Immediately loaded implants in a patient with involuntary mandibular movements: a clinical report.

Immediately loaded implant prostheses have been used to successfully rehabilitate completely edentulous arches. Risk factors for successful treatment have not included involuntary mandibular movements. The treatment was completed on a patient with a history of neuroleptic medications who had remaining mandibular teeth extracted and then developed involuntary mandibular movements. The patient was dissatisfied with a mandibular removable prosthesis and wanted a fixed prosthesis. The immediate implant loading of a complete arch fixed prosthesis was delivered, and the patient lost 3 of the 6 implants. The patient continued to have problems with her definitive prostheses as the symptoms of her involuntary mandibular movements worsened.

Temporomandibular disorder-type pain and migraine headache in women: a preliminary twin study.

AIMS: To determine whether shared genetic influences are responsible for the association between pain from temporomandibular disorders (TMD) and migraine headache. METHODS: Data were obtained from 1,236 monozygotic and 570 dizygotic female twin pairs from the University of Washington Twin Registry. TMD pain was assessed with a question about persistent or recurrent pain in the jaw, temple, in front of the ear, or in the ear. The presence of migraine headache was determined by self-report of doctor-diagnosed migraine. Univariate and bivariate structural equation models estimated the components of variance attributable to genetic and environmental influences. RESULTS: The best fitting univariate models indicated that additive genetic effects contributed 27% of the variance in TMD pain (95% confidence interval = 15% to 38%) and 49% of the variance in migraine headache (95% confidence interval = 40% to 57%). The best-fitting bivariate model revealed that 12% of the genetic component of TMD pain is shared with migraine headache. CONCLUSION: These preliminary findings suggest that the association between TMD pain and migraine headache in women may be partially due to a modest shared genetic risk for both conditions. Future studies can focus on replicating these findings with symptom- and diagnosis-based instruments.

Deep and superficial masseter muscle blood flow in women.

PURPOSE: Although changes in blood perfusion have been described as being associated with temporomandibular disorder (TMD) myofascial pain, very little is known about blood flow levels in the deep and superficial masseter muscle. This study investigated blood flow in deep and superficial sites of six healthy female participants at baseline and during intermittent and continuous biting exercises and recovery. MATERIALS AND METHODS: Blood flow was monitored unilaterally using a single-fiber probe laser Doppler flowmeter. The blood flow was continuously monitored at baseline and during two biting exercises: (a) intermittent at 25%, 50%, and 100% maximum voluntary bite force for 30 seconds each followed by 90 seconds rest between each biting level and (b) continuous biting at similar maximum voluntary bite force levels followed by 90 seconds rest. RESULTS: There was significantly higher blood flow in the deep sites compared to the superficial sites (p < 0.001) and a significant increase in blood flow during biting compared to baseline (p < 0.001). There were no significant changes in blood flow among the three levels of biting, between the intermittent and continuous exercises, or from baseline blood flow compared to recovery. CONCLUSIONS: This study showed regional differences in masseter muscle blood flow, perhaps related to differences in muscle fiber type and pattern of muscle fiber recruitment.

Are post-traumatic stress disorder symptoms and temporomandibular pain associated? Findings from a community-based twin registry.

AIMS: To determine whether symptoms of post-traumatic stress disorder (PTSD) are related to the pain of temporomandibular disorders (TMD) in a community-based sample of female twin pairs, and if so, to ascertain whether the association is due to the presence of chronic widespread pain (CWP) and familial/genetic factors. METHODS: Data were obtained from 630 monozygotic and 239 dizygotic female twin pairs participating in the University of Washington Twin Registry. PTSD symptoms were assessed with the Impact of Events Scale (IES), with scores partitioned into terciles. TMD pain was assessed with a question about persistent or recurrent pain in the face, jaw, temple; in front of the ear; or in the ear during the past 3 months. CWP was defined as pain located in 3 body regions during the past 3 months. Random-effects regression models, adjusted for demographic features, depression, CWP, and familial/genetic factors, were used to examine the relationship between the IES and TMD pain. RESULTS: IES scores were significantly associated with TMD pain (P < .01). Twins in the highest IES tercile were almost 3 times more likely than those in the lowest tercile to report TMD pain, even after controlling for demographic factors, depression, and CWP. After adjustment for familial and genetic factors, the association of IES scores with TMD pain remained significant in dizygotic twins (Ptrend = .03) but was not significant in monozygotic twins (Ptrend = .30). CONCLUSION: PTSD symptoms are strongly linked to TMD pain. This association could be partially explained by genetic vulnerability to both conditions but is not related to the presence of CWP. Future research is needed to understand the temporal association of PTSD and TMD pain and the genetic and physiological underpinnings of this relationship.

Correlation of admissions criteria with academic performance in dental students.

Our purpose was to compare admissions criteria as predictors of dental school performance in underachieving and normally tracking dental students. Underachieving dental students were identified by selecting ten students with the lowest class grade point average following the first year of dental school from five classes, resulting in a pool of fifty students. Normally tracking students served as a control and were randomly selected from students who had completed their first year of dental school not in the underachieving group. Admission measures of college grade point average (GPA), science grade point average (SGPA), academic average (AA), Perceptual Ability Test (PAT), college rigor, and academic load in college were evaluated with descriptive statistics, correlation, and regression analysis with first-year and graduating GPA as the dependent variables. Admissions criteria were generally weak predictors of first-year and graduating GPA. However, first-year dental school GPA was a strong predictor (R(2)=0.77) of graduating GPA for normally tracking students and a moderate predictor (R(2)=0.58) for underachieving students. Students who completed the first year of dental school having a low GPA tended to graduate with a low GPA. Therefore, remediation and monitoring would be important during the dental school experience for these students.

Diagnoses based on the Research Diagnostic Criteria for Temporomandibular Disorders in a biracial population of young women.

AIMS: To compare the clinical characteristics of diagnostic subtypes of temporomandibular disorders (TMD) based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) in terms of physical findings (Axis I) and psychosocial findings (Axis II) among Caucasian and African American young women. An ancillary goal was to assess the value of using self-reported TMD pain as a screening tool compared to RDC/TMD examinations. METHODS: A biracial community sample (n = 830) of young women 19 to 23 years old was screened for facial pain with the Chronic Pain Grade questionnaire. Patients were considered to be putative cases of TMD if they reported facial pain present within the last 6 months; putative controls had no facial pain history or jaw symptoms. Women with facial pain more than 6 months ago and jaw symptoms (jaw symptom-past pain, JSPP group) were added. 129 women were clinically examined for TMD diagnosis for final confirmation of case-control status. RESULTS: 41 of 43 Caucasian and 11 of 18 African American putative cases were confirmed as cases; 9 of 27 Caucasians, but 0 of 17 African Americans from the JSPP group were confirmed as cases. All 24 putative controls were confirmed as controls. Based on RDC/TMD Axis I, 80% of 61 cases were muscle-related diagnoses, 33% as disc-related diagnoses, and 48% as arthralgia/arthritis/arthrosis. Based on Axis I, there were no significant differences in diagnoses between African American and Caucasian women. Based on Axis II, cases had significantly greater depression (P = .002) and somatization with pain (P < .001) than controls as expected. African Americans had significantly greater somatization with pain than Caucasians (P = .020). There were no other significant racial differences. CONCLUSION: Among young women reporting facial pain, clinical TMD subtypes, pain impact, treatment utilization, and additional characteristics other than somatization with pain were similar between races. A high percentage of these young non-clinical cases presented severe depression and somatization.

Reports of body pain in a dental student population.

BACKGROUND: Dentists experience more neck, shoulder and lower back pain than do practitioners in other occupational groups. The authors examined the prevalence of musculoskeletal pain in dental students, by sex. METHODS: The authors investigated the body distribution and severity of reported musculoskeletal pain in a population of dental students, considering increased exposure to clinical experience with years in dental school. A total of 271 dental students in all four school years completed a questionnaire focusing on pain reported in five general body regions. RESULTS: Forty-six to 71 percent of students reported body pain, with the percentage generally increasing with years in dental school. Women reported having the worst pain in their neck/shoulder region (chi2, P = .004); men reported having the worst pain in their mid- to lower back regions (chi2, P = .015). Frequency and daily duration of the worst pain were higher in the third year of dental school than in the first year (Bonferroni test, P = .014 and P = .001, respectively), as was the persistence (in months) of the most symptomatic body pain (P = .001). Pain intensity was higher for women than for men (two-way analysis of variance, P < .05). The perception of how performance of dental procedures affects pain increased significantly with number of years in dental school (P = .001). CONCLUSIONS: Chronic musculoskeletal pain appears early in dental careers, with more than 70 percent of dental students of both sexes reporting pain by their third year. CLINICAL IMPLICATIONS: Musculoskeletal pain is a common complaint of dental professionals that may lead to serious physical disability. Since this type of pain occurs early in dental training, dentistry is obligated to further examine the mental, physical and ergonomic factors that may be contributory.

Chronic pain in a biracial population of young women.

This study investigated dimensions of chronic pain and temporomandibular disorders (TMDs) in a census tract sampling of African-American and Caucasian young women enrolled (from racially congruent households) at ages 9-10 in the longitudinal multicenter National Heart Lung and Blood Institute's Growth and Health Study (NGHS). The present study, which examined participants at the California clinical NGHS center when they were 19-23 years old, investigates five commonly reported chronic pains: back, head, face/jaw, abdomen, and chest. Chronic pain grade (CPG) status based on pain self-reports (frequency, duration, severity, and interference with usual activities) is reported for each of the five pain sites. Results show that chronic pain is common in this population of young women, although based on the CPG severity scores, only a small percentage is dysfunctional. Racial differences were not found for back, head, abdomen or chest pains. However, significant racial differences were found regarding facial pain and symptoms related to TMDs above and beyond socioeconomic status (SES) (lifetime prevalence: adjusted odds ratio (aOR)=2.14 and 95% confidence interval (CI)=1.40-3.31; 6 month period prevalence: aOR=2.03 and 95% CI=1.16-3.64). Not only were facial pain and jaw symptoms reported more frequently by Caucasians compared to African-Americans controlling for SES, but they were also reported to have an earlier onset.

Treatment planning in the 21st century: what's new?

Many variables affect treatment planning, and it is important for clinicians to consider why they plan certain procedures for patient care. New materials, technologies, and products are constantly being introduced and affect decision making in dentistry. In addition, patients are more informed, have higher esthetic concerns, and want a greater stake in treatment planning decisions than ever before. How dentists treatment plan needs to reflect the many influences on final treatment outcome. The purpose of this paper is to outline how treatment planning has changed in dentistry with the goal of providing the general dentist updated information to develop a cohesive treatment plan.

Complications associated with fixed partial dentures with a loose retainer.

STATEMENT OF PROBLEM: When 1 retainer of a definitive fixed partial denture (FPD) becomes loose, the clinician has the option of either sectioning and removing the FPD or attempting removal of the intact cemented retainer. Excessive force during attempted FPD removal may irreversibly damage dentition. PURPOSE: This study evaluated the type and frequency of complications that may accompany the removal of definitive cemented FPDs with a single loose retainer. MATERIAL AND METHODS: Participants included 22 patients with a definitive cemented FPD with complete cast crown coverage castings in which 1 retainer became loose and the other retainer remained cemented. Cemented FPD retainers were removed using 1 of 2 attachments supplied with a crown removal system (Dentco). The patient and FPD characteristics, type of attachment, number of attempts before removal, condition of removed FPD, and condition of the abutment teeth were recorded. Descriptive statistics were used to analyze the data. RESULTS: Clinical findings recorded prior to FPD removal showed that 41% of patients were unaware they had a loose FPD retainer and 82% reported no discomfort associated with the loose retainer. Caries were noted on 50% of the teeth with a loose retainer. Damage resulting from attempted removal of the cemented retainer included minor porcelain fracture (9%), minor core chipping (14%), minor incisal edge chipping of tooth preparations (27%), and major damage to the abutment tooth (4%). CONCLUSION: Retrieval of an intact FPD and recementation was possible 64% of the time.