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      Temporomandibular disorder in adults: retrospective study Translated title: Disfunção temporomandibular em adultos: estudo retrospectivo

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          Abstract

          ABSTRACT BACKGROUND AND OBJECTIVES: The temporomandibular disorder (TMD) comprises clinical signs and symptoms involving masticatory muscles, the temporomandibular joint (TMJ) and associated structures, does not affect all people equally, and all individuals are not equally susceptible to it. The aim of this study was to investigate signs and symptoms present in individuals with TMD. METHODS: Cross-sectional study with 471 individuals with TMD, 394 women and 77 men, based on data from clinical records, diagnostic exams and treatment of patients seen at the Federal University of Pelotas, Brazil, from 2000 to 2017. RESULTS: Data showed that 84% of the individuals were women. The most prevalent age group was 20-39 years old (45%, p<0.01). The most reported main complaints were TMJ pain (29.9%, p<0.01) for both genders, and facial pain (18%, p<0.01). The most common signs and symptoms were muscle pain, TMJ pain, facial pain and clicks in women and parafunctional habits in men, followed by limited mouth opening and tension headache. Dentate patients were the majority in the study (58%, p<0.01), followed by partial edentates (30%, p<0.01). CONCLUSION: The data found showed a high prevalence of TMD and the importance of its prevention in order to improve the health and well-being of the population.

          Translated abstract

          RESUMO JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibular (DTM) apresenta sinais clínicos e sintomas envolvendo músculos mastigadores, articulação temporomandibular (ATM) e estruturas associadas, não incide igualitariamente em todas as pessoas e todos os indivíduos não são igualmente suscetíveis a mesma. O objetivo deste estudo foi investigar sinais e sintomas presentes em indivíduos com DTM. MÉTODOS: Estudo transversal retrospectivo em 471 indivíduos portadores de DTM, 394 mulheres e 77 homens, a partir de dados obtidos de fichas clínicas, exames de diagnóstico e tratamento de pacientes atendidos na Universidade Federal de Pelotas, no período de 2000 a 2017. RESULTADOS: Dados mostraram que 84% dos indivíduos foram mulheres. A faixa etária mais prevalente foi dos 20-39 anos (45%, p<0,01). As queixas principais relatadas foram dor na ATM (29,9%, p<0,01) para ambos os sexos e dor facial (18%, p<0,01). Os sinais e sintomas mais presentes foram dor muscular, dor na ATM, dor facial e estalidos em mulheres e hábitos parafuncionais em homens, seguidos por limitação de abertura bucal e cefaleia tensional. A maioria dos pacientes eram dentados (58%, p<0,01), seguidos pelos edentados parciais (30%, p<0,01). CONCLUSÃO: Os dados encontrados evidenciaram elevada prevalência da DTM e a importância da sua prevenção com o objetivo de melhorar a saúde e o bem-estar da população.

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          Most cited references48

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          Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†.

          The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments. Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project-the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings. The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive self report instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions. The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations.
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            Temporomandibular disorders: Old ideas and new concepts.

            Background Temporomandibular disorders (TMD) is an umbrella term for pain and dysfunction involving the masticatory muscles and the temporomandibular joints (TMJs). TMD is the most common orofacial pain condition. Its prominent features include regional pain in the face and preauricular area, limitations in jaw movement, and noise from the TMJs during jaw movements. TMD affects up to 15% of adults and 7% of adolescents. Chronic pain is the overwhelming reason that patients with TMD seek treatment. TMD can associate with impaired general health, depression, and other psychological disabilities, and may affect the quality of life of the patient. Assessment Evaluations indicate that the recently published Diagnostic Criteria for TMD (DC/TMD) are reliable and valid. These criteria cover the most common types of TMD, which include pain-related disorders (e.g., myalgia, headache attributable to TMD, and arthralgia) as well as disorders associated with the TMJ (primarily disc displacements and degenerative disease). As peripheral mechanisms most likely play a role in the onset of TMD, a detailed muscle examination is recommended. The persistence of pain involves more central factors, such as sensitization of the supraspinal neurons and second-order neurons at the level of the spinal dorsal horn/trigeminal nucleus, imbalanced antinociceptive activity, and strong genetic predisposition, which also is included in DC/TMD. Conclusion The etiology is complex and still not clearly understood, but several biological and psychosocial risk factors for TMD have been identified. Several studies indicate that patients with TMD improve with a combination of noninvasive therapies, including behavior therapy, pharmacotherapy, physical therapy, and occlusal appliances. More stringently designed studies, however, are needed to assess treatment efficacy and how to tailor treatment to the individual patient.
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              Temporomandibular disorders and dental occlusion. A systematic review of association studies: end of an era?

              To answer a clinical research question: 'is there any association between features of dental occlusion and temporomandibular disorders (TMD)?' A systematic literature review was performed. Inclusion was based on: (i) the type of study, viz., clinical studies on adults assessing the association between TMD (e.g., signs, symptoms, specific diagnoses) and features of dental occlusion by means of single or multiple variable analysis, and (ii) their internal validity, viz., use of clinical assessment approaches to TMD diagnosis. The search accounted for 25 papers included in the review, 10 of which with multiple variable analysis. Quality assessment showed some possible shortcomings, mainly related with the unspecified representativeness of study populations. Seventeen (N = 17) articles compared TMD patients with non-TMD individuals, whilst eight papers compared the features of dental occlusion in individuals with TMD signs/symptoms and healthy subjects in non-patient populations. Findings are quite consistent towards a lack of clinically relevant association between TMD and dental occlusion. Only two (i.e., centric relation [CR]-maximum intercuspation [MI] slide and mediotrusive interferences) of the almost forty occlusion features evaluated in the various studies were associated with TMD in the majority (e.g., at least 50%) of single variable analyses in patient populations. Only mediotrusive interferences are associated with TMD in the majority of multiple variable analyses. Such association does not imply a causal relationship and may even have opposite implications than commonly believed (i.e., interferences being the result, and not the cause, of TMD). Findings support the absence of a disease-specific association. Based on that, there seems to lack ground to further hypothesise a role for dental occlusion in the pathophysiology of TMD. Clinicians are encouraged to abandon the old gnathological paradigm in TMD practice.
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                Author and article information

                Journal
                brjp
                BrJP
                BrJP
                Sociedade Brasileira para o Estudo da Dor (São Paulo, SP, Brazil )
                2595-0118
                2595-3192
                December 2021
                : 4
                : 4
                : 310-315
                Affiliations
                [2] Pelotas RS orgnameFederal University of Pelotas orgdiv1School of Dentistry Brazil
                [1] Pelotas RS orgnameFederal University of Pelotas orgdiv1School of Dentistry Brazil
                Article
                S2595-31922021000400310 S2595-3192(21)00400400310
                10.5935/2595-0118.20210052
                8fc08208-25cd-4910-abcb-10138cc0a98e

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 07 December 2020
                : 16 August 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 48, Pages: 6
                Product

                SciELO Brazil

                Categories
                Original Articles

                Facial pain,Síndrome da disfunção da articulação temporomandibular,Dor facial,Articulação temporomandibular,Temporomandibular joint disorder syndrome,Temporomandibular joint

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