Dr. Adams' Alabama Headache Blog

Monday, April 12, 2010

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posted by edanjou at 11:28 AM 0 comments

Wednesday, April 7, 2010

Self-Reported Temporomandibular Joint Dysfunction Symptoms in 220 American Dental Students

This study assessed the prevalence of Temporomandibular Joint (TMJ) Dysfunction in students at Tufts University of Dental Medicine. Three classes were administered in a 12 item questionnaire requiring a yes/no response to questions about discomfort and dysfunction of the TMJ and associated muscles. Of 125 forms administered, Class of 1990 ('98) returned 105 (mean age 26.8), Class of 1999 ('99) 115 (mean age=25.1) and Class of 2000 ('00) 100 (mean age of 23.7) Each class had a ratio of approximately 60 males to 40 females. The number responding to at least one item was 65 for '98, 76 for '99 and 45 for '00. There was no difference in sex response. Generalized chi square showed a significant difference in the responses of the three classes. Seperate Teates corrected 2x2 chi squared tests showed that the number responding in '98 was no different from '99 while the number responding in both '98 and '99 were significantly larger than in '00. Because of this the results of '00 could not be pooled with those of '98 and '99. Of 220 students, 43% reported clenching and grinding, 30% reported noises in the joint, 21% sore muscles of mastication, 13% frequent headaches, 11% difficulty and/or pain chewing or talking. 10% jaw "locking or going out" and 7% difficulty and/or pain on opening. Students who answered at least one of the 12 questions were requested to rate pain/discomfort on 11, 10-point Visual Analogue Scales (VAS) each locating a pain site. Of the 220 students, 24% responded to TMJ by clicking (mean VAS=4.3), 18.9% to neck pain (mean VAS=4.2), 16.9% to headaches (mean VAS=4.7), 13.8% to TMJ pain (mean VAS=4.2), 16.9% to headaches (mean VAS=4.7), 13.8% to TMJ pain (mean VAS=3.7), 13.3% to pain in teeth (mean VAS=3.2), 8.9% to face pain (mean VAS=3.6). The prevalence of symptoms is osmewhat higher than repoprted in Swedish dental students and young men of comparable age. The observations in this, the first of a series of students to track symptoms over each year of dental school, suggest that dental schools screen students for TM Dysfunction.

posted by Dr. Adams at 12:45 PM 0 comments

Tuesday, April 6, 2010

SCL-90 Scores of TMD Patients 6 and 12 Months Following Initiation of Treatment

This stidy was designed to assess the change in psychological variables following biteplate therapy in the treatment of Temporomandibular Dysfunction. The SCL-90 (Derogatis) is a self-report test which assesses 9 psychological dimensions. Thirty-one patients of the Gelb Craniomandibular/Orofacial Pain Center were selected at random from 150 patients treated in a six month period. The SCL-90 along with a 10-point Visual Analogue scale to measure pain were administered before treatment and at the end of treatment (6 months after treatment began). Then 6 months later, the inventories were mailed to the patients. Eighteen responded to the 6-month follow up. Their responses were analyzed with Wilcoxon Signed Rank Tests (WSRT). General pain decreased significantly from initial levels over the first 6 months ( and 6 months later the decrease was maintained. The pain levels of the two periods were no different. Two psychological dimensions showed significant reductions over teh assessment periods. Although depression did not show a significant reduction six months after treatment began. It did decrease a significant degree from pre-treatment level by the one year period. Likewise, hostility did not decrease significantly by 6 months after start of treatment, but did reduce to a significant level by one year following initiation of treatment. None of the other psychological dimensions showed significant changes for the periods assessed. The results indicate that a significant reduction in pain results from biteplate therapy after 6 months of treatment and this reduction from pre-treatment level persists six months after termination of treatment. The appearance of significant reductions in depression and hostility 6 months after termination argues for follow-up testing because impact on psychological dimensions may not become manifest until some time after treatment is terminated.

posted by Dr. Adams at 12:13 PM 0 comments

Thursday, April 1, 2010

The Effect of Pain Reduction On The Quality of Life (SF-36) In Orofacial Pain Patients

The aim of this study was to determine the effect of pain reduction on the quality of life in pain patients. The Visual Analogue Scale (VAS) was used to measure specific pain itmes (earache, TMJ pain, Headaches, neck, upper and lower back pain), whereas the Short Form 36 (SF-36)was used to measure the quality of life through its 8 items: Physical Functiong(PF), Role Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (PF), Role Emotional (RE) and Mental Health(MH). Fourty-four TMD and Orofacial pain patients (F=36, M=8, AGE= 35+/-13) with no history of physical disabilty of psychological problems were selected. Thirty control subjects (F=14,M=16, AGE=35+/-10) were selected randomly from the faculty and staff at the university. Patients and controls were requested to complete the VAS and the SF-36 forms at the initiation of the study and 3 months later. All patients had conservative treatment using intraoral appliance therapy with/out physical therapy modalities for the period of the study. The Wilcokon signed rank test was used to compare between pre and post treatment pain and SF-36 for patients and controls. There was a significant reduction in all pain items for patients, whereas there were no statistically significant changes for controls. SF-36 results showed a significant increase in all items fro patients with the exception of GH and RE. There were no significant changes in any of the SF-36 items for controls except an increase in social functioning. The Spearman's rhe was used to determine pre and post-treatment correlations between pain and SF-36 items. There were significant pre-treatment as well as post-treatment correlations for 1) TMJ pain and PF, RP, 2) face pain and VT, MH, 3) u/back and all SF-36 items except RE, 4) l/back and PF, VT. These results indicate that the reduction of pain in TMD and orofacial pain patients is associated with an improvement in patient's well-being, quality of life and perception of health as measured by the SF-36.

posted by Dr. Adams at 12:39 PM 0 comments

Wednesday, March 31, 2010

Effect of Graded Increas in Vertical Dimension on teh Cervical Flexor Strength

The effect of vertical dimension (VD) on maximizing isometric deltoid strength (IDS) has been researched in subjects with deep overbite. However, vertical dimension has been determined in these studies functionally using the Isometric Deltoid Press. In this study vertical dimension of occlusion was increased, 2, 4 and 6 mm using lower acrylic mouthplates. Twenty normal females, mean age 31 years, sat erect in a dental chair and were instructed to bite and either resist to their maximum ability a horizontal force applied to the forehead or a vertical downward force to the wrist of the first one then the other extended arm. This procedure was repeated in normal occlusion and while biting on mouthplates which raised the VD 2, 4 and 6mm. The order of testing was counterbalanced, with one investigator inserting the appliance while another performed the muscle testing. Horizontal and downward pressures were applied by a hand-held stain guage. Peake resistance was measured twice in each condition and averaged to produce a peak isometric strength (PIS). Mean strongest PIS for each site tested was compared to each subject's PIS while biting in habitual occlusion. PIS of cervical flexors with the elevated bite was significantly greater than that for habitual conclusion. PIS for right and left deltoids did not differ but mean deltoid PIS in the elevated condition was significantly greater than biting in habitual occlusion. In the peak condition, cervical flexors increased 24% and deltoids increased 30%. Strength was measures for habitual occlusion after all trialas were administered and were not found to differ from pre-experimental levels indicating that fatigue was not an important factor. In an earlier study, Hart et al was unable to show significant differences when the vertical dimension was raised gradually. However, his dependent variable was isokinetic strength. In earlier publications we have suggested that the strength phenomenon is more salient in isometric strength than isokinetic. Isometric strength of the cervical flexors and deltoids increase significantly when vertical dimension of occlusion is increased in deep overbite subjects.

posted by Dr. Adams at 12:08 PM 0 comments

Tuesday, March 30, 2010

SF-36 Scores of TMD, Chronis Back Pain, Combined Pain Patients and Controls

The SF-36 is a widely used survey to assess health status from the patient's point of view. This patient based, generic health status assessment survey obtains patient's assessments of their functioning and well-being and perception of their general health. It serves as a disability measurement instrument in 29 countries. The dimensions measured 1) Physical Functioning, PF, 2) Role Physical, RP, 3) Body Pain, BP, 4) General Health, GH, 5) Vitality, VT, 6) Social Finctioning, SF, 7)Role Emotional, RE or the effect on usual role due to physical or emotional health, 8) Mental Health, MH. It was of interest to compare the responses of pain patients seeking treatment for TMD, back, and combined TMD and back pain to determine whether their limitations were similar and to compare these scores with those of the asymptomatic controls. The SF-36 scores of four groups of 30 subjects each were analyzed with the Kruskal-Wallis ANOVA by ranks for independent samples. A seperate ANOVA was performed for each of the 8 dimensions. Mann-Whitney U tests were used to compare scores within each dimension. With the exception of VT, control scores were significantly higher, (greater function, least limitation) than those of the other three groups and chronic back pain scores were significantly smaller than all other groups. TMD and combined TMD/back pain scores were both significantly smaller than the scores of controls and significantly greater than those of chronic back pain patients. The difference in the presence of the back pain factor is probably due to the chronicity of the back pain patients who were specifically diagnosed opposed the the TMD being the presenting symptom in the combined pain group. TMD patients tend to suffer impairment in functioning that is intermediate between asymptomatic patietns and chronic back pain patients. The impact of TMD on dimensions of functioning is clearly revelaed I the scores of the SF-36 suggesting is as an importnant diagnostic instrument for disability in the treatmetn of TMD and the assessment of treatment outcome.

posted by Dr. Adams at 11:15 AM 0 comments

Thursday, March 18, 2010

Vertical Dimension and Electromyography of Masseters in Complete Denture Patients

The vertical dimension of occlusion (VDO) which achieves the highest isometric strength of sternocleidomastoid muscles (SCMs) has been determined in complete denture patients. The purpose of the present day study was to investigate the effect of this VDO on electromyographic (EMG) activity of the masseters in complete denture patients using the Davicon M44 Dual EMG. Seventeen complete denture patients with complete upper and lower dentures for at least one year, no history of physical trauma to the head and neck, no untreated chronic illness and no cervical symptoms require treatment in the past 5 years were selected for this study. Patients were seated in an upright position and instructed to resist a horizontally transmitted force applied until resistance failed. The load was recorded under five conditions: rest position, biting on existing denture, bting on wooden blocks (2, 6 &10 mm) increasing the VDO 2mm) increasing the VDO 2 mm, 6mm and 10 mm respectively. On the second visit, bilateral electrodes were applied to the masseter muscles with 2 active electrodes in parallel with the muscle fibers. The subjects were instructed to bite as hard as possible on the existing denture and peak EMG activity was recorded in microvolts. An acyrlic resin layer was then fitted over the lower denture of each subject to add height on the existing denture. This height was determined from the maximum isometric strenth of the SCM muscle. The data was analyzed using the student's t-test. The results showed a statistically significant difference in the mean EMG activity or the right masseter muscle between the maximum clench on existing denture and maximum possible clench on the increased VDO which achieved peak isometric of the SCM muscle. The mean EMG activity of the left masseter maximum clench on an increased which achieved peak isometric strength of the masseter muscle. In conclusion, the vertical dimension of the occlusion which achieved maximum isometirc strength of the SCM muscles has a significant effect on the electromyo-graphic activity of the masseter muscles in complete denture patients.

posted by Dr. Adams at 1:22 PM 0 comments

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