S J Davies

Occlusion: What is occlusion?

The aim of this series of papers is to explore the role of occlusion in dental practice. The range of opinion in the dental profession as to the importance of occlusion is enormous. It is very important that the profession in general and practising dentists in particular have a balanced view of occlusion. This is more important than every patient having a balanced occlusion. The fact that the study of occlusion is characterised by extremes makes it confusing and possibly difficult for individual dentists to find a philosophy which is in line with contemporary good practice supported by evidence from practice-based research.

Temporomandibular disorders, trismus and malignancy: development of a checklist to improve patient safety.

Trismus is a restriction in the ability to open the mouth. Trismus can occur following trauma, surgery, radiation therapy, infection, inflammatory diseases, temporomandibular disorders (TMD) or less commonly as a result of malignancy. Following two cases of delayed diagnosis of carcinoma presenting with features of TMD to a specialist clinic, a checklist was developed for completion in cases of trismus, to alert the clinician to suspicious features suggesting a possible non-TMD cause. The use of this checklist, together with an increased awareness, has improved early recognition of atypical features in patients presenting with trismus and has contributed to the early diagnosis of a further case of malignancy presenting to this clinic. This article discusses the presentation of malignancy with trismus, the relevance of imaging in these cases, and the implementation of a checklist to reduce the risk of future misdiagnosis.

occlusion: Good occlusal practice in removable prosthodontics

The loss of teeth may result in patients experiencing problems of a functional, aesthetic and psychological nature. This section addresses the very important subject of occlusal considerations for partial and complete dentures. The occlusion is particularly important given the bearing that occlusal factors have, especially on edentulous patients.

Anterior repositioning splint for temporomandibular joint disc displacement

This is the protocol for a review and there is no abstract. The objectives are as follows: To establish the effectiveness of anterior repositioning splint therapy in reducing symptoms (clicking) in patients with disc displacement with reduction (compared with any control comparison group).

An appraisal of the quality of referral letters from general dental practitioners to a temporomandibular disorder clinic.

Aim To assess the usefulness of referral letters from general dental practitioners (GDPs) to a clinic seeing referrals related to temporomandibular disorders. Design A retrospective analysis of all referral letters received by the TMD clinic at Manchester Dental Hospital over a ten-week period. Methods The new patient referral letters to the TMD clinic were examined against suggested criteria of 16 points of information considered to be useful by clinicians working in the clinic. The letters were then assessed using a quality scale based on the level of useful information given in the letter, and using this scale, classified into groups of ‘very helpful’, ‘some help’ or ‘a little helpful’. Results Out of the 100 letters analysed, the majority (94) proved to be a ‘little helpful’ for the TMD clinician; that is to say, the letter included only 0–4 points (out of 16) regarded as important information for the specialist. The maximum number of points of information contained in a letter was nine. No letters were categorised as ‘very helpful’ for the clinician, and only 6% of the referral letters were considered to provide some help (5–12 points). Conclusions During the period of the study, in general, referral letters to the TMD clinic concerned contained insufficient information. The introduction of a referral pro forma, produced by the TMD clinic, and guidelines might improve the quality of referrals.

Effect of temporal bone resection on temporomandibular joint function: A quality of life study

OBJECTIVES: Temporal bone resection for carcinoma may affect quality of life (QOL) and result in temporomandibular joint (TMJ) disorders. The aims of this study were to 1) assess TMJ function after temporal bone resection, and 2) assess the impact of TMJ dysfunction on QOL. STUDY DESIGN: Chart and patient review and QOL study. SETTING: Tertiary referral center (Manchester Royal Infirmary). SUBJECTS AND METHODS: Thirty patients who had undergone temporal bone resection were identified. Thirteen patients were alive and were included in the study. All patients were submitted to a clinical examination to identify TMJ disorders and determine facial nerve function, and they all answered the University of Washington QOL (UW-QOL) questionnaire (version 4). RESULTS: Eight patients had TMJ disorders with reduced mobility in either direction and/or significant pain. Main factors affecting QOL were pain (P = 0.001), appearance (P = 0.001), and anxiety (P = 0.000). Neither facial nerve palsy nor TMJ disorders affected QOL. The responses to the UW-QOL questionnaire showed that 69 percent of our patients had a good QOL. A total of 61.53 percent of our patients had TMJ dysfunction presenting as restriction of jaw mobility with or without pain. CONCLUSION: TMJ dysfunction is present in a significant number of patients after temporal bone resection, resulting in longstanding problems, which should be addressed accordingly. Poor QOL results from ongoing pain and psycho-social disturbance.

Centric splints more effective than distraction splints in anterior disc displacement without reduction

DesignA single-blind randomised controlled trial was conducted in a university prosthodontics department in Germany.InterventionOnly people who presented a clear-cut clinical diagnosis of anterior disc displacement without reduction (ADDWR) were included: limited mouth opening with deflection, and limited lateral movement of the incisors and/or pain had to be found. Additionally, patients had to present at least one antagonistic molar contact on each side. The clinical finding was verified by magnetic resonance images in open and closed mouth positions. After clinical examination and imaging, centric splints or distraction splints were randomly assigned. Patients were instructed to wear the splint 18 h each day. Directions as to the care of the splint were given.Outcome measureAfter 1, 3 and 6 months of therapy, patients provided their subjective evaluation by filling out a visual analogue scale form. Any change in their pain level or functional performance level was recorded. The outcome was evaluated using the Wilcoxon signed rank test for matched pairs. Success after 6 months was defined as improvement in active mouth opening of greater than 20% and pain reduction (on chewing) of at least 50%. Success was statistically verified using a logistic regression test.ResultsA total of 74 patients (65 females and nine males) fulfilled the inclusion criteria and agreed to participate. Thirty-eight patients received a centric splint and 36 a distraction splint. The improvements in mouth opening were significant in both groups. The improvements in pain on chewing, pain during other functions, pain at rest, functional limitation on chewing and other functions were also comparable in the two groups. The logistic regression test, however, suggested that patients using centric splints were treated more successfully than the others (odds ratio, 2.88; 95% confidence interval, 1.01–8.74).ConclusionsCentric splints seem to be more effective than distraction splints. Therefore, before the surgical treatment of ADDWR, centric splints should be used instead of distraction splints.