Heidi C. Crow

Examiner expectancy effects in the measurement of pressure pain thresholds

&NA; The ascending Method of Limits, used for the determination of pressure pain thresholds (PPT), is not a psychophysically robust method. The present study sought to determine if the examiners expectancy, based on whether the measurement site was clinically ‘painful’ or ‘non‐painful’, would bias the obtained PPT values. Twenty‐eight patients with facial or temporal area pain served as subjects, and in each subject, a pain site and a control site were identified and marked. According to a randomization schedule, the pain and control sites were correctly marked in half of the subjects and were mis‐labeled in the other half, thereby controlling the examiners knowledge of a site and thus the examiners expectancy of what the PPT should be. Two examiners, shown to be reliable with each other in both pre‐clinical and post‐clinical reliability studies, were blind to the true purpose of the study and to the marking procedures. Each examiner made one PPT measurement at each marked site in a counterbalanced measurement order. Manipulating the examiners prior knowledge of the measurement sites characteristics significantly lowered the obtained PPT values for control sites but did not significantly alter the PPT at the clinically painful sites. Nevertheless, the pain sites still had significantly lower PPTs than did control sites. We conclude that: (i) PPTs at pain sites are robust to a major source of measurement bias associated with the ascending Method of Limits; (ii) measurement order and knowledge of measurement site characteristics can influence obtained PPT; and (iii) the common protocol in which the examiner monitors the amount of pressure during PPT measurement in order to control the force application rate may serve as a mechanism that can bias the obtained values.

Devices for the diagnosis and treatment of temporomandibular disorders. Part III: Thermography, ultrasound, electrical stimulation, and electromyographic biofeedback

This last article in the three-part series on devices for the diagnosis and treatment of temporomandibular disorders (TMD) compared the claimed diagnostic usefulness of thermography with the present scientific evidence. In a similar manner, the therapeutic efficacy of ultrasound, electrical stimulation, and electromyographic biofeedback was also reviewed. This evaluation concluded that the application of thermography to the diagnosis of TMD is limited by variations within and among subjects and by intrinsic problems with controls of the test environment. It also concluded that evidence that therapeutic ultrasound alone is useful for the treatment of TMD is lacking, that positive clinical results of electrical stimulation may not be due to specific therapeutic effects, and that it is doubtful that the use of electrical stimulation devices can produce a position of the mandible that has any diagnostic or therapeutic significance. There is evidence, however, that relaxation training, assisted by EMG biofeedback, can reduce daytime muscle activity.

Predictive Factors for Functional Recovery after Free Tissue Transfer Oromandibular Reconstruction

BACKGROUND Recovery of upper aerodigestive tract function after reconstruction of segmental oromandiblectomy defects is frequently incomplete. The purpose of this study was to quantitate postreconstruction function and define variables that predict functional outcome in this population. METHODS A prospective study of 21 patients who underwent microvascular free tissue transfer reconstruction of segmental oromandibular defects was performed. Measures of swallowing, speech, bite, and oral intake were performed preoperatively and at 1, 3, 6, and 12 months postoperatively or until plateau. Preoperative versus maximal postoperative measures were compared and correlated with nine potentially predictive variables. Univariate and multivariate analyses were performed to determine the most significant predictive factors. RESULTS Baseline function in the study population was abnormal. Postoperative bite force improved, but swallowing, speech, and oral intake were worse than preoperative. Significant (univariate) predictors of outcome included diagnosis of cancer, tongue resection, pharynx resection, and flap skin paddle area. Only tongue resection remained significant in multivariate analysis. CONCLUSIONS Increasing need for oropharyngeal lining replacement, especially after tongue resection, is the most important predictor of functional outcome in reconstruction of segmental mandible defects.

Diseases of Periodontal Tissues in the Elderly

SummaryPeriodontal diseases are among the most prevalent conditions in adults, and afflict many individuals of all ages. They refer to a cluster of inflammatory conditions of the periodontium, the tissues that surround the teeth. Ultimately, periodontal diseases cause the loss of alveolar bone support and may lead to tooth loss. The clinical presentation of periodontal diseases is primarily independent of the age of a person, and successful diagnosis and treatment can be achieved in both young and old individuals. These diseases primarily include gingivitis, periodontitis and oral vesiculobullous diseases of the gingival tissues. Multiple oral, systemic and behavioural factors contribute to the occurrence and progression of these conditions. Appropriate treatment requires accurate diagnosis and the use of oral nonsurgical and surgical techniques, topical and systemic medications and an emphasis on self-applied oral hygiene practices.

Systematic review of reliability and diagnostic validity of joint vibration analysis for diagnosis of temporomandibular disorders.

AIMS To conduct a systematic review of papers reporting the reliability and diagnostic validity of the joint vibration analysis (JVA) for diagnosis of temporomandibular disorders (TMD). METHODS A search of Pubmed identified English-language publications of the reliability and diagnostic validity of the JVA. Guidelines were adapted from applied STAndards for the Reporting of Diagnostic accuracy studies (STARD) to evaluate the publications. RESULTS Fifteen publications were included in this review, each of which presented methodological limitations. CONCLUSION This literature is unable to provide evidence to support the reliability and diagnostic validity of the JVA for diagnosis of TMD.

Infield masticatory muscle activity in subjects with pain‐related temporomandibular disorders diagnoses

OBJECTIVES Pain-related temporomandibular disorders (TMDs) are the most prevalent conditions among TMDs. There is contrasting evidence available for association of pain-related TMD and masticatory muscle activity (MMA). The present investigation assesses the associations between MMA levels of masseter and temporalis muscles during awake and sleep among pain-related TMD diagnostic groups. SETTING AND SAMPLE POPULATION The department of Oral Diagnostic Sciences, University at Buffalo. Twenty females and six males participated in this study. MATERIAL AND METHODS Using the diagnostic criteria for temporomandibular disorders (DC-TMDs), participants were diagnostically categorized. Subjects used a custom monitoring system, which recorded infield muscle activities. A factorial model tested for association between independent variable (muscle, time period, MMA level, and diagnostic group) effects and the logarithm of MMA. Greenhouse-Geisser test was used to determine any statistically significant associations (p≤0.003). RESULTS No statistically significant association was found between four-way, three-way, and two-way analyses. However, among the main effects, range of magnitudes was the only variable to be statistically significant. Although the data suggest a trend of increased masseter MMA in the pain-related TMD diagnoses group both during awake and sleep time periods, such observation is not maintained for the temporalis muscle. In addition, temporalis MMA was found to be higher in the pain-related TMD diagnoses group only at extreme activity levels (<25 and ≥80% ranges). CONCLUSION This data support the association between masticatory muscle hyperactivity and painful TMD conditions.

Association between Arthralgia and Imaging Findings of Effusion in the Temporomandibular Joints: A Systematic Review

The temporomandibular disorders (TMD) encompass a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joints (TMJs), the masticatory muscles, and associated tissues [1]. Common manifestations of TMD consist of pain of a persistent, recurring, or chronic nature in the TMJ, masticatory muscles, or in the adjacent structures; limitation or other alterations in the range of mandible motion; and TM joint noises [2]. It has been suggested that differential diagnosis of TMDs should be based primarily on information obtained from the patient’s history, clinical examination, and when TMJ imaging procedures indicated [1]. Magnetic resonance imaging (MRI) is an example of such imaging procedures. It provides excellent representation of soft tissues in anatomical and semi-functional relationships. In addition, it may also be used for detection of the presence of joint effusion with acceptable levels of reliability [3]. Some authors have also suggested use of MRI for assessment of hard tissues; however the reliability has been shown to be poor [3-5]. Joint effusion is defined as a collection of fluid in the joint space. It is manifested as areas of high intensity signal in the TMJ space, on T2-weighted images [3-5]. It has been suggested that this accumulation of fluid could be a surrogate of an inflammatory process that may activate or sensitize nociceptive afferent neurons within the joint [4-6]. Alternatively, it could result in increased intra-articular pressure, which may cause mechanical trauma, leading to hypoxia and other inflammation induced changes within the joint space, and eventually leads arthralgia [7]. Several studies have been conducted on the association of joint effusion and TMJ pain associated with TMD. However, the results have been inconsistent. While the majority of studies have reported a statistically significant association [4-26], others have reported inconclusive findings [5-30]. Due to this difference in reporting, a systematic review was conducted to determine if there is an association between joint effusion and self-reported TMJ-pain during examination, as well as between joint effusion and arthralgia as defined by the Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD) [31].

Reliability and diagnostic validity of a joint vibration analysis device

BackgroundThis observational study was designed to evaluate the reliability and diagnostic validity of Joint Vibration Analysis (JVA) in subjects with bilateral disc displacement with reduction and in subjects with bilateral normal disc position.MethodsThe reliability of selecting the traces was assessed by reading the same traces at an interval of 30 days. The reliability of the vibrations provided by the subjects was assessed by obtaining two tracings from each individual at an interval of 30 min. The validity compared the Joint Vibration Analysis parameters against magnetic resonance imaging as the reference standard. The data were analyzed with exploratory factor analysis.ResultsThe short- term reliability of the Joint Vibration Analysis outcome variables showed excellent results. Implementing factor analysis and a receiver operating characteristic as analytical methods showed that six items of the Joint Vibration Analysis outcome variables could be scaled and normalized to a composite score which presented acceptable levels of sensitivity and specificity with a receiver operating characteristic of 0.8.ConclusionThis study demonstrated that the composite score generated from the Joint Vibration Analysis variables could discriminate between subjects with bilateral normal versus bilateral displaced discs.