Biomedical subjects

A de Wijer

Publications and source records attributed to A de Wijer.

9 recordsLinked to original sources

PubMed2005

Home-exercise regimes for the management of non-specific temporomandibular disorders.

There is a consensus on treatment strategies for temporomandibular disorders (TMDs) being reversible. Among reversible therapies, physiotherapy is often chosen for the treatment of TMD pain and dysfunction because it is simple and non-invasive, it has a low cost as compared with other treatments, it allows an easy self-management approach, it allows a good doctor-patient communication, and it can be managed by the general practitioner. Home-exercises regime protocols are reviewed in this article in the context of the biopsychosocial approach. The actual evidence for the efficacy of home physical exercises is weak because of the very limited number of randomized clinical trials (RCTs) available in literature. Therefore, there is a need for further well-designed studies and RCTs to investigate the therapeutic efficacy. Recent reports and clinical experience, however, suggest that this approach can be promising, particularly if it is tailored towards the individual patient. The favourable cost benefit ratio over other treatment modalities seems to indicate that physiotherapy can be regarded as a first choice approach in selected TMD patients.

Cost-Benefit Analysis↗

PubMed1996

Temporomandibular and cervical spine disorders. Self-reported signs and symptoms.

STUDY DESIGN: The authors assessed the results of an anamnestic self-administered questionnaire given to 111 patients with temporomandibular disorders and 103 patients with cervical spine disorders. OBJECTIVES: The present study was performed to investigate whether patients with cervical spine disorders and subgroups of patients with temporomandibular disorders differ regarding specific and accompanying signs and symptoms of temporomandibular disorders and cervical spine disorders. SUMMARY OF BACKGROUND DATA: Patients with temporomandibular disorders frequently show signs and symptoms related to cervical spine disorders, and, vice versa, patients with cervical spine disorders may show signs and symptoms related to temporomandibular disorders. Many authors have pointed out the existence of neuroanatomical and biomechanical relationships. METHODS: The questionnaire included questions about pain, symptoms of temporomandibular disorders, accompanying signs and symptoms, psychosocial factors, and general health. Before their clinical examination, all patients were requested by mail to complete the questionnaire. RESULTS: Patients with cervical spine disorders reported fewer symptoms of temporomandibular disorders than the subgroups of patients with temporomandibular disorders, more general health symptoms than patients with temporomandibular disorders with an arthrogenous or myogenous component, and fewer ear symptoms than patients with temporomandibular disorders. There was no difference between the patient groups regarding other associated signs and symptoms and psychosocial factors as measured with the questionnaire. Logistic regression analyses showed that six variables (jaws, ears, eyes, temporomandibular joint sounds, complaints of the shoulders, and pain in joints other than the temporomandibular joint) correctly classified 91% of the patients as having temporomandibular disorders or cervical spine disorders. CONCLUSIONS: The results of this study do not support the theoretical concept that cervical spine disorders may give rise to temporomandibular disorders. The authors' results indicate that the anamnestic questionnaire can be used as an aid to distinguish patients with cervical spine disorders from subgroups of patients with temporomandibular disorders.

Adult↗

PubMed1996

Symptoms of the stomatognathic system in temporomandibular and cervical spine disorders.

This study was performed to assess the prevalence of signs and symptoms of temporomandibular disorders (TMD) in patients with cervical spine disorders (CSD) and to compare patients with CSD and subgroups of patients with TMD with regard to the results of orthopaedic tests of the stomatognathic system. A group of 103 consecutive patients with signs and symptoms of CSD and a group of 111 consecutive patients with TMD were examined. All subgroups of TMD patients showed a significantly smaller range of motion than the CSD patients. Patients with TMD had limited mouth opening (< 40 mm) on active and passive mouth opening more often than CSD patients. TMD patients with myogenous problems reported oral habits more often than CSD patients, although no objective differences between CSD and TMD patients were found. Subgroups of TMD patients reported joint sounds, and pain on palpation and joint play tests of the temporomandibular joint (TMJ) more frequently than CSD patients. Joint sounds on active movements, pain on palpation of the TMJ, and pain on joint play tests correctly classified 82% of the patients with TMD and 72% of the patients with CSD. In spite of the biomechanical and anatomical relationship between the neck and the stomatognathic system, the results of the study show that CSD patients have signs and symptoms of TMD comparable with those of the adult Dutch population. It was concluded that the function of the masticatory system should be evaluated in patients with neck complaints in order to rule out a possible involvement of the masticatory system.

Adult↗

PubMed1996

Symptoms of the cervical spine in temporomandibular and cervical spine disorders.

This study was performed to assess the prevalence of signs and symptoms related to cervical spine disorders (CSD) in subgroups of patients with temporomandibular disorders (TMD) and to compare TMD patients and CSD patients with regard to the results of orthopaedic cervical spine tests. One hundred and eleven consecutive patients with TMD and 103 consecutive patients with signs and symptoms of CSD were examined. The results indicated that there is a considerable overlap in the signs and symptoms of patients with TMD and patients with CSD. Signs and symptoms on neck extension occurred more often in CSD patients than in subgroups of TMD patients. No significant differences in upper cervical extension, neck flexion, and shoulder girdle function were found between CSD patients and subgroups of patients with TMD. Patients with CSD reported neck pain during active and passive movements of the neck more often than the subgroups of patients with TMD. TMD patients and CSD patients did not differ with regard to pain on shoulder girdle function and palpation of the shoulder girdle. Logistic regression analyses showed that orthopaedic tests of the cervical spine are of minor importance in discriminating between patients with TMD and patients with CSD. It is concluded that TMD with a myogenous involvement in contrast to TMD with only an arthrogenous involvement should no longer be viewed as a local disorder of the stomatognathic system. The upper quarter, including the stomatognathic system, cervical spine, and shoulder girdle, should be evaluated in patients with more complex or persistent symptoms in the head and neck region.

Adult↗

PubMed1996

[Diagnosis and classification of temporomandibular dysfunction by the general dental practitioner].

Because of other diseases mimicking the symptoms of temporomandibular dysfunction (TMD), differential diagnosis is of the utmost importance. Diagnostic subgroups of TMD (osteoarthrosis, anterior disc displacement with/without reduction, TMD-myo) can be distinguished by a combination of active movements, passive opening and palpation. Active movement appeared to be the most powerful test for distinguishing the subgroups of TMD, e.g. myogenous, arthrogenous, myogenous and arthrogenous. It is advised to have an open mind in the clinical examination and to be aware of the many mimicking disorders before reaching a diagnosis. An anamnestic questionnaire addressing the pain history, signs and symptoms of TMD, functional impairments, correlates of TMD, psychosocial evaluation and general health status is mandatory. Headache and neck pain often accompany TMD. In appropriate situations it is advised to refer to the proper specialist, before starting treatment for TMD. Orthopedic tests of the cervical spine are of minor importance in discriminating between patients with TMD and patients with cervical spine disorders (CSD). It is therefore advised to evaluate the function of the stomatognathic system in patients with neck complaints to rule out a possible involvement of this system.

Cervical Vertebrae↗

PubMed1996

[Neck pain and temporomandibular dysfunction].

Cervical spine disorders (CSD) are common chronic conditions affecting the cervical region and related structures. In this article the coexistence and possible interrelationship between temporomandibular dysfunction (TMD) and CSD is discussed. Our data indicate that a questionnaire is an important aid for distinguishing between CSD patients and subgroups of patients with TMD. Orthopedic tests for the stomatognathic system can be used to discriminate between CSD patients and subgroups of patients with TMD. The orthopedic tests of the cervical spine were shown to be of minor importance in discriminating between patients with TMD and patients with CSD. In more complex cases the cooperation between dentists and 'specialised' physiotherapists can be useful.

Cervical Vertebrae↗

PubMed1995

Reliability of clinical findings in temporomandibular disorders.

The aim of the present investigation was to study the interexaminer reliability of orthopedic tests and palpation techniques routinely used in the clinical diagnosis of disorders of the masticatory system. The tests were performed by a dentist and a physiotherapist, who both used the tests routinely when examining patients with temporomandibular disorders. Seventy-nine patients participated in this study. In the analysis, percentage agreement, intraclass correlation, and Cohen's kappa were used. The interexaminer reliability of the tests measuring maximal active mouth opening and registration of clicking during active mouth opening was high. The interexaminer reliability was fair for the tests measuring the intensity of pain during active movements and moderate for tests recording joint sounds (kappa = 0.47 to 0.59). There was high interobserver agreement on several items of the traction and translation tests, although the kappa values were low. The interexaminer reliability of the multitest scores for compression was substantial for joint sounds (kappa = 0.66) and fair for pain (kappa = 0.40). The interexaminer reliability of the multitest scores for muscle palpation and joint palpation was moderate (kappa = 0.51) and fair (kappa = 0.33), respectively. It can be concluded that most variables determined during active movements can be measured with satisfactory reliability, whereas variables for other tests are not measured with the same reliability on the basis of the kappa scores. The main symptoms of temporomandibular disorders can be evaluated reliably with multitest scores. It is recommended that clinicians calibrate their techniques regularly to improve the reliability of results in daily practice.

Adolescent↗

PubMed1994

Interexaminer reliability of six orthopaedic tests in diagnostic subgroups of craniomandibular disorders.

Interexaminer reliability is defined as the degree of consistency among examiners when making observations of the same clinical variable. In the present study, the interexaminer reliability of six orthopaedic tests was determined in a group of 79 patients with signs and/or symptoms of craniomadibular disorders (CMD), subdivided into three subgroups of patients with a mainly myogenous, a mainly arthrogenous, and a combined myogenous and arthrogenous disorder. Multi-test scores were composed for each test and combinations of tests for the three main symptoms of CMD, viz. pain, joint noises and restriction of movement. Although the orthopaedic tests showed different reliability scores, overall reliability of the determination of these three main symptoms of CMD was satisfactory. In the subgroups, arthrogenous signs and symptoms could be determined reliably with the set of six tests, whereas the reliability of the tests in determining pain and joint noises in the myogenous group was rather low. It may be concluded that the tests are well suited to evaluate arthrogenous signs and symptoms, but that the clinician should be aware of erroneous results of the tests in evaluating pain of a myogenous origin.

Adult↗

PubMed1989

[Physiotherapy and muscle dysfunction].

This article gives information about the role of the physiotherapist on the patient with a craniomandibular dysfunction, caused by a masticatory muscle dysfunction. The approach of the physiotherapist is discussed and information about the relevant etiological factors and symptoms are described. The diagnostic procedure and therapeutic possibilities are considered next to the multidisciplinary approach.

Adolescent↗