Elliot N. Gale

Fears of the Dental Situation

Ratings of fear in the dental situation indicate that high fear and low fear patients rank the fears associated with the dental situation in about the same way (p = 0.98). Also, the attitude of the dentist is important to the patient, and may, partially, determine his attitude toward dentistry.

Psychological Stress Reduction During Dental Procedures

Behavioral methods of patient stress reduction during amalgam restorations were evaluated. Eighty adult patients were randomly assigned to one of four groups of 20 each: a control group, a relaxation group, a perceived control group, and an active distraction group. Both relaxation and distraction were found to be effective in reducing patient discomfort.

A Comparison of Different Treatments for Nocturnal Bruxism

One hundred bruxers were evaluated for bruxing activity before, during, and after treatment with a portable electromyograph (EMG). A six-month post-treatment follow-up of bruxing activity was obtained. Experimental treatment groups consisted of diurnal biofeedback, nocturnal biofeedback, massed negative practice, and splint therapy. A no-treatment control group was included. The comparative efficacy of treatments was determined by analyses of variance. Both EMG-measured frequency of bruxing episodes and duration of bruxing activity decreased significantly for nocturnal biofeedback and splint therapy treatments but not for massed negative practice, diurnal biofeedback (relaxation), or the no-treatment control group. The two-week treatment effects were transient, and bruxing activity generally returned to baseline levels when treatment was withdrawn. These findings are consistent with the findings of previous researchers with regard to nocturnal biofeedback and splint therapy but differ from previous findings for massed negative practice therapy.

Clinical Performance and Physical Properties of Twelve Amalgam Alloys

An assessment of the marginal failure rate of 1,041 restorations of twelve alloys was made at one year. In addition, physical property tests were conducted. A correlation was found between the clinical performance and creep (.79), flow (.62) and 24-hour compressive strength (.60).

Stress-induced muscular activity in mandibular dysfunction: Effects of biofeedback training

Surface electromyographic (EMG) recordings from the left and right masseteric areas during physical and psychological induced stress were obtained from 20 patients with mandibular dysfunction and 20 healthy controls. Integrated electromyographic activity was not significantly different for the two sides but was higher for patients than for controls during both stress and relaxation. Anxiety level, as measured with the Taylor Manifest Anxiety Scale, was higher for patients. Biofeedback treatment for the patients resulted in significantly reduced signs and symptoms of mandibular dysfunction. When the test procedures were repeated, the controls had not changed in their electromyographic responses during stress, whereas the patients showed a significant decrease in this respect. The results obtained are discussed in terms of a systems-oriented etiological concept.

Factors associated with nocturnal bruxism and its treatment

Using a single-subject design, two methods of treating nocturnal bruxism were evaluated. Neither technique was successful; both resulted in a rebound effect when treatment was stopped. In addition, the role of anxiety in bruxing behavior was evaluated. Contrary to most theoretical beliefs, bruxing resulting from anxiety was not as important as “anticipatory” anxiety resulting in bruxing.

Biofeedback in the treatment of long-term temporomandibular joint pain an outcome study

Eleven patients with long-term pain related to the temporomandibular joint (TMJ) were trained in tension awareness and relaxation using feedback of muscle tension level in the masseter through a digital display. At a follow-up examination 4–15 months after the termination of treatment, 8 of the 11 patients were totally symptom-free or significantly better; 1 patient was slightly better, and there was no effect for 2 patients. Possible reasons for failure and sex differences are discussed.

Electromyographic Activity of Anterior Temporal Area Pain Patients and Non-pain Subjects

Anterior temporal area and non-specific facial muscle activity were recorded from 11 patients with unilateral anterior temporal area muscle pain and from 11 matched asymptomatic individuals at various mandibular openings. No significant differences were observed (1) in temporal area EMG activity between pain and non-pain sides and (2) between temporal area and non-specific facial muscle EMG activity between patient and non-patient groups. In relation to increased vertical mandibular opening from centric occlusion: (a) anterior temporal area EMG activity decreased to a minimum level (with further opening, anterior temporal area EMG did not significantly change); and (b) non-specific facial muscle EMG activity decreased to a minimum level (with further opening, non-specific facial muscle EMG increased).

Methodological Considerations Concerning the Use of Bruxcore Plates to Evaluate Nocturnal Bruxism

The purpose of this study was to evaluate the Bruxcore Plate (BP) as a dependent measure of nocturnal bruxing activity. As part of a bruxism treatment study, we evaluated 100 nocturnal bruxers for bruxing activity before, during, and immediately after treatment and again at a six-month recall. The first 40 subjects wore both a BP and an EMG (electromyographic) unit for every night of each 14-night evaluation period (bcrseline; post-treatment; six-month recall). During the treatment period, these subjects wore the EMG unit but no Bruxcore Plates. Another 40 subjects wore the EMG unit and never used Bruxcore Plates. We evaluated a 20-subject no-treatment control group by two methods. Ten control subjects were evaluated with the EMG unit and the BP and another ten with the EMG unit alone. We hypothesized that the BP would not measure the same construct as an accepted EMG measure of bruxing activity, and that the BP would effect changes in EMG measured nocturnal bruxing activity. The results supported the conclusions that the BP did not measure the same construct as the EMG measure, and that the BP did effect changes in nocturnal bruxing activity. Correlations of BP scores with EMG data for equivalent measurement periods were low or non-existent. For the control group and the massed practice (negative practice) treatment group, there were significant interaction effects for EMG-measured bruxing episodes per hour for BP vs. no-BP Groups, with respect to measurement periods (time). Interpretation of these results indicated that BP evaluation of nocturnal bruxing activity was confounded with measurable treatment effects.

The Effects of Treatment on Masticatory Muscle Activity and Mandibular Posture in Myofascial Pain-dysfunction Patients

The purpose of this study was to evaluate tonic masticatory muscle activity and the postural rest position of the mandible, pre- and posttreatment, in patients with TM disorders. Forty-one patients diagnosed as suffering from myofascial pain-dysfunction (MPD) were evaluated, with electromyography (EMG) used to measure the muscle activity of the masseteric and anterior temporal areas at rest. Postural rest position was assessed by measurement of interocclusal distance. Twenty-three asymptomatic subjects were also tested as controls. Treatment for the pain group emphasized cognitive awareness of dysfunctional orofacial behavior and biofeedback training of the masseteric area to teach masticatory muscle relaxation. The pre-treatment EMG values of both the masseteric and anterior temporal areas were significantly higher for the pain group than for the control group. Post-hoc division of the pain group into successful and unsuccessful subgroups was made on the basis of the degree of symptom improvement. EMG activity decreased significantly in the masseters of both subgroups, but only the unsuccessful subgroup showed a significant decrease in anterior temporal activity following therapy. Interocclusal distance was significantly increased in both subgroups. These results suggest that tonic masticatory muscle activity may be elevated in MPD patients. They also suggest that a decrease in EMG activity in the masseter and anterior temporalis muscles and an opening of the postural rest position of the mandible may accompany completion of psychophysiological therapy, but these changes do not correspond directly with the outcome of that therapy.