Pain in masticatory muscles is one of the most frequent symptoms in patients with temporomandibular disorders (TMD) and can lead to changes in the patterns of neuromuscular activity of masticatory muscles and decrease in bite force. This study assesses the effects of three eight-week exercise programs on pain intensity, neuromuscular activation, and bite force of masticatory muscles in patients with TMD. Forty-five patients were divided into three groups: a therapeutic exercise program (G1), a therapeutic and aerobic exercise program (G2), and an aerobic exercise program (G3). The masticatory muscles’ pain was evaluated using the numeric pain rating scale (NPRS), surface electromyographic (sEMG) activity of the masseter was recorded during maximum voluntary contraction and at rest, and bite force was evaluated using a dynamometer. These parameters were evaluated twice at baseline (A01/A02), at the end of the eight-week intervention period (A1), and 8–12 weeks after the end of the intervention (A2). After intervention, G2 showed the best results, with a significantly decrease in masticatory muscles’ pain and increase in bite force. These results suggest that interventions to reduce pain in patients with TMD should be multimodal.

Effects of therapeutic and aerobic exercise programs in temporomandibular disorderassociated headachesObjective: To assess the effects of three 8-week exercise programs on the frequency, intensity, and impact of headaches in patients with headache attributed to temporomandibular disorder (TMD). Methodology: Thirty-six patients diagnosed with headache attributed to TMD participated in the study and were divided into three groups of 12 patients: a therapeutic exercise program (G1, mean age: 26.3±5.6 years), a therapeutic and aerobic exercise program (G2, mean age: 26.0±4.6 years), and an aerobic exercise program (G3, 25.8±2.94 years). Headache frequency and intensity were evaluated using a headache diary, and the adverse headache impact was evaluated using the Headache Impact Test (HIT-6). The intensity was reported using the numerical pain rating scale. These parameters were evaluated twice at baseline (A01/A02), at the end of the 8-week intervention period (A1), and 8-12 weeks after the end of the intervention (A2). Results: At A1, none of the G2 patients reported having headaches, in G1, only two patients reported headaches, and in G3, ten patients reported headache. The headache intensity scores (0.3 [95%

Introduction: The number of divers has grown a lot in recent years [1]. The characteristics of the equipment that the divers use in the oral cavity to be able to breathe during the immersion are susceptible to provoke temporomandibular disorders (TMDs) [2]. These patients have specific characteristics related to difficulties in the temporomandibular joint (TMJ), in the masticatory muscles and tissues of the oral cavity. All these complaints are known as "Diver's Mouth Syndrome" [3]. The objective of this study was to obtain what's known about TMDs in scuba diving. Materials and methods: Pubmed, cochcrane and B-on were used with the keywords "Temporomandibular Disorders" Mesh Term, AND/OR "Scuba Divers". Studies published in Portuguese, Spanish and English between 2018-1998 on humans were included. We included all clinical trials. Results: We found 6543 citations of which 2238 duplications were excluded. After screening based on title and abstract analysis, we arrive on 62 full-text articles to assess and selected 8 studies. In terms of study characteristics they can be divided in TMD caused by lack of experience or lack of training in scuba diving [3]; history of TMD previous to scuba diving [4,5]; temperature of the water and facial pain [5]; and TMD and design, material and universal or customised mouthpiece (MP) and TMD [5][6][7][8]. Discussion and conclusions: Diving in colder waters is related with an increase in facial pain due to muscle contraction and clenching of masticatory muscles thus inducing facial pain [5]. In terms of TMD and MP for oxygen bottles the major part of the studies reveal the more customised the MP the less prone to TMD the subject is, so we have the standard MP, less efficient assuming that the same measure is for all mouths; the temperature mouldable MP to the mouth after being softened in hot water which deform with ease and the customised MP that are more effective, more expensive and constructed in the likeness of each one by the dentists so recognised by the sleep society [5]. Inexperienced divers tend to be more prone to TMD due to the mistake they make and stress they are exposed to. Due to the study design being so weak until now more studies should be carried out on the clinical side in a standardised way so that studies can be compared rather than based only on self-report.

Introduction Articular disc displacement is the most common temporomandibular joint (TMJ) arthropathy [ 1 ]. Disc displacement without reduction (DDwoR) is an intracapsular biomechanical disorder involving the condyle-disc complex [ 1 ] and can cause TMJ pain, limited mouth opening [ 2 ] and a change in the opening pattern of the patient. At first, the treatment for DDwoR should be reversible and conservative and include drugs, interocclusal devices and physiotherapy (PT) [ 3 ]. Moreover, minimally invasive techniques such as viscosupplementation (VS) seems to reduce pain and symptoms associated with internal derangement and improve quality of life [ 4 ]. The aim of this study is to report the efficacy of a combined protocol (PT and VS) in the control of signs and symptoms of a patient with temporomandibular disorder (TMD). Materials and methods Female patient, 38 years, with signs and symptoms of TMD presents a clinical diagnosis of right TMJ DDwoR and left TMJ subluxation, according with the Diagnostic Criteria for Temporomandibular Disorders protocol (DC/TMD). The initial pain free opening (PFO) was 31 mm with an uncorrected deviation to the right side in terms of opening pattern. Interdisciplinary team composed by two dentists and two physiotherapists decided the following strategy: assessment of PFO and opening pattern (DC/TMD examination form) before and after any intervention. After the initial assessment we had the first session of PT to prepare for the VS composed of behavioural and cognitive therapy, manual therapy, motor control exercises and prescription of home exercises. One week after we performed the first session of VS with 1 ml of high molecular weight hyaluronic acid bilaterally in the TMJ followed by another session of PT. Two sessions were performed, once a week, in two consecutive weeks. All the assumptions of the Helsinki Declaration have been fulfilled and an informed consent for clinical case of Clínica Dentária Egas Moniz approved by the ethic commission of Instituto Universitário Egas Moniz. Results Data was collected before and after any intervention. In first session of PT, PFO measurements increased from 31 mm to 38 mm and opening pattern remained a right uncorrected deviation. After the VS and second PT session the PFO increased from 35 mm at the beginning of the intervention to 45 mm at the end and the opening pattern changed to a straight opening pattern. Discussion and conclusions VS has been proven to be effective for knee and other large joints [ 4 ]. Studies suggest that adding VS to PT and therapeutic exercise may increase functionality [ 5 ]. No significant differences between non-invasive conservative interventions and minimally invasive or invasive surgical interve...

Introduction Bruxism is defined as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible [ 1 ]. Its effects can be deleterious to the oral tissues and restorations, which highlights the importance of insight towards the fundamental aspects of occlusion in each patient. Dentists should therefore study and examine the individual occlusal schemes in order to plan and treat these patients [ 2 ]. Materials and methods Patient, male, 22 years old, with tooth wear compatible with bruxism. The diagnosis was made based on a multiple level of sensibility determined by the 2018 Bruxism Consensus of possible, probable or definitive diagnosis of bruxism. We applied a specific sleep bruxism questionnaire [ 3 ] plus a clinical examination and questionnaire about clinical signs and symptoms based on the Diagnostic Criteria for Temporomandibular Disorders [ 4 ]. After we applied an intra oral red coloured device for evaluation of bruxism during sleep for two, Bruxchecker®, and at the same time the patient slept with an electromyography device in the temporal muscle called Grindcare® with recording of audio and video during sleep. All the assumptions of the Helsinki Declaration have been fulfilled and an informed consent for clinical case of Clinica Dentária Egas Moniz approved by the ethic commission of Instituto Universitário Egas Moniz. Results We have a positive diagnose for definitive bruxism confirmed with 15.6 grindings/clenching bursts per hour on the first night and 4.7 grindings/clenching bursts per hour on the second night, with audio and video we could have the perception of sounds compatible with problems of the respiratory system but absence of sounds and images compatible with tooth grinding. Clinically signs of tooth attrition were observed as well as tongue and cheek indentations, our patient also answered positively to the specific sleep bruxism questionnaire. The Bruxchecker® was helpful to see the dental wear movements. Discussion and conclusions Polysomnography is the gold standard for the diagnosis of sleep bruxism. However, electromyography supplemented with audio and video recordings is increasingly advocated as an equally valid method. The existence of a device like Grindcare ® which measures the number of muscles bursts per hour associated with clinical examination allows to give a definitive bruxism diagnosis if used for a determined number of nights. Bruxchecker ® and Grindcare® results were somewhat confusing on both nights but this is due to extrinsic factors. The result was a definitive sleep bruxism diagnose according to the last bruxism consensus of 2018.