrumentos para avaliacao da disfuncao temporomandibular (DTM), sob a forma de indices, questionarios, protocolos, escalas de avaliacao e criterios de diagnostico. Este estudo, dividido em duas partes, visou caracterizar os principais instrumentos de avaliacao da DTM disponiveis na literatura, para auxiliar o clinico e o pesquisador na correta escolha da ferramenta apropriada para contemplar seus objetivos clinicos ou cientificos. Nesta parte I sao apresentados dois indices clinicos e tres questionarios (anamnesicos e funcionais); na parte II, um questionario funcional e dois conjuntos de criterios diagnosticos. Os indices sao ferramentas que organizam a avaliacao de sinais e sintomas, pela obtencao de pontuacoes. Os questionarios sao melhor aplicados para tracar perfis populacionais em estudos epidemiologicos. Para avaliacao dos eventuais impactos da DTM nas atividades de vida diaria, os questionarios funcionais sao mais adequados. Finalmente, ha poucos conjuntos de criterios sistematizados para obter o diagnostico da disfuncao. A utilizacao de uma ou outra ferramenta depende de sua aplicabilidade e dos objetivos do profissional que a ira utilizar.

Anamnestic Index Severity and Signs and Symptoms of TMD

Abstract The aim of this study was to determine the frequency and to characterize the symptoms and clinical signs of temporomandibular disorders (TMD) related to each severity category of Fonseca’s anamnestic index in a sample of Brazilian young adults (mean age 21.61±1.91 years, 87% females and 13% males), by the application of an anamnestic index proposed by Fonseca (1992) and by clinical examination considering mandibular range of motion and tenderness to palpation of stomatognathic system structures. A significant number of participants were classified with mild TMD (43.2%) and moderate TMD (34.8%). Pain frequency during mastication, temporomandibular joint (TMJ) pain, and TMJ sounds were shown to be good predictors of TMD severity. Neck pain, headache, difficulty during mouth opening and lateral deviation, and tenderness to palpation of masticatory sites and during protrusion accompanied the TMD severity but failed to demonstrate differences between moderate and severe groups, showing a poor ability to determine TMD severity progression. This study suggests that not only the frequency of signs and symptoms of TMD should be determined, but also symptom severity and its relationship to the presence of clinical signs in order to discriminate patients with real treatment needs in nonpatient samples.

Cervical spine signs and symptoms: perpetuating rather than predisposing factors for temporomandibular disorders in women

Aim: The purpose of this study was to assess in a sample of female community cases the relationship between the increase of percentage of cervical signs and symptoms and the severity of temporomandibular disorders (TMD) and vice-versa. Material and Methods: One hundred women (aged 18-26 years) clinically diagnosed with TMD signs and symptoms and cervical spine disorders were randomly selected from a sample of college students. Results: 43% of the volunteers demonstrated the same severity for TMD and cervical spine disorders (CSD). The increase in TMD signs and symptoms was accompanied by increase in CSD severity, except for pain during palpation of posterior temporal muscle, more frequently observed in the severe CSD group. However, increase in pain during cervical extension, sounds during cervical lateral flexion, and tenderness to palpation of upper fibers of trapezius and suboccipital muscles were observed in association with the progression of TMD severity. Conclusion: The increase in cervical symptomatology seems to accompany TMD severity; nonetheless, the inverse was not verified. Such results suggest that cervical spine signs and symptoms could be better recognized as perpetuating rather than predisposing factors for TMD.

Neck Pain Disability Is Related to the Frequency of Migraine Attacks: A Cross-Sectional Study

Migraine and neck pain can be critical causes of disability. The contribution of neck pain for the overall disability of individuals with migraine remains unknown.

Do women with migraine have higher prevalence of temporomandibular disorders

OBJECTIVES The aim of this study was to assess the prevalence of Temporomandibular Disorders (TMD), using the Research Diagnostic Criteria for TMD (RDC/TMD) in women with episodic and chronic migraine (M and CM), as well as in asymptomatic women. METHOD Sample consisted of 61 women, being 38 with M and 23 with CM, identified from a headache outpatient center; we also investigated 30 women without headaches for at least 3 months (women without headache group - WHG). Assessment of TMD was conducted by a physical therapist who was blind to the headache status. RESULTS The prevalence of TMD, assessed through the RDC, was 33.3% in the WHG, 86.8% in the M group and 91.3% of the CM group. Differences were significant when comparing M and CM groups with WHG (p<0.001), but not when comparing M and CM (p>0.05) as well as higher risk for TMD [odds ratio (OR)=3.15, 95% confidence interval (CI) 1.73-5.71 and OR=3.97, 95%CI 1.76-8.94]. CONCLUSION Women with migraine are more likely to have muscular and articular TMD, suggesting that both disorders might be clinically associated, which demonstrate the importance of physical therapy assessment in the multidisciplinary team.

Confiabilidade da fleximetria e goniometria na avaliação da amplitude de movimento cervical em crianças

Objective: To determine the intra and interrater reliability of fleximetry and goniometry in children and correlate the cervical spine range of motion (ROM) values obtained from these methods. Methods: One hundred six children participated in this study: 49 males (8.91±2.09 years) and 57 females (9.14±1.46 years). Their ages ranged from six to 14 years and symptom-free to cervical dysfunction. Two previously trained raters and two assistants assessed neck ROM. The measurements were made using fleximetry and goniometry (interrater reliability) and repeated them one week later (intrarater reliability). All measurements were made three times by each rater and the mean value was used for statistical analysis. Intraclass correlation coefficients (ICC 2.1 and 2.2) were used to investigate reliability and Pearsons correlation coefficient (p<0.05) was used to investigate the correlation between measurements obtained from the two techniques. Results: Moderate and excellent levels for intrarater reliability were observed for fleximetry and moderate reliability for goniometry. The interrater reliability was moderate and excellent for fleximetry and poor and moderate for goniometry. Significantly poor correlation was found among all neck ROM measurements obtained using both techniques, except for rotation to the left. Conclusions: The poor correlation between neck ROM measurements obtained from fleximetry and goniometry demonstrated that these techniques do not present interchangeable measurements. Since fleximetry presented higher reliability levels for assessments of neck ROM among children, the use of fleximetry rather than goniometry is recommended.

Craniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing.

INTRODUCTION The objective of the present study was to assess the craniocervical posture and the positioning of the hyoid bone in children with asthma who are mouth breathers compared to non-asthma controls. METHODS The study was conducted on 56 children, 28 of them with mild (n=15) and moderate (n=13) asthma (14 girls aged 10.79+/-1.31 years and 14 boys aged 9.79+/-1.12 years), matched for sex, height, weight and age with 28 non-asthma children who are not mouth breathers. The sample size was calculated considering a confidence interval of 95% and a prevalence of 4% of asthma in Latin America. Eighteen variables were analyzed in two radiographs (latero-lateral teleradiography and lateral cervical spine radiography), both obtained with the head in a natural position. The independent t-test was used to compare means values and the chi-square test to compare percentage values (p<0.05). Intraclass correlation coefficient (ICC) was used to verify reliability. RESULTS The Craniovertebral Angle (CVA) was found to be significantly smaller in asthma than in control children (106.38+/-7.66 vs. 111.21+/-7.40, p=0.02) and the frequency of asthma children with an absent or inverted hyoid triangle was found to be significantly higher compared to non-asthma children (36% vs. 7%, p=0.0001). The values of the inclination angles of the superior cervical spine in relation to the horizontal plane were significantly higher in moderate than in mild asthma children (CVT/Hor: 85.10+/-7.25 vs. 90.92+/-6.69, p=0.04 and C1/Hor: 80.93+/-5.56 vs. 85.00+/-4.20, p=0.04). CONCLUSIONS These findings revealed that asthma children presented higher head extension and a higher frequency of changes in hyoid bone position compared to non-asthma children and that greater the asthma severity greater the extension of the upper cervical spine.

Evaluation of mandibular range of motion in Brazilian children and its correlation to age, height, weight, and gender

This study aimed to measure the active mandibular range of motion (ROM) (mouth opening: MO; right and left lateral movements: RL and LL; protrusion: P) in Brazilian children of both genders and of various ages, weights, and heights, and to establish correlations among such variables. Study subjects (n = 303) were healthy boys and girls, with ages ranging between 6 and 14 years, who were regular students of a public school in the state of São Paulo. Analysis of variance and intra-class correlation coefficients were considered significant for p < 0.05. Weak significant correlations were observed between mandibular ROM and age, height, and weight. No statistically significant differences (p > 0.05) were observed regarding mandibular ROM between gender groups. Mean mandibular ROM values showed significant increases (p < 0.05) in relation to age, height, and weight, except for RL (p > 0.05), in the studied age range. Significantly smaller (p < 0.05) mean mandibular ROM values were observed for the intervals of 6 and 7 years of age, 1.15-1.35 m, and 17.30-26.50 kg, in relation to the other ranges. Nonetheless, no differences were observed among mean mandibular ROM values in the ranges 8 to 12-14 years, 1.36-1.75 m, and 47-85 kg. Thus, it is suggested that weight, height, and age variables be considered when obtaining mandibular ROM values, particularly in children aged 6 to 7 years, measuring 1.15-1.35 m, and weighing between 17.3-46.5 kg.

Principais instrumentos para avaliação da disfunção temporomandibular, parte II: critérios diagnósticos; uma contribuição para a prática clínica e de pesquisa

Na literatura especializada, encontram-se variados instrumentos para avaliacao da disfuncao temporomandibular (DTM), sob a forma de indices, questionarios, protocolos, escalas e criterios de diagnostico. Este estudo, dividido em duas partes, visou caracterizar os principais instrumentos de avaliacao da DTM disponiveis na literatura, para auxiliar o clinico e o pesquisador na correta escolha da ferramenta apropriada para seus objetivos clinicos ou cientificos. Na parte I foram caracterizados dois indices clinicos e tres questionarios (anamnesicos e funcionais); e, nesta parte II, um questionario funcional e dois conjuntos de criterios diagnosticos. Os indices sao ferramentas que organizam a avaliacao de sinais e sintomas, pela obtencao de pontuacoes. Os questionarios sao melhor aplicados em estudos epidemiologicos. Para avaliacao dos eventuais impactos da DTM nas atividades de vida diaria, os questionarios funcionais sao mais adequados. Finalmente, os criterios permitem obter o diagnostico da disfuncao. O RDC/TMD (Research diagnostic criteria for temporomandibular disorders, Criterios diagnosticos para pesquisa em DTM) e um dos poucos instrumentos que define criterios operacionais para o diagnostico clinico. O RDC/TMD, disponivel em traducao oficial para o portugues, tem a maior parte de suas propriedades psicometricas e acuracia verificadas, caracterizando-se como uma das ferramentas mais apropriadas para avaliacao da DTM.