PubMed Health⌕ Search

Biomedical subjects

G B Wexler

Publications and source records attributed to G B Wexler.

5 recordsLinked to original sources
PubMed2001

Temporomandibular disorders--traumatic etiology vs. nontraumatic etiology: a clinical and methodological inquiry into symptomatology and treatment outcomes.

The purpose of this research is to investigate the distinctions relating to Presenting Symptoms and Treatment Outcomes between patients suffering temporomandibular disorder (TMD) as a result of traumatic versus nontraumatic etiology. A geographically diverse cohort of 1,842 patients diagnosed with TMD was investigated with special emphasis placed on the following criteria: 1. The distribution of demographic and symptom characteristics of patients with trauma as an immediate precipitating factor versus those with other nontraumatic etiologies; 2. The relationship between nontrauma status and treatment outcomes; 3. The interrelationships between nontrauma status, psychosocial factors, and treatment outcomes. Trauma patients tended to be younger, less educated, and more likely to be male than the nontrauma patients. For this group the reported length of the TMD problem was, as expected, of shorter duration when compared to the nontrauma patient group. Length of treatment did not differ between the two groups. In comparison, trauma patients reported higher initial overall symptoms including pain and range of motion limitations. However, symptoms related to joint dysfunction did not vary appreciably. Treatment outcomes are complicated by the fact that TMD encompasses several different diagnostic entities. Trauma patients reported significantly higher percentages of improvement in palpation pain and perceived malocclusion. No significant differences were found for pain report, joint dysfunction, stress, and overall TMD symptomatology, as measured by the TMJ Scale's Global domain. Trauma patients manifested higher psychological dysfunction levels (excepting stress) and showed significantly more improvement in both psychosocial function and stress than the nontrauma group.

Adult↗
PubMed1999

Temporomandibular treatment outcomes within five diagnostic categories.

This study of temporomandibular disorder (TMD) treatment outcomes examines 274 consecutive patients in five diagnostic categories and a 25 patient comparison group to determine relative levels of symptom improvement. Employing a psychometric outcome measure, the TMJ Scale, it was found that patients receiving active TMD treatments manifest statistically significant symptom improvements. Untreated patients reported minor and statistically insignificant symptom variations. Patients with intracapsular TM joint dysfunctions exhibited higher levels of improvement in pain and other TMD symptoms than patients presenting with primarily muscle symptoms. This research supports the hypothesis that TMDs are not self-limiting and require active treatment interventions. It is suggested that some studies cited to show that TMDs are self-limiting have major methodological limitations, relying upon unvalidated and subjective assessments of symptom levels. This research also outlines a procedure for TMD practitioners to measure treatment efficacy and the relative effectiveness of differing treatment modalities in a valid, consistent and unbiased manner.

Adult↗
PubMed1998

Psychological factors and temporomandibular outcomes.

This study examines the effect of psychological dysfunction as an etiological factor in temporomandibular disorder (TMD). It employs a thoroughly validated psychometric measurement system, the TMJ Scale (Pain Resource Center, Inc., Durham, North Carolina), to determine the effects of pretreatment stress and psychological dysfunction upon presenting symptom levels. The study also addresses these parameters for the eventual treatment outcome. During the course of this study, 2,074 patients were evaluated. Seven hundred and fifty-four by Dr. Steed and 1,320 by Dr. Wexler. Both practices address essentially identical patient populations and focus special interest in craniofacial pain and the diagnosis and Phase I treatment of temporomandibular dysfunction. Of the patients in the study who were found to have clinically treatable temporomandibular disorders, 561 consecutive patients completed treatment and were deemed to have reached Maximum Medical Improvement (MMI). The TMJ Scale was re-administered to this post-treatment population. This study summarized findings pertinent to the four primary issues: 1. pre-treatment psychological factors and stress, which seem to be moderately related to presenting pain levels and overall TMD levels (excepting joint function); 2. treatment outcomes which appeared to be unrelated to the initial psychosocial symptom severity; 3. physical symptoms outcomes and psychosocial outcomes which appeared to be significantly related and; 4. intracapsular symptom improvement which appeared to be unrelated to psychological functioning changes but mildly related to stress.

Adult↗
PubMed1995

Assessing treatment outcomes in two temporomandibular disorder diagnostic categories employing a validated psychometric test.

This study measures the effects of treatment interventions on two classes of temporomandibular disorder (TMD) patients in a dental practice in Ottawa, Canada. Other studies of TMD treatment outcome have employed subjective, largely qualitative and nonquantitative measures of symptom levels to make this type of assessment, rendering such research largely incapable of being replicated. The current study employs the TMJ Scale, a validated and psychometrically-developed symptom inventory, to measure symptom levels before and after treatment. The study first determined the sensitivity (92.1%) and specificity (88.1%) of the TMJ Scale for 219 patients in the practice population. One hundred and eleven consecutive TMD patients completed TMJ Scales prior to treatment, and then were retested after the completion of treatment. Results indicate that patients with symptoms of internal joint derangement reported more symptomatic improvement than those with predominantly muscular symptomology, despite the fact that the latter manifested lower symptom levels initially. Patients with internal derangement symptoms initially presented with lower levels of psychological symptoms than patients with muscular symptoms. Substantial improvements in both groups were noted, employing TMJ Scale percentile rank changes as outcome measures. This study can serve as a model for future research toward establishing baselines for expected TMD symptom improvement.

Adolescent↗