Gary D. Klasser

Oral appliances in the management of temporomandibular disorders

Various types of oral appliances (OAs) have been used for over half a century to treat temporomandibular disorders (TMDs), but there has been considerable debate about how OAs should be designed, how they should be used, and what they actually do therapeutically. However, there is enough information in the scientific literature at this time to reach some evidence-based conclusions about these issues. The main focus of this review is on the materials and designs of various OAs in terms of their proposed mechanisms of action and their claimed clinical objectives. Based on current scientific evidence, an analysis is presented regarding the role that OAs can or cannot play in the management of TMDs. Finally, the concept that OAs may be an effective treatment modality for some TMDs owing to their potential for acting as an elaborate placebo rather than any specific therapeutic mechanism is considered.

Burning Mouth Syndrome: Recognition, Understanding, and Management

Burning mouth syndrome (BMS) can be a frustrating condition to the patient and the practitioner because the patient often experiences a continuous burning pain in the mouth without any apparent clinical signs, but the practitioner is unable to definitively diagnose symptoms even with the use of diagnostic testing or imaging. To overcome this dilemma, it is important for the practitioner to recognize and understand the complexities of BMS. The practitioner can then develop a sound approach to management of this condition and patients can be educated and reassured regarding BMS.

Separating oral burning from burning mouth syndrome: unravelling a diagnostic enigma

Burning mouth syndrome (BMS) is characterized by burning pain in the tongue or other oral mucous membrane often associated with symptoms such as subjective dryness of the mouth, paraesthesia and altered taste for which no medical or dental cause can be found. The difficulty in diagnosing BMS lies in excluding known causes of oral burning. A pragmatic approach in clarifying this issue is to divide patients into either primary (essential/idiopathic) BMS, whereby other disease is not evident or secondary BMS, where oral burning is explained by a clinical abnormality. The purpose of this article was to provide the practitioner with an understanding of the local, systemic and psychosocial factors which may be responsible for oral burning associated with secondary BMS, therefore providing a foundation for diagnosing primary BMS.

The Delphi Process in Dental Research

OBJECTIVE To explore how Delphi formal consensus procedures may augment decision making in oral health care in the absence of high-quality clinical and epidemiological data. METHODS A review and appraisal of the literature regarding the Delphi method was conducted using Medline databases and Google. RESULTS The Delphi method has a long history that highlights both its strengths and limitations. Delphi uses a series of anonymous questionnaires designed to develop a consensus of opinion and can provide guidance on topics that have not or cannot be studied in randomized controlled trials. The Delphi technique has been used to achieve consensus of opinion on a variety of issues including those related to oral health. Guidelines for the use of Delphi are presented. CONCLUSION Like any other research methodology, the process guidelines need to be systematic and comprehensive. Delphi expert opinion consensus may improve decision making in a wide variety of oral health circumstances.

Emerging approaches for prophylaxis and management of oropharyngeal mucositis in cancer therapy

Oral mucositis is a common treatment-limiting side effect of cancer therapy that may have a significant impact on quality of life and on the cost of care. Oral mucositis is the most distressing complication of cancer therapy as reported by head and neck cancer patients, in patients receiving dose-dense myelosuppressive chemotherapy and in patients receiving haematopoietic stem cell transplant. Mucositis may increase the risk of local and systemic infection, particularly in myelosuppressed patients. Severe oral mucositis can lead to the need to interrupt or discontinue cancer therapy, and thus may impact cure of the primary disease. Current care of patients with mucositis is essentially palliative, and includes appropriate oral hygiene, nonirritating diet and oral care products, topical palliative mouth rinses, topical anaesthetics and use of systemic opioid analgesics. Emerging approaches for prevention and treatment of oral mucositis are developing based on an increasing understanding of the pathobiology of mucosal damage and repair. New interventions are expected to be administered based on the mechanisms of initiation, progression and resolution of the condition. The approval by the FDA of keratinocyte growth factor (palifermin; Amgen) in 2004 represents a new step in prevention of oral mucositis in stem cell transplant patients based on the increasing understanding of the pathogenesis of mucositis. Progress in the prevention and management of mucositis will improve quality of life, reduce cost of care and facilitate completion of more intensive cancer chemotherapy and radiotherapy protocols. Improved management of mucositis may allow implementation of cancer treatment protocols that are currently excessively mucotoxic, but have potentially higher cure rates of the malignant disease.

Cancer and orofacial pain.

Orofacial pain is commonly associated with cancer and may motivate patients to seek care from an oral and maxillofacial surgeon. Pain may be a presenting symptom of primary tumors, metastatic disease, systemic cancer, or distant non-metastasized cancer. Patients with head and neck cancer undergoing therapy may suffer treatment-induced complications, which are often associated with acute pain. Following cancer therapy, permanent changes to tissues may cause late effects of treatment that may result in chronic orofacial pains. Oral and maxillofacial surgeons should be knowledgeable regarding these orofacial pain presentations.

Multiple sclerosis: an update for oral health care providers

Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of the central nervous system. The disease mostly affects young adults and is increasing in prevalence and incidence. Multiple sclerosis is characterized by periods of activity and remission which, after numerous relapses, cause permanent neurologic deficits. Diagnosis of MS is based on patient history and clinical examination supplemented by the findings of radiologic and laboratory tests. Numerous motor and sensory disturbances occur in MS and may present in the orofacial region. This medical management update highlights issues that are important to the oral health care provider, including orofacial manifestations of MS and dental considerations for patients with MS.

Burning Mouth Syndrome

Burning mouth syndrome (BMS) is an enigmatic, misunderstood, and under-recognized painful condition. Symptoms associated with BMS can be varied, thereby providing a challenge for practitioners and having a negative impact on oral health-related quality of life for patients. Management also remains a challenge for practitioners because it is currently only targeted for symptom relief without a definitive cure. There is an urgent need for further investigations to determine the efficacy of different therapies because this is the only way viable therapeutic options can be established for patients with this chronic and painful syndrome.

Orofacial Pain Syndromes: Evaluation and Management

Patients will often visit their primary medical practitioner with orofacial pain complaints. Hence, it is important to recognize and have an understanding of these conditions to properly evaluate and potentially manage these disorders. If the practitioner is uncertain or uncomfortable with these conditions, then patient referral to a knowledgeable health care practitioner should be considered for further evaluation and management. In this article, the evaluation and management of various neuropathic, neurovascular, and vascular pains are discussed.

Temporomandibular disorders and whiplash injury: a narrative review

OBJECTIVES The objective of this study was to conduct a review investigating the relationship between temporomandibular disorders (TMDs) and whiplash injuries (WIs). STUDY DESIGN The authors conducted a search of PubMed/Medline, Cochrane Database, and EMBASE for studies discussing the prevalence, incidence, severity, treatment, and prognosis of TMDs following WIs. English language studies published between January 2010 and March 2016 were included. Study quality was assessed by using the Ottawa-Newcastle scale. RESULTS Eight studies investigating TMDs in patients with histories of WI were included. These studies reported associations between WIs and TMDs and an increase in symptom severity among patients with TMDs and a history of WIs. Additionally, patients with TMD and trauma histories display more severe subjective, objective, and psychological dysfunction compared with typical patients with TMDs. This results in poorer treatment outcomes. CONCLUSIONS These findings highlight the need for early evaluation of patients with WI for TMDs and for a multidisciplinary approach to their management.