Long-term efficacy of resilient appliance therapy in TMD pain patients: a randomised, controlled trial.

The aim was to investigate long-term efficacy of a resilient appliance in patients with pain due to temporomandibular disorders (TMD). A randomised, controlled trial was performed in 80 recruited TMD pain patients. They were randomly allocated to one of two groups: treatment with a resilient appliance or treatment with a hard, palatal, non-occluding appliance. The primary treatment outcome was judged positive when patients' characteristic pain intensity decreased by at least 30%. Additional treatment outcomes were physical functioning, emotional functioning and headache. At the 12-month follow-up 50% of the patients in the treatment group and 42% in the control group had a 30% reduction of characteristic pain intensity, when calculated in an intent-to-treat analysis. Jaw function improved in both groups at the 6- and 12-month follow-up. Emotional functioning improved in both groups at the 6-month follow-up; an improvement concerning grade of depression was found in the control group at 12 months. Headache decreased in both groups at both follow-ups. There were no statistically significant differences found regarding primary and additional outcomes between groups at the 6- and 12-months follow-up. There was no statistically significant difference between the resilient appliance and the non-occluding control appliance in reducing TMD pain, physical functioning, emotional functioning and headache in a 12 months perspective.

Undergraduates' and graduates' perception of achieved competencies in temporomandibular disorders and orofacial pain in a problem-based dental curriculum in Sweden.

AIMS: Aims of this study were to assess undergraduates' and graduates' perceptions of their education by documenting their attitudes and investigating acquired competencies in temporomandibular disorders (TMD) and orofacial pain (OP). METHODS: In 2006, 141 undergraduates (in semesters 1, 6, and 10 of a 5-year dental programme) and 60 graduates of 2000 and 2001 were invited to fill in questionnaires designed for their levels. The four questionnaires contained open-ended questions, closed-ended questions, and questions requiring a scaled response on an 11-point numerical rating scale (NRS). Questions covered personal experience of pain, attitudes toward TMD/OP, clinical competencies, and satisfaction with their education. Participants rated importance of and satisfaction with clinical competencies on a 5-point scale. RESULTS: The importance of understanding TMD/OP patients was rated high (NRS 9-10) and attitudes to given statements about TMD/OP patients were positive. In general, perception of clinical competencies increased with level of education. Mean scores for importance of and satisfaction with clinical competencies of 10th semester undergraduates and graduates were above 4.0. Median graduate satisfaction with undergraduate education in TMD/OP patient management was high (NRS 9). All but one graduate had treated patients with TMD/OP. One-third of the responding graduates expressed a wish for additional training, such as in pharmacological treatment and evaluation of treatment outcome. CONCLUSION: In general, the perception of acquired clinical competencies in TMD and OP increased with level of education, and the importance of, and satisfaction with, training was highly rated. Positive attitudes toward these kinds of patients were expressed at all levels.

Treatment outcome in patients with craniomandibular disorders of muscular origin: a 7-year follow-up.

The outcome of different treatment modalities after 7 years was investigated in a selected group of 50 patients with craniomandibular disorders of muscular origin. To minimize the possible effects of selection on the clinical material, the selected treatment group was compared to a consecutive group of patients in terms of age, gender, intensity/duration of pain, and socioeconomic profile. Both groups were comparable in most respects, but the selected group had a longer duration and a higher intensity of pain at baseline. There were more men in the consecutive group than in the selected group. A combined treatment approach resulted in a better outcome than single treatments. Sixty-five percent of all patients in the selected group reported improvement at the 7-year follow-up. All of the 19 patients who received counseling combined with different occlusal treatments improved. Forty-three percent of the patients treated otherwise showed improvement. Patients who were aware of stress responded better to treatment.

Occlusal appliance therapy in patients with temporomandibular disorders. A double-blind controlled study in a short-term perspective.

Stabilization appliances are commonly used in the treatment of temporomandibular disorders (TMD), although the treatment effects are not fully understood. This study evaluated the short-term efficacy of a stabilization appliance in patients with TMD of arthrogeneous origin, using a randomized, controlled, and double-blind design. Sixty patients were assigned to two equally sized groups: a treatment group given a stabilization appliance and a control group given a control appliance. Improvement of overall subjective symptoms was reported in both groups but significantly more often in the treatment group than in the control group (P = 0.006). Frequency of daily or constant pain showed a significant reduction in the treatment group (P = 0.02) compared with the control group. The results of this short-term evaluation showed that both the stabilization appliance and the control appliance had an effect on temporomandibular joint (TMJ) pain. It is improbable that the difference observed between the groups is due to chance alone.

A longitudinal follow-up of the effect of occlusal adjustment in patients with craniomandibular disorders.

The aim of this study was to evaluate the effect of occlusal adjustment in a prospective longitudinal study. Fifty selected patients with craniomandibular disorders (CMD) including headaches were randomly assigned to a treatment (T) or a control (C) group. Both groups received counselling and occlusal adjustment was performed in T group. Subjective symptoms and clinical findings were registered before and 2 years after treatment. At a follow-up 48% in the T group and 84% in the C group had demanded rescue treatment. Eleven patients in the T group (48%) and 3 patients in the C group (13%) without rescue treatment, reported overall subjective improvement. No difference was found between the groups regarding overall intensity of pain expressed by the visual analogue scale. When all kinds of treatment were taken into account, 70% and 79% of the patients in the T and C group reported overall subjective improvement at follow-up. The conclusions from this study were that in a two-year perspective only single patients improved from counselling alone. A few more patients improved if one more kind of treatment, for example occlusal adjustment, was added to the initial counselling, but the majority of the patients required a comprehensive treatment program.

Occlusal adjustment in patients with craniomandibular disorders including headaches. A 3- and 6-month follow-up.

The aim of this study was to evaluate the therapeutic effect of occlusal adjustment on symptoms and signs of craniomandibular disorders (CMD), including headaches, after 3 and 6 months. Fifty patients were selected and randomly assigned to a treatment (T) or a control (C) group. All patients in the treatment group were subjected to occlusal adjustment, whereas the controls were comforted only. Pre- and post-treatment assessment of subjective symptoms and clinical signs was made by a dentist not performing the occlusal adjustment. There was significant improvement in overall subjective symptoms within the T group at the 3- and 6-month follow-up visits, but a statistically significant difference between groups was found at the 3-month follow-up only. With regard to changes in frequency of facial pain a significant deterioration was reported within the C group, which resulted in a significant difference between groups at the 6-month follow-up. No other significant differences were found within or between groups at the follow-ups with regard to the variables investigated. In conclusion, the results from this study that occlusal adjustment is a treatment modality with a statistically significant short-term effect on symptoms of CMD of muscular origin and superior to counseling.

Office and ambulatory blood pressure in patients with craniomandibular disorders.

To assess the physiologic response to daily life stress in patients with craniomandibular disorders (CMD), office and ambulatory blood pressure and heart rate were studied in 25 female patients and 25 controls. Significant differences (p < 0.05) were found between the groups for heart rate before the clinical examination and that in the patient group when compared before and after the clinical examination. Higher values were found for mean daytime systolic and diastolic blood pressure in the control group compared with the patient group (p < 0.05). The mean number of systolic blood pressure > or = 140 mmHg during 24 h and daytime was significantly higher (p < 0.05) in the control group than in the patient group. In this study the CMD patients with muscular diagnosis were not more stressed than healthy subjects in the daily activities as evaluated by ambulatory blood pressure measurements.

Short-term effect of occlusal adjustment on craniomandibular disorders including headaches.

The aim of this study was to assess the short-term effect of occlusal adjustment on craniomandibular disorders. Fifty patients were randomly selected and divided into a treatment (T) and a control (C) group. The initial clinical examination and the follow-up were made by one observer and the occlusal adjustment by another. There were no significant differences between groups with regard to frequency of headaches, facial pain, pain on mandibular function, or duration of headaches and facial pain. Fifty-two percent of the patients in the treatment group and 20% of the patients in the control group reported reduced subjective symptoms overall at follow-up examination. The improvement was statistically significant within the T group and significantly greater than in the C group. There was no significant change within or between groups with regard to frequency of headaches, facial pain, or pain on mandibular movements. There was an almost significant difference between groups after treatment with regard to changes in the number of tender muscles. The results of this study indicate that occlusal adjustment provides a general subjective improvement of craniomandibular disorders.

Assessment of occlusal interferences.

The variability in the assessment of occlusal variables was investigated in eight subjects by the repeated registrations of four observers. The following variables were investigated in three different ways: sliding between the RCP (retruded contact position) and the ICP (inter-cuspal contact position) in the sagittal, vertical and lateral plane. Interferences during lateral movements on the working and balancing sides as well as interferences causing deviation of the mandible during protrusive movements were recorded. The intra- and inter-observer error for the measurement of sagittal and vertical distance RCP-ICP was within acceptable limits. There was no significant difference between the three methods used. The intra- and inter-observer agreement between duplicate recordings of the lateral distance RCP-ICP was high and there were no differences between the different measurement modalities. The inter-observer agreement was lower than the intra-observer agreement concerning presence/absence of balancing side interferences, and positive inter-observer agreement was only found on lateral movement more than 3 mm from the RCP or the ICP. The observer error for the variable working side interferences should be acceptable for future research, while the observer error for measurement of lateral deviation of the mandible upon protrusion was somewhat larger.