Women with temporomandibular disorders (TMD) frequently report pain areas in body regions. This process is associated with central sensitization phenomena, present in chronic pain. The low-level laser therapy (LLLT) has been reported as a therapeutic option for the painful TMD treatment. The aim of this study was to analyze the effect of LLLT on pain intensity (visual analogue scale, VAS), pain sensitivity in orofacial and corporal points (pressure pain threshold, PPT), and on Short Form-McGill Pain Questionnaire (SF-MPQ) indexes of women with myofascial pain (subtype of muscle TMD). Ninety-one women (18-60 years) were included in the study, among which 61 were diagnosed with myofascial pain (Research Diagnostic Criteria for Temporomandibular Disorder-Ia and Ib) and were divided into laser (n = 31) and placebo group (n = 30), and 30 were controls. The LLLT was applied at pre-established points, twice a week, eight sessions (780 nm; masseter and anterior temporal = 5 J/cm, 20 mW, 10 s; TMJ area = 7.5 J/cm, 30 mW, 10 s). Pain intensity, pain sensitivity, and the SF-MPQ indexes were measured at the baseline, during laser sessions, and 30 days after treatment. For intra-group comparisons, the Friedman test was performed, and for inter-group, the Mann-Whitney test. Increased pain sensitivity was found in women with myofascial pain when compared to controls (p < 0.05). There was a reduction in pain intensity for both groups after LLLT. The LLLT did not change the PPT for any group (p > 0.05). Active laser and placebo reduced the indexes of sensory, total pain, and VAS, maintaining the results after 30 days; there was a reduction in the affective pain rating index for both groups, with no maintenance after 30 days for placebo, and the present pain intensity decreased in the laser group and did not change in the placebo after LLLT. In conclusion, the LLLT active or placebo are effective in reducing the overall subjective perception of myofascial pain (VAS and SF-MPQ indexes); however, they have no effectiveness in reducing the pain sensitivity in orofacial and corporal points (PPT increase).
Patients with temporomandibular disorders (TMD) often complain and have limitation in masticatory function, which can be affected by a complex interaction of factors. The aim of this study was analyze the masticatory function in patients with TMD using surface electromyography (EMG) and masticatory efficiency (ME). Twenty-seven patients with TMD and 25 considered control (n), aged between 18 and 60 years, paired by age and gender, were evaluated according to RDC/TMD. In both groups were performed: EMG with chewing gum, clinical evaluation of habitual chewing with stuffed cookie (CE) (number of chewing strokes and time) and analysis of ME with fuchsin beads. Nonparametric statistical analyses were used (Mann-Whitney) for comparisons between groups, with 5% significance level. For all variables, the TMD group showed higher values than the control, with statistical significance for ME (p<0.0001), number of chewing strokes (p=0.04), chewing time (p=0.009), right masseter EMG activity (p=0.05), left masseter (p=0.005), right anterior temporal (p=0.05) and left anterior temporal (p=0.001). The conclusion is that patients with TMD showed changed chewing pattern, but without impairment of masticatory function.
The aim of this study was to analyze the repeatability in a stereophotogrammetry digital system used for the evaluation of facial morphology. Thirty healthy Brazilian, 18 to 45 years old (26.71 ± 6.53), had 11 reference landmarks marked on their faces by the same examiner and were photographed with an interval of 1 week by the VECTRA M3. Nine angular measurements (nasolabial, mentolabial, nasofrontal, maxillofacial, nasal, maxillary, mandibular, facial convexity, full facial convexity) and 2 linear measurements (middle facial height and lower facial height) were taken. Repeatability was analyzed by the mean absolute differences, relative error of magnitude, technical error of measurement, intraclass correlation coefficient, and Bland-Altman analysis. Paired t test sought any systematic errors between the acquisitions. Associations among body mass index, age, and the error in the measurements were made using the Pearson correlation coefficient. For the technical error of measurement, the nasolabial and mentolabial angles showed values >2° (clinical limit set for this study). For the relative error of measurement, most of the measures were rated between good and excellent. The maxillofacial angle was only moderate. There was a systematic error for middle facial height. The nasolabial, mentolabial, facial convexity, full facial convexity, maxillofacial, and nasofrontal angles presented intraclass correlation coefficient values rated as excellent. The relationship between age/body mass index and the error found between measurements was not confirmed. The nasolabial and mentolabial angles should be interpreted with caution due to the variability showed. The results found stereophotogrammetry to be repeatable, giving accurate measures within the references established for this study.
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