Predoctoral education for TMD and orofacial pain: a philosophical overview.
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Education, Dental↗
Biomedical subjects
C S Greene
Publications and source records attributed to C S Greene.
Quality assurance in the teaching hospital.
The approach emergency medical service (EMS) systems take to quality assurance and quality improvement is evolving rapidly. Methods of quality assurance that have been applied to the prehospital care environment are reviewed. Impediments to effective quality assurance strategies are discussed and an overview of the scope of the activities and resources necessary to perform this task is presented. The potential efficacy and limitations of quality improvement in EMS are also discussed.
Clinical Competence↗
Treating TM disorders: a survey on diagnosis, etiology and management.
This survey of five dental groups revealed that the dental profession still is far from reaching a consensus about temporomandibular disorders. Despite a great deal of research that has clarified many issues in this field, clinicians often cling to outdated concepts and practices. However, many respondents did give answers that demonstrated their awareness of modern TMD diagnostic and treatment guidelines.
Bruxism↗
Cerebral blood flow during the acute therapy of severe hypertension with oral clonidine.
A major risk associated with the acute treatment of severe hypertension is a reduction in cerebral blood flow (CBF) with ischemic injury to the central nervous system. The authors studied CBF before and after the acute treatment of severe hypertension (diastolic blood pressure greater than 115 mm Hg) with clonidine in 13 patients. One patient did not reach goal blood pressure (diastolic blood pressure 105 mm Hg or a decrease by 30 mm Hg) after clonidine alone. In the remaining 12 patients, oral clonidine reduced supine blood pressure from 201.7 +/- 5.0/126.3 +/- 2.1 mm Hg to 149.4 +/- 5.3/96.8 +/- 1.7 mm Hg over an average time period of 85 +/- 7 minutes. Although mean CBF for the group did not change (72.6 +/- 4.2 v 73.7 +/- 3.5 mL/100 mg/min), a significant (greater than 10%) change occurred in 9 of the 12 patients (5 increases and 4 reductions). The magnitude and direction of the change were dependent upon initial CBF (r = -0.65, P less than .05); patients with low pretreatment CBF experienced an increase, whereas those with high initial flow exhibited a decrease. No significant adverse effects were observed. These data confirm previous reports that clonidine is effective in the acute treatment of severe hypertension and demonstrate that its effects on CBF are determined by the pretreatment levels of flow.
Administration, Oral↗
Conservative management of temporomandibular disorders: a posttreatment comparison between patients from a university clinic and from private practice.
Long-term (1 to 7.5 years) follow-up evaluations of 110 adult patients who were seen for diagnosis and treatment of symptoms related to myofascial problems (MP), internal derangement (ID), or both were conducted by means of telephone interview. One half of the patients were seen at the Northwestern University Dental School TMJ Clinic, while the other half were seen in the private office of one author (H. T. P.). The purpose of this study was to evaluate patient response to conservative therapy combined with advice about self-management, as compared with the response to advice only. Further, we desired to compare treatment outcomes among (1) diagnostic categories ID, MP, and ID plus MP, (2) clinic patients and private patients, and (3) patients with acute disease and those with chronic disease. Chronic disease was identified as that in which pretreatment symptoms had persisted for more than 4 months. The ridit analysis was used to assess differences in outcomes for patients in the three diagnostic categories and for clinic patients compared with private patients. The results revealed no significant differences. There was a trend for patients with acute conditions to improve more than those with chronic problems; however, further research is needed to determine whether a correlation exists between symptom duration and treatment outcome. At the time of the follow-up evaluation, 88% of all patients reported substantial or total improvement in their symptoms of pain and dysfunction. Therefore, conservative therapy, including advice about self-management, was found to be both adequate and appropriate for most of these patients.
Acute Disease↗
Technological methods in the diagnosis and treatment of temporomandibular disorders.
Although there have been numerous technological devices introduced for the diagnosis and treatment of temporomandibular disorders, many are either ineffective or are research tools without direct clinical application. This article reviews the various modalities and makes recommendations regarding their effectiveness based on the available clinical and scientific evidence.
Diagnostic Imaging↗
Can technology enhance TM disorder diagnosis?
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Dental Equipment↗
The effect of furosemide on intracranial pressure and hemorrhage in preterm rabbits.
The hypothesis that intracranial hypotension due to excessive postnatal fluid loss places the premature infant at risk for germinal matrix and intraventricular hemorrhage (GM-IVH) was tested in preterm rabbits delivered at 28 and 29 days of gestation (term 32 days). Furosemide administered to newborn pups induced a diuresis that resulted in a 11% to 22% loss in body weight and a concomitant decline in muscle water (13% to 16%) and sodium (18% to 21%). Paradoxically, no change occurred in the water or electrolyte content of the brain even though cerebrospinal fluid and brain tissue pressure, but not blood pressure, declined. These changes were absent in littermates treated with saline. Microscopic examination of brain sections revealed a greater incidence of intracranial hemorrhage, particularly in the germinal matrix and choroid plexus, in furosemide-treated than in saline-treated preterm rabbit pups. These results are consistent with the hypothesis that intracranial hypotension promotes the incidence of GH-IVH in preterm animals.
Animals↗
Effect of arthroscopic temporomandibular joint surgery on articular disk position.
This study used magnetic resonance imaging to assess disk-condyle relationships before and after arthroscopic surgery. Disk positions relative to condyles were found to be generally unchanged, despite the greater range of opening. Clinical findings were positive symptomatic changes with improved interincisal openings in 11 of 12 patients (92%). The results suggest that the clinical success of arthroscopic surgery as a treatment modality does not occur as a result of disk repositioning or recapturing.
Adult↗
Long-term status of TMJ clicking in patients with myofascial pain and dysfunction.
This study evaluated the long-term changes in TMJ clicking and general TM disorder symptoms in 190 subjects originally treated by conservative, nonsurgical modalities that were not specifically directed to the problems of TMJ noise or disk derangement. The findings are detailed and support the concept that if the symptoms of pain and dysfunction in patients with clicking can be treated successfully by conservative, nonsurgical modalities, it is generally not necessary to correct the internal derangement with surgery.
Cartilage, Articular↗
Hydrocephalus and intraspinal tumor.
Hydrocephalus with spinal subarachnoid obstruction is rare, and its cause is obscure. Two such patients are presented. The pathophysiology is reviewed. Spinal absorptive pathways for cerebrospinal fluid are postulated to play a critical role in such cases.
Aged↗
Treatment of scaphocephaly with sagittal craniectomy and biparietal morcellation.
A series of 50 consecutive patients with scaphocephaly treated by a new operation are reported, and the results are reviewed in detail. The treatment consists of a broad sagittal craniectomy plus extensive morcellation of both parietal bones and, occasionally, the squamous portion of the occipital bone, without dislodging the bony fragments from their dural attachments. The procedure can be done relatively rapidly (median operative time = 55 min) and with minimal loss of blood (median transfusion = 85 ml). The results are analyzed by several criteria and are considered to be excellent.
Blood Transfusion↗
Where does malpractice prevention end and harassment protection begin?
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California↗
Orthodontics and temporomandibular disorders.
The presumed relationship between occlusal disharmonies and temporomandibular disorders has been the cornerstone of traditional orthodontic thinking about these disorders. Current research, however, indicates that temporomandibular problems are actually medical orthopedic diseases or dysfunctions that have little to do with occlusal morphology or maxillomandibular relationships. Therefore, orthodontists must discard some of their traditional beliefs and practices, replacing them with modern concepts of musculoskeletal pain and dysfunction, in order to provide appropriate care for patients suffering from temporomandibular disorders.
Adult↗
Giant cerebellar hemangioma in an infant.
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Cerebellar Neoplasms↗
Incidence of temporomandibular symptoms in patients with major skeletal malocclusions: a survey of oral and maxillofacial surgery training programs.
A survey was done of 116 graduate training programs in oral and maxillofacial surgery to determine (1) the percentage of patients screened for orthognathic surgery who had symptoms of temporomandibular pain and dysfunction preoperatively and (2) how many who were asymptomatic preoperatively developed temporomandibular symptoms postoperatively. Of the fifty-one programs that responded, most reported that fewer than 20% of the patients were symptomatic before surgery and that few patients had symptoms postoperatively. The implications of these findings are discussed.
Humans↗
Indications for plain abdominal radiography in the emergency department.
Despite the proliferation of new imaging methods, plain abdominal radiographs remain the first films ordered in a significant number of emergency department patients. Several small studies suggest that abdominal films are ordered unnecessarily. Over-ordering takes two forms: inappropriate indications and poor choice of the number and/or types of views ordered. Criteria for obtaining plain abdominal radiographs are suggested based on the likelihood of radiographic findings and the probability of a change in management resulting from the findings. Benefit versus risk in fertile women is considered. Recommendations are made for the selection of views based on clinical suspicion and initial film review. There is a need for studies using larger sample sizes to confirm these conclusions.
Abdominal Injuries↗
The lowering of cerebral spinal fluid and brain interstitial pressure of preterm and term rabbits by furosemide.
CSF, brain interstitial, and arterial or venous pressures were measured in preterm and term rabbits. Ten to sixty minutes after the infusion of furosemide, in concentrations reported to inhibit CSF production, CSF and brain interstitial pressures fell an average of 1.4 and 1.8 cm H2O, respectively. No changes were observed in plasma osmolality, arterial or venous pressures. Histopathological examination of coronal brain sections showed the presence of germinal matrix and/or choroid plexus haemorrhages in four of eight brains examined. These results indicate that CSF and brain interstitial pressures of anaesthetised, restrained rabbits can be reduced to subatmospheric levels without altering serum osmolality. It remains to be established whether diminution of intracranial pressure by this method will increase the incidence of IVH in the awake, unrestrained preterm animal.
Animals↗