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Biomedical subjects

W D McCall

Publications and source records attributed to W D McCall.

At least 37 records · Page 2Linked to original sources

Devices for the diagnosis and treatment of temporomandibular disorders. Part I: Introduction, scientific evidence, and jaw tracking.

This three-part series of articles summarizes the uses of several devices or groups of devices intended for the diagnosis or treatment of temporomandibular disorders (TMD) and compares their claimed clinical usefulness with the present scientific evidence. Part I of this review defines TMD; discusses the principal criteria for evaluating published scientific clinical evidence such as reliability, validity, sensitivity, and specificity; gives a rationale for the clinical "gold standard" against which diagnostic and therapeutic devices must be compared; and evaluates the status of jaw tracking for the diagnosis of TMD. This review and evaluation led to the conclusion that, at the present time, the claim that jaw-tracking devices have a diagnostic value for TMD is not well supported by the scientific evidence.

Evaluation Studies as Topic↗

Devices for the diagnosis and treatment of temporomandibular disorders. Part II: Electromyography and sonography.

This second article in the three-part series on temporomandibular disorder (TMD) devices compares the claimed diagnostic usefulness of electromyography and sonography with the present scientific evidence. This review concludes that there is no evidence to support the use of either surface electromyography or silent period duration for the evaluation or diagnosis of TMD. Furthermore, in view of the available evidence, sonography and Doppler ultrasound have no particular advantage over a conventional stethoscope or direct auscultation.

Auscultation↗

The effect of L-tryptophan supplementation and dietary instruction on chronic myofascial pain.

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.

Dietary Carbohydrates↗

Interrater reliability in masticatory muscle palpation.

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.

Humans↗

Comparison of automatic and voluntary chewing patterns and performance.

Chewing, like respiration, is ordinarily performed as an automatic motor act, yet both can be voluntarily controlled. No in-depth analyses of voluntary chewing exist. Therefore, we have analyzed on a cycle-by-cycle basis voluntarily controlled chewing, and compared it with automatic chewing. We assessed the performance during voluntarily controlled chewing by obtaining constant error and variable error scores. Nine healthy adults with full dentition were subjects (Ss). Their three-dimensional jaw movements and movement times were derived from Kinesiograph recordings obtained while chewing a standard piece of gum on the right side of the mouth. Burst durations and onset latencies of masseter activity were obtained from surface-recorded EMGs. Frequency during automatic chewing was obtained from data recorded while the subject viewed a film. Next, the subject chewed in time with a metronome set at this "automatic" rate. Intrasubject variability among 30 consecutive chewing cycles during voluntary was less than during automatic chewing. In every S gape and ipsilateral jaw excursions and the variability of burst durations of masseter activity were less during voluntary than during automatic chewing, showing that both the spatial and temporal aspects of the two types of chewing differ significantly. Ss varied in ability to follow the metronome. A S's constant error might be small, yet his variable error might be large, as if feed-back-based corrections influenced cycle-to-cycle variability. Fast chewers had smaller constant and variable error scores than did slow chewers, suggesting a speed-accuracy relationship. In summary, both temporal and spatial aspects of voluntary chewing were modified compared with those of automatic chewing. During voluntarily controlled chewing, cycle-to-cycle variability was less compared with automatic chewing due to reductions in variability of occlusal phase and the masseter's burst durations, and total jaw excursions were less because gapes and ipsilateral deviations during closing were reduced.

Adult↗

The effect of prior jaw motion on the plot of electromyographic amplitude versus jaw position.

Fabrication of interocclusal splint at a thickness determined by the vertical dimension at which the jaw muscle EMG amplitude is minimum has been recommended. However, the effect of prior jaw motion and the effect of the recording site on the EMG amplitudes and on the vertical dimension of minimum EMG activity have not been documented. IEMG amplitudes at various static jaw positions achieved during opening and during closing were analyzed in nine subjects. Surface IEMGs were recorded over the left anterior temporal muscle, left masseter and left suprahyoids muscles, and by nonspecific EMG recording as described by Rugh and Drago. The jaw position was recorded in 5 mm increments by a kinesiograph. After 30 seconds of relaxation, 10 successive IEMG reading at 4-second integration times were obtained at each recording site. These 10 recordings at each requested jaw position were averaged and analyzed. The IEMG activity changed with different jaw position. As the jaw opened from centric occlusion, the IEMG from jaw closing muscles decreased to a minimum and then increased with further opening. Moreover, the IEMG for a particular jaw position differed depending on the history of the jaw movement, that is, whether the position was achieved after an opening step or after a closing step. Two factors, the amount of jaw opening and the history of jaw movement to reach that position, seemed to influence the IEMG differently in each of the recorded muscles.

Adult↗

Follow-up study of silent periods in complete denture wearers.

Electromyographic silent periods in response to chin taps during clench were recorded from the anterior temporalis and masseter muscles. Ten complete denture wearers were observed up to the 1-year stage of denture wear and eight patients up to the 2-year stage. Silent periods were also recorded from patients clenching on paper rolls in place of the dentures. Regarding the patterns of the silent periods, similar observations of double silent periods were made as in our previous study up to the half-year stage of denture wear (McCall, Tallgren & Ash, 1979). The frequency of the double silent periods was 13.8% at the 1-year stage and 7.3% at the 2-year stage. The mean duration of the silent periods did not differ significantly at the 1-year and 2-year stages. The mean silent period duration when clenching on paper rolls without dentures in the mouth was significantly shorter than when clenching with the dentures.

Adult↗

A numerical model of temporomandibular joint loading.

A numerical model of the mandible, its articulating surfaces, and the forces exerted by the primary masticatory muscles has been developed for the purpose of investigating loading of the temporomandibular joint. Evidence is presented which shows that the temporomandibular joint. Evidence is presented which shows that the temporomandibular joint is a load-bearing joint over the normal functional range of bite-force positions and angles. In this investigation, temporomandibular joint loads were found to vary from a maximum appositional force of 60% of the bite force (when bite forces were applied to the incisors) to a distracting force of about 5% of the bite force (when applied to the distal surfaces of the third molars). TMJ loads tended to reach a minimum as a result of vertically directed bite forces positioned at the second molars. A range of conditions in which bite forces were directed parallel to or within approximately 20 degrees of the mid-sagittal plane was found to be conducive to stability of the temporomandibular joint. This stability included symmetry in the direction and in the magnitude of condylar loads as well as the presence of small forces tending to oppose the condyle and articular eminence. TMJ loads tended to reach a maximum in response to mediolaterally directed bite forces. This result is consistent with the fact that no muscle of mastication exhibits a spatial orientation in which the muscle fibers are predominantly mediolateral in direction.

Bite Force↗

Measurement of silent period durations by hand and by commercial device.

Silent period durations obtained from the masseter muscle in response to taps to the chin during a clench were measured by the commercially available MDM device and by hand measurement from polygraph tracings. Of the 160 pairs of silent periods, 15 were measurable by polygraph but not by MDM, 20 were not measurable by polygraph but were measured by MDM, and 125 were measured by both. Of the 125 silent periods, the MDM gave a shorter reading in 112. Within-subject correlation coefficients between the two measurement methods ranged from -0.038 to + 0.95; the average (0.75) was significantly different from zero. The among-subject correlation coefficient was + 0.26 and was not significant. These data raise questions about the reliability and validity of silent period durations measured by the MDM device.

Electromyography↗

Three year follow-up TMJ patients: success rates and silent periods.

A telephone survey to assess treatment success was conducted 2-3 years after treatment of patients suffering from TMJ syndrome. Pre-treatment silent period durations were compared among groups of patients determined by their response to the telephone survey. The short-term (immediately post-treatment) improvement rate was 81%. Some 35% of patients were completely cured. There was no statistically significant difference in mean silent period duration among the groups of patients that achieved complete, partial or no relief of symptoms. The long-term (2-3 years after treatment) persistence of improvement rate was 72%. There was also no statistical difference in the mean silent period duration between those patients who had experienced persistence of success and those who reported either no relief or relapse of symptoms.

Adult↗

Masseteric silent periods electrically evoked in normal subjects and patients with temporomandibular joint dysfunction.

The mean latency and duration of electromyographic silent periods were compared in normal subjects and patients with symptoms of temporomandibular joint (TMJ) dysfunction. The silent periods were evoked in the masseter muscle by electrical stimulation of the mental nerve area and recorded at 100% and 50% of maximum masseter EMG activity. Two silent periods were typically observed. The mean latency of the early silent period as well as the mean duration of both the early and late silent periods were shorter at 100% than at 50% of the maximal voluntary activity. In comparing the two groups, the mean latencies were shorter and the mean durations were longer for both silent periods in the TMJ group compared with the normal group. The prolonged silent periods in the TMJ group do not appear to be caused by a difference in stimulus intensity or level of voluntary activity in the masseter muscle. These results permit the speculation that the mechanism of the prolonged silent period in the TMJ patients might be central rather than peripheral.

Adult↗

Influence of auriculotemporal nerve anaesthesia on the masseteric silent period.

Silent periods were evoked from the masseter muscles bilaterally in response to chin taps during a clench. Injection of 0.75 ml of 3% Mepivicaine posteromedial to each condyle led to a distribution of skin anaesthesia consistent with the distribution of the auriculotemporal nerve. Silent periods were evoked prior to and during anaesthesia in ten subjects. The silent period latencies (mean +/- standard deviation) prior to anaesthesia were 12.5 +/- 1.8 ms and 11.9 +/- 2.5 ms in the right and left masseters. During anaesthesia the latency decreased by 0.3 +/- 1.3 ms in the right masseter and by 0.3 +/- 2.1 ms on the left masseter. Neither change was statistically significant (P greater than 0.05). The silent period durations prior to anaesthesia were 20.3 +/- 4.0 ms and +/- 22.8 +/- 7.1 ms in the right and left masseters. During anaesthesia, these decreased by 2.74 +/- 5.8 ms on the right and 2.15 +/- 4.4 ms on the left. These decreases were not statistically significant (P greater than 0.05). These results failed to demonstrate an influence of the predominant nerve supply of the TMJ on either the latency or the duration of the masseteric silent period.

Anesthesia, Dental↗

The effect of voluntary activity on the masseteric silent period duration.

This study examined both TMJ and normal groups for any changes in the masseteric silent period with variation of the subjects' occlusal force. An analog meter was used to give each subject feedback on how hard the teeth were clenched together. Five silent periods were elicited at each of the four levels of occlusal force from 40% to 100% of maximum force. Results showed a small decrease in silent period duration for both groups when occlusal force was increased.

Dental Occlusion, Centric↗

Jaw muscle silent periods by tooth tap and chin tap.

Electromyographic silent periods from jaw closing muscles were elicited during a clench by tapping on the chin and on selected teeth both in asymptomatic subjects and in subjects reporting symptoms of temporomandibular joint dysfunction. The mean duration in response to a chin tap was significantly shorter in the asymptomatic group than in the dysfunction group. No significant differences in mean duration elicited by tooth taps were found between groups. Other comparisons of mean durations such as among muscles, among teeth, or between chin taps and tooth taps failed to achieve statistical significance.

Chin↗

The variability of EMG silent periods in TMJ patients.

The variability of the EMG silent period in jaw closing muscles of TMJ dysfunction patients was examined. Considerable within-subject variability was found in the duration of the silent period. This variability increased with symptom severity. The authors recommend that multiple measurements be averaged to obtain a more accurate estimate of the silent period duration.

Electromyography↗

Jaw muscle silent periods: the effect of acrylic splints.

Jaw muscle silent periods were recorded in response to a chin tap during maximal clench in asymptomatic subjects. The insertion of a palatal splint did not change the silent period duration. However, an occlusal splint, or part of it, caused a significant increase in the duration of the silent period.

Acrylic Resins↗