Biomedical subjects
Publications and source records attributed to E L Truelove.
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Pain-related beliefs, catastrophizing, and coping have been shown to be associated with measures of physical and psychosocial functioning among patients with chronic musculoskeletal and rheumatologic pain. However, little is known about the relative importance of these process variables in the functioning of patients with temporomandibular disorders (TMD). To address this gap in the literature, self-report measures of pain, beliefs, catastrophizing, coping, pain-related activity interference, jaw activity limitations, and depression, as well as an objective measure of jaw opening impairment, were obtained from 118 patients at a TMD specialty clinic. Controlling for age, gender, and pain intensity, significant associations were found between (1) pain beliefs and activity interference, depression, and non-masticatory jaw activity limitations, (2) catastrophizing and activity interference, depression, and non-masticatory jaw activity limitations, and (3) coping and activity interference and depression. Controlling for age, gender, pain intensity, and the other process variables, significant associations were found between (1) beliefs and activity interference and depression, and (2) catastrophizing and depression. No process variable was associated significantly with the objective measure of jaw impairment. The results suggest that for patients with moderate or high levels of TMD pain and dysfunction, beliefs about pain play an important role in physical and psychosocial functioning.
Oral mucositis is a treatment limiting toxicity of cancer therapy. The purpose of this study was to assess the impact of doxepin oral rinse in the management of oral mucosal pain in cancer patients. Forty-one cancer patients with oral mucosal pain were provided a solution of doxepin (0.5%) for oral rinsing. Oral pain was assessed prior to rinsing, and following rinsing for 4 h using a visual analogue scale (VAS). Adverse effects were recorded. Doxepin rinse resulted in a reduction of pain intensity of more than 50%, with pain relief extending for more than 3 h with pain not returning to baseline 4 h after rinsing. The rinse was tolerated by patients with mucosal damage, and had acceptable taste, and infrequent mucosal stinging with use. Some patients reported sedation after use, likely due to systemic absorption. The results of this single dose trial suggest that topical doxepin rinse has significant ability to provide clinically significant pain relief in patients with mucosal damage with an extended duration of effect.
Early recognition of dental erosion is important to prevent serious irreversible damage to the dentition. This requires awareness of the clinical appearance of erosion compared to other forms of tooth wear. An understanding of the etiologies and risk factors for erosion is also important. These form the basis of a diagnostic protocol and management strategy that addresses the multifactorial nature of tooth wear. The primary dental care team has the expertise and the responsibility to provide this care for their patients with erosion.
This article was prepared by the above authors and submitted to members of the TMD academic community for their endorsement. A total of 120 people signed an endorsement; their names are available on request.
OBJECTIVE: The purpose of this study was to validate the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the diagnostic subgroup of disk displacement with reduction, with magnetic resonance imaging used as a gold standard. STUDY DESIGN: The diagnoses from the clinical examination of 78 joints in 39 patients, each with disk displacement with reduction in at least one TMJ, were compared with magnetic resonance imaging diagnoses. The readers of the magnetic resonance images were blinded to the clinical diagnoses. The data analysis included kappa statistics and calculation of predictive values. RESULTS: The predictive value of the RDC/TMD for disk displacement with reduction was 0.65. For disk displacement alone-the movement of the disk on opening not being considered-the predictive value was 0.92. The diagnostic agreement between RDC/TMD and magnetic resonance imaging diagnoses for all joints examined was 53.8%. Most of the disagreement was due to false negative clinical diagnoses for asymptomatic joints. CONCLUSIONS: A positive RDC/TMD examination is predictive for internal derangement but not reliable with regard to the type of disk displacement; such examination is therefore of limited value in determining the true disk position and its functional movements.
This article was prepared and submitted to members of the TMD academic community for their endorsement. A total of 120 people signed an endorsement; their names are available on request.
Oral lichenoid reactions may present as chronic symptomatic mucosal reactions. Lichen planus-like reactions include those associated with drug reactions, graft-versus-host disease after bone marrow transplantation, and idiopathic lichen planus. The mainstay of management is topical steroids; in resistant cases, topical and systemic corticosteroids may be used. We evaluated the use of cyclosporine administered in an adhesive hydroxypropyl cellulose base in patients with oral lichenoid reactions that remained active despite the prior use of high-potency topical steroids and in some cases despite the combined use of topical and systemic immunosuppression. Signs and symptoms of ulcerative oral graft-versus-host-disease improved more than 50% in three of four patients with oral graft-versus-host disease treated with the addition of topical cyclosporine. However, in patients with persistent oral lichen planus less effect was seen with 7 of 14 patients demonstrating a partial reduction in signs and symptoms. The topical use of cyclosporine in a bioadhesive base may represent a useful adjunctive approach in management of oral lichenoid reactions, although dose escalation and placebo-controlled studies are needed.
The authors describe an innovative method for teaching dental professionals to differentially diagnose and treat HIV-related oral lesions. The method included a half day of didactic presentations and a half day of clinical grand rounds. The clinical grand rounds featured clinical stations where small groups of practitioners observed HIV oral manifestations and interacted with patients. Their observations were discussed with two dentists expert in diagnosing and managing oral complications of HIV. Videotapes of the patients' oral lesions augmented the discussions.
The use of medication in chronic orofacial pain is not without risk. It is important to be vigilant regarding side effects, including abuse. The treatment of chronic pain can be frustrating and confusing because most patients with pain experience remissions and relapses. The initial report of reduced pain by the patient to any of the treatments that have been attempted may lead to false optimism about the nature of the condition or the potential long-term response to medication. With time the patient may report a reduced response to the medication and suggest either a higher dose or a different medication. In such patients it is important to reexamine the original differential diagnosis. When in doubt, additional consultation with pain centers, other clinicians with experience in managing patients with chronic pain, and consultation with the patient's physician may be needed. If the patient develops an abnormal personality or behavioral profile, referral to a specialist in behavioral medicine may also be needed. The treatment of chronic benign pain should proceed as planned, being careful not to place the patient in an "at-risk position" regarding medications and their effects or side effects.
General dentists and specialists likely to treat TMD were surveyed to gain information on their understanding of TMD causes, diagnosis and treatment. While the role of psychophysiologic factors in the etiology of TMD has been widely acknowledged in the practicing community, there is still a high level of controversy about the pathophysiologic aspects of TMD and appropriate diagnoses and treatment.
The purpose of this study was to test the hypothesis that retraction of maxillary front teeth may lock the mandible in a posterior position, and to evaluate any relationship between condylar position and signs and symptoms of internal derangements in the temporomandibular joint. A total of 29 female patients treated for Angle Class II, Division 1 malocclusion with extraction of maxillary first premolars and 34 female patients treated for Angle Class I malocclusion without tooth extraction consented to participate in a radiographic and clinical follow-up examination. The mean ages of the patients were 16.9 (SD 3.0) and 16.6 (SD 2.6) years, and the mean times after treatment were 1.6 (SD 1.0) and 1.5 (SD 0.9) years, respectively. Condylar position was measured in percent anterior and posterior displacement from absolute concentricity on lateral, central, and medial tomographic sections of each joint. Mean condylar position was more posterior at right central (P less than 0.05) and medial (P less than 0.01) tomographic sections in patients treated with extraction. The difference was due to a higher frequency of anteriorly positioned condyles in the nonextraction cases. No intergroup differences in the sagittal occlusal slide from CR to CO and the number of patients with clicking were found. However, the condyles were located more posteriorly in all tomographic sections (P less than 0.05 for lateral, P less than 0.001 for central and medial) in patients with clicking than in those without.
One of the first to permit multiple diagnoses, this new TMD classification scheme offers guidelines for clinicians and those conducting clinical field studies. The scheme was applied to a TMD population, with control subjects.
Few diagnostic classification schemes for temporomandibular disorders (TMD) have been applied systematically to examine the prevalence of various subtypes of TMD in clinic or community populations. In this study, computer algorithms were developed for classifying subjects according to the scheme of Eversole and Machado (1985) and a classification scheme recently developed in our own research at the University of Washington. The diagnostic algorithms were applied to clinical examination data for (1) persons without TMD pain (community controls) and (2) persons reporting TMD pain in the prior 6 months (community subjects with pain), identified in a random sample survey of a health maintenance organization (HMO) population, as well as (3) clinic patients seeking treatment for TMD through the same HMO. Prevalence rates for myofascial pain dysfunction in clinic patients were much higher under the University of Washington approach, whereas rates of internal derangement (type I) and degenerative joint disease were similar under the two schemes. These similar prevalence rates were not, however, accompanied by high concordance between the two schemes. These results highlight the complexities of differential diagnosis of TMD in field research, and suggest that further evaluation of alternative diagnostic schemes is warranted.
The effects of a chlorhexidine rinse on salivary Streptococcus mutans, Lactobacillus, and Candida albicans counts and on periodontal conditions (gingival index, plaque index, pocket depths) were studied in 42 elderly subjects. Under supervision, they rinsed either daily or weekly for 6 weeks with a 0.12% chlorhexidine solution (Peridex). Saliva samples were taken for chemical and microbiologic examinations, and periodontal conditions were assessed at baseline, week 6, and 6 weeks after final rinse. Significantly lower S. mutans counts were found at week 6 for both rinsing groups (p less than 0.001). Lactobacillus and Candida counts were also generally lower at week 6, with the clearest improvement among persons with the highest counts of bacteria and yeast. Periodontal conditions were improved at week 6 (p less than 0.001) in both groups. Such improvements were not maintained 6 weeks after the rinsing regimen was completed. At baseline poor oral conditions were noticed, which placed most of the subjects at risk for tooth decay and periodontal disease. Without any other dental procedures but daily or weekly supervised rinsing, oral conditions were improved and this risk was reduced. Daily rinsing was not superior to weekly rinsing with 0.12% chlorhexidine.
This study analyzed factors associated with acute oropharyngeal herpes simplex virus (HSV) infection in 627 patients who had undergone allogeneic bone marrow transplantation for leukemia, lymphoma, or aplastic anemia. HSV infection developed in 233 (37%) of the patients; all but two were seropositive for HSV before transplant. Sixty-two percent of the seropositive patients had at least one episode of HSV reactivation during the first 100 days after transplant. Other factors that placed patients at increased risk for HSV infection were a pretransplant diagnosis of leukemia, being in remission at the time of transplant, and/or having been conditioned for transplant with chemoradiotherapy. Recognition of factors that may predispose patients to HSV infection helps determine those transplant recipients who might benefit most from antiviral prophylaxis or other approaches to prevention of HSV reactivation.
Adenosine 3',5'-cyclic monophosphate (cAMP) and guanosine 3',5'-cyclic monophosphate (cGMP) levels were measured in labial gland slices from controls and patients with cystic fibrosis (CF). Incubation in vitro with 10 microM epinephrine, 50 microM isoproterenol, or 10 microM carbachol increased cAMP levels by 2.3-fold, 3.1-fold, and 1.8-fold, respectively, in control glands and by similar amounts in CF glands. The only statistically significant CF-related difference was a decreased response to isoproterenol. Addition of MIX (3-isobutyl-1-methylxanthine) increased cAMP levels in control and CF glands by an order of magnitude under all conditions but did not eliminate the CF-related decrease in cAMP level obtained with isoproterenol. cGMP levels were measured only in the presence of MIX. Incubation with carbachol nearly doubled cGMP levels in control and CF glands but only the control gland response approached statistical significance (P = 0.06). cGMP levels in CF glands were nearly threefold greater than those in control glands, and disease-related differences obtained in the presence of carbachol and isoproterenol were statistically significant.
Although the mouth is often involved in Wegener granulomatosis, oral lesions as the initial sign are rare. This case report documents the importance of considering Wegener granulomatosis in patients with unique oral lesions. The most common lesion is a friable-granular-hyperplastic gingivitis associated with alveolar resorption and tooth mobility. The disease may remain localized to the mouth for several weeks or months before multiorgan involvement occurs. Gingival enlargement is a direct manifestation of Wegener granulomatosis, and it may be pathognomonic. Failure to recognize the clinical lesions can result in delayed diagnosis and treatment, with potentially fatal results.