The association between neck disability and jaw disability.

The association between cervical spine disorders (CSD) and temporomandibular disorders (TMD) has been extensively investigated. However, no studies investigating the relationship between the level of jaw disability and neck disability have been published. Therefore, the objective of this study was to determine whether there was a relationship between neck disability measured using the neck disability index (NDI) and jaw disability measured through the jaw function scale (JFS). A sample of 154 subjects who attended the TMD/Orofacial Pain clinic and students and staff at the University of Alberta participated in this study. All subjects were asked to complete the NDI, the JFS, the jaw disability checklist (JDC), and the level of chronic disability of TMD (chronic pain grade disability questionnaire used in the RDC/TMD). Spearman rho test was used to analyse the relationship between neck disability and jaw disability. Multiple regression analysis was used to determine the association between the level of chronic disability of TMD and neck disability. A strong relationship between neck disability and jaw disability was found (r = 0.82). A subject with a high level of TMD disability (grade IV) increased by about 19 points on the NDI when compared with a person without TMD disability. These results have implications for clinical practice. If patients with TMD have neck disability in addition to jaw disability, treatment needs to focus on both areas because the improvement of one could have an influence on the other.

A survey of prelicensure pain curricula in health science faculties in Canadian universities.

OBJECTIVE: The present exploratory, descriptive study aimed to determine the designated time for mandatory pain content in curricula of major Canadian universities for students in health science and veterinary programs before being licensed. METHOD: Major Canadian university sites (n=10) were chosen where health science faculties included at least medicine (n=10) and nursing (n=10); many also included dentistry (n=8), pharmacy (n=7), physical therapy (n=8) and/or occupational therapy (n=6). These disciplines provide the largest number of students entering the workforce but are not the only ones contributing to the health professional team. Veterinary programs (n=4) were also surveyed as a comparison. The Pain Education Survey, developed from previous research and piloted, was used to determine total mandatory pain hours. RESULTS: The majority of health science programs (67.5%) were unable to specify designated hours for pain. Only 32.5% respondents could identify specific hours allotted for pain course content and/or additional clinical conferences. The average total time per discipline across all years varied from 13 h to 41 h (range 0 h to 109 h). All veterinary respondents identified mandatory designated pain content time (mean 87 h, range 27 h to 200 h). The proportion allotted to the eight content categories varied, but time was least for pain misbeliefs, assessment and monitoring/follow-up planning. CONCLUSIONS: Only one-third of the present sample could identify time designated for teaching mandatory pain content. Two-thirds reported 'integrated' content that was not quantifiable or able to be determined, which may suggest it is not a priority at that site. Many expressed a need for pain-related curriculum resources.

Bruxism and orofacial movements during sleep.

Several issues remain to be clarified in the future research and management of SB. It is important to differentiate SB from other normal sleep orofacial activities and concomitant sleep disorders. Other orofacial activities may obscure the diagnosis of SB and may give an ambiguous clinical picture when evaluating treatment efficacy. Laboratory recordings provide a more specific diagnosis. Most of the clinical signs (e.g., tooth wear, masseter hypertrophy) are not exclusive to SB but could be concomitant with other habits or activities during wakefulness. No pathologic features in the central nervous system, such as a dysfunction of the dopaminergic system, have been observed in SB patients. Recent neurophysiologic studies have suggested that SB is a powerful microarousal event associated with central and autonomic nervous system activity during sleep. The additive contribution of psychosocial stress cannot be overlooked. There have been no recent major breakthroughs in SB management. Cognitive and behavioral managements, which include stress management, lifestyle changes, or improved coping mechanisms, may be beneficial. Oral splint appliances are useful to protect teeth from damage. A few medications (e.g., benzodiazepines, muscle relaxants) may be helpful for a short-term period, particularly when there is secondary pain, but controlled studies are needed to assess their efficacy, safety, and patient acceptance and tolerance.

Evaluation of glucosamine sulfate compared to ibuprofen for the treatment of temporomandibular joint osteoarthritis: a randomized double blind controlled 3 month clinical trial.

OBJECTIVE: To compare the treatment potential of glucosamine sulfate (GS) and ibuprofen in patients diagnosed with temporomandibular joint (TMJ) osteoarthritis (OA). METHODS: Forty women and 5 men received either GS (500 mg tid) or ibuprofen (400 mg tid) for 90 days in a randomized double blind study. ASSESSMENT: TMJ pain with function, pain-free, and voluntary maximum mouth opening, Brief Pain Inventory (BPI) questionnaire and masticatory muscle tenderness were performed after a one week washout and at Day 90. Acetaminophen (500 mg) dispensed for breakthrough pain was counted every 30 days to Day 120. RESULTS: In total, 176 adults were interviewed, 45 (26%) qualified, 39 (87%) completed the study (21 GS, 18 ibuprofen). Four discontinued due to stomach upset (3 ibuprofen, one GS), one due to dizziness (GS), one due to inadequate pain control (ibuprofen). Within-group analysis revealed significant improvement compared to baseline of all variables in both treatment groups but no change in acetaminophen used. Fifteen GS (71%) and 11 ibuprofen (61%) improved, with positive clinical response taken as a 20% decrease in primary outcome (TMJ pain with function). The number of patients with positive clinical response was not statistically different between groups (p = 0.73). Between-group comparison revealed that patients taking GS had a significantly greater decrease in TMJ pain with function, effect of pain, and acetaminophen used between Day 90 and 120 compared with patients taking ibuprofen. CONCLUSION: GS and ibuprofen reduce pain levels in patients with TMJ degenerative joint disease. In the subgroup that met the initial efficacy criteria, GS had a significantly greater influence in reducing pain produced during function and effect of pain with daily activities. GS has a carryover effect.