Longitudinal Stability of Common TMJ Structural Disorders.

The longitudinal course of temporomandibular joint (TMJ) disc displacement (DD) and degenerative joint disease (DJD) has never been conclusively described with magnetic resonance imaging and computed tomography, respectively. This 8-y observational study's objective was to assess the longitudinal stability of DD and DJD among 401 subjects. The Validation Project provided baseline measures; follow-up was performed in the TMJ Impact Project. With magnetic resonance imaging, 2 radiologists rendered a consensus diagnosis of normal/indeterminate, DD with reduction, or DD without reduction. Computed tomography consensus diagnoses included normal/indeterminate, grade 1 DJD, or grade 2 DJD. Radiologist reliability was assessed by kappa; a Hui-Walter model was used to estimate, after accounting for diagnostic disagreement, the frequency of diagnostic progression and reversal. Permutation tests were used to test the statistical influence of concurrent baseline diagnoses on diagnostic changes at follow-up. Of 789 baseline joint-specific soft tissue diagnoses of DD, 598 (76%) joints showed no change; 109 (14%) demonstrated progression; and 82 (10%) had reversal. Of 794 joints with baseline joint-specific hard tissue diagnoses of DJD, progression was observed in 122 (15%) joints, no change in 564 (71%), and reversal in 108 (14%). Radiologist reliability (kappa) was 0.73 (95% CI, 0.64 to 0.83) for DD and 0.76 (95% CI, 0.68 to 0.83) for DJD. After accounting for the influence of diagnostic disagreement, progression of hard tissue diagnoses in the right TMJ occurred in 15.2% of subjects (95% CI, 10.5% to 20.8%) and reversal in 8.3% (95% CI, 4.9% to 12.3%); results were similar for soft tissue diagnoses and the left TMJ. Concurrent baseline soft tissue diagnoses were associated with hard tissue diagnostic changes at follow-up ( P < 0.0001). Baseline hard tissue diagnoses showed no statistical association with soft tissue changes at follow-up ( P = 0.11). Longitudinally, 76% of baseline TMJ soft tissue diagnoses and 71% of the baseline hard tissue diagnoses remained stable. Diagnostic reversal and progression were confirmed for both soft and hard tissues.

Cephalometric analysis and long-term outcomes of orthognathic surgical treatment for obstructive sleep apnoea.

The aim of this study was to describe skeletal and posterior airway changes after orthodontic treatment and surgical jaw advancement, and to evaluate whether there is a correlation between increasing advancement and a long-term reduction in obstructive sleep apnoea (OSA). Lateral cephalograms and polysomnography (apnoea-hypopnoea index, AHI) were collected from patients treated with bilateral sagittal split osteotomy (BSSO) or maxillomandibular advancement (MMA) in combination with orthodontics. Patients completed a questionnaire and the Epworth Sleepiness Scale (ESS) to assess long-term outcomes. Descriptive statistics for cephalometric measurements and linear regression were performed to find estimates of the final OSA (AHI and ESS) as a function of mandibular advancement. Forty-three patients with surgical advancement of the maxilla (5.2mm) and mandible (8.3mm) had a 4-mm increase in posterior airway. Thirty-three patients completed the long-term survey (6.3±2.6 years after treatment); 91% reported a reduction of OSA and were pleased with their facial appearance. The maxillomandibular and posterior airway increased. There was no evidence of a linear relationship between greater amounts of mandibular advancement and improvement of OSA. Patients with less than 10mm advancement had successful objective short-term and subjective long-term OSA reduction.

Pharmacological management of recurrent oral mucosal ulceration.

A number of diseases can cause recurrent intraoral ulceration. This review focuses principally on drug management of intraoral ulceration associated with local and systemic conditions most likely to be observed on an outpatient basis by the general practitioner. These consist of recurrent aphthous stomatitis, erosive lichen planus, benign mucous membrane pemphigoid (BMMP), erythema multiforme. Behçet's disease, allergic stomatitis and infection. Information is provided on a spectrum of medication found useful in ulcer management, including topical antimicrobial and antifungal agents, topical and systemic corticosteroids, topical and systemic analgesics, and systemic immunosuppressive and anxiolytic drugs, plus details of dosage, important adverse reactions and interactions. A treatment guide for management of recurrent aphthae is presented. The reader is presumed to be familiar with differential diagnosis and the importance of establishing an accurate impression before starting drug therapy.

Stenting unprotected left main coronary artery stenosis in heart transplant patients--the good, bad, and the ugly.

The major cause of late death following orthotopic heart transplantation is coronary artery vasculopathy. Approximately 50% of heart transplant patients have coronary artery vasculopathy 5 years post-transplantation. With advances in interventional cardiology technology, heart transplant patients with selected lesions are now undergoing intravascular stenting with acute-gain and late-loss rates similar to stenting in non-transplanted patients. We describe 3 consecutive cases of stenting unprotected left main coronary artery disease in orthotropic heart transplant patients. With follow-up to 3 years and no evidence of restenosis, these results suggest that stenting unprotected left main coronary artery lesions in heart transplant patients can be performed with excellent immediate and long-term results.

Sialochemistry of whole, parotid, and labial minor gland saliva in patients with oral lichen planus.

This study was undertaken to determine whether oral lichen planus in otherwise healthy patients is associated with sialochemical abnormalities. Unstimulated and stimulated whole saliva, stimulated parotid saliva, and stimulated labial minor gland saliva were collected from 25 patients with oral lichen planus and from 25 age- and sex-matched controls. Flow rate and salivary concentrations of immunoglobulins A and G, albumin, amylase, lysozyme, lactoferrin, and total protein were determined by standard analytical techniques. Concentrations of inorganic components including sodium, potassium, calcium, chloride, and phosphate were also measured. No significant differences were found between the lichen planus patients and the controls. These findings do not support an association between oral lichen planus and salivary dysfunction in otherwise healthy patients.

Clinical diagnostic criteria for TMD. New classification permits multiple diagnoses.

One of the first to permit multiple diagnoses, this new TMD classification scheme offers guidelines for clinicians and those conducting clinical field studies. The scheme was applied to a TMD population, with control subjects.

Intraligamentary anesthesia: a double-blind comparative study.

Three local anesthetic agents (Xylocaine 2%, Xylocaine 2% with epinephrine 1:50,000, and Marcaine 0.5 with epinephrine 1:200,000) were injected intraorally using an intraligamentary injection technique. The study used a double-blind design and electrical tooth pulp stimulation to examine the duration of pulpal anesthesia. Patterns of recovery from each drug, subjective discomfort associated with each drug, pain of injection, and pain in comparison with local infiltration were also measured. The extent and duration of adjacent soft tissue anesthesia were recorded. Xylocaine 2% with epinephrine 1:50,000 produced the longest pulpal anesthesia. The decay pattern of this particular drug was less abrupt than that of the two others. No difference in discomfort or pain was found across the various drugs. There was no significant difference in pain at injection when intraligamentary anesthesia was compared with local infiltration. Post-injection pain was slightly lower with local infiltration. The extent of soft tissue anesthesia was significantly related to vasoconstrictor levels in the drugs. The study shows that duration of pulpal and soft tissue anesthesia can be tightly controlled by the operator and tailored specifically to planned dental procedures.

Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls.

An epidemiologic study of clinical signs and symptoms of temporomandibular disorders (TMD) was conducted with a probability sample of adults enrolled in a major health maintenance organization (HMO). This report presents data from a first wave field examination and interview conducted by trained, calibrated dental hygienist field examiners. Significant gender differences for vertical jaw opening measures were observed but no significant age differences were found for the distribution of clinically relevant findings. Clinic cases showed smaller amounts of vertical range of jaw motion but did not differ from community cases or controls on extent of lateral, protrusive, or retrusive mandibular movements; on classification of occlusion; or on dentally related variables. Clinic cases had more pain during all jaw excursions as well as during muscle and joint palpation. Joint clicking sounds were also observed more frequently in clinic cases.

An empirical investigation of the role of pornography in the verbal and physical abuse of women.

In studies of male aggressiveness and pornography, social psychologists have found evidence to support the theory that consumption of pornography by males increases their aggressiveness and antisocial attitudes toward women. The research reported here studied the presence of pornography and both sexual and nonsexual violence in the lives of two groups of women: a group of battered women drawn from shelters and counseling groups, and a comparison group of women from a mature university population. It was found that the partners of the battered women read or viewed significantly greater amounts of pornographic materials than did the partners of the comparison group. In addition, 39% of the battered women (in contrast to 3% of the comparison group) responded in the affirmative to the question, "Has your partner ever upset you by trying to get you to do what he'd seen in pornographic pictures, movies, or books?" It was also found that battered women experienced significantly more sexual aggression at the hands of their partners than did the women in the comparison group.

Temporomandibular joint findings in pediatric populations and young adults: a critical review.

The etiology, diagnosis and treatment of temporomandibular joint (TMJ) pain and dysfunction is a controversial subject. There are varying opinions regarding the contribution of occlusion (malocclusion) to the development of mandibular dysfunction and further, the contribution of occlusal alterations (orthodontic and restorative) to the development of pain and dysfunction. Epidemiologic investigations suggest there is a high incidence of subjective and objective symptoms in the pediatric population. Observations on incisal relationships, condyle position and joint sounds, and comparisons to controls seem to suggest that these factors are not the cause of pain or dysfunction. The purpose of this review is: (1) to bring the clinician's attention existing published information reporting the presence of symptoms in children, (2) to evaluate selected information in young adults, (3) to question anecdotal information on the etiology of TMJ problems. It is not in the purview of this paper to determine the overall etiology of TMJ dysfunction.

An experimental study of the control of the gag reflex with nitrous oxide.

Gagging represents a management problem during dental procedures. A controlled, double blind experiment on human volunteers evaluated the efficacy of nitrous oxide for suppressing experimentally-induced gagging. The ability of the subjects to tolerate palatal and oropharyngeal stimulation was evaluated by measuring the distance of the anatomic palatal and oropharyngeal structure which produce gagging. It was observed that under N(2)O/O(2) inhalation subjects tolerated a significantly more intrusive (deeper) oropharyngeal stimulation than under control conditions.

Sigmoid colon perforation: result of accidental swallowing of a toothpick.

Acute surgical abdomen is a very serious situation that arises in various medical conditions. Common among them are appendicitis, foreign-body ingestion, and intestinal obstruction or perforation. These complications usually require emergency abdominal surgery. A case of rectal bleeding accompanied by acute surgical abdomen following the accidental ingestion of a toothpick is described in this report.

CQI longitudinally applied to integrated service outcomes.

Citing data collected between 1987 and 1994 at the St. Paul-Ramsey Medical Center, Ramsey Clinic and Ramsey Foundation, Paul A. Sommers, Ph.D., executive vice president and chief administrative officer of Ramsey, Michael G. Luxenberg, president of Professional Data Analysts, and Eric. P. Sommers of the River Falls Clinic, write how CQI has been introduced. The key is the application of inferential evaluation.