Tinnitus, dizziness, and nonotologic otalgia improvement through temporomandibular disorder therapy.

U.S. Air Force otologic patients seeking care at Wilford Hall Medical Center for tinnitus, dizziness, and/or nonotologic otalgia without an identifiable cause and presenting with temporomandibular disorder (TMD) symptoms in the temple, jaw, or preauricular area or with otalgia at least once a month were referred to a TMD specialty clinic. The patients were provided a dental orthotic and TMD self-care instructions. After 3 months of orthotic wear, the percentages of patients reporting at least moderate symptom improvement of their tinnitus, dizziness, otalgia, and/or TMD were 64, 91, 87, and 92%, respectively. Follow-up telephone calls 6 months after completion of TMD therapy revealed that all patients maintained their symptom improvements. These findings imply that TMD was affecting the patients' otologic symptoms. Patients seeking care for tinnitus, dizziness, and/or nonotologic otalgia without an identifiable cause may have TMD, and their otologic symptoms may benefit from conservative reversible TMD therapy.

Referred craniofacial pain patterns in patients with temporomandibular disorder.

BACKGROUND: Referred pain is prevalent in the craniofacial region, and it would be helpful for dental practitioners to have drawings delineating regions with a high probability for a patient's referred pain source. METHODS: The author applied firm pressure for approximately five seconds to trigger points, nodules of spot tenderness, and selected masticatory structures within the head and neck region on 230 patients with temporomandibular disorder, or TMD. As firm pressure was being applied, subjects were asked whether pain was developing or intensifying in a location different than that being palpated. RESULTS: One hundred ninety-six subjects (85 percent) reported that referred pain was being generated. The cheek area, ear and forehead were the most frequently reported sites of referred pain generation; palpation over the trapezius muscle, lateral pterygoid area and masseter muscle were the most common sources of referred pain to the craniofacial region. The author provides figures displaying common referred pain sites and their sources. CONCLUSIONS: Patients with TMD often report referred craniofacial pain arising from palpation of the head and neck region. The author found that the pattern between referred pain source and site was consistent and predictable. PRACTICE IMPLICATIONS: Practitioners should consider craniofacial pain's propensity for referral when treating patients with TMD. Practitioners can use the figures presented to determine regions of high probability for a patient's referred pain source.

Usefulness of posture training for patients with temporomandibular disorders.

BACKGROUND: Many practitioners have found that posture training has a positive impact on temporomandibular, or TMD, symptoms. The authors conducted a study to evaluate its effectiveness. METHODS: Sixty patients with TMD and a primary muscle disorder were randomized into two groups: one group received posture training and TMD self-management instructions while the control group received TMD self-management instructions only. Four weeks after the study began, the authors reexamined the subjects for changes in symptoms, pain-free opening and pressure algometer pain thresholds. In addition, pretreatment and posttreatment posture measurements were recorded for subjects in the treatment group. RESULTS: Statistically significant improvement was demonstrated by the modified symptom severity index, maximum pain-free opening and pressure algometer threshold measurements, as well as by the subjects' perceived TMD and neck symptoms. Subjects in the treatment group reported having experienced a mean reduction in TMD and neck symptoms of 41.9 and 38.2 percent, respectively, while subjects in the control group reported a mean reduction in these symptoms of 8.1 and 9.3 percent. Within the treatment group, the authors found significant correlations between improvements in TMD symptoms and improvements in neck symptoms (P < .005) as well as between TMD symptom improvement and the difference between head and shoulder posture measurements at the outset of treatment (P < .05). CONCLUSIONS: Posture training and TMD self-management instructions are significantly more effective than TMD self-management instructions alone for patients with TMD who have a primary muscle disorder. PRACTICE IMPLICATIONS: Patients with TMD who hold their heads farther forward relative to the shoulders have a high probability of experiencing symptom improvement as a result of posture training and being provided with selfmanagement instructions.

Atypical presentation of odontogenic pain.

Pain referral patterns in the head and neck regions can be complex and frustrating for practitioners to diagnose and treat. This clinical case report involves a patient who did not respond to initial medical treatment for headache pain. The pain was found to be referred from a carious and pulpally involved mandibular molar that interestingly responded normal to pulp vitality testing.

Using soft splints in your dental practice.

A significant number of soft splints are fabricated by U.S. dentists every year. The efficacy of these splints is discussed, reported indications and contraindications are defined, and favorable and unfavorable characteristics reported by patients are presented. Maxillary and mandibular soft splint designs that have been found to be clinically acceptable are illustrated and an easy and rapid technique for adjusting and polishing a soft splint is proposed.

Tinnitus improvement through TMD therapy.

Many patients with temporomandibular disorder and coexisting tinnitus find that therapy improves or resolves their tinnitus in conjunction with their TMD symptoms. Ninety-three patients with TMD who reported having coexisting tinnitus were questioned and given clinical tests. These assessment instruments were then evaluated for their ability to suggest tinnitus improvement as a result of TMD therapy. This study suggests that asking targeted questions and performing a clinical test could be of significant value in helping practitioners identify which patients with TMD and coexisting tinnitus will experience improvement in, or resolution of, their tinnitus when TMD symptoms have improved significantly.

Identifying undiagnosed rheumatic disorders among patients with TMD.

If a patient with TMD has a coexisting rheumatic disorder, it may adversely affect the TMD symptoms and treatment outcome. A clinic that specializes in TMD treatment asked symptom-related questions of 104 patients with TMD, and a rheumatology clinic then performed rheumatologic evaluations. The authors review the results of the rheumatologic evaluations and the predictive probability for the questions. The findings of this study suggest questions that practitioners can ask to help identify patients with TMD who have a high probability of being diagnosed with a coexisting rheumatic disorder.

Identifying acute pulpalgia as a factor in TMD pain.

An acute pulpalgia and temporomandibular disorders can produce many of the same symptoms. To illustrate identification of an acute pulpalgia as a component in TMD, the authors review the evaluation of 11 patients at a clinic that specializes in TMD treatment. During the evaluation, thermal testing and periodontal ligament anesthesia were used to identify the offending tooth. After receiving endodontic treatment or having the tooth extracted, patients reported either complete or partial relief of TMD symptoms. The authors provide questions that may help practitioners identify a tooth with an acute pulpalgia as a contributing factor to TMD symptoms and suggest a technique to confirm this diagnosis.

Dental pulpalgia contributing to bilateral preauricular pain and tinnitus.

The case of a patient with bilateral preauricular pain and tinnitus is reported. Minimal relief was obtained with traditional temporomandibular disorders therapy, and complete relief was obtained after endodontic therapy. Pulpal conditions that can refer pain are discussed, and recommendations are made to help practitioners identify a possible pulpal etiology for symptoms and tests of temporomandibular disorders.

The impact of group discussion on the theory-perseverance bias.

The theory-perseverance bias was investigated in 3 related studies. In Study 1, a test of the hypothesis that group discussion attenuates this bias, male and female Canadian undergraduates examined information suggesting that either a positive or a negative relationship exists between risk preference and firefighting performance; they were then informed that this information was fictitious. They then recorded their beliefs regarding the actual relationship between these variables (a) immediately, (b) after 7 min of thought, (c) after a 7-min group discussion, or (d) after perusing a transcript of one of the discussions. Only the participants in the first condition made biased judgments. Study 2, which used Vinokur and Burnstein's (1974) procedures and which again drew a sample of Canadian students, provided support for a persuasive-arguments explanation of this group-discussion effect. The results of Study 3, which used procedures similar to those of Study 1, ruled out a social-comparison explanation for this effect. Factors that might enhance or diminish the effects of group discussion on this bias are suggested.

Treatment alternatives for patients with masticatory myofascial pain.

Alternative therapies are used by many people, and the dental literature has reported that some alternative therapies are comparable to splint therapy in the effective treatment of masticatory myofascial pain. The authors review the efficacy of alternative therapies and discuss their clinical implications. This review is intended to help dental practitioners to select alternative therapies they can use with or instead of splint therapy for treating patients who have a primary diagnosis of myofascial pain.

A simple questionnaire and clinical examination to help identify possible non-craniomandibular disorders that may influence a patient's CMD symptoms.

A patient with craniomandibular disorder (CMD) symptoms may have CMD, a local or systemic disorder that mimics CMD, or CMD superimposed with a local or systemic disorder that exacerbates the CMD symptoms. When evaluating a patient with CMD symptoms, the practitioner needs to determine whether local or systemic problems contribute to the patient's symptoms. The author presents a simple questionnaire that can help identify some non-CMD problems that may contribute to the patient's symptoms. A discussion of each question and examples of possible non-CMD disorders are provided. The author also describes a clinical examination that may be used in conjunction with the questionnaire to help identify some non-CMD conditions.

Using removable partial denture framework as matrix for pin-retained restoration.

A quick and easy method can restore a broken-down partial denture abutment with a pin-retained amalgam restoration. It has a high degree of patient acceptance as only one appointment is required, eliminating the need for the patient to leave a partial denture for adaptation to a wax pattern. The cost can be minimal. This technique can be used for Class II restorations; however, the practitioner must ensure sufficient clearance for the condenser to pass between the tooth and the partial denture, so all areas can be properly condensed.

A chamberless field exposure system for determining the effects of gaseous air pollutants on crop growth and yield.

A modification of the chamberless Zonal Air Pollution System (ZAPS) has been developed to permit the exposure of crops to various regimes of exposure to gaseous air pollutants under true field conditions. It provides 12 different levels and patterns of pollutant exposure, simulating a wide range of ambient conditions. The different levels and patterns of exposure are achieved through different rates of discharge of pollutant-enriched gas through manifolds suspended above individual plots. A feature of the layout is that, since the plots are grouped together in blocks of four, wind speed and direction dictate the actual exposure patterns received in any plot. For studies with ozone, O(3), enrichment of the ambient air occurs daily between 0700 and 2059 h (PDT). The overall O(3) concentration supplied to the manifolds is maintained proportional to that in the ambient air, except during the first 3 and the last 3 h of each enrichment period when enrichment is slowly increased and decreased, respectively, to provide smooth transitions from and to the ambient level. Additional control progressively reduces enrichment at low wind speeds. Over a season, the ZAPS results in typical unimodal distributions of concentrations on each plot, with good vertical mixing and reasonable horizontal distributions achieved by the large numbers of discharge orifices in the manifolds. Summary results from two seasons' experiments with processing peas are presented to provide examples of the use of the ZAPS to determine crop yield responses to ozone, based on simple linear regressions of yield against two different exposure indices.