Relationship between Oral Parafunctions and Signs and Symptoms of Craniomandibular Dysfunction in Children with Cleft Lip and Palate

The aim of this study was to evaluate the association of oral parafunctions with the presence of signs and symptoms of craniomandibular disorder in children with cleft lip and palate (CLP). A cross-sectional study was performed in which one hundred and eighty-eight children with CLP and absence of associated syndromes or malformations were investigated. During clinical examination, the presence of wear facets and dental occlusion were observed and palpation was performed in the temporomandibular joint region (TMJ) and orofacial musculature . The children and their guardians were interviewed regarding the presence of oral parafunctional habits (bruxism, the act of biting the lips and/or cheeks, nail biting, sucking of fingers and pacifiers) and signs and symptoms of craniomandibular dysfunction (headache, ear and/or neckache, tiredness or crack in the TMJ during mouth opening and chewing movements). The data were analyzed by means of absolute and relative frequency measurements, and bivariate analysis using Pearson’s chi-square test and likelihood ratio test were performed, considering the significance level of 5%. A higher prevalence of cleft lip and palate type (76.0%) and the presence of malocclusion (61.7%) was observed, highlighting the anterior crossbite (58.7%) and midline deviation (48.9%). There was a higher occurrence of teeth grinding (40.4%), onychophagy (28.7%) and biting lips and/or cheeks (28.7%). Onychophagia was associated with headache (p <0.05) and with pain or cracking during mouth opening (p <0.05). It was concluded that parafunctional oral habits may be associated with signs and symptoms of craniomandibular disorder in children with cleft lip and palate.Keywords: Craniomandibular Disorders. Nail Biting. Bruxism. Maxillofacial Abnormalities. Resumo O objetivo do estudo foi avaliar a associação de parafunções orais com sinais e sintomas da disfunção craniomandibular em crianças com fissuras labiopalatinas (FLP). Um estudo transversal foi realizado, no qual cento e oitenta e oito crianças com FLP e ausência de síndromes ou malformações associadas, foram investigadas. Durante exame clínico, a presença de facetas de desgaste e a oclusão dentária foram observadas e foi realizada a palpação na região da articulação temporomandibular (ATM) e musculatura orofacial. As crianças e seus responsáveis foram entrevistados com relação à presença de hábitos orais parafuncionais (bruxismo, ato de morder os lábios e/ou bochechas, onicofagia, sucção de dedos e de chupeta) e sinais e sintomas de disfunção craniomandibular (cefaléia, ouvido, dor, cansaço ou estalo na ATM durante movimentos de abertura bucal e de mastigação). Os dados foram analisados por meio de medidas de frequência absoluta e relativa e a análise bivariada foi realizada por meio dos testes do Qui-quadrado de Pearson (χ2) e a Razão de verossimilhança, considerando o nível de significância de 5%. Uma maior prevalência das fissuras envolvendo lábio e palato (76,0%) e presença de maloclusão (61,7%) foi observada, com destaque para mordida cruzada anterior (58,7%) e desvio de linha média (48,9%). Houve uma maior ocorrência do ato de ranger os dentes (40,4%), da onicofagia (28,7%) e do hábito de morder lábios e/ou bochechas (28,7%). A onicofagia foi associada à cefaléia (p<0,05) e à dor ou estalo durante abertura bucal (p<0,05). Conclui-se que hábitos orais parafuncionais podem estar associados a presença de sinais e sintomas da disfunção craniomandibular em crianças com FLP.Palavras-chave: Transtornos Craniomandibulares. Hábito de Roer Unhas. Bruxismo. Anormalidades Maxilofaciais.

Cefaleias e desordem crânio-mandibular

This work refers to studies in cephalgia and Craniomandibular Disorder (CMD) focusing on the aspects that they don't have appropriated delineation in order to establish more precise relations between occlusal, muscular and articular variables and headaches. It also presents studies relating the occlusion to CMD problems. The possible migraine physiopathological mechanisms are mentioned, pointing out the fact that its sintomatology occurs in trigemino-vascular sistem region. We bring out cephalgia classification and cite the importance of the establishment of a suitable odontological diagnostic by the dentists through occlusal, muscular and articular exams so that dentist's competence field will be plenarilly exerted.

The modulating effect of bruxism as a form of suppressed hostility on depression in a selected population of tension type headache (ttha) and craniomandibular disorders (cmds) individuals. O efeito modulador do bruxismo como uma forma de hostilidade reprimida numa população seleta com dor de cabeça por tensão muscular e distúrbios craniomandibulares (dcms).

AIMS: explore the hypothesis that bruxism and depression are forms of suppressed hostility in individuals presenting Craniomandibular Disorders (CMDs) and Tension-type Headache (TTHa). METHODS: We evaluated a group of 100 Craniomandibular Disorders and Tension-Type Headache individuals, a group of 38 CMDs and Facial Pain individuals and a group of 23 No Craniomandibular Disorders No Facial Pain individuals. Clinical examination, questionnaires, history of signs and symptoms, the Beck Depression Inventory (BDI) and the Cook-Medley Inventory (HO) were used to gather data. RESULTS: The frequency of Tension Type Headache was about 43.5% in the group of 230 Craniomandibular Disorder patients. Mean scores in hostility were 19.0, 17.7 and 17.2 in the groups presenting Tension-Type Headache and CMDs, CMDs and Facial Pain and No CMDs no Pain, respectively. Mean scores in depression were about 12.0, 9.1 and 5.7 respectively in the same groups. Mean scores in bruxism were about 12.9, 8.2 and 6.8, respectively in the same groups. The strongest correlation between bruxism and depression were observed in the TTHa group (r=0.4, p<0.0001) and in the Non CMD Non Pain group (r=0.48, p<0.02). CONCLUSION: Depression is a better indicator of hostility in subgroups presenting TTHa. Scores in bruxism and depression as a form of suppressed hostility are higher in CMDs and TTHa individuals than in controls without TTHa. Because scores in bruxism were higher in TTHa and CMDs individuals, there is a strong and positive association between bruxism and TTHa in individuals with concomitant Craniomandibular disorders.

The modulating effect of bruxism as a form of suppressed hostility on depression in a selected population of tension type headache (ttha) and craniomandibular disorders (cmds) individuals

AIMS: explore the hypothesis that bruxism and depression are forms of suppressed hostility in individuals presenting Craniomandibular Disorders (CMDs) and Tension-type Headache (TTHa). METHODS: We evaluated a group of 100 Craniomandibular Disorders and Tension-Type Headache individuals, a group of 38 CMDs and Facial Pain individuals and a group of 23 No Craniomandibular Disorders No Facial Pain individuals. Clinical examination, questionnaires, history of signs and symptoms, the Beck Depression Inventory (BDI) and the Cook-Medley Inventory (HO) were used to gather data. RESULTS: The frequency of Tension Type Headache was about 43.5% in the group of 230 Craniomandibular Disorder patients. Mean scores in hostility were 19.0, 17.7 and 17.2 in the groups presenting Tension-Type Headache and CMDs, CMDs and Facial Pain and No CMDs no Pain, respectively. Mean scores in depression were about 12.0, 9.1 and 5.7 respectively in the same groups. Mean scores in bruxism were about 12.9, 8.2 and 6.8, respectively in the same groups. The strongest correlation between bruxism and depression were observed in the TTHa group (r=0.4, p<0.0001) and in the Non CMD Non Pain group (r=0.48, p<0.02). CONCLUSION: Depression is a better indicator of hostility in subgroups presenting TTHa. Scores in bruxism and depression as a form of suppressed hostility are higher in CMDs and TTHa individuals than in controls without TTHa. Because scores in bruxism were higher in TTHa and CMDs individuals, there is a strong and positive association between bruxism and TTHa in individuals with concomitant Craniomandibular disorders.

Anger held inward, aggressive dream content in craniomandibular disorders and bruxers

Objective. To evaluate means in anger-in and aggressive dream con­tent in craniomandibular disorder/bruxers. Method. Two question­naires to evaluate anger-in and aggressive content in nightmares, clinical examination, and criteria for craniomandibular disorders/ bruxism were used in 70 subjects with craniomandibular disorders/ bruxism (66 females, mean age 31.3); in 28 bruxers without cranio­mandibular disorders (19 females, mean age 32.3); and in 39 controls without such disorders (26 females, mean age 30.6). Results. Anger-inward was not different between craniomandibular disorder/brux­ism (130.7) and non craniomandibular disorder/bruxism (105.6); but it was different when compared with control group (70.1): cra­niomandibular disorder/bruxism versus control group (p<0.001); non craniomandibular disorder/bruxism and control group (p<0.01). Frequencies of aggressive dream content in nightmares were about: craniomandibular disorder/bruxism: 71.4%; non craniomandibular disorder/bruxism: 67.9% and control group: 46.2% (p=0.02). Means in aggressive dream events were not different among the groups. Conclusions. Anger-in was higher in those with craniomandibular disorders/bruxism. Aggressive events in bad dreams and nightmares decreased from the more psychologically disturbed subgroup to the less psychological disturbed one.

Craniomandibular disorder/dysfunction. Characteristics and disorders of the masticatory organ

The practising physician often meets patients with pain located in different parts of the face and facial skull, mouth opening restriction or other motion disorder of the mandible. It is not always easy to identify and explain the cause. It is not widely known among doctors that most of these problems are due to masticatory dysfunction. There is a special group of patients showing functional disorders and there are some others who present a variety of different symptoms and visit several doctors. The masticatory organ, a functional unit of the human organism has a definite and separate task and function. In the early years of life it is capable of adaptation, while later on it tends to compensation. The authors outline the functional anatomy of the masticatory organ and the characteristics of multicausal pathology, the dynamics of the process of the disease and their interdisciplinary aspects. They discuss the basic elements of craniomandibular dysfunction. Based on the diagnostic algorithm, they summarize treatment options for masticatory function disorders. They emphasize the importance that physicians should offer treatment, especially an irreversible treatment, without a diagnosis. It occurs very often that the causes are identified after the patients become symptom-free due to treatment. The aim of this report is to help the general practitioners, dentists, neurologists, ear-nose-throat specialists, rheumatologists or any other specialists in the everyday practice who have patients with different symptoms such as pain in the skull, acoustic phenomenon of the joint or craniomandibular dysfunction. Orv. Hetil., 2015, 156(4), 122–134.