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Kakudate N, Yokoyama Y, da Silva Tagliaferro EP, Sumida F, Matsumoto Y, Gordan VV, Gilbert GH. The Evidence-practice Gap in Minimal Intervention Dentistry: An International Comparison Between Dentists in Japan and Brazil. Oper Dent 2024; 49:127-135. [PMID: 38196080 PMCID: PMC10984213 DOI: 10.2341/23-074-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES This study was designed to: 1) evaluate and compare the evidence-practice gap (EPG) in minimal intervention dentistry (MID) in Japan and Brazil by measuring concordance between dentists' clinical practice and published evidence; and 2) identify dentists' factors associated with the EPG in both countries. METHODS We performed a cross-sectional study using a web-delivered questionnaire among 136 Japanese and 110 Brazilian dentists. The questionnaire consisted of three questions concerning "restoration diagnosis and treatment," "deep caries diagnosis and treatment," and "caries risk assessment" regarding MID. A chi-square test was used to analyze differences in concordance among clinical practice and evidence from the literature between Japanese and Brazilian dentists. Logistic regression analyses were performed to analyze dentists' factors associated with overall concordance for all three questions. RESULTS Overall concordance was significantly higher in Brazil (55%) than in Japan (38%) (p<0.01). Concerning how evidence was obtained, textbooks, nonacademic journals, and seminars and workshops were used as information sources more frequently by Japanese than Brazilian dentists (p<0.001), whereas scientific journal articles in English were used more frequently by Brazilian dentists (p<0.001). On logistic regression analysis, overall concordance was higher for Japanese dentists who frequently obtained evidence from scientific journal articles in English (p<0.05), whereas Brazilian dentists who frequently obtained evidence from the Internet were associated with lower overall concordance (p<0.05). CONCLUSIONS Because overall concordance was significantly higher in Brazil than in Japan, Japan may have a greater EPG in MID practice. Specific characteristics of Japanese and Brazilian dentists showed significant associations with overall concordance.
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Affiliation(s)
- Naoki Kakudate
- Professor & Division Director, Division of Clinical Epidemiology, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Yoko Yokoyama
- Project Senior Assistant Professor, Graduate School of Media and Governance, Keio University, 5322 Endo Fujisawa, Kanagawa, 252-0882, Japan
| | - Elaine Pereira da Silva Tagliaferro
- Professor, Department of Community Dentistry, São Paulo State University (UNESP), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Futoshi Sumida
- Dentist, Daiich Dental Clinic, 5-5-7, Hanazono, Chitose, Hokkaido, 066-0028, Japan
| | - Yuki Matsumoto
- Director, Matsumoto Dental Clinic, 24-3, Komanomai, Doimachi, Okazaki, Aichi, 444-0204, Japan
| | - Valeria V Gordan
- Professor and Interim Associate Dean for Research, Department of Restorative Dental Sciences at the University of Florida College of Dentistry, Room D3-39 P.O. Box 100415 Gainesville, FL 32610-0415, USA
| | - Gregg H Gilbert
- Distinguished Professor, James R. Rosen Endowed Chair of Dental Research, & Chair, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Room SDB 109, 1720 Second Avenue South, Birmingham, AL 35294-0007, USA
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Minervini G, Marrapodi MM, La Verde M, Meto A, Siurkel Y, Ronsivalle V, Cicciù M. Pregnancy related factors and temporomandibular disorders evaluated through the diagnostic criteria for temporomandibular disorders (DC/TMD) axis II: a cross sectional study. BMC Oral Health 2024; 24:226. [PMID: 38350935 PMCID: PMC10863208 DOI: 10.1186/s12903-024-03930-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Temporomandibular disorder (TMD) is a multifaceted condition impacting the chewing system, with its frequency varying across different age groups and showing a higher incidence in women. The involvement of estrogen in TMD has been examined due to the presence of estrogen receptors in the TMJ area. However, the exact effect of estrogen on TMD is complex. During pregnancy, marked by significant hormonal fluctuations, the impact on TMD has been hypothesized but remains unclear due to inconsistent results from various studies. METHODS In this cross-sectional study, we enrolled 32 pregnant women consecutively. We gathered information on demographics, TMD evaluations (using the Graded Chronic Pain Scale, Jaw Functional Limitation Scale-20, and Oral Behaviors Checklist), and mental health assessments (including Patient Health Questionnaire-9, Patient Health Questionnaire-15, and Generalized Anxiety Disorder-7). We employed descriptive statistics to summarize continuous and categorical data and used t-tests and chi-square tests for comparisons. We also conducted multivariate linear regression, adjusted for demographic factors, to investigate correlations. RESULTS The study group mainly consisted of women aged 30-35 (40.6%) and 25-30 (18.8%). Most participants had completed high school (50%) and were married (71.9%). A notable association was found between younger women (under 30) and higher levels of somatic symptoms (p = 0.008) and generalized anxiety (p = 0.015). Women in their second trimester showed lower severity of somatic symptoms (p = 0.04). A significant link was also observed between depression severity and somatic symptom severity (p = 0.01). However, we found no significant correlations with other TMD-related health aspects. DISCUSSION Our study identified significant associations between psychosomatic and psychological symptoms with variables like age and pregnancy trimester in pregnant women. However, it notably failed to establish a clear relationship between pregnancy-related factors and the severity of temporomandibular disorders (TMD). More comprehensive studies with larger participant pools are necessary to further validate and expand these findings.
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Affiliation(s)
- Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India.
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, 80121, Italy.
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, Naples, 80138, Italy
| | - Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, Naples, 80138, Italy.
| | - Aida Meto
- Department of Dentistry, Faculty of Dental Medicine, University of Aldent, Tirana, Albania
- Clinical Microbiology, School of Dentistry, University of Modena and Reggio Emilia, Modena, Italy
| | - Yuliia Siurkel
- International European University School of Medicine, Akademika Hlushkova Ave, 42В, Kyiv, 03187, Ukraine.
| | - Vincenzo Ronsivalle
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, 95123, Italy
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, 95123, Italy
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Jadeja N, Sahu AK, Thakur R, Ismail BM, Kumar KH, Sadananda K, Mehta DN. Comparative Evaluation of CBCT and MRI in Temporomandibular Joint (TMJ) Disorders and their Relationship to Periodontal Health. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S844-S846. [PMID: 38595568 PMCID: PMC11000919 DOI: 10.4103/jpbs.jpbs_1056_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 04/11/2024] Open
Abstract
Cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) are diagnostic tools frequently employed to evaluate temporomandibular joint (TMJ) disorders, yet their comparative efficacy remains a subject of interest. In this study, we conducted a comparative evaluation of CBCT and MRI in diagnosing TMJ disorders and assessing their association with periodontal health. We recruited a sample of 100 patients presenting with TMJ symptoms and divided them into two groups. Group A underwent CBCT imaging, while Group B received MRI scans. Clinical assessments of periodontal health were performed using established periodontal indices. Diagnostic accuracy, sensitivity, specificity, and interobserver agreement were calculated for each imaging modality. In the current study, CBCT demonstrated superior diagnostic accuracy (85%) compared to MRI (72%) in identifying TMJ disorders. Sensitivity and specificity for CBCT were 87% and 83%, respectively, while for MRI, sensitivity was 68%, and specificity was 76%. Interobserver agreement was substantial for CBCT (κ = 0.75) and moderate for MRI (κ = 0.56). In addition, CBCT revealed a significant correlation between TMJ disorders and periodontal health (P < 0.05), while MRI showed a weaker association (P < 0.1). We concluded from this study and suggest that CBCT is a more accurate imaging modality for diagnosing TMJ disorders compared to MRI. Moreover, CBCT provides valuable insights into the relationship between TMJ disorders and periodontal health, highlighting the importance of comprehensive dental assessments.
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Affiliation(s)
- Neeldipsinh Jadeja
- Department of Oral Medicine and Radiology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, Gujarat, India
| | - Amit K. Sahu
- Department of Pedodontics and Preventive Dentistry, Government Sardar Vallabh Bhai Patel District Hospital, Satna, Madhya Pradesh, India
| | - Raksha Thakur
- Department of Pedodontics and Preventive Dentistry, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
| | - B Mohammed Ismail
- Department of Periodontology and Implantology, Mithila Minority Dental College and Hospital, Darbhanga, Bihar, India
| | - K Hanumantha Kumar
- Department of Periodontics, Government Dental College and Research Institute, VIMS, Ballari, Karnataka, India
| | - K. Sadananda
- Department of Periodontics, Government Dental College and Research Institute, VIMS, Ballari, Karnataka, India
| | - Dhaval N. Mehta
- Department of Oral Medicine and Radiology, Narsinbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat, India
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Riley JLI, Rindal DB, Velly AM, Anderson GC, Johnson KS, Gilbert GH, Schiffman EL. Practitioner/Practice- and Patient-Based Factors Contributing to Dental Practitioner Treatment Recommendations for Patients with Pain-Related TMDs: Findings from the National Dental PBRN. J Oral Facial Pain Headache 2023; 37:195-206. [PMID: 37975783 PMCID: PMC10664701 DOI: 10.11607/ofph.3263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 04/16/2023] [Indexed: 11/19/2023]
Abstract
AIMS To document National Dental Practice-Based Research Network (PBRN) practitioner treatment recommendations for patients with painful temporomandibular disorders (TMDs) and to identify practitioner/practice- and patient-related factors contributing to treatment recommendations made at the initial clinical visit. METHODS This prospective single-sample cohort study formed groups based on treatment recommendations made by 185 dental practitioners who treated 1,901 patients with painful TMDs. At the baseline visit, which this article describes, practitioners provided patients with their diagnoses and a treatment plan and then completed a comprehensive questionnaire. RESULTS Self-care, an intraoral appliance, medication, and practitioner-recommended jaw exercises were the most frequently recommended treatments. Practitioners recommended multiple treatments to most patients. TMD signs, symptoms, and diagnoses were primary considerations in treatment planning, but the practitioner's expectations for improvement were only significant for intraoral appliances and self-care. Female practitioners and those with expertise in TMDs more frequently recommended patient-directed and multidisciplinary treatments compared to their counterparts. CONCLUSIONS Practitioners used a wide range of treatments for patients with few consistent patterns. The propensity to use TMD signs, symptoms, and diagnoses when making treatment recommendations suggests a tendency to conceptualize patients using the biomedical model. Infrequent referral to nondental providers suggests a lack of availability of these providers, a misunderstanding of the complexity of TMDs, and/or discomfort with assessment of psychosocial factors. Implications include the need for comprehensive training in the assessment and management of TMD patients during dental school and participation in TMD continuing education courses following evidence-based guidelines.
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Yokoyama Y, Kakudate N, Sumida F, Matsumoto Y, Gordan VV, Gilbert GH. Causes of the Evidence-practice Gap and Its Association with the Effects of Minimal Intervention Dentistry Education to Clinicians. Oper Dent 2023; 48:137-145. [PMID: 36745521 PMCID: PMC10792988 DOI: 10.2341/22-012-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To identify causes of the evidence-practice gap (EPG) in dentistry in Japan and analyze whether these causes are associated with: (a) improvement of EPG in minimal intervention dentistry (MID) following an educational intervention and (b) specific dentist characteristics. METHODS We conducted a mixed-methods questionnaire survey among 197 Japanese dentists that integrated both quantitative and qualitative data. Causative factors for the EPG identified in the quantitative survey were clarified by qualitative analysis. We measured the EPG in a baseline survey using an EPG measurement tool based on MID. To examine how feedback using the latest scientific evidence affected change in the EPG, we measured the EPG again immediately after feedback was provided to participating dentists. RESULTS Qualitative analysis classified all dentists into one of four "EPG cause" groups, namely "evidence-", "dentist-", "patient-", and "health insurance system-related" causes. Quantitative analysis confirmed that improvement in the EPG following the feedback intervention was indeed associated with group classification. The highest concordance was found for the "evidence-related" group while the lowest concordance was in the "dentist-related" group (p=0.004). Concordance improved after evidence feedback in all groups but was lowest in the "dentist-related" group. More dentists reported practice busyness in the "dentist-related" group. CONCLUSIONS In this study, we identified four groups of causes of EPG among Japanese dentists. The degree of concordance between evidence and clinical practice was the lowest in the "dentist-related" group, and the results of this study are expected to provide useful information for the development of intervention methods for closing the EPG in the future.
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Affiliation(s)
- Yoko Yokoyama
- Project Senior Assistant Professor, Graduate School of Media and Governance, Keio University, 5322 Endo Fujisawa, Kanagawa, 252-0882, Japan
| | - Naoki Kakudate
- Professor & Division Director, Division of Clinical Epidemiology, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan
- Visiting Professor, University of Florida College of Dentistry, Gainesville, FL, USA P.O. Box 100415, Gainesville, FL 32610-0415, USA
| | - Futoshi Sumida
- Dentist, Daiich Dental Clinic, 5-5-7, Hanazono, Chitose, Hokkaido, 066-0028, Japan
| | - Yuki Matsumoto
- Director, Matsumoto Dental Clinic, 24-3, Komanomai, Doimachi, Okazaki, Aichi, 444-0204, Japan
| | - Valeria V. Gordan
- Professor and Interim Associate Dean for Research, Department of Restorative Dental Sciences at the University of Florida College of Dentistry, Room D3-39 P.O. Box 100415 Gainesville, FL 32610-0415, USA
| | - Gregg H. Gilbert
- Distinguished Professor & Chair, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Room SDB 109, 1720 Second Avenue South, Birmingham, AL 35294-0007, USA
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Jung SY, Kim E, Kim K, Cho J, Lee YJ, Ha I. Treatment for temporomandibular disorders in South Korea: a 9‐year trend using cluster analysis. J Oral Rehabil 2022; 49:691-700. [DOI: 10.1111/joor.13333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/13/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sung Yub Jung
- Jaseng Hospital of Korean Medicine 536 Gangnam‐daero, Gangnam‐gu Seoul 06110 Republic of Korea
| | - Eun‐San Kim
- Jaseng Spine and Joint Research Institute Jaseng Medical Foundation 3F, 538 Gangnam‐daero, Gangnam‐gu Seoul 06110 Republic of Korea
| | - Koh‐Woon Kim
- Department of Korean Rehabilitation Medicine College of Korean Medicine Kyung Hee University Seoul Republic of Korea
| | - Jae‐Heung Cho
- Department of Korean Rehabilitation Medicine College of Korean Medicine Kyung Hee University Seoul Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute Jaseng Medical Foundation 3F, 538 Gangnam‐daero, Gangnam‐gu Seoul 06110 Republic of Korea
| | - In‐Hyuk Ha
- Jaseng Spine and Joint Research Institute Jaseng Medical Foundation 3F, 538 Gangnam‐daero, Gangnam‐gu Seoul 06110 Republic of Korea
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Kakudate N, Yokoyama Y, Sumida F, Matsumoto Y, Takata T, Gordan VV, Gilbert GH. Web-based intervention to improve the evidence-practice gap in minimal intervention dentistry: Findings from a dental practice-based research network. J Dent 2021; 115:103854. [PMID: 34688779 DOI: 10.1016/j.jdent.2021.103854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/26/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To determine whether: the evidence-practice gap (EPG) in minimal intervention dentistry (MID) can be improved by a tailored web-based intervention, and specific clinical situations might impede implementing MID. METHODS We conducted a before-after intervention study and a qualitative study. Two web-based questionnaire surveys were conducted among 197 Japanese dentists. In the first questionnaire, a baseline EPG was measured using six questionnaire items. Subsequently, feedback material about the EPG was electronically prepared, including results of the first questionnaire, international comparisons with a previous study from the US, and a summary of recent evidence on MID. In the second questionnaire, the EPG was re-measured after participants read the material. The primary outcome was mean overall concordance between published evidence and the dentist's clinical practice for all six questions. During the second questionnaire, we performed qualitative content analysis using free-text responses to a question about difficult situations encountered when conducting MID. RESULTS Regarding before and after comparisons of concordance between the first and second questionnaires, mean overall concordance improved significantly, from 66% to 89% (p<0.001). Qualitative content analysis identified five difficult situations: "cases where decision making for treatment and prognosis is difficult", "inadequate practice resources", "limitations on patient visit and treatment period", "discrepancy between MID and the patient's values", and "limitations on health insurance and social understanding". CONCLUSIONS These results suggest that it is possible to reduce the EPG in MID using a web-based educational intervention among Japanese dentists. Qualitative content analysis revealed five difficult situations that might hinder implementation of MID. CLINICAL SIGNIFICANCE Although this intervention demonstrated educational effects, perfect concordance was not achieved by all participants. This is possibly associated with the five situations that participants reported facing when conducting MID. Creating an environment to improve these situations may facilitate a reduction in the EPG.
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Affiliation(s)
- Naoki Kakudate
- Division of Clinical Epidemiology, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan; University of Florida College of Dentistry, P.O. Box 100415, Gainesville, FL 32610-0415, USA.
| | - Yoko Yokoyama
- Graduate School of Media and Governance, Keio University, 5322 Endo Fujisawa, Kanagawa, 252-0882, Japan
| | - Futoshi Sumida
- Daiich Dental Clinic, 5-5-7, Hanazono, Chitose, Hokkaido, 066-0028, Japan
| | - Yuki Matsumoto
- Matsumoto Dental Clinic, 24-3, Komanomai, Doimachi, Okazaki, Aichi, 444-0204, Japan
| | - Tomoka Takata
- School of Dentistry, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Valeria V Gordan
- Department of Restorative Dental Sciences at the University of Florida College of Dentistry, Room D3-39 P.O. Box 100415 Gainesville, FL 32610-0415, USA
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Room SDB 109, 1720 Second Avenue South, Birmingham, AL 35294-0007, USA
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Outcomes of functional treatment of condylar mandibular fractures with an articular impact: a retrospective study of 108 children. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:177-183. [PMID: 34224922 DOI: 10.1016/j.jormas.2021.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The treatment of fractures of the mandibular condylar process remains controversial, especially in children. The aim of this study was to assess the long-term clinical and radiographic outcomes of functional treatments for mandibular condylar fractures with an articular impact. MATERIALS AND METHODS Young patients (< 15 years of age) presenting with either a unilateral or a bilateral mandibular fracture of the condylar process were included in this retrospective study. The clinical analysis focused on investigation of joint amplitudes at 1, 2, 6, 12, and 24 months after the beginning of the treatment, and at the end of their physical growth for the long-term study. Other clinical parameters included temporomandibular joint (TMJ) disorders and facial asymmetry. Photographs of patients and panoramic X-rays were assessed to identify any growth disorders at the end of the follow-up. RESULTS One hundred and eight patients were included in this study, and 33 patients who were no longer undergoing mandibular growth at the time of the last follow-up were included in the long-term study. The mean age at the time of the trauma was 9.33 years, and the mean follow-up was 82.2 months. A significant improvement was observed in the maximal mouth opening (MMO), diduction, and propulsion in the first months after the trauma, reaching 44.31 mm (p < 0.0001), 10.50 mm (p = 0.0001), and 6.33 mm (p = 0.01), respectively, at 6 months. Three patients experienced a clinical posterior vertical insufficiency, one of which required a surgical procedure, while four patients exhibited a ramus asymmetry of up to 10 mm, albeit with no clinical consequences. One case of TMJ ankylosis was noted. CONCLUSION Our study suggests that functional treatment is appropriate for fractures of the mandibular condyle with an articular impact in children, as it promotes mandibular growth and good functional recovery. Children have to be followed up, however, until completion of growth.
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LOXL2 promotes aggrecan and gender-specific anabolic differences to TMJ cartilage. Sci Rep 2020; 10:20179. [PMID: 33214607 PMCID: PMC7678826 DOI: 10.1038/s41598-020-77178-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 11/05/2020] [Indexed: 12/24/2022] Open
Abstract
In the United States, 5–12% of adults have at least one symptom of temporomandibular joint (TMJ) disorders, including TMJ osteoarthritis (TMJ-OA). However, there is no chondroprotective agent that is approved for clinical application. We showed that LOXL2 is elevated in the regenerative response during fracture healing in mice and has a critical role in chondrogenic differentiation. Indeed, LOXL2 is an anabolic effector that attenuates pro-inflammatory signaling in OA cartilage of the TMJ and knee joint, induces chondroprotective and regenerative responses, and attenuates NF-kB signaling. The specific goal of the study was to evaluate if adenoviral delivery of LOXL2 is anabolic to human and mouse TMJ condylar cartilage in vivo and evaluate the protective and anabolic effect on cartilage-specific factors. We employed two different models to assess TMJ-OA. In one model, clinical TMJ-OA cartilage from 5 different samples in TMJ-OA cartilage plugs were implanted subcutaneously in nude mice. Adenovirus LOXL2 -treated implants showed higher mRNA levels of LOXL2, ACAN, and other anabolic genes compared to the adenovirus-Empty-treated implants. Further characterization by RNA-seq analysis showed LOXL2 promotes proteoglycan networks and extracellular matrix in human TMJ-OA cartilage implants in vivo. In order to evaluate if LOXL2-induced functional and sex-linked differences, both male and female four-month-old chondrodysplasia (Cho/+) mice, which develop progressive TMJ-OA due to a point mutation in the Col11a1 gene, were subjected to intraperitoneal injection with Adv-RFP-LOXL2 every 2 weeks for 12 weeks. The data showed that adenovirus delivery of LOXL2 upregulated LOXL2 and aggrecan (Acan), whereas MMP13 expression was slightly downregulated. The fold change expression of Acan and Runx2 induced by Adv-RFP-LOXL2 was higher in females compared to males. Interestingly, Adv-RFP-LOXL2 injection significantly increased Rankl expression in male but there was no change in females, whereas VegfB gene expression was increased in females, but not in males, as compared to those injected with Adv-RFP-Empty in respective groups. Our findings indicate that LOXL2 can induce specifically the expression of Acan and other anabolic genes in two preclinical models in vivo. Further, LOXL2 has beneficial functions in human TMJ-OA cartilage implants and promotes gender-specific anabolic responses in Cho/+ mice with progressive TMJ-OA, suggesting its merit for further study as an anabolic therapy for TMJ-OA.
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Canceill T, Monsarrat P, Faure-Clement E, Tohme M, Vergnes JN, Grosgogeat B. Dental practice-based research networks (D-PBRN) worldwide: A scoping review. J Dent 2020; 104:103523. [PMID: 33186627 DOI: 10.1016/j.jdent.2020.103523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES For more than twenty years, dental practice-based research networks (D-PBRN) have helped to structure clinical research in private practice. They bring together practitioners working in several structures and may include a greater number of subjects. The aims of this study were thus to systematically explore the scientific production from dental private practices in general and to map and describe the D-PBRN activity worldwide. DATA SOURCES Two research procedures were carried out in parallel. The first was conducted as a scoping review to examine peer-reviewed literature indexed in the PubMed database and the second was performed on the World Wide Web to identify the main characteristics of the networks (location, scientific production…). STUDY SELECTION 368 publications were identified among which 202 were published by PBRN members and the others by private practitioners not affiliated to any network. 210 (57 % of the included articles) were produced in the USA. A higher number of diverse centers are involved in each study when it is conducted by a PBRN (59.06 ± 66.59 vs. 13.51 ± 31.58 for networks and independent teams, respectively; p < 0.01). 24 D-PBRN were identified, a majority being based in the USA and 8 in Europe. CONCLUSIONS Although dental practice-based research has grown over the years, the number of D-PBRN worldwide remains low. Even if it requires some investment to produce research in dental offices, this type of networks helps to fill the gap between private practice and research and to improve knowledge on oral health. RELEVANCE The mapping of all the dental PBRN together with the research topics studied throughout the world make the relevance of this article. The ways to improve practice-based research in dentistry are also discussed in the paper.
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Affiliation(s)
- Thibault Canceill
- Université Paul Sabatier, Faculté de Chirurgie Dentaire, Hôpitaux de Toulouse, 3 Chemin des Maraîchers, Toulouse Cedex 9, 31062, France; CIRIMAT, University of Toulouse, CNRS, INPT, Université Paul Sabatier, Faculté de Pharmacie, 35 Chemin des Maraichers, Toulouse cedex 9, 31062, France.
| | - Paul Monsarrat
- Université Paul Sabatier, Faculté de Chirurgie Dentaire, Hôpitaux de Toulouse, 3 Chemin des Maraîchers, Toulouse Cedex 9, 31062, France; Toulouse Institute of Artificial Intelligence ANITI, Toulouse, France; STROMALab, Université de Toulouse, CNRS ERL 5311, EFS, ENVT, Inserm, UPS, France
| | - Edouard Faure-Clement
- Université Lyon 1, Faculté d'Odontologie, 11 rue Guillaume Paradin, Lyon, 69008, France; Hospices Civils de Lyon, Pôle d'Odontologie, 6-8 place Deperet, Lyon, 69007, France
| | - Marie Tohme
- Université Lyon 1, Faculté d'Odontologie, 11 rue Guillaume Paradin, Lyon, 69008, France; Hospices Civils de Lyon, Pôle d'Odontologie, 6-8 place Deperet, Lyon, 69007, France
| | - Jean-Noël Vergnes
- Université Paul Sabatier, Faculté de Chirurgie Dentaire, Hôpitaux de Toulouse, 3 Chemin des Maraîchers, Toulouse Cedex 9, 31062, France; Division of Oral Health and Society, Faculty of dentistry, McGill University, Montreal, Quebec, Canada
| | - Brigitte Grosgogeat
- Université Lyon 1, Faculté d'Odontologie, 11 rue Guillaume Paradin, Lyon, 69008, France; Hospices Civils de Lyon, Pôle d'Odontologie, 6-8 place Deperet, Lyon, 69007, France; Université Lyon 1, LMI UMR CNRS 5615, 11 rue Guillaume Paradin, Lyon, 69008, France
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11
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Evidence-practice gap in minimal intervention dentistry: Findings from a dental practice-based research network. J Dent 2020; 102:103469. [PMID: 32916232 DOI: 10.1016/j.jdent.2020.103469] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES This study aimed to 1) quantify the evidence-practice gap (EPG) between dental clinical practice and published evidence on Minimal Intervention Dentistry (MID) among dentists in Japan; and 2) examine the hypothesis that dentist characteristics have a significant association with the EPG. METHODS We conducted a cross-sectional study via use of a web-based questionnaire survey of dentists who were affiliated with the Dental Practice-based Research Network Japan (n = 297). To quantify the EPG on MID, we used a questionnaire that included 10 clinical questions or scenarios to assess concordance between dental practice and published evidence on MID. We evaluated concordance by coding responses to each question as consistent or inconsistent with the evidence. An overall concordance was then determined as percent of responses that were consistent with published evidence for 10 questions. Subsequently, multiple logistic regression analysis was conducted to examine the associations between dentist characteristics and higher overall concordance (≥median) with published evidence. RESULTS Mean and median overall dentist-level concordance were both 60 % (SD: 18, interquartile range: 50-75 %). Logistic regression analysis showed that "gender of dentist", "city population", and "frequency of obtaining evidence from the scientific journal articles in English" were significantly associated with high concordance, with odds ratios (95 % CIs) of 2.33 (1.01-5.39), 2.01 (1.02-3.96), and 2.45 (1.08-5.59), respectively. CONCLUSIONS Japanese dentists demonstrated medium concordance with published evidence, indicating that an EPG on MID exists in Japanese dental clinical practices. Dentist-specific characteristics had significant associations with high concordance with published evidence. CLINICAL SIGNIFICANCE Despite the establishment and dissemination of the concept of MID, the EPG on MID exists in Japanese dental clinical practices. A high concordance was significantly associated with the following dentist characteristics: "female dentist", "dental clinic location in a government-ordinance-designated city", and "frequently obtaining evidence from the English-language scientific journal articles".
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Fichera G, Polizzi A, Scapellato S, Palazzo G, Indelicato F. Craniomandibular Disorders in Pregnant Women: An Epidemiological Survey. J Funct Morphol Kinesiol 2020; 5:E36. [PMID: 33467252 PMCID: PMC7739292 DOI: 10.3390/jfmk5020036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 11/16/2022] Open
Abstract
Temporomandibular joint (TMJ) disorder has been reported to be 1.5 to two times more common in women than men. Such a gender-based difference could be attributed to behavioral, hormonal, anatomical, and psychological characteristics. Physiological hormonal differences between genders could be one of the possible explanations for the higher incidence of temporomandibular disorder (TMD) in women. As the plasma level of certain female hormones increases during gestation, it could be assumed that there is a higher prevalence of dysfunctional signs and symptoms in pregnant women. We performed an epidemiological survey based on screening for TMD in a group of 108 pregnant women and found that 72% of young women reported significant signs of TMJ disorders, 9% of the young women reported mild signs of TMJ disorders, and 19% of the included subjects reported no signs or symptoms of TMD. The presence of estrogen receptors in the temporomandibular joint of female baboons could be the basis of an explanation for the increased prevalence of dysfunction in young women reported in the literature and the high feedback we have seen of joint noises in pregnant women. On the basis of the present findings, it could be assumed that gestation period could represent a risk factor for craniomandibular dysfunctions.
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Affiliation(s)
- Grazia Fichera
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, 95124 Catania, Italy; (G.F.); (S.S.); (G.P.); (F.I.)
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, 95124 Catania, Italy; (G.F.); (S.S.); (G.P.); (F.I.)
| | - Simone Scapellato
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, 95124 Catania, Italy; (G.F.); (S.S.); (G.P.); (F.I.)
- Department of Biomedical, Odontostomatological Sciences and of Morphological and Functional Images, University of Messina, 98125 Messina, Italy
| | - Giuseppe Palazzo
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, 95124 Catania, Italy; (G.F.); (S.S.); (G.P.); (F.I.)
| | - Francesco Indelicato
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, 95124 Catania, Italy; (G.F.); (S.S.); (G.P.); (F.I.)
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13
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Shoohanizad E, Garajei A, Enamzadeh A, Yari A. Nonsurgical management of temporomandibular joint autoimmune disorders. AIMS Public Health 2019; 6:554-567. [PMID: 31909075 PMCID: PMC6940567 DOI: 10.3934/publichealth.2019.4.554] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/24/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction Temporomandibular disorders (TMD) are observed in a number of autoimmune diseases but limited studies have assessed the effect of autoimmune diseases on TMD. Therefore, the present review article was conducted to determine the effect of autoimmune diseases on TMD. Methods International databases, including Web of Sciences, PubMed and Scopus, were searched in order to find related articles. The search key words were; temporomandibular joint (TMJ) autoimmune disorders, TMJ, TMD, medical therapy and non-invasive, local and systemic management. Published articles from June, 2010 to June, 2019 were included in the review. Results A total of 11 related articles including rheumatoid arthritis (RA), lupus erythematosus and systemic sclerosis were found. All articles noted that TMJ has unique features that distinguishes it from other human body joints. Cases of TMJ injury and TMD require specific treatments. Therefore, early diagnosis of TMD is essential. It was also mentioned in the articles that the collagen-induced arthritis (CIA) method is a suitable method for investigating TMD and its relationship with RA. Treatment methods included oral steroids, Disease-modifying antirheumatic drugs, nonsteroidal anti-inflammatory drugs, methotrexate 75 mg, and combination therapy with methotrexate. Conclusion Based on the results of this study, TMD exists in some autoimmune diseases, including RA, lupus erythematosus and systemic sclerosis. Therefore, there should be an interdisciplinary collaboration between physicians and dentists in order to choose the best conservative treatment and medication therapy for TMD to reduce the progression and pain associated with this type of disorder.
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Affiliation(s)
- Ehsan Shoohanizad
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ata Garajei
- Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry and Department of Head and Neck Surgical Oncology and Reconstructive Surgery, The Cancer Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Enamzadeh
- DMD, Private Practice, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Yari
- Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry and Department of Head and Neck Surgical Oncology and Reconstructive Surgery, The Cancer Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Sharma S, Breckons M, Brönnimann Lambelet B, Chung J, List T, Lobbezoo F, Nixdorf DR, Oyarzo JF, Peck C, Tsukiyama Y, Ohrbach R. Challenges in the clinical implementation of a biopsychosocial model for assessment and management of orofacial pain. J Oral Rehabil 2019; 47:87-100. [DOI: 10.1111/joor.12871] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/18/2019] [Accepted: 08/05/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Sonia Sharma
- Department of Oral Diagnostic Sciences, School of Dental Medicine University at Buffalo Buffalo NY USA
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology Malmö University Malmö Sweden
| | | | - Ben Brönnimann Lambelet
- Psychiatric Services of District Aargau Ambulatory Center for Psychiatry and Psychotherapy Aarau Switzerland
| | - Jin‐Woo Chung
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry Seoul National University Seoul Korea
| | - Thomas List
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology Malmö University Malmö Sweden
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Donald R. Nixdorf
- Division of TMD and Orofacial Pain, School of Dentistry University of Minnesota Minneapolis MN USA
| | - Juan Fernando Oyarzo
- TMD and Orofacial Pain, Faculty of Odontology Universidad Andres Bello Santiago Chile
| | - Christopher Peck
- Faculty of Dentistry The University of Sydney Surry Hills NSW Australia
| | - Yoshihiro Tsukiyama
- Section of Dental Education, Faculty of Dental Science Kyushu University Fukuoka Japan
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, School of Dental Medicine University at Buffalo Buffalo NY USA
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15
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Dentists' practice patterns of treatment for deep occlusal caries: Findings from a dental practice-based research network. J Dent 2019; 84:76-80. [PMID: 30935965 DOI: 10.1016/j.jdent.2019.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study quantified and compared practice patterns of treatment for deep occlusal carious lesions among Japanese dentists, and tested the hypothesis that dentist characteristics are significantly associated with the decision to choose an indirect pulp capping (IPC), a form of selective carious tissue removal that involves leaving a thin layer of demineralized tissue over the pulp, that is then covered with a protective liner. METHODS This cross-sectional study was conducted using a questionnaire survey of dentists affiliated with the Dental Practice-based Research Network Japan (n = 297). Dentists were asked to indicate what percentage of time they use three treatment options when treating patients with deep occlusal caries and possible mild pulpitis on a posterior tooth. Response options were "1. Stop before removing all caries and perform an IPC", "2. Remove all caries and proceed with a direct pulp cap", and "3. Remove all caries and proceed with endodontic-related procedures". Percentages of options 1-3 were compared by multiple comparison. Associations between dentist characteristics and a higher percentage of IPC provision (option 1) were analyzed via logistic regression. RESULTS Responses were obtained from 206 dentists. Median percentages (interquartile ranges) of options 1, 2 and 3 were 30% (10-59%), 10% (0-30%), and 40% (19-80%), respectively. The differences between option 3 and options 1 and 2 were significant (p < 0.001). In logistic regression analysis, a higher frequency of obtaining evidence from English-language scientific articles was significantly associated with a higher percentage of IPC, with an odds ratio of 2.28 (95%CI: 1.14-4.54). CONCLUSIONS Endodontic-related procedures remain the most frequent treatment option for deep occlusal caries. Frequent use of evidence-based information in English-language scientific articles was associated with Japanese dentists' preference toward IPC. CLINICAL SIGNIFICANCE Japanese dentists would most frequently choose endodontic-related procedures, followed by IPC and direct pulp capping for treatment of patients with deep occlusal caries with possible mild pulpitis on posterior teeth. Significant association was identified between use of evidence-based information in the English-language scientific literature and Japanese dentists' preference for IPC.
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Reissmann DR, Anderson GC, Heydecke G, Schiffman EL. Effect of Shortened Dental Arch on Temporomandibular Joint Intra-articular Disorders. J Oral Facial Pain Headache 2018; 32:329-337. [PMID: 30036887 DOI: 10.11607/ofph.1910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To investigate whether a shortened dental arch (SDA), as identified by reduced posterior occlusal contacts, is a risk factor for the progression of temporomandibular joint (TMJ) intra-articular disorders (ID), as identified using imaging techniques. METHODS This multisite, prospective observational study with a mean follow-up period of 7.9 years had a sample of 345 participants with at least 1 temporomandibular disorder (TMD) diagnosis at baseline. SDA was defined as reduced occlusal posterior support due to lack of occlusal intercuspal contacts in the molar region on the left and/or right side. SDA was assessed at baseline and at follow-up with metalized Mylar Tape. The presence or absence of a TMJ ID and the specific TMJ ID diagnoses for baseline and follow-up images were established by a calibrated, blinded radiologist at each of three sites by using bilateral magnetic resonance imaging for soft tissue imaging for disc displacement and by bilateral multidetector computed tomography or cone beam computed tomography for hard tissue imaging for degenerative joint diseases. Wilcoxon rank sum test and linear regression analyses were used to test for an impact of SDA on TMJ ID status. RESULTS At baseline, TMJ ID status of either side was not significantly affected by the presence of SDA on the ipsilateral or contralateral side of the jaw (all P > .05). Furthermore, the presence or absence of SDA at baseline was also not a significant predictor for progression of the TMJ ID status between baseline and follow-up (all P > .05). CONCLUSION The findings of this study suggest that there is no significant effect of SDA on progression of TMJ ID.
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Shahidi S, Salehi P, Abedi P, Dehbozorgi M, Hamedani S, Berahman N. Comparison of the Bony Changes of TMJ in Patients With and Without TMD Complaints Using CBCT. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2018; 19:142-149. [PMID: 29854888 PMCID: PMC5960734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
STATEMENT OF THE PROBLEM Temporomandibular joint disorders (TMD) may show a poor correlation between their clinical findings and radiological characteristics. PURPOSE The aim of this study was to assess the osseous alterations of temporomandibular joint (TMJ) in symptomatic and asymptomatic subjects by employing cone beam computed tomography (CBCT) images. MATERIALS AND METHOD In this study, CBCT images of 120 temporomandibular joints in 30 patients with TMJ disorder and 30 age- and sex-matched individuals without TMJ complaints were evaluated. Osteoarticular derangements of the joint were assessed by two experienced examiners. Data was statistically analyzed with SPSS software using chi-square test (p <0.05). RESULTS Out of 120 CBCT images (60 in each group), at least one osseous change was observed in 90% and 86.7% joints in symptomatic and asymptomatic subjects, respectively. There were no significant differences between symptomatic and asymptomatic subjects regarding frequency of osteoarticular changes including flattening (73.3% vs. 75%), irregularity (36.7% vs. 48.3%), sclerosis (20% vs. 8.3%), cyst (3.3% vs. 3.3%), erosion (13.3% vs. 21.7%), hypoplasia (3.3% vs. 5%), ankylosis (1.7% vs. Zero), osteophyte (43.3% vs. 40%), decrease joint space (3.3% vs. 3.3%), and increase joint space (5% vs. 5%). (p> 0.05). CONCLUSION By employing CBCT as a modern diagnostic imaging tool, findings of this study revealed that the frequency of various temporomandibular joint alterations on CBCT images is comparable in patients with and without TMD complaints, suggesting that some people with TMJ structural damage may not display clinical manifestations. Moreover, CBCT imaging might not be necessary for TMD patients and more attention should be given to clinical examination.
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Affiliation(s)
- Shoaleh Shahidi
- Dept. of Oral and Maxillofacial Radiology, Biomaterials Research Centre, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Parisa Salehi
- Orthodontic Research Centre, Dept. of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parnian Abedi
- Student of Dentistry, Students’ Research Committee, School of Dentistry, International branch, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mehrnoush Dehbozorgi
- Postgraduate Student, Dept. of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Iran.
| | - Shahram Hamedani
- Dental Research Development Centre, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Nazanin Berahman
- Postgraduate Student of Orthodontics, Dept. of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Iran
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Yokoyama Y, Kakudate N, Sumida F, Matsumoto Y, Gordan VV, Gilbert GH. Dentist's distress in the management of chronic pain control: The example of TMD pain in a dental practice-based research network. Medicine (Baltimore) 2018; 97:e9553. [PMID: 29505535 PMCID: PMC5943127 DOI: 10.1097/md.0000000000009553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We aimed to obtain greater understanding of dentists' distress when they diagnose and treat patients with temporomandibular disorders (TMD), and to explore ways in which TMD can be better treated.We conducted a cross-sectional study based on a questionnaire survey of dentists (n = 148). Dentists were queried using an open-ended questionnaire about distress they experienced when treating patients with TMD. Survey responses were analyzed using mixed methods. Associations between specific dentist and patient characteristics and types of distress were analyzed by one way analysis of variance and residual analysis.One hundred thirteen clinicians responded to the questionnaire, giving a 76% response rate. Thematic analysis identified 6 major themes: difficulty in predicting therapeutic effect and prognosis; difficulty in diagnosis; difficulty in the decision about whether to do occlusal adjustment; difficulty in specifying a cause; difficulty in communicating with patients and mental factors; and health insurance system barriers. Clinicians who reported difficulty in deciding whether to do occlusal adjustment saw significantly more patients who experienced shoulder stiffness and headache (P = .008 and P = .022, respectively). Dentists' knowledge of TMD guidelines was associated with a lower percentage of difficulty in predicting therapeutic effect and prognosis (residual analysis; P = .010).These findings provide important insights into clinician's perception of difficulties with patients experiencing TMD-related pain. Knowledge of the existence of TMD clinical practice guidelines may lower dentist distress, particularly with regard to prognosis. Further studies are needed to decrease dentist's distress and to overcome the evidence-practice gap in TMD treatment.
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Affiliation(s)
- Yoko Yokoyama
- Graduate School of Media and Governance, Keio University, Fujisawa City, Kanagawa
| | - Naoki Kakudate
- Division of Clinical Epidemiology, Kyushu Dental University, Kitakyushu, Fukuoka, Japan
- University of Florida College of Dentistry, Gainesville, FL
| | - Futoshi Sumida
- Mikami Dental and Orthodontics Clinic, Tomakomai, Hokkaido
| | | | - Valeria V. Gordan
- Department of Restorative Dental Sciences at the University of Florida College of Dentistry, Gainesville, FL
| | - Gregg H. Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
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Kakudate N, Yokoyama Y, Sumida F, Matsumoto Y, Gordan VV, Gilbert GH, Velly AM, Schiffman EL. Dentist Practice Patterns and Therapeutic Confidence in the Treatment of Pain Related to Temporomandibular Disorders in a Dental Practice-Based Research Network. J Oral Facial Pain Headache 2017; 31:152-158. [PMID: 28437512 DOI: 10.11607/ofph.1730] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To quantify the practice patterns of Japanese dentists in the management of pain related to temporomandibular disorders (TMD) and to identify specific characteristics that are significantly associated with the decision to perform occlusal adjustment for TMD-related pain. METHODS A cross-sectional study was conducted consisting of a questionnaire survey of dentists affiliated with the Dental Practice-Based Research Network Japan (JDPBRN) (n = 148). Participants were asked how they diagnosed and treated TMD-related pain. Associations between dentist characteristics and the decision to perform occlusal adjustment were analyzed via multiple logistic regression. RESULTS A total of 113 clinicians responded to the questionnaire (76% response rate), and 81% of them (n = 89) had treated TMD during the previous year. Dentists treated an average of 1.9 ± 1.8 (mean ± SD) patients with TMD-related pain per month. Most JDPBRN dentists used similar diagnostic protocols, including questions and examinations. The most frequent treatments were splints or mouthguards (96.5%), medications (84.7%), and self-care (69.4%). Occlusal adjustment for TMD-related pain was performed by 58% of the participants. Multiple logistic regression analysis identified two factors significantly associated with the decision to perform occlusal adjustment: dentist lack of confidence in curing TMD-related acute pain (odds ratio [OR] 5.60; 95% confidence interval [CI] 1.260 to 24.861) and proportion of patients with severe TMD-related pain (OR 0.95; 95% CI 0.909 to 0.999). CONCLUSION The most common treatments for TMD-related pain were reversible treatments; however, over half of the dentists performed occlusal adjustment for TMD-related pain. The results of this study suggest that an evidence-practice gap exists for occlusal adjustment for TMD-related pain.
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Chanton S, Vicheinnet S, Hosanguan C, Mutirangura W. Management of temporomandibular disorders by Ministry of Public Health dentists in Central Thailand. Int Dent J 2017; 67:281-286. [PMID: 28338212 DOI: 10.1111/idj.12299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Very little is known about the ability of dentists to diagnose and treat temporomandibular disorders (TMDs). The aims of this study were to investigate whether dentists in Central Thailand diagnosed TMD subcategories before initiating treatment for TMDs and to explore the frequency of corresponding treatments. METHODS A questionnaire covering TMD management was developed and posted to all Ministry of Public Health dentists (n = 969) in Central Thailand. The data were analysed using descriptive statistics. RESULTS The respondents (n = 502) comprised 109 (21.7%) male and 393 (78.3%) female dentists between 23 and 59 years of age (mean age = 34.7 years). In the preceding year, 427 (85.1%) reported encountering patients with TMDs, 356 (70.9%) had treated patients who had TMDs and 176 (49.4%) had diagnosed TMD subcategories. Most respondents regularly treated patients by providing patient education and encouraging self-care. The respondents who did not diagnose subcategories primarily treated TMDs with pharmacotherapy and physical therapy; orthopaedic appliances and occlusal therapy were used less often. Respondents who diagnosed TMD subcategories did not often use orthopaedic appliances or occlusal therapy to treat muscle disorders. For the treatment of derangement disorders, respondents used fewer pharmacotherapy, physical therapy and occlusal therapy techniques. For the treatment of osteoarthritis, respondents used less physical therapy and fewer orthopaedic appliances. CONCLUSION Most Ministry of Public Health dentists in the Central Thailand region encounter and treat patients with TMDs. Approximately 50% of the respondents diagnosed TMD subcategories before providing treatment for TMDs.
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Affiliation(s)
- Supang Chanton
- Nongyasai Hospital, Nongyasai District, Suphanburi Province, Thailand
| | - Supranee Vicheinnet
- Department of Occlusion, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Chanchai Hosanguan
- Department of Community Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Wantanee Mutirangura
- Department of Occlusion, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Rodrigues-Bigaton D, de Castro EM, Pires PF. Factor and Rasch analysis of the Fonseca anamnestic index for the diagnosis of myogenous temporomandibular disorder. Braz J Phys Ther 2017; 21:120-126. [PMID: 28460710 PMCID: PMC5537471 DOI: 10.1016/j.bjpt.2017.03.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/13/2016] [Accepted: 06/02/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Rasch analysis has been used in recent studies to test the psychometric properties of a questionnaire. The conditions for use of the Rasch model are one-dimensionality (assessed via prior factor analysis) and local independence (the probability of getting a particular item right or wrong should not be conditioned upon success or failure in another). OBJECTIVE To evaluate the dimensionality and the psychometric properties of the Fonseca anamnestic index (FAI), such as the fit of the data to the model, the degree of difficulty of the items, and the ability to respond in patients with myogenous temporomandibular disorder (TMD). METHODS The sample consisted of 94 women with myogenous TMD, diagnosed by the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), who answered the FAI. For the factor analysis, we applied the Kaiser-Meyer-Olkin test, Bartlett's sphericity, Spearman's correlation, and the determinant of the correlation matrix. For extraction of the factors/dimensions, an eigenvalue >1.0 was used, followed by oblique oblimin rotation. The Rasch analysis was conducted on the dimension that showed the highest proportion of variance explained. RESULTS Adequate sample "n" and FAI multidimensionality were observed. Dimension 1 (primary) consisted of items 1, 2, 3, 6, and 7. All items of dimension 1 showed adequate fit to the model, being observed according to the degree of difficulty (from most difficult to easiest), respectively, items 2, 1, 3, 6, and 7. CONCLUSION The FAI presented multidimensionality with its main dimension consisting of five reliable items with adequate fit to the composition of its structure.
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Affiliation(s)
- Delaine Rodrigues-Bigaton
- Programa de Pós-graduação em Ciências do Movimento Humano, Universidade Metodista de Piracicaba (UNIMEP), Piracicaba, SP, Brazil
| | - Ester M de Castro
- Programa de Pós-graduação em Ciências do Movimento Humano, Universidade Metodista de Piracicaba (UNIMEP), Piracicaba, SP, Brazil
| | - Paulo F Pires
- Programa de Pós-graduação em Ciências do Movimento Humano, Universidade Metodista de Piracicaba (UNIMEP), Piracicaba, SP, Brazil.
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Klinke T, Daboul A, Schwahn C, Frankenberger R, Hickel R, Biffar R. Dental practitioner recruitment for a randomized clinical trial in the field to evaluate the performance of a new glass ionomer restoration material. Trials 2016; 17:73. [PMID: 26861942 PMCID: PMC4748549 DOI: 10.1186/s13063-016-1198-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 01/26/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In 2009, we began recruiting dental practitioners across Germany to participate in a clinical trial to evaluate the clinical performance of EQUIA, a new glass ionomer restoration material. The aim of this paper is to discuss the outcomes of the dental practitioner recruitment and outline the process of establishing a practice-based research network. METHODS Study proposals were sent to randomly selected dental offices in 29 cities in Germany. The proposals were sent until a minimum of 10 clinics in each city declared participation. Later on, briefing lectures informed the participating practitioners about the design, methods, and material application procedure. Participants were familiarized with the guidelines of Good Manufacturing Practice (GMP) and Good Epidemiological Practice (GEP). A questionnaire describing the characteristics of each dental office was filled out by the participating practitioner. Additionally, participation levels were characterized according to the socioeconomic status and geographic districts of residence in Germany (Regions 0 to 9). The associations between the characteristics were tested by the Kruskal-Wallis Test and Chi-squared test (P < 0.05). RESULTS A total of 3194 private dental clinics were invited, 1712 clinics refused to participate, 1195 did not respond to the invitation, and 323 agreed to participate. Only 144 clinics participated in the lectures held in their cities and signed the participation agreement. Based on their geographic location, the highest participation was in Region 2 with a participation rate of 14.3%, and the lowest participation was in Region 6 with a participation rate of 1.7%. Regions with the lowest rate of unemployment and relatively higher rates of income (Regions 7 and 8) had the highest rate of refusals (86%). CONCLUSION The initial results of the dental practitioner recruitment in this study suggest that the recruitment and pre-randomization design were successful, and by reaching out to a considerable number of private dental clinics to participate, we were able to recruit a smaller number of highly motivated dentists in this clinical study. Regional differences in socioeconomic status, practitioner specialization, and differences in patient health care insurance have to be considered when recruiting dental practitioners for clinical trials. TRIAL REGISTRATION The trial has been registered at Deutsches Register Klinischer Studien (German register of clinical trials) on 6 September 2012 under DRKS-ID: DRKS00004220.
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Affiliation(s)
- Thomas Klinke
- Policlinic of Prosthodontics and Biomaterials, Greifswald University, Greifswald, Germany.
| | - Amro Daboul
- Policlinic of Prosthodontics and Biomaterials, Greifswald University, Greifswald, Germany.
| | - Christian Schwahn
- Policlinic of Prosthodontics and Biomaterials, Greifswald University, Greifswald, Germany.
| | - Roland Frankenberger
- Conservative Dentistry Department, Philipps University of Marburg, Marburg, Germany.
| | - Reinhard Hickel
- Policlinic for Restorative Dentistry and Periodontology, University of Munich, Munich, Germany.
| | - Reiner Biffar
- Policlinic of Prosthodontics and Biomaterials, Greifswald University, Greifswald, Germany.
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Reissmann DR, Behn A, Schierz O, List T, Heydecke G. Impact of dentists' years since graduation on management of temporomandibular disorders. Clin Oral Investig 2015; 19:2327-36. [PMID: 25843051 DOI: 10.1007/s00784-015-1459-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/18/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aims were to assess the impact of the number of years since dentists' graduation on appraisement of diagnostic needs and utilization of treatment options for temporomandibular disorders (TMD) and to investigate whether increased knowledge in TMD is sufficiently considered in today's dentist's undergraduate curricula and, therefore, represented in more evidence-based TMD management in dentists with less years since graduation. MATERIAL AND METHODS A questionnaire regarding knowledge and management of TMD was developed and was subsequently applied in a random sample of 400 dentists in a region in Northern Germany. RESULTS Of the 222 dentists (response rate 55.6 %), participating in the study, the frequency of TMD treatment need in the general population was estimated at 21.5 %, with lower values in dentists with more years passed since graduation. Measures regarding utilization of standardized examination forms, perceptions of insufficient specialization, and referrals of patients to TMD specialists indicated a lower quality and certainty in TMD management in participants with less time since graduation. While the provision of splints was a well-established treatment option in initial TMD management of all participants, additional TMD treatment options were mentioned less often, with lower proportions of participants making use of these options within the first decade since graduation. CONCLUSIONS Evidence-based TMD management is not fully represented in dental practitioners in Germany. This might be due to an insufficient consideration of TMD management in the dentist's undergraduate curricula. CLINICAL RELEVANCE Effective interventions to increase dentists' knowledge and to change dentists' practices in TMD management are required.
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Affiliation(s)
- Daniel R Reissmann
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. .,Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.
| | - Alexandra Behn
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Oliver Schierz
- Department of Prosthodontics and Materials Science, University of Leipzig, Leipzig, Germany
| | - Thomas List
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Guido Heydecke
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Aldrigue RHS, Sánchez-Ayala A, Urban VM, Pavarina AC, Jorge JH, Campanha NH. A Survey of the Management of Patients with Temporomandibular Disorders by General Dental Practitioners in Southern Brazil. J Prosthodont 2015; 25:33-8. [DOI: 10.1111/jopr.12255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - Vanessa M. Urban
- Department of Dentistry; State University of Ponta Grossa; Ponta Grossa Brazil
| | - Ana C. Pavarina
- Department of Dental Materials and Prosthodontics, Araraquara Dental School; University Estadual Paulista; Araraquara Brazil
| | - Janaina H. Jorge
- Department of Dental Materials and Prosthodontics, Araraquara Dental School; University Estadual Paulista; Araraquara Brazil
| | - Nara H. Campanha
- Department of Dentistry; State University of Ponta Grossa; Ponta Grossa Brazil
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