Lifespan of Splints in a Sample of German Soldiers Hospitalised with Post-traumatic Stress Disorder (PTSD) in Combination with Sleep Bruxism and Painful Temporomandibular Disorder (TMD).

PURPOSE: This cross-sectional longitudinal observational study aimed to clarify the question of whether painful temporomandibular disorders (TMD) in psychiatrically confirmed patients hospitalised for post-traumatic stress disorder (PTSD) therapy after using splint therapy (ST) show long-term therapeutic effects in the case of functional disorders. MATERIALS AND METHODS: One hundred fifty-three (153) inpatients (123 male and 20 female soldiers, age 35.8 ± 9.2 years, 26.6 ± 2.2 teeth) with confirmed PTSD (Impact of Event Scale - Revised ≥33), grade 3 to 4 chronic pain according to von Korff's Chronic Pain Scale and the research diagnostic criteria of painful TMD (RDC-TMD) were recorded. All participants received a maxillary occlusal splint that was worn at night. Control check-ups of the therapeutic effect of the splint were conducted for up to 9 years during psychiatric follow-ups. RESULTS: TMD pain worsened in 22 (14.4%) patients within the first 6 weeks and led to the removal of the splint. The pain intensity (PI) at BL was reported to be a mean of VAS 7.7 ± 1.1. Six weeks after ST (n = 131), the average PI was recorded as VAS 2.6 ± 1.3. Based on the last examination date of all subjects, the average PI was recorded as 0.7 ± 0.9. Seventy-two (72) patients used a second stabilisation splint in the maxilla after 14.4 ± 15.7 months, and 38 patients used between 3 and 8 splints during their psychiatric and dental treatment time (33.7 ± 29.8 months). CONCLUSION: The presented data shows that therapeutic pain reduction remained valid in the long term despite continued PTSD. The lifespan of a splint seems to be dependent on individual factors. Long-term splint therapy appears to be accepted by the majority of patients with PTSD and painful TMD.

Periodontal Disease and Tooth Wear in a Sample of German Soldiers with Posttraumatic Stress Disorder.

PURPOSE: Dental symptoms of post-traumatic stress disorder (PTSD) patients include a majority of painful temporomandibular joint and masticatory muscle findings, restricted mouth opening, and pronounced attritions. Traumatic occlusal force resulting in injury of the teeth and/or the periodontal attachment apparatus may exceed the adaptive capacity of the individual person or site. This observational cross-sectional study in soldiers with PTSD and a non-PTSD control group after military deployments aimed to evaluate a possible relationship between bruxism and periodontal diagnosis. MATERIALS AND METHODS: Ninety-six in-patients and 27 out-patients (21 women, 102 men) with specialist-confirmed PTSD and bruxism after up to 17 foreign assignments, and 36 male non-PTSD controls with up to 15 foreign assignments underwent general dental, functional, and periodontal examinations. RESULTS: All three groups showed no statistically significant differences in terms of age (34.8 ± 8.6 years), number of teeth (n: 26.3 ± 3.4), status of dentition (DMFT 9.7 ± 6.6), incidence of periodontitis (36%) and recessions (n: 5.8 ± 5.7). From the control group to the out-patient group to the in-patient group, the proportion of smokers and tobacco use increased statistically significantly, as did the extent of attrition. In the in-patient group, with statistically significantly lower educational levels, the number of perceived prophylaxis sessions was statistically significantly reduced in the last two years. CONCLUSIONS: Taking into account the retrospective recording of the last traumatic event, the average time of five years until therapy does not seem to have any consequences for the frequency and severity of inflammatory periodontal disease, recession, and wedge-shaped defects in soldiers with bruxism in PTSD, regardless of the need for in-patient or out-patient treatment.

[Dental disorders with a psychosocial background]. / Zahnmedizinische Beschwerdebilder mit psychosozialem Hintergrund.

While the mouth and teeth play a lifelong central role in a person's development and wellbeing, psychosocial aspects of disease and health are still only reluctantly included in dental explanatory models. Only dental anxiety with its disease quality of a specific phobia is generally recognized as a mental disorder requiring intervention. It is interpreted as an emotional reaction to aspects of dental treatment, which results in distress for the affected person and appears to be unreasonably intense given the actual dangers involved. Apart from that, the tendency to provide a somatic explanation for symptoms in the dental context persists. This bears implications for the expectations of those affected as well as for interdisciplinary cooperation. In order to improve interdisciplinary support and mutual understanding, the following article introduces the clinical pictures of craniomandibular dysfunction, bruxism, occlusal dysaesthesia, and somatoform prosthesis intolerance alongside dental anxiety. Psychosocial factors can profoundly influence the development, course, and management of these conditions.

Dental Anxiety and Higher Sensory Processing Sensitivity in a Sample of German Soldiers with Inflammatory Periodontal Disease.

(1) Background: Dental anxiety with disease value usually leads to avoidance of dental treatment. For the initial diagnosis of the level of anxiety, questionnaires such as the Hierarchical Anxiety Questionnaire (HAQ) are suitable. The construct of sensory processing sensitivity (SPS) describes a general trait in which people with a higher degree of SPS perceive information more strongly and process it more thoroughly. (2) Methods: This cross-sectional study evaluated the relationship between dental anxiety and higher levels of SPS in 116 soldiers referred with different stages of periodontitis for mandatory dental fitness before military deployment. (3) Results: The proportion of patients with periodontitis in stage III + IV was 39% and in stage I + II was 27%. The mean cumulative values of the questionnaires were 20.9 ± 10.6 for HAQ and 27.7 ± 16.0 for SPS. Eleven moderately anxious patients had a SPS value of 37.4 ± 13.5 and 10 highly anxious patients had a value of 36.3 ± 14.1. Patients diagnosed with stage III + IV periodontitis showed significantly higher values on the SPS subscale Low Sensory Threshold (LST), which describes overstimulation by external sensory stimuli, compared to patients with stage I + II periodontitis. Dental anxiety showed moderately significant correlations with the SPS subscale Ease of Excitation (EOE), which measures emotional reactivity to physiological stimuli. (4) Conclusions: Due to the frequency of dental anxiety and higher sensitivity in patients with severe periodontitis, it is useful to record said frequency.

Clinical outcome of a nonsurgical and surgical treatment protocol in different types of peri-implantitis: a case series.

OBJECTIVE: The replacement of missing teeth with dental implants has been standard practice in dentistry for many years. The success of dental implants depends on many factors, among which the diagnosis, clinical severity, and treatment of peri-implant diseases play a key role. In this prospective case series, the influence of cumulative treatment modalities on peri-implantitis with and without pus formation on clinical outcome was assessed. METHOD AND MATERIALS: During 2010, 28 patients were referred for peri-implantitis treatment. They presented two different types of peri-implant diseases: peri-implantitis with (17 implants) or without pus formation (33 implants). After microbiologic diagnosis, all patients were treated at baseline with full-mouth scaling and root planing. Two months later, further full-mouth scaling and root planing and additional antimicrobial photodynamic therapy (aPDT) was applied. Four months after baseline, patients with pus formation additionally underwent access flap surgery. Active human matrix metalloproteinase-8 (aMMP-8) levels were measured in eluates before and after all treatment modalities and 7 months after baseline. RESULTS: Clinical parameters (probing depth, bleeding on probing) and aMMP-8-levels improved in both groups after treatment and the final examination. In periimplantitis patients without pus formation, all parameters decreased after full-mouth scaling and root planing and the additional aPDT and no surgery was necessary to improve the parameters. In patients with pus formation, the parameters decreased only after access flap surgery. CONCLUSION: The presence of pus influences the clinical outcome of the treatment of peri-implant diseases. Whereas peri-implantitis cases without pus formation can be successfully managed nonsurgically, peri-implantitis with pus formation can be effectively treated after an additional observation time of 3 months postoperatively only with additional flap surgery.

Masticatory mucosa and periodontal phenotype: a review.

In recent years, the dimensions of different parts of the masticatory mucosa have become the subject of considerable interest in periodontics from both an epidemiologic and a therapeutic point of view. In the present article, the clinical relevance of the thickness of the masticatory mucosa for the development of gingival recessions, surgical root coverage, as well as graft harvesting will be reviewed. The concept of different periodontal phenotypes has recently been substantiated by experimental evidence using a novel, commercially distributed, ultrasonic measuring device. Based on observations made in a series of investigations, it has become clear that individuals with thin and vulnerable gingival tissue prone to the development of recession often also present with thin palatal mucosa that might not be very suitable for obtaining connective tissue of proper thickness for plastic periodontal surgery. Periodontal phenotypes are closely associated with, and are in fact an expression of, the so-called biologic width, which should be considered during subgingival placement of restorations in particular. Thus, a detailed analysis of the thickness of the masticatory mucosa may be necessary in several clinical situations.