ABSTRACT
The purpose of this research is to investigate the distinctions relating to Presenting Symptoms and Treatment Outcomes between patients suffering temporomandibular disorder (TMD) as a result of traumatic versus nontraumatic etiology. A geographically diverse cohort of 1,842 patients diagnosed with TMD was investigated with special emphasis placed on the following criteria: 1. The distribution of demographic and symptom characteristics of patients with trauma as an immediate precipitating factor versus those with other nontraumatic etiologies; 2. The relationship between nontrauma status and treatment outcomes; 3. The interrelationships between nontrauma status, psychosocial factors, and treatment outcomes. Trauma patients tended to be younger, less educated, and more likely to be male than the nontrauma patients. For this group the reported length of the TMD problem was, as expected, of shorter duration when compared to the nontrauma patient group. Length of treatment did not differ between the two groups. In comparison, trauma patients reported higher initial overall symptoms including pain and range of motion limitations. However, symptoms related to joint dysfunction did not vary appreciably. Treatment outcomes are complicated by the fact that TMD encompasses several different diagnostic entities. Trauma patients reported significantly higher percentages of improvement in palpation pain and perceived malocclusion. No significant differences were found for pain report, joint dysfunction, stress, and overall TMD symptomatology, as measured by the TMJ Scale's Global domain. Trauma patients manifested higher psychological dysfunction levels (excepting stress) and showed significantly more improvement in both psychosocial function and stress than the nontrauma group.
Subject(s)
Facial Pain , Pain Measurement , Temporomandibular Joint Disorders/etiology , Temporomandibular Joint/injuries , Adult , Female , Humans , Male , Middle Aged , Severity of Illness Index , Temporomandibular Joint/physiopathology , Temporomandibular Joint Disorders/physiopathology , Temporomandibular Joint Disorders/psychology , Temporomandibular Joint Disorders/therapy , Treatment Outcome , Wounds and Injuries/psychologyABSTRACT
SUMMARY: A general perception exists that outcomes of orthopaedic procedures in patient's with Workers' Compensation claims fare worse than those of patients without such claims. We retrospectively reviewed the outcomes of anterior cruciate ligament (ACL) reconstruction in patients who have Workers' Compensation claims. This minimum 2-year follow-up study analyzed the occupational, functional, and objective results of patients who underwent arthroscopic-assisted anterior cruciate ligament (ACL) reconstruction. Twenty-two patients with Workers' Compensation claims representing 5% of patients who underwent ACL reconstruction at our institution between 1987 and 1995 were included in the current study. All reconstructions were performed by the senior author (B.R.B.) using arthroscopic-assisted techniques (single and double-incision) with bone-patellar tendon-bone autografts followed by an accelerated rehabilitation protocol. Postoperative follow-up physical examinations revealed a negative anterior drawer in 19 patients (91%), a negative Lachman in 15 patients (68%), and a negative pivot shift in 21 patients (96%). The KT-1000 arthrometric evaluation at follow-up showed a mean maximum manual difference of 1. 9 mm with 15 patients (68%) having a maximum manual difference of =3 mm and 7 patients (32%) from 3 to 5 mm. The mean postoperative scores for the Hospital for Special Surgery scoring scale was 86, Noyes Sports activity scale 81, Noyes ADL score 36, Noyes Problem with Sports 75, Noyes Sports Function score 87, Lysholm score 82, and the Tegner score 5.9. The Noyes Occupational rating system increased from preoperative 48 to 60 postoperatively and the Noyes Job Title rating system score remained at 5 after surgery. Functional testing revealed mean deficits of no more than 9% between the reconstructed and normal knees. SF-36 testing revealed significantly higher scores in the Role Physical and General Health categories and a significantly lower score in the Mental Health category when compared with United States norms. Subjective evaluation revealed that 95% of the patients would undergo a similar procedure if faced with a similar injury to the contralateral knee in the future. The results of the current study show that ACL reconstruction leads to predictable functional and occupational results in those patients with work-related injuries. All of our patients were able to return to work. The hypothesis that Workers' Compensation compromises the results of ACL reconstruction was not observed in this study.
Subject(s)
Accidents, Occupational , Anterior Cruciate Ligament/surgery , Arthroscopy , Knee Injuries/surgery , Occupational Diseases/surgery , Workers' Compensation , Adult , Anterior Cruciate Ligament Injuries , Disability Evaluation , Female , Humans , Illinois , Knee Injuries/economics , Knee Injuries/rehabilitation , Male , Middle Aged , Occupational Diseases/economics , Occupational Diseases/rehabilitation , Range of Motion, Articular , Plastic Surgery Procedures , Retrospective Studies , Surveys and Questionnaires , Tendons/transplantation , Trauma Severity IndicesABSTRACT
Missing lateral incisors are usually discovered by age 9 when general orthodontic treatment needs are becoming apparent. Whether to close, open or maintain a space for a missing lateral incisor is an orthodontic decision that needs to fit within a total plan of dental management. Factors to consider include:- Skeletal base relationship, severity of crowding, overjet, overbite, position into which the canine erupts, crown sizes, crown shapes, crown colours, gingival contours, gingival display on smiling, patient and parent attitude toward options, availability of appropriate prosthetic services, time delay before effecting "final" prosthetic treatment, space and bone required for implant fixtures and financial and biological costs.
Subject(s)
Anodontia/therapy , Diastema/therapy , Incisor/abnormalities , Malocclusion/therapy , Orthodontics, Corrective , Attitude to Health , Cephalometry , Child , Cuspid/physiopathology , Dental Implants , Dental Prosthesis , Gingiva/pathology , Humans , Malocclusion/classification , Malocclusion/pathology , Odontometry , Patient Care Planning , Skull Base/pathology , Smiling , Space Maintenance, Orthodontic , Time Factors , Tooth Crown/pathology , Tooth Eruption/physiology , Tooth Movement TechniquesABSTRACT
This study of temporomandibular disorder (TMD) treatment outcomes examines 274 consecutive patients in five diagnostic categories and a 25 patient comparison group to determine relative levels of symptom improvement. Employing a psychometric outcome measure, the TMJ Scale, it was found that patients receiving active TMD treatments manifest statistically significant symptom improvements. Untreated patients reported minor and statistically insignificant symptom variations. Patients with intracapsular TM joint dysfunctions exhibited higher levels of improvement in pain and other TMD symptoms than patients presenting with primarily muscle symptoms. This research supports the hypothesis that TMDs are not self-limiting and require active treatment interventions. It is suggested that some studies cited to show that TMDs are self-limiting have major methodological limitations, relying upon unvalidated and subjective assessments of symptom levels. This research also outlines a procedure for TMD practitioners to measure treatment efficacy and the relative effectiveness of differing treatment modalities in a valid, consistent and unbiased manner.
Subject(s)
Occlusal Splints , Outcome Assessment, Health Care/methods , Temporomandibular Joint Disorders/diagnosis , Temporomandibular Joint Disorders/therapy , Adult , Chronic Disease , Facial Pain/complications , Female , Humans , Male , Malocclusion/complications , Osteoarthritis/complications , Osteoarthritis/diagnosis , Psychometrics , Reproducibility of Results , Sensitivity and Specificity , Severity of Illness Index , Stress, Psychological/complications , Temporomandibular Joint Disc/pathology , Temporomandibular Joint Disorders/etiology , Temporomandibular Joint Dysfunction Syndrome/diagnosis , Temporomandibular Joint Dysfunction Syndrome/etiology , Temporomandibular Joint Dysfunction Syndrome/therapy , Treatment OutcomeABSTRACT
A prospective study was undertaken to evaluate the postoperative pain and analgesic profiles of a group of 50 patients undergoing outpatient anterior cruciate ligament (ACL) reconstruction and to compare their profiles with those of a group of 50 patients undergoing outpatient non-ACL arthroscopic surgery. All patients received preoperative and postoperative ketorolac, intraincisional/intra-articular bupivacaine, intraoperative ketorolac, and propofol anesthetic. The percentage of patients receiving supplemental analgesia in the recovery room was 49% (average, 2.2 mg intravenous morphine sulfate) for the ACL group and 31% (average, 1.2 mg intravenous morphine sulfate) in the non-ACL group. Narcotic use and pain scores peaked in both groups on postoperative days 1 and 2. The ACL group used significantly more narcotic and had higher pain scores in the first week after surgery than did the non-ACL group. However, there were no subsequent admissions, readmissions, or emergency room visits for pain. All were satisfied with the outpatient nature of this surgery. Patients tolerate outpatient endoscopic ACL reconstruction with moderate pain and narcotic use. Outpatient endoscopic ACL reconstruction can be performed safely, effectively, and with considerable cost savings.
Subject(s)
Analgesics , Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament/surgery , Endoscopy , Knee Injuries/surgery , Pain, Postoperative/drug therapy , Adult , Ambulatory Surgical Procedures , Arthroscopy , Humans , Pain Measurement , Prospective StudiesABSTRACT
This study examines the effect of psychological dysfunction as an etiological factor in temporomandibular disorder (TMD). It employs a thoroughly validated psychometric measurement system, the TMJ Scale (Pain Resource Center, Inc., Durham, North Carolina), to determine the effects of pretreatment stress and psychological dysfunction upon presenting symptom levels. The study also addresses these parameters for the eventual treatment outcome. During the course of this study, 2,074 patients were evaluated. Seven hundred and fifty-four by Dr. Steed and 1,320 by Dr. Wexler. Both practices address essentially identical patient populations and focus special interest in craniofacial pain and the diagnosis and Phase I treatment of temporomandibular dysfunction. Of the patients in the study who were found to have clinically treatable temporomandibular disorders, 561 consecutive patients completed treatment and were deemed to have reached Maximum Medical Improvement (MMI). The TMJ Scale was re-administered to this post-treatment population. This study summarized findings pertinent to the four primary issues: 1. pre-treatment psychological factors and stress, which seem to be moderately related to presenting pain levels and overall TMD levels (excepting joint function); 2. treatment outcomes which appeared to be unrelated to the initial psychosocial symptom severity; 3. physical symptoms outcomes and psychosocial outcomes which appeared to be significantly related and; 4. intracapsular symptom improvement which appeared to be unrelated to psychological functioning changes but mildly related to stress.
Subject(s)
Temporomandibular Joint Disorders/etiology , Temporomandibular Joint Disorders/psychology , Adult , Facial Pain/etiology , Facial Pain/psychology , Female , Humans , Male , Outcome Assessment, Health Care , Pain Measurement , Psychometrics , Stress, Psychological/complications , Temporomandibular Joint Disorders/diagnosis , Temporomandibular Joint Disorders/therapyABSTRACT
Functional adaptations in knee kinematics and kinetics during level walking in 30 patients with unilateral anterior cruciate ligament deficiency and 30 healthy control subjects were studied. To examine the impact of time after injury on the functional adaptations, patients were placed into three time interval groups: early, intermediate, and chronic. The patients with anterior cruciate ligament deficiency had significantly decreased external knee flexion moments (balanced by net quadriceps contraction) and significantly increased external knee extension moments (balanced by net knee flexors contraction) as compared with the control subjects. As time after the injury increased, changes in the sagittal plane knee moments were more pronounced. A significant linear relationship (positive correlation) was found between the midstance knee flexion moment and the corresponding knee flexion angle. The patients with anterior cruciate deficiency had a greater knee flexion angle when generating a comparable midstance knee flexion moment as compared to the control subjects. The identification of gait adaptations over time provides additional information on the natural history of anterior cruciate ligament deficiency and may have implications regarding conservative rehabilitation, evaluation of outcomes, progression of meniscal injury, and the development of degenerative arthritis of the knee.
Subject(s)
Adaptation, Physiological , Anterior Cruciate Ligament/physiopathology , Gait/physiology , Knee Joint/physiopathology , Adult , Analysis of Variance , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Injuries , Case-Control Studies , Disease Progression , Female , Humans , Knee Injuries/physiopathology , Knee Injuries/surgery , Knee Joint/surgery , Linear Models , Male , Menisci, Tibial/physiopathology , Muscle Contraction/physiology , Muscle, Skeletal/physiopathology , Osteoarthritis/etiology , Osteoarthritis/physiopathology , Range of Motion, Articular/physiology , Thigh , Tibial Meniscus Injuries , Time Factors , Treatment Outcome , Walking/physiologySubject(s)
Femoral Fractures , Fractures, Bone , Pelvic Bones/injuries , Adolescent , Biomechanical Phenomena , Femoral Fractures/diagnosis , Femoral Fractures/physiopathology , Femoral Fractures/therapy , Fractures, Bone/diagnosis , Fractures, Bone/physiopathology , Fractures, Bone/therapy , Humans , Male , Pelvic Bones/diagnostic imaging , RadiographyABSTRACT
Endoscopic (single-incision) anterior cruciate ligament (ACL) reconstruction with bone patellar tendon bone can usually be secured with interference screws on the femur and tibia. Infrequently, patella alta, which results in a longer tendinous component of the graft construct, can result in construct mismatch, resulting in a large portion of the tibial bone plug extruding from the tibial tunnel, requiring graft fixation with staples or a suture/screw and post technique. This study investigated the hypothesis that initial graft fixation could be enhanced if the bone plug was removed and press fit into the tibial tunnel and then secured with an interference screw in the scenario of graft construct mismatch. Initial biomechanical fixation strengths of bovine patellar tendon were compared using a screw and post suture fixation compared with a free bone plug, which was removed from the graft and sandwiched along with the soft tissue with an interference screw. Twenty-eight bovine knees were randomly divided into two groups. Graft fixation was performed with a free bone plug excised from the tibial tubercle portion of the bone tendon bone construct. Fixation was achieved with a cannulated 9-mm x 20-mm interference screw. Fixation was performed in group 2 patients with a Krackow suture of no. 5 Ticron secured over a screw and post. An Instron materials testing system was used and loading rates at 1 mm/sec until failure was performed. Statistically significant differences were noted for load to failure and stiffness (P < .001). Group 1 specimens' mean maximum load to failure was 669 N (range, 511 to 819 N), whereas the load to failure for group 2 patients was 374 N (range, 266 to 491 N). Group 1 stiffness was 90 N/mm (range, 50 to 122 N/m) compared with a mean stiffness of 24 N/m (range, 16 to 33 N/m) for group 2 knees. In our bovine model, free bone block interference fixation was stronger and stiffer than fixation using sutures tied over a post. This fixation method of securing a soft tissue graft with an interference screw warrants further clinical investigation and may offer an improvement to the alternative of suture/post fixation.
Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament/surgery , Bone Screws , Bone Transplantation , Tendons/transplantation , Animals , Biomechanical Phenomena , Cattle , Equipment Failure , Femur/surgery , Suture Techniques , Tibia/surgeryABSTRACT
This study measures the effects of treatment interventions on two classes of temporomandibular disorder (TMD) patients in a dental practice in Ottawa, Canada. Other studies of TMD treatment outcome have employed subjective, largely qualitative and nonquantitative measures of symptom levels to make this type of assessment, rendering such research largely incapable of being replicated. The current study employs the TMJ Scale, a validated and psychometrically-developed symptom inventory, to measure symptom levels before and after treatment. The study first determined the sensitivity (92.1%) and specificity (88.1%) of the TMJ Scale for 219 patients in the practice population. One hundred and eleven consecutive TMD patients completed TMJ Scales prior to treatment, and then were retested after the completion of treatment. Results indicate that patients with symptoms of internal joint derangement reported more symptomatic improvement than those with predominantly muscular symptomology, despite the fact that the latter manifested lower symptom levels initially. Patients with internal derangement symptoms initially presented with lower levels of psychological symptoms than patients with muscular symptoms. Substantial improvements in both groups were noted, employing TMJ Scale percentile rank changes as outcome measures. This study can serve as a model for future research toward establishing baselines for expected TMD symptom improvement.
Subject(s)
Outcome Assessment, Health Care , Temporomandibular Joint Disorders/psychology , Temporomandibular Joint Disorders/therapy , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Personality Assessment , Psychometrics , Reproducibility of Results , Sensitivity and Specificity , Statistics as Topic , Surveys and Questionnaires , Temporomandibular Joint Dysfunction Syndrome/psychology , Temporomandibular Joint Dysfunction Syndrome/therapyABSTRACT
Dental hygienists are the designated dental auxiliary of the future in Australia. This article explains how their duties came into existence and why their duties in orthodontic practice seem limited in some instances. Dental hygienists, a class of operating dental auxiliaries, work in Australian orthodontic practices, but their employment is not widespread. The ratio of hygienists to dentists is reported to be 1:40 in Australia and 1:10 in South Australia (Pash, personal communication).