Classificação Internacional de Dor Orofacial, Primeira Edição (ICOP) - versão Português Brasileiro

Preface of the Brazilian version of the ICOP It is with great satisfaction and enthusiasm that we present the Portuguese version of the ICOP (International Classification of Orofacial Pain, in English). ICOP is the result of an effort by several world representative entities in the area of Orofacial Pain. That initiative culminated in a comprehensive document that aims to standardize the classification of Orofacial Pain. Originally published in 2020 by the International Headache Society (IHS), we now have our version in Portuguese, to be applied in research and clinical activities, also providing subsidies to discuss future steps. The ICOP is formatted in such a way that it provides a logical and coherent flow of reasoning for determining the diagnosis. We must also remember that this document is part of the initiative of the World Health Organization (WHO), through the International Classification of Diseases (ICD), and should be part of the entity's official document from 2022, which makes it even more important as a tool for “conversation” with other health specialties involved in the diagnosis and treatment of pain. We would like to say a huge thank you to all the members of the Committee involved in the translation process and especially the Brazilian Headache Society (SBCe) for their support for the materialization of this project. We also thank Cephalalgia for allowing the translation of the ICOP originally published by them, and the publication of the Brazilian version. We also emphasize that this is a “beta” version of the ICOP, which means that it must undergo adjustments and improvements after a period of use. Thus, we invite all of you to use, discuss, apply the criteria and, above all, give your opinion so that we can always take another step forward in the difficult but fundamental task of classifying Orofacial Pain. Good reading!

Research routes on improved sleep bruxism metrics: Toward a standardised approach

A recent report from the European Sleep Research Society's task force "Beyond AHI" discussed an issue that has been a long-term subject of debate - what are the best metrics for obstructive sleep apnoea (OSA) diagnosis and treatment outcome assessments? In a similar way, sleep bruxism (SB) metrics have also been a recurrent issue for >30 years and there is still uncertainty in dentistry regarding their optimisation and clinical relevance. SB can occur alone or with comorbidities such as OSA, gastroesophageal reflux disorder, insomnia, headache, orofacial pain, periodic limb movement, rapid eye movement behaviour disorder, and sleep epilepsy. Classically, the diagnosis of SB is based on the patient's dental and medical history and clinical manifestations; electromyography is used in research and for complex cases. The emergence of new technologies, such as sensors and artificial intelligence, has opened new opportunities. The main objective of the present review is to stimulate the creation of a collaborative taskforce on SB metrics. Several examples are available in sleep medicine. The development of more homogenised metrics could improve the accuracy and refinement of SB assessment, while moving forward toward a personalised approach. It is time to develop SB metrics that are relevant to clinical outcomes and benefit patients who suffer from one or more possible negative consequences of SB.

Obesity, sedentarism and TMD-pain in adolescents

BACKGROUND

Obesity is a chronic and prevalent disorder, affecting individuals of all age. Previous evidence suggests that it is associated with some types of chronic pain, especially musculoskeletal pain. In addition, sedentarism is also associated with an increase of the inflammatory factors and chronic pain. So, we conducted a cross-sectional study to evaluate the association between obesity, sedentarism and the presence of TMD-pain in adolescents.

METHODS

Temporomandibular Disorders were classified according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Obesity was assessed by the body mass index (BMI), bioimpedance (BIA), skinfold (triceps and subscapular) and circumferences (arm and abdominal). The level of physical activity was rated according to the instrument adopted by the Brazilian National School Health Survey. Descriptive statistics, univariate logistic regression and odds ratios (OR) with 95% confidence intervals (CI) were used to study the associations of interest.

RESULTS

The sample consisted of 690 individuals with a mean age of 12.7 (±0.76) years of whom 389 (56.4%) were girls. Of the total, 112 (16.2%) had TMD-pain, 110 (15.9%) were obese according to BMI, 74 (10.8%) according to BIA, and 127 (18.4%) following the skinfolds and circumferences assessments. There was no significant association between TMD-pain and obesity according to BMI (P = 0.95), BIA (P = 0.16), skinfold and circumference (P = 0.22), and neither with sedentarism (P = 0.94).

CONCLUSION

Obesity and sedentarism were not associated with the presence of TMD-pain in adolescents.

Musculoskeletal Disorders

Temporomandibular disorder (TMD), a type of musculoskeletal pain, is a main cause of pain in the orofacial region. It involves the masticatory muscles, temporomandibular joints (TMJs), and associated structures. The most common signs and symptoms are pain, limited range of motion, and TMJ sounds. TMD is a highly prevalent condition with a multifactorial etiology. Management aims to reduce pain and to improve function using a combination of therapeutic options. Noninvasive techniques are the first option and should be indicated considering the needs of each individual, the clinical features, and the mechanisms involved.

Relationship of Psychological Factors to Temporomandibular Disorders in Children

This study evaluated the incidence of TMDs and their relationship to psychological factors in children ages 6 to 12 years who sought dental treatment at the Ponta Grossa State University. Following ethics committee approval and informed consent, 75 children were included in the study. Exclusion criteria were craniofacial malformations, history of orthodontic treatment and maxillary fractures. TMD severity was classified, using the Fonseca anamnesis index questionnaire, as “no TMD” (control) and “mild,” “moderate” and “severe.” Parents completed the Child Behavior Checklist, which measures behavior problems and competencies. Data were analyzed using the Chi-square test (a=0.01). Regardless of gender, 40 children had internalizing problems (with TMD, n=32; without TMD, n=8). Children presenting internalizing problems and TMD were classified as having mild (n=23), moderate (n=8) and severe TMD (n=1). Thirty-one children interviewed had externalizing problems (with TMD, n=24; without TMD, n=7). Children presenting externalizing problems and TMD were classified as having mild (n=18), moderate (n=5) and severe TMD (n=1). In addition, 36 children had behavior problems (with TMD, n=26; without TMD, n=10), of whom 19 children had mild, 6 children had moderate and 1 child had severe TMD. Psychological problems were related to TMD in Brazilian children ages 6 to 12.

Obesity as a risk factor for temporomandibular disorders

We conducted a clinical cross-sectional study to evaluate the association between obesity and the presence of painful temporomandibular disorders (TMD), controlling for age, gender, presence of migraine, depression, non-specific somatic symptoms and obstructive sleep apnoea syndrome (OSAS) in an adult population. A total of 299 individuals (76·6% women) with a mean age of 36·8 ± 12·8 years were evaluated. TMD were classified using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Depression and non-specific somatic symptoms were scored by the Symptom Checklist-90, while pain and disability was rated by the Graded Chronic Pain Scale. Bioimpedanciometry (BIA) was used to assess obesity through total body fat percentage. Migraine was diagnosed according to the criteria of the International Classification of Headache Disorders-2 (ICHD-2). OSAS was classified according to the Berlin Questionnaire. We performed univariate and multivariate models, chi-square tests and odds ratios (OR) with 95% confidence intervals (CI). In the single regression analysis, TMD-pain was significantly associated with total body fat percentage (P = 0·01). In the multivariate analysis, migraine, age, non-specific somatic symptoms and OSAS showed to be stronger predictors of TMD-pain, and obesity did not retain in the regression model. The initial association found between obesity and TMD-pain is lost when it was corrected for gender, migraine, non-specific somatic symptoms and OSAS.

Painful temporomandibular disorders and central sensitization: implications for management-a pilot study

The objective was to investigate the presence of cutaneous allodynia and hyperalgesia in the trigeminal and extra-trigeminal areas, as a surrogate for central sensitization (CS), in women with a painful temporomandibular disorder (TMD) and without other painful conditions. Painful TMDs, depression, and non-specific physical symptoms (NSPS) were classified according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The amount of pain in the trigeminal and extra-trigeminal areas was determined using a visual analogue scale (0-100mm) after the application of a vibrotactile stimulus and assessment of the pressure pain threshold (PPT). Statistical tests (Fisher's, χ², and Mann-Whitney) were performed, with a significance level of 5%. The sample comprised 45 women (mean age 37.5 years; 16 with a painful TMD) who were free of any headache, fibromyalgia, or other painful condition. Painful TMD was associated with higher pain sensitivity and lower PPT values in the trigeminal (P<0.01) and extra-trigeminal regions (P<0.01). The presence of depression contributed significantly to increased pain sensitivity. The presence of hyperalgesia and allodynia in both the trigeminal and extra-trigeminal regions among women with a painful TMD indicated the presence of CS. Changes involving the central nervous system should be considered during the evaluation and management of patients with a painful TMD.

Migraine is the most prevalent primary headache in individuals with temporomandibular disorders

AIMS

To assess the prevalence of primary headaches (HA) in adults with temporomandibular disorders (TMD) who were assessed in a specialty orofacial pain clinic, as well as in controls without TMD.

METHODS

The sample consisted of 158 individuals with TMD seen at a university-based specialty clinic, as well as 68 controls. The Research Diagnostic Criteria for TMD were used to diagnose the TMD patients. HAs were assessed using a structured interview and classified according to the Second Edition of the International Classification for Headache Disorders. Data were analyzed by chi-square tests with a significance level of 5% and odds ratio (OR) tests with a 95% confidence interval (CI).

RESULTS

HAs occurred in 45.6% of the control group (30.9% had migraine and 14.7% had tension-type headache [TTH]) and in 85.5% of individuals with TMD. Among individuals with TMD, migraine was the most prevalent primary HA (55.3%), followed by TTH (30.2%); 14.5% had no HA. In contrast to controls, the odds ratio (OR) for HA in those with TMD was 7.05 (95% confidence interval [CI] = 3.65-13.61; P = .000), for migraine, the OR was 2.76 (95% CI = 1.50-5.06; P = .001), and for TTH, the OR was 2.51 (95% CI = 1.18-5.35; P = .014). Myofascial pain/arthralgia was the most common TMD diagnosis (53.2%). The presence of HA or specific HAs was not associated with the time since the onset of TMD (P = .714). However, migraine frequency was positively associated with TMD pain severity (P = .000).

CONCLUSION

TMD was associated with increased primary HA prevalence rates. Migraine was the most common primary HA diagnosis in individuals with TMD.

Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts total joint prostheses: part IV--soft tissue response

The purpose of this study was to evaluate soft tissue response to maxillo-mandibular counter-clockwise rotation, with TMJ reconstruction and mandibular advancement using TMJ Concepts total joint prostheses, and maxillary osteotomies in 44 females. All patients were operated at Baylor University Medical Center, Dallas TX, USA, by one surgeon (Wolford). Eighteen patients had genioplasties with either porous block hydroxyapatite or hard tissue replacement implants (Group 2) 26 had no genioplasty (Group 1). Surgically, the maxilla moved forward and upward by counter-clockwise maxillo-mandibular rotation with greater horizontal movement in Group 2. Vertically, both groups showed diversity of maxillo-mandibular mean movement. Group 1 showed a consistent 1: 0.97 ratio of hard to soft tissue advancement at pogonion; Group 2 results were less consistent, with ratios between 1: 0.84 and 1: 1.02. Horizontal changes in upper lip morphology after maxillary advancement/impaction, VY closure, and alar base cinch sutures showed greater movement in both groups, than observed in hard tissue. Counter-clockwise rotation of the maxillo-mandibular complex using TMJ Concepts total joint prostheses resulted in similar soft tissue response as previously reported for traditional maxillo-mandibular advancement without counter-clockwise rotation of the occlusal plane. The association of chin implants, in the present sample, showed higher variability of soft tissue response.