Quality of life and oral function following radiotherapy for head and neck cancer.

BACKGROUND: Multiple oral complaints occur following radiotherapy for oropharyngeal cancer, but the frequency and severity of symptoms of dysfunction and discomfort are not well understood. The purpose of this investigation was to assess the quality of life, oral function, and oral symptoms following radiotherapy. METHODS: A general quality of life survey (the European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire QLQ-C30), with an added oral symptom and function scale was mailed to 100 patients more than 6 months following radiotherapy. RESULTS: Sixty-five patients responded. Difficulty chewing or eating was reported by 43% of respondents. Dry mouth was reported by 91.8%, change in taste by 75.4%, dysphagia by 63.1%, altered speech by 50.8%, difficulty with dentures by 48.5%, and increased tooth decay by 38.5% of dentate patients. Pain was common (58.4%) and interfered with daily activities in 30.8%. Mood complaints were reported by approximately half the patients. Interference of the physical condition social activities was reported by 60%. The frequency of oral side effects correlated with radiation treatment fields and dose. CONCLUSION: Oral complications following radiotherapy for head and neck cancer are common and affect quality of life. Use of a general function scale such as the EORTC questionnaire with the addition of disease/site specific scales may provide useful data on outcome of therapy and upon the complications associated with therapy and impact upon the quality of life.

Effect of impact and injury characteristics on post-motor vehicle accident temporomandibular disorders.

OBJECTIVES: The objective of this study was to assess the potential effects of motor vehicle accident impact and injury characteristics on post-motor vehicle accident temporomandibular disorders in terms of presenting signs and symptoms, diagnoses, treatment regimens, and outcomes. STUDY DESIGN: A retrospective chart review of 50 patients with post-motor vehicle accident temporomandibular disorders from a private oral medicine practice was undertaken. Various demographic data and data related to temporomandibular disorders and motor vehicle accident impact and injury characteristics were collected. Chi-square and Fisher exact tests and multiple regression analyses were performed. RESULTS: Patients involved in front-end collisions or motor vehicle accidents resulting in severe vehicle damage reported more direct orofacial injury. However, those in rear-end collisions or accidents resulting in minimal vehicle damage required more treatment. Direct head or orofacial injury was therefore not a prognostic indicator. From multiple regression analyses, indicators of a poorer prognosis were minimal vehicle damage, lack of headrest use, driver position, and settlement of insurance claim. CONCLUSIONS: In this patients group several prognostic indicators for patients with post-motor vehicle accident temporomandibular disorders were identified; these indicators may influence the management approach for this patient population.

A comparison of TMD patients with or without prior motor vehicle accident involvement: initial signs, symptoms, and diagnostic characteristics.

The role of trauma in the etiology of temporomandibular disorders (TMD) is controversial. The objectives of this study were to compare presenting signs, symptoms, and diagnoses in patients who had motor vehicle accident trauma-related TMD to patients who had nontrauma-related TMD. Files of 50 trauma and 50 matched nontrauma TMD patients were reviewed. Information concerning presenting pain, temporomandibular joint (TMJ) and related symptoms, examination findings, and diagnoses was recorded. Posttraumatic TMD patients reported higher facial (P = .006) and headache (P = .0001) pain ratings, neck symptom frequency (P < .01), ear-related symptoms (P = .02), sleep disturbance (P < .001), and occupational and avocational disability frequencies (P < .0001). They had greater masticatory muscle (P < .001), neck muscle (P < .001), and TMJ tenderness (P = .01) scores and myofascial pain (P = .006) and arthralgia/capsulitis (P = .008) diagnoses. The nontrauma group had more subjective (P = .02) and objective (P = .05) TMJ crepitus and higher self-reports of parafunctional jaw habits (P = .05). Trauma may be an important etiologic factor for some TMD patients.

Temporomandibular disorders, headaches, and neck pain after motor vehicle accidents: a pilot investigation of persistence and litigation effects.

STATEMENT OF PROBLEM: There is a lack of long-term follow-up studies that involve post-motor vehicle accident temporomandibular disorders and compensation. PURPOSE OF STUDY: The purposes of this retrospective pilot study were (1) to assess patients who had previously been treated for temporomandibular disorders after motor vehicle accidents to determine the nature of their symptoms in terms of jaw, head, and neck pain and jaw dysfunction and (2) to determine whether there was a difference in the pain and dysfunction between those who had settled and those who had not settled their insurance claims. MATERIAL AND METHODS: Thirty previously treated patients with temporomandibular disorders after motor vehicle accidents were questioned by telephone regarding litigation status and current jaw, head, and neck pain and jaw dysfunction symptoms. They did not differ substantially from a smaller group who were not able to be interviewed. Descriptive statistics were calculated and statistical tests were performed. A total of 22 patients had their claims settled. RESULTS: Approximately three fourths had persistent complaints of jaw pain, jaw dysfunction, and headache, and more than 80% reported persistent neck pain. No apparent differences were found between those who had and had not settled their insurance claims. CONCLUSION: Jaw, head and neck pain, and jaw dysfunction continued to be problems for the majority of this patient population, regardless of litigation status in this retrospective study.

A comparison of TMD patients with or without prior motor vehicle accident involvement: treatment and outcomes.

The influence of previous trauma in the management of patients with temporomandibular disorders (TMD) is controversial. The objectives of this study were to compare treatment regimens and outcomes in motor vehicle accident trauma-related versus nontrauma-related TMD patients. Files of 50 trauma and 50 matched nontrauma TMD patients were reviewed. Information concerning treatment received, progress of symptoms with treatment, and findings from the final examination were recorded. As a whole group, posttraumatic TMD patients tended to receive more types of treatment (P < .0001), have more medications prescribed (including analgesics, P < .001; nonsteroidal anti-inflammatory drugs, P = .001; muscle relaxants, P = .001; and tricyclic antidepressants, P < .001), have more oral medicine clinic visits (P = .07) over a longer period of time (P = .06), and have a poorer treatment outcome (P < .001) as compared to the nontrauma group. When the patients were separated into TMD diagnostic classification subsets, only some of these differences between trauma and nontrauma patients were seen, but the subset group sizes were small and only a few of the groups could be compared. There did not seem to be a significant effect from settling insurance claims prior to the last clinic visit. Trauma may be an important prognostic factor in the management of some TMD patients.

Motor vehicle accidents and TMDS: assessing the relationship.

Patients involved in a motor vehicle accident, or MVA, may experience signs and symptoms suggesting temporomandibular joint or masticatory muscle injury. Because there are no published clinical studies assessing the potential relationship among reported variables suggesting injury, examination findings, and crash impact and postural variables, the authors gathered data from 219 patients identifying TMD after an MVA. The results suggest that TMJ or masticatory muscle injury may be associated with varying postural characteristics and impact events, including speed, direction of impact and vehicular damage.

Temporomandibular disorders, headaches, and neck pain following motor vehicle accidents and the effect of litigation: review of the literature.

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. It was found that postinjury neck symptoms and headaches can be persistent. Employment appears to be a better predictor of long-term outcome than compensation and litigation. In addition, limited consensus is available concerning prognostic factors. 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.

Early oral changes following bone marrow transplantation.

This study assessed and analyzed the early oral changes following chemoradiotherapy and bone marrow transplantation. The most notable changes involved mucosal color (white and red), atrophy, vascularity, ulceration, increased salivary viscosity and xerostomia, and the patients' subjective complaints of dryness and oral pain. The ventral tongue, buccal and labial mucosa, and marginal gingiva manifested the most notable changes, while the palate was least affected. The overall trend was for the oral changes to begin slightly before transplantation, to worsen over the first 2 weeks after transplantation, and then to resolve progressively over the remainder of the study period. These oral changes appear to result from a number of insults, including the conditioning chemoradiotherapy, posttransplant immunosuppressive chemotherapy, xerostomia, local trauma, oral infections (especially those caused by HSV), and possibly acute GVHD. Oral HSV infection and/or acute GVHD should especially be considered if the oral status markedly worsens 21 days or more after transplant.

Electric pulp testing with examination gloves.

The electric pulp test (EPT) is a valuable diagnostic aid in assessing the vitality of the dental pulp; however, its use with the operator wearing examination gloves is controversial. In this study, 15 female and 15 male subjects had two different clinically sound teeth tested with an Analytic Technology digital electric pulp tester, both with and without latex examination gloves being worn by the operator. Statistically significant differences between EPT results for the same teeth with the operator's hands being gloved and ungloved were noted. However, the mean differences in EPT results were small and were thought to be diagnostically insignificant for clinical situations. As long as the patient "completes the circuit" by also holding the metallic handle of the electric pulp tester's probe, dentists can easily, reliably, and accurately use the EPT while wearing examination gloves.