Jeffrey A. Burgess

Brief group cognitive-behavioral intervention for temporomandibular disorders

&NA; Temporomandibular disorders (TMD) are currently viewed as an interrelated set of clinical conditions presenting with signs and symptoms in masticatory and related muscles of the head and neck, and the soft tissue and bony components of the temporomandibular joint. Epidemiologie and clinical studies of TMD confirm its status as a chronic pain problem. In this report we present results from a randomized clinical trial which compared, at 3‐ and 12‐month follow‐ups, the effects of usual TMD treatment on TMD pain and related physical and psychological variables with the effects of a cognitive‐behavioral (CB) intervention delivered to small groups of patients before usual TMD treatment began. The purpose of this study was to determine whether a minimal CB intervention followed by dental TMD treatment enhanced the effects of usual clinical dental treatment. A second purpose of the study was to determine whether patients classified as high in somatization and psychosocial dysfunction would respond less favorably to this minimal intervention than would those low in somatization and dysfunction. Patients who participated in the CB intervention followed by usual treatment showed greater long‐term decreases in reported pain level and pain interference in daily activities than did patients who received only usual treatment. The benefits of CB intervention were not seen when the CB and UT groups were compared at 3‐month follow‐up. During the 3–12‐month follow‐up interval, however, the UT group maintained essentially the same level of improvement in characteristic pain while the CB group continued to improve, as hypothesized. During this same follow‐up interval, the CB group also showed a strong trend toward continued improvement in pain interference. Such effects were not observed for depression, somatization, or clinical measures of jaw range of motion. Additionally, as hypothesized, dysfunctional chronic pain patients did not appear to benefit from the brief CB intervention. Intent to treat analyses were also performed to assess generalizability of the results.

Orofacial pain of psychogenic origin: current concepts and classification

A description and attempt to classify the newly revised DSM-III and IASP classification schemes and those persistent orofacial pain syndromes that are commonly considered to be significantly associated with psychological or psychosocial factors, either as primary causes or as factors contributing to the maintenance of the chronic pain state are presented. The classification schemes include the DSM-III-R of the American Psychiatric Association and the new IASP taxonomy system, are the two systems currently available for classifying chronic orofacial pain states that are often considered to represent psychogenic pain conditions.

Short-term effect of two therapeutic methods on myofascial pain and dysfunction of the masticatory system

In conclusion, a short-term intervention with IS therapy was found to result in a substantial decrease in facial pain for most of the subjects treated. Generally, groups were not found to be significantly different in respect to palpation pain change from session 1 to session 2. Neither therapy significantly altered the range of mouth opening. EMG findings were variable but suggest that RI therapy may alter muscle myoelectric activity. From these findings, ice and stretch of the masticatory and neck musculature would appear to be a good short-term adjunctive therapy to control pain with little apparent risk of negative effects.

Pharmacological Management of Recurrent Oral Mucosal Ulceration

SummaryA number of diseases can cause recurrent intraoral ulceration. This review focuses principally on drug management of intraoral ulceration associated with local and systemic conditions most likely to be observed on an outpatient basis by the general practitioner. These consist of recurrent aphthous stomatitis, erosive lichen planus, benign mucous membrane pemphigoid (BMMP), erythema multiforme, Behçet’s disease, allergic stomatitis and infection. Information is provided on a spectrum of medication found useful in ulcer management, including topical antimicrobial and antifungal agents, topical and systemic corticosteroids, topical and systemic analgesics, and systemic immunosuppressive and anxiolytic drugs, plus details of dosage, important adverse reactions and interactions. A treatment guide for management of recurrent aphthae is presented. The reader is presumed to be familiar with differential diagnosis and the importance of establishing an accurate impression before starting drug therapy.

Temporomandibular disorders, headaches, and neck pain after motor vehicle accidents: A pilot investigation of persistence and litigation effects

STATEMENT OF PROBLEM There is a lack of long-term follow-up studies that involve post-motor vehicle accident temporomandibular disorders and compensation. PURPOSE OF STUDY The purposes of this retrospective pilot study were (1) to assess patients who had previously been treated for temporomandibular disorders after motor vehicle accidents to determine the nature of their symptoms in terms of jaw, head, and neck pain and jaw dysfunction and (2) to determine whether there was a difference in the pain and dysfunction between those who had settled and those who had not settled their insurance claims. MATERIAL AND METHODS Thirty previously treated patients with temporomandibular disorders after motor vehicle accidents were questioned by telephone regarding litigation status and current jaw, head, and neck pain and jaw dysfunction symptoms. They did not differ substantially from a smaller group who were not able to be interviewed. Descriptive statistics were calculated and statistical tests were performed. A total of 22 patients had their claims settled. RESULTS Approximately three fourths had persistent complaints of jaw pain, jaw dysfunction, and headache, and more than 80% reported persistent neck pain. No apparent differences were found between those who had and had not settled their insurance claims. CONCLUSION Jaw, head and neck pain, and jaw dysfunction continued to be problems for the majority of this patient population, regardless of litigation status in this retrospective study.

Effect of impact and injury characteristics on post-motor vehicle accident temporomandibular disorders

OBJECTIVES The objective of this study was to assess the potential effects of motor vehicle accident impact and injury characteristics on post-motor vehicle accident temporomandibular disorders in terms of presenting signs and symptoms, diagnoses, treatment regimens, and outcomes. STUDY DESIGN A retrospective chart review of 50 patients with post-motor vehicle accident temporomandibular disorders from a private oral medicine practice was undertaken. Various demographic data and data related to temporomandibular disorders and motor vehicle accident impact and injury characteristics were collected. Chi-square and Fisher exact tests and multiple regression analyses were performed. RESULTS Patients involved in front-end collisions or motor vehicle accidents resulting in severe vehicle damage reported more direct orofacial injury. However, those in rear-end collisions or accidents resulting in minimal vehicle damage required more treatment. Direct head or orofacial injury was therefore not a prognostic indicator. From multiple regression analyses, indicators of a poorer prognosis were minimal vehicle damage, lack of headrest use, driver position, and settlement of insurance claim. CONCLUSIONS In this patients group several prognostic indicators for patients with post-motor vehicle accident temporomandibular disorders were identified; these indicators may influence the management approach for this patient population.

Chronic orofacial pain: Initial analyses of treatment and outcome variables

A systematic and ongoing study of chronic TMJ/MPD pain is being conducted at the Orofacial Pain and Dysfunction Clinic at the Univ. of Washington. Early analysis of treatment and outcome data is presented for 117 consecutive TMJ/MPD patients whose modal length of conservative treatment was 5 months. 80% of the subjects were under forty and the female:male ratio was 4:l. An extreme range of pain duration and previous treatments is represented in this chronic pain patient sample. 56% of the patients received muscle & physical therapy; 70% bite appliances; 28% psychological counseling; 50% anti-inflammatory or analgesic drugs; and 30% muscle relaxant or psycho-active drugs. Follow-up questionnaire data revealed that pain was eliminated or insignificant in 62% of the patients, function was improved in 412, medications were reduced by 292, and stress levels reduced by 12%. Pain for 27% remained the same and was worse for 3%. Stress levels were improved for 46% and worse for 8%. Following therapy, patients subjectively reported a marked improvement in pain and function and a less dramatic improvement in medication usage and stress levels. Continued follow-up of these patients is being conducted.