Management of painful temporomandibular disorders: Methods and overview of The National Dental Practice-Based Research Network prospective cohort study.

BACKGROUND: Patients often seek consultation with dentists for temporomandibular disorders (TMDs). The objectives of this article were to describe the methods of a large prospective cohort study of painful TMD management, practitioners' and patients' characteristics, and practitioners' initial treatment recommendations conducted by The National Dental Practice-Based Research Network (the "network"). METHODS: Participating dentists recruited into this study treated patients seeking treatment for painful TMDs. The authors developed self-report instruments based on well-accepted instruments. The authors collected demographics, biopsychosocial characteristics, TMD symptoms, diagnoses, treatments, treatment adherence, and painful TMDs and jaw function outcomes through 6 months. RESULTS: Participating dentists were predominately White (76.8%) and male (62.2%), had a mean age of 52 years, and were general practitioners (73.5%) with 23.8% having completed an orofacial pain residency. Of the 1,901 patients with painful TMDs recruited, the predominant demographics were White (84.3%) and female (83.3%). Patients' mean age was 44 years, 88.8% self-reported good to excellent health, and 85.9% had education beyond high school. Eighty-two percent had pain or stiffness of the jaw on awakening, and 40.3% had low-intensity pain. The most frequent diagnoses were myalgia (72.4%) and headache attributed to TMDs (51.0%). Self-care instruction (89.4%), intraoral appliances (75.4%), and medications (57.6%) were recommended frequently. CONCLUSIONS: The characteristics of this TMD cohort include those typical of US patients with painful TMDs. Network practitioners typically managed TMDs using conservative treatments. PRACTICAL IMPLICATIONS: This study provides credible data regarding painful TMDs and TMD management provided by network practitioners across the United States. Knowledge acquired of treatment recommendations and patient reports may support future research and improve dental school curricula.

Associations of types of pain with crack-level, tooth-level and patient-level characteristics in posterior teeth with visible cracks: Findings from the National Dental Practice-Based Research Network.

OBJECTIVES: The objective of this study was to determine which patient traits, behaviors, external tooth and/or crack characteristics correlate with the types of symptoms that teeth with visible cracks exhibit, namely pain on biting, pain due to cold stimuli, or spontaneous pain. METHODS: Dentists in the National Dental Practice-Based Research Network enrolled a convenience sample of subjects each of whom had a single, vital posterior tooth with at least one observable external crack (cracked teeth); 2858 cracked teeth from 209 practitioners were enrolled. Data were collected at the patient-, tooth-, and crack-level. Generalized estimating equations were used to obtain significant (p < .05) independent odds ratios (OR) associated with teeth that were painful for 10 outcomes based on types of pain and combinations thereof. RESULTS: Overall, 45% of cracked teeth had one or more symptoms. Pain to cold was the most common symptom, which occurred in 37% of cracked teeth. Pain on biting (16%) and spontaneous pain (11%) were less common. Sixty-five percent of symptomatic cracked teeth had only one type of symptom, of these 78% were painful only to cold. No patient-, tooth- or crack-level characteristic was significantly associated with pain to cold alone. Positive associations for various combinations of pain symptoms were present with cracks that: (1) were on molars; (2) were in occlusion; (3) had a wear facet through enamel; (4) had caries; (5) were evident on a radiograph; (6) ran in more than one direction; (7) blocked transilluminated light; (8) connected with another crack; (9) extended onto the root; (10) extended in more than one direction; or (11) were on the distal surface. Persons who were <65 yo or who clench, grind, or press their teeth together also were more likely to have pain symptoms. Pain was less likely in teeth with stained cracks or exposed roots, or in non-Hispanic whites. CONCLUSIONS: Although pain to cold was the most commonly noted pain associated with symptomatic cracked teeth, no patient-, tooth- or crack-level characteristic was significantly associated with pain to cold alone. Characteristics were only associated with pain on biting and/or spontaneous pain with or without pain to cold. CLINICAL SIGNIFICANCE: Although often considered the most reliable diagnosis for a cracked tooth, pain on biting is not the most common symptom of a tooth with a visible crack, but rather pain to cold.

A novel, minimally invasive approach to managing mild epithelial dysplasia.

Conventional oral cancer screening examinations can be enhanced by direct tissue fluorescence visualization. Early dysplastic lesions detected during screening examinations often are monitored for progression or changes in appearance. Aggressive surgical intervention usually is contraindicated for mild epithelial dysplasia. As epithelial dysplasia progresses from mild to severe, the likelihood of it developing into carcinoma increases. Minimally invasive tissue management procedures should be considered as a possible method of early intervention to reduce the occurrence of oral cancer. This case report describes a novel approach to managing mild epithelial dysplasia when therapy is indicated (due to a high risk for oral cancer) but aggressive surgical management is contraindicated (due to a potential loss of function and increased morbidity).

Sensitivity of direct tissue fluorescence visualization in screening for oral premalignant lesions in general practice.

Various specialty clinics and research centers have conducted studies of direct tissue fluorescence visualization as a screening technique for oral premalignant lesions and early oral squamous cell carcinoma (OSCC). The effectiveness of the VELscope in a private practice setting is unknown. This pilot study is the first report to assess the VELscope system as a screening adjunct among lower-risk populations seen by a primary care clinician in a general practice setting. This study involved a retrospective comparison of two oral cancer screening examination protocols conducted on a presumably low-risk patient population seen in a private general dentistry practice. For one year, all patients age 12 or older received oral examinations, according to a standard oral cancer screening protocol. The following year, the same population was examined according to the same protocol with the addition of direct tissue fluorescence visualization using the VELscope. Screening with incandescent light examination yielded a prevalence of mucosal abnormalities of 0.83%, none of wich were premalignant. Screening with incandescent light examination combined with direct tissue fluorescence visualization yielded a 1.3% prevalence of mucosal abnormalities; based on surgical biopsy and histopathologic examination, 83% of these were potentially premalignant epithelial dysplasia.

Ethical decision-making for multiple prescription dentistry.

Technology provides a selection of treatment choices for dental problems. Dental ethics must be applied to the development of a treatment plan and the selection of methods. Treatment options should consider the patient's circumstances and desires as well as the dentist's decision as it relates to best practices in dentistry. This article presents four case studies that illustrate the process of ethical decision-making for the appropriate treatment.

An efficient and fully automated high-throughput transfection method for genome-scale siRNA screens.

RNA interference (RNAi), combined with the availability of genome sequences, provides an unprecedented opportunity for the massive and parallel investigations of gene function. Small interfering RNA (siRNA) represents a popular and quick approach of RNAi for in vitro loss-of-function genetic screens. Efficient transfection of siRNA is critical for unambiguous interpretation of screen results and thus overall success of any siRNA screen. A high-throughput, lipid-based transfection method for siRNA was developed that can process eighty 384-well microplates in triplicate (for a total of 30,720 unique transfections) in 8 h. Transfection throughput was limited only by the speed of robotics, whereas the cost of screening was reduced. As a proof of principle, a genome-scale screen with a library of 22,108 siRNAs was performed to identify the genes sensitizing cells to mitomycin C at concentrations of 0, 20, and 60 nM. Transfection efficiency, performances of control siRNAs, and other quality metrics were monitored and demonstrated that the new, optimized transfection protocol produced high-quality results throughout the screen.