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PubMed1992

Predicting response to treatment for temporomandibular disorders.

This study examined whether pretreatment psychological characteristics of temporomandibular disorder (TMD) patients were related to the response to treatment in a TMD and facial pain clinic. The care provided to patients was either an evaluation only or an evaluation followed by a course of physical medicine/dental procedures (occlusal appliances, physical therapy, anti-inflammatory medications). Outcomes were assessed in terms of pain levels, jaw function difficulties, and satisfaction with care at 6 months posttreatment by phone and 16 months posttreatment by mail. There were no pretreatment differences between treated and evaluated patients except for higher pretreatment jaw function difficulty scores in the evaluated only patients. Factor analysis of pretreatment scores revealed distrust, pain, anxiety, and somatization. Somatization predicted follow-up pain levels at both follow-ups in the treated patients but only at the 16-month follow-up in the evaluated only patients. Pretreatment pain levels predicted posttreatment pain in both groups only at the 6-month follow-up. Posttreatment jaw function difficulties were related inconsistently to the pretreatment dimensions, while satisfaction was not predicted by pretreatment scores except for a possible connection between this outcome and distrust. It is concluded that an overconcern about bodily functioning appears to decrease the likelihood that patients obtain pain relief from physical medicine care.

Adult↗
PubMed2003

[Relationship between occlusion and myoarthropathy. Introduction of an integrating neurobiological model].

For many decades, the relationship between occlusal factors and temporomandibular disorders has been discussed controversially in the dental literature. After a brief description of current points of view about this topic, a recently published clinical trial by Le Bell et al. (2002) is summarized. The results of this study are discussed on the basis of a novel neurobiologic model, which is based on the heterogeneous activation of the masticatory musculature. This model appears to be suitable to explain the pathogenic and therapeutic effects due to occlusal management of patients with myofascial facial pain.

Adult↗
PubMed2003

Comparison between predicted and actual treatment outcome in patients with temporomandibular disorders treated by TMD-trained general dental practitioners.

Patients diagnosed with TMD at a specialist clinic were subgrouped as having muscular or mainly TMJ symptoms. The individual possibility to reach a significant improvement (improvement > 50%) was predicted as good, dubious or poor. The TMD treatment was performed by trained general practitioners following strict treatment routines comprising mainly occlusal appliances and/or occlusal adjustment. Treatment outcome was evaluated when a stable occlusion on the appliance and/or in the bite was established. Improvement was measured in per cent by using a Numeric Rating Scale. Agreement between predicted and actual treatment outcome was evaluated for 206 patients treated by the general practitioners. In patients with muscular symptoms and where the predicted treatment outcome was good, 89% of the treated patients reported an improvement of 50% or more. Among those with a dubious prognosis the figure was the same. In patients with mainly TMJ symptoms and where the treatment outcome was judged to be good, 97% fulfilled the criteria of a successful treatment outcome. Seventy-three per cent of those where the predicted treatment outcome was dubious, had an improvement of 50% or more. The possibility to predict individual treatment outcome, and the actual treatment outcome, in TMD patients treated by trained general practitioners, after examination and treatment planning by a TMD specialist, was good and comparable to the results obtained in patients treated by a TMD specialist.

Adult↗
PubMed2003

Evaluation and management of TMDs, Part 2.

TMDs are only one of a host of different conditions that are part of the broader category of chronic orofacial pain disorders and dysfunctions. Due to multifactorial etiologies, it is imperative to adopt a multidisciplinary approach when evaluating and treating these patients. Table 1 lists the various conditions to consider in the differential diagnosis of orofacial pain disorders.

Anesthetics, Local↗
PubMed2003

Oral structures and sleep disorders: a literature review.

In recent years, a wealth of studies revealed the many physiological and histological changes the oropharyngeal muscles go through as a result of sleep disorders, in particular, as a result of Obstructive Sleep Apnea (OSA). This article presents a literature review of the most recent findings regarding sleep disorders and their effect on oropharyngeal structures. The article includes classifications and definitions of various sleep disorders; explains the negative implications of sleep disorders in children, as well as in adults; reviews the viable options to treat sleep disorders; suggests steps in which the orofacial myologists could be instrumental in identifying and referring patients with possible sleep disorders; and suggests further studies on the subject conducted by orofacial myologists.

Facial Muscles↗
PubMed2003

A mandibular protruding device in obstructive sleep apnea and snoring.

UNLABELLED: The overall purpose behind treatment in sleep-breathing disorders is to ease breathing and thereby reduce the risk of morbidity. The mandibular protruding device (MPD) is one method of treating both obstructive sleep apnea (OSA) and snoring. The aims of the studies were to study MPD users after 2 years and evaluate the following aspects of the MPD: subjective and objective effects on sleep, influences on airway passages and hard tissues, and the incidence and types of adverse events of the masticatory system including temporomandibular disorders. Further aims were to evaluate the impact of body posture and the effects of the MPD on pharyngeal width and to validate two methods for measuring mandibular protrusion and MPD advancement. MATERIALS AND METHODS: Seventy-seven subjects with OSA or snorers without OSA. were admitted to the study after a medical examination, which included a somnographic registration. The patients completed questionnaires regarding sleep quality and symptoms from the masticatory system, and underwent a clinical jaw function examination, were given an MPD, and were subjected to lateral cephalometric examination. Two follow-ups, 6 months and 2 years after MPD treatment were conducted. The study population comprised 65 patients at the 2-year follow-up. RESULTS: At the 2-year follow-up, a significant reduction of the subjective complaints was noted by 90% of the MPD users. In the objective evaluation, the oxygen desaturation index (ODI) of the OSA group (n = 39) decreased significantly from a mean of 14.7 to 3.1 and the mean arterial oxygen saturation (SaO2) increased significantly from 78% to 89%. The snorers maintained their initial values. In the total group, MPD treatment significantly increased most pharyngeal measures and lifted the hyoid bone. The pharyngeal area decreased significantly--by more than 50%--when the patient was supine, and the velum area increased significantly. At the 2-year follow-up, on upright cephalogram without MPD, the pharyngeal area had significantly increased and the velum area had significantly decreased. The mandible was posteriorly rotated (P < 0.01) as well as the lower incisors were proclined (P < 0.05). Mandibular advancement and vertical opening with an MPD, as measured with a ruler, compared well with measurements taken from a cephalogram. At the 2-year follow-up significant changes in the mean mandibular range of protrusion (+0.6 mm), overjet (-0.5 mm), and overbite (-0.8 mm) were registered. Nine of the 65 patients had developed a lateral open bite, and 2 were aware of the change. The reported frequency of headache was significantly reduced. At the 2-year follow-up there was a significant reduction in pain during mandibular movements. CONCLUSIONS: MPD treatment significantly reduced subjective complaints of sleep disturbances and significantly reduced ODI values among OSA patients. A high MPD compliance rate after 2 years (84%) indicated a well-tolerated treatment and a low rate of side effects were noted. The key factor in OSA and snoring is the obstruction of pharynx. The MPD treatment significantly increased the pharyngeal passages and significantly reduced the size of velum and thereby facilitated the breathing.

Adult↗
PubMed2003

Temporomandibular disorders in adolescents. Epidemiological and methodological studies and a randomized controlled trial.

The aim of the present thesis was to investigate different aspects of temporomandibular disorders (TMD) and pain such as prevalence, diagnostics, and treatment among adolescents. The reliability of a questionnaire and the clinical examination and diagnoses according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were assessed. Overall, we found it possible to assess and diagnose TMD in adolescents in a reliable way. The prevalence of TMD pain, gender differences, and the need for treatment were investigated among 864 adolescents from a Public Dental Service clinic. Seven percent of the subjects received a pain diagnosis according to the RDC/TMD, and the prevalence was higher among girls than boys. More subjects with TMD pain reported school absence and analgesic consumption compared to controls. Approximately every second subject who reported TMD pain also perceived a need for treatment. In an evaluation of psychosocial and dental factors, the following were found to play an important role in adolescents with TMD: stress, somatic complaints, and emotional problems. Three treatment methods were compared in a randomized controlled trial: brief information only, brief information and occlusal appliance, and brief information and relaxation therapy. In the brief information and occlusal appliance group, 60%--significantly more than in the other two groups--experienced a reduction of at least 50% in TMD pain. The influence of somatic and emotional stimuli was evaluated, and we found that adolescents with TMD pain were significantly more sensitive to not only aversive somatic but also pleasant somatic stimuli compared with healthy controls. The results suggest that not only nociceptive but also cognitive processes are implicated in chronic pain states in young TMD subjects. In conclusion, TMD pain is more common in girls than in boys and affects daily life. TMD pain in adolescents can best be improved by traditional treatment with occlusal appliance combined with brief information.

Adolescent↗
PubMedDate not supplied

Does tooth wear status predict ongoing sleep bruxism in 30-year-old Japanese subjects?

PURPOSE: This study investigated whether tooth wear status can predict bruxism level. MATERIALS AND METHODS: Sixteen Japanese subjects (eight bruxers and eight age- and gender-matched controls; mean age 30 years) participated in this study. From dental casts of these subjects, the tooth wear was scored by Murphy's method. Bruxism level in these subjects was also recorded for 5 consecutive nights in the subject's home environment using a force-based bruxism detecting system. The relationship between the tooth wear score and bruxism data was evaluated statistically. RESULTS: Correlation analysis between the Murphy's scores of maxillary and mandibular dental arch and bruxism event duration score revealed no significant relationship between tooth wear and current bruxism. CONCLUSION: Tooth wear status is not predictive of ongoing bruxism level as measured by the force-based bruxism detection system in 30-year-old Japanese subjects.

Adult↗