Validity of the Oral Behaviours Checklist: correlations between OBC scores and intensity of facial pain.

The first purpose of this study was to translate the Oral Behaviours Checklist (OBC) into Dutch and to examine its psychometric properties. The second purpose was to examine the correlations between scores on the OBC and facial pain, while controlling for the possible confounding effects of psychosocial factors, such as stress, depression, somatisation and anxiety. The OBC was translated, following the international RDC/TMD consortium guidelines. Its psychometric properties were examined by assessing the test-retest reliability and concurrent validity [correlations between the OBC and the previously developed Oral Parafunctions Questionnaire (OPQ)]. Participants were 155 patients with TMD (77% female; mean age and s.d. = 43.6 and 14.4 years). The translation of the OBC into Dutch proceeded satisfactorily. The psychometric properties of the Dutch OBC were good; test-retest reliability was excellent (ICC = 0.86, P < 0.001). Concurrent validity was good: the correlation between the OBC and OPQ was high (r = 0.757, P < 0.001), while the correlations between individual items ranged from 0.389 to 0.892 (P < 0.001). Similar to previous Dutch studies using the OPQ, no significant correlation was found between oral parafunctions and facial pain (r = 0.069, P = 0.892). No significant correlations could be found between oral parafunctional behaviours and facial pain.

Oral health-related quality of life in patients with tooth wear.

The aim of this study was to investigate the impact of tooth wear (TW) on patients' oral health-related quality of life. A total of 198 participants were included in the study. They belonged to the following four different diagnostic categories: 51 patients with TW, 46 patients with painful temporomandibular disorders (TMD), 43 complete denture wearers and 58 healthy controls. The Dutch version of the Oral Health Impact Profile (OHIP-NL) was used to assess the patients' oral health-related quality of life. The results of the study show that patients with TW have an impaired oral health-related quality of life compared with healthy controls (P < 0·001). Furthermore, the impact of TW and of edentulousness do not differ significantly, while both of these oral conditions seem to have a lower impact on quality of life compared with painful TMD (P < 0·05). It was concluded that TW has a negative impact on patients' quality of life. This impact is comparable with that of edentulousness.

Developing abbreviated OHIP versions for use with TMD patients.

The aim of this study was to evaluate the psychometric characteristics of three versions of the Dutch Oral Health Impact Profile (OHIP-NL), for clinical use with temporomandibular disorder (TMD) patients. To that end, two abbreviated OHIP versions (OHIP-NL14 and OHIP-NL5) were developed by respectively selecting 14 and five items from the officially translated and culturally adapted original 49-item OHIP-NL questionnaire. A total of 245 consecutive patients, referred by their dentist to the TMD clinic of the Academic Centre for Dentistry Amsterdam (77% women; mean age ± s.d. = 41·0 ± 14·9 years), completed the Research Diagnostic Criteria for TMD (RDC/TMD) axis II questionnaire and the OHIP-NL. Reliability and validity of all three OHIP versions were compared, and their associations with four psychological axis II variables, indicating the level of impairment of patients with TMD, were examined. According to guidelines for clinical application, internal consistency scores were sufficient for OHIP-NL and OHIP-NL14, but insufficient for OHIP-NL5. Test-retest reliability (n = 64) was excellent for OHIP-NL and OHIP-NL14 and fair to good for OHIP-NL5. For all three versions, there was evidence for score validity: associations between OHIP summary scores on the one hand and validation variables and other RDC/TMD axis II variables on the other hand met the expectations and were statistically significant (P < 0·001). In conclusion, the OHIP-NL and OHIP-NL14 both performed comparatively well and better than the OHIP-NL5. When the length of the questionnaire (i.e. the time needed for its completion) is an issue, the OHIP-14 would therefore be the preferred version.

[Oral health impact profile. an instrument for measuring the impact of oral health on the quality of life]. / Oral health impact profile. Meetinstrument voor de invloed van de mondgezondheid op de levenskwaliteit.

A Dutch-language version of the Oral Health Impact Profile, a questionnaire by means of which the impact of oral health on the quality of life of patients can be determined, was developed and subsequently psychometrically tested among a group of patients with complaints concerning missing dentition or their dentures. In addition, a shortened version of this so-called OHIP-NL49, the OHIP-NL14, was psychometrically tested among a group of patients with temporomandibular disorders. The psychometrical characteristics of both the OHIP-NL49 and the OHIP-NL14 were very good: both the reliability and the validity were high. The conclusion was, that the OHIP-NL49 and the OHIP-NL14 are well suited for determining the impact of oral health on the quality of life.

[Oral kinesiology and the quality of life]. / Orale kinesiologie en levenskwaliteit.

In a comparative study, the influence of oral health on the quality of life was investigated for people with temporomandibular pain, people with tooth wear and people with complete dentures. To this end, the study made use of the Oral Health Impact Profile. Both the total score and the scores on 4 of the 7 domains of the Oral Health Impact Profile were significantly higher in the research group with temporomandibular pain than in the research groups with tooth wear and complete dentures. These results suggest that among people with temporomandibular pain the influence of oral health on the quality of life is more negative than among people with tooth wear and among people with complete dentures. This result can probably be linked with the general finding that patients with temporomandibular pain bear a relatively high psycho-social burden.

[Occupational differentiation in dentistry 2. From Brueghel's syndrome to a radiant smile. An advanced postgraduate programme in oral kinesiology]. / Beroepsdifferentiatie in de tandheelkunde 2. Van Bruegel-syndroom tot stralende glimlach--masterprogramma orale kinesiologie.

Oral movement disorders, jaw pain, and tooth wear are examples of clinical problems that are part of the dental discipline 'oral kinesiology'. About half of the advanced postgraduate programme in oral kinesiology involves the diagnosis, indication, and management of patients with one or more oral kinesiologic problems. The remaining time is available for thematic courses and a research project. The breadth of the programme will hopefully lead to improved care for patients whose treatment until now has been dispersed between various dental specialists. Successful candidates will obtain an advanced postgraduate diploma in Oral Kinesiology, and can also apply to be recognized as a gnathologist.

[Treatment protocol for craniomandibular disorder 1. Diagnosis]. / Behandelingsprotocol voor craniomandibulaire dysfunctie 1. Diagnostiek.

In two essays the treatment strategy of the department of Oral Function of the Academic Center of Dentistry Amsterdam for treating craniomandibular disorder (CMD) patients will be presented. This first essay starts with a short description of the symptomatology, classification and etiology of CMD. Then it is described how to diagnose a CMD with the use of a standardized diagnostic protocol. Some important aspects of the differential diagnosis of CMD are discussed. Furthermore it is discussed when a CMD-patient can be treated by the dentist or when referral to a CMD specialist or oral surgeon is necessary.

[Treatment protocol for craniomandibular dysfunction 2. Treatment]. / Behandelingsprotocol voor craniomandibulaire dysfunctie 2. Behandeling.

In two essays the treatment strategy of the department of Oral Function of the Academic Center of Dentistry Amsterdam for treating craniomandibular disorder (CMD) patients is described. In this second essay a description is given of several dental, physiotherapeutical and psychological treatment modalities for CMD. Then treatment strategies for the different categories of CMD are described. It is also indicated which aspects of the treatment strategy are based upon 'evidence based care' and which aspects are more based upon principles of 'common sense' and 'clinical prudence'.

[Multidisciplinary diagnosis and treatment of craniomandibular disorders]. / Multidisciplinaire diagnostiek en behandeling van craniomandibulaire dysfunctie.

Treatment of craniomandibular disorders (CMD) requires a multidisciplinary approach. The CMD-team of the Academic Centre for Dentistry Amsterdam (ACTA) therefore consists not only of specialists in CMD and orofacial pain, but also of physiotherapists and a psychologist. Possible CMD-patients are referred to this team by the dentist-general practitioner, either directly or upon request of a family physician or a medical specialist; the many rules of such referrals are outlined in the article. The CMD-team regularly consults other disciplines for diagnosis and/or treatment of their patients. For instance, internal referrals are sometimes made to the departments of Oral radiology, Endontology, Periodontology, Orthodontics, or Oral and maxillofacial surgery. External referrals to, for example, a speech therapist or a medical specialist (e.g., a pain specialist) are arranged by the family physician upon request of the CMD-team.

[Role of the psychologist in the treatment of bruxism]. / De rol van de psycholoog bij de behandeling van bruxisme.

Although there is a controversy about the importance of psychological factors in the development, enhancement and perpetuation of bruxism and other parafunctional activities, the contribution of a psychologist in the treatment of the individual patient is recommended. This contribution consists of diagnostic examination and treatment, most often a short cognitive behavior modification therapy. Because bruxism is mostly examined and treated in relation to the complaints it might cause, especially CMD-complaints, diagnosis and treatment are mostly directed at both. For the diagnosis a questionnaire is used, including a psychological test, which is followed by one or more interviews. The treatment is directed at learning to recognize bruxism activities, to practice alternative behavior, and to learn to cope better with situations that may lead to an increase of bruxism.

Psychological characteristics of patients applying for treatment in a dental fear clinic.

The aim of the present study was to assess psychological characteristics of highly anxious dental patients. Subjects were 321 patients (203 women) applying for treatment at a dental fear clinic in The Netherlands. Patients filled out several questionnaires to assess the amount of psychological complaints (Dutch version of the Symptom Checklist 90-Revised; SCL-90) and dental anxiety (Dental Anxiety Scale, Short version of the Dental Anxiety Inventory) approximately 4 months prior to their first appointment. The total mean score on the SCL-90 for the highly anxious patients was 142.7 (SD=47.2) for men and 166.5 (SD=64.3) for women. The SCL-90 total score and the mean scores of all subscales were significantly higher, and above the 80th percentile for most of the subscales, than the mean scores of the Dutch general population. The results indicate that patients who apply for treatment at a dental fear clinic are not just dentally anxious; they show complaints on a wide range of other psychological dimensions.

[Psychosocial factors in patients with temporomandibular dysfunction]. / Psychosociale factoren bij temporomandibulaire dysfunctie.

In this article the possible involvement of psychosocial factors in temporomandibular dysfunction (TMD) is discussed, both from a scientific and a clinical point of view. Compared with patients with TMD, controls thought they had personal control over their health and had a more active problem-solving coping style. Patients with a negative treatment outcome were older, reported fewer stressors and more frequently considered health to be determined by external factors than patients who were treated successfully. It was concluded that the assessment of psychosocial variables and in particular health locus of control is important for understanding both subjective treatment need and treatment outcome for TMD.

[The use of a questionnaire in TMD]. / Het gebruik van een vragenlijst bij TMD.

The use of a questionnaire in a TMD-clinic seems to be a useful aid in diagnosis and treatment of patients with TMD. By using such a questionnaire, it becomes clear which patients have to be advised to attend to psychosocial factors. Besides, the completion of the questionnaire before the first clinical examination often changes the opinion of patients about their complaints. The possible role of psychosocial factors is introduced gradually, and thereby, patients are more receptive to learn adaptive, coping strategies.

Psychological characteristics of dissatisfied denture patients.

A field study was conducted to investigate the psychological characteristics of dissatisfied denture patients using validated personality inventories. In the present study dissatisfied denture patients are patients that keep complaining about their dentures and are referred to a psychologist because it was suspected that their complaints may also be due to psychological factors. The results show that these patients feel more inhibited in their social contacts and more often have the opinion that wearing dentures is unacceptable. Also these patients are high on neuroticism, less social adequate, more rigid, have less self-esteem and are more externally oriented.

Recurrence risk for germinal mosaics revisited.

A formula to calculate recurrence risk for germline mosaicism published by Hartl in 1971 has been updated to include marker information. For practical genetic counselling new, more elaborate tables are given.

[Anxiety and depression in craniomandibular disorders; the use of the Symptom Checklist 90]. / Angst en depressie bij craniomandibulaire dysfunctie. Het gebruik van de Symptom Checklist 90.

Anxiety and depression of CMD-patients in a Clinic for Special Dental Care were assessed with the Symptom Checklist-90. The results of the female patients did not differ from the general population; the men showed significantly higher scores. Approximately one third of the patients scored 'high' or 'very high' on anxiety or depression and may need special attention for psychological problems. The SCL-90 may be a useful instrument to assess the presence of clinically significant anxiety or depression. Psychological data should be interpreted with great care and always in combination with data from the dental examination.

[Anxiety management of dental patients]. / Angstbegeleiding en -bestrijding. Benadering van volwassenen.

The treatment of dentally anxious patients demands a behavioral approach, supported, if necessary, by pharmacological means. First of all coping is described. Next an overview is presented of the most common anxiety-reducing methods. To this goal the dentist has at his disposal: information, successive approximation, distraction and relaxation. Biofeed-back does not appear to be used. The systematic desensitisation, the deconditioning of dental anxiety, is dealt with separately, because this technique requires the aid of a psychologist.

[Psychological aspects of craniomandibular dysfunction]. / Craniomandibulaire dysfunctie. Psychische aspecten.

The role of psychological factors in the etiology and maintenance of craniomandibular dysfunction has been examined in different ways. A relation has been found between certain personality characteristics and craniomandibular dysfunction-complaints. The cause/effect relation however is unclear. The influence of stress on CMD has been demonstrated. The importance of socalled illness behaviour as a result of the complaints, especially with chronic patients has been increasingly recognized. The psychological treatment of CMD-patients often includes some form of relaxation therapy, and methods aimed at diminishing the influence of stress for example the teaching of coping skills. Motivating the patient not to seek a purely dental solution to his problem is one of the most important elements of a successful treatment program. A multidisciplinairy approach seems to be a promising approach to these multifactorially determined problems.