Antônio Sérgio Guimarães

Purpose: Sleep disturbances are common in temporomandibular disorders (TMD), yet insomnia‐related complaints are often treated as homogeneous despite frequent co‐occurrence with sleep‐disordered breathing. This study examined whether sleep–pain relationships differ between insomnia alone and comorbid insomnia and sleep‐disordered breathing (COMISA) in patients with chronic TMD‐related orofacial pain. Methods: In this cross‐sectional study, 50 adults with chronic TMD pain were classified as having insomnia alone ( n = 20) or COMISA ( n = 30) using validated questionnaires and overnight pulse oximetry. Pain intensity (VAS), pain frequency (days/week), circadian pain patterns, subjective sleep quality (PSQI) and objective nocturnal respiratory and autonomic parameters were assessed. Group comparisons and within‐group linear regression analyses were performed. Results: Pain intensity did not differ between groups (7.45 ± 1.67 vs. 7.33 ± 1.90; p = 0.95). Patients with COMISA reported more frequent pain (3.37 ± 1.35 vs. 2.55 ± 1.19 days/week; p = 0.04) and more frequent morning pain (93.3% vs. 50.0%; p < 0.001). Subjective sleep quality was associated with pain intensity in COMISA ( B = 0.200, r = 0.417, p = 0.022) but not in insomnia alone ( p = 0.353). In COMISA, lower minimum nocturnal oxygen saturation ( p = 0.043) and maximum nocturnal heart rate ( p = 0.021) were associated with pain intensity; no such associations were observed in insomnia alone. Conclusions: Sleep–pain relationships in chronic TMD vary by sleep phenotype. These findings support the need for further investigation of COMISA in relation to pain, particularly in orofacial pain and TMD populations.

Objective: To assess the prevalence of temporomandibular disorder (TMD)-related pain, anxiety, and depression among military police officers from Niteroi, Rio de Janeiro, Brazil, and to compare these outcomes with a civilian population. Methods: This cross-sectional study included 84 police officers treated at the Dental Service of the Military Police Hospital and 84 non-police officers treated at the School of Dentistry of Fluminense Federal University. Data were collected digitally using validated instruments: the TMD Pain Screener, the Symptom Questionnaire, and the Hospital Anxiety and Depression Scale. Statistical analyses were performed according to variable characteristics, with a significance level of 5%. Results: TMD-related pain was identified in 26.2% of police officers and 31.0% of civilians. No statistically significant differences were found between groups regarding anxiety or depression prevalence. In both groups, women showed a higher frequency of TMD symptoms (p < 0.05). Conclusion: Police officers and civilians showed similar TMD-related pain prevalence.

BACKGROUND AND OBJECTIVES: The use of orthodontic appliances is constantly associated with symptoms of temporomandibular disorder (TMD). In this sense, the present study aimed to investigate the development of TMD symptoms in patients undergoing orthodontic treatment with occlusal lifting. METHODS: This is a longitudinal, quantitative and descriptive study; 40 patients with an indication for orthodontic treatment, participating in the study. They were evaluated: before the start of orthodontic treatment (T0), 24 hours (T1) and 30 days (T2) after installation of the occlusal elevator. Symptom assessment was carried out by applying the DC/TMD symptom questionnaire. The assessment of psychosocial factors was carried out using the “WISE Clinicians” test (Web Based Interdisciplinary Symptom Evaluation). The data were entered into a Microsoft Excel spreadsheet for statistical analysis using the Chi-Square test, with a significance level of 5%. RESULTS: In the T1 assessment, 42.50% (n= 17) of patients reported feeling any type of pain and 57.50% (n= 23) did not feel any pain. At T2, the proportion of patients who reported pain was 30% (n= 12), while 70% (n= 28) did not show any symptoms; 10% (n=10) of patients reported pain at both times; 37.50% (n=15) did not experience pain at any time during the assessment; 32.50% (n=13) assessed pain at the first moment and after the second assessment they no longer expressed pain. CONCLUSION: It can be concluded that occlusal lifting was not significant in terms of pain in most patients and when compared to the control group.

BACKGROUND AND OBJECTIVES: The use of orthodontic appliances is constantly associated with symptoms of temporomandibular disorder (TMD). In this sense, the present study aimed to investigate the development of TMD symptoms in patients undergoing orthodontic treatment with occlusal lifting. METHODS: This is a longitudinal, quantitative and descriptive study; 40 patients with an indication for orthodontic treatment, participating in the study. They were evaluated: before the start of orthodontic treatment (T0), 24 hours (T1) and 30 days (T2) after installation of the occlusal elevator. Symptom assessment was carried out by applying the DC/TMD symptom questionnaire. The assessment of psychosocial factors was carried out using the “WISE Clinicians” test (Web Based Interdisciplinary Symptom Evaluation). The data were entered into a Microsoft Excel spreadsheet for statistical analysis using the Chi-Square test, with a significance level of 5%. RESULTS: In the T1 assessment, 42.50% (n= 17) of patients reported feeling any type of pain and 57.50% (n= 23) did not feel any pain. At T2, the proportion of patients who reported pain was 30% (n= 12), while 70% (n= 28) did not show any symptoms; 10% (n=10) of patients reported pain at both times; 37.50% (n=15) did not experience pain at any time during the assessment; 32.50% (n=13) assessed pain at the first moment and after the second assessment they no longer expressed pain. CONCLUSION: It can be concluded that occlusal lifting was not significant in terms of pain in most patients and when compared to the control group.

Resumo Objetivo: Apresentar as modalidades de tratamentos conservadoras e minimamente invasivas mais usadas disponíveis no arsenal terapêutico das desordens temporomandibulares (DTM). Revisão da literatura: Os objetivos do tratamento invariavelmente incluem redução da dor, diminuição das atividades parafuncionais e restauração da função. Dentre as alternativas conservadoras e minimamente invasivas, podemos citar os dispositivos interoclusais, exercícios terapêuticos, eletrofototermoterapia, agulhamento seco e infiltração de anestésicos locais em pontos gatilho, injeção de sangue autógeno para controle da luxação mandibular, terapia cognitivo comportamental, toxina botulínica, viscossuplementação, controle farmacológico da dor aguda e crônica. As DTMs afetam uma proporção significativa da população. Somente após o fracasso das opções não invasivas é que devem ser iniciados tratamentos mais invasivos e irreversíveis. No entanto, algumas condições, como a anquilose e neoplasias, por exemplo, são essencialmente tratadas cirurgicamente e tentativas de tratamentos conservadores podem trazer piora na qualidade de vida ou risco de morte. Considerações finais: Uma abordagem de equipe multidisciplinar para o manejo é essencial no cuidado fundamental de todos os pacientes com DTM, para que o tratamento possa ser especificamente adaptado às necessidades individuais do paciente.

Temporomandibular disorder (TMD) is a term that covers a number of clinical problems involving the masticatory muscles, TMJ and all associated structures leading to signs and symptoms such as jaw pain, otalgia, headaches and limitation of function. In this context, TMD has been related to facial type and there are three distinct facial types (euryprosopic, mesoprosopic, and leptoprosopic). Objective: The aim of this study was to investigate the correlation between myofascial pain and facial types classified by the RDC/TMD Axis I. Material and Methods: this study was composed of 64 women aged between 12 and 49 years, using data obtained from two institutions. We used the anthropometric methodology, which meets the criteria of simplicity and reliability. We also applied the Brugsh Facial Index. The individuals were classified as euryprosopic (51.56%), mesoprosopic (12.50%) and leptoprosopic (35.94%), without statistical significance among the groups (p=0,3492). Results: there is no statistical difference between the age groups (p=0.2976) and no association between facial type and age range. Conclusion: this study found that there was a correlation between myofascial pain and facial types, with the predominance of euryprosopic faced women aged between 20 and 29 years when compared with other facial types and other age groups. KEYWORDS Temporomandibular joint dysfunction syndrome; Anthropometric methodology; Mandibular disorders; Myofascial pain; Orofacial pain.

BACKGROUND AND OBJECTIVES: The number of temporomandibular joint (TMJ) surgeries has been growing in recent years. The objective of this study was to evaluate the factors measured for the indication of TMJ surgery. METHODS: This is an observational, quantitative, retrospective, cross-sectional study. A total of 99 surgical requests for TMJ surgery, assigned to a supplementary health operator, were analyzed. Information regarding age, gender, the patients’ main complaint, movement alteration, magnetic resonance results, diagnostic tests used, and previous therapy performed were collected. The T-test and the Chi-squared test were used (α=5%). RESULTS: 85% of patients were female, and the mean age among women (27.07±6.33) was lower when compared to men (31.98±9.55) (p=0.03). Almost half of patients did not receive any therapeutic approach prior to the surgery indication. Less than 10% of the requests described the Wilkes classification. Among the symptoms considered for the indication of surgery. pain report in the TMJ region (63.64%) stands out. The clicking and mouth opening limitation were among the highest prevalence as 52.5% and 67.7%. respectively. CONCLUSION: The factors evaluated for the indication of TMJ surgery by oral and maxillofacial surgeons in the present study do not match the recommendations of the Colégio Brasileiro de Cirurgia e Traumatologia Buco-Maxilo-Facial (CTBMF – Brazilian College of Oral and Maxillofacial Surgery and Traumatology). Few conservative treatments were previously recommended. Where the majority was decided without any diagnostic criteria.

Background Temporomandibular disorders (TMD) is a collective term that refers to complaints of temporomandibular joint (TMJ) pain, fatigue and/or pain of the craniocervical muscles, limitation of movement of the mandible, and TMJ noises. Sleep bruxism (SB) is a disorder involving rhythmic (phasic) or non-rhythmic (tonic) masticatory muscle activity during sleep and is not a movement disorder or a sleep disorder in otherwise healthy individuals. The present study aimed to support or reject the null hypothesis that there is no association between SB and TMD. Methods The study population was recruited from patients who visited the Artmedica Clinic, Mossoro city, Rio Grande do Norte, Brazil. Patients who underwent polysomnography received information about the research and were invited to participate following the inclusion and exclusion criteria. The study sample consisted of 40 individuals with age ranging from 19 to 76 years. The subjects were administered the questionnaire of the European Academy of Craniomandibular Disorders (AEDC). Those who answered affirmatively to at least one question of the questionnaire were recommended to visit the primary researcher’s dental clinic for examination; those who met the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were evaluated, and their condition was classified into one or more subtypes of TMD. The subjects were divided into 4 groups according to the polysomnographic findings and the responses to the AEDC questionnaire. Of the 40 individuals who answered the AEDC questionnaire and underwent polysomnography, 28 presented with TMD symptoms. The data were expressed as simple frequency and percentage values using statistical software. Values of p < 0.05 were considered to be significant. Results The results showed that the frequency of TMD in individuals diagnosed to have SB was 46.4%. According to the DC/TMD of the 28 individuals, the most prevalent TMD subtype was local myalgia (85.7%). Of the total subjects, 32.5% had TMD and SB, 36.4% were males, and in the age range of 31 to 40 years (40%). Conclusion In this study sample, there was no association between SB as currently defined and TMD, thus confirming previous findings on this topic.

Background: Anxiety is an important factor in the process of chronic pain in patients with Temporomandibular Dysfunction (TMD). Objective: The objective of this study was to evaluate the influence of minimally invasive management of muscular TMD on the levels of anxiety (state and trait), pain, and other parameters in patients with muscular TMD. Methods: A total of 83 patients (64 women and 19 men; mean age, 25.16 ± 4.40 years) who were clinically diagnosed with TMD were evaluated. During the first clinical session (T1) and after clinical evaluation and diagnosis, the participants filled out a pain visual analog scale and answered the Trait Anxiety Inventory (STAI-T) and State Anxiety Inventory (STAI-S). In addition, the bite strength of the participants was evaluated, and minimally invasive management (thermotherapy, orientation exercises, and cognitive behavioral therapy) was initiated in that session. After 8 weeks (T2), all parameters were reevaluated. The results obtained were statistically analyzed and found to have a significance level of 5%. Results: A significant decrease in pain, STAI-T, and STAI-S scales were observed from T1 to T2 (p < 0.0001). Higher values of bite strength were observed at T2 compared to T1 (p < 0.0001). Furthermore, a significant correlation was observed between the levels of pain, trait-anxiety, and state-anxiety. Conclusion: Minimally invasive management of TMD resulted in a reduction in the levels of pain and anxiety (trait and state) of the participants evaluated, suggesting a possible association of these factors with chronic myofascial pain.