Search PubMed⌕ Search

Biomedical subjects

E L Schiffman

Publications and source records attributed to E L Schiffman.

12 recordsLinked to original sources
PubMed1996

Temporomandibular joint iontophoresis: a double-blind randomized clinical trial.

This double-blind study evaluated the short-term effect of iontophoretic delivery of dexamethasone on the signs and symptoms of temporomandibular disorders in patients who had concurrent temporomandibular joint disc displacement without reduction and capsulitis. Twenty-seven patients with this clinical diagnosis were randomized to one of three groups: treatment group (dexamethasone sodium phosphate and lidocaine hydrochloride); control group (lidocaine hydrochloride); and placebo group (pH-buffered saline). Pretreatment and posttreatment data included items to calculate Helkimo's Anamnestic Dysfunction index, Helkimo's Clinical Dysfunction index, the Symptom Severity Index, and the Craniomandibular Index (CMI). The CMI is composed of the Dysfunction index (DI) and Muscle index. Analysis of variance showed no baseline differences on these measures between the three groups. Pretreatment and posttreatment values were compared with the paired t tests. Posttreatment, the treatment group had an increased mean maximal active mandibular opening of 6 mm (P = .02), increased mean lateral excursion of 1.2 mm to the noninvolved side (P = .05), and reduced mean DI scores of 0.51 to 0.39 (P = .01); no statistically significant decrease in pain symptoms was reported. Analysis of variance showed a significant difference in the DI scores (P = .04) between groups from pretreatment to posttreatment, with the treatment group showing the greatest improvement in the DI scores relative to the other two groups. No other questionnaire items, exam items, or resultant indexes showed changes in any of the groups at P < or = .05. These results suggest that iontophoretic delivery of dexamethasone and lidocaine was effective in improving mandibular function, but not in reducing pain, in temporomandibular disorders patients who had concurrent temporomandibular joint capsulitis and disc displacement without reduction.

Adolescent↗
PubMed1995

Treatment alternatives for patients with masticatory myofascial pain.

Alternative therapies are used by many people, and the dental literature has reported that some alternative therapies are comparable to splint therapy in the effective treatment of masticatory myofascial pain. The authors review the efficacy of alternative therapies and discuss their clinical implications. This review is intended to help dental practitioners to select alternative therapies they can use with or instead of splint therapy for treating patients who have a primary diagnosis of myofascial pain.

Acupuncture Analgesia↗
PubMed1992

The relationship of occlusion, parafunctional habits and recent life events to mandibular dysfunction in a non-patient population.

This study investigated the association between occlusion, oral habits and stress relative to the level of mandibular dysfunction in the total population and in specific diagnostic subgroups (normal, joint disorder, muscle disorder and joint/muscle disorder). A total of 269 nursing students were given a questionnaire and examination. The questionnaire included items to calculate an oral habit index and a social readjustment rating scale. The examination included items to calculate an occlusal index, two craniomandibular indices and a diagnostic criteria for specific subgroups. In the total population there was a positive association between mandibular dysfunction and three postulated risk factors. The total population was then divided into diagnostic subgroups. There was a positive association between the degree of mandibular dysfunction and parafunctional habits for normals, muscle disorders and joint/muscle disorders. There was a positive association between mandibular dysfunction and occlusion for normals only. Finally there was a positive association between mandibular dysfunction and stress for muscle disorders only. The results suggest that associations between postulated aetiologic factors and mandibular dysfunction vary depending on whether the subjects have a muscle and/or joint disorder. Since all associations were weak, other possible risk factors need to be investigated.

Adult↗
PubMed1992

The relationship between level of mandibular pain and dysfunction and stage of temporomandibular joint internal derangement.

Temporomandibular joint internal derangement (TMJ ID) is the most common intra-articular TM disorder and can progress from TMJ ID with reduction to TMJ ID without reduction. It is not known whether this anatomical progression is associated with increasing levels of mandibular dysfunction. The objective of this study was to determine whether the level of clinically detectable mandibular dysfunction was related to the stage of TMJ ID. Two clinicians examined 42 subjects prior to bilateral TMJ arthrographic evaluation. The level of mandibular dysfunction was calculated by Helkimo's Clinical Dysfunction Index (Di) and the Craniomandibular Index (CMI). Statistical analysis revealed that the level of mandibular dysfunction as determined by the Di and CMI was not related to the arthrographic presence or absence of TMJ ID. Therefore, the clinician cannot assume that the level of mandibular dysfunction is directly related to the absence or presence of TMJ ID. Epidemiologically, the CMI and Di can be used only for estimation of the degree of mandibular dysfunction, since they do not provide direct information on a specific TM disorder.

Adolescent↗
PubMed1991

The validity and predictive value of four assessment instruments for evaluation of the cervical and stomatognathic systems.

Four assessment instruments--a 10-item cervical pain questionnaire, a 10-item TMJ pain questionnaire, the Cervical Range of Motion (CROM) instrument, and the Craniomandibular Index--were used to evaluate 25 consecutive patients presenting to a physical therapy clinic for evaluation and treatment of cervical hyperextension-hyperflexion injuries. The assessment tools were tested for internal consistency between the cervical and stomatognathic measures as well as between the two sets of measures. The cervical questionnaire was strongly correlated to the CROM measurements. Tenderness to palpation of the superficial neck muscles was not correlated to the cervical questionnaire nor to measures of cervical flexion-extension or lateral flexion. It was, however, correlated to cervical rotation. The TMJ questionnaire was a useful predictor of muscular tenderness and self-reported symptoms in the stomatognathic system, but it was not related to the intra-articular signs of TMD. The flexion-extension and rotation measures of cervical mobility were useful predictors of masticatory muscle tenderness. These assessment tools are valid indicators of cervical or stomatognathic status and, when used together, provide a comprehensive description of jaw and neck status.

Humans↗
PubMed1990

The prevalence and treatment needs of subjects with temporomandibular disorders.

A cross-sectional study of prevalence of temporomandibular joint (TMJ) internal derangements, muscle disorders, and associated TM signs and symptoms was completed on 269 female nursing students. The prevalence of specific stages of internal derangements of the TMJ and muscle disorders was estimated, using established diagnostic criteria. The levels of dysfunction and symptomatology associated with each diagnosis were estimated with previously established indexes. When subjects with symptoms were asked if they had previous treatment for a TMJ problem, 6.7% responded positively. When subjects with symptoms who had not had treatment were asked why they had not sought treatment, most responded that it was not a problem or they could live with the symptoms. Thus, most subjects with clinically detectable dysfunction are functioning adequately without significant symptoms and do not need treatment.

Adult↗
PubMed1989

Clinical vs. arthrographic diagnosis of TMJ internal derangement.

Internal derangements of the temporomandibular joint (TMJ) have gained increased recognition as a potential source of pain and dysfunction of the masticatory system. The objective of this study was to evaluate the reliability of clinicians in predicting an arthrographic diagnosis of articular disc position in a typical patient population presenting for TMJ arthrographic evaluation. Two clinicians utilized a brief history, clinical examination (including evaluation of mandibular movement and TMJ auscultation), and tomographic TMJ imaging in evaluating 60 patients. The radiologist subsequently performed the arthrographic procedures on 102 TMJs (18 unilateral and 42 bilateral). Diagnostic agreement was determined for all possible diagnostic categories including: normal disc position, TMJ internal derangement with reduction, TMJ internal derangement without reduction/acute, TMJ internal derangement without reduction/chronic, and osteoarthrosis. The significance of the diagnostic agreement between the clinicians and arthrography was evaluated with a Kappa Statistical Test, which showed good reliability. For epidemiological studies, it was concluded that clinical and tomographic evaluation would provide sufficient reliability for determination of the presence and stage of TMJ internal derangement. However, in a specific clinical situation, a difficult diagnostic problem may require the use of arthrography, depending on the impact of the diagnosis on subsequent treatment decisions.

Adolescent↗
PubMed1987

The craniomandibular index: validity.

The CMI appears to be valid for use in clinical studies, but users must be aware of its numerous potential errors and its associated strict methodologic guidelines to ensure accuracy and reproducibility of results. The subjective nature of some items demands that the same rater who is unaware of the management status of the patient perform both evaluations. If multiple raters are used, it is recommended that the raters discuss all items, and compare scoring of demonstration subjects before the study and use a pressure algometer for muscle palpation.

Facial Pain↗
PubMed1986

Reliability of a craniomandibular index.

The Craniomandibular Index (CMI) was developed to provide a standardized measure of severity of problems in mandibular movement, TMJ noise, and muscle and joint tenderness for use in epidemiological and clinical outcome studies. The instrument was designed to have clearly defined objective criteria, simple clinical methods, and ease in scoring; it is divided into the Dysfunction Index and the Palpation Index. Inter-rater reliability (three raters) and intra-rater reliability (19 patients examined twice by one rater) were tested to determine whether the instrument has operational definitions sufficiently precise to allow for consistency in use between different raters and with one rater over time. Intraclass Correlation Coefficient for inter-rater reliability was 0.84 for the Dysfunction Index, 0.87 for the Palpation Index, and 0.95 for the CMI. Correlation for intra-rater reliability was 0.92 for the Dysfunction Index, 0.86 for the Palpation Index, and 0.96 for the CMI. These results support the reliability of the CMI for use in epidemiological and clinical studies. Users are cautioned about the subjectivity of numerous items within the CMI and the strict methodological guidelines that must be followed in order to assure accuracy and reproducibility of results.

Humans↗