Volumetric wear of various orthotic appliance materials.

The purpose of this study was to compare the resistance to wear of six commonly used orthotic appliance materials. These materials were: SR Ivocap (Ivoclar Vivadent, Inc., Amherst, NY), Eclipse (Dentsply International, York, PA), ProBase (Ivoclar Vivadent), Valplast (Valplast International Corp., Oceanside, NY), Impak (CMP Industries LLC, Albany, NY), and Clearsplint (Astron Dental Corp., Lake Zurich, IL). Twelve cylindrical specimens of each material were fabricated per manufacturer instructions. Occlusal wear was simulated in a custom-made wear simulator with each specimen receiving four wear scars in a two-body wear simulation using a 1.5 mm tungsten-carbide tipped stylus at 40 newtons for 2500 cycles at 1 Hz, while immersed in 37 degrees C distilled water (n = 48). The specimens were evaluated before and after wear testing using a three-dimensional (3D) noncontact profilometer (Proscan 2000, Scantron Corp., Eagan, MN). A mean change in volume was determined for each orthotic material. Results found that Clearsplint material displayed the greatest amount of volume loss/wear, while SR Ivocap, Eclipse, and ProBase materials had the least amount of wear. Valplast and Impak performed more moderately. Based upon this wear knowledge, practitioners are able to more reliably choose the appliance material necessary for their various patients.

Diagnosing, managing, and preventing cracked tooth syndrome.

Cracked tooth syndrome (CTS) can be a perplexing disorder to diagnose and manage. Many practitioners wonder whether the latest dental materials and adhesives can or should be used when restoring these teeth. The authors reviewed the literature and developed recommendations for how to diagnose and manage CTS and prevent it in susceptible teeth. As the population continues to age and people retain their teeth longer, it is anticipated that patients will present even more frequently with symptoms of CTS.

Medial pterygoid trismus (myospasm) following inferior alveolar nerve block: case report and literature review.

A patient developed a medial pterygoid trismus (myospasm) the day after receiving three inferior alveolar nerve blocks and a routine restoration. She had a significantly restricted mouth opening and significant medial pterygoid muscle pain when she opened beyond the restriction; however, she had no swelling, lymphadenopathy, or fever. A medial pterygoid myospasm can occur secondary to an inferior alveolar nerve block. This disorder generally is treated by the application of heat, muscle stretches, analgesic and/or muscle relaxant ingestion, and a physical therapy referral. The severity of the disorder typically dictates the extent of therapy that is needed.

Persistent dysesthesia following dental implant placement: a treatment report of 2 cases.

Occasionally, a patient has persistent dysesthesia symptoms (eg spontaneous or evoked painful or unpleasant sensations) following the placement of a dental implant. This disorder may be sufficiently superficial that an anesthetic and steroid mixture can be infiltrated into the region and satisfactorily treat the disorder. If an anesthetic infiltration can significantly reduce the patient's pain, this therapy may be beneficial. A 50:50 mixture of local anesthetic and steroid are combined in a dental anesthetic carpule and infiltrated into the painful region. If over the following week, the change in pain is greater than one would expect from an anesthetic infiltration, it suggests that this provided some degree of therapeutic response. A series of these infiltrations can be performed until the patient is symptom free or there is no additional improvement from these infiltrations. Two cases are discussed using this therapy.

Evaluation of a 3-D interactive tooth atlas by dental students in dental anatomy and endodontics courses.

Advances in information and communication technology continually offer innovations to assist faculty in their efforts to help students learn new information or develop new skills. However, faculty members are often hesitant to incorporate these innovations into their courses out of fear that these new methods may not provide the anticipated outcomes. Hence, students are often the subjects of educational trials to evaluate curriculum innovations by comparing a new teaching/learning method to traditional lecture-based instruction. The most typical finding is that students can learn equally well by either method. However, two questions that have not been studied extensively in dental education are whether dental students will actually use computer-based educational resources made available to them and whether students perceive these materials to provide a value-added learning experience. Accordingly, the goals of this study were to determine whether first-year dental students (D1), second-year dental students (D2), and third-year dental students (D3) would 1) use an interactive tooth atlas, available on a DVD, as a study aid and 2) perceive that the atlas provided sufficient value-added benefit for their dental anatomy (D1), preclinical laboratory endodontics (D2), and clinical endodontics (D3) courses to recommend adding it to their school's comprehensive electronic resources. A low percentage of the students (14 percent; 40/289) voluntarily downloaded the atlas from a DVD to their laptops prior to the addition of incentives in the form of atlas-related examination questions. Even after incentives were added, only 43 percent of the students (126/289) downloaded the DVD. After using the atlas, students responded to the statement "Using the 3D Interactive Tooth Atlas was beneficial for me" on a 0 to 10 scale with 0 representing strongly disagree, 5 representing unsure, and 10 representing strongly agree. The mean rankings were 5.34 for D1s, 6.79 for D2s, and 7.28 for D3s. Students also responded to the statement "The atlas should be added to our school's VitalBook" (digital library of curriculum materials). The mean rankings for this statement, using the same 0-10 scale, were 5.15 for the D1s, 6.63 for the D2s, and 7.26 for the D3s. Based upon these findings, the course directors decided not to add this atlas to the students' electronic resources.

Management and treatment of temporomandibular disorders: a clinical perspective.

A temporomandibular disorder (TMD) is a very common problem affecting up to 33% of individuals within their lifetime. TMD is often viewed as a repetitive motion disorder of the masticatory structures and has many similarities to musculoskeletal disorders of other parts of the body. Treatment often involves similar principles as other regions as well. However, patients with TMD and concurrent cervical pain exhibit a complex symptomatic behavior that is more challenging than isolated TMD symptoms. Although routinely managed by medical and dental practitioners, TMD may be more effectively cared for when physical therapists are involved in the treatment process. Hence, a listing of situations when practitioners should consider referring TMD patients to a physical therapist can be provided to the practitioners in each physical therapist's region. This paper should assist physical therapists with evaluating, treating, insurance billing, and obtaining referrals for TMD patients.

Pulpalgia contributing to temporomandibular disorder-like pain: a literature review and case report.

BACKGROUND: Dentists need to be cognizant that temporomandibular disorder (TMD) -like pain can be caused by a tooth pulpalgia. The author provides suggestive symptom characteristics and definitive diagnostic techniques. CASE DESCRIPTION: A patient had severe bilateral TMD-like pain, which increased when something cold touched a premolar and when the patient lay down, and which awakened her several times every night. The author identified the offending tooth and administered a ligamentary injection along the tooth, which eliminated her bilateral TMD-like pain. Occlusal adjustment of her tooth reduced her pain, and subsequent endodontic therapy eliminated her pain. To the author's knowledge, this is the first report of a pulpalgia in a posterior tooth causing bilateral TMD-like pain. CLINICAL IMPLICATIONS: Pulpalgia may cause symptoms that mimic TMD or may contribute to TMD signs and symptoms. When patients with TMD-like pain report feeling increased pain due to a cold stimulus' coming into contact with a tooth, practitioners should ensure that a pulpalgia is not contributing to their pain.

Otologic symptom improvement through TMD therapy.

OBJECTIVES: Some patients with a temporomandibular disorder (TMD) and coexisting otologic symptoms desire to know the probability of TMD therapy improving their otologic symptoms. The aim of this study was to determine a clinically valid method for identifying which otologic symptoms have a high probability of improving as a result of satisfactory TMD symptom improvement. METHOD AND MATERIALS: Two hundred TMD patients with coexisting tinnitus, otalgia, dizziness, and/or vertigo were asked about their otologic symptom characteristics and associations and were given clinical tests, which were speculated to predict otologic symptom response from TMD therapy. The subjects received conservative TMD therapy in a manner thought to be most advantageous for their disorders. These potential assessment instruments were then evaluated for their ability to predict otologic symptom improvement. RESULTS: After satisfactory TMD symptom improvement was obtained, the percent of subjects reporting significant improvement or resolution of their tinnitus, otalgia, dizziness, and vertigo was 83%, 94%, 91%, and 100%, respectively. The chi-square and Fisher exact probability tests identified significant correlations for tinnitus, otalgia, and dizziness improvement with younger age; for tinnitus and otalgia improvement with subjects who related that the otologic symptom began when the TMD symptoms began, was worse when the TMD symptoms were worse, and was related to stress; and for dizziness improvement with subjects relating more severe TMD symptoms. CONCLUSION: Asking TMD patients with coexisting otologic symptoms these specific questions will help practitioners identify which otologic symptoms have a high probability of benefiting from TMD therapy.

Preparation course for Part I of the National Dental Boards: lessons learned.

Student performance on national board examinations is the predominant litmus test for successful programs in health science education. Many different strategies have been used to increase passing rates among students. The objectives of this study were to investigate the influence of a voluntary eighteen-hour National Board Dental Examination Part I (NBDE Part I) preparation course on student performance on the NBDE Part I and to assess students' perspectives on the preparation course. Students' perspectives were obtained through a questionnaire and focus groups. There were significant associations between the students' GPA and the overall examination score and between the course grades corresponding with each section and the section scores. Students attending sessions devoted to specific NBDE subject areas did not obtain significantly better scores for that subject area than nonattending students. Also, the students did not obtain significantly better overall scores for NBDE Part I than in previous years when a preparation course was not conducted. Students most frequently rated the Dental Deck's NBDE Part I Cards as the most helpful study aid, followed by old NBDE Part I tests. The most frequent student rating for most of the presentations was "somewhat helpful," while the most frequent rating for resources placed on Blackboard such as tables and summary material was "helpful." Based upon the findings, we recommended discontinuation of the classroom presentation portion of the board preparation course.

Efficacy of group cognitive behavior therapy for the treatment of masticatory myofascial pain.

The purpose of this investigation was to evaluate the reduction in perceived pain in patients with myofascial pain (MFP) using a group cognitive behavior therapy (CBT) course. Twenty-six participants diagnosed as having MFP were enrolled. Each CBT session had a small-group format, where participants received instruction in habit reversal, stress management, and progressive relaxation. Participants served as their own control subjects and were surveyed for pain intensity, duration, and frequency at study enrollment, before attending the CBT course, and 2 to 3 weeks after course completion. Wilcoxon signed-rank tests revealed that changes in intensity, frequency, and duration were significant (p < 0.001 to p < 0.045). Thirty-three percent of the participants showed improvement with home care instructions before CBT course start, whereas 65% of the participants showed improvement after the CBT course. Participants attending CBT group training exhibited significant improvements in MFP intensity, frequency, and duration, compared with levels reported at the initial evaluation.

Headache improvement through TMD stabilization appliance and self-management therapies.

The purpose of this study was to assess headache response of unselected neurology clinic chronic headache patients to TMD stabilization appliance and self-management therapies, and to identify features of patients whose headaches are more likely to improve from these therapies. Twenty chronic headache patients in a nontreatment control period were provided appliance and self-management therapies, evaluated five weeks after therapy, and those who chose to continue using their appliances were evaluated three months later. The mean pretreatment Headache Disability Inventory (HDI) score of 64.5 suggested the headaches were severe. After five weeks, the mean HDI score decreased by 17 percent (p<0.003), headache medication consumption dropped by 18 percent (p<0.0001), and headache symptoms decreased by 19 percent (p<0.002). Comparing the three months with pretreatment follow-up, the fourteen participants who chose to continue using their appliances had a mean HDI score decrease of 23 percent (p<0.003), headache medication consumption drop of 46 percent (p<0.001), and headache symptom decrease of 39 percent (p<0.001). There was no correlation between response and headache type (p=0.722). These results suggest appliance and self-management therapies can be beneficial for many severe headache patients, irrespective of the headache type (tension-type, migraine without aura, and migraine with aura).