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Dissertations / Theses on the topic 'Temporomandibular disorders (TMD)'

Author: Grafiati

Published: 4 June 2021

Last updated: 25 April 2022

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Edwards, Emery Rose. "Illness Experience of People with Chronic Pain Resulting from Temporomandibular Disorders." Thesis, The University of Arizona, 2007. http://hdl.handle.net/10150/193257.

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This thesis discusses the illness experience of people living with chronic pain resulting from Temporomandibular disorders (TMD). The literature discusses various aspects of the experience of chronic pain, but there is little research reported specifically on the experience of living with TMD. Using analysis of sufferers' narratives, I discuss common explanatory models and coping strategies. I then present aspects of the bodily experience of TMD as seen in people with comorbid illnesses. The personal or mental aspects of TMD are explored, particularly in terms of fear, anxiety, and hope for the future. Lastly, the broader impacts of TMD are explored through sufferers' relationships with friends and family, and sufferers' ability to function in social contexts. It is concluded that TMD impacts many areas of sufferers' lives, and that the lived experience extends beyond diagnosis and treatment seeking to include the day to day management of TMD pain.

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Yang, X. (Xiaojiang). "Magnetic resonance imaging of the lateral pterygoid muscle in temporomandibular disorders." Doctoral thesis, University of Oulu, 2002. http://urn.fi/urn:isbn:9514266439.

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Abstract The fact that the lateral pterygoid muscle (LPM) and related symptoms play an important role in temporomandibular disorders (TMD) is widely recognized. In the study reported here, the LPM was investigated by magnetic resonance imaging (MRI) of patients with TMD. The visibility of the LPM in MRI with different projections was analyzed and a new imaging projection, condyle-the lateral pterygoid muscle projection (CLPM), for the LPM in MRI was introduced. Normal and abnormal findings of the LPM was compared with clinical symptoms of TMD. Compared with sagittal imaging of temporomandibular joint (TMJ), CLPM images and most of the oblique sagittal imaging were able to show the LPM clearly. Hypertrophy, atrophy and contracture of the LPM were found in TMJs either with disc in normal position or with disc displacements. Pathological changes of the superior belly and hypertrophy of the inferior belly combined with various pathological changes of the superior belly were the most frequently observed abnormal imaging findings of the LPM in TMD. The pathological changes of the LPM were associated with the main clinical symptoms of TMD. In patients with symptomatic condyle hypermobility, the pathological changes of the LPM and related symptoms were associated with the clinical symptoms of TMJs with disc in normal position. The imaging abnormalities of the LPM were common in TMJs with disc displacements and seemed to be fewer in condyle hypomobility cases in TMJs with anterior disc displacement with non-reduction (ADDnr). However, normal imaging of the LPM was also found in TMJs with severe osteoarthritic changes and disc displacement. The recognition of muscle alterations may lead to a more specific diagnosis and improve the understanding of the clinical symptoms and disease pathophysiology of TMD.

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Ahmed, Omer Abdelrahim Sidig. "Relationship of TMD diagnosis and self-reported biopsychosocial status of patients attending the TMD clinic." University of the Western Cape, 2018. http://hdl.handle.net/11394/6638.

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Magister Scientiae Dentium - MSc(Dent)
Background: This study aimed to investigate a possible relationship between the diagnosis of TMD and biographical, psychological and social status of patients. Materials and Method: All records of patients who attended the TMD clinic in the Mitchells Plain Oral Health Centre in the period from January 2015 to July 2018, and who were examined according to the DC/TMD protocol, were collected. All diagnostic observations, as well as their biographical, psychological and social data were recorded. Statistical analysis was performed by means of comparisons and association analysis among data to evaluate if there were any statistically relevant associations or differences.

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Mendes, Andreia Gonçalves. "Abordagem terapêutica da patologia inflamatória da articulação temporomandibular." Master's thesis, [s.n.], 2012. http://hdl.handle.net/10284/3793.

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Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária
A patologia inflamatória da articulação temporomandibular é uma das desordens intraarticulares mais comuns. Apesar de a sua etiologia ainda não estar bem explicada, sabe-se que um dos principais factores são os traumas (microtrauma e macrotrauma), e que estes levam à formação de processos inflamatórios nas superfícies articulares. O principal sintoma que acompanha estas desordens inflamatórias é a dor, e sendo esta o principal motivo da vinda do paciente às consultas, torna-se importante que o médico dentista conheça as abordagens necessárias para tratar esta patologia. Normalmente o tratamento das desordens temporomandibulares inflamatórias passa por uma abordagem multidisciplinar, farmacológica e com ajuda de tratamentos de fisioterapia. A maior parte destas patologias resolvem-se com tratamentos reversíveis e não-invasivos, tais como: medicação sistémica e local; terapia com laser de baixa intensidade, ultrassons, iontoforese e fonoforese. Com esta revisão bibliográfica pretende-se fornecer um conhecimento mais aprofundado sobre as patologias inflamatórias da ATM e a sua abordagem terapêutica. The temporomandibular joint inflammation is one of the most common pathology within the intra-articular disorders. Although its etiology is not yet fully explained, it is known that the major factor is trauma (microtrauma and macrotrauma) causing the formation of inflammatory processes in the articular surfaces. The main symptom that accompanies these inflammatory disorders is pain leading the patient to find a dentist. Thus, it is important that dentists know the approaches needed to treat this disorder. Normally the treatment of inflammatory temporomandibular disorders involves a multidisciplinary approach, with the help of pharmacological and physical therapy treatments. Most of these pathologies are resolved with reversible and non-invasive treatments, such as systemic and local medication, low-level laser therapy, ultrasounds, iontophoresis and phonophoresis. This bibliographic review aims to provide a deeper understanding on the inflammatory pathologies of the TMJ and its therapeutic approach.

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Lövgren, Anna. "Recognition of Temporomandibular Disorders : validity and outcome of three screening questions (3Q/TMD)." Doctoral thesis, Umeå universitet, Tandläkarutbildning, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-133997.

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Background Pain and dysfunction in the temporomandibular region (Temporomandibular Disorders, TMD) are common conditions in the general population with an estimated treatment need of 5-15% in the general population. However, in Sweden, traceable performed treatments are significantly lower. The reasons for this indicated under-treatment are not known. To easily detect patients with a potential TMD related condition, three screening questions, 3Q/TMD, have been introduced. The aim with this project was to evaluate the validity and outcome of the 3Q/TMD with the objective to recognize individuals with TMD and potential treatment need in the Public Dental Health service (PDHS). Methods The thesis is based on four study samples; three from the PDHS in the county of Västerbotten, Sweden and one sample from the specialized orofacial pain clinic at the Academic Centre for Dentistry, ACTA, Amsterdam, the Netherlands. The bases for all studies are individuals’ answers to the 3Q/TMD and quantitative approaches were used in the analyses. The prevalence of affirmative answers was evaluated in a large cross-sectional study over the lifespan. The validity of the 3Q/TMD in relation to the Diagnostic Criteria for TMD (DC/TMD) as reference standard was established in two case-control studies. The outcome of the 3Q/TMD on TMD treatment within general practice was evaluated in a cohort study. Results Affirmative answers to the 3Q/TMD increased during adolescence. Women answered affirmatively to the 3Q/TMD significantly more often compared to men for all age groups expect for the first and last parts of a one hundred-year lifespan. The highest prevalence was reported by women during their fertile period in life. In a general population sample, 74% of individuals with an affirmative answer qualified for a DC/TMD pain or dysfunctional diagnosis, as compared to 64% in a specialist patient sample. In the general population sample, for the individual 3Q/TMD questions, as well as combinations of questions, the negative predictive values were high (0.92-0.99). For the specialist sample, when at least one question was answered affirmatively the negative predictive value was high (0.90). The positive predictive value was high (0.89) when all three questions were positive. There was significantly more treatment performed or recommended for 3Q-positives (21.5%) compared to 3Q-negatives (2.2%) (P<0.001). The odds ratio for TMD-related treatment for 3Q-positives versus 3Q-negatives was 12.1 (95% CI: 6.3-23.4). Conclusion The 3Q/TMD is a convenient and valid tool to recognize individuals who would benefit from a further TMD examination within an adult, general population. Within specialized orofacial pain clinics, the questions are useful as guidance for further diagnostics. Although the 3Q/TMD was a factor related to TMD treatment, the majority of individuals with self-reported symptoms of TMD still did not receive traceable assessment or treatment. Factors associated with dentists’ clinical decision-making in relation to TMD warrants further research. The utilization of the 3Q/TMD as a part of a decision tree for the clinician can improve the health care for patients with TMD and is therefore recommended within dentistry.
Bakgrund Smärta och funktionsstörningar i käksystemet (TMD) är vanligt förekommande och de flesta av dessa patienter kan behandlas framgångsrikt i tandvården. Tidigare studier har visat att det kan finnas en skillnad mellan det skattade vårdbehovet och utförd behandling för patienter med TMD i tandvården. Anledningen till detta är inte känt och har identifierats som en kunskapslucka av Socialstyrelsen. Den vanligaste orsaken till akut smärta i ansiktsregion är tandvärk medan kronisk smärta oftast är relaterat till smärttillstånd i muskulatur och käkled (TMD). Att leva med smärta har en negativ påverkan på livskvaliteten oavsett om smärtan är orsakad av tandvärk eller TMD. Kvinnor uppger symtom på TMD ungefär två gånger så ofta som män och förekomsten är som högst bland kvinnor i arbetsför ålder. Smärtan är ofta relaterad till stress och långvarig smärta ökar risken för såväl spridning till andra lokalisationer som till sömnbesvär och nedstämdhet. Tidig intervention har visat sig betydelsefull för att minska risken för negativa konsekvenser relaterat till kroniska besvär. Sammantaget visar detta på vikten av ett system inom tandvården för att tidigt identifiera patienter som är i möjligt behov av fördjupad utredning och eventuellt behandling. Därför har tre screeningfrågor för TMD, 3Q/TMD införts inom tandvården. I Folktandvården i Västerbotten infördes frågorna i maj 2010 som en obligatorisk del av den digitala hälsodeklarationen för samtliga patienter. Syfte Syftet med avhandlingen har varit att synliggöra patienter med smärta och käkfunktionsstörning i befolkningen och att därmed förbättra omhändertagandet av patienter med TMD inom Folktandvården. De specifika målen var att: i) beskriva förekomst av frekvent smärta och dysfunktion i ansikte, käke och käkled för män och kvinnor för olika åldersgrupper baserat på tre screeningfrågor ii) bedöma de tre screeningfrågornas validitet i förhållande till en diagnos enligt Diagnostic Criteria for TMD, DC/TMD i två olika populationer iii) utvärdera utfallet av 3Q/TMD på klinisk beslutsprocess inom Folktandvården i Västerbotten, Sverige. Studiepopulation och metod Avhandlingen baserades på fyra olika urval av patientpopulationer, tre från Folktandvården i Västerbotten, Sverige och en från Specialistkliniken från Academish Centrum Tandheelkunde Amsterdam, ACTA, Amsterdam, Nederländerna. Underlaget för samtliga studier var baserade på individuella svar på de tre screeningfrågorna. Förekomsten av de som svarat ja på någon av frågorna utvärderades i en tvärsnittsstudie bland nästan 140 000 individer och över ett helt livsspann. Validiteten för 3Q/TMD i relation till en diagnos enligt DC/TMD utvärderades i två fall-kontroll studier. Först undersöktes en studiepopulation från Folktandvården i Västerbotten, Sverige för att representera allmän befolkningen. Därefter utvärderades screeningfrågorna bland de patienter som remitterats till en specialistklinik i Amsterdam, Nederländerna på grund av TMD relaterade besvär. Dessa representerar remitterade patienter. Utfallet av 3Q/TMD på TMD behandling i Folktandvården utvärderades i en prospektiv kohort studie. Resultat Förekomsten av de som svarat ja på någon av frågorna ökar under tonåren. Kvinnor svarar ja på någon av frågorna signifikant oftare än män i alla åldrar, utom i början och slutet av livsspannet. Den högsta prevalensen noterades för kvinnor i fertil ålder. I allmänbefolkningen kvalificerar 74% av de som svarat ja på någon av frågorna även för en DC/TMD diagnos. Motsvarande siffra för urvalet från specialistkliniken var 64%. I urvalet från allmänbefolkningen var det negativa prediktiva värdet högt för såväl alla enskilda frågor som för kombinationer av frågor (0.92-0.99). Bland de remitterade patienterna, var negativt prediktivt värde högt när individen svarade ja på minst en fråga (0.90). Positivt prediktivt värde var högt när individen svarat ja på alla tre frågorna (0.89). Behandling hade utförts eller rekommenderats signifikant oftare till de som svarat ja på någon av frågorna (21.5%) jämfört med de som svarat nej på alla tre frågor (2.2%) (P<0.001). Odds ratio för TMD behandling för 3Q-positiva jämfört med 3Q-negativa var 12.1 (95% CI:6.3-23.4). Slutsats Sammanfattningsvis visar resultaten att en betydande andel av befolkningen, framför allt kvinnor i arbetsför ålder, har smärta och/eller funktionsstörningar i käksystemet. Frågorna är lämpliga för att screena patienter i behov av en fördjupad utredning. De som svarat nej kommer med stor sannolikhet inte att kvalificera för en diagnos enligt DC/TMD. Bland remitterade patienter kommer majoriteten att svara ja på någon av frågorna. I allmäntandvården får två tredjedelar av det som svarat ja på minst en fråga, inte ett synliggjort omhändertagande baserat på vad som är angivet i deras tandvårdsjournal. Detta kan tyda på brister bland allmäntandläkare och tandhygienister i kliniskt beslutsfattande för patienter med TMD.

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Bauerle, Erin Ruane. "ASSOCIATION OF MASSETER MUSCLE CACNA2D1, CACNA1S, GABARAP, AND TRPM7 GENE EXPRESSION IN TEMPOROMANDIBULAR JOINT DISORDERS." Master's thesis, Temple University Libraries, 2016. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/392863.

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Oral Biology
M.S.
A major physiological risk factor of temporomandibular disorders (TMD) is sensitization of peripheral and central nervous system pain processing pathways. Calcium channel, voltage-dependent, alpha-2/delta subunit-1 (CACNA2D1) has a crucial role in relaying nociceptive information in the spinal dorsal horn. Up-regulation of CACNA2D1 results in abnormal excitatory synapse formation and enhanced presynaptic excitatory neurotransmitter release. Blocking CACNA2D1 with gabapentinoid-class drugs relieves orofacial hypersensitivity. Drs. Foley, Horton, and Sciote previously reported that in a small sample group (n=12), CACNA2D1 expression was greater in males than females, but increased in women with TMD. The objectives of this study are to corroborate these data and investigate expression patterns of other ion channel and conducting system genes. Additionally, since the null polymorphism ACTN3-577XX associates with muscle fiber microdamage during eccentric contraction, we tested for possible gene associations with ACTN3-R577XX genotypes. Masseter muscle samples came from human subjects (n=23 male; 48 female) with malocclusions undergoing orthognathic surgery. This population had skeletal disharmony of the jaws and thus was prone to eccentric contraction. Three males and eighteen females were diagnosed with localized masticatory myalgia. Muscle total RNA was isolated and CACNA2D1, CACNA1S, GABARAP, and TRPM7 expression was quantified using RT-PCR. Expression of these genes were compared based on TMD status and various characteristics that may influence TMD including: sex, age, facial symmetry, sagittal dimension, vertical dimension, ACTN3-577 genotype and fiber type. CACNA2D1 expression differed significantly between sexes, overall (p<0.02), and without TMD (p=0.001). Women with (n=13) and without (n=23) TMD differed significantly (p<0.03). CACNA2D1 expression was also significantly higher (p=0.031) in subjects below age 25. Similarly, GABARAP expression was significantly higher (p=0.001) for patients younger than 25 and for patients less than or equal to age 18 (p=0.013). Otherwise, CACNA1S, TRPM7 and GABARAP differences were not significant. GABARAP expression differed, but not significantly by sex and for the ACTN3-577XX-null genotype. In a population of malocclusion patients, masseter muscle CACNA2D1 expression is significantly higher than CACNA1S, TRPM7, and GABARAP. CACNA2D1 expression is greater in males than females without TMD. However, CACNA2D1 expression increases significantly in females with TMD-associated myalgia. This may support evidence for calcium channel regulation of nociception differences seen between sexes in TMD. It was also found that expression of CACNA2D1 and GABARAP is significantly higher in younger subjects. Additionally, observations presented here suggest potential influence of ACTN3-null condition on function of GABARAP.
Temple University--Theses

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Mena, Acuña Xochitl, and Nora Jawad. "The Relation Between Temporomandibular Disorders, Catastrophizing, Kinesiophobia and Physical Symptoms." Thesis, Malmö universitet, Odontologiska fakulteten (OD), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-19872.

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Objektiv: Temporomandibulär dysfunktion (TMD) utgör vanligaste formen av kronisk orofacial smärta. Kronisk TMD har negativ inverkan på det psykosociala tillståndet vilket påverkar livskvaliteten. Syftet är att utreda huruvida en korrelation mellan TMD, katastrofiering, kinesofobi och fysiska symtom föreligger. Material och metod: Studien baseras på data från TMJ Impact Project som utvärderar 401 individer (333 kvinnor, 86 män, medelålder 45.8) från den initiala studien The Validation Project som utvärderar diagnostiken enligt RDC/TMD, insamlingen utfördes på University of Minnesota, University of Washington och University of Buffalo (2003-2006). 218 individer hade smärtsam TMD, 111 icke-smärtsam TMD, 63 smärtfria kontroller och data saknades för 9 individer. Deltagarna genomgick diagnostik enligt RDC/TMD som inkluderar en klinisk- och radiologisk undersökning (axel I) och en psykosocial utvärdering (axel II). För att undersöka en potentiell korrelation mellan TMD, katastrofiering, kinesofobi och fysiska symptom användes följande instrument: Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, The Patient Health Questionnaire och Areas of Pain.Resultat: Deltagare med smärtsam TMD uppvisade statistisk signifikant grad av kinesofobi, somatisering och fysiska symtom jämfört med kontroller. Deltagare med smärtfri TMD uppvisade högre grad av kinesofobi jämfört med kontroller. Det råder en låg- till moderat positiv korrelation mellan katastrofiering och kinesofobi hos deltagare med smärtsam TMD (r=0,37 p<0,001) och smärtfri TMD (r=0,53 p<0,001).Konklusion: Resultaten uppvisar associationer mellan katastrofiering och kinesofobi hos patienter med TMD oberoende av smärtförekomst. Överlag föreslår resultaten att utvärderingen av kinesofobi och katastrofiering, utspridd smärta och multipla icke-TMD relaterade symtom kan vara av klinisk vikt vid utvärderingen av patienter med TMD.
Objectives: Temporomandibular disorders (TMD) are the most common causes of chronic orofacial pain and affects both psychological and social aspects of life. The aim was to investigate the possible relationship between TMD, catastrophizing, kinesiophobia and physical symptoms. Methods: The study was based on 401 participants (333 women, 86 men, mean age 45.8 years) in the TMJ Impact Project recruited at University of Minnesota, University of Washington and University of Buffalo 2003-2006. Of these, 218 had TMD pain, 111 non-painful TMD, 63 were pain-free controls and data was missing for 9 individuals. Participants were diagnosed in accordance with the Diagnostic Criteria for TMD, including a clinical and radiographic examination (axis I) and a psychosocial assessment (axis II). The possible correlations between TMD, catastrophizing, kinesiophobia and physical symptoms were evaluated with the Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, the Patient Health Questionnaire, together with Areas of Pain. Results: Compared to controls, participants with TMD pain showed a statistically significant degree of kinesiophobia, somatic symptoms, and areas of pain and participants with non-painful TMD showed a higher degree of kinesiophobia. There was a positive, low to moderate correlation between catastrophizing and kinesiophobia for participants with TMD pain (r=0.37, p<0.001) and non-painful TMD (r=0.53, p<0.001).Conclusions: The results suggest an association between catastrophizing and kinesiophobia in individuals with TMD regardless of presence of pain. The findings suggest that evaluating fear of movement and catastrophizing, as well as widespread pain and multiple non-TMD symptoms can be useful in the assessment of patients with TMD.

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Klobas, Luciano. "The Manifestations and the Treatment of Temporomandibular Disorders in Patients with Chronic Whiplash-associated Disorders Grades 2 and 3." Doctoral thesis, Uppsala universitet, Käkkirurgi, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-198420.

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The main aim of this project was to encircle the subtype of temporomandibular disorders (TMD) present in patients with chronic whiplash-associated disorders (WAD) and study the debut of TMD symptoms, the provoking factors and the outcome of conservative TMD treatments. The results could add to the aetiological discussion about TMD mainly as being part of chronic WAD pain or not. The subjects were referred patients with chronic WAD at a specialized rehabilitation centre where they were diagnosed using a standardized classification of WAD diagnosing that resulted in approximately 20% WAD grade 2 and 80% WAD grade 3. In Studies I and II, a total 136 individuals with chronic WAD were found to have a significantly higher prevalence of pain associated with TMD compared to a control group of 66 general dental patients. The symptoms debuted approximately six months after the whiplash injury and were most often provoked by stress. In Study III, the effect of a therapeutic jaw exercise (TJE) program on TMD was studied over six months in patients with chronic WAD and TMD, randomized to TJE (25 subjects) or not (30 subjects). TJE had no effect on TMD. In Study IV, patients with chronic WAD and TMD were found to have a mainly myogenous origin of TMD pain. Five months of stabilisation appliance therapy (SAT) equally resulted in an almost complete perceived reduction of jaw pain and frontal headache in patients with chronic WAD and TMD (n=14) and TMD patients without WAD (n=10). In the long-term, TMD was significantly lower in patients with chronic WAD who were treated compared to patients with chronic WAD and TMD who were not treated (n=9). TMD in patients with chronic WAD grades 2 or 3 may be the same kind of musculoskeletal disorder as in TMD patients without WAD, and not primarily part of the WAD pain. A functional TMD examination as well as assessment of perceived stress can be recommended as part of the standardized screening procedure for patients with chronic WAD grades 2 and 3. Patients with symptoms and signs of TMD could be recommended SAT. Patients with symptoms of frontal headache alone should also be considered as candidates for SAT.

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Jesus, Beatriz Cione Adriano de. "Estudo da relação de parâmetros psicossociais na resposta terapêutica de pacientes com disfunção temporomandibular." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/23/23139/tde-03112016-143252/.

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O presente estudo avaliou a relação dos parâmetros do eixo II dos Critérios de Diagnóstico de Pesquisa das Disfunções Temporomandibulares (RDC/TMD) na resposta terapêutica de pacientes com DTM. Trinta e três pacientes (média de idade de 33,2 anos ± 13,4) com artralgia da articulação temporomandibular (ATM) foram submetidos a três terapêuticas: laser de baixa potência (LBP) + piroxicam (LPi), LBP + placebo de piroxicam (L) e piroxicam + placebo de LBP (Pi). Os pacientes receberam a terapêutica por 10 dias. As avaliações foram feitas na 1a e 4a sessões de tratamento. A presença e intensidade de dor espontânea, dor à palpação e máxima abertura bucal foram mensuradas. A evolução destas foi comparada à classificação dos pacientes de acordo com os parâmetros do eixo II: grau de dor crônica (GDC), depressão e sintomas físicos não específicos (SFNE). Os dados foram analisados usando os testes de Fisher, Wilcoxon, t de Student, Kruskal-Wallis, U de Mann-Whitney e análise de variâncias, adotando-se p<0,05 como nível de significância. Foi possível observar melhora significativa (p<0,05) dos pacientes estudados quanto ao tempo em relação à EVA e dor à palpação tanto muscular quanto articular. Notou-se diferença estatística significante (p<0,05) entre os grupos de GDC e abertura bucal 4ª sessão e dor articular; entre os grupos de SFNE (incluindo e excluindo itens de dor) e palpação muscular 1ª sessão. Entre os grupos de GDC e as variáveis de EVA e palpação muscular foi encontrada diferença marginalmente significativa, apresentando p-valores próximos a 0,05 (p<0,1). Não foi encontrada diferença estatística significante entre os grupos de depressão e as variáveis consideradas. Portanto, foi observada relação entre alta incapacidade e maiores médias dor articular, grau de SFNE incluindo e excluindo itens de dor classificados como severos e palpação muscular inicial. A depressão não apresentou relação com as variáveis estudadas.
The aim of this study was assess the influence of Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II parameters on treatment outcome of low-level laser therapy (LLLT) associated with piroxicam in patients with TMD. Thirty-two patients (mean age 33.2 years old ± 13.4) with temporomandibular joint (TMJ) arthralgia were enrolled in the study and received three kinds of treatment: LLLT + piroxicam (LPi), LLLT + placebo piroxicam (L) e piroxicam + placebo LLLT (Pi). Patients were managed for ten days. Follow-up evaluations were done at the 1st and 4th consults. The presence and intensity of spontaneous pain through the visual analogue scale (VAS), painful palpation and mandibular maximum vertical opening were measured. The therapeutic outcomes of this population were compared between the classifications of axis II scores: graded chronic pain (GCP), depression and non-specific physical symptoms (NEPS). The data was analyzed using the following statistic models: Fisher\'s test, Student t test, Wilcoxon, Mann-Whitney U test, Kruskal-Wallis test and Analysis of Variance. The statistical significance level set was p<0.05. The variables VAS, painful joint and muscle palpation showed improvement over time. Significant difference was found between GCP groups and maximum mouth opening on the 4th session and painful TMJ palpation; between NEFS (including and excluding pain items) and painful muscle palpation on the 1st consult. Between groups of GCP and VAS\'s variables it was found a marginally significant relation, showing p-values near 0.05 (p<0.1). No statistical difference was found on the comparison between depression and the physical variables considered. Thus, it is possible to conclude that there is an association between high incapacity and higher mean values to painful joint palpation, severe NEPS including and excluding pain items and baseline painful muscle palpation. No relation between depression and the studied variables was observed.

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Aguiar, Aroldo dos Santos. "Adaptação transcultural para o português brasileiro da Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK/TMD)." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/17/17152/tde-07062017-120246/.

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INTRODUÇÃO: O medo do movimento (cinesiofobia) parece desempenhar um papel importante no desenvolvimento da dor crónica. No entanto, em Disfunção Temporomandibular (DTM), há uma escassez de estudos sobre este tema. A Escala de Tampa para Kinesiophobia para DTM (TSK / TMD) é o instrumento mais utilizado para medir o medo de movimento e não está disponível em Português do Brasil. OBJETIVO: O objetivo deste estudo foi adaptar transculturalmente o TSK/TMD para o Português Brasileiro e avaliar suas propriedades psicométricas em termos de consistência interna, confiabilidade, validade de construto e estrutural. MÉTODOS: Um total de 100 pacientes do sexo feminino com DTM crônica participaram do processo de validação da TSK/TMD-Br. O coeficiente de correlação intraclasse (CCI) foi utilizado para a análise estatística de confiabilidade (teste-reteste), ? de Cronbach para consistência interna, correlação de Pearson para classificar a validade de construto e análise fatorial confirmatória (AFC) para a validade estrutural. RESULTADOS: AFC aprovou o modelo pré-especificado com dois domínios e 12 itens (Evitando Movimento-EM/Foco Somático-SF) e todos os itens apresentaram carga fatorial superior a 0,4. Foram encontrados níveis aceitáveis de confiabilidade (CCI> 0,75) para todas as questões e domínios da TSK/TMD-Br. Para consistência interna, ? de Cronbach de 0,78 para ambos os domínios. Foram observadas correlações moderadas (0,40 BACKGROUND: Fear of movement (kinesiophobia) seems to play an important role in the development of chronic pain. However, in Temporomandibular Disorders (TMD) there is a scarcity of studies about this topic. The Tampa Scale for Kinesiophobia for TMD (TSK/TMD) is the most widely used instrument to measure fear of movement and it is not available in Brazilian Portuguese. OBJECTIVE: The purpose of this study was to culturally adapt the TSK/TMD to Brazilian Portuguese and to assess its psychometric properties in terms of internal consistency, reliability, and construct and structural validity. METHODS: A total of 100 female patients with chronic TMD participated in the validation process of the TSK/TMD-Br. The intraclass correlation coefficient (ICC) was used for statistical analysis of reliability (testretest), Cronbach\'s alpha for internal consistency, Pearson\'s rank correlation for construct validity, and confirmatory factor analysis (CFA) for structural validity. RESULTS: CFA endorsed the pre-specified model with two domains and 12-items (Activity Avoidance - AA/ Somatic Focus - SF) and all items obtained a loading factor greater than 0.4. Acceptable levels of reliability were found (ICC>0.75) for all questions and domains of the TSK/TMD-Br. For internal consistency, Cronbach\'s ? of 0.78 for both domains were found. Moderate (0.40

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Wiesinger, Birgitta. "On the relationship between spinal pain and temporomandibular disorders." Doctoral thesis, Umeå universitet, Klinisk oral fysiologi, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-31240.

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Both spinal pain and temporomandibular disorders (TMD) commonly occur in the general population. Previous studies demonstrate neurophysiologic and biomechanical couplings between the trigeminal and cervical regions. This investigation tested the null hypothesis of no relationship between spinal pain (neck, shoulder and/or low back) and TMD, by using questionnaires and clinical examinations of the jaw function. In an age- and sex-matched case-control study, the specific aim was to compare the prevalence of signs and symptoms of TMD among cases with long-term spinal pain and controls without spinal pain. The results showed that subjects with spinal pain had signs and symptoms of TMD significantly more often than did controls. The associations remained after excluding all participants with jaw pain. Furthermore, the comorbidity pattern was similar, regardless of location of spinal pain. In a cross-sectional study, the specific aim was to test whether there is a reciprocal cross-sectional dose-response-like relationship between spinal pain and TMD. Two different designs were used, one with frequency/severity of spinal pain as independent variable, and the other, with frequency/severity of TMD symptoms as independent variable. The analysis showed increasing odds for presence of TMD symptoms with increasing frequency/severity of spinal pain, and increasing odds for presence of spinal pain with increasing frequency/severity of TMD symptoms. In a case-control study within a 2-year prospective cohort, the specific aim was to test whether there is a reciprocal temporal relationship between signs and symptoms in trigeminally, and symptoms in spinally, innervated areas. Incidence of symptoms in these areas was analyzed in relation to presence of spinal pain, headaches, and signs and symptoms of TMD at baseline. The main findings were that presence of signs of TMD at baseline increased the onset of spinal pain and symptoms in the trigeminal area, and that spinal pain increased the onset of symptoms in the trigeminal area. An augmentation effect between the significant baseline variables was observed for the incidence of headaches and jaw pain. In conclusion, the investigation demonstrated a cross-sectional and temporal relationship between spinal pain and TMD; thus, the null hypothesis was rejected. The results indicate common pathophysiological mechanisms in the development of spinal pain and TMD. The comorbidity and reciprocal influence that were found call for an integrated and multidimensional approach in the management of individuals with long-term spinal pain and TMD.

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Bisegna, Nicola Moreno. "Influência do stress nas disfunções temporomandibulares." Master's thesis, [s.n.], 2015. http://hdl.handle.net/10284/5273.

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Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária
O stress, influenciando a função muscular e estando presente em pacientes com alta percepção de sintomatologia somática, é um factor etiológico de maior importância na fisiopatologia das disfunções temporomandibulares (DTMs). O facto de o stress estar associado a comorbidades tais como ansiedade e depressão pode influenciar o tratamento das DTMs. Pacientes com DTMs crónicas podem apresentar características cognitivas e comportamentais associadas à presença de stress psicossocial, indicadoras da incapacidade de adaptação a agentes stressantes e da presença estratégias de coping mal adaptativo. Os objectivos desta revisão narrativa da literatura são a exposição do papel do stress nas DTMs e a avaliação das necessidades de tratamento relativamente aos níveis de stress psicossocial apresentados pelos pacientes, incluindo a necessidade de decisão por tratamentos multidisciplinares. Nesta revisão bibliográfica foram utilizados livros e artigos científicos, a pesquisa bibliográfica foi efectuada nos sítios “MEDLINE/PubMed”, “Science Direct” e “B-on” e utilizaram-se combinações das palavras-chave “Stress”, “Physiology”, “HPA”, “TMD” e “Temporomandibular Disorders”, “Personality”, “Coping”, “Orofacial Pain”. Não foram impostos limites temporais relativamente ao ano de publicação mas a pesquisa resultou limitada às fontes em inglês, português e italiano. Em conclusão, na abordagem terapêutica das DTMs é necessário avaliar não só os sinais e sintomas físicos do paciente, bem como, os psicológicos, avaliando o comportamento deste perante a doença e a interferência desta na qualidade de vida dos pacientes. Só dessa forma é possível estabelecer um plano de tratamento adequado ao paciente motivando-o à adesão.
Stress, due to its influence on muscular function and by being present in patients with high somatic symptoms perception, is a major etiological factor in the temporomandibular disorders (TMDs). TMDs treatment could be affected by stress comorbidities like depression and anxiety. Patients with chronic TMDs can present cognitive and behavioral characteristics associated to psychosocial stress, underlining the inability to adapt to stressors and the use of maladaptative coping strategies. The objectives of this narrative literature review are the exposition of the role of stress in TMDs and the evaluation of the needs for treatment related to the degree of psychosocial stress presented by the patient, including the decision to need a multidisciplinary approach or not. In this bibliographic review books and scientific articles have been used. The bibliographic research was made on the websites “MEDLINE/PubMed”, “Science Direct” and “B-on” using the keyowrds “Stress”, “Physiology”, “HPA”, “TMD” and “Temporomandibular Disorders”, “Personality”, “Coping”, “Orofacial Pain”. No temporal restrictions related to the publication years have been imposed but the language of the sources has been limited to English, Portuguese and Italian. In conclusion, in the TMDs therapeutic approach is needed to evaluate not only the physical, but also the psychological signs and symptoms, evaluating the illness behaviors and the interference of the illness in the quality of life of the patient. Only in this way is possible to establish a treatment plan appropriate for the patient and motivate him to adhere.

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Jussila, P. (Päivi). "Prevalence and associated risk factors of temporomandibular disorders (TMD) in the Northern Finland Birth Cohort (NFBC) 1966." Doctoral thesis, Oulun yliopisto, 2019. http://urn.fi/urn:isbn:9789526222332.

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Abstract Temporomandibular disorders (TMD) are described as a variety of dysfunctions and pains related to the masticatory system. Clicking in the temporomandibular joints (TMJs) and pain in the masticatory muscles are the most common symptoms and signs of TMD. Other frequently reported symptoms are headache, facial pain, and symptoms in the ears. The prevalence of TMD signs in the adult population has been shown to vary between 33% and 86%, being more common in women than in men. TMD has been found to be most prevalent at 20–50 years of age. The aim of this cross-sectional study was to investigate the prevalence of TMD and associated risk factors in the Finnish adult population based on the Northern Finland Birth Cohort (NFBC) 1966. Altogether 1 962 cohort subjects at the age of 46 years (1 050 women, 912 men) responded to questionnaires and participated in a clinical medical and dental examination in 2012–2013. The stomatognathic examination was performed according to a modified protocol of diagnostic criteria for TMD (DC/TMD). The prevalence of TMD signs among the examined cohort subjects was 34.2%; women had clinical signs of TMD more often than men. Clinical signs were registered more often than self-reported TMD symptoms. The most common clinical signs were clicking in the TMJs (26.2%) and palpation pain in the masticatory muscles (11.2%). The most common diagnosis was disc displacement with reduction (7.0%). TMD signs were associated with unstable occlusion. Occlusal disturbances were associated with palpation pain in the masticatory muscles, as well as myalgia and arthralgia diagnoses. Pain-related TMD symptoms and clinical signs correlated strongly with a poor self-reported health condition as well as with painful general health problems
Tiivistelmä Purentaelimistön toimintahäiriöt (engl. temporomandibular disorders, TMD) on yhteisnimitys leukanivelten, puremalihasten, hampaiston ja niihin liittyvien kudosten sairaus- ja kiputiloille. Leukanivelen naksuminen ja kipu purentaelimistön alueella ovat tavallisimmat oireet, mutta myös päänsärky, kasvokipu ja korvaoireet ovat yleisiä TMD-potilailla. Väestötutkimuksissa on havaittu suurta vaihtelua TMD:n esiintyvyydessä (33–86 %). TMD:n oireita sekä löydöksiä todetaan tavallisimmin 20–50-vuotiailla ja naisilla enemmän kuin miehillä. Tutkimuksen tarkoituksena oli selvittää TMD:n esiintyvyyttä ja riskitekijöitä suomalaisessa aikuisväestössä Pohjois-Suomen syntymäkohortti 1966:n (Northern Finland Birth Cohort, NFBC) aineistossa. Vuosina 2012–2013 tutkittiin 1 962 kohortin henkilöä 46 vuoden ikäisinä (1 050 naista, 912 miestä). Tutkimus koostui kyselyistä sekä lääketieteellisestä ja suun terveydentilan kliinisestä tutkimuksesta. Purentaelimistön tutkimuksessa käytettiin kansainvälistä TMD:n diagnostista kriteeristöä (engl. diagnostic criteria for TMD, DC/TMD). TMD-löydösten esiintyvyys tutkitussa kohorttiaineistossa oli 34,2 %. Kliiniset löydökset tutkituilla henkilöillä olivat yleisempiä kuin heidän raportoimansa oireet. Yleisimmät löydökset olivat leukanivelen naksuminen (26,2 %) ja palpaatiokipu puremalihaksissa (11,2 %). Yleisin diagnoosi oli leukanivelen välilevyn palautuva virheasento (7,0 %). TMD-löydösten ja epästabiilin purennan välillä havaittiin yhteys. Purennassa olevien häiriöiden ja puremalihasten palpaatiokivun sekä leukanivelkivun välillä todettiin selvä yhteys. TMD-löydöksillä ja niihin liittyvillä kivuilla havaittiin tilastollisesti merkitsevä yhteys koettuun heikentyneeseen terveydentilaan sekä kivuliaisiin yleissairauksiin

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Barnabei, Tabitha Richards. "Association of Masseter Muscle PITX2, ENPP1 and ESR1 Expression, Muscle Fiber Type, Temporomandibular Joint Disorders and Subclassifications of Craniofacial Asymmetry." Master's thesis, Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/454652.

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Oral Biology
M.S.
Craniofacial asymmetry is a dentofacial deformity with genetic influences. The genes PITX2, ENPP1 and ESR1 have multiple genetic associations with functional properties in muscle and bone. The objectives of this study are to investigate how PITX2, ENPP1 and ESR1 gene expression associates with four subclassifications of craniofacial asymmetry, temporomandibular disorders and fiber type differences compared between right and left masseter muscles. We developed an asymmetry classification that diagnosed four types of asymmetry with distinctive growth patterns: Group 1 – menton deviation without ramal difference (“mandibular body asymmetry”); Group 2 –menton deviation with shorter ramal height on the deviated side (“typical asymmetry”); Group 3 – shorter ramal height on the opposite side of menton deviation (“atypical asymmetry”); Group 4 – menton deviation with shorter ramal height and maxillary canting on the deviated side (“C-shaped asymmetry”). Some of these patients are at high risk for TMD; therefore, temporomandibular joint functioning is assessed as a routine part of the pre-surgical evaluation. TMD was diagnosed using the Diagnostic Criteria for TMD (DC/TMD). The clinical examination includes mandibular range of motion, palpation for pain, joint noise and bruxism. In addition, the Jaw Pain and Function (JPF) questionnaire was used to assess patient reported symptoms as an indication of perceived severity before and one year after orthognathic surgery. Masseter muscle samples were collected from 174 subjects undergoing surgical treatment for correction of malocclusion. Muscle serial cross-sections were mounted for immunostaining with five antibodies specific for myosin heavy chain (MyHC) isoform. We classified masseter fibers into 4 fiber type groups: type I, type I/II hybrid, type IIA and/or IIX, neonatal and atrial. With the remaining muscle samples, total RNA was isolated and PITX2, ENPP1, and ESR1 expression was quantified using TaqMan qRT-PCR. Average relative quantity gene expression values and percent differences between left and right masseter samples were calculated. In this population, there is a high prevalence of facial asymmetry (48%). Pre-surgical mean JPF scores are significantly different between symmetric (JPF=1.97) and asymmetric (JPF=6.9; p<0.001) patients; with scores ≥ 6 diagnostic for presence of TMD. ENPP1 and ESR1 expression is differentially expressed between right and left masseter muscle in patients with asymmetry. ENPP1 is differentially expressed in asymmetry group 4 (p=0.01) and ESR1 is differentially expressed in asymmetry group 1 (p=0.048), group 2 (p=0.004) and group 4 (p=0.02). Masseter fiber type properties of type I, type I/II hybrid and type II fibers associate with facial asymmetry and specific subclassifications, suggesting functional differences between type I, type I/II and type II fibers may be important factors in the development of symmetry between facial sides. There are significant differences in the left-right percent differences of fiber area of type I fibers in asymmetry group 3 (p=0.05), type I/II hybrid fibers in group 3 (p=0.02), and type II fibers in asymmetric patients (p=0.03), asymmetry group 2 (p=0.05) and group 4 (p=0.005). Additionally, there are significant differences in the left-right percent differences of percent occupancy of type I fibers in asymmetric patients (p=0.04), asymmetry group 2 (p=0.01) and group 3 (p=0.05) and type II fibers in asymmetry group 2 (p=0.04). By comparing gene expression with masseter muscle fiber type properties, we found significant results for PITX2 and ENPP1 suggesting their roles as genetic factors influencing jaw bone length and masticatory muscle strength in malocclusion. There are significant positive correlations between left-right percent differences of PITX2 and type I fiber area (r=0.86; p=0.03), type I/II hybrid fiber area (r=0.94; p=0.006), and type I/II hybrid fiber percent occupancy (r=0.90; p=0.01). Also, there are positive correlations approaching significance between left-right percent differences of ENPP1 and type I fiber area (r=0.80; p=0.06) and type I/II hybrid fiber area (r=0.75; p=0.09). Given the high prevalence of TMD in a population of patients with facial asymmetry, we compared differences in gene expression in masseter muscle of patients with specific TMD diagnostic conditions. Average PITX2 expression is significantly increased (p=0.0375) and average ENPP1 is increased, but not significantly, in all TMD patients diagnosed by the clinician. Average ESR1 is slightly increased compared to JPF scores and may be an essential factor for patient reported TMD symptoms. With these results, PITX2, ENPP1, and ESR1 should be considered biomarkers for asymmetry and TMD; however, further studies are needed to provide a more thorough understanding of the genetic influences on the craniofacial complex.
Temple University--Theses

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Anacleto, Mateus Aparecido. "Avaliação da amplitude dos movimentos mandibulares por um sistema de ultrassom 3D no pré e pós tratamento de indivíduos com disfunção temporomandibular." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/58/58133/tde-14072015-095202/.

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Disfunções Temporomandibulares e Dor Orofacial ou DTM, referem-se a um conjunto de alterações funcionais e/ou estruturais que se manifestam nas articulações temporomandibulares (ATMs), nos músculos da mastigação e nas estruturas associadas que compõem o aparelho mastigatório (Okeson, 2013). A DTM tem o potencial de não só interferir nas atividades funcionais do sistema estomatognático, mas também de afetar o comportamento social e psicológico do indivíduo. Este trabalho avaliou a amplitude dos movimentos mandibulares e a dor a palpação muscular no pré e pós-tratamento de participantes com DTM. Os participantes incluídos na pesquisa responderam ao Research Diagnostic for Temporomandibular Dysfunction (RDC/TMD) para viabilizar a formulação do diagnóstico de DTM e qualificar a dor a palpação dos músculos faciais, e submetidos à análise dos movimentos através de uma análise 3D, o JMA que avalia os movimentos mandibulares por vias ultrassônicas, no pré e póstratamento com placa estabilizadora por 30 e 60 dias. Os participantes foram reavaliados, com o objetivo de saber se haverá uma melhora na amplitude dos movimentos mandibulares pela abertura, lateralidades e protrusão e da movimentação condilar dentro da cavidade articular no plano sagital e frontal. Os resultados demonstraram não ter diferenças estatísticas na maior parte dos movimentos excursivos mandibulares (abertura, lateralidade e protrusão) avaliados tanto pelo sistema de ultrassom JMA quanto pelo exame do RDC/TMD. Na análise descritiva dos resultados obtidos através da palpação dos músculos na aplicação do RDC/TMD observamos uma grande melhora no quadro clinico de dor a palpação após 60 dias de uso da Placa Oclusal estabilizadora. Também não observamos diferenças estatisticamente significantes entre os dados coletados de amplitude dos movimentos pelo sistema informatizado JMA e pelo questionário RDC/TMD, ou seja, podemos afirmar que a avaliação pelo JMA é precisa e confiável.
Temporomandibular Disorders and Orofacial Pain or TMD, refer to a set of functional and / or structural changes that are manifested in the temporomandibular joints (TMJ) in the masticatory muscles and associated structures that make up the masticatory system (Okeson, 2013). The TMD has the potential to not only interfere with the functional activities of the stomatognathic system, but also affect the social and psychological behavior of the individual. This study evaluated the range of mandibular movements and muscle palpation pain in the pre and post-treatment of participants with TMD. Participants included in the study responded to the Research Diagnostic for Temporomandibular Dysfunction (RDC / TMD) to allow the formulation of a diagnosis of TMD and qualify pain palpation of the facial muscles, and subjected to analysis of movement through 3D JMA assessing movements mandibular by ultrasonic means, before and after treatment with stabilizing plate for 30 and 60 days. Participants were reassessed in order to know if there will be an improvement in the range of mandibular movements for opening, laterality and protrusion and condyle movement within the joint cavity in the sagittal and frontal plane. The results showed no statistical differences have in most excursive mandibular movements (opening, lateral and protrusive) assessed both by JMA ultrasound system as the examination of the RDC / TMD. In the descriptive analysis of the results obtained by palpation of the muscles in the application of the RDC / TMD noticed a great improvement in the clinical picture of pain palpation after 60 days of use board stabilizing occlusal. We did not observe statistically significant differences between the data collected from the range of motion by the computerized system JMA and the questionnaire RDC / TMD, other words, we can say that the evaluation by the JMA is accurate and reliable.

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Walber, Luiz Fernando. "Estudo sobre a validade diagnóstica e prognóstica dos critérios de diagnóstico para pesquisa das desordens temporomandibulares (RDC/TMD)." Pontifícia Universidade Católica do Rio Grande do Sul, 2008. http://hdl.handle.net/10923/574.

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The primary objective of this study was to determine, in our cultural background, the validity of the RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders) as a diagnostic tool for patients with temporomandibular disorders. Sixty nine patients with TMD and 70 subjects from the control group, all females, underwent the RDC/TMD and were compared in a case-control study. The second objective was to verify the prognostic validity of the RDC/TMD in a longitudinal treatment outcome study. Patients with TMD underwent conservative treatments (bite-splints and occlusal adjustment, etc. ) according to the treating clinician, who was blind to all RDC/TMD results. These patients were recalled after six months for a re-evaluation of orofacial pain intensity. The improvement criteria for patients to be included in the responding group (rTMD) was a 30% reduction in pain intensity at rest as compared to baseline using Visual Analogue Scales (VAS). The results were also compared to a patient’s self-assessment scale (better/same/worse) to determine the degree of reliability. Patients who improved were included in Group I (rTMD). Those who did not improve (nonresponding TMD) were part of Group II (nrTMD). Asymptomatic controls were included in Group III. The database and statistical analyses were made in the SPSS version 11. 5 for Windows. The variables were both categorical/recoded as well as continuous; therefore, both parametric (Student’s t test, two-sided test, ANOVA, P<0. 05) and non-parametric (Pearson’s Chi-Square, Fisher’s exact test, two-sided test, P<0. 05) tests were used. The results comparing TMD patients versus controls have shown that 57. 1 % of patients in the test group were diagnosed with miofascial pain.Disk intereference with reduction was observed in 24. 3 % of temporomandibular joints on the left side and in 18. 6 % of those on the right side. The diagnosis of arthralgia was identified in 61. 4% of joints on the left side as well as in 62,9 % of those on the right side. The Chronic Pain Grade was of mild intensity for 60. 9% of patients, and the Chronic Pain Intensity was 66. 9 on average for the test group and 0. 01 for controls. The Disability Points was moderate for 20% of the test group. The average depression score was 1. 02 in the test group and 0. 56 in the control one. Depression was moderate for 40% of patients as well as for 22. 9% in controls. Somatization with pain was 1. 25 on average for TMD patients and 0. 44 in controls. Moderate somatization with pain was found in 30% of TMD patients and 27. 5% in controls. Somatization without pain was 1. 12 on average for the test group and 0. 35 in the control group. Moderate somatization without pain was observed in 25. 7 % in patients and 24. 3 % in controls. The results have shown statistically significant difference between TMD patients and controls. However, when we compare responding versus non-responding TMD patients, no significant difference was observed for any of the items studied. Therefore, it is concluded that the diagnostic validity was positive, but not the prognostic one.
O primeiro objetivo deste estudo foi determinar, no nosso meio, a validade dos Critérios de Diagnóstico de Pesquisa das Desordens Temporomandibulares RDC/TMD como fator de diagnóstico em pacientes com desordens temporomandibulares. Sessenta e nove pacientes com DTM e 70 pessoas do grupo-controle, todas do gênero feminino, foram submetidas aos Critérios de Diagnóstico de Pesquisa das Desordens Temporomandibulares (RDC/TMD) e comparados em um estudo caso-controle. O segundo objetivo foi o de verificar a validade prognóstica do RDC/TMD através de um estudo longitudinal tipo resultado de tratamento. As pacientes com DTM foram submetidas a tratamento por meio de dispositivos - placas de mordida e/ou ajuste oclusal, etc. , da maneira que o clínico responsável julgou necessário, o qual foi “cego” a todos os resultados do RDC/TMD. Estas pacientes foram chamadas seis meses após o tratamento realizado para a reavaliação da intensidade de dor orofacial. O critério de melhora clínica para que as pacientes com DTM pudessem ser incluídas no grupo de respondentes ao tratamento (rDTM), foi uma redução de 30% na intensidade da dor sobre a avaliação de dor em repouso no início do tratamento, utilizando-se escalas visuais análogas (VAS). Os resultados foram comparados com a auto-avaliação da paciente (melhor/igual/pior) para determinar o grau de confiabilidade dos resultados. As pacientes que melhoraram foram incluídas no Grupo 1a (rDTM). Aquelas que não melhoraram fizeram parte do Grupo 1b (nrDTM) e os assintomáticos foram incluídos no Grupo 2. A base de dados e a análise estatística foram realizadas no programa SPSS versão 11. 5 para Windows®.As variáveis foram ambas categóricas/recodificadas e contínuas; portanto, tanto testes não-paramétricos (Pearson’s Chi-Square, Fisher’s exact test, two-sided test, P<0. 05) quanto paramétricos (Student’s t test, two-sided test, ANOVA, P<0. 05) foram empregados. Os resultados comparativos entre pacientes com DTM e controle mostraram que 57,1 % das pacientes do grupo-teste foram diagnosticadas com desordem miofascial. O deslocamento de disco com redução ocorreu em 24,3 % das articulações do lado esquerdo e em 18,6 % das articulações no lado direito. O diagnóstico de artralgia foi estabelecido em 61,4% nas articulações do lado esquerdo e em 62,9 % nas articulações do direito. O grau de dor crônica foi de média intensidade para 60,9 %, a incapacidade por dor crônica foi em média de 66,9 para o grupoteste e de 0,01 para o grupo-controle. A incapacidade foi moderada para 20 % do grupo-teste. A depressão média foi de 1,02 no grupo-teste e de 0,56 no grupo-controle. A depressão foi moderada para 40 % das pacientes do grupo-teste e para 22,9 % no grupo-controle. A somatização com dor foi em média de 1,25 no grupo-teste e de 0,44% no grupo-controle. Ela foi moderada para 30 % das pacientes do grupo-teste e 27,5 % no grupo-controle. A somatização sem dor foi em média de 1,12 no grupo-teste e de 0,35 no grupo-controle. A somatização moderada ocorreu em 25,7 % das pacientes do grupo-teste e em 24,3 % no grupo-controle. Os resultados apresentaram diferenças estatísticamente significativas entre os grupos teste e controle. Ao comparar as pacientes respondentes e não respondentes ao tratamento da DTM não foram evidenciadas diferenças estatísticamente significantes para qualquer um dos ítens estudados. Portanto, concluiu-se que a validade de diagnóstico foi positiva, mas a validade prognostica foi negativa.

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Gonçalves, Maria Claudia. "Frequência e severidade da disfunção temporomandibular em mulheres com migrânea e migrânea crônica." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/17/17142/tde-06072015-081733/.

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A Migrânea e a Disfunção Temporomandibular (DTM) são doenças crônicas e tem como aspecto mais importante a dor crônica. Muitos trabalhos descrevem sinais e sintomas de DTM em pacientes com cefaleia sugerindo uma associação entre essas duas condições. Porém, ainda são poucos os trabalhos que utilizaram um critério que fornecesse não apenas sinais e sintomas, mas também a classificação diagnóstica. Assim, o objetivo deste trabalho foi avaliar a frequência da DTM a partir da aplicação do RDC/TMD e a severidade da DTM através do Índice Anamnésico de Fonseca em mulheres com Migrânea, Migrânea Crônica e mulheres sem queixa de cefaleia. Participaram deste estudo 91 mulheres, divididas em três grupos: 30 mulheres no Grupo Controle (GC), 38 mulheres no Grupo Migrânea (GM) e 23 mulheres no Grupo Migrânea Crônica (GMC). As voluntárias dos grupos GM e GMC foram selecionadas durante a primeira consulta no Ambulatório de Cefaleia (ACEF) do Hospital das Clínicas de Ribeirão Preto da Faculdade de Medicina da Universidade de São Paulo e as do GC entre as acompanhantes dos pacientes naquele mesmo dia. Foram inclusas voluntárias com idade entre 18 e 55 anos, que não tivessem ingerido antiinflamatórios e/ou analgésicos nas últimas 24 horas antecedentes à avaliação fisioterapêutica, que não tivesse história de trauma na face, nem usasse prótese dentária parcial ou total e foram excluídas voluntárias com outros tipos de cefaleia e doenças sistêmicas como fibromialgia e artrite reumatóide. Para o GC, as voluntárias não podiam ter queixa de cefaleia nos últimos 3 meses. Três examinadores participaram da coleta. Para análise dos dados foi utilizado a análise da variância (ANOVA two-Way p<0,05) na comparação dos dados antropométricos e da amplitude de movimento mandibular entre os três grupos e Tukey como post-hoc análise para avaliar a diferença no número de locais dolorosos e o número de diagnósticos, com nível de significância de (p<0,05). O teste qui-quadrado foi utilizado para verificar a diferença de diagnóstico entre os três grupos e para verificar a freqüência da severidade entre os três grupos foi utilizado o teste exato de Fisher. As voluntárias dos grupos com migrânea apresentaram maior frequência de diagnósticos de DTM em comparação ao GC, p<0,05 e não foi observada diferença entre os grupos com migrânea. Os diagnósticos, segundo o RDC/TMD, do grupo I (dor miofascial) foram os mais prevalentes nos três grupos estudados e foi mais freqüente nos grupos com migrânea. Os diagnósticos dos grupos I+III estiveram presentes nos três grupos estudados e com maior freqüência no grupo GM. Não foram encontrados diagnósticos individuais pertencentes apenas aos grupos II e III. O número de pontos dolorosos musculares foi significativamente maior nos grupos GM e GMC em relação ao controle e não houve diferença entre os grupos com GM e GMC. As voluntárias dos grupos com migrânea apresentaram maiores graus de severidade de DTM, em comparação ao GC, p<0,05 e o GMC apresentou maior severidade que o GM. Os resultados deste trabalho demonstraram que Mulheres com Migrânea tem maior frequência de DTM, apresentam maior número de diagnósticos e de pontos dolorosos segundo o RDC/TMD que mulheres sem migrânea bem como maiores graus de severidade de DTM. Portanto a DTM e a Migrânea estão clinicamente relacionadas.
Migraine and Temporomandibular Disorders (TMD) are chronic disorders and their most important aspect is the chronic pain. The persistent cranial-cervical and orofacial pain is the predominant reason why people seek treatment. Besides the pain, the affected areas are also similar suggesting an association between these two conditions. Many studies describe signs and symptoms of TMD in patients with headache suggesting an association between these two conditions. However, there are few studies that use a criterion that provides not only signs and symptoms, but also the diagnostic classification. The Diagnostic Criteria for Research in Temporomandibular disorders (RDC / TMD) provide a diagnostic classification with reports of acceptable levels of reliability, provide specifications for the conduct of a clinical standard and allow the development of clinical diagnoses (Axis I), the classification psychosocial classification of the individual (Axis II). The objective of this study was to evaluate the frequency of the DTM from the application of the RDC / TMD and TMD severity through the history index of Fonseca in women with migraine, chronic migraine and women with complaints of headache. The study included 91 women, divided into three groups: 30 women in the control group (CG), 38 women in the migraine group (GM) and 23 women in Chronic Migraine Group (CMG). The voluntary groups GM and GMC were selected during the first appointment and at the Headache Clinic (ACEF) of the University Hospital of Ribeirão Pretos Faculty of Medicine, (University of São Paulo) and the ones of CG were selected among the companions of the patients during that day. There were included volunteers aged between 18 and 55, who had not ingested anti-inflammatory and / or painkillers in the last 24 hours before the physical therapy evaluation and who didnt have a history of face trauma, or wore partial or total dentures and volunteers with other types of headache and systemic diseases such as fibromyalgia and rheumatoid arthritis were excluded. For the GC, the volunteers could not have complained of headache in the last 3 months. Three examiners participated in data collection, I and II in the initial screening of volunteers and III in the implementation of the RDC / TMD and the history index of Fonseca, the examiner III was blind to the conditions of the volunteers and was previously trained. In order to analyze the Data it was used analysis of variance (two-way ANOVA p <0.05) in comparison of anthropometric data and range of mandibular movement between groups and Tukey as posthoc analysis to evaluate the difference in the number of painful sites and the number of diagnoses, with a significance level of p <0.05. The chi-square test was used to determine the difference in diagnosis between the three groups and to determine the frequency of severity among the three groups used the Fisher exact test. The voluntary group with migraine showed a higher frequency of diagnosis and higher severity of TMD in comparison to the CG, p <0.05 and no difference was observed between the groups with migraine.

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Galhardo, Alessandra Pucci Mantelli. "Disfunção temporomandibular em mulheres climatéricas: sensibilidade dolorosa, risco oferecido pela massa óssea sistêmica e diagnóstico feito pelo RDC/TMD comparado à ressonância magnética (3,0 Tesla)." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/23/23150/tde-18062011-102133/.

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O aumento da expectativa de vida tem despertado o interesse de pesquisas, com o intuito de proporcionar um envelhecimento saudável e de qualidade. Segundo dados do último censo realizado pelo IBGE em 2010, a população brasileira é composta por 97.342.162 mulheres, das quais se estima que cerca de 30 milhões estejam entre os 40 e 65 anos de idade, período que inclui o climatério. Portanto, condições clínicas como a osteoporose se tornam relevantes, tanto sob o ponto de vista de política de saúde pública, quanto em relação ao aspecto social, por comprometer a qualidade de vida. As mulheres também sofrem mais por disfunção temporomandibular (DTM) do que os homens, sendo que o início desse quadro se dá a partir da puberdade, com picos durante o período reprodutivo e remissão após a menopausa. O envolvimento dos hormônios sexuais femininos na osteoporose já está bem definido, porém sua participação na DTM ainda é motivo de controvérsias. Assim, esse trabalho se propôs a investigar o papel da massa óssea sistêmica de mulheres climatéricas como fator de risco para DTM articular, bem como o comportamento da dor por DTM nos períodos da transição para menopausa (entre 48 e 55 anos), pós-menopausa (de 56 a 65 anos) e senescência (de 65 a 70 anos). Para tanto, 100 mulheres atendidas pelo Setor de Climatério da Divisão de Ginecologia do HC FMUSP foram avaliadas clinicamente pelo Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), visando obter os diagnósticos e suas associações, bem como quantificar o grau de sensibilidade dolorosa por DTM, por meio do Índice Craniomandibular (ICM), ambos aplicados por uma única examinadora. As densitometrias ósseas forneceram os dados sobre a massa óssea do colo do fêmur e da coluna lombar (L1-L4). O desempenho do RDC/TMD como teste diagnóstico também foi alvo de análise, considerando a ressonância magnética de 3,0 Tesla como padrão de referência, ao submeter 30 mulheres, das 100 avaliadas, a esse exame de imagem. Após análise dos resultados, constatou-se que o risco oferecido pela osteopenia foi de 1,33 (IC95% 1,20 1,46), com aumento nesse risco de 0,33, enquanto a osteoporose demonstrou risco de 1,39 (IC95% 1,23 1,55), aumentado em 0,39. Houve predominância de diagnósticos articulares (68,0%), enquanto 18,0% foi de diagnósticos musculares e 14,0% correspondeu à ausência de condições clinicamente diagnosticáveis, segundo o RDC/TMD. O desempenho do RDC/TMD para diagnosticar a DTM articular revelou acurácia de 68,0%, sensibilidade de 83,0%, especificidade de 53,0%, probabilidade pré-teste de 52,0%, valor preditivo positivo de 60,0% e negativo de 74,0%, razão de verossimilhança positiva de 1,77 e negativa de 0,32. Quanto à sensibilidade dolorosa por DTM, constatou-se que, com o avançar da idade houve clara tendência à sua diminuição (A=-4,5; p=0,0324). Concluiuse, então, que a diminuição dos hormônios sexuais femininos, peculiar ao envelhecimento, aumenta o risco à DTM articular, embora a dor por essa disfunção diminua com a idade. O RDC/TMD pode ser empregado para rastreamento de grandes populações, mas sua indicação na prática clínica deve ser feita com cautela.
Increased life expectancy has attracted research attention, interested in provide a quality and healthy aging. According to the latest census conducted in 2010 by IBGE, Brazilian population consists of 97,342,162 women, whom estimates 30 million are between 40 and 65 years old, a period that includes the climacteric. Therefore, clinical conditions such as osteoporosis becomes significant, either from public health policy standpoint or in relation to the social aspect, by compromising life quality. Women also suffer more from temporomandibular disorders (TMD) than men, and the beginning of this situation occurs after puberty, with peaks during the reproductive and remission periods after menopause. Female sex hormones involvement in osteoporosis is well established, but their participation in the TMD is still controversial. Thus, this study aims to investigate the role of systemic bone mass in menopausal women as a risk factor for articular TMD, as well as the TMD pain behavior during menopause transition periods (48 to 55 years), postmenopausal (56-65 years) and senescence (65-70 years). Therefore, 100 women attended by the HC - FMUSP Gynecology Division, Climacteric Sector, were clinically evaluated by the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), used to obtain diagnoses and their associations, as well as to quantify the TMD pain sensitivity degree through the Craniomandibular Index (CMI), both applied by a single examiner. The bone densitometry provided bone mass data of femoral neck and lumbar spine (L1-L4). The RDC/TMD performance as a diagnostic test also was subjected to analysis, considering the 3.0 Tesla magnetic resonance imaging as reference standard, undergoing 30 women, of 100 assessed, in this imaging exam. After analyzing the results, it was shown that the risk posed by osteopenia was 1.33 (IC95% 1.20 1.46), with a risk increase of 0.33, while the risk of osteoporosis showed 1.39 (IC95% 1,20 1.23 to 1.55), increased by 0.39. Joint diagnoses predominated (68.0%), while 18.0% muscular diagnoses and 14.0% corresponds to the absence of clinically diagnosable conditions, according to the RDC/TMD. The performance of the RDC/TMD to diagnose articular DTM revealed accuracy of 68.0%, sensitivity of 83.0%, specificity 53.0%, pre-test probability of 52.0%, positive predictive value of 60.0 % and negative 74.0%, positive likelihood ratio of 1.77 and negative 0.32. As for the soreness sensibility in TMD, it was found that aging shows a clear tendency towards its reduction (A =- 4.5, p = 0.0324). Then, the study concluded that the decrease in female sex hormones, peculiar to aging, increases the risk of articular TMD, although this pain disfunction decreases with age. The RDC/TMD can be used for large populations screening, but its indication in clinical practice should be done with caution.

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Krooks, L. (Laura). "Malocclusions in relation to facial soft tissue characteristics, facial aesthetics and temporomandibular disorders in the Northern Finland Birth Cohort 1966." Doctoral thesis, Oulun yliopisto, 2018. http://urn.fi/urn:isbn:9789526220109.

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Abstract Epidemiological studies on malocclusions in Finland have so far concentrated on children and adolescents. Regarding the Finnish adult population, there is scarce epidemiological knowledge available on malocclusions even though the number of adults seeking orthodontic treatment has increased during the last decades. Occlusion is an important factor in the function of the masticatory system, and its role in the aetiology of temporomandibular disorders (TMD) is one of the most disputed topics in dentistry. Malocclusions can affect the characteristics of the facial soft tissue profile. The aim of the study was to investigate the prevalence of malocclusions and the role of occlusion in TMD as well as the association of facial characteristics with malocclusions and facial aesthetics. The study population consisted of subjects from the Northern Finland Birth Cohort 1966 (NFBC1966). Data were collected using questionnaires, standardized clinical examination and facial photos. The profile photographs were analysed using linear and angular soft tissue cephalometric measurements. The most common malocclusion in the NFBC1966 subjects was lateral crossbite. This study showed a significant association between asymmetric malocclusions and TMD. TMD signs associated significantly with lateral crossbite, scissors bite, negative overjet, and the length and lateral deviation in slide between retruded contact position and intercuspal position (RCP-ICP). Soft tissue profile characteristics were highly correlated with negative overjet. The ANB-angle was significantly associated with the perception of facial attractiveness. In conclusion, malocclusions were associated with signs and symptoms of TMD in the Finnish adult population. Overjet appeared to affect the facial profile more than overbite. Facial convexity seemed to be a more important determinant of facial aesthetics for orthodontists than for dentists and laypersons
Tiivistelmä Suomalaiset epidemiologiset tutkimukset purennan poikkeamista ovat tähän asti keskittyneet tarkastelemaan lapsia ja nuoria. Tarkkaa epidemiologista tietoa suomalaisen aikuisväestön purennan poikkeamista on tällä hetkellä saatavilla vain niukasti, vaikka oikomishoitoon hakeutuvien aikuispotilaiden määrä on Suomessa viime vuosina lisääntynyt. Purennalla on tärkeä merkitys purentaelimistön toiminnassa ja sen rooli purentaelimistön toimintahäiriöiden (TMD) etiologiassa on yksi kiistanalaisimpia aiheita hammaslääketieteessä. Purennan poikkeamat voivat vaikuttaa myös kasvojen pehmytkudosprofiilin piirteisiin. Tutkimuksen tarkoituksena oli selvittää purennan poikkeamien esiintyvyyttä ja tutkia kasvojen piirteiden yhteyttä purennan poikkeamiin sekä kasvojen estetiikkaan. Lisäksi tutkittiin purennan poikkeamien yhteyttä TMD:hen. Tutkimusjoukko koostui Pohjois-Suomen syntymäkohortti 1966 -tutkimukseen osallistuneista. Tutkimuksen aineisto kerättiin kyselomakkeiden, standardoidun kliinisen tutkimuksen ja kasvovalokuvien avulla. Profiilivalokuvien analysointi perustui pehmytkudoksen kefalometrisiin lineaari- ja kulmamittauksiin. Tässä tutkimuksessa yleisin purennan poikkeama oli sivualueen ristipurenta. Asymmetriset purennan poikkeamat olivat merkittävästi yhteydessä TMD:hen; erityisesti sivualueen ristipurenta, saksipurenta, negatiivinen horisontaalinen ylipurenta sekä nivelaseman ja keskipurennan (RCP-ICP) välisen liu’un pituus ja sivuttainen deviaatio. Negatiivisen horisontaalisen ylipurennan todettiin vaikuttavan voimakkaasti kasvojen profiiliin. ANB-kulma oli merkitsevästi yhteydessä kasvojen arvioituun viehättävyyteen. Purennan poikkeamilla näyttää olevan yhteys TMD:n oireisiin ja kliinisiin löydöksiin suomalaisessa aikuisväestössä. Horisontaalinen ylipurenta näyttää vaikuttavan kasvojen profiiliin enemmän kuin vertikaalinen ylipurenta. Kasvojen kuperuus painottuu enemmän oikomishoidon erikoishammaslääkärien näkemyksessä kasvojen estetiikasta hammaslääkäreihin ja maallikoihin verrattuna

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Atassi, Mounir. "Mechanical monitoring of inhibitory jaw reflexes in health and simulated dysfunction." Thesis, University of Dundee, 2014. https://discovery.dundee.ac.uk/en/studentTheses/abca297e-8951-447b-8c9e-0bb529d211a9.

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Objectives: Previous studies in the Oral Neurophysiology Laboratories in Dundee have defined the electromyographic properties of the inhibitory jaw reflex that can be evoked in human subjects by electrical stimulation of the lip. This reflex, in contrast with the more widely studied biphasic inhibitory reflexes evoked by stimulation of intra-oral nerves, consists of just a single phase of inhibition and usually requires the application of stimuli which excite nociceptive nerves. The aims of the present studies were to define the mechanical manifestations of this reflex in the form of changes in biting forces, and to investigate whether the mechanical manifestation of the inhibitory jaw reflex evoked by stimulation of the human upper lip, can be modulated by experimentally-controlled conditions that mimic symptoms of a myogenous temporomandibular disorder. Methods: Three series of experiments were performed on 49 volunteer subjects in total. The experiments involved recording bite forces between the anterior teeth and electromyograms (EMGs) from the masseter muscles. Transcutaneous electrical stimuli were applied to the hairy skin of upper lip while the subjects maintained a biting force of around 50N with the aid of visual feedback. In the first series of experiments, a range of electrical stimuli below and above the nociceptive threshold was delivered. In the second set of experiments, double stimuli with a range of different inter-stimulus intervals were applied. Finally in a third series of experiments, electrical stimulation was repeated before, immediately after, and 5 and 10 minutes following a 3-minute accelerated chewing task. This task consisted of chewing 1.5g of a tough chewing gum at 1.5 times the subject’s natural chewing rate and in 18 cases, muscle fatigue and/or pain were reported by the subjects. Results: Following stimulation at intensities that were described as sharp or painful, all the subjects showed both a suppression of the masseter EMG and a reduction of biting force. When analysing the maximum responses in each subject, the mean reduction in the EMG inhibition was to 15.78 ± 14.4% and 10.39 ± 7.92% of the baseline (for the ipsi- and contra-lateral EMGs respectively), whereas the biting force was reduced only to 83.98 ± 11.04% of baseline (+ S.D.). The latencies of onset of these responses were: 38.17 ± 3.58ms, 38.97 ± 4.49ms and 51.83 ± 6.23ms respectively. The response observed in the force record was weaker than in that observed in either EMG (Paired t tests, P < 0.005 in both cases). When applying double stimuli, it was found that the prolongation of the EMG inhibitory jaw reflex (to 144.70 ± 46.93% of the control level) evoked by double stimulation of the upper lip (with a 10 ms inter-stimulus interval) resulted in a greater increase in the depth of the accompanied relaxation (to 223.63 ± 70.88% of that seen in the control responses) compared to a relatively smaller increase in the duration of the relaxation (to 128.32 ± 27.23% of that seen in the control responses). Following the accelerated chewing task, 17 out of 22 subjects reported pain and/or fatigue in one or both of the masseter muscles. The integral for the bite force relaxation significantly decreased in size immediately following the conditioning procedure (to 76.04 ± 35.63% of the control level, P = 0.014; single sample t-test with Bonferroni correction, test value 100). Conclusion: The inhibitory jaw reflex evoked by stimulation of the human lip can be demonstrated mechanically as well as electromyographically although the mechanical version of the response appears less marked. In addition to that, the onset of reflex relaxation in bite force lags several milliseconds behind the corresponding reductions in electromyographic activity. The depth of force relaxation can be increased by increasing the duration of EMG recorded inhibitory reflex. Finally, the results from a chewing task suggest that induced acute pain and/or fatigue cause clear changes in the mechanical manifestation of this inhibitory jaw reflex.

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Eaves, Emery Rose. "TMD Revisited: Appreciating the Work of Illness, the Balancing of Risks, and the Construction of Moral Identity Involved in Dealing with Chronic Pain." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/556810.

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Temporomandibular Disorder(s) (TMD), a common cause of chronic pain affecting the face and jaw, profoundly impacts interactions as fundamental to human existence as smiling, laughing, speaking, eating, and intimacy. Since landmark anthropological research on TMD in the 1990s, considerable changes have occurred in the way TMD is thought about and responded to. Knowledge about TMD among dentists and physicians has increased since publication of the Research Diagnostic Criteria (RDC-TMD), and a well-funded TMJ association now advocates for research and support of the condition. On the other hand, concerns in the medical world about increases in chronic pain and associated risks of misuse of pain medications have increased. Physicians are trained to perform a gatekeeper role, preventing those patients at-risk of becoming drug abusers from gaining access to opioid pain medications. These differing contextual factors and my focus on a group of participants drawn from a complementary and alternative medicine (CAM) trial, rather than from a pain clinic, provide an expanded and updated view of TMD. I present analyses of semi-structured, open-ended interviews with 44 participants interviewed multiple times over the course of their participation in an NIH-funded trial evaluating Traditional Chinese Medicine (TCM) for TMD. In contrast to earlier studies of participants who were consumed by an endless search for diagnosis and treatment, these participants were largely focused on coping and "just dealing with" the daily experience of severe pain. Three articles comprise the body of work presented in this dissertation. Topics include the Works of Illness, the Paradox of Hope, and the construction of moral identity through consumption of over-the-counter (OTC) medications. First, using a "works of illness" framework, I draw attention to the considerable work sufferers undertook to manage competing demands of social and physical risk imposed by chronic pain. I refer to these forms of work as the work of stoicism and the work of vigilance and identify double binds created in contexts that call for both. Multiple voices in the narratives of sufferers are highlighted as essential to the construction of a positive identity in the face of illness. In more in-depth exploration of the work of hope, hope is revealed as a fundamental and paradoxical aspect of autobiographical work. I describe multiple forms of hope in a typology of ways of hoping and raise as an issue the manner in which the paradox of hope--keeping hopes in check while also avoiding despair-- intersects with participant expectations in the trial. I suggest this may have an impact on the placebo effect. Trade-offs between physical harm reduction and reducing potential harm to one's identity produce narratives of harm justification as pain sufferers work to describe their use of OTC medications as minimal and responsible. Sufferers in this study, describing medications as "just over-the-counter" or "not real pain medication" distanced, themselves from association with the addictive potential of prescription pain medications. Participants avoided harm to their identities by consuming OTC pain medications as idioms of self-care. This case study provides important lessons about the experience of chronic pain in the USA. While much attention has been directed at overuse and addiction to pain medication, less has focused on the experience of those soldiering through pain and navigating paradoxes between social and physical demands. This study also directs attention to anthropology's potential contribution to drug trials, to the necessity of studying hope as well as expectations, and to how both impact the placebo response.

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Machado, Maria de Ferraz Almeida e. Peixoto. "Alterações posturais em atividades de lazer/ocupacionais e sua relação com disfunções temporomandibulares." Master's thesis, [s.n.], 2014. http://hdl.handle.net/10284/4352.

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Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária
As alterações posturais que o corpo humano sofre ao realizar atividades diárias, tanto a nível profissional como de lazer, podem influenciar diversas partes do organismo. Um dos sistemas afetados é o sistema estomatognático (SEG), uma vez que os seus componentes interagem de forma direta com a região cervical da coluna vertebral. O objetivo principal deste trabalho de revisão é identificar e fazer um levantamento de conhecimento adquirido no domínio do modo como as características posturais associadas ao uso dos computadores, realização de atividades desportivas (mergulho e ginástica) e de atividades musicais (utilização de instrumentos de cordas e de sopro) podem predispor os indivíduos para sofrerem de disfunções temporomandibulares (DTMs) ou para a presença a de sinais e sintomas das mesmas. Realizou-se uma revisão da literatura utilizando as seguintes palavras-chave: temporomandibular joint disorders, scuba diving, sports and TMD, gymnastic and TMD, joint laxity, hypermobility joint, ergonomic, computer workers, computer work environment, visual display terminal, musicians positions, music and TMD, risk factors, musculoskeletal diseases. The posture changes to which the human body is subject when performing different activities, both professional and leisure, can affect different parts of the organism. One of these is the stomatognathic system, because its components interact directly with the cervical column of the spine. The aim of this review work is to identify and withdraw knowledge acquired in terms how the postural characteristics associated to the use of computers, performance of sport activities (scuba diving and gymnastic) and of musical activities (use of string and wind instruments) can predispose individuals to be affected by temporomandibular joint disorders (TMDs) or for the presence of signals and symptoms that disease. The author conducted a literature review using the following key words: temporomandibular joint disorders, scuba diving, sports and TMD, gymnastic and TMD, joint laxity, hypermobility joint, ergonomic, computer workers, computer work environment, visual display terminal, musicians positions, music and TMD, risk factors, musculoskeletal diseases.

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MACHADO, Luciana Pimenta e. Silva. "Critérios de Diagnóstico para Pesquisa das Desordens Temporomandibulares (RDC/TMD): avaliação de radiologistas sobre adequação." Universidade Federal de Goiás, 2011. http://repositorio.bc.ufg.br/tede/handle/tde/1368.

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The aim of this study was to investigate the opinion of specialists in radiology, from different parts of the world, regarding to the proposed criteria for image acquisition and interpretation by Computed Tomography (CT), Cone Beam Computed Tomography (CBCT) and Resonance imaging (MRI) in diagnosing temporomandibular joint disorders (DATM) as part of Diagnostic Criteria for Research of Temporomandibular Disorders (RDC/TMD). Radiology specialists were invited by email to participate as volunteers in the study from three different eligible populations: researchers with publication DATM indexed on PubMed, ORADLIST members and individual contact. The link to access the questionnaire was mailed to volunteers interested in participating who matched the inclusion criteria. The sample was composed of specialists in radiology with experience in the interpretation of sectional images (CT, CBCT and/or MRI) of the temporomandibular joint (TMJ) who answered a questionnaire in English, which was developed and maintained online (LimeSurvey 1.87+). In a three months period, two recalls were sent and a period of 40 days after the last notification was given for responses submission. The questionnaire was divided into three parts with closed and open questions. Part I was related to issues of participant identification (gender, age, country of activity, area of activity, time and experience as a radiologist in the interpretation of sectional images of the TMJ and monthly time dedicated to the activity of interpreting sectional images of ATM). Part II contained questions related to the adequacy of the proposed criteria for the interpretation of sectional images of the ATM as part of the RDC/TMD. The criteria were presented into two columns' tables and the participants were asked whether that set of criteria was considered adequate or not for assessement and diagnosis of TMJ osseous and non-osseous tissues according to each imaging modality. If the respondent not considered criteria appropriate, he/she should indicate what type of suggestion: if insertion of new items, the modification or deletion of existing items. Part III had questions related to the need to include a minimal technical protocol for TMJ CT, CBCT and MRI acquisition as part of the RDC/TMD. If deemed necessary, the respondent should indicate which would be his/her suggestion protocol for acquisition of each imaging technique (CT, CBCT and MRI). Fifty-seven radiologists from different countries completed the questionnaire. The results indicate that 87 to 98% of radiologists considered the criteria adequate and that 81.6% of respondents considered necessary to include a minimal technical protocol for CT, CBCT and MRI acquisition as part of the RDC/TMD. Two to thirteen percent of respondents suggested insertion, modification and deletion of items in the proposed criteria. Ninety percent of respondents considered necessary to include a minimal technical protocol for CT/CBCT and 81.7% for MRI. We conclude that, according to the opinion of the worldwide community of specialists in radiology, the need for adjustments in the criteria for assessment of sectional images of the ATM is minimal, however, the need for the inclusion of a protocol to acquire minimal technical parameters of those images as part of protocol standardization of studies using the RDC/TMD is clear.
O objetivo desse estudo foi investigar a opinião de especialistas em radiologia, de várias partes do mundo, quanto aos critérios propostos para aquisição e interpretação de imagens por Tomografia Computadorizada (TC), Tomografia Computadorizada por Feixe Cônico (TCFC) e Ressonância Magnética (RM) no diagnóstico das desordens da articulação temporomandibular (DATM) como parte dos Critérios de Diagnóstico para Pesquisa das Desordens emporomandibulares (RDC/TMD). Especialistas em radiologia foram convidados por meio de e-mail a participar como voluntários do estudo a partir de três diferentes populações elegíveis: pesquisadores com publicação indexada sobre DATM no PubMed, membros da ORADLIST e contato individual. O link de acesso ao questionário foi enviado por email aos voluntários interessados em participar os quais preencheram os critérios de inclusão. A amostra foi composta por especialistas em radiologia com experiência na interpretação de imagens seccionais (TC, TCFC e/ou RM) da articulação temporomandibular (ATM) que responderam um questionário na língua inglesa, desenvolvido e mantido online (LimeSurvey 1.87+). Num período de três meses, duas notificações foram enviadas e um prazo de 40 dias após a última notificação foi estabelecido para o envio das respostas. O questionário foi dividido em três partes com perguntas fechadas e abertas. A parte I relacionava-se às questões de identificação do participante (gênero, idade, país de atuação, área de atividade, tempo de experiência como radiologista e na interpretação de imagens seccionais da ATM e o tempo de dedicação mensal à atividade de interpretar imagens seccionais da ATM). A parte II continha questões relacionadas à adequação dos critérios propostos para interpretação das imagens seccionais da ATM como parte do RDC/TMD. Os critérios foram apresentados em tabelas de duas colunas e os participantes eram questionados se aquele conjunto de critérios era considerado adequado ou não para a interpretação e diagnóstico dos tecidos ósseos e não-ósseos da ATM de acordo com cada modalidade de imagem. Caso não os considerasse adequado, deveria indicar qual o tipo de sugestão: se inserção de novos items, a modificação ou eliminação de itens existentes. A parte III continha perguntas relacionadas à necessidade de se incluir um protocolo técnico mínimo para a aquisição de TC, TCFC e RM como parte do RDC/TMD. Caso considerasse necessário, deveria indicar qual seria sua sugestão de protocolo para aquisição de cada uma das técnicas de imagem (TC, TCFC e RM). Cinqüenta e sete radiologistas de vários países responderam o questionário. Os resultados indicam que 87 a 98% dos radiologistas consideraram os critérios adequados e que 81,6% dos respondentes consideram necessária a inclusão de um protocolo técnico mínimo para aquisição das imagens por TC, TCFC e RM como parte do RDC/TMD. Dois a treze porcento dos respondentes sugeriram inserção, modificação e eliminação de items nos critérios propostos. Noventa porcento dos respondentes consideram necessária a inclusão de protocolo técnico mínimo para TC/TCFC e 81.7% para a RM. Conclui-se que, de acordo com a opinião da comunidade mundial de especialistas em radiologia, é mínima a necessidade de ajustes nos critérios para interpretação de imagens seccionais da ATM, entretanto, é clara a necessidade da inclusão de um protocolo técnico mínimo para a aquisição das referidas imagens como parte do protocolo de normatização das pesquisas que utilizam o RDC/TMD.

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Oliveira, Simone Saldanha Ignacio de. "Efeitos do uso da placa oclusal sobre o equilíbrio postural em indivíduos dentados, não reprogramados, com sinais e sintomas de desordem temporomandibular diagnosticados pelo RDC/TMD e ressonância magnética." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/23/23150/tde-13092013-183828/.

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A desordem temporomandibular (DTM) de origem multifatorial pode estar associada a fatores oclusais e também a alterações posturais. O objetivo desse estudo foi investigar os efeitos do uso da placa sobre o equilíbrio postural em indivíduos dentados, não reprogramados, com sinais e sintomas de desordem temporomandibular (DTM). Colaboraram com a pesquisa 70 pacientes (59 placa e 21 controle), entre 18e 84 anos, de ambos os gêneros, diagnosticados com DTM por meio do questionário do RDC/TMD além de ressonância magnética da articulação temporomandibular. O estudo foi de ensaio clínico, randomizado, controlado, prospectivo e de intervenção. Foram respondidos os questionários de risco de quedas - FES-I e de qualidade de vida - SF-36 antes que fosse realizada a avaliação do equilíbrio postural por meio da plataforma de força. Cumprida estas etapas eram feita a randomização: o grupo da amostra recebia placa oclusal com critérios de estabilidade oclusal além de orientação para que fizesse exercícios terapêuticos, enquanto o grupo controle era orientado para fazer apenas exercícios terapêuticos. Após 12 semanas, os dois grupos eram reavaliados. A análise estatística foi feita por frequências, avaliação da associação entre grupos por teste de Fisher; medidas quantitativas considerando por média, mediana, desvio padrão, percentis 25 e 75 além de valores máximo e mínimo; as comparações entre os tempos fez uso de teste não paramétrico de Wilcoxon enquanto a entre grupos usou o teste de Mann-Whitney, com nível de significância de 5%. O total de pacientes, que completou o estudo de risco de queda e qualidade de vida, era composto por 77% de mulheres, com média de idade de 42,5 anos. Os itens significantes do risco de queda contribuíram para reduzir a preocupação em cair da mesma forma que os de qualidade de vida auxiliaram o aumento dos domínios saúde mental, dor e vitalidade. Dos setenta pacientes, 64 completaram o RDC/TMD (47 placa e 17 controle), com diferenças significativas no que diz respeito ao diagnóstico de dor miofascial, deslocamento do disco, artralgia direita e esquerda, grau de dor crônica, depressão esomatização relacionada a placa. Dentre os mesmos 70 pacientes, 49 completaram o estudo sobre o equilíbrio postural (36 placa e 13 controle), que apresentou aumento significante na velocidade anteroposterior do CP nas condições olhos abertos e fechados (VAPoa e VAPof), durante a postura em pé no grupo placa. Concluiu-seque o uso da placa foi eficaz no tratamento da DTM sendo que seu efeito pode ser observado no equilíbrio postural a ponto de diminuir a preocupação em cair além de melhorar os domínios de saúde mental e dor, com consequente repercussão sobre a qualidade de vida.
Temporomandibular disorder (TMD) of multifactorial origin may be associated with occlusal factors but also with changes in posture. The objective of this study was to investigate the effects of the use of the occlusal splint on the postural equilibrium of non-reprogrammed, dentate individual with signs and symptoms of temporomandibular disorder. The research group consisted of 70 patients (59 with occlusal splints, 21 in the control group) between 18 and 84 years of age, of both genders, diagnosed with TMD by way of the RDC/TMD questionnaire and magnetic-resonance imaging of the temporomandibular joint. The research was performed via a randomized, controlled, prospective clinical study and intervention. The questionnaires regarding risk of falls - FES-I and quality of life - SF-36 were filled out before evaluating postural equilibrium by way of a force platform. In the randomization, the sample group received occlusal splint, occlusal-stability criteria, and advice about therapeutic exercises; the control group only received advice about therapeutic exercises. After 12 weeks, the groups were re-evaluated qualitatively by frequency, evaluation of the association between the group via Fisher testing; quantitatively via average, median, standard deviation, 25 and 75 percentiles, and minimum and maximum values; comparison between the times via non-parametric Wilcoxon testing and between the groups via Mann-Whitney testing with a threshold of significance of 5 %. Of the universe of the patients who completed the risk-of-fall and quality-of-life study, 77 % were women with an average of of 42.2 years. The items that were significant to the risk of falling contributed to reducing fear of falling, and those significant to quality of life to increasing the domains of mental health, pain, and vitality. Out of the 70 participants, 64 completed the RDC/TMD (47 occlusal splint and 17 controls) with differences that were significant to the diagnosis of miofascial pain, slipped disc, left and right arthralgia, degree of chronic pain, depression, and somatization related to the oclusal splint. Of the 70, 49 completed the postural-equilibrium study (36 occlusal splint and 13 controls), a significant increase in anteroposterior speed of the COP with eyes open and eyes closed (AVPeo and AVPec) occurring in the oclusal splint group while standing. It is therefore concluded that use of the oclusal splint was efficacious in the treatment of TJM and that there was an effect on the postural equilibrium, with improvement occurring in regards to fear of falls and in the domains of mental health, pain, and the quality of life.

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Kling, Olaf Ansgar Chrysanthus [Verfasser], Nikolaus [Akademischer Betreuer] Gerstdorff, Christoph [Akademischer Betreuer] Engelke, and Dietmar [Akademischer Betreuer] Kubein-Meesenburg. "Vergleichende Analyse der Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) und der real-time-Magnetresonanztomographie / Olaf Ansgar Chrysanthus Kling. Gutachter: Christoph Engelke ; Dietmar Kubein-Meesenburg. Betreuer: Nikolaus Gerstdorff." Göttingen : Niedersächsische Staats- und Universitätsbibliothek Göttingen, 2011. http://d-nb.info/1042733341/34.

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Vestlund, Sandra, and Linn Nykvist. "How does changes in symptom severity index relate to patients’ global impression of change?" Thesis, Umeå universitet, Tandläkarutbildning, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-178498.

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Background: The treatment outcome of temporomandibular disorders (TMD) can be assessed with Symptom Severity Index (SSI). In addition to this self-report measure, Patients’ Global Impression of Change (PGIC) provides information about the overall impression of change. The use of SSI and PGIC when assessing treatment outcome in the field of TMD, and their correlation, has not previously been reviewed. Aim: The aims of this study were to investigate the correlation between the scales SSI and PGIC, to gain knowledge about which factors that contribute to the impression of change and to identify the diagnoses that have the most improvement. Methods: Data from 193 patients was analyzed. The percentage change in symptoms between baseline and follow up was compared to PGIC. The patients were divided into three groups based on main diagnoses, for further analysis. PGIC categories “much improved” and “very much improved” were set as successful treatment outcome. Different factors impact on PGIC were analyzed. Results: Majority of the patients had a successful treatment outcome. A higher mean percentage change correlated with a better PGIC value. Patients with articular related diagnoses needed a greater reduction in SSI to rate the impression of change as improved. According to the regression analysis, diagnosis group, age, number of treatment visits and SSI-baseline were associated with treatment outcome. Conclusions: The present study supports the use of both SSI and PGIC for assessment of the treatment outcome when treating TMD. However, a possible discrepancy between the scales addresses the need for further examination and change of treatment approach.

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Nunes, Rejane. "Avaliação dos resultados de tratamento em pacientes com disfunção temporomandibular (DTM) atendidos no ambulatório de oclusão da Faculdade de Odontologia da PUCRS utilizando questionário RDC/DTM : um estudo longitudinal." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2014. http://hdl.handle.net/10183/102479.

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O objetivo deste trabalho foi avaliar os resultados de tratamento realizado com Placa de Michigan, em pacientes com Dor Orofacial, que buscaram atendimento no Ambulatório de Oclusão da Faculdade de Odontologia da PUCRS, utilizando o questionário RDC/DTM, e associar algumas variáveis entre os resultados encontrados. Os métodos empregados foram o questionário RDC/DTM, um método já consagrado no uso para pesquisa nesta área, e ainda a aplicação de um questionário de acompanhamento sobre a dor após três meses do início do tratamento. Os resultados obtidos foram satisfatórios.
The objective of this study was to evaluate the treatment results when the stabilization (Michigan-type) splint was used, in patients with orfacial pain, who were seeking treatment in the Occlusion clinical at the Faculty of Dentistry of PUCRS, using the RDC/TMD, and associate some variables among the results found. The methods employed were the RDC/TMD, a stablished method for research in this área, and also a pain follow-up questionnaire three months after the beginning of treatment. Satisfactory results were obtained.

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Alder, Emma K. "Temporomandibular Joint Disorder: An Investigation of Masseter Muscle Activity in Response to Stressful Computer Data Entry." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1339772763.

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Trpkova, Biljana. "Posterior-anterior cephalometric assessment of adolescents with TMJ internal derangement." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq28994.pdf.

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Santos, Alcylene Carla de Jesus dos. "Teleatendimento e disfunção temporomandibular: uma abordagem ocupacional." Programa de pós-graduação em saúde coletiva, 2008. http://www.repositorio.ufba.br/ri/handle/ri/10347.

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Introdução: A disfunção temporomandibular (DTM) caracteriza-se por dor na musculatura mastigatória, na articulaçãotemporomandibular, estalidos e limitação funcional. Tem como fatores etiológicos o estresse e a sobrecarga articular, condições presentes no teleatendimento. Embora o potencial patogênico nesta atividade seja um problema de saúde pública, a investigação acerca da DTM nesta população ainda é incipiente. Objetivo: descrever a frequência de disfunção temporomandibular entre teleatendentes e identificar fatores associados a sua ocorrência, focalizando, em especial, aqueles relacionados à ocupação. Métodos: Conduziu-se um estudo de corte transversal, exploratório, envolvendo 200 teleatendentes de um call center, mediante realização de entrevista e exame físico. Foram considerados aspectos clínicos, sócio demográficos, ocupacionais, psicossociais da ocupação (JCQ) e estresse psíquico (SQG12). Estabeleceram-se os sinais e sintomas, e a gravidade da DTM através da escala RDC/TMD e TMI respectivamente. Procedeu-se a análise descritiva e odds ratio (OR) foram estimados por meio de regressão logística não-condicional, empregando-se o IC a 95% como critério para aceitar as associações. Resultados: A frequência de DTM entre os teleatendentes foi 40,50%, com baixa gravidade (TMI=0,08±0,02). Observou-se uma associação positiva entre tempo de atividade (ORajust= 2,0; 95%IC: 1,1- 4,0), número médio de ligações por dia (ORajust=2,1; 95%IC: 1,1- 3,9) e nível de estresse (ORajust= 2,1; 95%IC: 1,1- 4,4) e a DTM. Considerações finais: Sugere-se, na população estudada, uma associação entre tempo de atividade maior do que 7 meses, número médio acima de 82 ligações por dia, alto nível de estresse e DTM. O conhecimento dos fatores ocupacionais associados à DTM nesta população favorece o estabelecimento de ações preventivas ou interceptativas, com vistas a diminuir a prevalência. Indica ainda a necessidade de atenção a esta atividade que está relacionada a múltiplos efeitos.
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Kinniburgh, Robert D. "Spatial relationships and osseous morphology associated with adolescent TMJ disc status." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://catalog.hathitrust.org/api/volumes/oclc/47926474.html.

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Thesis (Ph. D.)--University of Alberta, Dept. of Oral Health Sciences, 1999.
eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

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Williamson, Philip Charles. "Condyle angulation and position associated with adolescent TMJ disc status." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0003/MQ28999.pdf.

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Barlow, Peter A. "A non-invasive technique for the diagnosis of temporomandibular joint disorders." Thesis, University of Sussex, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.296542.

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Rezvani, Mahya. "Förekomsten av whiplashtrauma hos TMD patienter." Thesis, Malmö högskola, Odontologiska fakulteten (OD), 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-19719.

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Syfte Syftet med litteraturöversikten var att beskriva förekomst av whiplashtrauma hos TMD patienter. Metod En systematisk litteratursökning av PubMed, CochraneLibrary och Bandolier databaser genomfördes för artiklar publicerade från 1 januari 1966 till 11 november 2011. Den systematiska sökningen identifierade121 artiklar. Efter borttagning av brev till redaktion och författarinlägg, utfördes en initial screening av abstract på 108 artiklar. Efter den initiala screeningen lästes 32 artiklar i fulltext med tillämpning av inklusions- och exklusionskriterier. Två av författarna utvärderade den metodologiska kvaliteten på de inkluderade studierna. Resultat Sex studier mötte inklusionskriterierna och inkluderades i rapporten. Den rapporterade förekomsten av whiplashtrauma hos TMD populationerna varierade mellan 8,4 % och 70 % (median 35 %). Förekomst av whiplashtrauma hos kontrollgrupperna varierade mellan 1,7 % och 18 %. TMD patienter med historik av whiplashtrauma rapporterade gravare TMD symptom och mer smärta jämfört med TMD patienter utan nackskada.Konklusion Resultaten från denna litteraturöversikt visar en högre förekomst av whiplashtrauma hos TMD patienter vilket tyder på att whiplashtrauma kan vara en riskfaktor för TMD. Stora variationer sågs mellan de olika inkluderade studierna och i samtliga studier fanns också brister gällande diagnoskriterier. Sammantaget så gör dessa begränsningar det svårt att bedöma traumaförekomst hos TMD patienter och i vilken utsträckning whiplashskada kan bidra till utvecklingen av TMD. Fler väldesignade studier som använder tydligt definierade diagnostiska kriterier med hög reliabilitet och validitet som t.ex RDC/TMD behövs för att kunna dra en säkrare slutsats om TMD vid whiplashtrauma.
Aim The aim ofthis systemic literature review was to describe the prevalence of whiplash trauma in TMD populations. Method A systemic literature search of the PubMed, Cochrane Library and Bandolier databases was carried out for articles published from 1 January 1966 to 11 November 2011. This systemic search identified 121 articles. After exclusion of letters to editor and author replies, an initial screening of the abstracts of 108 articles was carried out. After the initial screening 32 articles were read in full text applying the inclusion and exclusion criteria. Two of the authors evaluated the methodological quality of the included studies. Result Six studies matched the inclusion criteria and were included in the review. The reported prevalence of whiplash trauma in the TMD populations varied from 8.4% to 70% (median 35%). The prevalence of whiplash trauma in the control groups varied from1.7% to 18%.TMD patients with a history of whiplash trauma reported more TMD symptom and more pain compared to TMD patient without a neck injury.Conclusion The results from this literature review show a higher prevalence of whiplash trauma in TMD patients which indicate that whiplash trauma could be risk factor for TMD. A large variation could be seen between the included studies and there were also weaknesses with regard to the diagnostic criteria. In summery we suggest that these limitations make it difficult to assess the prevalence of neck trauma in TMD patients and to which extent a whiplash injury can contribute to the development of TMD. More well designed studies using the RDC/TMD criteria and well-defined criteria with high reliability and validity for whiplash trauma are needed in order to make a more reliable conclusion.

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Uekama, Ira Cristina. "Estudo de alterações locais e sistêmicas em indivíduos portadores de disfunção temporomandibular." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/58/58133/tde-22052012-164136/.

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Disfunção temporomandibular (DTM) é um termo coletivo que engloba um largo espectro de alterações articulares e musculares no sistema estomatognático. Estas disfunções são caracterizadas por dor, ruídos articulares e funções irregulares da mandíbula, e representam a principal causa de dor não dentária da região orofacial. A prevalência de indivíduos com necessidade de tratamento está entre 5 e 12%, calcula-se que no Brasil 8,5 milhões de brasileiros precisariam ter algum tipo de intervenção. Estudos epidemiológicos sobre DTM têm se apresentado deficientes quanto à padronização de índices e classificações. Conscientes disso realizou-se um levantamento de prontuários dos pacientes atendidos no Serviço de Oclusão, Disfunção Temporomandibular e Dor Orofacial, do projeto DAPE da Faculdade de Odontologia de Ribeirão Preto USP, que realiza atendimento na área de DTM para população encaminhada pelo Sistema Único de Saúde (SUS), entre os anos de 2010 e 2011. Avaliou-se 117 prontuários de indivíduos, que foram submetidos à classificação do Índice Anamétido de Helkimo, divididos de acordo com a severidade de sinais e sintomas, em dois grupos : AiI (leves a moderados) e AiII (severos). Posteriormente os grupos foram subdivididos com relação ao gênero e faixa etária. Os dados foram coletados por meio de entrevista, onde os indivíduos foram questionados quanto à presença de hábitos parafuncionais, alterações otológicas, oftalmológicas, sistêmicas e comportamentais. Os dados foram tabulados em planilha de Excel, e submetidos à Análise Estatística, utilizando o Teste de Kruskal-Wallis e Teste de Miller, ambos com significância de 0,05. A prevalência de cada alteração também foi avaliada. Os resultados evidenciaram que indivíduos com DTM apresentaram altas prevalências nas alterações locais e sistêmicas pesquisadas.
Temporomandibular (DTM) is a collective term that encompasses a broad spectrum of clinical problems and deformations in orofacial area. These disorders are characterized by pain, joint noises and irregular functions of the jaw, and represent the leading cause of orofacial pain not dental. The prevalence of individuals in need of treatment is between 5% and 12%, it is estimated that in Brazil 8.5 million Brazilians would have some kind of intervention. Epidemiological studies on TMD have presented handicapped on the standardization of indexes and ratings. Aware of this was done a survey of medical records of patients seen in Orofacial Pain service of special Patients clinic FORP-USP, who performs service in the area of TMD for population forwarded by the Central regulating (SUS), the city of Ribeirão Preto, between the years 2010 and 2011. Assessed-if medical records of individuals, these 117 were subjected to the classification of the Anamétido Index of Helkimo, and divided according to the severity of symptoms and signs, in two groups AiI (mild to moderate) and AiII (severe). Later groups were sub-divided in relation to gender and age group. The data were collected through interview, where individuals were questioned as to the presence of parafunctional habits, changes otologicals, ophthalmologicals, systemic and behavioral. The data were tabulated into Excel spreadsheet, and subjected to statistical analysis, using the Kruskal-Wallis test, and Miller\'s Test, both with significance of 0.05. The prevalence of each change was also evaluated. The results showed that TMD patients showed a high prevalence in the surveyed local and systemic changes.

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Bertoli, Elizangela. "A COMPARISON BETWEEN MASTICATORY MUSCLE AND TEMPOROMANDIBULAR JOINT PAIN PATIENTS WITH REGARD TO THE PREVALENCE AND IMPACT OF POST-TRAUMATIC STRESS DISORDER SYMPTOMS." UKnowledge, 2005. http://uknowledge.uky.edu/gradschool_theses/239.

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The purpose of this study was to evaluate masticatory muscle (MM) and temporomandibular joint (TMJ) pain patients regarding the prevalence of Posttraumatic Stress Disorder (PTSD) symptoms, and evaluate the level of psychological dysfunction and its relationship to PTSD symptoms in these patients. This study included 445 adult patients (male = 42, female = 403). Psychological questionnaires included the Symptom Check List-90-Revised (SCL-90-R), the Multidimensional Pain Inventory, the Pittsburgh Sleep Quality Index and the PTSD Check List Civilian. The total sample of patients was divided into two major groups: The MM group (n=242) and TMJ group (n=203). Each group was divided into three subgroups according to the presence of a stressor and severity of PTSD symptoms. Thirty six patients (14.9%) in the MM group and 20 patients (9.9%) in the TMJ group presented symptomatology of PTSD. MM and TMJ pain patients in the positive PTSD subgroups scored higher on all scales of the SCL-90-R (p = .000) than the other two subgroups and reached levels of distress that were indicative of psychological dysfunction. MM and TMJ pain patients in the positive PTSD subgroups were more often classified as dysfunctional than as adaptive copers and presented with more sleep disturbances than patients in the no stressor and negative PTSD subgroups. A somewhat elevated prevalence rate for PTSD symptomatology was found in the MM than in the TMJ group. Significant levels of psychological dysfunction appear limited to temporomandibular disorder patients with symptoms of PTSD.

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Reynolds, Breanna C. "Thrust Joint Manipulation to the Cervical Spine in Participants with a Primary Complaint of Temporomandibular Disorder (TMD): A Randomized Clinical Trial." Diss., NSUWorks, 2019. https://nsuworks.nova.edu/hpd_pt_stuetd/76.

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Background: Temporomandibular disorder (TMD) is a common and costly problem often leading to chronic pain. There exists moderate evidence for physical therapy (PT) interventions in the management of TMD. A known relationship between TMD and the cervical spine exists with some evidence to support cervical intervention treatments. Cervical spine thrust joint manipulation (TJM) is an effective PT intervention explored in a limited fashion for this population. Objectives: To determine the immediate and short term (1 and 4 week) effects of cervical TJM on pain, dysfunction, and perception of change in individuals with a primary complaint of TMD. Methods: In this single blind randomized clinical trial, individuals with TMD (n=50) were randomly assigned to receive cervical TJM or sham manipulation in 4 PT visits over 4-weeks. All participants also received behavioral education, a home exercise program, and soft tissue mobilization. Primary outcomes included jaw range of motion (ROM), Numeric Pain Rating Scale (NPRS), TMD Disability Index, Jaw Functional Limitation Scale (JFLS), Tampa Scale of Kinesiophobia (TSK-TMD), and Global Rating of Change (GROC). Self-report and objective measurements (with blinded assessor) were taken at baseline, immediately after baseline treatment, 1-week, and 4-weeks. A 2 x 4 mixed model ANOVA was used with treatment group as the between-subjects factor and time as the within-subjects factor. Separate ANOVAs were performed for dependent variables and the hypothesis of interest was the group by time interaction. Results: Statistically significant 2-way interactions were noted in JFLS (p = .026) and TSK-TMD (p = .008), favoring the thrust manipulation group. Both groups showed statistically significant main effects in all measures over time. GROC and PASS favored the thrust manipulation group with statistically significant differences in successful outcomes noted immediately after baseline treatment (NNT = 5) and at 4-weeks (NNT = 4). Conclusion: Both groups received identical multi-modal treatments with the addition of the randomized intervention: cervical TJM or sham manipulation. Differences between groups were small, however, improvements favored the TJM on all measures. Cervical TJM may be beneficial in the treatment of TMD.

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Paleologo, Saverio Gianfranco. "A eficácia do método de reeducação postural global em doentes com disfunção temporomandibular: revisão de literatura." Bachelor's thesis, [s.n.], 2017. http://hdl.handle.net/10284/6289.

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Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciado em Fisioterapia
Objetivo: Realizar uma revisao bibliográfica para tentar perceber os efeitos dos tratamentos com técnicas baseadas na reeducação postural global (RPG), em indivíduos com diagnóstico de disfunção temporo mandibular (DTM). Metodologia: Pesquisa nas bases de dados da PubMed, PEDro, Scielo, Ebsco e Cochrane library para conhecer os resultados e os aconselhamentos dos autores que utilizaram a técnica sobre uma amostra com DTM. Critérios de inclusão: estudos publicados com um limite temporal de 10 anos (2007 e 2017), com idioma em Inglês e português, sobre estudos randomizados controlados e não randomizados, em humanos, onde foi utilizado o método de RPG em doentes com disfunção da ATM. Critérios de exclusão: foram removidos estudos em que os doentes com disfunção da ATM são tratados por técnicas que não sejam de exercícios de reeducação postural global ou alongamentos globais e estudos que utilizaram terapias combinadas, onde efetuaram programas de exercícios em complemento com outras técnicas de Fisioterapia não manuais. Resultados: A presente revisão da literatura inclui uma totalidade de 5 estudos, 4 randomizados controlados e 1 não randomizado (quase experimental). Para além de modalidades relacionadas com a RPG, são abordadas outras terapêuticas, como PNF, indução miofascial, compressão isquémica, alongamento estático e técnicas de relaxamento combinada com respiração controlada. Conclusão: O método de RPG para DTM apresenta várias vantagens, principalmente em doentes com desvios posturais ou com DTM miogénica, podendo também ser utilizado de forma preventiva. Contudo, esta modalidade deverá ser utilizada segundo os objetivos dos doentes e suas limitações físicas, associando assim um programa de exercício terapêutico continuado, entretanto constatamos pouca concordância no que diz respeito aos tempos terapêuticos para os vários indivíduos.
Objetive: To perform a literature review to try to understand the effects of treatments with techniques based on global postural reeducation (GPR) in individuals with a diagnosis of temporomandibular joint dysfunction (TMD) Method: Search the databases of PubMed, PEDro, Scielo, Ebsco and Cochrane library to know the results and the advice of the authors who used the technique on a sample with TMD. Inclusion criteria: published studies with a 10 year time limit (2007 and 2017), with English and Portuguese language, on randomized controlled and nonrandomized studies in humans, where the RPG method was used in patients with TMJ dysfunction . Exclusion criteria: studies were removed in which patients with TMD dysfunction are treated by techniques other than postural global exercises or global stretches and studies using combined therapies where they performed exercise programs in addition to other non-manual physiotherapy techniques. Results: The present review of the literature includes a total of 5 studies, 4 randomized controlled and 1 non-randomized (almost experimental). In addition to RPG-related modalities, other therapies such as PNF, myofascial induction, ischemic compression, static stretching, and relaxation techniques combined with controlled breathing are discussed. Conclusion: Based on these review studies, the RPG method for TMD has several advantages, especially in patients with postural deviations or with myogenic TMD, otherwise it may be used in a preventive manner. However, this modality should be used secondarily to the patients' goals and their physical limitations, thus associating a program of continuous therapeutic exercise, although there is little agreement as to the therapeutic times for individuals.
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Luca, Carlos Eduardo Pitta de. "Estudo da correlação entre a posição do disco da articulação temporomandibular, avaliada através da técnica do relógio em exames de ressonâncias magnéticas com a posição da cabeça da mandíbula avaliada pelo método de Pullinger." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/23/23139/tde-22092014-140858/.

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A associação entre sinais e sintomas de Disfunções Temporomandibulares (DTM) e achados em imagens de ressonância magnética (RM) tem sido controversa, dessa forma, este estudo avaliou a posição do disco, pelo método do relógio, e verificou a associação com a posição da cabeça da mandíbula, com a dor muscular à palpação, abertura passiva e ativa, presença de estalo e idade em pacientes portadores de DTM que foram submetidos ao exame de RM. O disco foi classificado em 0- posição normal (banda posterior em 11 e 12 horas); 1- início do deslocamento (posição entre 11 e 10 horas); 2- deslocamento médio (posição entre 10 e 9 horas); e 3- deslocamento avançado (posição entre 9 e 8 horas). A posição da cabeça da mandíbula foi classificada de acordo com o método de Pullinger em 1- posterior; 2- anterior; e 3- concêntrica. As classificações foram realizadas por três examinadores. A associação entre os dados clínicos e imaginológicos foi realizada utilizando o coeficiente de correlação intraclasse, coeficiente de correlação de Spearman, análise de variância, teste exato de Fisher ou teste de Kruskal-Wallis conforme a necessidade, com 5% de nível de significância. Sessenta casos foram incluídos no estudo, com predomínio de mulheres e média de 37 anos de idade. Houve concordância excelente entre os examinadores para posição do disco e da cabeça da mandíbula, porém não houve correlação entre essas duas variáveis. A presença de estalo, dor muscular à palpação e amplitude de abertura de boca também não apresentaram correlação estatisticamente significante com a posição do disco. Apenas a dor muscular à palpação foi associada a abertura de boca (p<0,05). Conclui-se que não há associação entre sinais e sintomas clínicos e posição do disco com a posição da cabeça de mandíbula em pacientes portadores de DTM.
The association between signs and symptoms of temporomandibular disorders (TMD) and findings on magnetic resonance imaging (MRI) has been controversial, thus, this study evaluated the disc position, by the clock method, and verified the association with the condyle position, muscle pain on palpation, passive and active opening, presence of temporomandibular joint (TMJ) sound and age in patients with TMD who underwent MRI. The disc position was classified as 0 - normal position (posterior band at 11 and 12 hours); 1 - mild displacement (position between 11 and 10 hours); 2 - Moderate displacement (position between 10:09 hours); and 3 - Severe displacement (position 9 to 8 hours). The condyle position was graded according to the Pullinger\'s method as 1 - posterior; 2 - anterior; and 3 - concentric. Three examiners performed the analyses. The association between clinical and imaging data was performed using the intraclass correlation coefficient ICC -, Spearman correlation coefficient, analysis of variance, Fisher\'s exact test or Kruskal-Wallis test as appropriate, with 5% significance level. Sixty cases were included in the study, with a predominance of women and average age of 37. There was excellent agreement between the examiners to disc and condyle position, but there was no significant correlation between these two variables. The presence of TMJ sound, muscle pain on palpation and range of mouth opening also showed no statistically significant correlation with the disc position. Only muscle pain on palpation was associated with mouth opening (p <0.05). It is concluded that there is no association between clinical signs and symptoms and disc position with condyle position in patients with TMD.

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Soares, Ana Rita Silva Coimbra. "Artrite idiopática juvenil: da etiologia ao tratamento." Master's thesis, [s.n.], 2015. http://hdl.handle.net/10284/5091.

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Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária
A Artrite Idiopática Juvenil (AIJ) é uma patologia sistémica do tecido conjuntivo, caracterizada por um processo inflamatório imunológico que pode afetar uma ou várias articulações, incluindo a articulações temporormandibulares (ATMs). A AIJ quando atinge a ATM pode causar assimetria e/ou diminuição do crescimento mandibular e /ou craniofacial, com subsequente instabilidade articular e funcional. Estas alterações podem então induzir carga funcional assimétrica nas ATMs e músculos da mastigação, sintomas dolorosos orofaciais e alterações da estética facial, importantes. Este trabalho consiste numa revisão da literatura sobre a AIJ referindo as manifestações clinicas, principais diagnósticos diferenciais e as diferentes abordagens terapêuticas sistémicas e quando esta afeta as ATMs. Esta revisão foi realizada com limite temporal, de 2000 a 2015, e utilizaram-se as seguintes palavras-chave: temporomandibular joint (TMJ), TMJ disorders, arthritis, Juvenile idiopathic arthritis (JIA), orofacial manifestations of JIA, treatment of JIA. O tratamento de pacientes que sofrem AIJ quando este afeta as ATMs destina-se especificamente a manter as funções do sistema estomatognático (SEG), reduzir sintomas orofaciais, evitar danos permanentes nos componentes cartilaginosos e ósseos da ATM e a reduzir as alterações desfavoráveis no crescimento mandibular e craniofacial. Para o tratamento destes pacientes é essencial uma abordagem multidisciplinar, e os médicos dentistas devem ser incluídos na equipa de tratamento. Juvenile idiopathic arthritis (JIA) is a connective tissue systemic pathology, characterized by an inflammatory immune process that can affect one or several joints, including temporormandibular joints (TMJs). When TMJs are affected by JIA it can lead to imbalance and/or reduction of mandibular and/or craniofacial growth, with subsequent joint instability and functionality. These changes can induce functional asymmetric load on TMJs and chewing muscles, painful orofacial symptoms and important changes on facial aesthetics. This work consists on a literature review about JIA clinical manifestations, main differential diagnoses and different systemic and orofacial therapeutic approaches. The limits of time of this review were from 2000 to 2015, and it was used the following keywords: temporomandibular joint (TMJ), TMJ disorders, Arthritis, Juvenile idiopathic arthritis (JIA), orofacial manifestations of JIA, treatment of JIA. The treatment of patients with JIA, when TMJ are affected, is specifically intended to maintain the functions of the stomatognathic system, reduce orofacial symptoms, prevent permanent damage on cartilage and bone components of TMJ and reduce the unfavorable changes in mandibular and craniofacial growth. For the treatment of these patients is essential a multidisciplinary approach, and dentists should be included in the treatment team.

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Peres, Claudia Maria 1966. "Avaliação da qualidade de vida e dos sintomas de stress em mulheres menopausadas com disfunção da articulação temporomandibular." [s.n.], 2008. http://repositorio.unicamp.br/jspui/handle/REPOSIP/275160.

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Orientador: Vera Aparecida Madruga Forti
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação Fisica
Made available in DSpace on 2018-08-10T20:00:26Z (GMT). No. of bitstreams: 1 Peres_ClaudiaMaria1966-_M.pdf: 1302254 bytes, checksum: 830a6821ea61927ef7fffe7925c07edd (MD5) Previous issue date: 2008
Resumo: A literatura relata que, a menopausa tem início entre 38 e 55 anos (dependendo do fator genético). Devido a diminuição na produção do hormônio estrogênio em 75% a 80% das mulheres ocorrerão sintomas tipo: suores noturnos, fogachos (ondas de calor), secura vaginal tornando a relação sexual desagradável, diminuição da libido, do brilho da pele, da memória e da atenção, insônia, irritabilidade, baixa auto-estima, osteoporose em 25% das mulheres (perda de massa óssea em 1% ao ano) e outras doenças ósteo-musculares. Nessa fase também ocorrerá aumento da gordura corporal na região do abdome com elevação da incidência de doenças cardiovasculares. As mulheres menopausadas com sintomas de disfunção temporomandibular (DTM) podem apresentar depressão, ansiedade e stress pela constância da sintomatologia de desconforto e dor. Dessa forma, o objetivo geral desta pesquisa foi de avaliar a qualidade de vida e os sintomas de stress em mulheres menopausadas com DTM que freqüentavam o serviço do Centro de Saúde da Comunidade/ Coordenadoria de Serviços Sociais da Universidade Estadual de Campinas. Foram selecionadas 30 voluntárias, funcionárias e alunas da UNICAMP, com idades entre 38 e 65 anos, diagnosticadas como portadoras da sintomatologia de DTM e com menopausa clinicamente comprovada (12 meses sem menstruações). As voluntárias foram avaliadas através de uma ficha de anamnese, do Questionário de Qualidade de Vida SF-36 e do Inventário de Sintomas de Stress de Lipp (ISSL). Para a análise da ficha de anamnese utilizamos a estatística descritiva e para os dados coletados no Questionário de Qualidade de Vida SF-36 foi utilizado o Software EpiInfo 6® (DEAN et al., 1995). Na análise do ISSL, após a soma dos resultados brutos verificou-se a porcentagem correspondente nas tabelas de correção dos sintomas e das fases de stress. Os resultados obtidos na ficha de anamnese mostraram que as mulheres apresentavam dor crônica sendo: 73,33% de dor nas ATMs, 73% das mulheres apresentaram dores nos músculos masseter e escalenos, 56% nos músculos pterigóideo lateral e pterigóideo medial, 50% no ângulo da mandíbula e nos músculos temporais, 46% no músculos rombóides e 43,33% cefaléia e dor no ouvido. Em relação ao aperto e ao ranger dos dentes as mulheres descreveram respectivamente 73,33% e 66,66%. Já em relação à queixa principal foi relatado: dor nos músculos trapézios 20%, fundo de olho 16,66%, crepitação nas ATMs 13,33%. Quanto à QV os piores escores encontrados foram relacionados com aspectos físicos, dor e vitalidade. Já em relação ao ISSL os resultados mostraram que a fase de stress com maior escore (43,33%) foi à fase de resistência e os sintomas de stress com maior porcentagem foram os psicológicos com 43,33%. As conclusões de nossa pesquisa mostraram que queixas reincidentes constavam nos dados da ficha de anamnese, no SF-36 e no ISSL, sendo interessante a aplicação desse modelo em novas pesquisas por multiprofissionais e em outro tipo de população para consolidação da mesma
Abstract: The literature reports that Menopause begins between 38 to 55 years old (depending on generic factors). Because of the estrogen hormone decreases, in 75% a 80% of the women will have symptoms like: night sweating, flashes, vaginal dryness, uncomfortable coupling and diminishing of sexual desire, diminishing of skin moisture and shine, attention deficit and memory loss, insomnia, irritability, low self-steam, depression, and 25% of them, will develop osteoporosis (bone mass decreases 1% a year) and others osteo-muscular diseases. In this phasis will also have increases of adiposity in abdomen with increases of incidents of cardiovascular diseases. Menopause women with symptoms of temporomandibular joint (TMJ) disorder can have depression, anxiety and stress altered by the constant symptoms of discomfort and pain. The general objective of this search was evaluate the quality of life and the symptoms of the stress in menopause women with TMJ disorder that have been used the ¿Centro de Saúde da Comunidade/Coordenadoria de Serviços Sociais da Universidade Estadual de Campinas¿. 30 volunteers were selected, employees and students of UNICAMP, between 38 and 65 years old, with TMJ disorder and also menopause diagnosis proved (12 months without menstruation). The volunteers were evaluated through a anamnesis chart, Quality of Life Questionary SF-36 and the Lipp Stress Symptom Inventory (ISSL). To analyse the anamnesis chart, we have been used the describing estatistics and for the collected dates in the Quality of Life Questionary SF-36, were used the Software EpiInfo 6® (DEAN et al., 1995). The analysis of ISSL, after the addition of the global results, we verified the corresponding percentage in schedules of the symptoms corrections and the stress phases. The anamnesis chart results showed that the women had chronics pains: 73,33% TMJ pain, 73% of women had masseters and scalenos muscles pain, 56% in lateral pterigoideo pain and medial pterigoideo, 50% in jaw angle and in temporal muscles, 46% in rhomboids muscles and 43,33% of headaches and ears pain. The pressure and screak of the teeth were described by the women 73,33% and 66,66% respecting. In relaction of main complaint were reported: 20% of trapeziums muscles pain, 16,66% in eyes, 13,33% TMJ crackles. In relation of Quality of Life, the worst scores found were in relation with physics aspects, pain and vitality. About ISSL, the results showed that stress phasis with the biggest score (43,33%) was that of resistence and the stress symptoms with greatest percentage were the psycologics with 43,33%. The final conclusion of our search showed that reincidence complaint appeared in anamneses chart, in SF-36 and in ISSL, beind interesting the application of this model in new searches for a several professionals and in other kind of population, to consolidate itself
Mestrado
Atividade Fisica, Adaptação e Saude
Mestre em Educação Física

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Orajärvi, M. (Marko). "Effect of estrogen and dietary loading on rat condylar cartilage." Doctoral thesis, Oulun yliopisto, 2015. http://urn.fi/urn:isbn:9789526207377.

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Abstract The temporomandibular joint (TMJ) is a synovial joint which attaches the mandible to the skull. The head of the mandibular condyle is covered by condylar cartilage, which functions as both growth and articular cartilage. Masticatory forces are transmitted to the condylar cartilage, and the consistency of a person’s diet partly defines the loading force. Condylar cartilage acts as a load-absorbing structure together with the articular disc. Temporomandibular disorders (TMDs) are a wide group of pathological conditions involving pain and dysfunction in the masticatory system. Females comprise the majority of patients, having more symptoms and clinical signs than men. Because of this gender distribution, it has been suggested that the female sex hormone estrogen has an influence on the pathogenesis of TMJ osteoarthrosis. However, little is known about how estrogen affects condylar cartilage. The effect of estrogen deficiency and altered dietary loading on condylar cartilage was studied with female rats, which were distributed to four groups depending on ovariectomy and diet consistency, and further to two distinct age groups. Expression of type II and X collagens, adiponectin, ERα, MMP-3, MMP-8, TRAP, and cathepsin K was investigated. Markers of apoptosis and proliferation of cartilage cells were investigated. A lack of estrogen increased and a soft diet decreased the thickness of condylar cartilage. Expression of proliferating cell nuclear antigen (PCNA, proliferation marker) was higher in ovariectomized rats fed a normal diet when compared with control rats. The area of type II and X collagens in condylar cartilage was larger when estrogen was not present and smaller when the diet consistency was soft. Expression of MMP-3 was higher in ovariectomized rats than in control rats. Ovariectomized rats fed a soft diet had higher expression of MMP-8 than ovariectomized rats fed a normal diet. However, control rats fed a soft diet had lower proportional expression of MMP-8 than normal diet controls. The proportional amount of cartilage cells stained against adiponectin was higher in rats fed a soft diet when compared with rats fed a normal diet. The proportional amount of cartilage cells expressing ERα was higher in ovariectomized rats than in control rats. Osteoclast markers cathepsin K and TRAP showed that ovariectomized rats had fewer osteoclasts than control rats had. The average size of osteoclasts was smaller in ovariectomized rats when compared with control rats. The results of this study show that estrogen and altered dietary loading have an effect on condylar cartilage. Further studies are needed to evaluate the significance of these changes, and especially their association with TMJ disorders
Tiivistelmä Leukanivel on synoviaalinivel, joka liittää mandibulan eli alaleuan kalloon. Alaleuan nivellisäkkeen eli kondyylin päässä oleva rustokerros toimii sekä kasvu- että nivelrustona. Purentavoimat välittyvät kondyylirustoon, ja kuormituksen määrä on riippuvainen ruoan kovuusasteesta. Kondyylirusto toimii kuormituksen vastaanottajana yhdessä nivelvälilevyn kanssa. Purentaelimistön toimintahäiriöihin (TMD) kuuluu laaja joukko patologisia tiloja, joihin liittyy kipua ja dysfunktiota purentaelimistössä. Potilaista suurin osa on naisia, ja heillä on oireita sekä sairauden kliinisiä tunnusmerkkejä enemmän kuin miehillä. Sukupuolijakaumasta johtuen on arveltu, että naissukupuolihormoni estrogeenilla voisi olla vaikutusta leukanivelartroosin patogeneesiin. Tällä hetkellä tietoa on hyvin vähän siitä, miten estrogeeni vaikuttaa leukanivelrustoon. Estrogeenin puutoksen ja muunnellun purentarasituksen vaikutusta leukanivelrustoon tutkittiin naarasrotilla, jotka jaettiin neljään eri ryhmään munasarjojen poiston ja dieetin kovuusasteen mukaan sekä lisäksi kahteen eri ikäryhmään. Tyypin II ja X kollageenin, adiponektiinin, estrogeenireseptori α:n, MMP-3:n, MMP-8:n, TRAP:n ja katepsiini K:n ekspressio tutkittiin. Rustosoluista tutkittiin apoptoosin ja proliferaation merkkiaineet. Estrogeenin puute lisäsi ja pehmeä dieetti pienensi kondyyliruston paksuutta. PCNA:n (proliferating cell nuclear antigen) ekspressio oli suurempi normaalilla dieetillä olleilla ovariapoistetuilla rotilla kuin kontrollirotilla. Tyypin II ja X kollageenien osuus oli suurempi ovariapoistettujen rottien kondyylirustossa kuin pehmeällä dieetillä olleilla. MMP-3:n ekspressio oli korkeampi ovariapoistetuilla rotilla kuin kontrolleilla. Ovariapoistetuilla rotilla, jotka olivat pehmeällä dieetillä, oli suurempi MMP-8:n ekspressio kuin normaalilla dieetillä olleilla ovariapoistetuilla rotilla. Kuitenkin MMP-8:n ekspressio oli pienempi pehmeällä dieetillä olleilla kontrollirotilla kuin normaalilla dieetillä olleilla. Adiponektiinin tunnistavalle vasta-aineelle positiivisten solujen suhteellinen lukumäärä oli suurempi pehmeällä dieetillä olleilla rotilla kuin normaalilla dieetillä olleilla. Estrogeenireseptori α:a ekspressoivien solujen suhteellinen lukumäärä oli suurempi ovariapoistetuilla rotilla kuin kontrolleilla. Osteoklastien merkkiaineet katepsiini K ja TRAP osoittivat, että ovariapoistetuilla rotilla oli vähemmän osteoklasteja kuin kontrollirotilla. Osteoklastien keskimääräinen koko oli pienempi ovariapoistetuilla rotilla kuin kontrolleilla. Tutkimuksen tulokset osoittavat, että estrogeeni ja muunneltu purentarasitus vaikuttavat leukanivelrustoon. Lisätutkimuksia tarvitaan, jotta voidaan arvioida näiden muutosten merkitsevyys ja erityisesti niiden yhteys leukanivelen toimintahäiriöihin

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McCormick, Emma, and Magdalena Sjöwall. "Central sensitization in orofacial pain." Thesis, Malmö högskola, Odontologiska fakulteten (OD), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-19833.

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Syfte. Att retrospektivt undersöka relationen mellan central sensitisering i det orofacialaområdet och refererad smärta, som kliniskt fynd, samt psykosociala faktorer hos patienter medDC/TMD-muskeldiagnosen myofasciell smärta med refererad smärta (MPR). Studien syftadeäven till att undersöka skillnader gällande psykosociala faktorer mellan patienter somdiagnostiserats med DC/TMD muskeldiagnoserna myofasciell smärta med refererad smärta(MPR), lokal myalgi (LM) och patienter med orofacial smärta eller käkdysfunktion men ejkäkmuskeldiagnos (WMD) som kontrollgrupper.Material och metod. Information från 85 patienters DC/TMD-undersökning utförd påOrofaciala smärtenheten vid Malmö högskola mellan september 2012 till årsslutet 2013insamlades retrospektivt. Undersökta variabler inkluderade smärtintensitet, smärt-relateraddysfunktion, psykosociala faktorer (depression, ångest och stress) samt refererad smärta.Patienterna indelades i grupper baserade på muskeldiagnos enligt DC/TMD samt utbredning avsmärta. Non-parametrisk statistik användes och P < 0,05 betraktades som signifikant.Resultat. Patienter med MPR uppvisade en signifikant korrelation mellan totala antaletrefererade smärtlokalisationer och smärt-relaterad dysfunktion (rs = 0,43, n = 49, p = 0,002),depression (rs = 0,32, n = 49, p = 0,023) och stress (rs = 0,39, n = 49, p = 0,006). Patienter meden generell smärtutbredning uppvisade en signifikant högre grad av stress (p = 0,020) samt flerantal refererade smärtlokalisationer (p = 0,019) jämfört med patienter med lokal och/ellerregional orofacial smärta.Konklusion. Studien indikerar att grad av central sensitisering kan bedömas med hjälp avutbredningen av refererad smärta, undersökt enligt DC/TMD, hos patienter med diagnosenmyofasciell smärta med refererad smärta i det orofaciala området. Studien kunde inte påvisaskillnader gällande psykosociala faktorer mellan de undersökta grupperna.
Objective. The aim of this study was to retrospectively investigate the relation between referredpain, as a clinical finding, and psychosocial factors versus central sensitization in patients withmyofascial pain with referral (MPR) as assessed according to DC/TMD. The study also aimedto investigate differences regarding psychosocial factors between patients demonstratingmyofascial pain with referral (MPR) and patients diagnosed with the DC/TMD muscle diagnoselocal myalgia (LM) as well as OFP/TMD patients without masticatory muscular diagnose(WMD) as control patients.Material and methods. Patients’ medical records of 85 patients examined at the Orofacial PainUnit at Malmö University during September 2012 till the end of 2013 were retrospectivelyexamined for DC/TMD data. Examined variables included pain intensity, pain-related disability,psychosocial factors (depression, anxiety and stress) and referred pain. The patients weredivided into groups based on DC/TMD muscle diagnosis as well as extension of pain. Nonparametricstatistics were used and a probability level of P < 0.05 was considered as significant.Results. Patients with MPR demonstrated significant correlations between the total number ofreferred pain sites and disability score (rs = 0.43, n = 49, p = 0.002), depression (rs = 0.32, n =49, p = 0.023) as well as stress (rs = 0.39, n = 49, p = 0.006). Patients with generalized paindistribution demonstrated a significantly higher degree of stress (p = 0.020) as well as highernumber of referred pain sites (p = 0.019) than patients with local and/or regional orofacial pain.Conclusion. This study indicates that the degree of central sensitization can be estimated bythe extent of referred pain, as assessed according to DC/TMD, in patients with myofascial painwith referred pain in the orofacial region. This study could not detect a difference inpsychosocial factors between the three groups, myofascial pain with referral (MPR), localmyalgia (LM) and no masticatory muscle diagnosis (WMD).

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Kling, Olaf Ansgar Chrysanthus. "Vergleichende Analyse der Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) und der real-time-Magnetresonanztomographie." Doctoral thesis, 2011. http://hdl.handle.net/11858/00-1735-0000-0006-B280-5.

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Vieira, Jason Santos. "Avaliação psicológica e funcional na Oclusão em desportistas: estudo piloto." Master's thesis, 2013. http://hdl.handle.net/10316/36741.

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Trabalho final do 5º ano com vista à atribuição do grau de mestre no âmbito do ciclo de estudos de Mestrado Integrado em Medicina Dentária apresentado à Faculdade de Medicina da Universidade de Coimbra.
Este estudo piloto teve como objectivo a sondagem de uma metodologia, que permitisse, no caso de se mostrar promissora, realizar um estudo clínico posterior. Com a sua realização pretendemos avaliar parâmetros que possam consubstanciar o ponto de partida para um estudo clínico com maior significância, que avalie o estado psicológico (stress, ansiedade, depressão) e a sua relação com possíveis sinais e sintomas de disfunções musculares ou articulares da cabeça e pescoço em desportistas praticantes da modalidade de futebol 11. Pretendemos esclarecer, se, na nossa amostra, a prática da modalidade pode influenciar tanto o aspecto psicológico do indivíduo, como o aspecto funcional dos músculos e articulações da cabeça e pescoço dos praticantes da mesma. Para a realização deste estudo piloto contámos com 20 voluntários do sexo masculino, com idades compreendidas entre os 20-25 anos, todos praticantes amadores da modalidade de futebol e pertencentes à equipa de futebol 11 da Associação Académica de Coimbra. Foi dado a cada atleta um questionário de avaliação do estado/traço de ansiedade (Inventário de Traço de Ansiedade de Spilberg) e a primeira parte do Research Diagnostic Criteria for Temporomandibular Disorders (adaptado para português), que consiste em um questionário de avaliação clínica, de grande difusão internacional. De seguida, cada elemento da amostra foi submetido a um exame clínico, a segunda parte do Research Diagnostic Criteria for Temporomandibular Disorders (adaptado para português). Os dados recolhidos do preenchimento dos questionários e do exame clínico foram agrupados em tabelas que permitem a associação dos diferentes aspectos característicos das disfunções temporomandibulares com os diferentes estados/traços de ansiedade. Foi efectuada uma pesquisa bibliográfica numa base de dados de artigos médicos (Pubmed), através da página da web http://www.ncbi.nlm.nih.gov. A pesquisa foi efectuada para artigos publicados entre os anos de 2003 e 2013 e foram seleccionados 20 artigos, tendo em atenção a data e a revista de publicação, bem como o conteúdo científico do resumo. As disfunções temporomandibulares são consideradas um grupo heterogéneo de disfunções psicofisiológicas de etiologia multifactorial, biopsicossocial e a dor nos músculos da mastigação, na articulação temporomandibular e desvios dos movimentos mandibulares são considerados os seus principais sintomas. Factores biomecânicos, neuromusculares, biopsicossociais e neurobiológicos podem contribuir para estas disfunções. Estes factores são classificados como factores predisponentes (condições estruturais, metabólicas e psicológicas), precipitantes (trauma físico ou psíquico, desequilíbrio ortopédico/função anómala do sistema estomatognático), perpetuantes (parafunções, factores hormonais, factores psicossociais, factores genéticos). Os achados presentes mostram que cerca de 50% da amostra apresenta sinais e sintomas de DTM, contudo, não foi encontrada uma associação óbvia entre a prática da modalidade e a presença desses sinais e sintomas. No que concerne aos diferentes traços de ansiedade, podemos mostrar que 65% da amostra apresenta valores médios de ansiedade. Apenas 15% da amostra apresenta valores de ansiedade elevados e muito elevados. Contudo, não foi encontrada uma associação óbvia entre a prática da modalidade e os resultados de ansiedade obtidos.

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Chang, Pei-Kun, and 張培焜. "Investigate the roundness variations of condyle head of the temporomandibular disorders (TMD) patients with the image processing and analysis technique." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/89288533402371017742.

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碩士
國立屏東科技大學
生物機電工程系所
99
Purpose: The purpose of the study was to analyze the roundness variations of condyle head in routine panoramic radiographic examination and establish a new evaluation system for temporomandibular disorders (TMDs). The panoramic radiographs of patients from hospital clinic were collected and processed to obtain the round variation of each condyle head. The processing method was analyzed with Kruskal-Wallis test and ANOVA. Then patients were divided into two groups: one was symptomatic TMDs (SS); one was no TMDs (NoSS). The roundness variations of each group were obtained and analyzed with t-test. The image processing technique of panoramic radiograph for roundness variation of condyle was confirmed to be feasible by Kruskal-Wallis test and ANOVA with p-value < .05. The results between groups were analyzed to be significant by t-test with p-value < .05. Therefore, the roundness variation of condyle head may be a new reference parameter of TMDs.

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Poacher, Elizabeth. "The relative effectiveness of three treatment protocols in the management of temporomandibular disorder." Thesis, 2011. http://hdl.handle.net/10321/671.

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Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011.
The relationship between TMD and dysfunction in the cervical spine has been reported in the literature and there are many case studies which have shown favourable results when treatment was aimed at the TMJ, cervical spine relationship. However, the numerous TMD treatment protocols described in the literature concerning this relationship, and the effectiveness of these treatments have not been well established. In spite of this many chiropractors treat TMD. TMD is a multifactoral condition and conservative treatment options need to be further investigated in order to determine if manual interventions directed at the cercival spine in the treatment of TMD are beneficial. Objectives: The purpose of this study was to compare myofascial trigger point therapy and manipulative therapy of either the TMJ, cervical spine or a combination of the two in order to determine their effectiveness for the TMD. Method: Thirty participants with TMD were randomly assigned to one of three treatment groups. Participants in each group received two treatments per week for two weeks with a follow up consultation in the third week. Data were collected before the commencement of the first, second, and fourth treatments and at the follow up consultation. Outcome measures included algometer readings, CROM, Mouth opening readings, NRS and a disability questionnaire. SPSS version 15.0 was used for analysis of the data. A p value <0.05 was considered as statistically significant. Multivariate testing was used for intra- and inter-group comparisons. Profile plots were generated to assess the direction and trend of the effect and to visually compare the trends in the different treatment groups. Results: Inter-group comparisons did not reveal any statistically significant different improvements between the three treatment groups. Conclusion: All groups responded favourably to treatment and showed trends towards improvement. However, statistically analysis revealed that no one treatment protocol was superior to the other. Although no definitive inferences may be drawn regarding the effectiveness of each treatment approach, within group trends indicated that the combination of the two treatment approaches may be preferred.

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Silva, Ana Margarida Domingues Dias da. "Relação entre a disfunção temporomandibular e os fatores psicossomáticos." Master's thesis, 2015. http://hdl.handle.net/10400.14/18777.

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Introdução: A oclusão é definida como o contacto que existe entre os dentes maxilares e mandibulares. O termo disfunção temporomandibular (DTM) é utilizado para reunir um grupo de doenças que acometem os músculos mastigatórios, a articulação temporomandibular (ATM) e as estruturas adjacentes. Os principais sintomas da DTM são dor, limitação de abertura, sons articulares, desvio mandibular e dificuldades mastigatórias. Estes sintomas podem aparecer isolados ou combinados. A dor é o sintoma mais comum das DTM e é esta a razão pela qual os pacientes se dirigem ao médico dentista. Os pacientes têm dores quando realizam movimentos mandibulares, em repouso ou quando lhes é feita a palpação muscular. Os portadores de DTM são particularmente importantes do ponto de vista psicológico, sendo necessário avaliar os fatores psicossomáticos na presença de dores crónicas orofaciais. Objetivo: Realizar uma revisão bibliográfica em que se avalie o papel dos fatores psicossomáticos nas disfunções temporomandibulares. Materiais e Métodos: A pesquisa dos artigos a rever foi realizada no Pubmed, Google Académico e ScienceDirect. Nos motores de busca acima citados, os termos de pesquisa utilizados foram: “Occlusion”, “TMJ”, “TMD” , “Stress”, “Anxiety”, “Depression”, “TMD+Stress”, “TMD+Anxiety” e “TMD+Depression”. Os artigos publicados antes do ano de 2000 foram excluídos da revisão bibliográfica. Resultados: Foram selecionados 14 artigos que relacionam a disfunção temporomandibular com os fatores psicossomáticos. Dos 14 artigos escolhidos, 11 são de caráter observacional e 3 de caráter experimental. Conclusão: Os fatores psicossomáticos têm um papel muito importante nas disfunções temporomandibulares. Os indivíduos portadores desta patologia apresentam maiores níveis de ansiedade, stress e depressão comparativamente com os pacientes saudáveis.
Introduction: Occlusion is defined as the contact that exists between the maxillary and mandibular teeth. The term temporomandibular disorders (TMD) are used to join a group of diseases that affect the masticatory muscles, the temporomandibular joint (TMJ) and adjacent structures. The main symptoms of TMD are pain, opening limitation, joint sounds, and mandibular deviation and chewing difficulties. These symptoms may appear alone or together. Pain is the most common symptom of TMD and this is the reason why patients go to the dentist. Patients have pain when jaw movements occur or when someone made to them muscle palpation. The patients with TMD are particularly important from a psychological point of view. It is necessary to evaluate the psychosomatic factors in the presence of orofacial chronic pain. Objective: Evaluate the role of psychosomatic factors in temporomandibular disorders through a literature review. Materials and Methods: The search of the articles to review was conducted in PubMed, Google Scholar and ScienceDirect. The terms used in the research were: "Occlusion", "TMJ", "TMD", "Stress", "Anxiety," "Depression," "TMD + Stress", "TMD + Anxiety" and "TMD + Depression". The articles published before 2000 were excluded from the literature review. Results: We selected 14 articles relating TMD and psychosomatic factors. From the 14 articles, 11 are observational and 3 are experimental. Conclusion: Psychosomatic factors have an important role in temporomandibular disorders. People with this disease have higher levels of anxiety, stress and depression compared to healthy patients.

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Albert, Héloïse. "O ácido hialurónico no tratamento das disfunções da articulação temporomandibular." Master's thesis, 2018. http://hdl.handle.net/10284/7126.

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As disfunções temporomandibulares, que envolve a articulação temporomandibular e/ou os músculos da mastigação e as estruturas anexas, são uma das causas mais comuns de dor orofacial. Dentro dos tratamentos não cirúrgicos, a viscossuplementação, ou seja, a infiltração intra-articular de ácido hialurónico, é uma técnica minimamente invasiva que permite lubrificar e devolver a capacidade funcional à articulação temporomandibular. Esta revisão bibliográfica narrativa tem como objectivo avaliar a efetividade da viscossuplementação utilizando infiltrações de ácido hialurónico no tratamento dos sinais e sintomas de pacientes com disfunções temporomandibulares articulares. A pesquisa bibliográfica desta revisão foi realizada a partir das bases de dados on-line B-On, PubMed e Rearchgate.
Temporomandibular disorders, which involve the temporomandibular joint and/or the chewing muscles and the attached structures, are one of the most common causes of orofacial pain. Within the non-surgical treatments, the viscossuplementation, that is, intra-articular infiltration of hyaluronic acid is a minimally invasive technique that allows lubrication and restoration of functional capacity to temporomandibular joint. This narrative bibliographic review aims to evaluate the effectiveness of viscossuplementation using hyaluronic acid injections in the treatment of signs and symptoms of patients with articular temporomandibular disorders. The bibliographic search of this review was carried out from the online databases B-On, PubMed and Rearchgate.

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Graça, Liliana da Costa. "Reabsorção condilar após cirurgia ortognática." Master's thesis, 2017. http://hdl.handle.net/10284/6539.

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A articulação Temporomandibular (ATM) é a principal ligação entre o crânio e a mandíbula e é das articulações mais complexas e solicitadas funcionalmente no corpo humano. Esta articulação não é imune a alterações, quer estas sejam provocadas por mecanismos intrínsecos ao sistema estomatognático, quer através de acidentes ou até mesmo de cirurgias de correção dos maxilares - Cirurgia Ortognática. A alteração na ATM que mais comummente ocorre após a cirurgia ortognática é a reabsorção condilar. Esta revisão narrativa da literatura teve como objectivo aferir a real relação entre a cirurgia ortognática e a reabsorção condilar, bem como, as características desta patologia. A literatura verifica uma relação entre a cirurgia ortognática e a reabsorção condilar, associada mais frequentemente ao tipo de osteotomia e ao tipo de fixação pós-cirúrgica. No entanto, mais estudos caso-controlo, como amostras de maior dimensão deverão ser realizados para suportar estas evidências.
The temporomandibular joint (TMJ) is the main connection between the skull and the mandible and is the most complex and functionally requested joint in the human body. This joint is not immune to changes, whether these are caused by mechanisms intrinsic to the stomatognathic system, on through accidents or even surgery for correction of the jaws. The most common alteration in TMJ after orthognatic surgery is condylar resorption. This narrative review of the literature aimed to assess the relationship between orthognatic surgery and condylar resorption as well as the characteristics of this pathology. The literature shows a relationship between orthognathic surgery and condylar resorption, most frequently associated with the type of osteotomy and the type of postoperative fixation. However more case-control studies with larger sample sizes should be performed to support this evidence.

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