[Restoration of pathological tooth wear]. / Herstel van pathologische gebitsslijtage.

On account of tooth wear, a 30-year-old man and a 23-year-old woman were referred to a clinic for specialised dental services by their general dentist. The man suffered from degradation of hard dental tissues. He was not in pain but had some functional problems. In addition, the diminishing aesthetics bothered him. The woman suffered from pain frequently, had mild functional complaints and a deep bite. Treatment of pathological tooth wear begins with a sound diagnosis and investigating and eliminating aetiological factors. Sufficient motivation on the patient's side is also important. The treatment should be as minimally invasive as possible. When indirect restorations are absent a dynamic treatment plan would be preferred, in which new spatial relations can be tested in composites. For the treatment of localised loss of dental tissue the Dahl Concept might be considered. Both cases emphasise the importance of evaluating the implemented treatment. Long-term follow-up is necessary for the enhancement of knowledge and experience in the interpretation of the aetiology of and approach to severe tooth wear.

An extended replication study of dental factors associated with temporomandibular joint sounds.

A previous study demonstrated associations between dental factors and joint sounds. To support these findings, this replication study was carried out in another sample of nonpatients. It was found that temporomandibular joint sounds are common in nonpatients. Their prevalence in young adults exceeded the prevalence in adults. The small size of the control group rendered the results of multivariate analysis statistically inconclusive. Tentative interpretation suggests that attrition of the anterior teeth or generally in the dentition, unilateral non-working-side interferences, morphologic occlusion, and premolar contacts are related to the presence of sounds. Temporomandibular joint sounds in nonpatients are considered to be normal and not a manifestation of subclinical problems. Definite answers on the causality of temporomandibular joint sounds will have to be based on prospective longitudinal studies.

Cataracts, radiculomegaly, septal heart defects and hearing loss in two unrelated adult females with normal intelligence and similar facial appearance: confirmation of a syndrome?

Two unrelated, adult females with normal intelligence are described. They show a similar clinical picture with a long and narrow face, congenital cataract, microphthalmia, microcornea, a high nasal bridge, a short nose, a broad nasal tip, a long philtrum, bilateral hearing loss, persistent primary teeth, oligodontia, variable root length including dental radiculomegaly, heart defects and cutaneous syndactyly of the 2nd-3rd toes. Abnormalities present in only one of the two patients were a cleft palate and a transverse vaginal septum, respectively. There are numerous similarities between our two patients and the family described by Wilkie et al. ((1993): Clin Dysmorphol 2: 114-119) and all may be examples of the same entity.

[Temporomandibular joint sounds: a psychological problem?]. / Kaakgewrichtsgeluiden: een psychologisch probleem?

In this article the role of psychological variables in the etiology and presentation of temporomandibular joint sounds is studied. It is concluded that psychological differences observed in the literature are most likely not related to temporomandibular joint sounds. These differences probably are an artefact, caused by using self-report as a substitute for the objective presence of symptoms. A comparison between self-report and objective measurement shows that psychological variables are indeed mainly involved in the reporting of temporomandibular joint sounds. When objective measurements are used, no substantial psychological differences are found. A theory is presented that explains the reporting of symptoms from attention and interpretation. Using this theory the reporting of temporomandibular joint sounds can be predicted quite well.

Psychological factors related to the prevalence of temporomandibular joint sounds.

This study focuses on the association between psychological factors and TMJ sounds, and the most suitable research design to establish this relation. A traditional research design is simulated to demonstrate how self-report may bias findings. A refined design is presented to obtain unbiased estimates of the role of psychological variables. In the 'naïve' design the importance of psychological variables was overestimated and the role of physiological variables was underestimated. It was concluded that future studies in the aetiology of TMJ clicking should abandon the use of self-report as a proxy for objective findings. With the refined design it was found that psychological factors play only a minor role in the prevalence of TMJ sounds. Findings do not support speculation about mechanisms that relate psychological factors to the presence of TMJ sounds.

Spatial and morphologic aspects of temporomandibular joints with sounds.

Various spatial and morphological aspects of the temporomandibular joint may be involved in the development of TMJ sounds. The present study examines their contribution to the prediction of sounds. A non-patient sample was studied using sensitive sound measurement and panoramic radiography. It was found that temporomandibular joint sounds are common in asymptomatic subjects showing substantial variation in several spatial and morphological parameters. An autonomous contribution of spatial relationships, asymmetries or morphology of bony structures to the prediction of joint sounds could not be detected. When unilateral sounds were present, they were more likely to be found on the side with the less steep condylar movement path. Joint imaging is not indicated in the detection of relationships between bony structures and their eventual asymmetries and joint sounds.

The reliability of clinical methods for recording temporomandibular joint sounds.

Measurement errors in recording temporomandibular joint sounds may originate from variation between observers and from variation in the phenomenon. Laboratory settings enable various procedures to be used to minimize both sources of variation. These procedures yield some excellent intra- and inter-examiner reliabilities, but this does not imply that dentists in a clinical setting are likely to evaluate temporomandibular joint sounds in a comparable way. This study was designed to evaluate clinical joint sound assessment methods (palpation and stethoscopy) without using special precautions to minimize variance. An attempt was made to quantify the signal variance. Within- and between-examiners agreement is estimated for both methods in a sample of 44 non-patients. The results show that two clinically experienced craniomandibular disorders specialists were able to reach fair to good agreement on the identification of (the number of) temporomandibular joint sounds. There was some disagreement with respect to the number of reciprocal clicks. Compared with the palpation technique, stethoscopy is more sensitive, especially with regard to crepitation. Based on the electronically recorded sounds, both examiners appeared to be overconsistent. It is concluded that the use of both palpation and stethoscopy in clinical settings can be justified but that both methods have limitations. When, in a given clinical setting, these limitations are acceptable, there appears to be no need for extra-sensitive but expensive electronic recording devices.

Dental factors associated with temporomandibular joint sounds.

Dental factors commonly associated with signs and symptoms of temporomandibular disorders were investigated in a group of nonpatients. A highly sensitive technique was used to establish the presence of temporomandibular joint (TMJ) sounds. In a discriminant analysis nonworking side interferences, attrition, molar contacts, horizontal range of jaw movement, and morphologic occlusion contributed significantly to the prediction of sounds. Further study of morphologic aspects of the joint and stress-related parafunctions may contribute to the understanding of the development of TMJ sounds. We concluded that TMJ sounds are a fairly common sign associated with mild deviations in certain morphologic and functional aspects of the stomatognathic system.

Evaluation of a technique for recording temporomandibular joint sounds.

Analysis of temporomandibular joints sounds may contribute to the differential diagnosis of temporomandibular joint disorders. In this article an advanced system for the recording of joint sounds is presented. The method proved to be reliable. The problem of filtering out artifacts has been solved to a great extent but not completely. Temporomandibular joint sounds measured with this technique vary considerably in energy, frequency spectrum, and peak-to-peak amplitude over 3 months, as well as within 1 day. These differences seem to reflect natural variations in joint sounds caused by the physical impossibility of performing identical jaw movements. The results indicate that joint sound characteristics do not yet offer a solid basis for inferences concerning the development of temporomandibular joint abnormalities in the clinical setting.

Temporomandibular joint clicking: a literature overview.

In view of the literature, it can be stated that too little is known about the prognosis of TMJ clicking, factors determining the need for treatment, and long-term results of therapy. Consequently, there is a need for more standardized research, leading to classification of the various types of clicking and knowledge about changes in the course of time.