Effect of clinical experience and training with visual feedback on standardized palpation outcomes-Potential implications for assessment of jaw muscle sensitivity.

BACKGROUND: The evaluation of muscle pain and sensitivity by manual palpation is an important part of the clinical examination in patients with myalgia. However, the effects of clinical experience and visual feedback on palpation of the masticatory muscles with or without a palpometer are not known. OBJECTIVE: To estimate the effects of clinical experience and visual feedback on the accuracy of palpation in standardized settings. METHODS: Thirty-two dentists (age 35 ± 11 years) classified as either specialists (n = 16) or generalists (n = 16) participated in this experiment. All dentists were instructed to target force levels of 500- or 1000-gf, as determined on an electronic scale using either standardized palpometers or manual palpation (MP). All dentists participated in four different tests: MP, MP with visual feedback (MPVF), palpometer (PAL) and PAL with visual feedback (PALVF). Actual force values for each type of palpation from 0 to 2, 2 to 5 and 0 to 5 s were analysed by calculating target force level. RESULTS: The relative differences during 2-5 and 0-5 s with 1000 gf were significantly lower for generalists than for specialists (p < .05). In generalists and specialists, the coefficients of variation and the relative differences during 2-5 s were significantly lower for PAL and PALVF than for MP (p < .05). CONCLUSIONS: These findings suggest that the use of a palpometer, but not clinical experience with palpation of masticatory muscles, increases the accuracy of palpation, and ≥2 s of palpation with a palpometer is optimal for masticatory muscles.

Effect of sleep restriction on somatosensory sensitivity in the oro-facial area: An experimental controlled study.

BACKGROUND: No studies have addressed the effect of SR on somatosensory function in the oro-facial area. OBJECTIVES: The aim of this study was to investigate the effect of sleep restriction (SR) on the somatosensory perception of the tip of the tongue. MATERIALS AND METHODS: Using a crossover study design, 13 healthy participants took part in a random order, to a two arms experiments: the SR and control/no SR-arms. For all participants, the Epworth Sleepiness Scale (ESS) was used to assess sleepiness and mechanical sensitivity, and pain detection threshold was estimated at the tongue tip and right thumb (as a body area control site). In the SR-arm of the study, on day one, we estimated sensory baseline perception and repeated tests on day two, after a night of voluntary SR, and on day 3, after a recovery night. In the second arm, same sensory tests were done but no SR was requested. RESULTS: Significantly more sleepiness was observed after SR in comparison with baseline and recovery testing days (P < 0.05). After SR, mechanical pain threshold on the tip of the tongue was significantly lower on day after SR (day 2) and a rebound, higher values, were observed on the third day (P < 0.05); no difference on thumb site. In the control arm, no SR and no significant differences between days were observed for all the variables of interest. CONCLUSIONS: The present results suggest that SR may affect somatosensory perception in the oro-facial area.

Effect of sleep restriction on somatosensory sensitivity including occlusal sensation in the orofacial area.

PURPOSE: To investigate the effect of sleep restriction on somatosensory sensitivity related to occlusion. METHODS: Twelve healthy participants participated in an experimental voluntary total sleep restriction (SR) study. In a study design, they were invited to sleep as usual, normal sleep (NS) or to restrict their sleep for four nights. Following the SR night, participants were followed for 3 consecutive days including the 2 sleep nights. In NS experiment, all participants were instructed to maintain NS both nights. During all nights, actigraphy data were collected and total sleep time was estimated. On days before and after sleep conditions, all participants underwent measurements of tactile detection threshold (TDT), interocclusal detection threshold (IDT), perception of unpleasantness (POU), and the Epworth sleepiness scale (ESS). RESULTS: As expected, total sleep time on the first night in SR experiment was significantly shorter than on the second night in SR experiment and on the first night in NS experiment (P<0.05). ESS values on Day-2 following SR experiment were significantly higher than on Day-1 and Day-3 in SR experiment and Day-2 in NS experiment (P<0.05). There were no significant differences in TDT and IDT between each day at each measurement point in both experiments. POU was significantly lower on Day-2 in SR experiment than on Day-1 and Day-3 in SR experiment and on Day-2 in NS experiment (P<0.05). CONCLUSIONS: The present results suggest that SR affects to occlusal sensation related to POU.

Comparing the occlusal contact area of individual teeth during low-level clenching.

The aim of this study was to investigate the occlusal contact area (OCA) in individual teeth during low-level tooth clenching in 24 healthy participants. Before measurements were made, the 100% maximum voluntary contraction (MVC) was determined. At baseline, all subjects were instructed to close their mouth and touch the opposing teeth with minimal force. Occlusal contact was recorded during three jaw motor tasks (baseline, 20% MVC, and 40% MVC) using a blue silicone material. OCA thickness was determined from images and defined on five levels: level 1 (0-149 µm), level 2 (0-89 µm), level 3 (0-49 µm), level 4 (0-29 µm), and level 5 (0-4 µm). Premolar and molar OCAs increased significantly from baseline to 20% MVC and 40% MVC. The OCA of each anterior tooth did not change significantly with increasing clenching intensity at all levels. Our findings suggest that premolar and molar OCAs may be altered by low-intensity clenching, affecting the teeth and periodontal tissues.