Temporomandibular joint pathosis in patients with myofascial pain: a comparative analysis of magnetic resonance imaging and a clinical examination based on a specific set of criteria

OBJECTIVE: We sought to determine the prevalence of joint diseases in patients with either of 2 forms of myofascial pain (with and without limited mouth opening) and to verify the accuracy of temporomandibular joint-related clinical diagnoses through the use of magnetic resonance imaging (MRI). STUDY DESIGN: On the basis of the results of a clinical examination carried out according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), 61 patients were divided into 2 subgroups. The first group consisted of 36 patients who had myofascial pain with limited mouth opening (MPLO), whereas the other 25 patients were diagnosed with myofascial pain without limited mouth opening. MRI was carried out on all patients. The clinical joint-related diagnoses from RDC/TMD were compared with MRI results. RESULTS: Patients with MPLO often had joint diseases that were not detected by means of a clinical examination alone. The kappa statistic was used to compare MRI and clinical diagnoses, confirming poor agreement in patients with MPLO (kappa=0.13) and acceptable agreement in patients with myofascial pain without limited mouth opening (kappa=0.72). CONCLUSION: Restricted mandibular mobility is frequently associated with temporomandibular joint diseases that were not identified during a clinical examination. Therefore, an adaptation of the classification scheme used for the RDC/TMDs may result in the improvement of the sensitivity of clinical joint-related diagnoses, especially in patients with MPLO.     

Delayed assessment of the nasolacrimal system at naso-orbito-ethmoid fractures and a modified technique of dacryocystorhinostomy

Nineteen patients between 8 and 65 years of age (mean age 32) who were treated for naso-orbito-ethmoid area traumas and suffering from epiphora were evaluated. The time after the trauma was at least 4 months. The patients were divided into two groups. The first group consisted of 10 (52.7%) patients who have undergone a surgical procedure for the fractures before. The second group has 9 (47.3%) members who have never been surgically treated after trauma. All of the patients were evaluated with dacryocystography. Obstruction was found to be in the bony nasolacrimal canal in 13 (68.4%) patients. The nasolacrimal canal was intact in six (31.6%) of the patients. Dacryocystorhinostomy (DCR) was essential for five (50%) of the patients in the first group and eight (88.8%) of the patients in the second group. No additional surgical intervention was carried out for nasal deformities of the patients resulting from naso-orbito-ethmoid fractures. Palpebral malposition was present in six (32%) patients. Relief in tear flow was supplied in all patients. Our aim is to compare the outcomes of a modified technique of DCR and incidence of nasolacrimal system injury in patients with naso-orbito-ethmoid fractures and epiphora on whom reduction was or was not carried out. In conclusion, early surgical reduction of naso-orbito-ethmoid fractures should be performed to prevent problems and deformities of the nasolacrimal system.     

The time characteristics of the exacerbation of chronic periodontitis and of odontogenic perimaxillary abscesses]

Time course of some laboratory values and clinical manifestations of inflammatory process is studied in 52 patients with exacerbations of chronic periodontitis and 284 patients with odontogenic perimaxillary abscesses. Routine laboratory studies (clinical and biochemical analyses of the blood and urine) were carried out. Acute odontogenic inflammations are characterized by an intermittent course with periodicity of about a week. The end of the first week from the disease onset coincided with recovery in exacerbation of chronic periodontitis and with the beginning of stabilization of inflammatory process in abscess. Recovery after abscess was observed 2 weeks after disease onset. These regularities may be useful for specifying the pathogenesis, terms of check-ups, and duration of treatment.     

Clinical and radiological features of central giant-cell lesions of the jaw

OBJECTIVE: The purpose of this study was to evaluate the clinical and radiological features of central giant-cell lesions that were diagnosed in The Netherlands between January 1, 1990, and January 1, 1995. STUDY DESIGN: A population-based retrospective study was carried out, examining all patients with a central giant-cell lesion from this period. RESULTS: In 83 patients there was a central giant-cell granuloma (89 lesions). Aggressive signs and symptoms (pain, paresthesia, or root resorption) were found in 16 (19.3%) patients. Multiple lesions occurred in 3 (3.6%) patients. The overall recurrence rate was 26.3%, and there was a higher recurrence rate in patients who exhibited aggressive signs and symptoms than in patients without these features (RR 1.6). In 5 patients a clinical diagnosis of cherubism or concomitant neurofibromatosis type 1 was made (14 lesions). CONCLUSION: In a general population, large and aggressive lesions are less common than suggested by the literature. Multiple lesions, however, occur more frequently than previously assumed. In patients with aggressive signs and symptoms, surgical curettage is not an effective therapy.     

Additional clinical and microbiological effects of amoxicillin and metronidazole after initial periodontal therapy

Abstract. The aims of this study were to evaluate the clinical and microbiological effects of initial periodontal therapy (IT) and to determine the additional effects of systemic amoxicillin (Flemoxin Solutab®) 375mg TID plus metronidazole 250mg TID therapy in patients with adult. Actimobacillus actinomycetemcomitans (Aa) Associated periodontitis in conjunction with either Porphyromonas gingivalis (Pg) Bacteroides forsythus (Bf) and or Prevotella intermedia (Pi). In addition the adverse effects of the antimicrobial therapy were also documented. A total of 22 patients were enrolled. The deepest, bleeding pocket in each quadrant was selected and at these 4 experimental sites clinical measurements and microbiological testing was carried out at baseline, after (IT), i.e., 21 weeks after baseline, and after antimicrobial therapy (AM), i.e. 35 weeks after baseline. At baseline, the mean plaque index (PI) amounted 0.5, 0.1 after IT and 0.3 after systemic AM. The mean bleeding index decreased from 1.6 to 1.2 after IT and a further decrease to 0.7 Lifter AM was noted. Suppuration was completely eliminated after AM. The mean change of probing pocket depth (PPD) after IT amounted 1.4 mm and was further reduced with an additional mean change of 1.1 mm after medication. Clinical attachment gain was 1.1 mm after IT and an additional 0.9 mm was observed after AM. One of the 22 Aa positive patients and 4 of 17 Pg positive patients became negative for these species after IT. The number of patients with detectable Pi decreased from 16 to 10 after IT. After AM in comparison to baseline, suppression below detection level for Aa was achieved in 19 out of 22, for Pg in 9 out of 17, for Bf in 13 out of 14, and for Pi in 11 out of 16 patients. By contrast, higher frequencies of Peptostreptococcus micros and Fusobacteriam nucleation were found after AM. On the basis of the microbiological results the study group was separated into 2 subgroups: group was consisted of subjects who had no detectable levels of Aa, Pg, Bf and <5° of Pi after AM. Group B consisted of those who will showed presence of one of these 3 species and or ≥5° levels of Pi. After AM group B had significantly higher PI, BI, PPD and CAL scores then group A. It is concluded that group A showed low plaque scores and no detectable periodontal pathogens. This microbiological condition has been associated with a long-term stable periodontium.     

A follow-up of osteotomies for dysgnathia.

An invitation to report for a follow-up was accepted by 74 patients (51 females and 23 males) who had undergone various types of osteotomy (50 mandibular and 30 maxillary osteotomies; 6 patients had undergone both mandibular and maxillary osteotomy). Their age at the time of operation ranged from 15 to 44 years. The follow-up period ranged from 3 months to 7 years. Maxillary osteotomy was never followed by a relapse, but 12 of the 50 patients treated by mandibular osteotomy showed some relapse: hyperplasia of the mandibular condylar process caused some relapse in 2 cases, and in 10 other cases only partial relapse (1, 2 or 3 mm) occurred. The distribution over the various types of operation corresponded with the various methods used in the entire series, so that no particular type of operation had evident advantages or disadvantages. It is essential that stable occlusion is achieved during the operation. Osteosynthesis of the fracture fragments proved unnecessary after a sagittal split operation. No indications that an oversize tongue played a role were found. The results with regard to the temporomandibular joint were particularly favorable. Stable occlusion is essential in preventing relapse; this is one of the reasons why a careful long-term follow-up is indicated (at 2-year intervals). For the time being this is perhaps best carried out by the operating surgeon, who has previous models and knows the patient.     

The effect of alendronate sodium on alveolar bone loss in periodontitis (clinical trial)

Alendronate sodium is a potent inhibitor of bone resorption which has been effectively used to control osteolysis, and to treat Paget's disease and osteoporosis. The objective of this study was to investigate the effect of alendronate sodium, systemically induced in the treatment of patients with periodontitis. Twenty-four adult periodontitis patients were included in the study (for six months) and were divided into two groups. Group I, included twelve patients who received one tablet of fosamax (alendronate sodium, MSD) every morning for six months. Group II, also included twelve patients who received no drug during the study period. All patients received initial periodontal therapy. Bone mineral density (BMD) of the maxilla and mandible was measured for all subjects using a dual energy absorptiometer (DEXA) at the beginning of the study and at the end of six months using DPX. MD Scanner. Clinical periodontal measurements were carried out for all patients at the initial appointment and six months later in the form of pocket depth, attachment level and gingival index. A statistically significant difference in bone density (P < 0.001) was observed favouring the alendronate group (Group I). Alendronate sodium had no effect on the clinical parameters and could play an important role as an adjunct to conventional periodontal therapy in management of periodontal diseases.     

R5An audit of local compliance with general anaesthetic guidelines outlined for paediatric dentistry

Objectives: To assess current practice in terms of diagnosis, treatment planning and consent in the use of dental general anaesthetic (GA). To compare current practice to national guidelines and implement any changes required to improve clinical practice. Methods: A retrospective study was carried out over 1 year (2004–2005). 100 paediatric patients undergoing long (comprehensive care) and short (extractions only) dental GA were randomly selected. A proforma was designed to collect data, from patient records, regarding presenting complaint, medical history, treatment carried out during and before GA and consent. Patients who attended oral and maxillofacial clinics were not included. Results: In most cases, GA was justified inline with guidelines but consent and treatment planning could be improved. Conclusion: The department is adhering to guidelines in prescribing GA for patients. It is hoped that by producing a departmental policy, this could improve.     

Clinical experience with osteosynthesis of subcondylar fractures of the mandible using TCP plates.

AIM: To evaluate the clinical and radiological results obtained with a new kind of osteosynthesis device (Modus TCP) plates, Medartis, Basel, Switzerland), especially designed for low subcondylar fracture (LSCF) and high subcondylar fracture (HSCF) of the mandible in association with the high submandibular approach (HSMA). METHOD: A prospective clinical and radiological study was carried out over a 41-month period. All adult patients suffering from a displaced LSCF or HSCF who consented to the surgical treatment were included in the study. All fractures were operated on using an HSMA and were stabilised using a 4- or 9-hole TCP((R)) plate. No intermaxillary fixation was used and a soft diet was started on the 1st postoperative day. Clinical examinations and control X-rays were carried out on the 10th postoperative day, in the 1st, the 3rd and, at least, in the 6th postoperative months. MATERIAL: Sixty-four patients (12 females, 52 males - mean age: 28.3) with a total of 75 fractures (54 LSCF, 21 HSCF) were included in the study. Mean postoperative follow-up was 14 months. RESULTS: In the 6th postoperative month, all fractures were consolidated in 79% of the cases in an anatomical position. A secondary displacement of the fracture occurred in 6.6% of the cases. Plate fracture was not observed. Dental occlusion remained unchanged in 94% of the patients. The mandibular movements (mouth opening, protrusion, lateral movements on the unfractured and fractured side) had normal mean values (49.5, 10.4, 12.8, 12.1mm, respectively). These movements were symmetrical in 95% of the patients. No patient complained about articular pain or noise. No facial nerve palsy was noticed, not even a transiently one. All patients but one found the scars acceptable. CONCLUSION: TCP plates, in association with HSMA, were found to be an efficient osteosynthesis device for stabilising subcondylar fractures.     

Clinical and radiographic evaluation of a resin-based root canal sealer

PURPOSE: To conduct a preliminary clinical and radiographic evaluation of a resin-based root canal sealer used in conjunction with gutta percha. METHODS: In a retrospective study on 180 patients who were seen for root canal therapy, a total of 295 root canals were treated with laterally condensed gutta-percha cones in conjunction with a methacrylate-based endodontic sealer (EndoRez). Root canal therapy had been carried out in one visit using standardized techniques. The results were assessed clinically and radiographically 14-24 months postoperatively and a comparison to baseline radiographs was made. 145 patient records were available for a follow-up examination. Success of root canal treatment was based on absence of clinical symptoms, a normal or slightly widened periodontal ligament and reduction of periapical radiolucencies with an absence of pain in patients that had pre-existing lesions associated with pain. RESULTS: The overall success rate was 913%. Root canals had been adequately filled to the working length in 110 teeth (75.7%), short from the working length in six cases (4.1%) and flush in 19 teeth (13.1%). Extruded sealer occurred in 10 (6.9%) instances. 49 teeth out of 55 (89.1%) that had preoperative apical radiolucencies revealed partial or total healing at the 14-24 months recall evaluation. 83 teeth out of 90 (92.2%), without preoperative radiolucencies, showed no radiographic changes. At the 14-24 months recall all patients reported being comfortable. 13 (9.0%) cases were judged failures.     

The prevalence of A. actinomycetemcomitans, P. gingivalis and P. intermedia in selected subjects with periodontitis

Abstract. The present study was carried out in a private periodontal practice. 8 clinical criteria were chosen to select patients for microbiological examination. These criteria characterize prominent features of disease which at the start, during, or in the maintenance phase of treatment suggest difficulties in the progress of the periodontal therapy. Based on these clinical characteristics, an inventory was made of the prevalence of the 3 putative periodontal pathogens: Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia. Out of 320 referred patients 91 patients did meet 1 of the clinical criteria and consequently were selected for microbiological examination. Results showed that young patients (19–30 years) with periodontitis demonstrated the presence of A. actinomycetemcomitans more often (69%: p (0.005) compared to older age cohorts. A. actinomycetemcomitans was found more often when localized breakdown (in particular in the 1 st molar and incisor region) was observed and in patient who responded poorly to scaling and rootplaning. P. gingivalis and P. intermedia were most frequently recovered in patients showing primarily a bone loss pattern of angular defects of 5 mm. Retrospectively, these patients were further categorized, based on full mouth radiographs, in (1) patients with primarily horizontal bone loss and (2) patients with primarily angular bony defects. Results showed that A. actinomycetemcomitans occurred less frequently in patients showing horizontal bone loss ( p (0.05).     

Oral lichenoid lesions related to dental restorative materials

OBJECTIVES: To determine the effectiveness of replacing restorations considered to be the cause of an oral lichenoid lesion (oral lichenoid reaction)(OLL). DESIGN: Clinical intervention and nine-month follow up. SETTING: The study was carried out in the University Dental Hospital of Manchester, 1998-2002. SUBJECTS AND METHODS: A total of 51 patients, mean age 53 (SD 13) years, who had oral lesions or symptoms suspected to be related to their dental restorations were investigated. Baseline patch tests for a series of dental materials, biopsies and photographs were undertaken. Thirty-nine out of 51 (76%) of patients had their restorations replaced. RESULTS: The clinical manifestations of OLL were variable; the majority of OLL were found to be in the molar and retro molar area of the buccal mucosa and the tongue. Twenty-seven (53%) patients had positive patch test reactions to at least one material, 24 of them for one or more mercury compound. After a mean follow up period of nine months, lesions adjacent to replaced restorations completely healed in 16 (42%) patients (10 positive and 6 negative patch tests). Improvement in signs and symptoms were found in 18 (47%) patients (11 positive and 7 negative patch tests). CONCLUSION: OLLs may be elicited by some dental restorations. Replacing restorations adjacent to these lesions is associated with healing in the majority of cases particularly when lesions are in close contact with restorations. A patch test seems to be of limited benefit as a predictor of such reactions.     

Can low frequency,low intensity magnetic fields be used in cancer treatment?

In order to develop new therapeutic treatments for progressive malignant diseases, a clinical study was started in 1988 to determine whether the application of magnetic fields is able to cure cancer or to ameliorate the clinical situation of tumor patients. In parallel with this study, concomitant biological investigations have been carried out.Seventy-five patients were treated with a low intensity (4–6 mT), low frequency (8 Hz, 20 Hz) magnetic field (MF). Additional in-vivo and in-vitro experiments were carried out under similar conditions. No effects on tumor growth, proliferation or metabolism could be shown. However, impressive pain relief, which may have been caused by MF, was observed in some patients. This observation needs further investigation. Nevertheless, low frequency, low intensity magnetic fields as used in our study are not likely to be an appropriate modality for treating tumors.     

Consent: the patients' view--a summary of findings from a study of patients' perceptions of their consent to dental care

AIM: A study was carried out which aimed to investigate peoples' perceptions of how their consent was given for dental treatment. METHOD: A structured questionnaire was completed by 50 patients receiving treatment in the British NHS and 12 of them completed an in-depth recorded interview. The data was analysed using a combination of quantitative and qualitative methods. RESULTS: The findings showed that 80% of patients had not been given any written treatment plan (FP17DC). 79% of patients mistakenly thought that the form signed requesting NHS treatment (FP17) was a consent form. When options were offered patients were more likely to consider that they were involved in the consenting process. However consent is still often implied rather than explicit. There was a range of experience reported by patients from those who felt that the dentist made the treatment decisions to those who felt that decisions had been made collaboratively. Although some patients were happy with the way their consent was obtained examples were also given of lack of information, confusion and even of deceit. CONCLUSIONS: There is an urgent need to clarify the status of NHS documentation regarding consent and a general need for awareness to be raised in the dental profession about the importance of obtaining consent which is freely given based on appropriate information which has been adequately understood.     

Immediate functional and non-functional loading of dental implants: a 2- to 60-month follow-up study of 646 titanium implants

BACKGROUND: The aim of this study was the evaluation, from a clinical point of view, of implants subjected to immediate functional loading (IFL) and to immediate non-functional loading (INFL) in various anatomical configurations. METHODS: The study included 152 patients who had given their informed consent. A total of 646 implants were inserted. The implants were placed in 39 totally edentulous mandibles, 14 edentulous maxillae, 23 edentulous posterior mandibles, 16 edentulous anterior mandibles, 16 edentulous anterior maxillae, and 15 edentulous posterior maxillae. Fifty-eight implants were used to replace single missing teeth. In 65 cases, IFL was carried out for 422 implants. INFL was carried out in 116 cases, (224 implants). RESULTS: In the IFL group 6 of 422 implants failed (1.4%); in the INFL group 2 of 224 implants failed (0.9%). All the other implants appeared, from clinical and radiographic observations, to have successfully osseointegrated and have been functioning satisfactorily since insertion. All failures were observed in the first few months after implant loading. CONCLUSION: Immediate functional and non-functional loading seems to be a technique that gives satisfactory results in selected cases.     

Use of the Research Diagnostic Criteria for Temporomandibular Disorders for multinational research: translation efforts and reliability assessments in The Netherlands

AIMS: To outline the steps taken to conduct and to culturally adapt Dutch translations of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) history questionnaire, clinical examination form, and verbal instructions to the patients, and to assess the reliability of the clinical examination. METHODS: For the linguistic translation from English into Dutch, the forward and back-translation approach was followed. For cultural adaptation, an expert panel reviewed the translation, and a pretest was performed on a small clinical sample. Examiner training and calibration were carried out, and the clinical reliability of a "gold standard examiner" and 3 clinicians was assessed on 18 symptomatic TMD patients and 6 asymptomatic controls. The order of the examinations was based on a quasi-random Latin square design. Intraclass correlation coefficients (ICCs) were calculated to assess the overall interexaminer reliability of the clinical examination. RESULTS: A linguistically valid and culturally equivalent translation of the RDC/TMD into Dutch resulted from the above-outlined procedure. As for the clinical reliability, the ICC values obtained could mostly be considered "excellent" or, less frequently, as "fair to good." Poor reliability was found only for some of the palpation tests. For uncommon diagnoses (disc displacement without reduction and without limited mouth opening; osteoarthritis), no reliable ICC value could be calculated. CONCLUSION: The mode described by the authors for preparing clinical sites for RDC/TMD-based research is a feasible one.     

A 22-year study of paroxysmal trigeminal neuralgia in 211 patients with a 3-year appraisal of the role of cryotherapy

The scope of this investigation included a comparative study of 211 patients with paroxysmal trigeminal neuralgia (PTN) seen over 22 years (from 1959 to 1981) and the use of an open-nerve freezing technique (cryotherapy) on peripheral branches of the trigeminal nerve in 42 of these patients over 3 years (from 1978 to 1981). The study was divided into three parts. Part I was an analysis of clinical findings in all patients. Part II dealt with 33 medically uncontrolled patients and was an assessment of cryotherapy under the most adverse conditions. Part III consisted of an unselected group of 16 patients whose pain could be controlled by chemotherapy but who were not in remission. It was an assessment of cryotherapy in 9 of them as a replacement or adjuvant to chemotherapy. A total of 62 operations were performed, resulting in immediate pain relief and the gradual return of sensation in the treated nerve in all patients. The procedure had to be repeated in 6 patients early in the study to achieve this; one probable reason was inadequate freezing. The longest period of relief has been 2 1/2 years so far; the first patient treated 3 years ago, failed to return and could not be traced. Migration of pain to smaller branches of the trigeminal nerve occurred in 16 patients from 3 to 9 months postoperatively. This was abolished by further cryotherapy in the areas of migration. It is postulated that cryotherapy acts both peripherally and centrally to produce pain relief; if the technique is correctly carried out, the results can be long lasting and may be permanent.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mechanical and chemical home plaque control: a study of Brazilian children and adolescents with disabilities

The purpose of this study was to evaluate the compliance of children and adolescents with disabilities with a home plaque control program. A random sample of 52 students between 7 and 21 years old was solicited from a special school, in Belo Horizonte, Brazil. Measurement of the Debris Index and the presence of bleeding on light probing of the buccal gingival papillae were included as part of the initial clinical examination. Plaque control instructions were given during the first and subsequent clinical sessions. During the fourth clinical session, the patients who had more than 25% sites with bleeding papillae on light probing were placed in a separate group (Group 2) which used a mechanical and chemical plaque control protocol. Group 1 consisted of persons who used mechanical plaque control only. All of the patients were followed up for two more recalls (days 51,81) during which they were given plaque control instruction and had another gingival examination. On day 111, the final Debris Index and gingival examination were carried out. A significant reduction (p < 0.02) was found between the first and final Debris Index recordings in both groups. Subjects in Group 1 had a significant reduction (p < 0.001) when the first gingival examination was compared with days 21, 51, 81, and 111. Group 2 showed significant reduction (p < 0.01) in gingival bleeding when day 21 was compared with days 81 and 111. Our study suggests that it is possible for these children/adolescents and their parents to learn and comply with mechanical and chemical plaque control at home.     

Oral surgery in patients on anticoagulant treatment without therapy interruption.

PURPOSE: Conflicting opinions exist in literature concerning the management of oral surgery in patients on oral anticoagulants because no consensus on perioperative protocols is available, including precise guidelines regarding the need for therapy modification or withdrawal. The aim of this study was to evaluate bleeding complications associated with oral surgery performed on patients on oral anticoagulants without therapy modification or withdrawal but following a standardized comprehensive perioperative management protocol. PATIENTS AND METHODS: Patients on oral anticoagulant therapy with warfarin and in need of oral surgery underwent a thorough general and oral clinical evaluation to assess thromboembolic and bleeding risk; 255 subjects who, on the morning of surgery, had INR values 相似文献   

A clinical study of the Br?nemark dental implant system

A clinical study using the Br?nemark dental implant system was carried out on 13 patients aged 41 to 68 years. Clinical and psychological effects of treatment were assessed at 6-monthly intervals over a period of 3 years by means of a clinical examination, a personality assessment using Cattell's 16 PF Questionnaire and a general subjective questionnaire. Six per cent of implants failed to osseointegrate. Fifty per cent of bridges became loose, but remained stable after retightening. A similar percentage of fractures occurred, mainly teeth separating from acrylic gumwork. There was some soreness of peri-implant mucosa, particularly on cleaning. Despite these problems, there was considerable evidence of improved well-being of patients, who felt more secure following treatment and, as a result, their personal and social relationships improved.