Biomedical subjects
Publications and source records attributed to J W Stockstill.
When asked about altered sensation in hands or arms, forearms, cervical area or neck, 29 percent of Nebraska dentists surveyed said they felt pain, followed by numbness and tingling. The prevalence suggests the possibility of an occupational concern.
Nocturnal clenching and grinding can be recorded with a portable electromyograph unit and a standard cassette tape recorder, which registers the clenching episodes on a cassette tape. The information can then be coded by a new instrument, called a Pulse Identifier, that subsequently transfers the data to a polygraph chart recorder. This study evaluated the reliability and validity of the Pulse Identifier when interfaced with other instruments that measure nocturnal clenching/grinding. A known number of clenching incidents over a baseline period of time were evaluated by three "blind" scores. The results demonstrated an interscorer reliability coefficient of 0.99 and a validity coefficient of 0.99.
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The objectives of the preliminary diagnostic and treatment protocol are 1. To reveal retention or resistance form deficiencies. 2. To reveal need for augmentive periodontal crown-lengthening surgical procedures. 3. To evaluate pontic form for the existing space. 4. To preplan occlusal plane deficiencies and methods of corrective treatment to establish Curve of Spee. 5. To preplan occlusal scheme, i.e., canine guidance, group function, mutually protected occlusion, and cross-bite conditions. 6. To aid in preplanning sequence of treatment and method of preservation of occlusal vertical dimension. 7. To serve as a visual aid for discussion of treatment recommendations with patient prior to actual treatment. 8. To act as a medicolegal record to document the clinician's pretreatment planning in complex treatment situations for possible use in peer review or litigation. 9. To aid in fabrication of an elastomer reduction guide for use during crown preparation. 10. To aid in fabrication of a vacuum-formed template for provisional restoration of crown and abutment teeth after preparation.
Structured clinical decision analysis in dentistry in fixed prosthodontics, as in any branch of dentistry, allows the practitioner to think through more clearly the problems at hand based on the clinical data and extenuating factors presented by the patient. This discipline of decision making is intended to complement the experience level and educational background of the clinician in assisting him or her through the decision process. Additionally, CDA helps the clinician define not only the pre-existing condition of the patient prior to irreversible therapy, but also which treatment strategies may best be suited for that individual over an extended period. The systematic nature of decision analysis stimulates the focusing of one's attention on those factors considered to be germane to the overall complexity of the case and, at the same time, excluding those factors having little or no influence on its final outcome. With further implementation of computerized databases and procedural outcome probabilities based on clinical and laboratory studies as well as the clinical experience of those choosing to use it, the future for structured, formalized clinical decision analysis seems quite promising.
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This case report of an anomalous insertion of the anterior belly of the digastric muscle in a cadaver considers the components involved in mandibular movement as well as the radiologic changes that could be expected in asymmetric function of the temporomandibular joints. The occlusal scheme of the cadaver was noted and, after transcranial radiographs were taken, both joints were anatomically dissected. While the left condyle-disc relationship appeared normal and properly approximated, the right joint (which was assumed to be translating in an anterior, inferior, and medial direction on each opening, ie, left lateral deviation) was found to have a complete articular disc perforation with severe bony erosion and condylar spicule formation. These findings may shed some light on dyskinesia diagnosis and treatment outcome; ie (1) what degree occlusally related etiologies may be affixed to individuals with aberrant mandibular movement, (2) why many diagnosed cases of mandibular dysfunction continue following irreversible dental restorative treatment via augmentation of the existing "malocclusion," and (3) what may be the clinical implications of or limitations inherent in the use of jaw-tracking devices in the diagnosis and interpretation of dyskinetic movement in the presence of aberrant muscle attachments.
This experiment was designed to study the effect of L-tryptophan on nocturnal bruxism. Portable EMG recorders were used to monitor unilateral masseter muscle activity during sleep in eight patients identified as nocturnal bruxists. Following an initial baseline period, the patients were given, in a randomized double-blind study, either tryptophan (50 mg/kg of body weight) or a placebo for 8 days followed by an additional 8 days of reverse medication. Dietary patterns and food intake were monitored throughout the experimental period. No significant treatment differences in bruxing levels were found, suggesting that L-tryptophan supplementation in the absence of dietary manipulation is ineffective in the treatment of nocturnal bruxism.
This study examined the stress-mediating characteristics of the personality construct of hardiness within a population of dental patients diagnosed with a temporomandibular disorder (TMD). It was found that hardiness, consisting of feelings of control and commitment, was significantly lower in TMD patients when compared with a matched control group of non-TMD subjects. A third proposed factor of hardiness, challenge, was not found to differ significantly between the groups. Anxiety and depression self-ratings also did not differ significantly between the groups.
This literature review and survey highlights the controversies surrounding the significance of joint sounds in general, the problems and pitfalls of joint sound analysis and interpretation, and the degree of importance given peripheral and temporomandibular joint sounds by physicians and dentists. The instrumentation and devices currently proposed for use in the detection and interpretation of joint sounds may not meet the standards of validity, reliability, sensitivity, and specificity, and as pointed out by one investigator, "The only objectivity currently associated with these instruments is their ability to record sounds of undetermined origin." In addition, no solid evidence is available that these particular sounds, when detected, are both repeatable over time and distinctly characteristic for particular disorders or significant pathologic changes. Some degree of caution should be used, therefore, when interpreting joint sounds in the absence of significant signs and symptoms of temporomandibular disorders. The clinical significance of these same sounds may become more or less apparent relative to the information obtained in a comprehensive temporomandibular disorder evaluation and examination including both subjective and objective pain assessments, mandibular range of motion measurements, and the interpretation of radiologic findings.
Effects of L-tryptophan supplementation and dietary manipulation were tested on patients with chronic myofascial pain around the temporomandibular joints. In this study, however, reduction of chronic pain reported in previous similar studies was not duplicated. No significant reduction in pain was noted in the groups receiving tryptophan and dietary manipulation compared with control groups.
Muscle palpation is an important procedure in screening for TM disorders and assessing results of treatment outcome studies, but interpretation of response may be subjective and vulnerable to examiner bias. Masticatory muscle palpation scoring was evaluated with respect to interrater agreement on 31 myofascial pain-dysfunction patients participating in a medication study. Two clinicians independently palpated the temporomandibular joints, muscles of mastication, and related head and neck musculature on three different occasions over the 6-week period of the study. Standardization of palpation technique and initial protocol for interpretation of subject response were discussed prior to the first examination. Further clarification and reinforcement of examination methodology and scoring were carried out prior to the second examination, 1 week later. Another 5 weeks passed, with no further standardization, before the third and last examination. A behaviorally anchored scoring system (0 to 3) was used to rate response to palpation. Results indicate that two investigators can achieve a fair degree of reliability when carefully standardized, further interrater standardization can result in higher reliability, and reliability can be maintained over at least a 5-week period of time.
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