Journal of oral rehabilitation
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Temporomandibular disorders (TMD) is a collective term embracing a number of clinical problems, which involve the masticatory musculature, the temporomandibular joint or both. Virtually all theories dealing with the aetiology and treatment of TMD have recognized the importance of psychological factors. This paper reports the development of a computerized on-line program (NUS TMD v1.1) for the diagnosis of pain-related disability and psychological status of TMD patients based on Axis II of the research diagnostic criteria (RDC)/TMD (Dworkin, S. ⋯ Approximately 73% of the sample population were moderately or severely depressed. Patients that were moderately and severely depressed had significantly higher scores for limitation related to mandibular functioning than normal patients. The three most frequent jaw disabilities were: eating hard foods (84%), yawning (78%) and chewing (65%).
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This review, divided into two parts, evaluates the literature on the relationship between dental occlusion and temporomandibular disorders (TMD) and the need for occlusal therapy in the management of TMD. The first part of the review focuses on the aetiological importance of occlusal interferences and the place of occlusal adjustment in the management and prevention of signs and symptoms of TMD. This has long been a controversial issue, which has not yet been resolved. ⋯ Experienced clinicians also repudiate the need for occlusal adjustment in the management of TMD, whereas (less experienced) general dentists adhere to a concept focusing on the occlusion in diagnosis and treatment of TMD. There is a consensus that generalized prophylactic occlusal adjustment is not justified. There is an obvious need for research with evidence-based methods, to be able to answer the many remaining questions in this field.
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The bite force at different levels and the corresponding electromyographic (EMG) activity of the masseter and anterior temporalis muscles were recorded in 12 healthy subjects in order to evaluate the modulation of EMG-force curves by a standardized painful stimulus. Hypertonic saline (5%) was infused into the right masseter muscle for up to 15 min to induce pain. The pain intensity was scored continuously by the subjects on a 10-cm visual analogue scale (VAS). ⋯ The slope of the curve became less steep in the right masseter muscle during and after painful biting in every position. The results suggest that tonic saline-induced jaw-muscle pain is able to modulate the motor unit recruitment pattern of the jaw-closing muscles on the painful side. The main effect of pain in this experiment was an inhibition of static EMG activity.
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Recent evidence suggests that evaluation of muscle tenderness in temporomandibular disorders (TMDs) patients might be improved by the use of pressure algometry; nevertheless, the evaluation of the diagnostic value of this tool has received little attention. The aim of this study was to assess the diagnostic value of pressure algometry in myofascial pain of the jaw muscles, by calculation of sensitivity (Se), specificity (Sp) and positive predictive values (PPV). Pressure pain thresholds (PPTs) of masseter and anterior temporalis muscles were assessed in 40 female myogenous TMD patients and 40 age-matched female controls. ⋯ Setting a cutoff value 1 s.d. below the mean PPT values of control subject, sensitivity and specificity were 0.67 and 0.85, respectively, for the masseter muscle and 0.77 and 0.87, respectively, for the temporalis muscle. When taking into account the prevalences of myofascial pain in the general population and in TMD clinics, the PPV ranged from 0.5 to 0.7. As a result of the low PPV, pressure algometry has strong limitations when used as a solitary diagnostic tool.
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Clinical procedures, such as acid etching and reshaping of the teeth supporting removable partial dentures by grinding off some enamel surface, increase the permeability of dental enamel. Teeth take several months in vivo to partially recover from such damage. In the meantime, the tooth is more susceptible to carious decay. ⋯ The adhesive resin film covering the etched or ground enamel surfaces was found to decrease significantly the diffusion through dental enamel. This finding confirms the clinical value of dental adhesives used to protect ground or accidentally acid-etched enamel surfaces. SEM analysis showed that adhesive resin covers the porous surface of the acid-etched and ground enamel tightly.