Effects of occlusal wear on 16-year progression of non-carious cervical lesions-Results of the study of health in Pomerania (SHIP-START).

BACKGROUND: It is still discussed whether occlusal wear (OW) affects the formation of non-carious cervical lesions (NCCLs). OBJECTIVE: To estimate effects of OW on the presence and development of NCCLs, using 16-year follow-up data from a cohort study. METHODS: Occlusal and cervical defects were measured in 728 cast models (one from the upper jaw and one from the lower jaw) of 364 participants. Adjusted mixed-effects ordinal logistic models analysing estimated cross-sectional (N = 1308 teeth/291 subjects) and longitudinal (N = 718 teeth/226 subjects) associations of OW with NCCLs using tooth level data. RESULTS: OW size was cross-sectionally (OR = 1.74; 95% CI: 1.27-2.38 for OW size; OR = 0.97; 95% CI: 0.94-0.99 for squared OW size), but not longitudinally (OR = 1.14; 95% CI: 0.99-1.30) associated with odds of higher NCCL sizes. For cross-sectional analyses, predicted probabilities of an NCCL size of 0 decreased from about 0.996 to 0.010 for OW sizes of 0 to 25. CONCLUSION: Results suggest an association between OW and NCCL size. However, as longitudinal results were non-significant, while consistent in direction, large-scaled cohort studies are demanded to more precisely estimate effect strength.

Mandibular advancement device: prescription in adult dental sleep medicine - guideline of the German Society of Dental Sleep Medicine.

PURPOSE: Obstructive sleep apnea (OSA) may result in severe health onditions, reduces quality of live, and affects high percentages of the adult population. Due to recent changes in the German health care regulations, mandibular advancement devices (MAD) will become available as a treatment option for OSA to a greater extent for general dentists and their patients. METHODS: A guideline development group consisting of nine members representing four German dental and medical organizations was formed, in order to provide critical information and orientation to the main stakeholders (dentists and patients), regarding the use of MAD for the treatment of OSA within dental sleep medicine. RESULTS: This guideline aims to inform physicians and dentists, particularly those with acquired qualification/specialization in sleep medicine (or in the diagnosis and treatment of sleep-related breathing disorders), as well as experts, payers, and patients. It delivers recommendations on technical requirements for MAD prescription and fabrication, clinical procedures, maintenance, and follow-up procedures. CONCLUSION: A MAD should be designed for long-term therapy and must be a custom made, adjustable, bimaxillary retained two-splint system equipped with adjustable protrusive elements. The fabrication in a dental laboratory should be based on dental impressions or scans and three-dimensional registrations of the starting position taken with a bite gauge.

Training of the lateral pterygoid muscle in the treatment of temporomandibular joint disc displacement with reduction: A randomised clinical trial.

BACKGROUND: Disc displacement with reduction (DDwR) therapy should be performed only when pain or discomfort is presented. Data on treatment options for painful DDwR are very limited. OBJECTIVE: The aim was to investigate whether isometric training of the lateral pterygoid muscle (LPM) is equivalent to stabilisation appliance therapy with regard to the treatment of painful DDwR. The training program is based on the science of Janda. METHODS: This was a prospective, randomised study with a comparative treatment group. Sixty patients (≥18 years) with DDwR and pain were randomly assigned to two groups: (1) muscle training and (2) stabilisation appliance. The following variables were recorded at baseline examination and after 2, 4 and 6 months: changes in orofacial pain, clicking sounds of the temporomandibular joint (TMJ), force degrees for the lateral movement of the mandible and interincisal opening distance. p values of <.05 were considered statistically significant but 95% confidence intervals were also presented. RESULTS: A decrease in orofacial pain intensity was seen in both groups (p < .0001). Registered TMJ clicking disappeared after 6 months of treatment in 37% (n = 11) of the patients in the training group and in 27% (n = 8) of the appliance group (p = .0009 and p = .0047). Muscle training showed 27 improvements in Janda force degrees at the end of the study (p < .0001). CONCLUSION: Muscle training and appliance therapy improved mouth opening and reduced pain intensity in both patient groups. Muscle training might be a promising option in the treatment of patients suffering from painful DDwR.

Consensus-based clinical guidelines for ambulatory electromyography and contingent electrical stimulation in sleep bruxism.

As yet, there are still no evidence-based clinical diagnostic and management guidelines for ambulatory single-channel EMG devices, like the BUTLER® GrindCare® (GrindCare), that are used in patients with sleep bruxism. Therefore, a consensus meeting was organised with GrindCare developers, researchers, and academic and non-academic clinicians experienced with the use of ambulatory EMG devices. The aim of the meeting was to discuss and develop recommendations for clinical guidelines for GrindCare usage, based on the existing clinical and research experience of the consensus meeting's participants. As an important outcome of the consensus meeting, clinical guidelines were proposed in which an initial 2-week baseline phase with the device in its inactive (non-stimulus) mode for habituation and assessment of the number of jaw-muscle activities is followed by a 4-week active phase with contingent electrical stimuli suppressing the jaw-muscle activities. As to avoid the commonly reported reduction in sensitivity to the stimuli, a 2-week inactive phase is subsequently installed, followed by a repetition of active and inactive phases until a lasting reduction in the number of jaw-muscle activities and/or associated complaints has been achieved. This proposal has the characteristics of a single-patient clinical trial. From a research point of view, adoption of this approach by large numbers of GrindCare users creates a great opportunity to recruit relatively large numbers of study participants that follow the same protocol.

New insights in the link between malocclusion and periodontal disease.

AIM: We aimed to investigate associations between malocclusions and periodontal disease by comparing it to that of smoking in subjects recruited from the population-based cross-sectional study "Study of Health in Pomerania." MATERIALS AND METHODS: Sagittal intermaxillary relationship, variables of malocclusion and socio-demographic parameters of 1,202 dentate subjects, 20-39 years of age, were selected. Probing depth (PD) and attachment loss (AL) were assessed at four sites by tooth in a half-mouth design. Analyses were performed with multilevel models on subject, jaw and tooth level. RESULTS: Distal occlusion determined in the canine region, ectopic position of canines, anterior spacing, deep anterior overbite and increased sagittal overjet were associated with AL (p-value <0.05). Associations between malocclusions and PD: deep anterior overbite with gingival contact (odds ratio [OR] = 1.40, 95% CI: 1.08-1.82; p-value = 0.0101) and anterior crossbite (OR = 1.75, 95% CI: 1.29-2.38; p-value = 0.0003). Regarding crowding, only severe anterior crowding was compatible with a moderate to large association with PD (OR = 1.93, 95% CI: 0.89-4.20). Compared to smoking, the overall effect of malocclusions was about one half for AL and one-third for PD. CONCLUSION: Malocclusions or morphologic parameters were associated with periodontal disease.

Alexithymia and temporomandibular joint and facial pain in the general population.

BACKGROUND: Associations of alexithymia with temporomandibular pain disorders (TMD), facial pain, head pain and migraine have been described, but the role of the different dimensions of alexithymia in pain development remained incompletely understood. OBJECTIVES: We sought to investigate the associations of alexithymia and its subfactors with signs of TMD and with facial pain, head pain and migraine in the general population. METHODS: A total of 1494 subjects from the general population completed the Toronto Alexithymia Scale-20 (TAS-20) and underwent a clinical functional examination with palpation of the temporomandibular joint and masticatory muscles. Facial pain, migraine and head pain were defined by questionnaire. A set of logistic regression analyses was applied with adjustment for age, sex, education, number of traumatic events, depressive symptoms and anxiety. RESULTS: Alexithymia was associated with TMD joint pain (Odds Ratio 2.63; 95% confidence interval 1.60-4.32 for 61 TAS-20 points vs the median of the TAS-20 score) and with facial pain severity (Odds Ratio 3.22; 95% confidence interval 1.79-5.79). Differential effects of the subfactors were discovered with difficulties in identifying feelings as main predictor for joint, facial, and head pain, and externally oriented thinking (EOT) as U-shaped and strongest predictor for migraine. CONCLUSION: Alexithymia was moderately to strongly associated with signs and symptoms of TMD. These results should encourage dental practioners using the TAS-20 in clinical practice, to screen TMD, facial or head pain patients for alexithymia and could also help treating alexithymic TMD, facial or head pain patients.

Standard and limit values for the symmetry of articulation parameters in the temporomandibular joint area - evaluations of the associated project of the SHIP study.

The articulation parameters, especially the horizontal condylar inclination angle (HCI), the Bennett angle (BA), and the immediate side shift (ISS) were determined in 259 subjects (100 males; 159 females) of the associated project with reference to the population-representative baseline study (Study of Health in Pomerania, SHIP 0). The evaluations were based on a clinical functional status and electronic motion recording with the ultrasonic measuring system Jaw Motion Analyser (JMA, Zebris, Isny, Germany). The reference plane, to which all measured values were represented and the HCI calculated, was the hinge axis infraorbital plane (HA-IOP). The HCI was determined after an excursive movement with a length of 4 mm to the HA-IOP in the sagittal view and the BA after a mediotrusive excursion movement of 6 mm in the horizontal view to the midsagittal plane. For the standard and limit values, the average value in addition to the standard deviation and the 10th and 90th percentile value (10th percentile value, 90th percentile value) were determined: HCI right 52.1 ± 10.14 degrees (39.4 degrees, 64.0 degrees), HCI left 53.1 ± 9.67 degrees (42.3 degrees, 67.0 degrees), BA right 15.2 ± 7.53 degrees (6.7 degrees, 25.0 degrees), BA left 14.2 ± 7.84 degrees (5.4 degrees, 24.1 degrees). The HCI was approximately 2 to 3 degrees larger in females (males: right 50.5 ± 9.47 degrees, left 51.9 ± 8.99 degrees; females: right 53.1 ± 10.42 degrees, left 53.8 ± 10.03 degrees). Likewise, the BA in the age group ≥ 40 years (males: right 14.4 ± 6.62 degrees, left 13.1 ± 7.14 degrees; females: right 17.0 ± 9.02 degrees, left 16.9 ± 8.72 degrees). The latter proved to be statistically significant in the t test for independent samples, assuming variance equivalence on the right, with P = 0.009, and with rejection of the variant equivalence on the left, with P = 0.002. The right and left HCI and BA joint values showed highly significant linear dependence at P < 0.001, but rather low, however, for the HCI with r2 = 0.175 for the HCI and r2 = 0.228 for the BA. In 46% of cases, the right and left HCI values differed up to 5 degrees only; a further 20.9% were in an interval difference of between 5 and 10 degrees. The following results were shown for the differences in the BA: 56.4% of the cases were between 0 and 5 degrees, and 26.2% were in the interval ranges of 5 to 10 degrees. ISS occurred in 18.1% of cases on the right side of the joint, and in 27.8% of cases on the left side. On both sides of the joint it was significantly more frequent in the age group ≥ 40 years with assumed variance equality than in the age group < 40 years (P = 0.002 right, P = 0.003 left). The groups relating to the Helkimo index (HI) did not differ significantly in all function-specific parameters. If it is assumed that there is no significant influence on the occlusion if the HCI values differ by 7 to 8 degrees from the average value, only approximately one third of all cases (35.1%) were characterized by a purely average value setting in the articulator. In 41.7% of cases, one joint value was situated outside the average value range; in 23.2% of the cases both values were outside the average value range. Without a measurement of the condylar path inclination, however, it is impossible to decide to what extent the HCI deviates from the average value, and which joint side is larger or smaller than the other and to what extent. These results suggest that in extensive and complex cases, the articulator should be adjusted according to individual, function-specific joint values.

Motion analysis of the mandible: guidelines for standardized analysis of computer-assisted recording of condylar movements.

Mandibular movement recording has long been established as the method for the physiological design of indirect dental restorations. Condylar movement recording is the basis for individual, patient-specific programming of partially or fully adjustable articulators. The settings derived from these recordings can generally be used in both traditional mechanical and electronic virtual articulators. For many years, condylar movement recordings have also provided useful information about morphological conditions in the temporomandibular joints (TMJs) of patients with masticatory system dysfunction based on the recorded movement patterns. The latest clinical application for recorded jaw-motion analysis data consists of functional monitoring of the patient as a diagnostic and surveillance tool accompanying treatment. Published parameters for the analysis of such recordings already exist, but a standardized and practicable protocol for the documentation and analysis of such jaw-movement recordings is still lacking. The aim of this article by a multicenter consortium of authors is to provide an appropriate protocol with the documentation criteria needed to meet the requirements for standardized analysis of computer-assisted recording of condylar movements in the future.

Oral bony outgrowths: prevalence and genetic factor influence. Study of twins.

OBJECTIVE: The aim of the study was to verify the influence of a genetic factor on the etiology of oral bony outgrowths and to determine the prevalence and type of oral bony outgrowths (tori and exostoses) among a group of Lithuanian twins. MATERIALS AND METHODS: In total, 162 twins (81 twin pairs) were analyzed for the presence or absence, type, and size of oral bony outgrowths. Statistical analysis was carried out to find the prevalence of bony protuberances and the relationship between zygosity and occurrence of oral bony enlargements. Zygosity of twins was confirmed by DNA analysis. RESULTS: 59.9% of the subjects had oral bony outgrowths. Mandibular tori were found in 56.8% and palatal tori in 1.8% of the sample. Palatal exostoses and mandibular exostoses were present in 1.8% and 3.1% of the sample, respectively, whereas maxillary exostoses were not found. A higher percentage of tori and exostoses were found in the group of older subjects (>18 years old, p=0.025). No significant difference was found between men and women in the prevalence of bony outgrowths. High κ and r values (0.91±0.062) showed very good concordance of oral bony outgrowths between monozygotic and moderate concordance (0.58±0.141) between dizygotic co-twins (p<0.001). The calculation of heritability estimate verifies dominant influence of genetic factor on the etiology of oral bony outgrowths (h(2)=0.658). CONCLUSION: The most common bony outgrowth was torus mandibularis. Our results show that the genetic factor is dominant in the etiology of oral bony outgrowths.

A comparison of periodontal status in the two regional, population-based studies of SHIP and INVEST.

OBJECTIVES: To compare the prevalence of periodontal disease between two randomly selected population-based studies (the Oral Infections and Vascular Disease Epidemiology Study (INVEST) and the Study of Health in Pomerania (SHIP)) and address relevant methodological issues. METHODS: Comparison was restricted to 55- to 81-year olds. Attachment loss (AL), probing depth (PD) and tooth count were assessed in INVEST (full-mouth, six sites) and SHIP (half-mouth, four sites). Subjects were classified according to the CDC/AAP case definition. Recording protocols were standardized. Mixed linear or logistic models were used to compare INVEST with SHIP. RESULTS: Mean half-mouth AL was lower in INVEST versus SHIP (INVEST: 2.9 mm versus SHIP: 4.0 mm, p < 0.05). Findings were similar across multiple periodontal disease definitions. After equalization of recording protocols and adjustment for periodontal risk factors, mean AL and PD were 1.2 and 0.3 mm lower in INVEST versus SHIP (p < 0.001). The odds for severe periodontitis (CDC/AAP) was 0.2-fold in INVEST versus SHIP (p < 0.001). Confounding effects of age, gender, race/ethnicity, education and use of interdental care devices were highest as indicated by change-in-estimate for study. CONCLUSION: Implementation of the proposed method for comparison of epidemiological studies revealed that periodontitis was less prevalent in INVEST compared with SHIP, even after extensive risk-factor adjustment.

Association between coronal caries and malocclusion in an adult population.

PURPOSE: Only a few but conflicting results have been reported on the association between malocclusions and caries. We investigated this association using data from the population-based cross-sectional Study of Health in Pomerania (SHIP). METHODS: Sagittal, vertical and transversal intermaxillary relationship, space conditions and sociodemographic parameters of 1210 dentate subjects (median age 30 years, interquartile range 25-35 years) were collected. Caries was assessed with the Decayed-Missing-Filled Surfaces index but analyzed as ordered outcome (four levels: sound, enamel caries, caries, tooth loss) in ordinal multilevel models, taking into account subject, jaw, and tooth level simultaneously. RESULTS: Anterior open bite ≤3 mm (odds ratio [OR] = 2.08, 95% confidence interval [CI]: 1.19-3.61), increased sagittal overjet of 4-6 mm (OR = 1.31, CI: 1.05-1.64), distal occlusion of ½ premolar width (OR = 1.27, CI: 1.05-1.53) and distal 1 premolar width (OR = 1.31, CI: 1.06-1.63) were associated with adjusted increased odds for a higher outcome level (caries). Anterior spacing (OR = 0.24, CI: 0.17-0.33), posterior spacing, (OR = 0.69, CI: 0.5-0.95), posterior crowding (OR = 0.57, CI: 0.49-0.66) and buccal nonocclusion (OR = 0.54, CI: 0.33-0.87) were associated with a lower outcome level (caries). CONCLUSION: The results from this population-based study suggest that a connection between caries and malocclusion exists to a limited extent in young adults. The associations with caries are contradictory for several malocclusion variables. Distal occlusion (OR = 1.31, CI: 1.06-1.63) and related skeletal anomalies displayed positive associations with caries whereas crowding did not. Orthodontic treatment of anterior crowding would probably not interfere with caries experience. These aspects should be considered for patient information and in treatment decisions.

Are third molars associated with orofacial pain? Findings from the SHIP study.

OBJECTIVES: To examine the association between third molars and orofacial pain. We hypothesized that impacted third molars are a cause of orofacial pain. METHODS: Magnetic resonance images of 1808 participants from two population-based cohorts from Northeastern Germany were analysed to define the status of third molars according to the Pell and Gregory classification. A self-reported questionnaire and a clinical dental examination were used to detect chronic and acute complaints of orofacial pain, masticatory muscle pain, migraine and other types of headache. Logistic regression models were used to analyse the associations between third molar status and orofacial pain. RESULTS: Individuals with impacted third molars in the maxilla had a higher chance of chronic orofacial pain than those with erupted third molars (odds ratio 2.19; 95% CI 1.19-4.02). No such association was detected for third molars in the lower jaw. Third molars were not associated with masticatory muscle pain, migraine or other types of headache. CONCLUSIONS: Impacted maxillary third molars might be a cause of chronic orofacial pain. Thus, physicians should consider the eruption/impaction status of third molars in their decision-making process when treating patients who complain of orofacial pain.

Association Between Symptoms of Posttraumatic Stress Disorder and Signs of Temporomandibular Disorders in the General Population.

AIMS: To estimate the association between signs of temporomandibular disorders (TMD) and symptoms of posttraumatic stress disorder (PTSD) in a representative sample from the general population of northeastern Germany. METHODS: Signs of TMD were assessed with a clinical functional analysis that included palpation of the temporomandibular joints (TMJs) and masticatory muscles. PTSD was assessed with the PTSD module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, ed 4. The change-in-estimate method for binary logistic regression models was used to determine the final model and control for confounders. RESULTS: After the exclusion of subjects without prior traumatic events, the sample for joint pain consisted of 1,673 participants with a median age of 58.9 years (interquartile range 24.8), and the sample for muscle pain consisted of 1,689 participants with a median age of 59.1 years (interquartile range 24.8). Of these samples, 84 participants had pain on palpation of the TMJ, and 42 participants had pain on palpation of the masticatory muscles. Subjects having clinical PTSD (n = 62) had a 2.56-fold increase in joint pain (odds ratio [OR] = 2.56; 95% confidence interval [CI]: 1.14 to 5.71, P = .022) and a 3.86-fold increase (OR = 3.86; 95% CI: 1.51 to 9.85, P = .005) in muscle pain compared to subjects having no clinical PTSD. CONCLUSION: These results should encourage general practitioners and dentists to acknowledge the role of PTSD and traumatic events in the diagnosis and therapy of TMD, especially in a period of international migration and military foreign assignments.

Prevalence and clinical signs of degenerative temporomandibular joint changes validated by magnetic resonance imaging in a non-patient group.

The aim of this study is to investigate associations between degenerative bony changes of the temporomandibular joint (TMJ) evaluated by magnetic resonance imaging (MRI) and signs and symptoms of temporomandibular disorders (TMD) in a non-patient group. A total of 307 subjects (140 males and 167 females) were selected from the cross-sectional epidemiological study "Study of Health in Pomerania" (SHIP) for this evaluation. A clinical functional examination of the masticatory muscles and the TMJs was performed as well as an MRI examination of the TMJs. Another 77 subjects (25%) exhibited degenerative changes of one or both TMJs in the MRI. Clinical analysis revealed pain on palpation of the masticatory muscles in 113 subjects. Some 39 subjects had pain during palpation of the TMJs. There were significant associations between the MRI confirmed diagnosis of osteoarthrosis and some clinical signs (joint noises, joint palpation pain, reduced mouth opening) and symptoms (reported pain in the jaw and masticatory muscles) of TMD as well as further MRI diagnoses (disc displacement with and without reduction, fibrosis of the posterior ligament). Although there were some associations, clinical examination alone is not sufficient for diagnosing degenerative joint diseases. MRI is a necessary diagnostic adjunct for estimating the prevalence of TMD subgroups in non-patient populations.

The influence of dynamic occlusal interferences on probing depth and attachment level: results of the Study of Health in Pomerania (SHIP).

BACKGROUND: The purpose of this study was to investigate potential associations between dynamic occlusal interferences and signs of periodontal disease in posterior teeth based on dental and medical measurements obtained from a population-based sample in the cross-sectional epidemiological study entitled, "Study of Health in Pomerania" (SHIP). METHODS: Medical history and dental and sociodemographic parameters of 2,980 representatively selected dentate subjects, 20 to 79 years of age, were collected. The analysis was performed on posterior teeth only using a mixed linear model that considers the clustered structure of the data. The model also was adjusted with respect to known risk factors for periodontal disease. RESULTS: The presence of non-working side contacts only was significantly related to probing depth (P<0.0001) and attachment loss (P=0.001). The presence of non-working side contacts and working side contacts on the same tooth was significantly related to increased probing depth (P=0.004) but not attachment level. The effect magnitude was a mean increase of 0.13 mm for probing depth and 0.14 mm in attachment loss. Known risk factors for periodontal disease that also showed significant associations with probing depth and attachment loss included male gender, age, smoking, education, and plaque score. Other factors significantly related to probing depth and/or attachment loss were tilted teeth, restored occlusal surfaces versus sound surfaces, elongated teeth, and tooth type (molar versus premolar). CONCLUSION: The effect of non-working contacts on periodontal disease status was discernible, but weak in terms of magnitude and specificity.

Influence of examiner differences on KIG-classification when assessing malocclusions.

OBJECTIVE: Indication systems such as the German KIG system (Kieferorthopädische Indikationsgruppen = Orthodontic Indication Groups) presuppose the objective assessment of underlying malocclusions. In this survey, we aimed to investigate the degree of agreement among the findings of several examiners in the assessment of different malocclusions and their classification according to the KIG system. SUBJECTS AND METHODS: Calibrated examiners assessed in the clinical evaluation and on plaster models orthodontic malocclusions in 180 adults (aged 20-49, 64 male, 116 female) from the population-based Study of Health in Pomerania (SHIP). Clinical examination was carried out by an experienced orthodontist, and the plaster models were also analysed by an examiner experienced in orthodontics. To compare inter- and intra-individual model examiners, we had two examiners with differing orthodontic experience carry out additional analyses of 60 of the 180 models (29 male, 31 female). RESULTS: The examiner differences yielded various KIG classifications and hence different assessments (i. e., whether KIG case-costs should be borne by health insurance). The comparison "clinical examination versus model analysis" revealed differences regarding 16.7% of the study participants in the assessment of whether the expense would be borne by the statutory health insurance fund. At 5.0-8.3%, the number of participants whose assessments had differed was much smaller in the inter-individual comparison of model-examiners and was smallest (at 3.3-6.7%) when comparison was made between intra-individual assessments (by a sole examiner). With regard to overall malocclusion assessment, the greatest examiner differences were again revealed when comparing the clinical examination with the model analysis (median kappa 0.57). The model-examiner comparison revealed larger differences among examiners with less orthodontic experience (median kappa 0.61 and 0.62) than the comparison between examiners with orthodontic experience (median kappa 0.70). CONCLUSIONS: There can occasionally be considerable examiner differences in the classification of participants according to orthodontic indication groups and hence varying assessments of whether such persons are KIG cases or not. Various means of data collection (clinical evaluation-plaster models) in the assessment of malocclusions by multiple examiners and by those with little orthodontic experience may negatively influence agreement among examiners.

Subgingival debridement with a teflon-coated sonic scaler insert in comparison to conventional instruments and assessment of substance removal on extracted teeth.

OBJECTIVE: Previous studies have shown that endotoxins are located on the periodontally diseased root cementum and not within it. To what extent a Teflon-tubed sonic scaler was capable of removing bacterial deposits in comparison to conventional scaling instruments, and the resulting root surface roughness and root surface topography, were recently assessed. The objective of the present study was to evaluate how much root cementum is removed with these instruments. METHODS AND MATERIALS: Eighty-two teeth were treated subgingivally on one approximal site either with a Teflon-coated sonic scaler insert (tSS), a Gracey curette, a conventional sonic scaler (SS), a piezoelectric ultrasonic scaler insert (US), or an oscillating Periotor insert (PT) before extraction. The untreated site served as control. The width and length of cementum removal were compared histomorphometrically. Nonparametric analyses were carried out for statistical comparison. RESULTS: The US, PT, and tSS inserts removed less substance than the curettes or SS inserts. The cementum removed was 40 microm for root surfaces treated with the curette or SS, 30 microm for those treated with US, 20 microm for PT, and 17 microm for tSS. CONCLUSION: The Teflon-coated sonic scaler inserts can be a reasonable choice for gentle maintenance treatment of compliant patients with good plaque control, and little or no subgingival deposits.

Risk factors for headache, including TMD signs and symptoms, and their impact on quality of life. Results of the Study of Health in Pomerania (SHIP).

OBJECTIVE: The aim of this investigation was to evaluate the role of various signs and symptoms of temporomandibular disorders (TMD), among other potential risk factors, in developing frequent headache in a population-based sample of the cross-sectional epidemiologic Study of Health in Pomerania (SHIP). The impact of headache and of myogenous and arthrogenous signs of TMD on the quality of life of this sample was evaluated. METHOD AND MATERIALS: Medical history and dental and sociodemographic parameters of 4,255 subjects were checked for correlations with frequent headache using a multivariate logistic regression model. The quality of life of the headache sufferers was evaluated with a questionnaire on mental and physical health. RESULTS: Of the sample, 9% reported suffering from frequent headache. Significant values for the odds ratios for the whole sample were found for pain on palpation of the masticatory muscles; the anamnestic question on masticatory muscle pain; ear noises; lateral palpation pain of the temporomandibular joints (TMJ); several sleep disorders; psychosomatic complaints; and risk for women. Palpation pain of the muscles showed a dose/response effect. Subjects with a higher education level had a significantly reduced risk for developing frequent headache. Anamnestic questions for pain in the TMJ area, TMJ clicking, smoking, alcohol abuse, contraceptives, income, and chronic diseases did not correlate significantly with frequent headache. Subjects who reported frequent headache exhibited a significant reduction of physical and mental health scores. Pain upon muscle palpation showed significantly reduced scores on both scales for both genders. CONCLUSION: Within the limitations of this study, in addition to sensitive TMJs, mainly palpation-sensitive masticatory muscles showed a significant relation to the occurrence of frequent headache. Because of the number of tested covariates originally included in the model, this relation seems essential.

Association of malocclusion and functional occlusion with subjective symptoms of TMD in adults: results of the Study of Health in Pomerania (SHIP).

An analysis of exclusively representative population-based studies on adults has shown that only few and inconsistent associations could be detected between malocclusions and clinical signs of temporomandibular disorders (TMD)--and none for functional occlusion factors (occlusal interferences, non-working side contacts, etc). The aim of this study was to analyze associations between morphologic occlusion as well as factors of functional occlusion and subjectively perceived symptoms of TMD--again on the basis of the population-based Study of Health in Pomerania (SHIP), providing a sample of 4310 subjects (out of 7008 subjects yielding a response rate of 68.8%) aged 20 to 81 years, and other international representative studies from the systematic review. Besides occlusal factors also parafunctions and socioeconomic status (SES) were taken into account (including age and sex). Multiple logistic regression analysis was used--adjusted for SES. In this study, none of the occlusal factors were significantly associated with the indication of more frequent subjective TMD symptoms. However, the parafunction "frequent clenching" was connected with subjective TMD symptoms (odds ratio = 3.4). Compared with other population-based studies few and (across studies) inconsistent associations between malocclusions and subjective TMD symptoms could be ascertained. No significant associations of factors of functional occlusion with TMD symptoms were identifiable.

Oral parafunctions and positive clinical examination findings.

STATEMENT OF PROBLEM: Oral parafunctional activity can be fatigued and painful masticatory muscles and/or pain in the temporomandibular joints. There is controversial discussion in the literature as to what role parafunctional activity plays in the multi-causal pathologic process. PURPOSE: The purpose of this study was to determine any association between the level of parafunctional habits versus the level of mandibular dysfunction and to test the hypothesis that TMD/bruxer patients have significantly increased muscle tension and joint pain. MATERIAL AND METHODS: There were 307 subjects (140 males und 167 females) selected for this investigation. 299 subjects were examined regarding any relationships between clenching and the incidence of muscle sensitivity. The age of subjects ranged from 20 to 54 years old, with a mean age of 35.4. 114 subjects had at least one sign of temporomandibular disorders (tenderness/pain on palpation of the joints or muscles, TMJ sounds, pain or deviation during maximum mouth opening (active/passive). RESULTS: 81 subjects admitted to clenching, while 218 said they did not. Among the "non-clenchers", 68.8% had no sensitive muscles, 31.2% indicated sensitive masticatory muscles. Those who clenched their teeth were distributed as follows: 53.1% were diagnosed with bilateral masticatory muscle sensitivity, 46.9% showed no such indications. The two groups were not homogeneously divided, with regard to pain/discomfort (p = 0.001; Fisher's precision test). CONCLUSION: This study found a statistically solid relationship between the incidence of "clenching" and muscle palpation findings, as well as between sensitivity in the mandibular joints from lateral and to cranial and dorsal with positive muscle palpation findings. The agreement between sensitivity of the masticatory musculature and the mandibular joint demonstrates that intensive clenching can predominantly lead to pathologic phenomena in the muscles or joints.