The challenge of ecological validity in temporomandibular disorders research.

OBJECTIVE: To review the ecological validity of outcomes from current research involving temporomandibular disorders (TMDs), with an emphasis on chronic myofascial pain and the precocious development of degenerative disease of the temporomandibular joint (TMJ). MATERIALS AND METHODS: Current approaches used to study TMDs in terms of neuromechanics, masticatory muscle behaviours, and the dynamics of the autonomic nervous system (ANS) were assessed for ecological validity in this review. In particular, the available literature was scrutinized regarding the effects of sampling, environmental and psychophysiological constraints and averaging data across biological rhythms. RESULTS: Validated computer-assisted numerical modelling of the neuromechanics used biological objective functions to accurately predict muscle activation patterns for jaw-loading tasks that were individual-specific. With respect to masticatory muscle behaviour, current findings refute the premise that sustained bruxing and clenching at high jaw-loading magnitudes were associated with painful TMDs such as myofascial pain. Concerning the role of the ANS in TMDs, there remains the need for personalized assessments based on biorhythms, and where the detection of dysregulated physiologic oscillators may inform interventions to relieve pain and restore normal function. CONCLUSIONS: Future human research which focuses on TMD myofascial pain or the precocious development and progression of TMJ degenerative joint disease requires experimental designs with ecological validity that capture objectively measured data which meaningfully reflect circadian and ultradian states.

Mechanobehavior and mandibular ramus length in different facial phenotypes.

OBJECTIVES: To test the hypotheses that mechanobehavior scores (MBS) were correlated with mandibular ramus lengths (Co-Go) and differed between facial phenotypes. MATERIALS AND METHODS: Subjects gave informed consent to participate. Co-Go (mm), mandibular plane angles (SN-GoGn, °), and three-dimensional anatomy were derived from cephalometric radiography or cone beam computed tomography. Temporomandibular joint (TMJ) energy densities (ED) (mJ/mm3) were measured using dynamic stereometry and duty factors (DF) (%) were measured from electromyography, to calculate MBS (= ED2 × DF,) for each TMJ. Polynomial regressions, K-means cluster analysis, and analysis of variance (ANOVA) with Tukey post-hoc tests were employed. RESULTS: Fifty females and 23 males produced replete data. Polynomial regressions showed MBS were correlated with Co-Go (females, R2 = 0.57; males, R2 = 0.81). Cluster analysis identified three groups (P < .001). Dolichofacial subjects, with shorter normalized Co-Go, clustered into two subgroups with low and high MBS compared to brachyfacial subjects with longer Co-Go. SN-GoGn was significantly larger (P < .03) in the dolichofacial subgroups combined (33.0 ± 5.9°) compared to the brachyfacial group (29.8 ± 5.5°). CONCLUSIONS: MBS correlated with Co-Go within sexes and differed significantly between brachyfacial and dolichofacial subjects.

Psychosocial Scores and Jaw Muscle Activity in Women.

AIMS: To test whether women with temporomandibular disorder (TMD)-related pain showed higher psychosocial scores and higher awake- and sleep-time jaw muscle activities (characterized by duty factors) compared to pain-free controls and whether psychosocial scores and the jaw muscle duty factors were associated. METHODS: Subjects gave informed consent to participate. The Diagnostic Criteria for TMD (DC/TMD) were used for diagnosis of TMD pain, and 31 and 36 women were included in the TMD-related pain and control groups, respectively. DC/TMD Axis II instruments were used to determine psychosocial scores. Subjects self-recorded masseter and anterior temporalis electromyography (EMG) over 3 days and 3 nights. The duty factor (time of muscle activity/total recording time [%]) was quantified using subject-specific EMG/bite-force calibration via data recorded in the laboratory. Group differences (α = .05) were assessed for psychosocial scores and duty factors using chi-square and two-sample t tests. Linear regression assessed whether psychosocial scores were associated with duty factors. RESULTS: Average duty factors were ≤ 2.4% for awake and sleep times in both muscles, and between-group comparisons showed no significant differences. For physical symptom scores, there were significantly fewer TMD-related pain subjects in the normal category and significantly more in the moderate-severe category (all P < .01) compared to controls. Subjects with elevated compared to normal psychosocial scores showed significantly higher jaw muscle duty factors by ≥ 1.5-fold. CONCLUSION: A significantly larger proportion of TMD-related pain subjects compared to control subjects had moderate-severe physical symptom scores. Awake- and sleep-time jaw muscle duty factors were not different between groups and were generally low among all subjects. Additionally, higher than normal psychosocial scores were associated with significantly more low-magnitude jaw muscle activity.

Reliability and diagnostic validity of a joint vibration analysis device.

BACKGROUND: This observational study was designed to evaluate the reliability and diagnostic validity of Joint Vibration Analysis (JVA) in subjects with bilateral disc displacement with reduction and in subjects with bilateral normal disc position. METHODS: The reliability of selecting the traces was assessed by reading the same traces at an interval of 30 days. The reliability of the vibrations provided by the subjects was assessed by obtaining two tracings from each individual at an interval of 30 min. The validity compared the Joint Vibration Analysis parameters against magnetic resonance imaging as the reference standard. The data were analyzed with exploratory factor analysis. RESULTS: The short- term reliability of the Joint Vibration Analysis outcome variables showed excellent results. Implementing factor analysis and a receiver operating characteristic as analytical methods showed that six items of the Joint Vibration Analysis outcome variables could be scaled and normalized to a composite score which presented acceptable levels of sensitivity and specificity with a receiver operating characteristic of 0.8. CONCLUSION: This study demonstrated that the composite score generated from the Joint Vibration Analysis variables could discriminate between subjects with bilateral normal versus bilateral displaced discs.

Assessment of knowledge on temporomandibular disorders among Mexican dental educators.

Temporomandibular disorders (TMDs) is an umbrella term that embraces a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joints, muscles and all associated tissues. Because of the relatively high number of patients with TMDs in the population, instruction in this area of health care should be included on all dental curricula. Although levels of knowledge among dentists have been evaluated in several countries, they have not been in Mexico. This study evaluates the dental faculty's range of knowledge about TMD at five dental schools in Puebla, Mexico. Using an observational design, a survey was administered to 161 educators in order to assess their knowledge of TMD. Four domains were assessed, including: a) pathophysiology; b) psychophysiology; c) psychiatric disorders; and d) chronic pain. Overall knowledge of TMD was measured using a consensus of TMD experts' answers as a reference standard1The results show that educators' overall knowledge had 55% agreement with the reference standard. Individually, the psychophysiological domain was correctly recognized by 77.7% of the educators; correct responses on the other domains ranged from 38% to 56%. This study demonstrates the need to incorporate standardized TMDs instruction into the dental curricula at Mexican Universities, without which graduating dentists will lack the necessary knowledge or experience to diagnose and manage their TMD patients.

Los Trastornos Témporomandibulares (TTM) incluyen un grupo de condiciones musculo-esqueléticas y neuromusculares que afectan a la Articulación Temporomandibular (ATM), los músculos masticadores y otros tejidos asociados. Debido al número relativamente alto de pacientes con TTM en la población, la educación en esta área de la salud debe ser incluida en las currículas de las escuelas de odontología. A pesar de que el nivel de conocimiento sobre TTM ha sido evaluado en diversos países, esto no ha sido realizado en México, por lo que el objetivo del presente estudio fue evaluar el nivel de conocimiento sobre los TTM de los profesores de odontología en cinco universidades de Puebla, México. Bajo un diseño observacional, se administró una encuesta a 161 docentes de odontología para evaluar el nivel de conocimiento sobre los TTM. La encuesta incluyó cuatro dominios: a) patofisiología; b) psicofisiología; c) trastornos psiquiátricos y d) dolor crónico. Se usaron las respuestas otorgadas con un consenso de expertos como estándar de referencia1 para evaluar el nivel global de conocimiento sobre los TTM. Los resultados mostraron que los docentes tuvieron un nivel global de conocimiento del 55% de acuerdo al estándar de referencia. El dominio psicofisiológico individualmente fue el mejor reconocido con el 77% de acuerdo con los expertos; las respuestas correctas en los otros dominios oscilaron entre el 38% y el 56%. El presente estudio demostró la necesidad de incorporar educación sobre los TTM estandarizada en la currícula de las escuelas o facultades de odontología en las universidades mexicanas. Hasta que esto suceda, las generaciones de odontólogos no tienen el conocimiento ni la experiencia necesarios para diagnosticar y manejar a los pacientes con Trastornos Temporomandibulares.

Assessment of knowledge on temporomandibular disorders among Mexican dental educators / Evauación del conocimiento sobre trastornos temporomandibulares en docentes de odontología en México

Temporomandibular disorders (TMDs) is an umbrella term that embraces a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joints, muscles and all associated tissues. Because of the relatively high number of patients with TMDs in the population, instruction in this area of health care should be included on all dental curricula. Although levels of knowledge among dentists have been evaluated in several countries, they have not been in Mexico. This study evaluates the dental faculty's range of knowledge about TMD at five dental schools in Puebla, Mexico. Using an observational design, a survey was administered to 161 educators in order to assess their knowledge of TMD. Four domains were assessed, including: a) pathophysiology; b) psychophysiology; c) psychiatric disorders; and d) chronic pain. Overall knowledge of TMD was measured using a consensus of TMD experts' answers as a reference standard1The results show that educators' overall knowledge had 55% agreement with the reference standard. Individually, the psychophysiological domain was correctly recognized by 77.7% of the educators; correct responses on the other domains ranged from 38% to 56%. This study demonstrates the need to incorporate standardized TMDs instruction into the dental curricula at Mexican Universities, without which graduating dentists will lack the necessary knowledge or experience to diagnose and manage their TMD patients.

Los Trastornos Témporomandibulares (TTM) incluyen un grupo de condiciones musculoes que léticas y neuromusculares que afectan a la Articulación Temporomandibular (ATM), los músculos masticadores y otros tejidos asociados. Debido al número relativamente alto de pacientes con TTM en la población, la educación en esta área de la salud debe ser incluida en las currículas de las escuelas de odontología. A pesar de que el nivel de conocimiento sobre TTM ha sido evaluado en diversos países, esto no ha sido realizado en México, por lo que el objetivo del presente estudio fue evaluar el nivel de conocimiento sobre los TTM de los profesores de odontología en cinco universidades de Puebla, México. Bajo un diseño observacional, se administró una encuesta a 161 docentes de odontología para evaluar el nivel de conocimiento sobre los TTM. La encuesta incluyó cuatro dominios: a) patofisiología; b) psicofisiología; c) trastornos psiquiátricos y d) dolor crónico. Se usaron las respuestas otorgadas con un consenso de expertos como estándar de referencia1 para evaluar el nivel global de conocimiento sobre los TTM. Los resultados mostraron que los docentes tuvieron un nivel global de conocimiento del 55% de acuerdo al estándar de referencia. El dominio psicofisiológico indivi dualmente fue el mejor reconocido con el 77% de acuerdo con los expertos; las respuestas correctas en los otros dominios oscilaron entre el 38% y el 56%. El presente estudio demostró la necesidad de incorporar educación sobre los TTM estandarizada en la currícula de las escuelas o facultades de odontología en las universidades mexicanas. Hasta que esto suceda, las generaciones de odontólogos no tienen el conocimiento ni la experiencia necesarios para diagnosticar y manejar a los pacientes con Trastornos Temporomandibulares.

Smoking cessation practices in the dental setting.

According to the US Centers for Disease Control, approximately 20.6% of the American adult population currently smokes cigarettes. There is no doubt that tobacco use has a negative effect on oral and general health. Dentists can be effective in assessing their patients' smoking status, health beliefs, and related behavior patterns. A total of 608 patients-smokers, former smokers, and nonsmokers-participated in this study. The Five A's protocol was utilized with follow-up interviews to assess smoking cessation (quit rates) among the patients. Of the 608 subjects, 170 (28%) were current smokers, 140 (23%) were former smokers, and 298 (49%) had never smoked. Females comprised 56% of the study group. Of the 170 smokers who were assessed at baseline, successful follow-ups were performed with 64 (38%). Based on a follow-up of these smokers, the 7-day abstinence quit rate was 22%. Among participants who received nicotine replacement therapy (NRT), 40% quit. Of the participants who did not receive NRT, 19% quit.

Systematic review of reliability and diagnostic validity of joint vibration analysis for diagnosis of temporomandibular disorders.

AIMS: To conduct a systematic review of papers reporting the reliability and diagnostic validity of the joint vibration analysis (JVA) for diagnosis of temporomandibular disorders (TMD). METHODS: A search of Pubmed identified English-language publications of the reliability and diagnostic validity of the JVA. Guidelines were adapted from applied STAndards for the Reporting of Diagnostic accuracy studies (STARD) to evaluate the publications. RESULTS: Fifteen publications were included in this review, each of which presented methodological limitations. CONCLUSION: This literature is unable to provide evidence to support the reliability and diagnostic validity of the JVA for diagnosis of TMD.

Development of a brief and effective temporomandibular disorder pain screening questionnaire: reliability and validity.

BACKGROUND: Available screening instruments for identifying temporomandibular disorders (TMDs) exhibit methodological or logistic limitations. The authors conducted a study to develop and assess the validity of a self-report instrument in screening patients for pain-related TMDs. METHODS: By using psychometric methods for item selection, the authors developed short (three-item) and long (six-item) versions of the questionnaire and evaluated them for validity among 504 participants. RESULTS: Internal reliability was excellent, with coefficient α values of 0.87 and 0.93 for the short and long versions, respectively. When the authors dichotomized instrument scores at optimal thresholds, both versions had a sensitivity of 99 percent and a specificity of 97 percent for correct classification of the presence or absence of TMD. The specificity was at least 95 percent in the correct identification of people with nonpainful TMJ disorders or headahce without TMD pain. CONCLUSIONS: With use of appropriate psychometric methodology, the selected items exhibited excellent content validity. The excellent levels of reliability, sensitivity and specificity demonstrate the validity and usefulness of this instrument. CLINICAL IMPLICATIONS: Using this instrument will allow clinicians to identify more readily-and cost-effectively-most patients with painful TMD conditions for whom early and reliable identification would have a significant effect on diagnosis, treatment and prognosis.

The Research Diagnostic Criteria for Temporomandibular Disorders. VI: future directions.

The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Validation Project has provided the first comprehensive assessment of reliability and validity of the original Axis I and II. In addition, Axis I of the RDC/TMD was revised with estimates of reliability and validity. These findings are reported in the five preceding articles in this series. The aim of this article is to present further revisions of Axis I and II for consideration by the TMD research and clinical communities. Potential Axis I revisions include addressing concerns with orofacial pain differential diagnosis and changes in nomenclature in an attempt to provide improved consistency with other musculoskeletal diagnostic systems. In addition, expansion of the RDC/TMD to include the less common TMD conditions and disorders would make it more comprehensive and clinically useful. The original standards for diagnostic sensitivity ( < or = 0.70) and specificity (< or = 0.95) should be reconsidered to reflect changes in the field since the RDC/TMD was published in 1992. Pertaining to Axis II, current recommendations for all chronic pain conditions include standardized instruments and expansion of the domains assessed. In addition, there is need for improved clinical efficiency of Axis II instruments and for exploring methods to better integrate Axis I and II in clinical settings.

The Research Diagnostic Criteria for Temporomandibular Disorders. V: methods used to establish and validate revised Axis I diagnostic algorithms.

AIMS: To derive reliable and valid revised Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms for clinical TMD diagnoses. METHODS: The multisite RDC/TMD Validation Project's dataset (614 TMD community and clinic cases, and 91 controls) was used to derive revised algorithms for Axis I TMD diagnoses. Validity of diagnostic algorithms was assessed relative to reference standards, the latter based on consensus diagnoses rendered by two TMD experts using criterion examination data, including temporomandibular joint imaging. Cutoff points for target validity were sensitivity > or = 0.70 and specificity > or = 0.95. Reliability of revised algorithms was assessed in 27 study participants. RESULTS: Revised algorithm sensitivity and specificity exceeded the target levels for myofascial pain (0.82, 0.99, respectively) and myofascial pain with limited opening (0.93, 0.97). Combining diagnoses for any myofascial pain showed sensitivity of 0.91 and specificity of 1.00. For joint pain, target sensitivity and specificity were observed (0.92, 0.96) when arthralgia and osteoarthritis were combined as "any joint pain." Disc displacement without reduction with limited opening demonstrated target sensitivity and specificity (0.80, 0.97). For the other disc displacement diagnoses, osteoarthritis and osteoarthrosis, sensitivity was below target (0.35 to 0.53), and specificity ranged from 0.80 to meeting target. Kappa for revised algorithm diagnostic reliability was > or =0.63. CONCLUSION: Revised RDC/TMD Axis I TMD diagnostic algorithms are recommended for myofascial pain and joint pain as reliable and valid. However, revised clinical criteria alone, without recourse to imaging, are inadequate for valid diagnosis of two of the three disc displacements as well as osteoarthritis and osteoarthrosis.

Smoking cessation practices in the dental profession.

AIM: The purpose of this review is to describe the current status of smoking cessation initiatives in the dental profession. REVIEW: A review of the initiatives undertaken by the dental profession to adopt smoking cessation recommendations as standard of care is presented. SUMMARY: Facts about the effects of smoking on the major oral diseases are stated and supported by national statistics. The barriers for compliance by dental professionals are described based on published research, but even more importantly, possible solutions are offered. CLINICAL SIGNIFICANCE: Awareness of the harmful effects of smoking tobacco can help dental professionals become more motivated to comply with current recommendations for smoking cessation in order to improve the oral and general health of the public.

Technological devices in the diagnosis of temporomandibular disorders.

Claims have been made that certain diagnostic devices should be routinely used to differentiate between jaw dysfunction and normal variation and between various pathologic conditions of the temporomandibular joint. The claims that jaw-tracking devices have diagnostic value for detecting TMD are not well supported by the scientific evidence. The clinical usefulness of electromyography devices is limited because of technical, methodologic, and data interpretation problems, as well as significant overlap between asymptomatic and symptomatic groups. Claims for the use of sonography and vibratography machines to discriminate between various intracapsular TMJ conditions have not been substantiated by well-designed research. Until acceptable levels of technical and diagnostic validity have been clearly established, these diagnostic devices cannot be relied on as aids in differential diagnosis or in clinical decision making in the TMD field.

Oral cancer screening, dental needs assessment and risk factors literacy in Hispanic population of western New York.

Thus far in 2007, 5370 people have died of oral cancer in the United States. While early detection is vital for most cancers, it is of utmost importance in the case of oral cancer, because most oral cancers are detected at advanced stages. It is important to focus on those groups at highest risk. In terms of oral cancer, men over the age of 40 in lower socio-economic groups who smoke, drink alcohol heavily and who have an unhealthy diet are at higher risk for developing oral cancer. Hispanics exhibit many of these high risk characteristics. Unfortunately, those at higher risk are also less likely to be screened for oral cancer than those at lower risk, because they make fewer regular dental visits. This paper presents the results from an ongoing outreach program developed by the School of Dental Medicine (SDM) at the University at Buffalo that was undertaken to assess the dental needs of and provide oral cancer screening and basic oral health instructions to the Hispanic community of Western New York. A total of 110 community members volunteered to participate in this program. The overall goal of the SDM is to increase its presence in the community in order to assist with treatment needs.

Care of patients with temporomandibular disorders: an educational challenge.

The ability to recognize, evaluate, and manage patients with temporomandibular disorders is an important component of general dental practice. Therefore, information about these disorders should be a basic part of the dental curriculum. Although most dental schools do include this subject in their educational programs, its teaching typically involves the presentation of didactic material in formal lectures or in seminars. This teaching, however valuable, rarely includes the "hands-on" clinical experience of actually caring for this patient population. To address this lack of clinical experience, the Department of Oral Diagnostic Sciences of the School of Dental Medicine at the University at Buffalo has also developed a special elective program to offer dental students in their final undergraduate year the opportunity to obtain such experience.

Evaluación histológica del sistema canalicular bajo dos diferentes técnicas de instrumentación: estudio experimental y revisión bibliográfica / Histologic evaluation of the root canal system under two different instrumentation techniques: experimental study and review of the literature

El presente trabajo tiene como finalidad comparar histológicamente la eficacia de las diferentes técnicas de instrumentación utilizadas para la preparación del sistema canalicular. Para la realización del mismo fueron utilizados tres monos Macacus Cynomolgus; los dientes de la arcada inferior fueron asignados al azar a los grupos de experimentación: instrumentación mecánica escalonada o ultrasónica, instrumentando un total de 27 canales. El análisis histológico fue realizado bajo microscopio de luz. En síntesis el presente estudio confirma una vez más que las técnicas de instrumentación a nuestra disposición no son completamente efectivas para la remoción del tejido pulpar y predentario. De igual modo se establece que no existe diferencia alguna en los resultados obtenidos bajo la utilización de diferentes modalidades de instrumentación, estableciendo de esta manera que la eficacia de ambas técnicas es similar cuando son utilizadas con precisión y respetando los principios básicos de instrumentación del sistema canalicular