J Orofac Pain
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The hypothesis of this short-term study was that repeated episodes of clenching at submaximal bite force levels can induce a progressive increase in pain and tenderness in masticatory muscles. On each day for 5 consecutive days, 10 women clenched on a bite force transducer for 15 minutes at 25% of their maximal bite force. The development of pain, tenderness, and unpleasantness in the masticatory muscles was evaluated with use of 10-cm visual analog scales (VAS) and the McGill Pain Questionnaire (MPQ). ⋯ The following days, the clenching tasks did not increase these scores; in contrast, there were significant decreases on day 5 in both pain intensity (-49.8% +/- 14.6%), tenderness (-46.1% +/- 14.2%), unpleasantness (-50.4% +/- 8.5%), and MPQ scores (-45.8% +/- 13.3%) (P < .05) when compared to day 1. The clenching procedure failed to induce a progressive increase in pain and tenderness in the masticatory muscles during 5 days. None of the evaluated parameters from this study suggested the start of a vicious cycle.
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Comparative Study
Comparing TMD diagnoses and clinical findings at Swedish and US TMD centers using research diagnostic criteria for temporomandibular disorders.
The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guidelines, originally developed in the United States, were translated and used to classify TMD patients on physical diagnosis (Axis I) and pain-related disability and psychologic status (Axis II) in a TMD specialty clinic in Sweden. The objectives of the study were to determine if such a translation process resulted in a clinically useful diagnostic research measure and to report initial findings when the RDC/TMD was used in cross-cultural comparisons. Findings gathered using the Swedish version of the RDC/TMD were compared with findings from a major US TMD specialty clinic that provided much of the clinical data used to formulate the original RDC/TMD. ⋯ Axis II assessment of psychologic status showed that 18% of patients yielded severe depression scores and 28% yielded high nonspecific physical symptom scores. Psychosocial dysfunction was observed in 13% of patients based on graded chronic pain scores. These initial results suggest that the RDC guidelines are valuable in helping to classify TMD patients and allowing multicenter and cross-cultural comparison of clinical findings.
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Randomized Controlled Trial Clinical Trial
Effects of salmon calcitonin on patients with atypical (idiopathic) facial pain: a randomized controlled trial.
The analgesic properties of salmon calcitonin for the treatment of atypical facial pain (AFP) were investigated. An initial open-label trial of salmon calcitonin in subjects with refractory AFP was followed with a randomized, double-blind, placebo-controlled crossover trial of salmon calcitonin in the management of AFP. Salmon calcitonin (100 IU in 1 mL saline) was administered in an open-label fashion to 13 subjects with refractory AFP five times per week for 6 weeks. ⋯ Therefore, it was imperative to halt the study for ethical reasons. There was no difference in outcome measures (P > .05) in subjects administered either active drug or placebo, and a high incidence of side effects led to dropout in subjects taking salmon calcitonin. Although salmon calcitonin may have analgesic properties, it is not efficacious for AFP, largely because of the side effects.
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A literature review concerning the relationships between motor vehicle accidents and temporomandibular disorders, whiplash, headache, neck pain, and litigation was undertaken. The review shows that many patients recover or resume work prior to settlement, but most unsuccessfully treated patients do not generally recover following the settlement of legal claims; the postinjury problems are not strictly psychologic. Litigating patients and nonlitigating patients are often not dramatically different in most important regards (including pain and return to work), with litigating patients deserving the same treatment as other patients with chronic pain. ⋯ Patients with postinjury temporomandibular disorders tend to respond less well to treatment than do noninjury patients with temporomandibular disorders, as do litigating compared to nonlitigating temporomandibular disorders patients, but a cause and effect relationship is not known. The incidence of temporomandibular disorders following motor vehicle accidents may not be as high as has been claimed in whiplash cases. More research is required in the area of temporomandibular disorders, motor vehicle accidents, and litigation.
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The case of a patient with bilateral preauricular pain and tinnitus is reported. Minimal relief was obtained with traditional temporomandibular disorders therapy, and complete relief was obtained after endodontic therapy. Pulpal conditions that can refer pain are discussed, and recommendations are made to help practitioners identify a possible pulpal etiology for symptoms and tests of temporomandibular disorders.