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Aims: To investigate whether any of the pretreatment physical signs, symptoms, and responses on psychological questionnaires would predict treatment outcomes after a standardized temporomandibular disorder (TMD) treatment program. Methods: The care provided to 157 TMD patients was a short course of physical therapy, an occlusal appliance, and over-the-counter nonsteroidal anti-inflammatory drugs (OTC NSAIDs). A multidimensional outcome assessment was performed using six variables. Follow-up data were available on 81.5% of enrolled subjects and elapsed time from initial visit to the two follow-up points was 13 +/- 4.7 and 33.6 +/- 9.8 months, respectively. Multiple regression analyses were conducted to assess the relationship between 18 predictor variables and the six outcome variables. Results: The results showed that the combination of a higher initial visual analog scale (VAS) pain score plus a lower jaw function interference score was significantly associated with a reduction of VAS pain after treatment (P < .05; adjusted R2 = 0.54). Moreover, the combination of a higher initial activity limitation score plus a lower jaw function interference score was associated with a greater reduction of the activity limitation score after treatment (P < .05; adjusted R2 = 0.36). None of the other outcomes were found to relate to any of the pretreatment variables. It must be noted that no single variable was a strong predictor and the odds ratios between the above three variables and the predicted outcomes were not robust. Conclusion: The corollary of these results suggests that if a high degree of jaw function interference is present (eg, clicking, locking), then the prognosis of improvement with brief self-directed physical therapy, an occlusal appliance, and OTC NSAID is lower, at least within the time frame of this study. [ABSTRACT FROM AUTHOR]

PURPOSE: The relationship between sleep bruxism (SB) and temporomandibular disorders (TMD) is unclear. This study aimed to estimate SB prevalence in an adolescent population and to investigate the relationship between SB frequency and prevalence of TMD signs/symptoms. MATERIALS AND METHODS: First-year students at a high school in Okayama, Japan, were recruited in 2005, with 195 subjects responding. The SB detection device was a miniature disposable device (BiteStrip, SLP) that indicated the total SB events per night on a 4-grade score. The subjects were divided into severe and nonsevere SB groups with SB frequency cutoffs. The subjects were examined for temporomandibular joint (TMJ) noise during mouth opening/closing, tenderness of the masticatory/cervical muscles, and range of TMJ condylar movement. The presence/absence of headache and shoulder stiffness was also determined by the interview. The odds ratio (OR) and confidence interval (CI) were calculated to test the relationship between SB frequency, gender difference, and presence of the TMD signs/symptoms by multiple regression analysis. RESULTS: Severe SB (more than 125 events per night) was significantly related to the presence of TMJ clicking (OR: 3.74, CI: 1.22-11.49, P = .02), while gender (male) was not related to the presence of TMJ clicking. Severe SB was not related to headache, though gender (male) was significantly related to headache (OR: 2.52, Cl: 1.04-6.11, P= .04) in these subjects. CONCLUSION: These results suggest that the presence of TMJ clicking was closely related to severe SB in an adolescent population. [ABSTRACT FROM AUTHOR]

AIMS: To examine whether any signs and symptoms of temporomandibular disorders were significantly associated with masseter muscle activity levels during sleep. METHODS: One hundred three healthy adult subjects (age range, 22 to 32 years) participated in the study. They were asked to fill out questionnaires, undergo a calibrated clinical examination of their jaws and teeth, and perform 6 consecutive nightly masseter electromyographic (EMG) recordings with a portable EMG recording system in their home. The EMG data were considered dependent variables, while the questionnaire and examination data were considered independent variables. Multiple stepwise linear regression analysis was utilized to assess possible associations between these variables. RESULTS: Both gender and joint sound scores were significantly related to the duration of EMG activity. None of the other independent variables were found to be related to any of the muscle activity variables. CONCLUSION: The results suggest that both gender and clicking are significantly related to duration of masseter EMG activity during sleep. [ABSTRACT FROM AUTHOR]

PURPOSE: This study investigated whether tooth wear status can predict bruxism level. MATERIALS AND METHODS: Sixteen Japanese subjects (eight bruxers and eight age- and gender-matched controls; mean age 30 years) participated in this study. From dental casts of these subjects, the tooth wear was scored by Murphy's method. Bruxism level in these subjects was also recorded for 5 consecutive nights in the subject's home environment using a force-based bruxism detecting system. The relationship between the tooth wear score and bruxism data was evaluated statistically. RESULTS: Correlation analysis between the Murphy's scores of maxillary and mandibular dental arch and bruxism event duration score revealed no significant relationship between tooth wear and current bruxism. CONCLUSION: Tooth wear status is not predictive of ongoing bruxism level as measured by the force-based bruxism detection system in 30-year-old Japanese subjects. [ABSTRACT FROM AUTHOR]

AIMS: To test whether 3-week duration recordings of sleep bruxism are correlated with daily behaviors. METHODS: Twelve patients with a sleep bruxism disorder were monitored to see if any daily behaviors (stress, physical activity, anger), jaw-pain/headache symptoms, or sleep quality were correlated with their sleep bruxism levels. A telemetric-based system was used for monitoring bruxism levels, which were detected with an intra-appliance piezoelectric film system. Bruxism was defined as a force applied to the occlusal surface of the splint at or above a level of 10% maximum voluntary contraction. Bruxism levels were recorded at night for at least 3 weeks on the 12 subjects in this study (6 females and 6 males). Patients used standard (100 mm) visual analog scaling methods during this period to rate their daily behaviors, sleep quality, and jaw-pain/headache symptoms in a diary. Correlation analysis was performed between these recorded variables. RESULTS: The subjects demonstrated both bruxism and sleep disturbance, and the mean bruxism score for the male subjects was significantly higher than that for the female subjects. Overall, no single diary variable was consistently correlated with the bruxism levels in these subjects. CONCLUSION: These data support the conclusion that bruxism is not strongly related to any of the subject's self-monitored daytime activities or sleep quality. [ABSTRACT FROM AUTHOR]

AIMS: To test the reliability and utility of a force-based bruxism detection system (Intra-Splint Force Detector [ISFD]) for multiple night recordings of forceful tooth-to-splint contacts in sleeping human subjects in their home environment. METHODS: Bruxism-type forces, i.e., forceful tooth-to-splint contacts, during the night were recorded with this system in 12 subjects (6 bruxers and 6 controls) for 5 nights in their home environment; a laboratory-based nocturnal polysomnogram (NPSG) study was also performed on 1 of these subjects. RESULTS: All 12 subjects were able to use the device without substantial difficulty on a nightly basis. The bruxer group exhibited bruxism events of significantly longer duration than the control group (27 seconds/hour versus 7.4 seconds/hour, P < .01). A NPSG study performed on 1 subject revealed that, when the masseter muscle electromyogram (EMG) was used as a 'gold standard,' the ISFD had a sensitivity of 0.89. The correlation coefficient between the duration of events detected by the ISFD and the EMG was also 0.89. CONCLUSION: These results suggest that the ISFD is a system that can be used easily by the subjects and that has a reasonable reliability for bruxism detection as reflected in forceful tooth-to-splint contacts during sleep. [ABSTRACT FROM AUTHOR]

Aims: Stabilization appliances and mandibular anterior repositioning appliances have been used to treat patients with internal derangement of the temporomandibular joint (TMJ) based on the assumption that these appliances work by decompressing the TMJ. The purpose of this study was to indirectly test this assumption. Methods: Bilateral TMJ tomograms of 7 subjects with unilateral anterior disc displacement without reduction (ADDwor) were taken during comfortable closure and during maximum clenching in maximum intercuspation; tomograms were also taken with the 2 types of occlusal appliances in use. Outlines of the condyle and the temporal fossa were automatically determined by an edgedetection protocol, and the minimum joint space dimension of the joints with and without ADDwor was automatically measured for each experimental condition as the outcome variable. Results: Upon comfortable closure and maximum clenching, the minimum joint space dimensions of the ipsilateral and contralateral joints with the use of stabilization appliances and mandibular anterior repositioning appliances were not significantly different from those seen in maximum intercuspation. Conclusion: These findings do not indicate that these appliances induce an increase in joint space during closing and clenching in joints with ADDwor. [ABSTRACT FROM AUTHOR]

AIMS: The pressure pain threshold (PPT) in the superficial masseter muscle was measured with and without cutaneous anesthesia to determine whether there would be a difference in PPT scores. METHODS: In 14 healthy male subjects, cutaneous tissues in the target areas were anesthetized with lidocaine with the help of an iontophoretic device. As a control, physiologic saline solution was applied iontophoretically to the contralateral masseter site. The subject and the PPT examiner did not know which side contained anesthesia, and the selection of which side to anesthetize was done in a random fashion. Multiple PPT measurements were made in the target sites before and immediately after the iontophoretic anesthesia. RESULTS: The PPT level on the lidocaine side was not statistically different from the PPT level recorded on the control side (339.0 +/- 87.6 kPa and 337.5 +/- 77.7 kPa, respectively). CONCLUSION: Pressure pain sensation in the human masseter is not derived predominantly from the cutaneous tissues, but from the muscle itself. [ABSTRACT FROM AUTHOR]