Jaw disorders in the pediatric population.

PURPOSE: This article will review the etiology, risk factors, history, and physical assessment of temporomandibular joint disorders (TMDs). In particular, this article discusses the role of the pediatric provider in diagnosing and beginning the initial treatment of TMDs, as well as the appropriate treatment plans. It also reveals some of the controversies regarding etiology and treatment of TMDs, as well as the paucity of research specific to TMDs in pediatrics. DATA SOURCES: A computerized search in PubMed and Ovid Medline, from 2006 to 2012, was conducted. A few seminal articles were included that were published before 2006. Hand searching was also performed, which included a few articles between 2012 and 2015. CONCLUSIONS: Although TMDs are mostly found in adults, it is also a finding in pediatrics, which increases in prevalence during adolescence. More research specific to pediatric patients with TMDs needs to be conducted so that pediatric-specific care can be provided. IMPLICATIONS FOR PRACTICE: TMD is a condition found in the pediatric population, and it is important for providers to take an adequate history and physical examination that incorporates the temporomandibular joint (TMJ) and muscles of mastication. It is also critical that providers begin initial education and management, followed by appropriate referrals.

Restraint Reduction, Restraint Elimination, and Best Practice: Role of the Clinical Nurse Specialist in Patient Safety.

PURPOSE: Baseline restraint prevalence for surgical step-down unit was 5.08%, and for surgical intensive care unit, it was 25.93%, greater than the National Database of Nursing Quality Indicators (NDNQI) mean. Project goal was sustained restraint reduction below the NDNQI mean and maintaining patient safety. BACKGROUND/RATIONALE: Soft wrist restraints are utilized for falls reduction and preventing device removal but are not universally effective and may put patients at risk of injury. Decreasing use of restrictive devices enhances patient safety and decreases risk of injury. DESCRIPTION: Phase 1 consisted of advanced practice nurse-facilitated restraint rounds on each restrained patient including multidisciplinary assessment and critical thinking with bedside clinicians including reevaluation for treatable causes of agitation and restraint indications. Phase 2 evaluated less restrictive mitts, padded belts, and elbow splint devices. Following a 4-month trial, phase 3 expanded the restraint initiative including critical care requiring education and collaboration among advanced practice nurses, physician team members, and nurse champions. EVALUATION AND OUTCOMES: Phase 1 decreased surgical step-down unit restraint prevalence from 5.08% to 3.57%. Phase 2 decreased restraint prevalence from 3.57% to 1.67%, less than the NDNQI mean. Phase 3 expansion in surgical intensive care units resulted in wrist restraint prevalence from 18.19% to 7.12% within the first year, maintained less than the NDNQI benchmarks while preserving patient safety. INTERPRETATION/CONCLUSION: The initiative produced sustained reduction in acute/critical care well below the NDNQI mean without corresponding increase in patient medical device removal. IMPLICATIONS: By managing causes of agitation, need for restraints is decreased, protecting patients from injury and increasing patient satisfaction. Follow-up research may explore patient experiences with and without restrictive device use.

Comparison of subjective symptoms of temporomandibular disorders in young patients by age and gender.

The authors assessed the subjective symptoms of temporomandibular disorders (TMDs) in 167 young patients using self-reported forms, with five ratings for pain intensity and six ratings for difficulty in activities of daily living (ADL), to compare TMD symptoms according to gender and three age groups: group 1: 6- to 12-year-olds (juvenile); group 2: 13- to 15-year-olds (early adolescent); group 3: 16- to 18-year-olds (late adolescent). No significant gender differences were found in the symptoms among the groups, except for headache and neck pain in group 3. Pain intensity and tightness in the jaw/face, headache, and neck pain, as well as the ADL-related difficulty in prolonged jaw opening, eating soft/hard foods, and sleeping significantly differed among the groups (p < 0.01, Kruskal-Wallis test). Therefore, late adolescent patients with TMDs have higher pain intensity in the orofacial region and greater difficulty in ADL than do early adolescent and juvenile patients with TMDs.

Comparison of subjective symptoms among three diagnostic subgroups of adolescents with temporomandibular disorders.

AIM: To compare subjective symptoms among three diagnostic subgroups of young patients with temporomandibular disorders (TMDs). DESIGN: We comprehensively examined 121 patients with TMDs (age ≤20 years; 90 female patients and 31 male patients) who completed self-reported forms for assessing subjective symptoms, which consisted of five items on pain intensity in the orofacial region and six items on the level of difficulty in activities of daily living (ADL) (rating scale, 0-10). They were divided into three diagnostic subgroups: temporomandibular joint (TMJ) problem (JT) group, masticatory muscle pain (MM) group, and the group with a combination of TMJ problems and masticatory muscle pain (JM group). Their symptoms were compared using the Kruskal-Wallis and Mann-Whitney U-tests. RESULTS: The intensity of jaw or face tightness and difficulty in talking and yawning were not significantly different among the groups. However, the MM and JM groups had a significantly higher rating for jaw or face pain, headache, neck pain, tooth pain, and difficulty in eating soft foods (P < 0.01). CONCLUSIONS: Young patients with MM or JM report more intense pain in the orofacial region and have more difficulties in ADL than those with JT problems alone.