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

Effect of dextrose phonophoresis versus pulsed electromagnetic field on temporomandibular dysfunction: A randomized, controlled study

OBJECTIVE

This study investigated and compared the efficacy of dextrose phonophoresis and Pulsed Electromagnetic Field (PEMF) on pain, range of motion (ROM) and function in patients with Temporomandibular Dysfunction (TMD).

METHODS

45 patients with TMD aging from 25 to 45 years, with mean age 29 ± 2.5 years were included in this study, they were assigned randomly into 3 equal groups each contain fifteen TMJ dysfunction patients. Group (A) in which each patient received 50% dextrose phonophoresis for 5 min and therapeutic ultrasound for 5 min, Group (B) in which each patient received Pulsed Electromagnetic Field (PEMF) with frequency of 50 HZ for 50 min, and traditional physiotherapy ultrasound for 5 min, while in the control group (C) the patients received traditional physiotherapy ultrasound for 5 min only, the frequency of treatment session in the three groups was 3 days per week for 4 weeks. The assessment tools were visual analog scale (VAS) for pain evaluation, plastic ruler for TMJ ROM measurements while Fonseca's questionnaire was used for evaluation of TM function at baseline and 4 weeks later.

RESULTS

Paired t-test for comparison between pre and post treatment measurements in each group showed significant decrease pain as well as improvement of ROM and Fonseca's questionnaire in group A and B than placebo group.

CONCLUSIONS

The results found that both dextrose phonophoresis and PEMF have beneficial effects considering pain, ROM and function in patients with (TMD).

Increased Oral Health-Related Quality of Life Postsynergistic Treatment with Ultrasound and Photobiomodulation Therapy in Patients with Temporomandibular Disorders

Background and objective: The object of this study was to analyze the oral health-related quality of life (OHRQoL) of patients with temporomandibular disorders (TMDs) who were treated simultaneously with ultrasound (US) and photobiomodulation therapy (PBMT). Materials and methods: This study included 13 patients of both genders, with diagnosis of TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders. The patients were treated with equipment consisting of US and PBMT in the same system. The treatment was applied to the left and right sides of the face in the masseter muscle, anterior temporalis muscle, and temporomandibular joint, two sessions per week for a total of eight sessions. The OHRQoL was assessed by the Oral Health Impact Profile (OHIP-14) at three moments: pretreatment (T₀), after the eight treatment sessions (T₁), and 30 days after termination of treatment (T₂). The Wilcoxon, Mann-Whitney U, Kruskall-Wallis, and Spearman's correlation coefficient tests were applied, with a significance threshold of 5%. Results: Psychological discomfort, physical pain, and psychological limitation were the domains where the highest scores were obtained at T₀. The total OHIP-14 scores at T₁ and T₂ were significantly lower than at T₀. No statistical differences were observed between T₁ and T₂. Conclusions: We conclude that synergistic treatment was effective in improving the OHRQoL of patients with TMDs, and that its beneficial effects persisted at 1 month after termination of treatment.

Soft versus hard occlusal splint therapy in the management of temporomandibular disorders (TMDs)

Aim

To compare between soft and hard occlusal splint therapy for the management of myofacial pain dysfunction (MPD) or internal derangement (ID) of the temporomandibular joint (TMJ) with reciprocal clicking.

Patients and methods

This study included 50 patients (age range: 24–47 years) who had been diagnosed with MPD or ID of the TMJ in the form of reciprocal clicking. Patients were divided into two groups. They were treated for 4 months with either a vacuum-formed soft occlusal splint constructed from 2-mm-thick elastic rubber sheets (soft splint group) or a hard flat occlusal splint fabricated from transparent acrylic resin (hard splint group). Monthly follow-up visits were performed during the treatment period. Before treatment and 1, 2, 3 and 4 months after treatment, the dentist measured all parameters of TMJ function (pain visual analog scores, tenderness of masticatory muscles, clicking and tenderness of the TMJ, and range of mouth opening).

Results

All parameters of TMJ function showed significant improvement in both groups during the follow-up period, with a statistically significant difference between the two groups at the 4-month follow-up visit.

Conclusions

Both forms of occlusal splints (soft and hard) improved TMJ symptoms in patients with MPD or ID of the TMJ. However, the soft occlusal splints exhibited superior results after 4 months of use.

Trends in management of myofacial pain

We systematically reviewed the myofascial pain publications in the literature. The aim of this article is to review the methods of management and their outcome and factors associated with prognosis. The topics of interest in the diagnostic process are myofascial trigger points electromyography, jaw tracking, joint sound recorder, sonography, and vibratography, exclusion of other orofacial pain and temporomandibular disorders. Management modalities are occlusal therapy, physiotherapy, multidimensional rehabilitation antinociceptive therapy, anti-inflammatory and analgesics, muscle relaxants, stretch, and spray technique, transcutaneous electric nerve stimulation, and in severe cases botulinum toxin may be tried. The disease required interdisciplinary interaction in terms of occlusal therapy, antinociceptive therapy and physiotherapy because management of the disease may be influenced by the specialist primarily treating the patients.

Effectiveness of a home exercise program in combination with ultrasound therapy for temporomandibular joint disorders

[Purpose] This study compared the effectiveness of home exercise alone versus home exercise combined with ultrasound for patients with temporomandibular joint disorders. [Subjects and Methods] This study enrolled 23 female and 15 male patients who were divided randomly into two groups. The home exercise group performed a home exercise program consisting of an exercise program and patient education, and the home exercise combined with ultrasound group received ultrasound therapy in addition to the home exercise program. Pain intensity was evaluated using a visual analogue scale. Pain free maximum mouth opening was evaluated at baseline and 2 weeks after the treatment. [Results] There was no difference between the two groups in baseline values. After the treatment, the visual analogue scale decreased and pain free maximum mouth opening scores improved significantly in each group. Additionally, both values were higher in the home exercise combined with ultrasound group than in the home exercise group. [Conclusion] The combination of home exercise combined with ultrasound appears to be more effective at providing pain relief and increasing mouth opening than does home exercise alone for patients with temporomandibular joint disorders.

Thermography as a quantitative imaging method for assessing postoperative inflammation

OBJECTIVE

To assess differences in skin temperature between the operated and control side of the face after mandibular third molar surgery using thermography.

METHODS

127 patients had 1 mandibular third molar removed. Before the surgery, standardized thermograms were taken of both sides of the patient's face using a Flir ThermaCam™ E320 (Precisions Teknik AB, Halmstad, Sweden). The imaging procedure was repeated 2 days and 7 days after surgery. A region of interest including the third molar region was marked on each image. The mean temperature within each region of interest was calculated. The difference between sides and over time were assessed using paired t-tests.

RESULTS

No significant difference was found between the operated side and the control side either before or 7 days after surgery (p > 0.3). The temperature of the operated side (mean: 32.39 °C, range: 28.9-35.3 °C) was higher than that of the control side (mean: 32.06 °C, range: 28.5-35.0 °C) 2 days after surgery [0.33 °C, 95% confidence interval (CI): 0.22-0.44 °C, p < 0.001]. No significant difference was found between the pre-operative and the 7-day post-operative temperature (p > 0.1). After 2 days, the operated side was not significantly different from the temperature pre-operatively (p = 0.12), whereas the control side had a lower temperature (0.57 °C, 95% CI: 0.29-0.86 °C, p < 0.001).

CONCLUSIONS

Thermography seems useful for quantitative assessment of inflammation between the intervention side and the control side after surgical removal of mandibular third molars. However, thermography cannot be used to assess absolute temperature changes due to normal variations in skin temperature over time.

Rational treatment of fibromyalgia for a solo practitioner

Fibromyalgia (FM) is a challenging condition, but the management of patients with FM is becoming facilitated by new medications that act in what are thought to be some of most important pathophysiological features in this syndrome. However, it is of pivotal importance that an interdisciplinary approach is used to improve pain, fatigue, sleep and other domains to improve quality of life. Here, we present elements of management that the solo practitioner can tackle, focussing in the formally approved drugs for FM and other drugs commonly used in this condition. Further, the elements of an ideal multidisciplinary team are presented, and on how to incorporate their recommendations for the treatment of FM.

The application of infrared thermography in the assessment of patients with coccygodynia before and after manual therapy combined with diathermy

OBJECTIVE

This study examines the potential usefulness of a novel thermal imaging technique in the assessment of local physiologic responses before and after conservative therapies for coccygodynia.

METHODS

Patients with coccygodynia were selected on the basis of detailed history taking, clinical examination, and dynamic series radiography. They underwent therapeutic modalities consisting of 6 to 8 sessions of manual medicine treatments (massage of the levators followed by Maigne's manipulative technique) and external physiotherapy (short-wave diathermy) 3 times a week for 8 weeks. We performed the assessments with numeric pain rating scale (NPRS) and infrared thermography (IRT) before treatment and at 12 weeks.

RESULTS

A total of 53 patients (6 males and 47 females) ranging from 18 to 71 years of age and clinically diagnosed with coccygodynia received the full course of therapy and assessments. There were significant differences in both NPRS and surface temperature obtained by IRT in the 12-week follow-up (P < .05). The correlation between NPRS improvement and temperature decrement was significantly high (r = 0.67, P < .01).

CONCLUSIONS

The study shows that IRT can objectively show the decrement of surface temperatures correlating with changes in subjective pain intensity after treatment of coccygodynia. With the advantages of being painless, noninvasive, and easy to repeat, IRT appears to be useful as a quantifiable tool for monitoring the dynamics of the disease activity in coccygodynia.

Muscle disorders and dentition-related aspects in temporomandibular disorders: controversies in the most commonly used treatment modalities

This review explores the aetiology of temporomandibular disorders and discusses the controversies in variable treatment modalities.Pathologies of the temporomandibular joint (TMJ) and its' associated muscles of mastication are jointly termed temporomandibular disorders (TMDs).TMDs present with a variety of symptoms which include pain in the joint and its surrounding area, jaw clicking, limited jaw opening and headaches. It is mainly reported by middle aged females who tend to recognize the symptoms more readily than males and therefore more commonly seek professional help.Several aetiological factors have been acknowledged including local trauma, bruxism, malocclusion, stress and psychiatric illnesses. The Research Diagnostic Criteria of the Temporomandibular Disorders (RDC/TMD) is advanced to other criteria as it takes into consideration the socio-psychological status of the patient.Several treatment modalities have been recommended including homecare practices, splint therapy, occlusal adjustment, analgesics and the use of psychotropic medication; as well as surgery, supplementary therapy and cognitive behavioural therapy. Although splint therapy and occlusal adjustment have been extensively used, there is no evidence to suggest that they can be curative; a number of evidence-based trials have concluded that these appliances should not be suggested as part of the routine care.Surgery, except in very rare cases, is discouraged since it is the most invasive alternative; recent studies have shown healthier outcome with cognitive behavioural therapy.

Can infrared thermography be a diagnostic tool for arthralgia of the temporomandibular joint?

This paper presents a review of the use of infrared thermography in diagnosis of temporomandibular joint (TMJ) arthralgia. The question examined was whether the infrared thermography could be reliably used as a tool to diagnose arthralgia by objectively assessing the site of origin and the degree of irritation. Controlled studies were performed by using advanced thermographic devices to show both diagnostic validity and reliability of infrared thermography as a screening test for selecting healthy subjects from patients with unilateral TMJ arthralgia. The study revealed that thermography fails to meet the criteria of high level of evidence. Further studies are required to confirm these results in order to specify analysis of facial thermal patterns and to better understand the relationship between TMJ arthralgia and regional temperature changes. Until then infrared thermography cannot be recommended for routine use as a diagnostic technique to identify TMJ disorders.

Regulation of mandibular postures: mechanisms and clinical implications

This review argues that (1) the habitual mandibular position is constantly variable and so cannot be considered as a craniomandibular reference point, (2) there is no unique centric relation, (3) mandibular posture greatly depends on head posture, (4) clinical evaluation of the occlusal vertical dimension is mostly empirical, and (5) neither the vertical dimension at rest nor the centric relation can be determined by means of existing instrument-based clinical methods. However, some physiological conditions exist that facilitate the recording of craniomandibular position.

Reliability, validity, and utility of various occlusal measurement methods and techniques

STATEMENT OF PROBLEM

The controversy continues regarding the efficacy of several commercially available devices that are used as aids in the diagnosis of occlusal abnormalities.

PURPOSE

This article reviews the reliability, validity, and utility of instruments that claim to detect occlusal interferences and abnormal vertical dimension of occlusion.

MATERIAL AND METHODS

Data, opinions, and technical information from 37 published articles were reviewed. Evidence for method reliability, validity, and utility was assessed.

RESULTS

Although occlusal contact detection devices can document the occlusal contact patterns on teeth, the basic in vivo testing of their reproducibility and validity has not been performed. Moreover, while EMG and jaw tracking systems can indeed measure jaw muscle activation and jaw position, no cost-benefit analysis of these devices has yet been conducted. One manufacturer suggests that these instruments be used in conjunction with an electrical muscle stimulation device to find a new resting jaw position that is more open vertically. This new, more open position has been inappropriately labeled as evidence of vertical dimension of occlusion over-closure.

CONCLUSION

None of the instruments reviewed can be said to be more than ancillary documentation devices and they have been inadequately tested for reliability and validity. Moreover, because scientifically acceptable disease definitions are not available for these 2 conditions, the issue of over-diagnosing becomes a substantial concern.

Temporomandibular disorders: a review of current understanding

OBJECTIVE

The purpose of this article is to conduct a narrative review of current evidence regarding the understanding, evaluation, management, and treatment of temporomandibular disorders to provide a broad perspective and updated introduction to an important and controversial subject with rapidly changing developments and limited well-designed research.

DATA SOURCES

Studies were identified through a search of MEDLINE for 3 topics (temporomandibular disorder, temporomandibular joint, and chronic pain) over a 10-year period (January 1988 to August 1998) and of bibliographies of identified studies and review articles.

STUDY SELECTION

More than 5000 articles were produced. In-depth review of all of this literature was beyond the scope of the present article, which is intended to provide an overview. The amount and diversity of the literature and the limitations of covering such a broad topic being recognized, the papers selected were those that reviewed limited topics or studied focused areas. This report is not a systematic (qualitative) or meta-analysis (quantitative) review. An acknowledged limitation of this narrative review method lies in the potential for bias in selection. The referenced works do not include all papers reviewed; only pertinent literature and reviews with comprehensive references were selectively included.

CONCLUSIONS

Advances in basic and clinical science have resulted in important changes in the understanding and management of temporomandibular disorders. Many treatments are not supported by research, and the role of dentistry is changing to a more diagnostic and management-based model from the hands-on treatment procedures of the past. The present science-based understand-ing of a biopsychosocial disorder is important in properly and responsibly dealing with patients with temporomandibular disorders.

Management of temporomandibular disorders: concepts and controversies

STATEMENT OF PROBLEM

Controversy continues in the area of epidemiology, etiology, diagnosis, and management of temporomandibular disorders (TMD). The field is replete with testimonials and clinical opinion, but it has been lacking in scientific foundation.

PURPOSE

This article reviews the recent temporomandibular disorder and orofacial pain literature and summarizes the concepts published in the 1993 and 1996 American Academy of Orofacial Pain guidelines. Temporomandibular disorders rarely occur as single entities but rather as multiple problems with overlapping symptoms.

CLINICAL SIGNIFICANCE

The multicausal nature of these problems and the number of conditions with similar signs and symptoms demand an effective differential diagnostic process. Diagnostic criteria are used from an operational standpoint to establish specific diagnoses based on a multiaxial diagnostic model.

CONCLUSION

Because little is known about the natural course of the various classifications of temporomandibular disorders, and because most treatment approaches are reported to be equally effective, a conservative, noninvasive management program is endorsed. The emphasis is on a medical multidisciplinary model similar to ones used for other musculoskeletal disorders that involve the patient in the physical and behavioral management of his or her own problem. This article concludes that a majority of temporomandibular disorder patients achieve good relief of symptoms with noninvasive reversible therapy.

The validity and utility of disease detection methods and of occlusal therapy for temporomandibular disorders

Our evaluation of the clinical usefulness or devices for the diagnosis or treatment of temporomandibular disorders (TMD) led to the conclusion that the only current gold standard for TMD is a global clinical examination, because none of the instruments can be said to provide more than ancillary documentation and none have proven diagnostic validity or utility. Regarding the therapeutic efficacy of occlusal adjustment, we could find no comparative studies that test the efficacy of occlusal adjustment in preventing TMD. The studies we reviewed on the relationship of occlusion to TMD are not convincing, powerful, or practical enough to make any recommendations about a causal association.

Current terminology and diagnostic classification schemes

This article reviews the current terminology and classification schemes available for temporomandibular disorders. The origin of each term is presented, and the classification schemes that have been offered for temporomandibular disorders are briefly reviewed. Several important classifications are presented in more detail, with mention of advantages and disadvantages. Final recommendations are provided for future direction in the area of classification schemes.

Effect of continuous passive motion on the results of TMJ meniscectomy. Part I: Comparison of chewing movement

In order to evaluate the therapeutic effect of continuous passive motion (CPM) on the outcome of TMJ meniscectomy, chewing movement was analyzed before surgery and six months after surgery in 31 patients receiving CPM (CPM group), 26 patients without CPM (non-CPM group), and in ten normal subjects. The surgical procedure consisted of either total meniscectomy or partial meniscectomy with disk repair. It was found that chewing in patients receiving CPM was closer to the normal range than for patients in the non-CPM group. The results from the CPM group demonstrated chewing parameters for patients with partial meniscectomy returning to the normal range. However, for the patients with total meniscectomy, some parameters remained out of the normal range. From these results, we conclude that CPM has a positive influence on the outcome of TMJ surgery.

Temporomandibular disorders. 2. Non-surgical treatment

There are many treatment modalities for temporomandibular disorders (TMD), most of which are effective in controlling symptoms, at least in the short term. The non-surgical treatment of temporomandibular disorders continues to be the most effective way of managing over 80 per cent of patients who present with symptoms of temporomandibular pain and dysfunction. In this, the second article in the series, a general overview of the current non-surgical treatment strategies for TMD will be presented.

Chewing pattern analysis in TMD patients with and without internal derangement: Part I

In order to investigate the chewing movement of temporomandibular disorders (TMD) patients with and without internal derangement of the temporomandibular joint (TMJ), analysis of the envelope of motion during chewing was performed in 103 TMD patients with unilateral internal derangement (ID group), 94 TMD patients without internal derangement (NID group) and 10 normal subjects (normal group). The analysis of numeric parameters revealed that the ID group demonstrated a significantly restricted range of motion compared to the NID or normal groups, and the NID group demonstrated significant irregularity of chewing compared to the ID or normal groups. The analysis of chewing also demonstrated that the chewing pattern for the ID group demonstrated more frequent deviation of the turning point to the nonchewing side in the frontal plane and a narrow anteroposterior pattern in the sagittal plane compared to the other groups. No characteristic chewing patterns were identified for the NID group.

Dental quackery: a retrospective view

Instances of dental quackery are easy to spot in history, but what qualifies as quackery in contemporary dentistry? A historical perspective leads to an evaluation of questionable practices in the field today.

Current status of diagnostic procedures for temporomandibular disorders

Temporomandibular disorders encompass a group of musculoskeletal conditions that involve the joints, the masticatory musculature, or both. In any given patient, there may be several overlapping TM disorders, an orofacial pain condition mimicking a TM disorder or a concomitant TMD and non-TM disorder. The differential diagnosis becomes extremely important.

Temporomandibular disorders: assessment of psychological factors

Factors such as psychological stress, anxiety, depression, oral habits, and chronic pain behaviors have been found in subgroups of Temporomandibular Disorders (TMD) patients. This paper reviews the current status of diagnostic methods and instruments designed to identify various psychological factors. The authors offer the following general conclusions: Although the DSM-III-R has significant limitations, it is currently the most common gold standard with which other psychological instruments are compared. There are several specific assessment instruments, such as the Beck Depression Inventory and the Zung Self-Rating Depression Scale, which have been found to have acceptable sensitivity and specificity scores. In addition, certain simple screening questions may be cost-effective for the identification of psychological factors. Because of studies indicating that the dentists' recognition of psychological factors is inaccurate, a brief screening questionnaire may be useful in TMD patients. The literature does not support the routine use of the MMPI. A major conclusion of this review is that there are several psychological instruments available which have demonstrated reasonable validity through a blind comparison with a gold standard. There is need for further development and testing of brief screening instruments using clinical decision methods.

Reliability and validity of diagnostic modalities for temporomandibular disorders

Temporomandibular disorders (TMD) encompass a group of musculoskeletal conditions that involve the temporomandibular joint (TMJ) or joints, the masticatory musculature, or both. These conditions are typically characterized by pain in the pre-auricular area that is usually aggravated by chewing or other jaw function and is often accompanied, either singly or in combination, by limitation of jaw movement, joint sounds, palpable muscle tenderness, or joint soreness. As with most other musculoskeletal conditions, the diagnostic "gold standard" for TMD is based upon an evaluation of the patient's history and clinical examination, supplemented, when appropriate, by TM joint imaging. It is against this "gold standard" that the reliability and validity of diagnostic modalities must be compared. With regard to electronic devices, several reviews of the scientific literature have concluded that the diagnostic reliability, validity, sensitivity, and specificity of such devices in the diagnosis of TMD have not been established. In addition, although clinical examination of the dentition may provide useful diagnostic information for some conditions, specific occlusal relationships have poor sensitivity and specificity when related to the presence or absence of TMD. TMJ imaging, when indicated, is useful in the detection of pathology within the joint, provided that validated criteria are applied to an analysis of the image. However, the assessment of condylar position as a diagnostic criterion for TMD has very poor reliability and validity.

Effects of intraoral appliance and biofeedback/stress management alone and in combination in treating pain and depression in patients with temporomandibular disorders

To assess the differential efficacy of two commonly used treatments for temporomandibular disorders (TMD), intraoral appliances (IAs) and biofeedback (BF), separately and in combination, two studies were conducted. The first study directly compared IA treatment, a combination of biofeedback and stress management (BF/SM), and a waiting list control group in a sample of 80 TMD patients. Both treatments were determined to be equally credible to patients, ruling out this potential threat to the validity of the results obtained. The results demonstrated that the IA treatment was more effective than the BF/SM treatment in reducing pain after treatment, but at a 6-month follow-up the IA group significantly relapsed, especially in depression, whereas the BF/SM maintained improvements on both pain and depression and continued to improve. The second study examined the combination of IA and BF/SM in a sample of 30 TMD patients. The results of this study demonstrated that the combined treatment approach was more effective than either of the single treatments alone, particularly in pain reduction, at the 6-month follow-up. These results support the importance of using both dental and psychologic treatments to successfully treat TMD patients if treatment gains are to be maintained.

Vibration analysis of the temporomandibular joints with meniscal displacement with and without reduction

The vibrations of 102 joints demonstrating meniscal displacement with either early or late reduction (MDR-early/MDR-late) and 70 joints displaying meniscal displacement without reduction either incomplete or complete (MD-incomplete/MD-complete) were analyzed and compared to 83 arthrographically normal but symptomatic joints (NID) using electrovibratography (EVG). The total power density of the vibration [I(T)], peak power density [I(max)] and power density at each 50Hz range between O to 600 Hz [I(f)] showed the highest in the MDR-late group followed by the MDR-early group, suggesting that the level of vibration is related to the degree of disk displacement and reduction. The wave characteristic parameters such as the correlation coefficients between I(T) and each I(f) showed higher correlation at higher frequency ranges as the degree of disk displacement progressed, from MDR-early to MDR-late to MD-incomplete. The diagnostic sensitivity of EVG when using I(T) as a determining parameter was 96.6% for the MDR-early group, 91.8% for the MDR-late group, 77.8% for the MD-incomplete group and 57.4% for the MD-complete group with the specificity for the NID group at 75%.

Deep thermometry of temporomandibular joint and masticatory muscle regions

A study was designed to measure noninvasively the deep temperature of the temporomandibular joint (TMJ) region and corresponding regions of the masticatory muscles at rest. With a transcutaneous probe, the deep thermometry of the right and left anterior (Ta) and the posterior portion (Tp) of the temporal muscles, the mid-portion of the superficial belly of the masseter muscles (Mm), and the TMJ regions were measured. In 20 normal male subjects, the deep temperature of the Ta region (mean 36.342 degrees C), the Tp region (mean 36.345 degrees C), and the TMJ region (mean 36.06 degrees C) was higher than that of the Mm region (mean 35.897 degrees C) at rest. In addition, no differences in the deep temperature were observed between the right and left Ta, Tp, Mm, and TMJ regions at rest. All of the normal subjects showed differences between the right and left TMJ region of less than 0.3 degrees C. In 10 patients with craniomandibular disorders, however, eight patients showed differences of more than 0.3 degrees C between the asymptomatic and asymptomatic TMJ region. Because of high sensitivity and specificity, the deep thermometry measurements can provide useful non-invasive information.

A clinical study of temporomandibular joint (TMJ) vibrations in TMJ dysfunction patients

Using electrovibratography (EVG), the vibrations of 309 temporomandibular joints (TMJs) from 213 patients with clinical symptoms of temporomandibular joint dysfunction (TMD) were compared to TMJ arthrography. Of 309 imaged joints, 221 had an internal derangement (ID) and 88 were arthrographically normal (NID). Among the parameters derived from the power spectrum function of joint vibration, the total power density from 0 to 600 Hz (I(T)), the peak power density I(max)), and the power density at each 50 Hz frequency range (I(f)), each of these was significantly greater in ID than in NID patients. The frequency range that included (I(max) and the frequency range containing 50%, 75%, and 90% of I(T) was significantly lower in ID than in NID patients. The diagnostic sensitivity and specificity of a patient's perception of TMJ sounds were 43% and 80%, respectively, while those for a doctor's perception were 54% and 72%. When using I(T) as a parameter, the sensitivity and specificity of the EVG were 75% and 77%, respectively. By using these parameters of TMJ vibration energy analysis, a separation may be made between patients with normal joint anatomy and internal derangement.

The dilemma of scientific knowledge versus clinical management of temporomandibular disorders

The dilemma of scientific knowledge versus clinical management of TMD is discussed by focus on five questions; (1) What is scientific evidence and how is it transmitted? (2) What important evidence is lacking in the field of TMD? (3) What clinical concepts have been challenged by the scientific evidence? (4) Why is there adherence to concepts that appear to conflict with the evidence? (5) How does the clinician provide patient care in the face of uncertainty while retaining scientific integrity? It is concluded that no fundamental reason for a dilemma between scientific evidence and clinical practice need exist provided that (1) clinical investigators use appropriate research protocols and report results in refereed scientific journals and (2) dentists are familiar with the requirements of sound scientific evidence, interpret this evidence and its clinical implications, and apply it to the care of TMD patients.

Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

Subjects of the past decade in the dental literature are reflected in this year's Committee report. We note the decrease in the prevalence of caries, the influence of dental implants, the advancements in dental materials, and the continued efforts to control adhesive events in the oral cavity. This year we included comments from and about many significant review articles published this past year. The Committee continues to be concerned about the quality of some of the work reported and the quality of the reporting. We have attempted to select the distinguished work, that which provides new information to our profession. The subjects covered include pulp biology, caries prevention, periodontics, implants, craniomandibular function and dysfunction, occlusion, and dental materials.