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Biomedical subjects

D C McKay

Publications and source records attributed to D C McKay.

At least 19 recordsLinked to original sources
PubMed2006

Limitation of the diagnostic value of MR images for diagnosing temporomandibular joint disorders.

OBJECTIVES: Many studies have shown that MRI findings are reliable when experienced calibrated observers work as a group. The hypothesis was that MRI findings can be used as the gold standard also when evaluation is made by single expert observers. STUDY DESIGN: Temporomandibular joint (TMJ) MRIs of 34 patients were evaluated independently by four reviewers with expert knowledge of radiology for the presence of 13 specified pathologic entities, as well as the quality of the images, on a 5-step scale from "Sure Yes" to "Sure No". Intraclass correlation coefficients were calculated to estimate the rating reliability of the examiners. A coefficient of at least 0.8 was deemed good, between 0.60 and 0.80 was deemed acceptable, and less than 0.60 was considered poor. Additionally, weighted kappa statistics were used for pair-wise comparisons across all four reviewers. RESULTS: The hypothesis was not supported by the results. None of the 13 correlation coefficients for comparisons between single examiner evaluations of pathologic entities was good and 8 were poor. CONCLUSION: A diagnosis of TMD based on MRI examination protocols made by a single examiner should not be accepted as a gold standard with regard to TMJ disorders.

Humans↗
PubMed2003

The frequency range of TMJ sounds.

There are conflicting opinions about the frequency range of temporomandibular joint (TMJ) sounds. Some authors claim that the upper limit is about 650 Hz. The aim was to test the hypothesis that TMJ sounds may contain frequencies well above 650 Hz but that significant amounts of their energy are lost if the vibrations are recorded using contact sensors and/or travel far through the head tissues. Time-frequency distributions of 172 TMJ clickings (three subjects) were compared between recordings with one microphone in the ear canal and a skin contact transducer above the clicking joint and between recordings from two microphones, one in each ear canal. The energy peaks of the clickings recorded with a microphone in the ear canal on the clicking side were often well above 650 Hz and always in a significantly higher area (range 117-1922 Hz, P < 0.05 or lower) than in recordings obtained with contact sensors (range 47-375 Hz) or in microphone recordings from the opposite ear canal (range 141-703 Hz). Future studies are required to establish normative frequency range values of TMJ sounds but need methods also capable of recording the high frequency vibrations.

Auscultation↗
PubMed2003

The dynamic range of TMJ sounds.

It is of clinical interest to record the amplitudes of temporomandibular joint (TMJ) sounds. The aim was to test the hypothesis that sealing the meatus, when placing a microphone in the ear canal affects such recording by increasing the sound pressure level (SPL). Bilateral recordings of 249 TMJ clickings were made from three subjects, using sampling rates of 48 or 96 kHz and 24 bits A/D conversion, with and without the ear canals sealed by Silicone putty. The peak-to-peak equivalent sound pressure level (peSPL) was higher (P < 0.001) when the ear canal was sealed (range of mean differences was 8.3-24.9 dB peSPL). This means that the signal to noise ratio can be improved by sealing the meatus because the electronic noise level is not increased. Most important is that the dynamic range of the clicking sounds was 62 dB that is larger than the effective dynamic range of a 16 bits sound card. Future studies are needed to establish normative peSPL values. However, cards with at least 24 bits A/D conversion will be required, especially in patients with suspected disc displacement with reduction, where the difference in loudness between opening and closing clicking often is large.

Auscultation↗
PubMed2002

Localization of TMJ sounds to side.

Differential diagnosis depends in cases with disk displacement on accurate identification of sound source. Mistakes may occur when clicking from one temporomandibular joint (TMJ) is heard on both sides of the head at auscultation and neither examiner nor patient, is sure about side. The hypothesis was that the head tissues affect spectral characteristics of TMJ sounds and that differences due to different positioning of sensors can be used in localization of source. The aim was to compare bilateral electronic recordings of unilateral TMJ sounds to obtain and compare attenuation, phase shift and time delay. Recordings were made from 12 subjects with unilateral clicking. Small electret condenser microphones, bandwidth 40-20 000 Hz, were placed at the openings of the auditory canals and the sounds were recorded at a sampling rate of 48 000 Hz. The head tissues acted as a filter causing a frequency dependent attenuation and phase shift. There was a time difference between the ipsi- and the contra lateral recordings, the latter always having a longer delay time (range 0.2-1.2 ms, group mean 0.68 ms, s.d. 0.292 ms). In conclusion, spectral analysis of bilateral electronic TMJ sound recordings is of diagnostic value when bilateral clicking is heard at auscultation and can help to avoid diagnosing a silent joint as clicking.

Adult↗
PubMed2000

Kinematic and kinetic observations on ballistic depression and elevation of the human mandible.

To study mandibular motions with respect to time (kinematics) and the forces causing and resulting from these motions (kinetics), four subjects generated rapid depression and elevation of the mandible (displacement of 0.224 m; peak velocity of 0.237 m s(-1) during depression and 0.269 m s(-1) during elevation). The motion of depression (duration of 0.195 s; kinetic energy of 2.072 x 10(-3) J) could be divided into a phase of acceleration (2.742 m s(-2); +/- 0.28 gn) and a phase of deceleration (2.264 m s(-2); - 0.23 gn), and the terminal excess kinetic energy of depression was absorbed and dissipated by, primarily, the temporomandibular joint. Similarly, the ensuing motion of elevation (duration of 0.182 s; kinetic energy of 2.948 x 10(-3) J) could be divided into a phase of acceleration (3.498 m s(-2); + 0.36 gn) and a phase of deceleration (2.931 m s(-2); -0.30 gn), and the terminal excess kinetic energy of elevation was absorbed and dissipated by, primarily, the dentitions and, secondarily, by the temporomandibular joint. Rapid depression of the mandible appeared to be under the central control of a preprogrammed motor command, and ensuing rapid elevation of the mandible appeared to be under the peripheral control of a segmental and/or transcortical reflex. During rapid depression and elevation of the mandible, the anterior suprahyoid, anterior temporalis, and sternocleidomastoid muscles were myoelectrically active 56%, 73%, and 71% of the time, respectively, and myomechanically active 42%, 59%, and 57% of the time, respectively. Over a follow-up period of 12 months, the studied mandibular motions did not cause injury to the dentitions and temporomandibular joint.

Biomechanical Phenomena↗
PubMed2000

Rotational and translational loading of the temporomandibular joint.

Following an introduction to the functional properties of a three-dimensional instantaneous helical axis pertaining to circular (rotatory) and linear (translatory) motions of the mandible, this feasibility study applied the concept of a mandibular average finite helical axis to the maneuver of cyclic opening and closing of the mouth in three healthy subjects. Through the accelerations and decelerations of a mandibular incisor point (instead of a mandibular condylar point) as well as the laws of physics, the kinetic reaction forces and reaction pressures in the upper and lower cavities of the temporomandibular joint (TMJ) were estimated over opening-closing distances of five and ten mm from centric occlusion. The translatory reaction pressures in the upper TMJ cavity (17-29 mm Hg) exceeded the rotatory reaction pressures in the lower TMJ cavity (5-12 mm Hg). The estimated reaction pressures were in close agreement with synovial fluid pressures measured in vivo in the TMJ of humans and pigs, and the biologic significance of frequent and/or prolonged increased TMJ hydrostatic pressures is discussed.

Bite Force↗
PubMed1999

Electrognathographic and electromyographic observations on jaw depression during neck extension.

Albeit never substantiated through experimental and clinical evidence, the theoretical linchpin of the mechanics of a so-called whiplash injury of the temporomandibular joint (TMJ) is the postulate that a pre-existing depressor force (continual anchoring force), generated by the anterior suprahyoid (SH) muscles, will always act on the mandible and cause traumatic mouth opening (anterior acceleration of the TMJ condyles) when the neck is extended (posterior acceleration of the head). To test aspects of this postulate, six subjects assumed the positions of neutral (0 degrees ), medium (32 degrees ) and maximum (58 degrees ) neck extension while the mandible was in its postural positions of rest and light centric occlusion. By means of surface electromyography, it was shown that the relative contractile activities of the anterior SH muscles never exceeded 7.3% of the contractile activity required to anchor the mandible in a position of maximum depression. By means of electrognathography, it was shown that the maxillary and mandibular incisors were never separated by more than 2.6 mm during neutral, medium, and maximum extension of the neck. In other words, during neck extensions there was no evidence of a continual or induced voluntary or involuntary depressor force that would and could anchor the mandible in a position of traumatic mouth opening. Accordingly, and in agreement with other biophysical and biomedical evidence, it was concluded that there is no foundation for the pseudoscientific speculations and unsubstantiated opinions offered in support of a concept and diagnosis of a so-called TMJ whiplash injury. Additionally, this study found co-activation of cervical flexor muscles and mandibular elevator as well as depressor muscles.

Acceleration↗
PubMed1998

Whiplash injuries of the temporomandibular joint in motor vehicle accidents: speculations and facts.

Referring to the temporomandibular joint (TMJ) of the human mandibular locomotor system, it has been asserted that displacement of the TMJ disc and inflammation of TMJ tissues are the results of acute and indirect trauma to the TMJ; on occasion this is allegedly experienced in motor vehicle accidents and commonly known as a TMJ whiplash injury. It is postulated that the TMJ whiplash injury is released in the occupant or occupants of a target vehicle when its rear end is impacted by the front end of a bullet vehicle. On the basis of detailed analyses of TMJ trauma/pain histories and TMJ magnetic resonance images, presented as circumstantial evidence in favour of the postulated TMJ whiplash injury, and detailed analyses of the mathematical biophysics of the mandibular locomotor system as well as direct experimental evidence, it is concluded that the postulated TMJ whiplash injury does not exist as a single and independent disease entity caused by motor vehicle accidents. If TMJ disc displacement and inflammation are present, they are expressions of an insidious and progressive pre-existing (pre-accident) disease entity that is comprised of TMJ synovitis/osteoarthritis (phase of inflammation with presence of immune system cells), TMJ internal derangement (phase of disc displacement and deformation with presence of proteinases), and TMJ osteoarthrosis (phase of degeneration with absence of immune system cells). For the asserted TMJ whiplash manoeuvre and ensuing injury to occur as postulated, the laws of physics and biology would have to be suspended.

Accidents, Traffic↗
PubMed1997

Masticatory tooth contact patterns: predicted and observed cuspid and first molar contacts in cuspid and group function.

Using the mouth as an "in vivo articulator," the bilateral nonmasticatory ("empty") contact patterns of opposing cuspid and first molar teeth were determined in two healthy subjects with well-defined cuspid function and two healthy subjects with well-defined group function. The electronically recorded "empty" contact patterns pertained to the static intercuspal position and dynamic laterotrusion to the right and the left. On the basis of the "empty" tooth contact patterns and the number of electronically recorded masticatory cycles of one masticatory sequence, we postulated two simple models that attempted to predict the masticatory ("functional") tooth contacts of one sequence of unilateral mastication of apple and banana. Statistical comparisons between the predictions of the two models and the actual ("functional") contacts of in vivo mastication showed that the models predicted fairly well the observed tooth contacts on the nonchewing-side of the mouth, but not the observed tooth contacts on the chewing-side of the mouth. In consequence, "empty" (nonmasticatory) tooth contact patterns should not be equated with "functional" (masticatory) tooth contact patterns.

Adult↗
PubMed1997

Reflex jaw motions and jaw stiffness pertaining to whiplash injury of the neck.

Because a so-called mandibular whiplash injury requires the absence of short-latency jaw-closing reflexes in order to explain the postulated mechanism of injury (excessive jaw opening); the authors studied the presence and absence and more importantly, the kinematics (duration, displacement, velocity, acceleration) of monosynaptic and possibly, polysynaptic myotatic (stretch) reflexes in the jaw elevator muscles. In six healthy adults jaw jerk maneuvers were elicited through a brisk tap on the chin, and surface electromyography identified elevator reflexes while translational electrognathography identified the kinematics of the reflexes. The maneuvers were done while maintaining the rest position (3% MVC) and moderate clenching of the teeth (30% MVC). Electromyography was also used to identify phasic elevator excitations during a passive brisk neck extension maneuver. A sudden and unexpected elongation of the jaw elevators released autogenic reflex responses that, in conjunction with augmented tissue elasticity (stiffness), elevated the mandible into centric occlusion within approximately 150 milliseconds. In 86% of trials, the responses occurred regardless of the prevailing resting and clenching contractile activities. There was no evidence of a depressor force that consistently would and could anchor the mandible in a position of extreme or moderate depression, the theoretical linchpin of the mandibular whiplash injury. It was concluded that the mandibular locomotor system is very efficient in maintaining the rest and intercuspal positions of the mandible. This study found no evidence corroborating the mechanism claimed to release a so-called mandibular whiplash injury.

Acceleration↗
PubMed1996

Canine tooth guidance and temporomandibular joint sounds in non-patients and patients.

In 46 non-patients and 46 patients, the authors examined the presence (+) and absence (-) of canine tooth guidance (CG), i.e. dynamic dental articulation events in contrast to static dental occlusion events. During a right and a left laterotrusion of the mandible, the number of simple, mutually exclusive and exhaustive tooth guidance events (possibilities) was four. In addition, the authors examined the associations between temporomandibular joint (TMJ) sounds and canine guidance events. In non-patients, CG+ was relatively infrequent (30%), and CG- was relatively frequent (70%). In patients, CG+ was relatively infrequent (22%), and CG- was relatively frequent (78%). In both non-patients and patients, bilateral CG+ was rather infrequent (15%). In both non-patients and patients with the presence of TMJ sounds, CG+ was relatively infrequent (38%) while CG- was relatively frequent (61%). In non-patients as well as patients, no evidence was found that distal CG+ (putative lateral retrusive guidance) was associated with ipsilateral TMJ sounds (relative risk = 0%), nor that the association between mesial CG+ (putative lateral protrusive guidance) and ipsilateral TMJ sounds was beyond that of mere chance (relative risk = 50%).

Cuspid↗
PubMed1996

Mediotrusive tooth guidance and temporomandibular joint sounds in non-patients and patients.

In 46 non-patients and 46 patients, the authors examined the presence (+) and the absence (-) of laterotrusive (LG) and mediotrusive (MG) tooth guidance, i.e. dynamic dental articulation events in contrast to static dental occlusion events. During a right and left laterotrusion/mediotrusion of the mandible, the number of compound, mutually exclusive and exhaustive tooth guidance events (possibilities) was six. In addition, the presence and the absence of temporomandibular joint (TMJ) sounds, provoked TMJ pains, and the associations between TMJ sounds and tooth guidance events were examined. In non-patients, LG+ and MG+ was relatively infrequent (30%) while LG+ and MG- was relatively frequent (70%). In patients, LG+ and MG+ was relatively frequent (58%) while LG+ and MG- was relatively infrequent (42%). LG- and MG+ was absent in non-patients and rare in patients (3%). Either unilateral or bilateral MG+ was relatively infrequent in non-patients (30%) and relatively frequent in patients (59%). Bilateral MG+ was relatively infrequent in non-patients (20%) and relatively frequent in patients (52%). Either unilateral or bilateral TMJ sounds were relatively infrequent in non-patients (39%) and relatively frequent in patients (74%). Either unilateral or bilateral provoked TMJ pains were absent in non-patients and relatively frequent in patients (72%). The authors found no evidence that TMJ sounds were associated with the ipsilateral absence of so-called balancing contacts (MG-) in non-patients and patients. Finally, no evidence supporting the use of a so-called positive predictive value, and "extension concept' of probability theory was found.

Adult↗
PubMed1996

TMD diagnostic decision-making and probability theory. Part I.

This article is an educational analysis and discussion of some recently proposed diagnostic criteria, diagnostic methods, and diagnostic decision processes, pertaining specifically to temporomandibular disorders (TMD). On the basis of a discussion of classic probability theory, classic measurement theory, and examples using nonparametric inferential statistical tests, it is suggested that certain TMD diagnostic criteria and methods, and their associated decision matrix, favor subjective clinical opinions (largely pseudoscientific observations) and arbitrary clinical indices rather than objective scientific facts.

Binomial Distribution↗
PubMed1996

TMD diagnostic decision-making and probability theory. Part II.

As it specifically pertains to temporomandibular disorders (TMD), this article is an educational analysis and discussion of some recently proposed diagnostic criteria, diagnostic methods, and diagnostic decision processes. On the basis of a discussion of classic probability theory, classic measurement theory, and examples using nonparametric inferential statistical tests, it is suggested that certain TMD diagnostic criteria and methods, and their associated decision matrix, favor subjective clinical opinions (largely pseudoscientific observations) and arbitrary clinical indices rather than objective scientific facts.

Data Interpretation, Statistical↗
PubMed1992

Temporomandibular joint vibration analysis in a sample of non-patients.

In a sample of 20 non-patients, 60% of the subjects had an absence of subjective temporomandibular joint (TMJ) complaints (noises/sounds) that agreed with objective joint vibration analyses (electrovibratography). Among the remaining 40% of subjects, only 50% of the examined joints showed agreement between subjective and objective findings. Subjects appeared to be unable to reliably detect "weak" (early) symptoms of TMJ dysfunction but were able to reliably detect "strong" (late) symptoms of TMJ dysfunction and possibly disease. As measured through active protrusion and laterotrusion of the mandible, the guidance angles of the anterior teeth could not explain the absence and presence of TMJ vibrations.

Adult↗