Dr. Adams' Alabama Headache Blog

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

noreply@blogger.com (Dr. Adams) — Wed, 07 Apr 2010 19:45:00 +0000

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.

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

noreply@blogger.com (Dr. Adams) — Tue, 06 Apr 2010 19:13:00 +0000

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.

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

noreply@blogger.com (Dr. Adams) — Thu, 01 Apr 2010 19:39:00 +0000

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.

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

noreply@blogger.com (Dr. Adams) — Wed, 31 Mar 2010 19:08:00 +0000

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.

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

noreply@blogger.com (Dr. Adams) — Tue, 30 Mar 2010 18:15:00 +0000

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.

Vertical Dimension and Electromyography of Masseters in Complete Denture Patients

noreply@blogger.com (Dr. Adams) — Thu, 18 Mar 2010 20:22:00 +0000

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.

Coping Strategies, SF-36, SCL-90 in Mild and Severe TMD Pain

noreply@blogger.com (Dr. Adams) — Wed, 17 Mar 2010 19:48:00 +0000

Coping strategies are self generated cognitive maneuvers used by chronic pain patients to deal with their stress. In this study, the pain level, duration and coping strategies of 49 female TMD patients as measured by the Coping Strategies Questionnaire-Revised (CSQ-R) were compared with psychological status (SCL-90 scores) and degree of disability (SF-36 Health Status.) High intensity reported pain was found to be associated with more frequent use of Catastrophizing Coping Self Statements, Distraction and Praying than low intensity pain. While individual dimensions of the SCL-90 (Anxiety, Depression, Somatization, and General Stress Index) showed no statistical difference, all dimensions were higher in the high pain patients. High pain were more disabled than low pain patients (Mann-Whitney U analysis of SF-36, z -3.26, p=0.001). When long term pain (2-50 yrs) was compared with short term pain responses (1 month-1.5 yrs), long term patients used Distancing and Ignoring more than short term patients. Degree of disability was the same between long and short-term pain. When patients used three coping strategies (Catastrophizing, Distraction, and Praying), significantly higher levels of anxiety, depression, somatization and general stress were reported. Patients who used Distancing more often reported higher levels of anxiety and general stress. Patients using a wide variety of coping strategies (flexibilty) reported higher levels of pain, more psychological distress and greater disability. Using a diversity of coping strategies was not related to long duration of pain. The use of the combination of three strategies, Catastrophizing, Distraction, and Praying are associated with elevated psychological scores abd greater disability. Intensity, not duration of pain appears to determine which coping strategies are used by patients. Some of these strategies may be maladaptive.

Active Resistance Exercise for TMD Related Tension Pain

noreply@blogger.com (Dr. Adams) — Tue, 16 Mar 2010 19:07:00 +0000

Rocobado and Kraus have proposed exercises to relieve muscle tension pain related to TMD and craniocervical dysfunction. The Profile Toner (Tasmark, Inc. N. Easton, MA) is an ective resisted motion device originally designed for toning muscles of the neck to elimanated double chin. It is a polyurethane foam ball 5 inches in diameter. The purpose of this experiment was to examine the effect of active resisted motion exercise of the cervical flexors on pain reported in 10 body sites and neck mobility. Thirty female TMD patients (mean age 35.6 yr., range 24-48) were selected in order of appearance for treatment at a TMD center. They were assigned at random to either Experimental (E) or Control (C) groups of 15 each. For 8 weeks E subjects performed flexing exercises, bending the neck so as to compress the ball between the chin and chest (as a nut cracker) and a second set opening the mandible pushed into the ball. C subjects performed the same number of exercises compressing the ball at the elbow joint. Pain levels were recorded on 10, 10 point visual analogue scales pre and post experimentally. Rotation, bending and flexion were recorded on a protractor. The pain points of both groups pre-experimentally did not differ but the mean reduction of the E group (14.3,43.7%) was significantly greater than that of the C group (2.6, 10%), t=3.9. TMJ pain reduction tended toward significance for the E group (p=0.058) as did headache (p=0.07) and face pain (p=0.08). Neck pain reduced significantly for the E group. A significant increase in right and left bending of the neck (7.0 degrees vs 0.28 degrees and 7.5 degrees vs 0.9 degrees) as well as flexion (3.7 degrees vs -2.6 degrees0 occured in the E group. Neck exercises may be an effective adjunct to the MPD treatment, reducing pain and increasing mobility of the neck.

Relationship Between TMDs Pain, Somatization, Depression and SF-36 Scores.

noreply@blogger.com (Dr. Adams) — Mon, 15 Mar 2010 16:39:00 +0000

519 subjects were selected at random from a pool of 5,000 patients attending a multidisciplinary facial pain center. Pain was measured by a pain scored questionnaire composed of 20 Visual Analogue Scales (VAS). Ten pain sites were monitored, each by a VAS for the right and left sides. Possible scores were 0-10 for each VAS and 0-20 for each site with left and right scores combined. A global pain score for each site was obtained by adding scores of all ten sites yielding a maximum possible score of 200. The purpose of the study was to determine the relationship between reported pain and three dimensions of the SCL-90 (somatization, anxiety, and depression) and the globak score of the SF-36. Although pain was significantly correlated with Somatization (r=0.52), Anxiety (r=0.31) and Depression (r=0.36), the coefficient of determination was relatively weak for each (r=27), 0.10, and 0.11 respectively). Pain was not correlated the SF-36 global score (r=0.015). On the other hand, Somatization scores were significantly correlated to Anxiety (r=0.66, r=0.44), Depression (r=0.71, r=50) and Anxiety significantly correlated with Depression (r=0.82, r=0.67) with strong coefficients of determination. In order to ascertain whether high pain patients responded differently than low pain patients, patients were divided into two groups: total pain scores of less than 50 were placed in the Moderate pain group (mean 28.5) and total pain scores of => 50 were placed in the Severe pain group (mean 83.9). In all three measures of the SCL-90, the Severe pain patients scored significantly higher than the Moderate pain patients (p< 0.0001) but in all eight dimensions of the SF-36 there was no difference between Severe and Moderate pain responses. The scores of the three dimensions of the SCL-90, Somatization, Anxiety, and Depression, suggested by Dworkin et al. are sensitive to differences in pain intensity while none of the dimensions of the SF-36 are. In addition, scores of the 3 SCL-90 scales are strongly intercorrelated.

The Effectiveness of Multi-faceted Treatment of TMDs

noreply@blogger.com (Dr. Adams) — Fri, 12 Mar 2010 16:58:00 +0000

In this retrospective study, 519 subjects were selected at random from a pool of 5000 patients who had completed treatment of attended at least three treatment sessions before terminating treatment. Treatment consisted of intraoral appliances: a soft upper for sleep and a mandibular repositioning device for daytime and a self administered home program for muscle relaxation. When indicated physical therapy was prescribed. Prior to treatment, on the next to last treatment and on the last treatment day, patients filled out a pain score sheet composed of 20 Visual Analogue Scales(VAS). Ten pain sites were monitored, each by a VAS for the right and left sides. Possible scores were 0-1-for each site and 0-2- for each site when left and right scores combined. A global pain score for each site was obtained by adding scores of all ten sites yielding a maximum possible score of 200. Pre-treatment mean pain was 54.6, next to last visit was 29.9 and last visit mean was 24.9. Each mean was significantly from the pretreatment baseline. Only subjects reporting pain in a site were studied. Each of the ten sites showed a significant reduction from a range of means 7.2-10 to 2.5-4.6. The post-treatment means of the five major diagnostic sites for TMDs (TMJ Pain, Clicking, Headache, Face Pain, and Neck Pain) were compared to scores of 220 dental students as a control. The pain levels of the two groups were almost identical (means ranging from 3.8 to 4.2) Overall, 92% of patients showed improvement and 8% were worse. An interesting finding of this research is that Neck, Upper Back, and Lower Back pain decreased significantly with a treatment of the oral condition. This lends support to the view that TMD treatment may affect areas outside the stomatognathic system. It was concluded that multidimensional treatment of TMDs is effective, reducing pain in 10 sites and in five sites to levels of dental student controls.

Effect of Splint Design on Head Posture and Cervical Symptoms

noreply@blogger.com (Dr. Adams) — Thu, 11 Mar 2010 16:34:00 +0000

This study compared the effect of two types of occlusal appliances on head posture, cervical symptoms and cervical range of motion in temporomandibular disorders (TMDs) patients. Twenty-two subjects diagnosed with TMDs (Research Diagnostic Criteria) were randomly assigned to two equal groups: Group-I received a three-dimensionally balanced mandibular occlusal splint, while group-II received a mandibular occlusal splint, which maintained mandibular position. Head posture and cervical range of motion (CRM) were measured using the Cervical Range of Motion Instrument (Performance Attainment Associates, St. Paul, MN). Cervical symptoms were assessed using a 10-point Visual Analogue Scale (VAS). Measurements were recorded pre-insertion, 10 minutes post-insertion and two weeks post-insertion. A T-test showed that there was a significant change in head posture from pre-insertion to 2 weeks post-insertion in group-I (mean=4.7°, t df=10=3.34, p=0.007) while there was no change in group-II (mean=0.41°, t df=10=0.36, p>0.05). ANOVA showed that there was a significant effect for time in cervical symptoms in group-I F df=3=9.95, >0.05, (mean=452.2 to 447.3 p>0.05). An ANOVA of CRM data showed a main effect for group-I, F df=3=5.87, p=0.002 (mean=8.6 to 10.6, t=4.8, p>0.05 (mean=8.7 to 9.1, p>0.05). It was concluded that different splints affect TMDs patients differently. The three dimensionally balanced splint reduced forward head posture and improved cervical symptoms and CRM significantly.

Activation and Expression in the Synovial Membrane After Induced Synovitis

noreply@blogger.com (Dr. Adams) — Mon, 08 Mar 2010 17:36:00 +0000

NF-kB plays a pivotal role in pathogenesis in general arthritis. However, the participation of NF-kB in inflammation of the temporomandibular joint (TMJ) is poorly understood. We examined NF-kB expression in rat TMJs with synovitis induced by condyle hypermobility. By immunohistochemistry, NF-kB immunoreactivity was found mainly in the cytoplasm, not the nucleus, of the synovial lining cells of induced synovitis and control TMJs. Southwestern histochemistry, a new method for detecting transcription factors, showed greater NF-kB expression in the nucleus of the synovial lining in the hypertrophic synovium than in the control synovium. Increased levels of the synovial lining cells with immunoreactivity for inducible nitric oxide synthase (iNOS), which is transcriptionally regulated by NF-kB, were also seen in the inflamed synovium. These findings indicated that excess mechanical stress increases NF-kB activation in the TMJ and suggest that active NF-kB is incolved in the progression of the TMJ inflammation.

Radiographic Signs of Bone Destruction in the Arthritic Temporomandibular Joint

noreply@blogger.com (Dr. Adams) — Tue, 02 Mar 2010 17:11:00 +0000

To investigate the progression of radiographic changes of the temporomandibular joint (TMJ) with the reference to plasma levels of interleukin-1B (IL-1B), C-reactive protien (CRP) and disease duration.

Twenty-one patients with chronic inflammatory joint disease and TMJ involvement were included. Individualized tomography of the TMJ was performed twice with an interval of at least 12 months.

Significant progression of the overall grade of radiographic changes occurred during the observation period, whereas erosions showed great interindividual variability. Progression of TMJ bone loss was correlated to raised levels of CRP and, in patients with a diagnosis of rheumatoid arthritis, or with a shorter duration, also to a plasma IL. Progression of an overall grade of radiographic changes in the TMJ occurs in patients with chronic inflammatory joint disease. Raised levels of serum CRP are associated with progression of TMJ bone lpss.

TMJ and Juvenile Arthritis

noreply@blogger.com (Dr. Adams) — Mon, 01 Mar 2010 14:23:00 +0000

This study assessed the temporomandibular joint (TMJ) abnormalities in juvenile idiopathic arthritis (JIA) by longitudinal radiographic examinations from childhood to adulthood. Radiographic TMJ evaluations of 60 JIA patients were obtained at baseline (mean age 8.6 years, mean disease duration 3.2 years) and 1 to 3 times thereafter, with the final examination on verage 27 years after baseline. A radiographic grading system for severity of TMJ abnormality was applied. Cumulative radiographic TMJ abnormalities increased from baseline to final examination (42% to 75%, P<.001), as did bilateral TMJ involvement (60% to 82%, P<.001). Of patients with abnormalities, 53% showed progression, and 16% revealed signs of improvement. TMJ abnormalities were associated with physical limitations at baseline and reduced well-being and more extensive jiont involvement at the final examination. The frequency of TMJ abnormalities in JIA was high and increased from childhood to adulthood. Although progression of TMJ abnormalities was the general rule, near normalization also occurred on occasion.

Tinnitus

noreply@blogger.com (Dr. Adams) — Sun, 28 Feb 2010 14:57:00 +0000

Tinnitus is a ringing, swishing or other type of noise that seems to originate in the ear or head.

It is not a single disease, but a symptom of an underlying condition. Nearly 36 million Americans suffer from this disorder. In almost all cases, only the patient can hear the noise.

Tinnitus can arise in any of the following areas: the iner ear, or by abnormalities in the brain. Some tinnitus or head noise is normal. Anything, such as wax or a foreign body in the external ear, that blocks the background sounds will cause us to be more aware of our own head sounds. Fluid, infection, or disease of the middle ear bones or ear drum (tympanic membrane) can also cause tinnitus.

One of the most common causes of tinnitus is damage to the microscopic endings of the hearing nerve in the inner ear. Advancing age, loud noise, and some medications can lead to inner ear problems. Tinnitus can in very rare situations be a symptom of such serious problems as an aneurysm or a brain tumor (acoustic tumor).

Actual Patient Account

noreply@blogger.com (Dr. Adams) — Thu, 25 Feb 2010 15:23:00 +0000

DRG was an almost 80 year old maile with a history of Parkinson's Disease that was officially diagnosed in 2002.

When itially seen by Dr. Adams after church one Sunday, he was walking with a shuffling gait, using two canes, was unable to raise his head and had had headaches almost continuously for almost fifty years despite being seen by medical centers and many physcians.

At that time, Dr. Adams inserted a dry wax splint as a trial device. David was able to walk down the hall unassisted for the first time in several years. His posture was immensely improved.

After inserting and balancing an occlusal relation splint, David's headaches were reduced by 90% and his gait improved. He still had some shuffling, but his head was more erect and he was able to breath better. He continued to have dull aches and minimal tenderness to his jaw muscles.

David had an improved quality of life for several years and finally sucumbed to the Parkinson's Disease in October of 2009.

We both thank you for and appreciate your compassionate and generous care that enabled David to be more comfortable during several of his last years.

Estrogen and Inflammation of the Temporomandibular Joint

noreply@blogger.com (Dr. Adams) — Mon, 08 Feb 2010 18:55:00 +0000

Estrogen is known to play a role in temporomandibular joint (TMJ) disorders and estrogen effects can be mediated by ERalpha present in the TMJ. Cells expressing the estrogen receptor ERalpha are present in the temporomandibular joint (TMJ) but changes in expression due to estrogen and inflammation have not been characterized.

Sixteen female rats were divided into two groups such that one group received 17 beta estradiol (E2) and the other was given vehicle (VEH). Groups were then subdivided further, one received injections of saline and the other received Complete Freund's adjuvant (CFA) within the superior joint space of the TMJ.

The four groups include no E2/saline, E2/saline, no E2/CFA, and E2/CFA. After treatment, the rats were sacrificed, and the TMJ anterior, disc, retrodiscal and synovial tissues were analyzed by western blot and immunocytochemistry.

Positive stained cells were counted using a Nikon epifluorescent microscope.

Results: The western blot showed that ERalpha protein significantly decreased with inflammation. The number of ERalpha-positive cells in the TMJ was not affected by inflammationor 17 beta-estradiol with exception of the retrodiscal tissue.

In the retrodiscal tissue, 17 beta-estradiol significantly decreased the number of ERalpha-positive cells but only in a noninflamed joint.

In conclusion, inflammation and 17 beta-estradiol can modulate ERalpha expression in the TMJ but the effects are tissue specific.

noreply@blogger.com (Dr. Adams) — Mon, 08 Feb 2010 14:24:00 +0000

DF, actual patient account:
"I've seen a lot of commercials about athlete's getting appliances to increase their balance, strength, and stability. I don't believe they have the same appliance that I wear. I never thought that the cause of all of my headaches, neck and facial pain would have any connection to a joint in my jaw. Dr. Adams called it the "TMJ", I never even knew I had a "TMJ"!

After talking with Dr. Adams and going through a few tests, I was fitted for my new "appliance". It's amazing how quickly my symptoms subsided, even my posture has improved. I highly recommend checking into this for anyone with any type of pain or problems with balance."

noreply@blogger.com (Dr. Adams) — Tue, 02 Feb 2010 17:35:00 +0000

A discussion of the abstract to determine the frequency and degree of orofacial myofunctional disorder (OMD) in a sample of patients with temporomandibular disorder (TMD), the dental records of 240 patients with a diagnosis of TMD were reviewed. Mean patient age and mean TMD duration, gender frequency, complaints, and signs and symptoms were calculated. The results show that the sample studied was quite characteristic of a TMD group. The presence of the following signs and symptoms was significant: muscular pain, TMJ pain, joint noise, at least one otologic symptom headache, and neck and shoulder pain. Most subjects presented some degree of OMD, with grade high prevailing over grade low. The importance of evaluating these stomatognathic strutures and functions during the clinical examination of patients with TMD is emphasized.

Equilibrium and the dental connection

noreply@blogger.com (Dr. Adams) — Fri, 29 Jan 2010 21:37:00 +0000

Balance is defined as a state of equilibrium or parity characterized by the cancellation of all forces by equal opposing factors. This is the act of maintaining an upright posture (static balance) or in locomotion (dynamic balance or gait). This system depends on vestibular function, vision, and proprioception to maintain posture, to navigate one's surroundings, to coordinate motion of body parts, to modulate fine motor control, and to initiate the vestibuloculomotor reflexes. These parts of the vestibular system provide our brains with information about changes in the head movement with respect to the pull of gravity. Besides the visual, vestibular and skeletal systems, which contribute to balance disorders, the dental (stomatognathic) system may also contribute to balance disorders. It is when all four of these systems are in coordination with one another, that a person will maintain equilibrium and balance, proper gait and posture.

noreply@blogger.com (Dr. Adams) — Wed, 27 Jan 2010 19:39:00 +0000

A recent abstract discussed the limited studies have demonstrated that low intensity laser therapy (LILT) may have a therapeutic effect on the treatment of myofascial pain syndrome (MPS). Sixty (60) patients with MPS and having one active trigger point in the anterior masseter and anterior temporal muscles were selected and assigned randomly to six groups (n=10): Groups 1 to 3 were treated with GaAIAS (780 nm) laser, applied in continuous mode and in a meticulous way, twice a week, for four weeks. Energy was set to 25 J/cm2, 60 J/cm2, and 105 J/cm2, respectively. Pain scores were assessed just before, then immdeiately after the fourth application, immediately after the eighth application, at 15 days and at one month following treatment. A significant pain reduction was observed over time (p<0.001). The analgesic effect of the LILT was similar to the placebo groups. Using the parameters described in this experiment, LILT was effective in reducing pain experienced by patients with myofascial pain syndrome. Thus, it was not possible to establish a treatment protocol. Analyzing the analgesic effect of the LILT suggests it is a possible treatment of MPS and may help to establish a clinical protocol for this therapeutic modality.

noreply@blogger.com (Dr. Adams) — Mon, 25 Jan 2010 17:39:00 +0000

A recent investigation of the relative importance of systemic and local inflammatory mediator (serotonin; 5-HT; tumore necrosis factor, soluble interleukin-1 receptor II: IL-1sRII) in the modulation of the temporomandibular joint (TMJ) pressure pain in the threshold in patients with seropositive or seronegative rheumatoid arthritis (RA) and to investigate to what extent TMJ pressure pain threshold is related to other TMJ pain parameters. Statistical analyses indicated that TMJ pressure pain threshold was only correlated to systemic factors. TMJ movement pain was in turn mainly correlated to systemic mediators in the seropositive patients but to local mediators in the seronegative patients where synovial fluid IL-1sRIIwas positively correlated to TMJ pain on mouth opening. Seropositive patients had a higher systemic inflammatory activity but lower TMJ movement pain intensities than seronegative patients. The results indicate that TMJ pressure pain threshold is modulated by systemic rathar than local inflammatory mediators and suggest that it is unrelated or only weakly related to other TMJ pain entities RA patients. A rheumatoid factor-dependent systemic modulation, in combination with local factors, seems to account for TMJ pain in RA patients.

noreply@blogger.com (Dr. Adams) — Thu, 21 Jan 2010 22:22:00 +0000

A recent discussion to determine the short-term effectiveness of a stabilization appliance with a prefabricated occlusal appliance in myofascial pain patients in a randomized controlled trial. The main treatment outcome in the groups tested was a positive improvement in overall symptoms without any statistically significant differences between the groups at either 6 to 10 weeks. At the 6 week follow-up, 72% of all the patients reported a 50% reduction of the worst pain, whereas at the 10 week follow-up, the percentages were 69% and 61%, respectively. According to the verbal scale, 85% of all patients reported themselves to be "better", "much better", or "symptom-free"at the 6 week follow-up, and 83% reported this at the 10 week follow-up. The effectiveness of the prefabricated occlusal appliance seemed to be the same as that of the stabilization appliance. The prefabricated appliance can therefore be recommended as a short-term therapy in adult patients with myofascial pain.

Eating Disorders and Headaches

noreply@blogger.com (Dr. Adams) — Mon, 18 Jan 2010 13:25:00 +0000

A recent discussion in regards to the comparison of the prevalence of psychologic, dental, and temporomandibular disorder signs and symptoms between young women suffering from chronic eating disorders and a control group of age-matched, healthy women, and to evaluate the impact of frequent vomiting on these signs and symptoms among the eating disorder group. Women with eating disorder showed a significantly higher sensitivity to muscle palpation and higher levels of depression, somatization, and anxiety, as well as a higher prevalence of intensive gum chewing, dental erosions and attrition, than the healthy controls. Vomitting patients showed higher muscle sensitivity to palpation than nonvomitting patients and greater emotional and psychologic distress. Women with chronic eating disorders suffer from higher muscular sensitivity to palpation, greater emotional distress, and more hard tissue destruction (dental erosions, dental sensitivity) than healthy women.