ABSTRACT: Botulinum neurotoxin A (BoNT-A) causes an anticholinergic effect on neuronal fibers, which control muscle contraction and autonomic disorders. Thus, it has been widely used in facial aesthetics, decreasing the action of motor muscles and consequent wrinkles. This preliminary study evaluated the effect of BoNT-A in 77 patients, the treatment satisfaction index was defined in percentage (from 0% to 100%). The evaluation was carried out on 15th, 30th, 60th, 90th, and 180th days after BoNT. The data were analyzed using the Friedman, Student t, Mann-Whitney test with t (alpha=0.05). The results showed that at 15th and 30th days the scores were similar in all muscles with high level of satisfaction and until 90th days the scores decreased significantly for Corrugator supercilii 79.38%, Occipitofrontalis 71.46%, Orbicularis oculi 70.43%; but the satisfaction was good. At 180 days, there was a drop in effectiveness in all treated muscles since the scores decreased significantly, showing low satisfaction by the participants. This study demonstrated that the BoNT-A had attested satisfaction effect by participants for up to 90th days, but at 180th days the satisfaction was low. In the comparative analyzes between women under 40 and over 40 years of age, there was no significant differences.

Abstract BoNT-A has been widely used for TMD therapy. However, the potential benefits compared to dry needling techniques are not clear. Objective this study aimed to compare the immediate effects of botulinum toxin type A (BoNT-A) injections and Acupuncture in myofascial temporomandibular disorders (TMD) patients. Methodology 54 women were divided into three groups (n=18). AC patients received four sessions of traditional acupuncture, being one session/week during 20-min. BoNT-A patients were bilaterally injected with 30U and 10U in masseter and anterior temporal muscles, respectively. Moreover, a control group received saline solution (SS) in the same muscles. Self-perceived pain was assessed by visual analog scale, while pressure pain threshold (PPT) was verified by a digital algometer. Electromyographic evaluations (EMG) of anterior temporal and masseter muscles were also measured. All variables were assessed before and 1-month after therapies. The mixed-design two-way repeated measures ANOVA and Tukey’s post-hoc tests were used for analysis, considering a=0.05. Results Self-perceived pain decreased in all groups after one month of therapy (P<.001). BoNT-A was not better than AC in pain reduction (P=0.05), but both therapies were more effective in reducing pain than SS (P<0.05). BoNT-A was the only treatment able to improve PPT values (P<0.05); however, a severe decrease of EMG activity was also found in this group, which is considered an adverse effect. Conclusion after one month of follow-up, all therapies reduced the self-perceived pain in myofascial TMD patients, but only BoNT-A enhanced PPT yet decreased EMG.

Abstract Objective the aim of this study was to describe the frequency of psychosocial diagnoses in a large sample of patients attending a tertiary clinic for treatment of temporomandibular disorders (TMD). Material and Methods six hundred and ninety-one patients who sought treatment for pain-related TMD were selected. Chronic pain-related disability (Graded Chronic Pain Scale, GCPS), depression [Symptoms Checklist-90 (SCL-90) scale for depression, DEP] and somatization levels (SCL-90 scale for non-specific physical symptoms, SOM) were evaluated through the Research Diagnostic Criteria for TMD (RDC/TMD) Axis II psychosocial assessment; TMD diagnoses were based on the Axis I criteria. Results the majority of patients presented a low disability or no disability at all, with only a small portion of individuals showing a severely limiting, high disability pain-related impairment (4.3%). On the other hand, abnormal scores of depression and somatization were high, with almost half of the individuals having moderate-to-severe levels of depression and three-fourths presenting moderate-to-severe levels of somatization. The prevalence of high pain-related disability (GCPS grades III or IV), severe/moderate depression and somatization was 14.3%, 44% and 74.1% respectively. Gender differences in scores of SCL-DEP (p=0.031) and SCL-SOM (p=0.001) scales were signficant, with females presenting the highest percentage of abnormal values. Conclusion patients with TMD frequently present an emotional profile with low disability, high intensity pain-related impairment, and high to moderate levels of somatization and depression. Therefore, given the importance of psychosocial issues at the prognostic level, it is recommended that clinical trials on TMD treatment include an evaluation of patients’ psychosocial profiles.

A síndrome da fibromialgia (SFM) é uma síndrome dolorosa crônica. A coexistência de uma condição dolorosa causada pela disfunção temporomandibular (DTM) e pela SFM tem sido frequentemente descrita por vários estudos. No entanto, a hipótese mais provável é que um conjunto de características da SFM pode levar ao aparecimento de sintomas de DTM e elas não são apenas condições coexistentes. Por isso, o objetivo deste estudo é apresentar uma revisão da literatura sobre a relação entre a fibromialgia e os sinais e sintomas da disfunção temporomandibular. Para este fim, fez-se uma pesquisa bibliográfica que envolveu o período de 1990 a 2013 nas bases de dados Medline, Pubmed, Lilacs e Scielo. Foram usadas as palavras-chave fibromialgia, disfunção temporomandibular e dor facial. Neste trabalho, apresenta-se um conjunto de achados da literatura que mostram que a fibromialgia pode levar a sintomas de DTM. Estes estudos mostraram um maior envolvimento do sistema estomatognático na SFM e que os distúrbios miogênicos do sistema mastigatório são os mais comumente encontrados nesses pacientes. A SFM parece ter uma série de características que constituem fatores predisponentes e desencadeantes para a DTM.

Fibromyalgia syndrome (FMS) is a chronic painful syndrome and the coexistence of a painful condition caused by Temporomandibular Disorders (TMD) and FMS has been frequently raised for several studies; however, a more likely hypothesis is that a set of FMS characteristics may lead to the onset of TMD symptoms and they are not merely coexisting conditions. Therefore, our aim is presenting a review of literature about the relation between fibromyalgia and the signs and symptoms of temporomandibular disorders. For this purpose, a bibliographic search was performed for the period of 1990–2013, in the Medline, Pubmed, Lilacs and Scielo databases, using the keywords fibromyalgia, temporomandibular disorders and facial pain. Here we present a set of findings in the literature showing that fibromyalgia can lead to TMD symptoms. These studies demonstrated greater involvement of the stomatognathic system in FMS and myogenic disorders of masticatory system are most commonly found in those patients. FMS appears to have a series of characteristics that constitute predisposing and triggering factors for TMD.

Facial pain often persists long after any identifiable organic pathology has healed. Moreover, in a subgroup of patients with temporomandibular disorder (TMD), no treatment is effective. Knowledge of factors associated with persistent pain in TMD could help identify personalized treatment approaches. Therefore, we conducted a critical review of the literature for the period from January 2000 to December 2013 to identify factors related to TMD development and persistence. The literature findings showed that chronic TMD is marked by psychological distress (somatization and depression, affective distress, fear of pain, fear of movement, and catastrophizing) and characteristics of pain amplification (hyperalgesia and allodynia). Furthermore, these factors seem to interact in TMD development. In addition, our review demonstrates that upregulation of the serotonergic pathway, sleep problems, and gene polymorphisms influence the chronicity of TMD. We conclude that psychological distress and pain amplification contribute to chronic TMD development, and that interactions among these factors complicate pain management. These findings emphasize the importance of multidisciplinary assistance in TMD treatment.

El elongamiento y mineralización del proceso estilóide ha sido descrito en la literatura como un acontecimiento que puede ser asintomático o manifestarse como Síndrome estiloestilohióideo o Síndrome de Eagle. Este estado, se caracteriza por un conjunto de señales y síntomas como el dolor facial leve, disconformidad en la deglución, limitaciones en los movimientos de la cabeza, cuello y la abertura bucal, otalgia, cefalea y disfagia que pueden ser confundidos con el Desorden Temporomandibular. Uno de los principales recursos de diagnóstico para el elongamiento del proceso estiloide es la evaluación radiográfica. El propósito de este trabajo fue investigar en la población adulta totalmente desdentada, la prevalencia del elongamiento del proceso estiloide. En este trabajo, los autores analizaron 233 radiografías panorámicas del servicio de tiraje de la FOP-UNICAMP en pacientes adultos, de ambos sexos, totalmente desdentados. Fueron realizadas mediciones de las imágenes de los procesos estiloides y fueron consideradas elongadas las imágenes de los procesos estiloides mayores de 30 milímetros conforme a los estudios obtenidos en la revisión de la literatura. Las imágenes que no permitieron realizar las mediciones en forma segura fueron despreciadas. Los resultados fueron organizados en tablas y divididos según los factores de edad, sexo y lado predominante. Los datos permitieron observar que de las 233 radiografías analizadas, fue posible medir 341 procesos estiloides, siendo que de estos, 50,1%(n=176) presentaron medida mayor de que 30 milímetros . De estas imágenes, 64%(n=113), fueron mujeres y 35%(n=63) hombres. Los valores promedios obtenidos fueron de 33, 5 milímetros para los individuos de sexo masculino y de 31,38 milímetros para los de sexo femenino. En relación con la edad, la mayor prevalencia fue comprendida entre 61 y 70 años, con un porcentaje de 61,8 % (nt=110; n=68), seguida de la facha hectárea entre 51 años y 60 años, con un porcentaje de 52%(nt=341; nd=159; n=82) para el lado derecho y de 28,4% (nt=341; ne=182; n=97) para el lado izquierdo. Los autores concluyeron que: existió una mayor prevalencia de proceso estiloide elongado en individuos de sexo femenino, no ocurrió predominio en cuanto al lado de presencia del proceso elongado, existió una mayor prevalencia de elongamiento del proceso estilóide en los individuos de edades entre 51 y 70 años, y baja prevalencia entre los individuos con menos de 30 años.

The elongation and mineralization of the styloid process is described in the literature as an occurrence that may be asymptomatic or that can be manifested as a stylohyoid-style syndrome or Eagle’s Syndrome. This morbid state is characterized by a set of signs and symptoms such as vague facial pain, discomfort when swallowing, limited movement of the head, neck and mouth opening, otalgia, dysphagia and dizziness, which may be mistaken for the symptoms of Temporomandibular Disorder. One of the main diagnostic resources for elongation of the styloid process is X-ray evaluation. The purpose of this study was to investigate the prevalence of elongation of the styloid process in a totally edentate adult population. In this work, the authors analyzed 233 panoramic X-rays of totally edentate adult patients of both sexes from the screening service of the Piracicaba School of Dentistry (FOP-Unicamp). Measurements were made of styloid process images and those larger than 30 mm were considered elongated, according to the literature. The images that did not allow for accurate measurements were neglected. The findings were organized into tables and divided according to the factors of age group, sex and predominant side. These data revealed that, of the 233 analyzed X-rays, 341 styloid processes were measurable, of which 50.1% (n=176) showed a measure of more than 30 mm . Of these images, 64% (n=113) were taken from females and 35% (n=63) from males. The mean values obtained were 33.5 mm for the males and 31.38 mm for the females. With regard to the age group factor, the highest prevalence was found in the 61 to 70 age group, with a percentage of 61.8% (nt=110; n=68), followed by the 51 to 60 age group, with a percentage of 52% (nt=100; n=52). As for the side, 159 images of the right hand side styloid process and 182 of the left hand side were measured. A prevalence of 24% (nt=341; nd= 159; n=82) was found for the right hand side and of 28,4% (nt=341; ne=182; n=97) for the left. The authors concluded that the females showed a greater prevalence of elongated styloid process; the elongation process was not found to predominate on either side; the greatest prevalence of elongation of the styloid process was found in the 51 to 70 age group, and a low incidence among individuals under 30.

The purpose of this work was to analyze water sorption by polymerized acrylic resins under different pressure, temperature and time treatments. A thermo-cured acrylic resin was used as the denture base (Classico Ltda.) and ethylene glycol di-methacrylate as a cross-linking agent, with processing carried out in a water bath at 73 °C for nine hours. Forty-five samples were prepared following the criteria and dimensions of specification # 12 of the American Dental Association (ADA), using a matrix in the shape of a stainless steel disc with 50 ± 1 mm diameter and 0.5 ± 0.05 mm thickness. The control group samples were stored in distilled water for 30 days, while groups GII to GIX were placed in a polymerization device with adjustable pressure, time and temperature. An analysis of the variance of the results revealed the influence of different factors on water sorption only, with significant factors being temperature, time, pressure and the interaction between time and temperature. Other interactions exerted no significant influence on water sorption. Neither additional treatments nor the control group (GI) showed any significant difference in comparison to the averages of other treatments.

A proposta deste estudo foi comparar as alterações dimensionais de 3 resinas submetidas à polimerização com os seguintes ciclos: 1) banho d’água em 73ºC durante 12 horas - ciclo longo, 2) banho d’água durante 3 horas - ciclo curto, 3) energia de microondas por 3 minutos a potência de 500 W, após armazenamento em água destilada a 37 ± 2ºC durante 30 dias. As resinas usadas foram Clássico, Lucitone 550 e Acron MC. As resinas Clássico e Lucitone 550 foram submetidas aos três ciclos, enquanto a resina Acron-MC somente ao ciclo 3. Amostras medindo 65,0 x 10,0 x 3,0 mm e com marcas iguais em três pontos eqüidistantes foram confeccionadas a partir da inclusão de matrizes de aço em gesso-pedra tipo III. Foram confeccionados 21 corpos-de-prova para cada combinação resina/ciclo de polimerização e que foram submetidos a 3 leituras para cada posição (A e B), com o auxílio do microscópio de mensuração (precisão de 0,001 mm), imediatamente após a polimerização e depois do período de imersão em água por 30 dias. Os resultados mostraram que todas as resinas, independendo do ciclo a que tenham sido submetidas e das medidas avaliadas, apresentaram expansão dimensional após terem sido mantidas em água; a composição da resina interferiu na expansão dimensional mais do que o ciclo de polimerização ao qual as resinas foram submetidas; a resina convencional, quando polimerizada com energia de microondas, apresentou alteração dimensional semelhante à resina desenvolvida para a polimerização em microondas.

This study examined the influence of three polymerization cycles (1: heat cure - long cycle; 2: heat cure - short cycle; and 3: microwave activation) on the linear dimensions of three denture base resins, immediately after deflasking, and 30 days after storage in distilled water at 37± 2ºC. The acrylic resins used were: Clássico, Lucitone 550 and Acron MC. The first two resins were submitted to all three polymerization cycles, and the Acron MC resin was cured by microwave activation only. The samples had three marks, and dimensions of 65 mm in length, 10 mm in width and 3 mm in thickness. Twenty-one test specimens were fabricated for each combination of resin and cure cycle, and they were submitted to three linear dimensional evaluations for two positions (A and B). The changes were evaluated using a microscope. The results indicated that all acrylic resins, regardless of the cure cycle, showed increased linear dimension after 30 days of storage in water. The composition of the acrylic resin affected the results more than the cure cycles, and the conventional acrylic resin (Lucitone 550 and Clássico) cured by microwave activation presented similar results when compared with the resin specific for microwave activation.