Longitudinal Multilevel Modeling of Facial Pain, Muscle Tension, and Stress.

The role of masticatory muscle activation on pain in temporomandibular muscle and joint disorders (TMJD) is controversial. This single-group, prospective panel study examined the relationships among masticatory muscle tension, emotional distress, and TMJD pain in a sample of 7,023 observations obtained from 171 individuals using longitudinal multilevel modeling. Three main hypotheses were tested. The first posited that emotional distress and muscle tension directly influenced pain (hypothesis 1a: Distress → TMJD Pain; hypothesis 1b: Muscle Tension → TMJD Pain). The second posited that emotional distress directly influenced muscle tension (Distress → Muscle Tension), and the third posited that the effect of emotional distress on pain was mediated by muscle tension (Distress → Muscle Tension → TMJD pain). We also examined the fit of the data to possible alternative models. All the data used in this study were collected via an experience sampling methodology. The fit of the preferred models was better than that of the alternative models, with the preferred models explaining large proportions of the data, especially for level 2 variance (hypothesis 1a = 41% variance; hypothesis 1b = 69% variance; hypothesis 2 = 48% variance). In the mediation model, the addition of muscle tension to the model reduced the impact of emotional distress. The findings support a causal role for masticatory muscle tension in TMJD pain. Clinically, the results suggest that addressing tension and other oral parafunctions in those diagnosed with TMJDs should be an important part of the conservative, noninvasive care of individuals diagnosed with the myofascial pain or arthralgia of TMJD.

Exploration of the relationship between parent/guardian sociodemographics, intention, and knowledge and the oral health status of their children/wards enrolled in a Central Florida Head Start Program.

OBJECTIVE: The purpose of this study was to identify possible relationships between parent/guardian sociodemographics, intention, knowledge, and the oral health status of their child/ward. Intention includes three factors as defined in the Theory of Planned Behavior: attitudes, subjective norms and perceived control, and oral health status was measured by decayed, missing and filled teeth (dmft) scores. METHODS: A convenience sample of parent/guardian with child/ward with age of three to five (n = 181 dyads) enrolled in a Head Start program in the state of Florida participated. A cross-sectional observational study comprised of two components, parent/guardian questionnaire and an oral health status form for recording dmft scores of participating child/ward was employed. RESULTS: Parent/guardian race/ethnicity and years of education were significantly related to dmft of child/ward. The highest rates of severe early childhood caries (ECC) were found in child/ward whose parent/guardian is Hispanic and parent/guardian with less than a high school education. Multivariate regression analysis found that increased education level of parent/guardian was significantly associated with lower dmft in this population. No significant relationship was found between parent/guardian self-reported intention (attitudes, subjective norms and perceived control), knowledge and dmft scores of the child/ward. CONCLUSION: Researchers have called for greater attention to the impact of parental influences in the aetiology of ECC. Results from this study were consistent with current studies where parent/guardian race/ethnicity and educational level served as predictors of oral health status of children. In this study population, parent/guardian intention and knowledge were not shown to significantly impact the oral health status of their child/ward.

Measuring the short-term effects of incorporating academic service learning throughout a dental hygiene curriculum.

OBJECTIVES: Academic service learning (ASL) provides the venue for dental hygiene education to take oral healthcare services directly into communities while at the same time promoting professional responsibility within the student bodies. The purpose of this study was to quantitatively examine the change in pre-existing attitudes and behaviours of dental hygiene students following the incorporation of ASL activities throughout a five-semester dental hygiene curriculum. METHODS: Seventy-seven first-year dental hygiene students who participated in ASL from the graduating classes of 2008-2010 participated in the study. A survey instrument developed by Shiarella, based on Schwartz's Helping Behaviors Model, was used to assess students' attitudes towards community service. Additionally, questions were developed using Shinnamon's Methods and Strategies for Assessing Service-Learning in the Health Professions. RESULTS: Internal estimates of reliability for scales (Cronbach's α) were all >0.8. The results revealed statistically significant improvements over time in enhanced learning (P = 0.0001), self-awareness (P = 0.0001), sense of volunteerism (P = 0.013), impact on career choices (P = 0.001) and decrease in personal costs (P = 0.0001). There were no significant changes in other subscales over time. Further investigating these domains revealed minimal to no changes in attributes of service learning. CONCLUSION: Service learning integrated into the dental hygiene curriculum can enhance learning and improve students' self-awareness, sense of volunteerism, career choices and perception of personal costs. In concert with the literature on ASL, these experiences throughout the curriculum have potential for increasing students' awareness of community need and their roles as oral health professionals.

Novel methodology to evaluate the effect of residual moisture on epoxy resin sealer/dentine interface: a pilot study.

AIM: To evaluate the sealer/dentine interface associated with an epoxy resin sealer using the combination of Goldner's trichrome stain (GTS) and scanning electron microscopy (SEM) to verify the use of the experimental methodology. METHODOLOGY: Extracted human maxillary incisors (6) were subjected to root canal treatment. Subsequent to pulp removal, canal instrumentation and smear layer removal using EDTA and NaOCl, teeth were randomly and equally assigned to a 'wet' or 'dry' group. The 'dry' group was desiccated (95% ethanol/suction/paper points/air-drying), whilst the 'wet' group was treated with a saline rinse/suction/single paper point. Canals were then filled with an epoxy-based resin sealer and warm vertical gutta-percha compaction. After 7-day storage at 37°C, roots from each group were sectioned into apical, middle and coronal horizontal subsections that were cut and split into paired halves and evaluated with GTS or SEM. With GTS sections, hybrid layer and sealer tubular penetration were measured (n=15 measurements/intracanal location/condition) and evaluated using a two-factor repeated measures analysis of variance. The SEM qualitative analysis of paired sections was included as a complementary confirmation of GTS analyses. RESULTS: In dry and wet groups, there was no conspicuous sealer/dentine interface hybrid layer, irrespective of canal location. However, dry specimens exhibited more uniform sealer distribution with deeper tubular penetration in the coronal and middle third (P<0.05). In contrast, there was decreased sealer distribution and tubule penetration in the apical third, regardless of moisture condition (P<0.05). CONCLUSIONS: The experimental methodology (combination of GTS and SEM) can be used to evaluate the intracanal resin sealer/dentine interface. The pilot data indicated that thorough drying of the root canal system may result in improved epoxy resin sealer distribution and deeper resin sealer tubular penetration, especially in the coronal and middle thirds of root canals.

Effect of magnification lenses on student operator posture.

A distinct body of literature supports the association between clinical postures of the dental practitioner and work-related musculoskeletal disorders (WRMD). Several aids or devices have been tested to improve clinical posture in the interest of decreasing WRMD. The use of magnification lenses while performing dental procedures may increase the quality of work and decrease the likelihood of musculoskeletal problems. To date, only anecdotal and personal opinions had existed regarding the benefits of using magnification lenses, and no empirical evidence had authenticated the contention that use of magnification lenses exerts a positive change in operator posture. The objective of this study was to assess the effect magnification lenses had on the posture of dental hygiene students. Using a randomized crossover design, researchers videotaped nineteen senior dental hygiene students performing an intra-oral procedure with and without the use of magnification lenses. The tapes were then evaluated by a panel of five dental hygiene educators calibrated in the use of Branson's Posture Assessment Instrument (PAI). Results of a paired t-test indicate that the posture of the students while wearing magnification lenses was more acceptable (p=.019) than when wearing traditional safety glasses. Results of this study indicate a quantifiable change in acceptability of posture for clinicians wearing magnification lenses and suggest that the use of such lenses in dental education may be warranted.

Effectiveness of an oral and pharyngeal cancer awareness program for health professionals.

BACKGROUND: Of approximately 31,000 patients diagnosed as having oral/pharyngeal cancers (OPCs) each year in the United States, about half will die of the disease within five years, for reasons associated with patient behaviors as well as delays in diagnosis by health care professionals. METHODS: To address an apparent lack of OPC knowledge of health care professionals, a brief, non-discipline-specific, multi-component educational intervention was designed and presented to 352 health care professionals in community health centers and hospital training programs. OPC knowledge was assessed before and three months after the intervention. RESULTS: A 44% post-intervention response rate was obtained. There were significant (p < or = 0.05) increases in knowledge regarding oral sites at risk for OPC, etiologic factors, and early signs and symptoms. There were significant interactions (p < or = 0.01) between increases in knowledge and various health provider groups. A significant increase in perceived competency in OPC knowledge (p < or = 0.001) was reported, and significantly fewer participants felt the need for additional training. CONCLUSION: A brief, multi-component educational intervention can increase health care professionals' knowledge regarding OPC.

Effect of sonic and mechanical toothbrushes on subgingival microbial flora: a comparative in vivo scanning electron microscopy study of 8 subjects.

OBJECTIVES: The purpose of this initial study was to evaluate the effects of both a sonic and a mechanical toothbrush versus the effects of no treatment on depth of subgingival penetration of epithelial and tooth-associated bacteria. METHOD AND MATERIALS: Eight adult subjects exhibiting advanced chronic periodontitis with at least 3 single-rooted teeth that were in separate sextants with facial pockets > or = 4 mm and < or = 8 mm and that required extraction constituted the experimental sample. Teeth were either subjected to 15 seconds of brushing with a mechanical toothbrush or a sonic toothbrush or left untreated. The test tooth and the associated soft tissue wall of the periodontal pocket were removed as a single unit. Samples were processed and coded for blind examination by scanning electron microscopy. Distributional and morphologic characteristics of dominant bacteria with specific emphasis on spirochetes were evaluated for both epithelial- and tooth-associated plaque. RESULTS: No differences were found in morphotypes or distributional and aggregational characteristics of epithelial-associated microbes in the 1- to 3-mm subgingival zone between the mechanical and sonic toothbrush-treated groups and the control group. Both toothbrush groups featured disruption of microbes that extended up to 1 mm subgingivally. Root surfaces on the sonic-treated samples appeared plaque-free at low magnification; however, at 4,700x, a thin layer of mixed morphotypes and intact spirochetes was found subgingivally and slightly subgingivally. In comparison, mechanical brush samples featured incompletely removed plaque, both subgingivally and subgingivally, with intact spirochetes present on subgingival root surfaces. CONCLUSION: Results suggest similar effects for both sonic and mechanical toothbrushes on epithelial- and tooth-associated bacterial plaque in periodontal pockets and adjacent root surfaces that extend up to 1 mm subgingivally. Further, the presence of intact subgingival spirochetes suggests limited exposure to acoustical or mechanical energy from the toothbrushes evaluated.

Perceptions of social support in doctoral programs among minority students.

This study examined the perceptions of social support reported by 70 African-American, 44 Hispanic, 20 Native-American, and 69 Asian-American doctoral students (N = 203) concerning their experiences in graduate school. The Doctoral Student Survey was used to measure the levels and types of social support provided. One-way analysis of variance of mean scores indicated that a majority of doctoral students perceived the academic environment on campus and faculty advisers to be strong sources of social support, while perceiving the social environment on campus as unsupportive of their progress. The African-American and Native-American doctoral students perceived the social environment on campus to be less supportive than did the Hispanic and Asian-American doctoral students, and Native-American doctoral students perceived their departments to be less supportive than did the African-American, Hispanic, and Asian-American doctoral students.

Dental hygiene fear: gender and age differences.

Studies aimed at examining gender and age differences as they relate to dental anxiety have begun to appear in the literature. The purpose of this investigation was to explore fear and anxiety in a dental hygiene setting and evaluate gender and age differences among four sub-scales of dental hygiene fear. The Dental Hygiene Fear Survey (DHFS) was developed to address patient reaction to dental hygiene treatment. The University of Washington Dental Fears Model was the theoretical model used for it identifies four domains of dental fear: fear of specific stimuli, generalized anxiety, fear of catastrophe, and distrust. Males and females respond differently to dental hygiene treatment with women reporting significantly (p<.05) greater fear overall than males. Examination of the four dental hygiene fear sub-scales show that females report greater fear (p<.05) in relation to specific fear and generalized anxiety. There were no significant differences across age categories on total fear scores or within any of the sub-scales. Characterization of the dental hygiene fear patient along with knowledge of procedures that elicit anxiety can assist the practitioner in recognizing dental hygiene-related fear. With this foundation, the practitioner can then develop management strategies specific to this phenomenon.

Effect of an oral health training program on knowledge and behavior of state agency long-term-care surveyors.

This study examines the effect of a training program on long-term-care (LTC) surveyors' knowledge of factors affecting oral health and their behavior in citing oral health deficiencies of LTC residents. Twenty surveyors were recruited for the experimental group, along with a non-equivalent comparison group of 31 surveyors. The experimental group participated in a three-hour interactive, case-based training program. The experimental group had a significant increase in total knowledge (p < 0.002) post-test scores with a moderate effect size, eta 2 = 0.115. The training program resulted in a statistically significant increase (p < 0.0001) in oral health citation behavior for the experimental group for six months following training. This study provides evidence that an interactive case-based training program can affect participants' knowledge regarding oral health of LTC residents and participants' oral health citation behavior. As the elderly population experiences an increased life expectancy with increased need for assistance with Activities of Daily Living (ADL), similar training programs will become an important factor in assessing the quality of care provided to LTC residents.

Validity and reliability of the oral health-related quality of life instrument for dental hygiene.

PURPOSE: The purpose of this study was to examine reliability, construct validity, and produce a concise instrument for assessing Oral Health-Related Quality of Life (OHRQL). METHOD: The OHRQL model for dental hygiene served as the theoretical basis in the development of this instrument. The survey utilized five-point Likert scale items, designed to assess the domains of symptom status, functional status, and health perceptions. The instrument was administered to 321 functionally independent older adults from six Area Agency on Aging nutrition centers and three retirement communities in the Kansas City and St. Louis areas in Missouri. Scale reliability was demonstrated by calculating the coefficient alpha for each subscale. Item analysis was subsequently conducted to provide additional supportive evidence for reliability. Construct validity was assessed using a one-way multivariate analysis of variance MANOVA to examine the effect of known subgroups. Analysis of variances (ANOVA) for groups on each subscale was conducted as a follow-up test to the MANOVA. RESULTS: Coefficient for the seven subscales ranged from 0.74 to 0.89. No significant difference was found among males and females. However, there were significant differences in patterns of subscale means (p < .05) for subgroups reporting 'good' versus 'poor' denture fit; 'presence' or 'absence' of recent toothache; 'presence' or 'absence' of loose teeth; 'presence' or 'absence' of gingival recession; 'presence' or 'absence' of dentures interfering with eating; and self-report of 'good' versus 'poor' general health. CONCLUSION: These preliminary results provided initial supportive evidence of the OHRQL's reliability and validity. Future studies are needed to confirm this preliminary conclusion.

Clinical examination findings of temporomandibular disorder patients: a factor analytic study.

To assess the latent factor structure of clinical examination findings obtained from temporomandibular disorder patients, exploratory factor analysis was used to examine the relationships of a large number of variables obtained from a clinical examination to a smaller number of latent variables, or factors. Two independent samples of patients--an initial sample that consisted of 330 patients who complained of facial pain and a validation sample of 161 additional patients--were examined to determine whether the factor structure was reliable. A principal axis factor analysis with varimax rotation was used for both sets of data. The factor structure for the two samples was consistent between the two sets of data. Results identified two muscle pain factors (an "intraoral muscle" factor and an "extraoral muscle" factor) two unilateral jaw pain factors, and two factors that concern joint noise (clicking and crepitus). The implications of these findings for the current nosologic systems for temporomandibular disorders are discussed.

Oral health-related quality of life: a model for dental hygiene.

During the past decade, dental hygiene has been challenged to develop conceptual models to define the discipline. Such models can provide a common language and infrastructure for the discipline to define the process of care. Health-Related Quality of Life conceptual models have been adopted by many health professions to assist in planning health-related interventions and assessing outcomes to care. Based on the Natural History of Disease Schema, the Wilson & Cleary model, and Neuman's Systems Model, a new conceptual model for dental hygiene is proposed. The Oral Health-Related Quality of Life Model, composed of six primary domains: Health/Preclinical Disease, Biological/Clinical Disease, Symptom Status, Functional Status, Health Perceptions, and General Quality of Life. This model proposes a dynamic relationship among these domains and characteristics unique to individual clients or populations, and may have utility for interdisciplinary communication. As an integrated model, it may serve as a foundation for assessing, planning, implementing, and evaluating outcomes to dental hygiene care. This paper reviews possible application of the model for clinical practice, research, and education.

Effects of tartar-control dentifrice on tooth sensitivity: a pilot study.

PURPOSE: The purpose of this three-week, double-blind pilot study was to assess the effects of a tartar-control dentifrice on tooth sensitivity. METHOD: Fifty-six volunteer dental hygiene students completed a 14-item questionnaire regarding their oral health. Eighteen students were excluded from the study due to prior tooth sensitivity. Thirty-eight students were randomly assigned to either the experimental group using a tartar-control dentifrice (containing tetrapotassium pyrophosphate, PEG-6, disodium pyrophosphate, and tetrasodium pyrosulphate in a 5.0% soluble pyrophosphate formulation) or the control group using a regular dentifrice. Participants brushed for three weeks twice daily and then completed a post-treatment questionnaire, which included questions about tooth sensitivity. Differences between groups in reported sensitivity were measured by Fisher's Exact Test. RESULTS: Fisher's Exact Test revealed a statistically significant difference in sensitivity experienced by the experimental group compared to the control group (p < 0.05), which reported no sensitivity. The phi coefficient, used to examine the strength of the relationship between tartar control paste and tooth sensitivity, was found significant at p < 0.02. CONCLUSION: These findings suggest that patients may experience dentinal hypersensitivity when using the tartar-control toothpaste tested. Further long-term studies are required to test various brands of tartar-control dentifrice with a larger, more diverse sample for clinical measures of sensitivity.

In vitro effect of the Sensonic toothbrush on Treponema denticola.

The purpose of this in vitro study was to compare the effects of the Sensonic. Oral-B Braun mechanical and Oral-B manual toothbrushes upon the morphology and cellular integrity of Treponema denticola. This spirochete was chosen because of its frequent isolation from active lesions of inflammatory periodontal disease and its pathogenic potential. T. denticola, strain ATCC 33421, was grown in an anaerobic nitrogen rich atmosphere in enhanced 1186 mycoplasma broth. 160, 5-ml aliquots of cultured microbes were assigned to 1 of 3 brushing treatment groups and a control group. Samples were further divided into 4 groups of 10 samples each and assigned to one of 4 brushing exposure times: 15, 30, 45, and 60 seconds. After treatment, 0.2 ml of each sample was applied to a millipore filter and examined by SEM. Intact microbes were counted from 10 non-overlapping fields at 4500x. Remaining treated samples were pelleted and examined by TEM. A statistically significant reduction of intact microbes for the Sensonic treatment group at each exposure time was found when compared to Oral-B Braun, Oral-B manual, and non-treated controls. TEM examination of Sensonic treated samples revealed separation of the outer membrane at lower exposure times and only cellular debris after exposures of 45 and 60 s. These results suggest that exposure to the sonic frequency generated by the Sensonic toothbrush is capable of severely disrupting the structural integrity of T. denticola.

Effectiveness of a prescale gel on subgingival calculus.

A prescale gel product, designed to facilitate the removal of calculus, has recently been introduced and marketed to the dental profession. The purpose of this study was to evaluate the effectiveness of this gel on the removal of subgingival calculus. 10 patients, each with 5 periodontally diseased teeth scheduled for extraction, participated in this in vivo/in vitro study. 4 teeth per patient were randomly assigned using a 2-by-2 block design and treated in vivo with either active or placebo gel, with or without scaling, prior to extraction. To assess possible overexposure to the product, 10 selected teeth from the sample were treated with active gel for an extended exposure time. Standardized scaling was performed on a 4x4 mm treated root area in vitro on groups as assigned. Quantification of residual calculus was determined by one examiner blind to treatment group assignment using SEM photomicrograph montages and the Java image analysis computer system. Repeated measures ANOVA showed no statistically significant treatment effect for gel (p > 0.05) in the scaled and no-scaled groups. The 5th group exposed to the prescale gel for an extended time was evaluated descriptively for root surface morphological changes with no noticeable effect. Based on the results of this investigation, treatment of subgingival calculus with prescale gel offers no advantage for calculus removal over scaling alone. The findings suggest no significant clinical impact of product use.

The effect of personal protective equipment on high-and low-dental fear patients.

PURPOSE: This investigation was designed to examine both high- and low-dental-fear patients' perceptions about and anxiety responses to personal protective equipment (PPE) as presented in a videotaped, simulated interaction between oral healthcare worker and patient. METHODS: Sixty-two individuals representing a convenience sample presented at the University of Missouri-Kansas City (UMKC) Dental School and were screened for eligibility. The Dental Fears Survey was administered to participants to assess level of dental fear. Subjects were then matched according to fear level, gender, and age, and randomly assigned to an experimental or control group. Subjects viewed a videotaped vignette of a male dentist conducting a new patient interview. The control group viewed a tape in which the provider did not utilize PPE. The experimental group viewed the provider putting on PPE at completion of the interview. Subjects were instructed to complete a semantic differential scale at completion of the tape in order for the researchers to assess their attitude toward the scene. Paired adjectives in the semantic scale were scored from 1 to 7, with low scores reflecting negative evaluations and high scores reflecting positive evaluations. Heart rate and skin conductance were measured prior to and during the viewing of the videotapes by means of a photoplethysmograph and an electrodermograph, respectively. RESULTS: A two-factor ANOVA found the main effect of fear to be significant (p < .05), with subjects exhibiting high levels of dental fear rating both videotapes (PPE & NO PPE) more negatively than subjects exhibiting low levels of dental fear. A repeated measure ANOVA was used for analysis of heart rate and skin conductance. The Dunn's Multiple Means Comparison Test showed that skin conductance increased significantly (p < .05) in both groups from baseline to presentation of the oral healthcare environment. CONCLUSIONS: A videotaped presentation of the dental environment produced significantly more negative evaluations from patients with high fear than from patients with low fear. Both groups experienced a significant increase in skin conductance (perspiration) upon presentation of the oral healthcare environment. However, presence of PPE did not adversely affect patient perceptions of the oral healthcare provider.

Effects of subgingival irrigation with chlorhexidine on the periodontal status of patients with HA-coated integral dental implants.

The purpose of this study was to examine the effect of chlorhexidine irrigation on the periodontal status of patients with HA-coated dental implants as measured by clinical, microbiological, and immunological measures. Thirty non-adjacent implants were randomly assigned to receive a one-time irrigation with either 0.12% chlorhexidine or sterile saline, or no irrigation. All parameters were measured at baseline, 2, 5, and 8 weeks. Results showed no significant differences between any treatment modalities at any time interval. A statistically significant decrease in probing depth (P < .05) occurred within the chlorhexidine and no-treatment groups at all time intervals compared to baseline.