J Orofac Pain
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The purpose of this study was (1) to evaluate the reproducibility of two masticatory muscle and joint tenderness detection methods; (2) to evaluate the reproducibility of maximum mandibular movement measurements; and (3) to investigate factors influencing examiner agreement. The tenderness assessment procedures involved application of a standard pressure for 2 seconds over four anatomically defined masticatory muscle sites, one control forehead site, and two temporomandibular joint sites on each side of the face. One technique utilized a pressure algometer (PAP), while the other technique required that a trained examiner apply pressure with the index fingertip (FPP). ⋯ ICCs for mandibular movement measurement were much less variable, ranging from 0.59 to 0.68 for lateral movement and from 0.78 to 0.93 for opening movement. These results indicate good to excellent agreement between calibrated examiners for mandibular movement measurement and for tenderness assessment methods at two masseter (i.e., superficial and deep) and the anterior temporalis sites. Only fair agreement was found for the middle temporalis and lateral TMJ capsule sites using these methods.
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Comparative Study
Somatic complaints, psychologic distress, and treatment outcome in two groups of TMD patients, one previously subjected to whiplash injury.
The aim of this study was to compare somatic complaints and psychologic distress in a group of whiplash patients with temporomandibular disorders (TMD) and a group of patients with TMD only, and to assess the outcome after conservative TMD treatment consisting of counseling, muscle exercises, and a stabilization splint. Each group consisted of 16 patients (12 women and 4 men) with a mean age of 42 years. ⋯ The whiplash patients had higher scores than the TMD patients on the SCQ muscle score and on the following subscores of SCL-90-R: obsession, somatization, depression, and anger/hostility. The treatment outcome as assessed by the change of self-reported frequency of headache, number of tender muscles upon palpation, and change of values on a visual analogue scale for headache intensity showed that the whiplash patients obtained only a decrease in the proportion of tender muscles, while those in the TMD only group showed improvement on all treatment criteria.
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The purpose of this project was to test the within-day and between-days reproducibility of a new and inexpensive algometer. Twelve symptom-free men and nine women participated. Pressure pain thresholds (PPTs) of the bilateral masseter and temporalis muscles were assessed during four sessions (mornings and afternoons of days 1 and 3). ⋯ When the within-session reproducibility for all muscles was considered, only the PPT values between measurements 2 and 4 were not significantly different. Analysis of variance showed that the interindividual variability of PPT was 1.4 to 6.8 times higher than the variability observed within or between sessions and days. No gender difference was found.
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Recently developed Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) have been shown to be reliable for diagnosing and assessing TMD in U. S. and Swedish adult populations; however, few studies have focused on clinical examination methods and diagnostic criteria for use with children and adolescents. ⋯ Interexaminer and intraexaminer reliability was assessed for clinical examination, questionnaire items, and diagnosis. Reliability values ranged from acceptable to excellent for the RDC/TMD clinical exam and questionnaire, and from good to excellent reliability for measuring virtually all modified clinical parameters of TMD assessed in these young patients.
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The aim of this study was to investigate whether the treatment effect of intramuscular glucocorticoid injection differs between patients with fibromyalgia and those with localized myalgia of the masseter muscle concerning pain, tenderness to digital palpation, pressure pain threshold, pressure pain tolerance level, maximum voluntary occlusal force, or intramuscular temperature. Twenty-five patients with fibromyalgia and 25 patients with localized myalgia of the masseter muscle were first asked to assess their pain on a visual analogue scale; afterward, a routine clinical examination, including tenderness to digital palpation, was performed. For each patient, the pressure pain threshold, pressure pain tolerance level, and maximum voluntary occlusal force, as well as the intramuscular temperature, were recorded. ⋯ In the fibromyalgia group, there was a reduced tenderness to digital palpation in response to the treatment. The localized myalgia group responded with a general improvement of symptoms as well as a significant reduction of pain intensity and tenderness to digital palpation. The results of this study indicate that patients with fibromyalgia and localized myalgia in many respects show a similar response to local glucocorticoid treatment.