Dr. Adams' Alabama Headache Blog

Relationship between SCL-90 Depression SUbscale and Course of TMD Treatment

2010-08-01T13:29:00.000-07:00

The depression and somatization (non-pain) subscales of the SCL-90 are being used increasingly for assessment of the stress factors in TMD patients. To determine if scores on these subscales were related to entering treatment and number of treatment visits, 92 charts were selected at random from patients who started treatment for TMD over one year ago. Patients were classified into 2 groups; 1)evaluation visit only (NT), not electing treatment (N-30, 32.6%) and 2) continuing treatment (CT), (N=62, 67.4%). Mean depression scores of NT and CT groups as well as the mean somatization non-pain score of the NT and CT groups were not significantly different. Initial pain, measured on a 10-pt visual analogue scale, for the CT group tended to be lower than pain reported by the NT group. Of the 62 patients who continued with treatment, the number of visits tje patients attended was correlated only with depression scores. This association remained significant after adding age, sex, and initial pain level in a multiple regression analysis. CT patients' depression scores were divided into two groups based on the normal limit if Axis II of the Research Diagnostic Criteria for TMD: 1) High (>0.535, N=39) and 2) Low (< or = 0.535, N=23). The mean of visits for the group with high depression scores (7.0, SD=3.17) was significantly greater than the mean number of visits of paitents with low depression scores. Results indicate that patients with high depression scores make more visits than patients with lower depression levels.

SCL-90 Nonspecific Physical Symptoms in Tinnitus vs. Non Tinnitus TMD Patients

2010-07-13T12:46:00.000-07:00

Nonspecific physical symptoms were analyzed to determine differences in response to the SCL-90 Somatization subscale between tinnitus TMD patients (T's) and non-tinnitus TMD patients (NT's). Forty-eight T's were found among 300 TMD patient records (4 were rejected due to incomplete records leaving 23 female and 21 male Ts) and 48 NTs were selected at random from the same population abd balanced for gender. Raw scores of the nonsepecific physical symptoms, pain items included showed that the Ts scores significantly higher than NTs. When pain items were excluded were not significantly different from NTs. Raw scores were then ordinalized as Normal, Moderate, or Severe according to Axis II scoring critieria of the Research Diagnostic Criteria for TMD. With pain items included, Chi Square tests comparing the three categories showed the distribution of the Ts to be significantly different from that of NTs, excepting the Normal vs. Moderate categories. When pain items were excluded, the distibutions over the three categories were not different. Thus, Tinnitus TMD patients tended to report higher pain item scores, placing more of them in the Severe of the Axis II, Research Diagnostic Criteria.

Effect of Electronic Anesthesia T.E.N.S. on T.M.J. and Orofacial Pain

2010-07-09T13:46:00.000-07:00

The use of Transcutaneous Nerve Stimulation in the treatment of orofacial pain is still a new field. This study was designed to evaluate the effectiveness of a new 3M Dental Electrical Anesthesia T.E.N.S. device in reducing orofacial pain. Forty patients Tufts University's Gelb Craniomandibular and Orofacial Pain Center were selected as subjects on the basis of unilateral pain. Subjects divided in 26 muscle pain patients (MP) and 14 joint pain patients (JP). Each subject acted as his own control, under going two trials in sequence at the same visit, a placebo trial and T.E.N.S. trial. A different T.E.N.S. unit was used for each trial. Electrode placements were standard-ized for the masseter (MP) and the temporomandibular joint (JP). Subjects scored a 10-point visual analogue pain scale and had their interincisal opening measured in mm before and after the placebo trial and after the a T.E.N.S. trial. Electrodes were attached for 20 minutes in each trial. The mean baseline pain level for MP was 6.6 and for JP, 6.3. Pain levels after placebo were MP 6.3, JP 5.4. Two way ANOVAS showed that there was no significant change in pain or incisal opening for either group following placebo, but following T.E.N.S., MP pain dropped to 2.94, JP dropped to 2.42. Interincisal opening did not increase significantly following the placebo but did after T.E.N.S.:30.5 to 36.7 for MP and from 28.1 to 32.4 for JP. After T.E.N.S. there was approximately 57% reduction in pain whether it was joint or muscle. The data showed that the 3M Dental Anesthesia T.E.N.S. is effective in reducing orofacial pain and increasing interincisal opening regardless of whether the origin of pain is joint or muscle. This study was supported by the 3M Company.

Relation Between Mandibular Position and Strength of Extremities

2010-07-08T13:01:00.000-07:00

A review by Forgione concluded that strength in muscles outside of the stomatognathic system may well be increased by a mandibular orthopedic repositioning appliance (MORA). These authors demonstrated isometricstrenth increase of the deltoid muscle with a MORA set to functional criterion. To determine whether this type of MORA affects muscle strength in extension and flexion in all the extremities, 20 females (age 30-50 yrs) were selected with clear loss of vertical support through loss of teeth or wear, no history of untreated chronic illness or recent trauma. All were found to be noticably stronger in deltoid isometric strength with teeth disoccluded than when bting in habitual. MORAs were constructed as described by Gelb and refined adjustment performed according to deltoid isometric testing. I counter-balanced, double blind procedure using the Standard Maximal Voluntary Isometric Contraction Testing apparatus produced 12 strength measures: Shoulder Extension and Flexion and Knee Extension and Flexion for both right and left. These strength measures were obtained under three conditions: Uabitual Bite, MORA, and Placebo. Data were analyzed by a treatment by Subject 2 were significantly less than MORA strength measures. These findings reinforce and extend earlier findings of bite related increased isometric strength in parts of the body other than the stomatognathis system.

Physical Changes Related to TMD Bite Appliance Therapy.

2010-07-07T12:14:00.000-07:00

This study was designed to compare the effects of two types of appliance, flat plane (FP) and anterior repostioning (AR) on selected subjective and objective dimensions from Research Diagnistic Criteria. Twenty patients visiting the Gelb Craniomandibular/Orofacial Pain Center were selected in order of appearance and assigned randomly to two groups. The age range was 18-45 years. One group was fitted with a FP and the other an AR. Prior to insertion, a 10-pt visual analoogue scale (VAS) was administered to rate headache, joint clicking, and joint pain and ear stiffness. Patients were then tested for 1) unassisted maximum interincisal opening, 20 excursions, 3) opening click and 4)joint sounds on excursion. After 2 months, the VAS was readministered and the patients retested. Two-factor, mixed factorial ANOVAS were performed on all testes except click opening and joint sounds on excursion. Headache, subjective rating of clicking, and joint pain reduced significantly in both FP and AR. Ear stuffiness did not change. In contrast, the mean of the AR increased significantly (33.35 mm to 41.6 mm) for interincisal opening while FP did not. Also, for excursions, there was a significant main effect for sequence and group sequence interaction. Mean FP increased 1.125 mm while mean AR increased 3.5 mm. While joint sounds on excursion did not differ, click on opening decreased significantly to zero for AR patients. While both appliances significantly reduced subjective symptoms, AR was more effective in reducing Axis-1 objective measures.

Relationship Between TMD Multiple Somatic Complaints and SCL-90 Depression Scores

2010-07-06T11:48:00.000-07:00

Many TMD patients experience a variety of non-specific symptoms in addition to pain and mandibular dysfunction. To study the prevalence of multiple somatic complaints in patients with TMD and study its relationship to SCL-90 depression scores, three measures of multiple somatic symptoms were selected. Using cut-off points from the Research Diagnostic Criteria Report, above average values were determined for 1)the somatization scale (SOMA) and 2) the somatization scale with only non-pain items (SOMANP). In addition, a scale measuring multiple pain sites (MULPAIN) was used. 46 records were selected at random from the patient population of the Gelp Craniomandibular/Orofacial Pain Center and analyzed. 56.5% of the patients exhibited above average values for SOMA, 30.4% for SOMANP and 37% of the patients had 2 or more pain on MULPAIN. Scores on the Depression Scale were significantly correlated to SOMA, SOMANP,and MULPAIN. After controlling for possible confounding effects of age, sex, intial pain level, duration of the problem, diagnosis of cervical condition and history of whiplash or trauma by multiple regression analysis, the positive correlation with depression scores remained significant for the SOMA and SOMANP but not for MULPAIN. The results indicate that approximately one third of TMD patients reported non-pain symptoms and multiple pain sites. Non-pain symptoms (SOMANP) were found to be as strongly correlated to depression as a mixture of pain and non-pain symptoms (SOMA).

SCL-90 Scores and Symptoms of Tinnitus-TMD, TMD Patients and Controls

2010-07-05T10:35:00.000-07:00

Tinnitus is occasionally reported by Temporomandibular Disorder (TMD) patient. In order to assess the presence of tinnitus, the SCL-90 and a list of 30 somatic complaints were used to compare 50 TMD patients with tinnitus (TTs), 50 TMD patients without tinnitus (NTTs) and 50 non patient controls (NPCs) in retroactive study. Records of TTs were selected from 200 patients who had been treated at the Gelb Craniomandibular Orofacial Pain Center. NTTs were randomly selected from the same population and NPCs were chosen from the students, faculty, and staff of the dental school. Mann-Whitney U tests were performed on raw scores of each of the nine dimensions of the SCL-90. TTs were significantly greater than NTTs on all dimensions except Obsessive- Compulsive, Interpersonal Sensitivity, and Hostility and greater than NPCs on all dimensions except Obsessive Compulsive, Interpersonal Sensitivity, Hostility, Phobia, and Paranoia. Scores on the 30 symptom list were available for only 36 tinnitus patients, so 36 were randomly selected from the 50 NTTs. Mann Whitney U showed that TTs as a group reported significantly more symptoms than NTTs. With respect to specific symptoms, only three were significantly greater than NTTs: Pressure in eye, Neck Pain and Difficulty Swallowing. No NTT symptoms were greater in TTs. TMD patients with tinnitus exhibit SCL-90 scores indicating greater emotional stress than TMD patients not reporting this problem. In addition, those with tinnitus generally exhibit a higher frequency of somatic complaints. These findings suggest that TMD patients with tinnitus may require broader treatment including psychological, to help cope with the greater physical and emotional stress.

Effect of Passive Jaw Motion Device on Range of Motion

2010-07-02T09:59:00.000-07:00

This study was designed to evaluate the effectiveness of a passive jaw motion device. (PJMD) on patients with restricted opening prior to being considered for surgery. Twenty patients with interincisal opening (IIO) of 35mm or less were selected in order of appearance to the Gelb Craniomandibular/Orofacial Pain Center. IIO, right lateral (RL) and left lateral (LL) excursions and protrusion (PR) were measured. Patients were treated with appliance therapy for 4 weeks. Half of patients, randomly chosen, were simultaneously treated with PJMD. Measurements were then repeated. A 2-factor, factorial ANOVA was performed for each mandibular motion. For IIO there was a significant main effect for groups, sequence as well as significant group interaction as well as significant group by sequence interaction. PJMD pre(27.7 mm) increased significantly to 38.3 mm while control did not change (25.4 mm pre, 27.1 mm post). For RL, there was a significant main effect for groups and sequence as well as a significant group by sequence interaction. The PJMD mean pre (7.6) was no different from control(6.1) but it increased significantly to 10.3 mm, while the control mean remained stable (6.4 mm) For LL and PR there were significant main effects fro group and sequence but not for group by sequence interaction. This study is preliminary and suggests that the PJMD is effective in increasing maximum incisal opening and excursion to the right. Although LL and PR tended in the same direction, they did not attain significance. This study is ongoing and will ultimately include 50 patients. This study was supported by the Therabite Corporation.

Effect of Jaw Motion Device on Pain and Range of Motion

2010-07-01T09:37:00.000-07:00

This study evaluated the effect of a jaw motion device on pain and range of motion in TM joint and muscle disorders. Patients were classified as joint or muscle accordiing to the Research Diagnostic Criteria for TMD. 21 patients in each of the two groups were assigned at random to three treatment groups of seven: 1) motion device therapy (MDT), 2) bitestick therapy (BT), and 3)control. Before and after 4 weeks, pain was assessed by response on a 10 point visual analogue and MO by direct measurement in mm. Joint patient using MDT reported significantly greater pain reduction than with BT. However, joint MDT scores were not different from those of joint controls. Joint BT scores were no different from joint controls. MDT on teh muscle patients produced significantly greater pain reduction than BT on muscle patients, as well as controls. Pain scores for the muscle BT were no different from muscle controls. ANOVA was performed on change scores in MO from pre- to post-treatmeant. The MO for joint patients under MDT was significantly greater than joint BT as well as joint controls. Joint BT produced MO no different, from joint controls. The mean MO for muscle MDT, 16.29, was significantly greater than that of muscle BT, 4.86, as well as muscle controls, 1.14. Mean MO of the BT patients was significantly greater than that of muscle controls. The results suggest that the jaw motion device is effective in increasing MO in both joint and muscle TMD patients. It also appears to decrease pain more effectively in muscle TMD patients than in joint TMD patients.

Vertical Dimension's Effect on Sternocleidomastoid in Complete Denture Patients

2010-06-24T12:50:00.000-07:00

Al-Abbasi et al. (IADR Abstracts, vol. 74, #997, 1994) found isometric strength (IS) of the sternocleidomastoid muscles (SCMS) increased with bite elevating appliances in deep bite subjects. This study examined the effect of vertical dimension on the IS of the SCMS of complete denture patients. Ten males and 7 females were seated upright and instructed to resist maximally a horizontally applied force provided by a hand-held strain gauge. A headrest was place 2 inches from the occiput to prevent hyperflexion of the neck. Steadily increasing pressure was applied to the forehead until resistance was recorded under 6 conditions: 1) mandibular rest postion (RP), biting 2) without dentures, 3) on existing dentures, 4) on blocks placed over the premolar to molar region which increased the vertical dimension of occlusion (VDO) 2 mm, 5) 6mm and 6) 10 mm. IS did not increase monotonically as VDO was increased from 2 to 10 mm above denture height. In some cases IS decreased as 10 mm. However, in no case did IS decrease as 2 mm above the the denture VDO. Therefore, the maximum IS under 2, 2, and 10 mm was selected for the overall analysis. Two way ANOVA for repeated measures showed the mean PR biting on dentures was not different from that of RP and both were significantly greater than without dentures. The mean IS of the SCMs of the maximum PR was significantly greater than RP and biting with and without dentures. The results indicate that, altering the VDO has a significant effect on the IS of the SCMs. The IS of the SCMS in this sample was not maximized at the denture VDO.

Bruxism's Effect on the Masticatory System: The "Weak Link" Theory

2010-06-11T11:41:00.000-07:00

Studies have shown that parafunctional activity is more intense and of longer duration than mastication. Although occlusal trauma would be expected, occlusal forces have not correlated consistently with masticatory system damage. This may be due, in part, to the difficulty of objectively quantifying nocturnal parafunction and in part, to evaluatin singular classes of damage. Rather, damage could be assessed according to a "Weak Link" theory. The theory proposes that when forces are of severe intensity and prolonged duration, damage may be seen either 1) in the periodontal tissue (trauma from occlusion), 2) on the tooth as wear or 3) on the orofacial structures as in temporomandibular disorders. The theory predicts that damage will occur in a particular individual in one area while no or little damage will be found in the other two areas. To test this prediction, twenty-two subjects were selected on the basis of reports of nocturnal bruxism. Subjects were drawn from three dental practices. Prior to rating subjects, examiners rated cases until interexaminer reliability was .90 consistently. Each subjects was evaluated on the Russell Periodontal index, the Helkimo Dysfunction Index and a Tooth Wear Index to assess masticatory breakdown. Each subject wore a Bruxcore intraorally for four nights to obtain and objective score of bruxism. Only three of the eleven subjects with a mild bruxism score scored high on one index while significantly more (ten of eleven subjects) with a moderate to severe bruxism score registered high on one index (Mann Whtiney) These findings conform to the "Weak Link" theory. Moderate to intense bruxism will tend to damage only the "weakest part" of the masticatory system. The "weakest part" may differ from patient to patient.

Incidence of Cervical Disorders in a T.M.D. Population

2010-06-10T13:09:00.000-07:00

A study was conducted to assess the incidence of cervical pain and dysfunction in a temporomandibular dysfunction (TMD) population and to examine the association of cervical spinal dysfunction (CSD) with A) history of trauma, B) bruxism, or C) dental treatment as possible etiologic factors. 250 patients (82% female) reporting sequentially to the Tufts Gelb TMD and Orofacial Pain Center were selected as subjects. The above etiologic factors were considered singly or in combination based on verbal identification of an immediate correlation to the time of trauma and emergence of symptoms. Dental treatment was taken into account only when the patient reported emergence of symptoms immediately following the respective dental procedures. Bruxism was considered only when confirmed by personal knowledge or by report of a significant other. 70.8% of the sample had TMD associated with CSD while only 29.2% had TMD without CSD. Bruxism was involved in 71% of the sample population (74% in TMD, CSD patients and 64% in the TMD only patients). Bruxism was a single, causative etiologic factor was found with 22% of entire sample. Of the entire population of patients, 32% symptoms were reported immediately following dental treatment. The data indicate that CSD is associated with TMD more frequently (70%) than TMD alone (29%) in a oralfacial pain population. When history of trauma is present, CSD is associated with TMD more often (38%) than not (6%).

Bilateral Surface EMG Activity of 200 Temporomandibular Dysfunction Patients

2010-06-09T12:49:00.000-07:00

Bilateral Surface electromyography was performed to establish norms on 200 Temporomandibular Dysfunction Syndrome patients (149 females and 51 males) ranging from 19 to 58 years of age. Electrode placements were over the masseter and anterior temporalis muscles of seated patients. Peak uV values were recorded under the following conditions: relaxed-dissoccluded (RD), swallow (PS), first contact of habitual bite (CH) and maximum forced bite in habitual, without causing or increasing pain (FB). Rather than right versus left, all analysis was based on lower masseter reading in uV. Mean RD was 2.80 for the lower and 5.43 for the higher side for masseter and 3.21 and 5.68 for temporalis. For CH the masseter means were 3.99 and 6.70 and for temporalis 8.33 and 4.96. Analysis of the more active conditions revealed two patterns of readings. In one pattern, the higher uV value for both masseter and temporalis occured on the same side (unilateral) while in the other, the higher masseter value was on one side while the higher temporalis was on the opposite side (crossover). In PS, masseter means were 7.7 and 10.0 while temporalis means were 10.3 and 6.2. In the FB condition 104 patients showed a unilateral pattern: masseter 61.6 and 98.2, temporalis 135.0 and 104.3. In the FB more than half the sample (108) could not generate more than 50 uV in the lower masseter reading. TMD patients show up to 50% difference in EMG activity in mandibular maneuvers. Two bite patterns, unilateral and crossover were found to be almost equally distributed in this patient population.

Effect of Appliance Therapy on Specific Symptom Sites of TMD

2010-06-03T10:44:00.000-07:00

A retrospective study was designed to evaluate the effect of flat plane, intraoral appliances on the number of sites of specific Temporomandibular Disorder (TMD) symptoms. Fifty-five subjects were selected at patients visiting the Gelb Craniomandibular and Orofacial Pain Center at Tufts University School of Dental Medicine. The criteria of selection were: 1) No physical therapy or chiropractic treatments prior to or during the four visits, 2) No muscle relaxants, psychotropic or pain medication or any active treatment for their presenting symptoms and 3) Treatment having consisted of only a full coverage, flat plane, lower appliance. Symptom sites were recorded on the day of appliance insertion and on the fourth visit during an eight week period. Symptom sites for each of the four areas of the body studied were given a maximal score of 100 according to the following weighting: 1) Headache (29 of 55 subjects) frontal=25, occipital=25, right temporal=25 and left temporal= 25; 2) Neck complaints (24 of 56 subjects) stiffness/pain= 50 and tightness=50; 3) Joint sounds (24 of 55 subjects) right side=50; and 4) Joint pain (28 of 55 subjects) right side= 50, left side= 50. Wilcoxon Signed Rank Tests showed a significant reduction in all TMD symptom sites; 1)the number of headache sites in 29 subjects showed a reduction of 65%, 2)neck symptom sites in 24 subjects reduced 57%, 3) the number of joint sound sites in 24 subjects reduced 74%, and 4) the number of joint pain sites in 28 subjects reduced 71%. Results suggest that the sole use of flat plane, appliance therapy is effective in reducing the number of specific head, neck, and TM joint symptom sites in TMD patients.

Effectiveness of Electronic Anesthesia in Controlling Pain During Periodontal Sealing.

2010-06-02T10:01:00.000-07:00

T.E.N.S. has been used in dentistry for discomfort and pain control. This study was designed to evaluate the effectiveness of electronic anesthesia (3M Electronic Anesthesia) in reducing pain and discomfort of periodontal sclaing and curettage. 36 subjects (Ss), 18 each sex, were classified according to their clinical condition as follows: Group 1, sensitive teeth; Group 2, periodontal pockets from 1 to 3 mm; Group 3, periodontal pockets 4 to 6 mm. Two operators treated the patients, one treated 13, the other 23. In each of the Ss, two quadrants were chosen at random (an upper and a lower) and were treated using an inactive stimulator, then the other two were treated with an active stimulator. On a 10-point visual analogue scale, Ss first reported pain they recalled from their typical scalings prior to the prior to the experiment (RTS), then they rated pain of treatment after each quadrant treated. There were no significant effects for groups, sex, arches or operators. The mean pain score after the active stimulator for the maxilla (2.9) was significantly lower than that of the inactive group (3.9). Similarly, mandibular pain mean for the active group (2.2) was significantly lower than that of the inactive group (3.6). While mean RTS scores were no different from each other of from pain scores under inactive treatment and correlated significantly (maxillary Pearson r=0.31. p=0.03; mandibular Pearson r=0.54, p=0.0001), they were significantly different for the active groups (maxillary T=2.54 df 35, p=0.01, mandibular T= 4.28 df 35). These findings suggest strongly that electronic anesthesia can produce significantly lower pain levels than past experiences and when directly compared with non-stimulated scaling on the same treatment day. This study was founded by 3M Corporation.

SCL-90 and Pain Scores Before and After TMD Biteplate Therapy

2010-06-01T09:35:00.000-07:00

Use of the Symptom Checklist ( SCL-90) is increasing in the research and treatment of Temporomandibular Disorders. To determine whether the dimensions assessed tend to be indicators of enduring tendencies or short term characteristics associated with pain, the SCL-90 and a 10-point numerical graphic analogue pain scale were administered to 50 TMD patients (TMDs) selected at random at the Gelb Craniomandibular and Orofacial Pain Center and 50 non-patient controls. TMD patients were treated by intraoral appliance therapy with regular adjustment visits. Three months after insertion, tests were readministered to both groups. Median pain levels for TMDs (5) decreased significantly to (2) according to the Wilcoxon Signed Rank Test (WRST. The median pain level for controls (1) remained unchanged (1), WRST. WRSTs performed on SCL-90 pre and post raw scores of TMDs showed significant reduction in all dimensions except Phobic Anxiety. Pre and post scores for controls were stable. The SCL-90 profile of the 42 TMDs who showed pain reduction was no different from that of the control group. Reduction in pain in all TMDs was significantly correlated with reduction in all psychological dimensions except Paranoid Ideation. No positive correlations were found for controls. The reductions of pain has broad psychological impact and the SCL-90 was found to be sensitive to it. These findings suggest strongly that with pain patients, scores on the majority of SCL-90 dimensions be considered part of a reactive pattern to pain. In the presence of pain, SCL-90 scores cannot serve as a valid indicator of enduring psychological tendencies. Without considering the transitory, score-elevating effect of pain, the origin of pain may, in whole or in part, be attributed to incorrectly to the dimensions elevated.

Effect of Bruxism on Success Rate of Dental Implants

2010-05-27T13:03:00.000-07:00

Occlusal forces of bruxism are traumatic, damaging teeth or supporting bone. With implants, there are no ligamentous attachments between bone and implant with foces transmitted directly to bone. In addition, receptors in the periodontal ligaments are absent and communication with the motor nucleus of the trigeminal nerve, effecting feedback controling jaw closure and protecting from excessive closing forces is non-existant. It would be expected that dental implant and superstructure problems would be more likely in bruxing patients than non-bruxers. To test this hypothesis, 47 patients with implant prostheses were studied: 17 exhibited signs of bruxism and 30 controls did not brux according to a bruxism questionnaire. The two groups were compared for 1)pain, 2)implant mobility, 3) periodontal pocket depth and 4) problems with dental implants and prosthetic superstructures such as implant abutment fracture, gold screw loosening or fracture, broken denture teeth, clip loosening and porcelain breakage. A positive significant relaitonship was found between bruxism (based on a bruxism questionnaire) and problems with prosthetic superstructures based on implant examination: 76% of the bruxism group and 27% of teh control group had problems with superstructures. Ten patients were selected at random from each group and fitted with a Bruxcore bruxism monitoring device to assess current bruxing. The experimental subgroup showed significantly greater Bruxcore scores and tooth wear indices than the control group. The results indicate that tooth wear index and the Bruxcore may be used to diagnose bruxism and bruxism reduces long-term success of implant treatment.

SCL-90 Scores of Treated TMD Patients and Normal Controls

2010-05-26T12:08:00.000-07:00

Thirty one consecutive patients, attending the Gelb TMD Orofacial Pain Center, who had recieved at least three months of biteplate treatment were administered a second SCL-90 and 10-point Visual Analog Pain Scale. 30 females and 1 male comprised the patient. 50 non-patient controls were recruited from the students and staff of tufts Dental School. Over the period of treatment, general pain level reduced significantly(Wilcoxon Signed Rank Test [WSRT]) from a median of 6 pre-treatment to a median of 3 after the treatment period. During the same period pain pre-, median=2.01, was no different from pain post, median=1.6. WSRTs showed that with the exception of Phobia, scores on all dimensions decreased significantly: 1) Somatization, p=0.03, 2) Obsessive Compulsive p=0.007, 3) Interpersonal Sensitivity, p=0.003, 4) Depression, p=0.015, 5) Anxiety, p=0.001, 6)Hostility, p=0.018, 7) Paranoia, p=0.038, 8)Psychiticism, p=0.02. For controls, there was no differnece between pre- and post- treatment scores on all dimensions decreased significantly. TMD patients were then divided into pretreatment high pain (greater than 5) and low pain (5 and lower) groups of 18 and 13 respectively. Both groups reported a significant reduction in pain from the start of therapy: High pain p=0.0002 and low pain 0.0185. WSRTs performed on the scores of low patients showed a significant reduction in only the Hostility scores, p=0.0145. Somatization, Hostility, and Paranoia. Selecting specific items of the Somatization dimension responses of the group of 31 patients showed significant reduction in the headache item (p=0.0157), the muscle pain item (p=0.002), the numbness item (p=0.0157) and the back pain item (p=0.033). Biteplate therapy for TMD reduces reported stress levels significantly in 9 of 10 dimensions of the SCL-90. Analysis of the high pain patients indicates that the greater reduction in these patients may overshadow the smaller changes of the low pain group.

Quantitative Assessment of Posture and Cervical Function in CMD Patients

2010-05-25T11:46:00.000-07:00

This study was designed to find whether there is any difference of head posture and neck function between patients with craniomandibular disorders and asymptomatic women. 40 female volunteers between 18 and 55 years of age joined the study: 20 CMD patients with chronic orofacial pain and frequent headache (equal of more than three times a month) and 20 age-matched asymptomatic women. Subjects in both groups had no history of physical trauma on the head and neck area in recent ten months. In present study, 70% (14) of twenty CMD patients had more than one headache per week, the mean frequency of headache in CMD patient was 8.83 per month. By using computer assisted video-digitizing posture analysis (VDPA)system which can provide life-sized, 640dpi X 480dpi resolution, true color images allowing hand digitizing, the head posture as well as full range of neck motion in three dimensions were recorded and computed. The validity of the VDPA system has been tested by repeated measurements of eleven angles and one linear distance. An extremely strong correlation was present between the readings from goniometer and VDPA system. The mean difference between ten repeated measurements was 0.12. A highly significant difference of eye-tragushorizontal angle was found between two groups as tested by Student's test. The CMD patients showed a more forward head posture. The CMD patients also had much less mean cervical movement in all three dimensions including bilateral side bending, rotation, and cervical extension/flexion than the asymptomatic group. These differences were significant as tested by Student t-test. The results strongly indicated that most of CMD female patients with frequent headache syndrome had cervical dysfunction. Thus, the evaluation of head posture and cervical function are recommended.

Effect of Eye Dominance on Head Posture and Mandibular Deviation

2010-05-24T13:10:00.000-07:00

This study was designed to determine whether eye dominance (ED) affects head posture and in turn, whether head posture is associated with frenum midline deviation. Fifty females were selected for this study: 25 TMJ patients at random from patients attending the Gelb Craniomandibular Pain Center (average age=31) and 25 non-patient controls from the staff and students of the dental school (average age=28). ED was tested by the Porta test, hole testm and point test. Head rotation was measured with the Arthroidial Protractor and maxillo-mandibular frenum alignment was determined in habitual occlusion as coincident, mandibular frenum to right or left. For the control group, 84% was right ED (Binomial p, two tail 0.002) while ED was equally distributed in the TMJ group. The finding for the control group is in agreement with previously published research. For both groups head rotation occured significantly tot he side of the dominant eye: coincidence of ED and ipsilateral head rotation was 84% for TMJ subjects and 92% for controls. Twenty three TMJ patients showed mandibualr deviation compared to only six controls. Seventeen of the 23 TMJ patients (74%) demonstrated midline deviation to the opposite side of head rotation compares to only 6 controls. The findings indicate that ED and direction of head roation are strongly associated in both TMJ patients and non-patient controls suggesting that ED dictates position of the head. In TMJ patients, mandibular deviation occurs with much greater frequency than controls and tends to occur in the contralateral direction of head rotation.

Effect of Repostioning and Flat Occlusal Splints on Masticatory Muscle Tenderness

2010-05-23T12:50:00.000-07:00

To compare the effects of Flat Occlusal (FO) and Anterior Repostioning (AR) splint therapies for TMD, 20 (18 female and 2 male) patients were assigned randomly to 2 groups: FO or AR. Prior to splint insertion, each patient was administered a 10 point visual analogue scale (VAS) to measure severity of symptoms. This scale was especially designed for the present study. Patients rated degree of 1) earache, 2) ear stuffiness, 3) headache, 4) facial pain, and 5) neck (pain/stiffness). At this time, masticatory muscles were palpated according to the Research Diagnostic Criteria for TMD (Dworkin and LaResche, 1992) and patients scored levels of discomfort on the VAS. Patients were examined and evaluated every 2 weeks and after the 8th week the same evaluation was repeated. For all sites, a mean score was obtained by averaging right and left scores. Wilcoxon T tests revealed that patients in the FO group reported significant reduction in earaches, whereas the AR group reported significant reduction in earaches, ear stuffiness, headaches, facial pain, and neck stiffness. Mann-Whitney U tests comparing AR to FO showed in4 of 10 sites that AR muscle tenderness scores were significantly lower than FO in the following sites: 1) back of temple, 2)middle temple, 3)front temple and 4) lateral pterygoid. While both appliances reduced reported symptoms, the AR splint was signicicantly more effective in reducing temporalis and lateral pterygoid muscle palpation tenderness.

Relationship Between Life Event Stress and TMD Symptoms

2010-05-22T11:56:00.000-07:00

To assess the correlation between temporomandibular disorder (TMD) symptoms and Life Event Questionnaire (LEQ) scores in subjects who seek TMD patients, 9 males, and 27 females (mean age=29) and 24 control subjects, 6 males and 18 females (mean age=27) were selected. TMD patients were seen for an initial examination during a four month period prior to beginning the study. Patient reported symptoms from a 40 item symptomatology checklist and LEQ scores were analyzed. Pearson r correlation matrix indicated a significant relationship between the number of reported symptoms and LEQ scores for both TMD and controls. TMD patients had a median of 8.5 symptoms and a mean LEQ score of 101.64. 42% of control subjects reported TMD symptoms with a median of 0.036 symptoms and a mean LEQ score of 59.54. A Mann-Whitney U test showed that mean number of TMD symptoms of the TMD group was significantly higher than that of controls. The mean LEQ score of the TMD patients was no different from that of the controls. The most frequently reported symptoms among TMD patients were jaw joint clicking (83%), jaw joint pain (69%), cheek pain (58%), neck pain (50%) and neck stiffness (50%). A Pearson r correlation indicated a significant relationship between TMD patients' LEQ scores and both jaw joint clicking and neck pain. Most frequently reported symptoms among control subjects were neck stiffness (50%), jaw joint clicking (40%), forehead facial pain (40%), lower back stiffness (40%) and jaw joint pain (30%). Pearson r also indicated a significant relationship between control subjects' LEQ scores and the five most frequently occuring symptoms. The results indicate that event related stress, measured by the LEQ, may not affect most TMD symptomatology but may be correlated with joint clicking and neck pain.

Maxillomandibular Relationship in TMD Patients Before and After Short Term Bite Plate Therapy

2010-05-21T11:23:00.000-07:00

The purpose of this study was to assess the maxillomandibular relationship in temporomandibular disorder (TMD) patients, before and after short term flat bite plate therapy, to determine whether there is transverse shift of the mandible toward the frenel midline. Twenty subjects, 17 females and 3 males (mean age=38 years +/- 12.2) from the patient population attending the Gelb Craniomandibular and Orofacial Pain Center at Tufts University of Dental Medicine were selected based of the Research Diagnostic Criteria for TMD. Thirteen subjects had a diagnosis of myofascial pain (RDL I.a), while 7 subjects had at least one diagnosis of disc displacement with reduction (RDC II.a). Impressions were taken, and diagnostic casts were fabricated for all subjects. A Vinyl Polysiloxane Plaster bite registration material (Regisil PB Cartilage System) was used to record the maxillomandibular relationship, both in full bite as well as in first contact. The casts were then mounted on a Denar condylartracing articulator, using the bite registration material, and then the maxillomandibular relationship evaluated using the Centric Check System. The frenel attachment to the upper and lower gingiva was used as a reference to evaluate mandibular shift. At the initial visit, all subjects showed a mandibular shift, with 9 subjects shifting to the left side and 11 shifting to the right. System questionnaires were used to assess associated pain and discomfort. Bite plate therapy was provided to the patient for 4 weeks, eftar which a second set of bite registrations were taken and symptom questionnaires provided. A Binomial test was performed to evaluate the rate of occurence of mandibualr shift. All subjects shifted to the frenal midline position, following short term bite plate therapy, regardless of the original position right or left. The results of this study indicated that the mandible will shift toward the frenal midline position after short term bite plate therapy.

Effectiveness and Safety of Round End Toothpicks in Plaque Control

2010-05-20T11:06:00.000-07:00

This study was designed to assess the effectiveness and safety of using wooden, round end toothpicks for plaque control. Sixty subjects (Ss) were assigned at random to either and experimental (E) or a control (C) group. Seven Ss were eliminated because of lack of compliance or illness. Consequently 27 E and 26 C Ss completed the study. Ss in both groups were instructed to brush twice per day and the E group was instructed in the use of toothpicks as an adjunct to brushing. Ss were evaluated with the Loe Silness Gingival Index for gingivitis (4 periodontal surfaces were scored from 0-3, mild to severe gingivitis for each tooth and the total surfaces divided by the number of teeth to obtain a gingival score). Plaque deposit was evaluated by a modified Quigley-Hein Plaque Index (scoring for each of the 4 surfaces of each crown ranged from 0-5, no plaque to plaque covering 2/3 of the crown). Scores of all teeth were divided by 4 then by the number of teeth to yield a plaque score for each subject. Ss were evaluated at the start of the experiment, 15 and 30 days later, then paid $50.00. Wilcoxon Signed Rank Test (WSRT) showed a significant reduction in gingival scores of the E group from pre-experimental to post 30 days. Similarly, Gingival scores of the C group reduced significantly over the 30 day period while the C group showed no difference over the same period. A Mann-Whitney U test showed that the gingival index for the E Ss was no different from that of the C group. Reduction in gingival scores can be accounted by the brushing regimen. The significant reduction in plaque scores in the E group is related to the toothpick use. The almost identical gingival scores in E and C groups indicate that toothpicks did not inflame or abrade the gingiva. Toothpicks when used as directed are effective in lowering plaque scores and are safe for the gingiva.

SCL-90 Scores of TMD Patients One Year Follow-Up

2010-04-15T12:07:00.000-07:00

This study examined the clinical utility of the SCL-90 by using the Depression scale and a 7 item subset of the Somatization scale which excluded items related to pain to predict various outcome measures following bite plate therapy in the treatment of Temporomandibular Dysfunction. A random sample of 211 patients was selected from patients attending the Gelb Craniomandibular/Orofacial Pain Center with their last visit at least one year previous. Age, sex, initial pain level, depression, and 7 items from the Somatization scale (SOMANP) were from the first visit. Follow-up questionnaires were sent asking current pain level and disability, number of practitioners consulted and satisfaction with treatment. Twenty-five (53) responded. A comparison of those responding with 79 patients not responding showed no significant differences in age, sex, initial pain, depression or SOMANP SCORES. Responders were classified according to the RDC graded chronic pain scale from 0 to 4: 17% at 0, 47% at 1, 22.7% at 2, and 13.3% at 3. None were in Grade 4. With each higher step in grade there was an increase in pretreatment depression, SOMANP, initial pain and a decrease in age. However only in the initial pain scores were significantly different from the other. A high SOMANP score was correlated significantly with low satisfaction and a high number of health professionals consulted. Depression was not correlated with satisfaction of treatment or number of practitioners consulted. There was a strong sex difference in the mean SOMANP:0.61 for the 46 females vs. 0.10 for the 7 males. Duration of the problem was significantly correlated with both Depression and SOMANP. However both were placed as predictor variables in regression analysis, only Depression remained significant. Although Depression and SOMANP scales are highly correlated, there is value in looking at both these scales. The SOMANP predicted 2 variables better than the Depression scale: Satisfaction with Treatment and number of Health Practitioners Consulted. The Depression Scale was more highly related to Duration of the Problem.

Vertical Dimension and Electromyography of Sternocliedomastoids in Complete Denture Patients

2010-04-14T11:39:00.000-07:00

The vertical dimension of occlusion (VDO) which achieves the highest isometric strength of sternocliedomastoid muscles (SCMs) has been determined in complete denture patients. The purpose of the present study was to investigate the effect of this VDP on the electromyographic (EMG) activity using Davicon M44 Dual EMG of the SCMs in complete denture patients. Seventeen complete denture patients (mean age 58.7 +/- 10.89 yrs) with the complete upper and lower dentures for at least one year, no history of physical trauma to the head and neck, no untreated chronic illness and no cervical symptoms requiring treatment in the last 5 years were selected for this study. Patients were seated in an upright position and instructed to resist a horizontally transmitted force applied to the forehead of the patient by a hand-held strain gauge. The load in kilograms was applied until resistance failed. The load was recorded under five conditions: rest position, biting on existing denture, biting on wooden blocks (2, 6, and 10mm) increasing the VDO 2mm, 6mm, and 10mm respectively. On second visit, bilateral electrodes were applied to the middle of the SCM muscle with 2 active electrodes in parallel with the muscle fibers. The subjects were instructed to bite as hard as possible on the existing denture and peak EMG activity was recorded in microvolts. An acrylic resin layer was then filtered over the lower denture of each subject to add height on the existing denture. This height was determined from the maximum isometric strength of the SCM muscle. The recorded data was analyzed using students t-test. The results showed a statistically significant difference in the mean EMG activity of the right SCM muscle between maximum clench on existing denture and maximum possible clench on an increased VDO which achieved peak isometric strength of the SCM muscles. The mean EMG activity of the left SCM of maximum clench on existing dentures was greater than the mean EMG activity of the left SCM of maximum clench on an increased VDO which achieved peak isometric strength of the SCM muscle. In conclusion, the vertical dimension of occlusion which achieved maximum isometric strength of the sternocliedomastoid muscles has a significant effect on electromyographic activity of those muscles in complete denture patients.

Temporalis and Masseter Surface EMG in TMD and Control Subjects

2010-04-13T11:21:00.000-07:00

The purpose of this study was to compare bilateral surface electromyographic readings of temporalis and masseter muscles in three mandibular positions: 1)relaxed open (RO), 2) bite to first contact (FC)and 3) biting with maximum force (MB). Thirty asymptomatic females (as determined by an 11 item questionnaire) were selected from the students and staff at Tufts University School of Dental Medicine to serve as controls (mean age= 26.13, S.D.=4.5). Thirty orofacial pain patients were selected at random from the patients being seen at the Gelb Craniomandibular Orofacial Pain Center (mean age=34.65, S.D.=9.36) to serve as experimental subjects. Recordings were obtained from a Davicon, 4-channel EMG device. The order of mandibular positions was the same for all subjects. Two readings were made at each position sampling two seconds of EMG trace and the lower value of the two recorded as the response with all recordings except MB where the higher value was recorded. A 3 factor factorial ANOVA showed that the overall effect for groups was significant and the effect of mandibular positions was significant as well. The group by side by position interaction was significant. There were no differences in the RO and FC positions between groups or within each group. Differences occured only in the MB condition. The mean of the TMD temporalis right was significantly lower than that of the controls while the mean of the TMD temporalis left was also significantly less than that of the control group. Similarly, the mean of the TMD masseter right was significantly less that of the control group. The mean of the TMD masseter left was also significantly less than that of the control group. In maximum bite, differences between TMD and control EMG levels were significant but not in low function.

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2010-04-12T11:28:00.001-07:00

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Self-Reported Temporomandibular Joint Dysfunction Symptoms in 220 American Dental Students

2010-04-07T12:45:00.000-07:00

This study assessed the prevalence of Temporomandibular Joint (TMJ) Dysfunction in students at Tufts University of Dental Medicine. Three classes were administered in a 12 item questionnaire requiring a yes/no response to questions about discomfort and dysfunction of the TMJ and associated muscles. Of 125 forms administered, Class of 1990 ('98) returned 105 (mean age 26.8), Class of 1999 ('99) 115 (mean age=25.1) and Class of 2000 ('00) 100 (mean age of 23.7) Each class had a ratio of approximately 60 males to 40 females. The number responding to at least one item was 65 for '98, 76 for '99 and 45 for '00. There was no difference in sex response. Generalized chi square showed a significant difference in the responses of the three classes. Separate Teates corrected 2x2 chi squared tests showed that the number responding in '98 was no different from '99 while the number responding in both '98 and '99 were significantly larger than in '00. Because of this the results of '00 could not be pooled with those of '98 and '99. Of 220 students, 43% reported clenching and grinding, 30% reported noises in the joint, 21% sore muscles of mastication, 13% frequent headaches, 11% difficulty and/or pain chewing or talking. 10% jaw "locking or going out" and 7% difficulty and/or pain on opening. Students who answered at least one of the 12 questions were requested to rate pain/discomfort on 11, 10-point Visual Analogue Scales (VAS) each locating a pain site. Of the 220 students, 24% responded to TMJ by clicking (mean VAS=4.3), 18.9% to neck pain (mean VAS=4.2), 16.9% to headaches (mean VAS=4.7), 13.8% to TMJ pain (mean VAS=4.2), 16.9% to headaches (mean VAS=4.7), 13.8% to TMJ pain (mean VAS=3.7), 13.3% to pain in teeth (mean VAS=3.2), 8.9% to face pain (mean VAS=3.6). The prevalence of symptoms is somewhat higher than reported in Swedish dental students and young men of comparable age. The observations in this, the first of a series of students to track symptoms over each year of dental school, suggest that dental schools screen students for TM Dysfunction.

SCL-90 Scores of TMD Patients 6 and 12 Months Following Initiation of Treatment

2010-04-06T12:13:00.000-07:00

This study was designed to assess the change in psychological variables following bite plate therapy in the treatment of Temporomandibular Dysfunction. The SCL-90 (Derogatis) is a self-report test which assesses 9 psychological dimensions. Thirty-one patients of the Gelb Craniomandibular/Orofacial Pain Center were selected at random from 150 patients treated in a six month period. The SCL-90 along with a 10-point Visual Analogue scale to measure pain were administered before treatment and at the end of treatment (6 months after treatment began). Then 6 months later, the inventories were mailed to the patients. Eighteen responded to the 6-month follow up. Their responses were analyzed with Wilcoxon Signed Rank Tests (WSRT). General pain decreased significantly from initial levels over the first 6 months ( and 6 months later the decrease was maintained. The pain levels of the two periods were no different. Two psychological dimensions showed significant reductions over teh assessment periods. Although depression did not show a significant reduction six months after treatment began. It did decrease a significant degree from pre-treatment level by the one year period. Likewise, hostility did not decrease significantly by 6 months after start of treatment, but did reduce to a significant level by one year following initiation of treatment. None of the other psychological dimensions showed significant changes for the periods assessed. The results indicate that a significant reduction in pain results from bite plate therapy after 6 months of treatment and this reduction from pre-treatment level persists six months after termination of treatment. The appearance of significant reductions in depression and hostility 6 months after termination argues for follow-up testing because impact on psychological dimensions may not become manifest until some time after treatment is terminated.

The Effect of Pain Reduction On The Quality of Life (SF-36) In Orofacial Pain Patients

2010-04-01T12:39:00.000-07:00

The aim of this study was to determine the effect of pain reduction on the quality of life in pain patients. The Visual Analogue Scale (VAS) was used to measure specific pain items (earache, TMJ pain, Headaches, neck, upper and lower back pain), whereas the Short Form 36 (SF-36)was used to measure the quality of life through its 8 items: Physical Functioning(PF), Role Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (PF), Role Emotional (RE) and Mental Health(MH). Fourty-four TMD and Orofacial pain patients (F=36, M=8, AGE= 35+/-13) with no history of physical disability of psychological problems were selected. Thirty control subjects (F=14,M=16, AGE=35+/-10) were selected randomly from the faculty and staff at the university. Patients and controls were requested to complete the VAS and the SF-36 forms at the initiation of the study and 3 months later. All patients had conservative treatment using intraoral appliance therapy with/out physical therapy modalities for the period of the study. The Wilcokon signed rank test was used to compare between pre and post treatment pain and SF-36 for patients and controls. There was a significant reduction in all pain items for patients, whereas there were no statistically significant changes for controls. SF-36 results showed a significant increase in all items fro patients with the exception of GH and RE. There were no significant changes in any of the SF-36 items for controls except an increase in social functioning. The Spearman's rhe was used to determine pre and post-treatment correlations between pain and SF-36 items. There were significant pre-treatment as well as post-treatment correlations for 1) TMJ pain and PF, RP, 2) face pain and VT, MH, 3) u/back and all SF-36 items except RE, 4) l/back and PF, VT. These results indicate that the reduction of pain in TMD and orofacial pain patients is associated with an improvement in patient's well-being, quality of life and perception of health as measured by the SF-36.

Effect of Graded Increase in Vertical Dimension on teh Cervical Flexor Strength

2010-03-31T12:08:00.000-07:00

The effect of vertical dimension (VD) on maximizing isometric deltoid strength (IDS) has been researched in subjects with deep overbite. However, vertical dimension has been determined in these studies functionally using the Isometric Deltoid Press. In this study vertical dimension of occlusion was increased, 2, 4 and 6 mm using lower acrylic mouthplates. Twenty normal females, mean age 31 years, sat erect in a dental chair and were instructed to bite and either resist to their maximum ability a horizontal force applied to the forehead or a vertical downward force to the wrist of the first one then the other extended arm. This procedure was repeated in normal occlusion and while biting on mouthplates which raised the VD 2, 4 and 6mm. The order of testing was counterbalanced, with one investigator inserting the appliance while another performed the muscle testing. Horizontal and downward pressures were applied by a hand-held stain gauge. Peake resistance was measured twice in each condition and averaged to produce a peak isometric strength (PIS). Mean strongest PIS for each site tested was compared to each subject's PIS while biting in habitual occlusion. PIS of cervical flexors with the elevated bite was significantly greater than that for habitual conclusion. PIS for right and left deltoids did not differ but mean deltoid PIS in the elevated condition was significantly greater than biting in habitual occlusion. In the peak condition, cervical flexors increased 24% and deltoids increased 30%. Strength was measures for habitual occlusion after all trialas were administered and were not found to differ from pre-experimental levels indicating that fatigue was not an important factor. In an earlier study, Hart et al was unable to show significant differences when the vertical dimension was raised gradually. However, his dependent variable was isokinetic strength. In earlier publications we have suggested that the strength phenomenon is more salient in isometric strength than isokinetic. Isometric strength of the cervical flexors and deltoids increase significantly when vertical dimension of occlusion is increased in deep overbite subjects.

SF-36 Scores of TMD, Chronis Back Pain, Combined Pain Patients and Controls

2010-03-30T11:15:00.000-07:00

The SF-36 is a widely used survey to assess health status from the patient's point of view. This patient based, generic health status assessment survey obtains patient's assessments of their functioning and well-being and perception of their general health. It serves as a disability measurement instrument in 29 countries. The dimensions measured 1) Physical Functioning, PF, 2) Role Physical, RP, 3) Body Pain, BP, 4) General Health, GH, 5) Vitality, VT, 6) Social Functioning, SF, 7)Role Emotional, RE or the effect on usual role due to physical or emotional health, 8) Mental Health, MH. It was of interest to compare the responses of pain patients seeking treatment for TMD, back, and combined TMD and back pain to determine whether their limitations were similar and to compare these scores with those of the asymptomatic controls. The SF-36 scores of four groups of 30 subjects each were analyzed with the Kruskal-Wallis ANOVA by ranks for independent samples. A separate ANOVA was performed for each of the 8 dimensions. Mann-Whitney U tests were used to compare scores within each dimension. With the exception of VT, control scores were significantly higher, (greater function, least limitation) than those of the other three groups and chronic back pain scores were significantly smaller than all other groups. TMD and combined TMD/back pain scores were both significantly smaller than the scores of controls and significantly greater than those of chronic back pain patients. The difference in the presence of the back pain factor is probably due to the chronicity of the back pain patients who were specifically diagnosed opposed the the TMD being the presenting symptom in the combined pain group. TMD patients tend to suffer impairment in functioning that is intermediate between asymptomatic patients and chronic back pain patients. The impact of TMD on dimensions of functioning is clearly revealed I the scores of the SF-36 suggesting is as an important diagnostic instrument for disability in the treatment of TMD and the assessment of treatment outcome.

Vertical Dimension and Electromyography of Masseters in Complete Denture Patients

2010-03-18T13:22:00.000-07:00

The vertical dimension of occlusion (VDO) which achieves the highest isometric strength of sternocleidomastoid muscles (SCMs) has been determined in complete denture patients. The purpose of the present day study was to investigate the effect of this VDO on electromyographic (EMG) activity of the masseters in complete denture patients using the Davicon M44 Dual EMG. Seventeen complete denture patients with complete upper and lower dentures for at least one year, no history of physical trauma to the head and neck, no untreated chronic illness and no cervical symptoms require treatment in the past 5 years were selected for this study. Patients were seated in an upright position and instructed to resist a horizontally transmitted force applied until resistance failed. The load was recorded under five conditions: rest position, biting on existing denture, bting on wooden blocks (2, 6 &10 mm) increasing the VDO 2mm) increasing the VDO 2 mm, 6mm and 10 mm respectively. On the second visit, bilateral electrodes were applied to the masseter muscles with 2 active electrodes in parallel with the muscle fibers. The subjects were instructed to bite as hard as possible on the existing denture and peak EMG activity was recorded in microvolts. An acyrlic resin layer was then fitted over the lower denture of each subject to add height on the existing denture. This height was determined from the maximum isometric strenth of the SCM muscle. The data was analyzed using the student's t-test. The results showed a statistically significant difference in the mean EMG activity or the right masseter muscle between the maximum clench on existing denture and maximum possible clench on the increased VDO which achieved peak isometric of the SCM muscle. The mean EMG activity of the left masseter maximum clench on an increased which achieved peak isometric strength of the masseter muscle. In conclusion, the vertical dimension of the occlusion which achieved maximum isometirc strength of the SCM muscles has a significant effect on the electromyo-graphic activity of the masseter muscles in complete denture patients.

Coping Strategies, SF-36, SCL-90 in Mild and Severe TMD Pain

2010-03-17T12:48:00.000-07:00

Coping strategies are self generated cognitive maneuvers used by chronic pain patients to deal with their stress. In this study, the pain level, duration and coping strategies of 49 female TMD patients as measured by the Coping Strategies Questionnaire-Revised (CSQ-R) were compared with psychological status (SCL-90 scores) and degree of disability (SF-36 Health Status.) High intensity reported pain was found to be associated with more frequent use of Catastrophizing Coping Self Statements, Distraction and Praying than low intensity pain. While individual dimensions of the SCL-90 (Anxiety, Depression, Somatization, and General Stress Index) showed no statistical difference, all dimensions were higher in the high pain patients. High pain were more disabled than low pain patients (Mann-Whitney U analysis of SF-36, z -3.26, p=0.001). When long term pain (2-50 yrs) was compared with short term pain responses (1 month-1.5 yrs), long term patients used Distancing and Ignoring more than short term patients. Degree of disability was the same between long and short-term pain. When patients used three coping strategies (Catastrophizing, Distraction, and Praying), significantly higher levels of anxiety, depression, somatization and general stress were reported. Patients who used Distancing more often reported higher levels of anxiety and general stress. Patients using a wide variety of coping strategies (flexibilty) reported higher levels of pain, more psychological distress and greater disability. Using a diversity of coping strategies was not related to long duration of pain. The use of the combination of three strategies, Catastrophizing, Distraction, and Praying are associated with elevated psychological scores and greater disability. Intensity, not duration of pain appears to determine which coping strategies are used by patients. Some of these strategies may be maladaptive.

Active Resistance Exercise for TMD Related Tension Pain

2010-03-16T12:07:00.000-07:00

Rocobado and Kraus have proposed exercises to relieve muscle tension pain related to TMD and craniocervical dysfunction. The Profile Toner (Tasmark, Inc. N. Easton, MA) is an effective resisted motion device originally designed for toning muscles of the neck to eliminated double chin. It is a polyurethane foam ball 5 inches in diameter. The purpose of this experiment was to examine the effect of active resisted motion exercise of the cervical flexors on pain reported in 10 body sites and neck mobility. Thirty female TMD patients (mean age 35.6 yr., range 24-48) were selected in order of appearance for treatment at a TMD center. They were assigned at random to either Experimental (E) or Control (C) groups of 15 each. For 8 weeks E subjects performed flexing exercises, bending the neck so as to compress the ball between the chin and chest (as a nut cracker) and a second set opening the mandible pushed into the ball. C subjects performed the same number of exercises compressing the ball at the elbow joint. Pain levels were recorded on 10, 10 point visual analogue scales pre and post experimentally. Rotation, bending and flexion were recorded on a protractor. The pain points of both groups pre-experimentally did not differ but the mean reduction of the E group (14.3,43.7%) was significantly greater than that of the C group (2.6, 10%), t=3.9. TMJ pain reduction tended toward significance for the E group (p=0.058) as did headache (p=0.07) and face pain (p=0.08). Neck pain reduced significantly for the E group. A significant increase in right and left bending of the neck (7.0 degrees vs 0.28 degrees and 7.5 degrees vs 0.9 degrees) as well as flexion (3.7 degrees vs -2.6 degrees 0 occurred in the E group. Neck exercises may be an effective adjunct to the MPD treatment, reducing pain and increasing mobility of the neck.

Relationship Between TMDs Pain, Somatization, Depression and SF-36 Scores.

2010-03-15T09:39:00.000-07:00

519 subjects were selected at random from a pool of 5,000 patients attending a multidisciplinary facial pain center. Pain was measured by a pain scored questionnaire composed of 20 Visual Analogue Scales (VAS). Ten pain sites were monitored, each by a VAS for the right and left sides. Possible scores were 0-10 for each VAS and 0-20 for each site with left and right scores combined. A global pain score for each site was obtained by adding scores of all ten sites yielding a maximum possible score of 200. The purpose of the study was to determine the relationship between reported pain and three dimensions of the SCL-90 (somatization, anxiety, and depression) and the globak score of the SF-36. Although pain was significantly correlated with Somatization (r=0.52), Anxiety (r=0.31) and Depression (r=0.36), the coefficient of determination was relatively weak for each (r=27), 0.10, and 0.11 respectively). Pain was not correlated the SF-36 global score (r=0.015). On the other hand, Somatization scores were significantly correlated to Anxiety (r=0.66, r=0.44), Depression (r=0.71, r=50) and Anxiety significantly correlated with Depression (r=0.82, r=0.67) with strong coefficients of determination. In order to ascertain whether high pain patients responded differently than low pain patients, patients were divided into two groups: total pain scores of less than 50 were placed in the Moderate pain group (mean 28.5) and total pain scores of => 50 were placed in the Severe pain group (mean 83.9). In all three measures of the SCL-90, the Severe pain patients scored significantly higher than the Moderate pain patients (p< 0.0001) but in all eight dimensions of the SF-36 there was no difference between Severe and Moderate pain responses. The scores of the three dimensions of the SCL-90, Somatization, Anxiety, and Depression, suggested by Dworkin et al. are sensitive to differences in pain intensity while none of the dimensions of the SF-36 are. In addition, scores of the 3 SCL-90 scales are strongly intercorrelated.

The Effectiveness of Multi-faceted Treatment of TMDs

2010-03-12T08:58:00.000-08:00

In this retrospective study, 519 subjects were selected at random from a pool of 5000 patients who had completed treatment of attended at least three treatment sessions before terminating treatment. Treatment consisted of intraoral appliances: a soft upper for sleep and a mandibular repositioning device for daytime and a self administered home program for muscle relaxation. When indicated physical therapy was prescribed. Prior to treatment, on the next to last treatment and on the last treatment day, patients filled out a pain score sheet composed of 20 Visual Analogue Scales(VAS). Ten pain sites were monitored, each by a VAS for the right and left sides. Possible scores were 0-1-for each site and 0-2- for each site when left and right scores combined. A global pain score for each site was obtained by adding scores of all ten sites yielding a maximum possible score of 200. Pre-treatment mean pain was 54.6, next to last visit was 29.9 and last visit mean was 24.9. Each mean was significantly from the pretreatment baseline. Only subjects reporting pain in a site were studied. Each of the ten sites showed a significant reduction from a range of means 7.2-10 to 2.5-4.6. The post-treatment means of the five major diagnostic sites for TMDs (TMJ Pain, Clicking, Headache, Face Pain, and Neck Pain) were compared to scores of 220 dental students as a control. The pain levels of the two groups were almost identical (means ranging from 3.8 to 4.2) Overall, 92% of patients showed improvement and 8% were worse. An interesting finding of this research is that Neck, Upper Back, and Lower Back pain decreased significantly with a treatment of the oral condition. This lends support to the view that TMD treatment may affect areas outside the stomatognathic system. It was concluded that multidimensional treatment of TMDs is effective, reducing pain in 10 sites and in five sites to levels of dental student controls.

Effect of Splint Design on Head Posture and Cervical Symptoms

2010-03-11T08:34:00.000-08:00

This study compared the effect of two types of occlusal appliances on head posture, cervical symptoms and cervical range of motion in temporomandibular disorders (TMDs) patients. Twenty-two subjects diagnosed with TMDs (Research Diagnostic Criteria) were randomly assigned to two equal groups: Group-I received a three-dimensionally balanced mandibular occlusal splint, while group-II received a mandibular occlusal splint, which maintained mandibular position. Head posture and cervical range of motion (CRM) were measured using the Cervical Range of Motion Instrument (Performance Attainment Associates, St. Paul, MN). Cervical symptoms were assessed using a 10-point Visual Analogue Scale (VAS). Measurements were recorded pre-insertion, 10 minutes post-insertion and two weeks post-insertion. A T-test showed that there was a significant change in head posture from pre-insertion to 2 weeks post-insertion in group-I (mean=4.7°, t df=10=3.34, p=0.007) while there was no change in group-II (mean=0.41°, t df=10=0.36, p>0.05). ANOVA showed that there was a significant effect for time in cervical symptoms in group-I F df=3=9.95, >0.05, (mean=452.2 to 447.3 p>0.05). An ANOVA of CRM data showed a main effect for group-I, F df=3=5.87, p=0.002 (mean=8.6 to 10.6, t=4.8, p>0.05 (mean=8.7 to 9.1, p>0.05). It was concluded that different splints affect TMDs patients differently. The three dimensionally balanced splint reduced forward head posture and improved cervical symptoms and CRM significantly.

Activation and Expression in the Synovial Membrane After Induced Synovitis

2010-03-08T09:36:00.000-08:00

NF-kB plays a pivotal role in pathogenesis in general arthritis. However, the participation of NF-kB in inflammation of the temporomandibular joint (TMJ) is poorly understood. We examined NF-kB expression in rat TMJs with synovitis induced by condyle hypermobility. By immunohistochemistry, NF-kB immunoreactivity was found mainly in the cytoplasm, not the nucleus, of the synovial lining cells of induced synovitis and control TMJs. Southwestern histochemistry, a new method for detecting transcription factors, showed greater NF-kB expression in the nucleus of the synovial lining in the hypertrophic synovium than in the control synovium. Increased levels of the synovial lining cells with immunoreactivity for inducible nitric oxide synthase (iNOS), which is transcriptionally regulated by NF-kB, were also seen in the inflamed synovium. These findings indicated that excess mechanical stress increases NF-kB activation in the TMJ and suggest that active NF-kB is involved in the progression of the TMJ inflammation.

Radiographic Signs of Bone Destruction in the Arthritic Temporomandibular Joint

2010-03-02T09:11:00.000-08:00

To investigate the progression of radiographic changes of the temporomandibular joint (TMJ) with the reference to plasma levels of interleukin-1B (IL-1B), C-reactive protien (CRP) and disease duration.

Twenty-one patients with chronic inflammatory joint disease and TMJ involvement were included. Individualized tomography of the TMJ was performed twice with an interval of at least 12 months.

Significant progression of the overall grade of radiographic changes occurred during the observation period, whereas erosions showed great interindividual variability. Progression of TMJ bone loss was correlated to raised levels of CRP and, in patients with a diagnosis of rheumatoid arthritis, or with a shorter duration, also to a plasma IL. Progression of an overall grade of radiographic changes in the TMJ occurs in patients with chronic inflammatory joint disease. Raised levels of serum CRP are associated with progression of TMJ bone lpss.

TMJ and Juvenile Arthritis

2010-03-01T06:23:00.000-08:00

This study assessed the temporomandibular joint (TMJ) abnormalities in juvenile idiopathic arthritis (JIA) by longitudinal radiographic examinations from childhood to adulthood. Radiographic TMJ evaluations of 60 JIA patients were obtained at baseline (mean age 8.6 years, mean disease duration 3.2 years) and 1 to 3 times thereafter, with the final examination on verage 27 years after baseline. A radiographic grading system for severity of TMJ abnormality was applied. Cumulative radiographic TMJ abnormalities increased from baseline to final examination (42% to 75%, P<.001), as did bilateral TMJ involvement (60% to 82%, P<.001). Of patients with abnormalities, 53% showed progression, and 16% revealed signs of improvement. TMJ abnormalities were associated with physical limitations at baseline and reduced well-being and more extensive joint involvement at the final examination. The frequency of TMJ abnormalities in JIA was high and increased from childhood to adulthood. Although progression of TMJ abnormalities was the general rule, near normalization also occurred on occasion.

Tinnitus

2010-02-28T06:57:00.000-08:00

Tinnitus is a ringing, swishing or other type of noise that seems to originate in the ear or head.

It is not a single disease, but a symptom of an underlying condition. Nearly 36 million Americans suffer from this disorder. In almost all cases, only the patient can hear the noise.

Tinnitus can arise in any of the following areas: the iner ear, or by abnormalities in the brain. Some tinnitus or head noise is normal. Anything, such as wax or a foreign body in the external ear, that blocks the background sounds will cause us to be more aware of our own head sounds. Fluid, infection, or disease of the middle ear bones or ear drum (tympanic membrane) can also cause tinnitus.

One of the most common causes of tinnitus is damage to the microscopic endings of the hearing nerve in the inner ear. Advancing age, loud noise, and some medications can lead to inner ear problems. Tinnitus can in very rare situations be a symptom of such serious problems as an aneurysm or a brain tumor (acoustic tumor).

Actual Patient Account

2010-02-25T07:23:00.000-08:00

DRG was an almost 80 year old maile with a history of Parkinson's Disease that was officially diagnosed in 2002.

When itially seen by Dr. Adams after church one Sunday, he was walking with a shuffling gait, using two canes, was unable to raise his head and had had headaches almost continuously for almost fifty years despite being seen by medical centers and many physcians.

At that time, Dr. Adams inserted a dry wax splint as a trial device. David was able to walk down the hall unassisted for the first time in several years. His posture was immensely improved.

After inserting and balancing an occlusal relation splint, David's headaches were reduced by 90% and his gait improved. He still had some shuffling, but his head was more erect and he was able to breath better. He continued to have dull aches and minimal tenderness to his jaw muscles.

David had an improved quality of life for several years and finally sucumbed to the Parkinson's Disease in October of 2009.

We both thank you for and appreciate your compassionate and generous care that enabled David to be more comfortable during several of his last years.

Estrogen and Inflammation of the Temporomandibular Joint

2010-02-08T10:55:00.000-08:00

Estrogen is known to play a role in temporomandibular joint (TMJ) disorders and estrogen effects can be mediated by ERalpha present in the TMJ. Cells expressing the estrogen receptor ERalpha are present in the temporomandibular joint (TMJ) but changes in expression due to estrogen and inflammation have not been characterized.

Sixteen female rats were divided into two groups such that one group received 17 beta estradiol (E2) and the other was given vehicle (VEH). Groups were then subdivided further, one received injections of saline and the other received Complete Freund's adjuvant (CFA) within the superior joint space of the TMJ.

The four groups include no E2/saline, E2/saline, no E2/CFA, and E2/CFA. After treatment, the rats were sacrificed, and the TMJ anterior, disc, retrodiscal and synovial tissues were analyzed by western blot and immunocytochemistry.

Positive stained cells were counted using a Nikon epifluorescent microscope.

Results: The western blot showed that ERalpha protein significantly decreased with inflammation. The number of ERalpha-positive cells in the TMJ was not affected by inflammationor 17 beta-estradiol with exception of the retrodiscal tissue.

In the retrodiscal tissue, 17 beta-estradiol significantly decreased the number of ERalpha-positive cells but only in a noninflamed joint.

In conclusion, inflammation and 17 beta-estradiol can modulate ERalpha expression in the TMJ but the effects are tissue specific.

2010-02-08T06:24:00.000-08:00

DF, actual patient account:
"I've seen a lot of commercials about athlete's getting appliances to increase their balance, strength, and stability. I don't believe they have the same appliance that I wear. I never thought that the cause of all of my headaches, neck and facial pain would have any connection to a joint in my jaw. Dr. Adams called it the "TMJ", I never even knew I had a "TMJ"!

After talking with Dr. Adams and going through a few tests, I was fitted for my new "appliance". It's amazing how quickly my symptoms subsided, even my posture has improved. I highly recommend checking into this for anyone with any type of pain or problems with balance."

2010-02-02T09:35:00.000-08:00

A discussion of the abstract to determine the frequency and degree of orofacial myofunctional disorder (OMD) in a sample of patients with temporomandibular disorder (TMD), the dental records of 240 patients with a diagnosis of TMD were reviewed. Mean patient age and mean TMD duration, gender frequency, complaints, and signs and symptoms were calculated. The results show that the sample studied was quite characteristic of a TMD group. The presence of the following signs and symptoms was significant: muscular pain, TMJ pain, joint noise, at least one otologic symptom headache, and neck and shoulder pain. Most subjects presented some degree of OMD, with grade high prevailing over grade low. The importance of evaluating these stomatognathic strutures and functions during the clinical examination of patients with TMD is emphasized.

Equilibrium and the dental connection

2010-01-29T13:37:00.000-08:00

Balance is defined as a state of equilibrium or parity characterized by the cancellation of all forces by equal opposing factors. This is the act of maintaining an upright posture (static balance) or in locomotion (dynamic balance or gait). This system depends on vestibular function, vision, and proprioception to maintain posture, to navigate one's surroundings, to coordinate motion of body parts, to modulate fine motor control, and to initiate the vestibuloculomotor reflexes. These parts of the vestibular system provide our brains with information about changes in the head movement with respect to the pull of gravity. Besides the visual, vestibular and skeletal systems, which contribute to balance disorders, the dental (stomatognathic) system may also contribute to balance disorders. It is when all four of these systems are in coordination with one another, that a person will maintain equilibrium and balance, proper gait and posture.

2010-01-27T11:39:00.000-08:00

A recent abstract discussed the limited studies have demonstrated that low intensity laser therapy (LILT) may have a therapeutic effect on the treatment of myofascial pain syndrome (MPS). Sixty (60) patients with MPS and having one active trigger point in the anterior masseter and anterior temporal muscles were selected and assigned randomly to six groups (n=10): Groups 1 to 3 were treated with GaAIAS (780 nm) laser, applied in continuous mode and in a meticulous way, twice a week, for four weeks. Energy was set to 25 J/cm2, 60 J/cm2, and 105 J/cm2, respectively. Pain scores were assessed just before, then immdeiately after the fourth application, immediately after the eighth application, at 15 days and at one month following treatment. A significant pain reduction was observed over time (p<0.001). The analgesic effect of the LILT was similar to the placebo groups. Using the parameters described in this experiment, LILT was effective in reducing pain experienced by patients with myofascial pain syndrome. Thus, it was not possible to establish a treatment protocol. Analyzing the analgesic effect of the LILT suggests it is a possible treatment of MPS and may help to establish a clinical protocol for this therapeutic modality.

2010-01-25T09:39:00.000-08:00

A recent investigation of the relative importance of systemic and local inflammatory mediator (serotonin; 5-HT; tumore necrosis factor, soluble interleukin-1 receptor II: IL-1sRII) in the modulation of the temporomandibular joint (TMJ) pressure pain in the threshold in patients with seropositive or seronegative rheumatoid arthritis (RA) and to investigate to what extent TMJ pressure pain threshold is related to other TMJ pain parameters. Statistical analyses indicated that TMJ pressure pain threshold was only correlated to systemic factors. TMJ movement pain was in turn mainly correlated to systemic mediators in the seropositive patients but to local mediators in the seronegative patients where synovial fluid IL-1sRIIwas positively correlated to TMJ pain on mouth opening. Seropositive patients had a higher systemic inflammatory activity but lower TMJ movement pain intensities than seronegative patients. The results indicate that TMJ pressure pain threshold is modulated by systemic rathar than local inflammatory mediators and suggest that it is unrelated or only weakly related to other TMJ pain entities RA patients. A rheumatoid factor-dependent systemic modulation, in combination with local factors, seems to account for TMJ pain in RA patients.

2010-01-21T14:22:00.000-08:00

A recent discussion to determine the short-term effectiveness of a stabilization appliance with a prefabricated occlusal appliance in myofascial pain patients in a randomized controlled trial. The main treatment outcome in the groups tested was a positive improvement in overall symptoms without any statistically significant differences between the groups at either 6 to 10 weeks. At the 6 week follow-up, 72% of all the patients reported a 50% reduction of the worst pain, whereas at the 10 week follow-up, the percentages were 69% and 61%, respectively. According to the verbal scale, 85% of all patients reported themselves to be "better", "much better", or "symptom-free"at the 6 week follow-up, and 83% reported this at the 10 week follow-up. The effectiveness of the prefabricated occlusal appliance seemed to be the same as that of the stabilization appliance. The prefabricated appliance can therefore be recommended as a short-term therapy in adult patients with myofascial pain.

Eating Disorders and Headaches

2010-01-18T05:25:00.000-08:00

A recent discussion in regards to the comparison of the prevalence of psychologic, dental, and temporomandibular disorder signs and symptoms between young women suffering from chronic eating disorders and a control group of age-matched, healthy women, and to evaluate the impact of frequent vomiting on these signs and symptoms among the eating disorder group. Women with eating disorder showed a significantly higher sensitivity to muscle palpation and higher levels of depression, somatization, and anxiety, as well as a higher prevalence of intensive gum chewing, dental erosions and attrition, than the healthy controls. Vomitting patients showed higher muscle sensitivity to palpation than nonvomitting patients and greater emotional and psychologic distress. Women with chronic eating disorders suffer from higher muscular sensitivity to palpation, greater emotional distress, and more hard tissue destruction (dental erosions, dental sensitivity) than healthy women.

2010-01-15T13:44:00.000-08:00

A recent discussion in regards to the testing for an association between rhythmic masticatory muscle activity during sleep, as assessed according to polysomnographic criteria for sleep bruxism, and myofascial pain, as well as the chance of occurrence of myofascial pain in patients with sleep bruxism. Most myofascial pain patients reporter mild or moderate pain (46.67% and 43.33%, respectively), and only 3 (10%) reported severe pain. Pain duration ranged from 2 to 120 months (mean 34.67+/- 36.96 months). Significant associations between daytime clenching and myofascial pain. Sleep bruxism is significantly associated with myofascial pain; although sleep bruxism represents a risk factor for myofascial pain, this risk is low; and daytime clenching probably contstitutes a stronger risk factor for myofascial pain than sleep bruxism.

2010-01-12T15:15:00.000-08:00

A recent abstract discussing The Jolt Syndrome, The Muscle Dysfunction Following Low-Velocity Impact. Pain Manag, Nov/Dec 1990.

Despite involving forces insufficient to cause tissue injury, many low velocity collisions and occupational accidents result in pain and sometimes disability. This article proposes that the underlying mechanism in this dysfunctional state is an unusual sustained positive feedback loop, flowing from the proprioceptor in the muscle spindle and joint capsules to this neuologic circuit, an increase in muscle tension and an imbalance in the motor position of the jolted muscles.

This study used a three pronged approach. The office archives were carefully evaluated for appropriate cases. A review of the literature was conducted. Consultation with a varied group of basic and chemical scientists and back care providers was also included. The premise of this study was that there can be pain without specific injury. Myofascial structures can be made painful without injury when stretched into the supra-physiologic stretch reaction or suddenly reflexly contracted.

Muscle spindles are encapsulated muscle fibers connected to or ensheathed in windings of sensory fibers and innervated by small efferents. There are twelve of these in each muscle. The tension of the intrafusal muscle fibers is set by the gamma efferent and it is this tension that determines the sensitivity of the local extrafusal muscle fibers to stretch. Experiments with cats have indicated that gamma efferents may be highly responsive to very small disturbances as rapid stretching of partially contracted muscles occurs. Work with muscles of cats demonstrates a powerful synaptic activity among interneurons associated with ascending tracts, as well as spinal reflex pathways. This indicates that a flurry of afferent discharge from the spindles may reflexly generate exaggerated sensitivity to stretching. Evidently, the more structurally compromised a tissue, the less force necessary to cause systematic disruption.

Despite involving forces insufficient to cause tissue injury, many low velocity collisions and occupational accidents result in pain and sometimes disability. The mechanism proposed is a positive feedback loop, flowing from the proprietory in muscle spindles and joint capsules. The effects of this neurologic circuit are an increase in muscle tension and an imbalance in the motor patterns of the jolted muscles. Treatment should focus on reestablishing dynamically efficient motor patterns via properly selected exercises and posture training.

Auto Accidents and Whiplash Injury

2010-01-05T10:38:00.000-08:00

A recent abstract discussing The Whiplash and TMJ Dysfunction. The Spine Research Institute of San Diego.

TM injuries occur during motor vehicle accidents. This abstracts several articles to describe the forces involved to the TM joint during rear-end motor vehicle accidents. It also challenges the article by Howard et. al, that used a poorly designed model-without considering other works contrary to their methodology-which oversimplified the working of the cervical spine.

There is good supporting evidence that the TMJ receives injury during the initial acceleration phase during whiplash injuries. Stretching and tearing of the posterior attachments, as well as the discal attachments of the medial and lateral parts of the condyle, may occur. In the second phase (the deceleration phase), the head and neck are snapped forward into flexion. The exact sequela of events in this phase are yet undetermined. Enough evidence is presently available to refute Howard's criticism of TM whiplash injuries. Enough evidence also exists to substantiate that major injuries occur to the TM joint apparatus during whiplash related injuries.

The TM joint and related structure can receive sumstantial injuries during cervical whiplash related accidents.

If you suspect you may or may have had a whiplash injury due to an auto accident or experience headaches as a result of an auto accident, please see your Neuromuscular/TMD Dentist.

Case Report-Temporomandibular Disorder associated with Trauma

2009-12-28T05:13:00.000-08:00

BCH, a 22 year old caucasian female involved in an automobile accident in 1995, which resulted in several broken bones and facial trauma. She has had 3 operations related to the trauma. She has had constant head and neck pain since being released from the first hospital admission. Headaches and pain were not releived by medication.

After a thorough examination, including x-ray, evaluation, JVA, EMG, jaw tracker and extensive medical history, it was determined that BCH had a Temporomandibular Dysfunction due to trauma. Treatment plan suggested and implemented was upper and lower Splint Therapy and Physical Therapy for the muscles to stabilize the joint.

After insertion and balancing of the occlusal splint, BCH began to cry- "the first time in 5 years 1 month and 3 1/2 weeks that I do not have a headache."

Contact me via email, if you have any questions. Or you can visit our website.

Charitable donations

2009-12-26T07:49:00.000-08:00

Dr. Adams supports local and regional charities.

During the year of 2009, he has supported local high school sports, bands for trips to various competitions and parades, local swim teams, as well as MDA, Children's Hospital, St. Jude and many others too numerous to mention.

Will you help him get out jail for the MDA? To help him get out please make donations here for the MDA.

Christmas Greetings

2009-12-22T09:53:00.000-08:00

Sing of the holidays that end the year!
Each cause for celebration and reflection.
As darkness rules the earth, sing of good cheer,
Sustained by will and nourished by affection.
Of Christmas, and New Year's Eve,
Now sing that you might magnify the light!
Sing, for in your joy you will believe,
Granted grace throughout the bitter night.
Rekindle for these reckonings the fire
Each carries as a favor to the heart,
Eloquent of rapture and desire,
Twin grounds of both sincerity and art.
In quest of fellowship and common feeling,
Needing company, nor care concealing,
Giving and receiving equal measure,
Sing, then, of passion, faith, and simple pleasure!

MERRY CHRISTMAS TO ALL!!!!

2009-12-17T09:34:00.000-08:00

DIAGNOSTIC EQUIPMENT

"Doctor, my jaws are making noise and popping. What is happening in my jaw joint?"

When tissues rub together, the movement causes vibrations. When using a stethoscope, you can hear approximately 50% of the vibration. But with the computer program we use called JVA (joint vibration analysis) we can hear 100% of the vibration and can classify the vibration into hard or soft vibration.

This diagnostic equipment is used in many Dental Schools in the United States as well as around the World.

2009-12-15T13:20:00.000-08:00

Cardiovascular and Sleep-Related Consequences of Temporomandibular Disorders

Individuals who have a temporomandibular disorder have more than pain associated with their head and dysfunction of their jaws. They can have cardiovascular and sleep related consequences of their temporomandibular disorder.

Contact me via email, if you have any questions. Or you can visit our website.

Headaches

2009-12-09T10:19:00.000-08:00

This blog is about headaches. Dr. Adams can treat yours.

Welcome!

2009-11-13T09:41:00.000-08:00

Welcome to the Alabama Headache blog for Dr. Adams. Please check back for additional posts.