A proposal for a database of sounds generated by temporomandibular joints and a tool for automateddiagnosisbasedonanRDC/TMDquestionnaire.

The prevalence of TMD indicates a need to develop new tools that are useful in the case of screening examinations. These methods can support diagnosis at the early stage of the disorder. The purpose of this research was to develop a comprehensive tool that would function as both a database of sounds generated by TMJ and as software which facilitates automated diagnosis. The software would also use the data from the RDC/TMD questionnaire. Such a tool may significantly reduce the time spent by dentists on making manual RDC/TMD diagnoses. Moreover, this solution would enable dentists who do not specialise in TMD to make effective diagnoses. 95 patient took part in the clinical examination: 30 man and 65 females. The mean age of the participants was 33 years. Patients participating in the clinical process were examined according to the Polish version of the RDC/TMD questionnaire (Axis I and Axis II). Subsequently, all subjects were auscultated with an electronic stethoscope. An application has been implemented based on the RDC/TMD diagnostic flow chart. This tool was used for the automated generation of RDC/TMD diagnoses for all patients. As a result of the kind permission and participation of the patients under examination, it was possible to store records of ninety-five people. Each record contains RDC/TMD questionnaire data, auscultation signals and RDC/TMD diagnoses. For the first time, a database was created that has the potential to facilitate further examination. However, the developed system is universal and can therefore be adapted to new DC/TMD criteria.

A comparison of temporomandibular disorder headache in young adults in relation to perceived stress.

Chronic pain in the head and face region has a predicted prevalence of 20% in Europe, and is more common in women than men. The etiology of temporomandibular disorder (TMD) is multifactorial, and high levels of psychological stress amplify its symptoms. We were interested in how headache reported in RDC/TMD is associated with stress. Individuals with an average age of 18 years were included in the study. They were all volunteer participants in a research project. Clinical evaluation of each subject was performed using the RDC/TMD dual-axis diagnostic system. All participants filled out the PSS-10 questionnaire. A total of 138 individuals participated in the study, of which 107 were female. Headache was reported by 83 participants (59.4%), with females presenting higher scores on the PSS-10; this was statistically significant. A comparison between PSS-10 questionnaire results and headache level shows insignificant differences. However, the higher the stress level in the participant, the higher the headache score. Females are more susceptible to perceived stress, which can have an effect on TMD.

New Methods for the Acoustic-Signal Segmentation of the Temporomandibular Joint.

(1) Background: The stethoscope is one of the main accessory tools in the diagnosis of temporomandibular joint disorders (TMD). However, the clinical auscultation of the masticatory system still lacks computer-aided support, which would decrease the time needed for each diagnosis. This can be achieved with digital signal processing and classification algorithms. The segmentation of acoustic signals is usually the first step in many sound processing methodologies. We postulate that it is possible to implement the automatic segmentation of the acoustic signals of the temporomandibular joint (TMJ), which can contribute to the development of advanced TMD classification algorithms. (2) Methods: In this paper, we compare two different methods for the segmentation of TMJ sounds which are used in diagnosis of the masticatory system. The first method is based solely on digital signal processing (DSP) and includes filtering and envelope calculation. The second method takes advantage of a deep learning approach established on a U-Net neural network, combined with long short-term memory (LSTM) architecture. (3) Results: Both developed methods were validated against our own TMJ sound database created from the signals recorded with an electronic stethoscope during a clinical diagnostic trail of TMJ. The Dice score of the DSP method was 0.86 and the sensitivity was 0.91; for the deep learning approach, Dice score was 0.85 and there was a sensitivity of 0.98. (4) Conclusions: The presented results indicate that with the use of signal processing and deep learning, it is possible to automatically segment the TMJ sounds into sections of diagnostic value. Such methods can provide representative data for the development of TMD classification algorithms.

A Novel Method of Temporomandibular Joint Hypermobility Diagnosis Based on Signal Analysis.

Despite the temporomandibular joint (TMJ) being a well-known anatomical structure its diagnosis may become difficult because physiological sounds accompanying joint movement can falsely indicate pathological symptoms. One example of such a situation is temporomandibular joint hypermobility (TMJH), which still requires comprehensive study. The commonly used official research diagnostic criteria for temporomandibular disorders (RDC/TMD) does not support the recognition of TMJH. Therefore, in this paper the authors propose a novel diagnostic method of TMJH based on the digital time-frequency analysis of sounds generated by TMJ. Forty-seven volunteers were diagnosed using the RDC/TMD questionnaire and auscultated with the Littmann 3200 electronic stethoscope on both sides of the head simultaneously. Recorded TMJ sounds were transferred to the computer via Bluetooth® for numerical analysis. The representation of the signals in the time-frequency domain was computed with the use of the Python Numpy and Matplotlib libraries and short-time Fourier transform. The research reveals characteristic time-frequency features in acoustic signals which can be used to detect TMJH. It is also proved that TMJH is a rare disorder; however, its prevalence at the level of around 4% is still significant.

The effect of root canal rinsing protocol on the push-out bond strength to the dentin cementation of the fiber post.

B a c k g r o u n d: Studies on the effect of root canal rinsing protocols on fiber post bonding to dentin are inconclusive. This study reports investigation of this topic. O b j e c t i v e s: to determine effects of irrigation protocol by means of a push-out test on the strength of adhesion between the post and dentin in an in vitro study. Materials and Method: Thirty human single-rooted teeth were prepared using hand instruments and the step-back technique, filled with gutta-percha, sealed with AH Plus (Dentsply), and divided into three groups: A: rinsed with NaCl; B: rinsed with 2% chlorhexidine (CHX); C: not rinsed before cementation of posts. The fiber posts were set using RelyX and Built-it. The tooth roots were sliced and the push-out test was performed. The area of contact between the post and dentin was calculated and the destroying force was established. The results were statistically analyzed. R e s u l t s: The mean adhesive strength was 10.69 MPa in group A, 16.33 MPa in group B, and 16.72 MPa in C. The adhesive strength in group B and C was statistically significantly higher than in group A (p = 0.0016, ANOVA). Conclusion: Rinsing root canals with CHX seems to be the most effective method prior to setting a fiber post.

Candida prevalence and oral hygiene due to orthodontic therapy with conventional brackets.

BACKGROUND: Conventional brackets are often used during orthodontic therapy of patients with malocclusion. The complex construction of such brackets greatly inhibits oral hygiene, which predisposes to increased carriage of microbiota. Orthodontic brackets could act as reservoir of yeast and predispose to oral candidosis. The aim of this study was to assess Candida prevalence and the role of oral hygiene during fixed appliance therapy. A further aim was to characterize the isolated yeasts according to their ability to form biofilms. METHODS: Seventeen participants (average age 17 ± 7 years) were monitored by taking oral rinses and elastomeric ligature samples, and by evaluating the approximal plaque index (API) and gingival bleeding index (GBI) before and after placement of the orthodontic conventional brackets for 12 weeks. Isolated yeasts were counted and biofilm formation was evaluated. RESULTS: One hundred and sixteen samples (67 oral rinses and 49 orthodontic elastomers) were collected. Ten patients (58.8% subjects) were Candida-carriers (two were colonized after bracket placement) and C. albicans was the most common species. The average number of yeasts in the oral cavity showed some fluctuation during the study, but in general had an upward trend (adj. R2 = 0.7967, p = 0.07025). A correlation was found between median number of yeasts and the periodontal indices (API, GBI). The average API values decreased in the Candida-carriers (adj. R2 = 0.95; p = 0.01709), while average GBI values increased in the noncarriers (adj. R2 = 0.92; p = 0.0256). CONCLUSIONS: Treatment with orthodontic appliances promotes Candida yeast colonization, which is variable over time in terms of strain and species, with dominance of C. albicans, and without increased biofilm-forming activity. The API value decreases over time in carriers, and the GBI value increases in uncolonized patients, which may have predictive significance for the development of oral candidiasis during orthodontic treatment.

Evaluation of the psychoemotional status of young adults with symptoms of temporomandibular disorders.

BACKGROUND AND PURPOSE: Temporomandibular disorders (TMD) are among the most frequent pathologies of the stomatognathic system. One problem often associated with TMD is the psychoemotional status. The aim of study was to evaluate the psychoemotional status of young adults with pain symptoms associated with TMD. MATERIAL AND METHODS: We analyzed the data of 260 volunteers. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) form was used to diagnose TMD. The relationships between TMD/RDC clinical diagnoses and psychoemotional status, as described by the Beck's Depression Inventory (BDI) and Perceived Stress Scale (PSS-10), were analyzed. We divide the group into four on the basis of RDC/TMD Axis I diagnosis. Group 0 included 30 students lacking TMD symptoms. Group I consisted of 30 people with myofascial pain (group IA in RDC/TMD). Group II contained 23 people with disk displacement with reduction (group IIA in RDC/TMD). Group III contained ten people (Group III diagnosis, often associated with pain). RESULTS: We did not find statistically significant differences between the study groups. In subjects with pain (Groups I and III), we found the mean value on the BDI and PSS-10 scales to be higher than among the pain-free subjects (Groups 0 and II). CONCLUSION: In young adults with TMD accompanied by pain, psychoemotional status should also be evaluated.

Relationship between oral hygiene and fungal growth in patients: users of an acrylic denture without signs of inflammatory process.

OBJECTIVES: To answer to the following questions: is there any relationship between oral hygiene and the growth of yeast in patients without mucosal inflammation; and is there a need for mycological examination patients without mucosal inflammation? BACKGROUND: Patients with candidiasis may report varied symptoms, but such infections are most often asymptomatic. In addition to its high incidence in denture users (60%-100%), there is a concern that Candida species from the oral cavity may colonize the upper gastrointestinal tract and lead to septicemia, which has a 40%-79% mortality rate and can require a prolonged hospital stay. It is thus important for all physicians to be aware of the risk factors, diagnosis, and treatment of oral candidiasis in older patients. METHODS: A retrospective study was carried out on a group of patients who had undergone mycological examination and assessment of the intensity of yeast growth, and oral hygiene. RESULTS: Ninety-one denture wearers who lacked signs of clinical inflammation were included in the study. The growth of Candida albicans was as follows: 14 patients had up to 20 colonies; 19 patients had over 20 colonies. Ten percent of patients with good oral hygiene proved to have more than 20 yeast colonies. 5% of patients with bad oral hygiene had more than 20 colonies. CONCLUSIONS: There was no relationship found between hygiene and the growth rate of fungal microorganisms. In patients without clinical symptoms of stomatitis, mycological examination should be considered.

The Evaluation of Anthropometric Measurements of Young Polish Women's Faces.

Face proportions are under constant evaluation during prosthetic or surgical diagnostics and treatment. The aim was to evaluate the proportions of the faces of young Polish women as compared with other ethnic groups. MATERIALS AND METHODS: The evaluation included 60 photographs of the faces of women, average age 17.9 years. En face images were made with the camera lens situated at the same distance from the photographed subjects. Using Adobe Photoshop software, midsaggital and even anthropometric points were determined in the photographs and then the distance between these points was measured. Four relationships between vertical measurements, 3 between horizontal measurements, and 4 proportions between vertical and horizontal measurements were calculated. The results were evaluated in comparison with the golden ratio (1.618) and the measurements performed for native Americans and Latin American beauty contests winners described in the relevant literature. RESULTS: The result for the average vertical face proportion value of the examined women was close to the golden ratio (GR) and amounted to 1.592 for the proportions between nasion-stomion and stomion-gnation (98% of GR) and 1.372 for nasion-subnasale and subnasale-gnation (85% of GR).Average measurement results for young Polish women's faces were not statistically significantly different for 6 out of 11 relationships under evaluation as compared with the population of native American females and only 2 face proportions were the same as for beauty contests winners from Latin America. CONCLUSION: Face proportions of young Polish women were different from those of the females living in the American continent.

Relation between Headache and Mastication Muscle Tone in Adolescents.

Headache is a common problem in the population, which decreases the quality of life and makes everyday functioning difficult. It often coexists with typical symptoms of temporomandibular disorders. The objective of the study was to clarify whether there is a relationship between the presence of headache in young volunteers and the mastication muscle tone. Material and Method. Volunteers aged 18 years who underwent general dental examination, clinical evaluation, and examination using the dual-axis diagnostic system Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) form in the Polish language version participated in the study. On the basis of the examination results, these individuals were divided into three groups according to RDC results. A group of healthy individuals (axis I value 0), a group of sick individuals (axis I diagnosis Ia, IIa, or IIIa), and a group of individuals suffering from depression (axis II values 1-3) were singled out. Then, volunteers were divided into two groups: group I reporting headache and group II without any pain. In each of these individuals, the contractile activity of the masseter muscles and anterior temporal muscles was recorded bilaterally as the surface electromyographic activity (sEMG) at rest, during swallowing, and maximum clenching. The activity index ranging between +100 (activity of the masseter muscles only) and -100 (activity of the anterior temporal muscles only) was used to indicate the predominance of activity of the study muscles. Results. The statistical analysis of data showed that there was a significant relationship between the presence of headache and a change in the mastication muscle tone, expressed as the predominant activity of the temporal muscles, only in the group of sick individuals during maximum clenching. Summary. The diversity of sEMG results implies that a change in the mastication muscle tone is not a direct consequence of headache, but it has to be modified by other factors.

Frequency of temporomandibular disorders diagnoses based on RDC/TMD in a Polish patient population.

OBJECTIVE: To assess the frequency and age distribution of Axis I and Axis II diagnoses among Polish patients with temporomandibular disorders (TMD). METHOD: One hundred sixty-three (n = 163) consecutive adult patients seeking TMD treatment were assessed based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guidelines. Descriptive statistics on the frequency of diagnoses and mean age of the diagnostic groups was performed. RESULT: Frequency of muscle disorders, disc displacements, and other joint disorders was 56.9, 48.9, and 31%, respectively. Disc displacement was the most common diagnosis in younger patients. Severe somatization and depression were shown in 11.9 and 15.8% of patients, respectively. Only 10.5% of the patients showed severe pain-related impairment. Females tended to have higher psychosocial scores than males. DISCUSSION: The frequency of Axis I TMD diagnoses in Polish patients is similar to other populations, whereas Axis II findings slightly differ from previous reports from other countries.

[Interdisciplinary surgical and prosthetic treatment of adenocarcinoma of the palate].

INTRODUCTION: The palatal mucosa requires careful testing prior to prosthetic treatment. Pathological changes may occur during the period of use of a dental prosthetic, especially when worn constantly. Aim of the report: We describe the case of a patient who experienced extensive changes in the mucosa of the hard palate over 12 years of dentures used. CASE PRESENTATION: The 78-year-old female patient was referred to the Department of Otolaryngology of the Jagiellonian University Hospital in Krakow with a diagnosis of adenocarcinoma of the palate. In connection with the planned extensive surgery, there was indication for the use of a palatal plate with an obturator in order to close the expected gap in the palate structure. No recurrence of the tumor was seen in the period examined. Summation: Despite the extensive tumor, two small defects in the palate remained after surgery. These were effectively sealed and the patient reached the five-year survival point.

The evaluation of the effect of carbon dioxide laser radiation on dentine tissue.

of this study was to analyze the effects of carbon dioxide (CO2) laser light on the structure and elemental composition of dentine. METHODS: The evaluation was conducted on samples from extracted teeth. The surface of the dentine was exposed to the radiation from a CTL 1401 CO2 laser (Centre of Laser Technology, Poland). The radiation and frequency parameters were as follows: group I with 5 W and 1 Hz, group II with 10 W and 1 Hz, group III with 5 W and 5 Hz, and group IV with 10 W and 5 Hz. The altered dentine structure was macroscopically and microscopically evaluated using a Nova NanoSEM 200 Scanning Electron Microscope (FEI Europe) with integrated microanalysis X-ray system for elemental analysis in points. RESULTS: There were significant differences between groups in the macro- and microstructure of laser defects. CONCLUSIONS: CO2 laser radiation causes irreversible, destructive changes in dentine. The structural dentine lesions developed under the influence of the CO2 laser radiation may hinder proper adhesion of bonding systems with the damaged tissue. Laser defects in the structure should be treated like defects of noncarious origin requiring preparation and filling with composite materials in accordance with the procedures.

The Prevalence of TMD in Polish Young Adults.

PURPOSE: The prevalence of temporomandibular disorders (TMD) in the general Polish population has not yet been thoroughly investigated. The aim of this study was to determine how frequently Polish young adults demonstrated the signs and symptoms of TMD, and how often they were aware of these. MATERIALS AND METHODS: The study involved 260 volunteers of approximately 18 years of age (and with an F:M ratio of 2.8), who had completed the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) questionnaire in its internationally accepted Polish version. The volunteers were students from three randomly selected high schools in Kraków, Poland. Following the clinical examinations, all participants received none or one or more of the RDC/TMD axis I diagnoses on one or both sides: muscle disorders (group I), disk displacements (group II), arthralgia, osteoarthritis, and osteoarthrosis (group III). Classification on RDC/TMD axis II involved pain-related impairment (Graded Chronic Pain Severity, from 0: no TMD pain in the prior 6 months, to IV: high disability-severely limiting), depression, and somatization levels (normal, moderate, severe). RESULTS: On the RDC/TMD axis I, 69 (26.5%) of the participants received one or more of the possible diagnoses. Awareness of TMD was present in 20 (7.7%) people from that group, in the form of self-complaints. The difference between females and males was statistically significant (p  = 0.0013). On the RDC/TMD axis II assessment, a diagnosis of pain, depression, or somatization was given in 38 (14.6%) cases from that group. CONCLUSION: Muscle disorders were most frequently diagnosed in the group of Polish young adults, and the prevalence of the disease did not differ across similar groups of young people.

Correlation between age and gender in Candida species infections of complete denture wearers: a retrospective analysis.

AIM: Denture-related stomatitis is a disorder that often affects denture wearers. The purpose of this study was to evaluate the intensity, genera, and frequency of yeasts in the oral cavity of complete denture wearers in terms of subject gender and age. MATERIALS AND METHODS: Nine hundred twenty patients (307 males and 613 females) with complete upper dentures were selected for the study and divided into four age groups: ≤50 years, 51-60, 61-70, and >70 years. Yeast samples were taken as a smear from the palate. The data were collected from January 15, 2007 to January 15, 2012. RESULTS: The distribution of the number of yeast colonies by gender was statistically significant (P=0.02). Across all subjects, there was a statistically significant relationship between the intensity of yeast growth and the gender (P=0.01). In every age group, the number of infection-free individuals was greater among males than females. Intermediate, intense, and abundant growth of yeast occurred most frequently in the youngest group of females. CONCLUSION: The genera of Candida species and the frequency of yeast infection in denture wearers appear to be influenced by both age and gender. The complete denture wearers ≤50 years of age appeared to have the greatest proclivity to oral Candida infections.

Activity of the masticatory muscles and occlusal contacts in young adults with and without orthodontic treatment.

BACKGROUND: Symmetry evaluation of the craniofacial complex generally involves models of mandibular movement and masticatory muscle activity, especially during the development of the craniofacial complex. The aim of this screening study was to detect differences in the asymmetry and activity indices and in the occlusal contact distribution in groups with and without orthodontic treatment, and between the sexes in the healthy population. MATERIAL AND METHOD: This screening study involved the participation of 149 Caucasian (F = 101, M = 48) 18-year-old volunteers, of whom 77 had received orthodontic treatment (Group I) and 72 had not (Group II). All participants underwent sEMG recording with an eight-channel electromyograph (Bio EMG III). A T-Scan III device was used to analyze the occlusal contact points. We measured the voltage of the right and left temporalis anterior (RTA, LTA) and of the right and left masseter muscles (RMM, LMM). On the basis of the Naeije study, we calculated the Asymmetry and Activity indices (AsI, AcI). RESULTS: No significant differences were found in the asymmetry or activity indices, or in the occlusal contact distribution of young adult subjects with or without orthodontic treatment. There were two findings in the females. First (p = 0.04), a higher voltage (131.12 µV) was recorded in the right temporalis anterior muscle in female group, compared to 119.65 µV in the male group. Secondly (p = 0.002), the activity index showed a predominance of the temporalis anterior (AcI = 10.52). In the males, the activity index showed a predominance of the masseter muscles (AcI =-1.22). CONCLUSIONS: The null hypothesis was supported, as we found that no significant differences were observed in occlusal contact, asymmetry, or activity indices between healthy young adults with or without orthodontic treatment. However, there do exist significant differences in the activity index between genders.

The Polish face in profile: a cephalometric baseline study.

BACKGROUND: This study reports the cephalometric evaluation of a group of adolescent Polish individuals describing dento-facial structure as well as details of incisor position and soft tissue characteristics. The results should reveal morphological features specific to Polish persons and serve as a comparative material for future diagnostic procedures. METHODS: The study was based on an analysis of cephalgrams of 122 Polish adolescents average age 18 years 6 months analysed in a computer system using the Kracovia composite system analysis describing dento-facial morphology ad modum Björk as well as soft tissue factors. The control material was based on published reports by Björk (Dento-facial characteristics) Riketts and Holdaway (soft tissue profile). RESULTS: The comparative study revealed a slight reduction in the sagittal jaw relationship with a significant reduction in the vertical jaw relationship and a distinctive mandibular morphology with a reduced jaw angle and an increase in the "Beta angle". These findings were reflected in the soft tissue pattern. The soft tissue profile reflected the skeletal cephalometrics observation. CONCLUSION: The dento-facial profile of Polish adolescents demonstrates specific characteristics which should be taken into account when diagnosing facial form in connection with orthodontic treatment planning in particular Polish patients.