Ziad Al-Ani

Risk management in clinical practice. Part 8. Temporomandibular disorders

Temporomandibular disorders can arise apparently idiopathically, as a result of macro-trauma or micro-trauma such as parafunction, as a result of a separate disease process or as a consequence of dental treatment. The objectives of this chapter are to make the practitioner aware of his/her responsibilities in any of these situations. Precise record keeping and careful risk management are essential. Guidelines are given to protect not only the practitioner but also the patient.

Inter-examiner and intra-examiner reliability of the measurement of marginal bone loss around oral implants.

The purpose of this study was to test whether a handheld magnifier could be used as an accurate instrument to examine the periapical radiographs and measure the marginal bone levels around dental implants system. A radiologic evaluation of marginal bone loss around 11 Astra Tech (Astra Tech AB, Mölndal, Sweden) oral implants was performed. A total of 22-recorded readings of mesial and distal bone loss were performed using a handheld magnifier with a graticule. There were 3 independent examiners who determined radiographic bone assessment. Thevalues of interclass correlation coefficient for the agreement between pairs of examiners showed a relatively high agreement (0.993 for A vs B, 0.995 for B vs C, and 0.995 for A vs C) and the same for intra-examiner reliability result (0.998 for B vs B). These results showed that a handheld magnifier could be used as a simple, reliable, and reproducible method for measuring bone loss around oral implants.

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.