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Biomedical subjects

J C Türp

Publications and source records attributed to J C Türp.

At least 19 recordsLinked to original sources
PubMed1998

[Correlation between myoarthropathies of the masticatory system and ear symptoms (otalgia, tinnitus)].

Speculations concerning a possible association between temporomandibular disorders (TMDs) and ear symptoms of otalgia and tinnitus have been made in the dental and medical literature for a long time. Current understanding of this association is reviewed. An analysis of relevant studies published between 1947 and 1996 shows that a relatively high percentage of TMD patients reported the presence of ear pain and noise. However, a cause-effect relationship has not been established to date. Theories that try to explain the concurrence of TMD symptoms and ear symptoms (particularly tinnitus) by a common underlying cause remain speculative. It has to be taken into consideration that due to their high prevalence, TMDs and ear symptoms in a given patients may be present by chance alone. A methodological weakness of most of the studies available is the fact that control groups were not considered. Owing to the lack of prospective, controlled, and randomized studies, statements regarding the effectiveness of certain dental measures for the treatment of otalgia and tinnitus in TMD patients are not well supported.

Algorithms↗
PubMed1998

The effect of musculoskeletal facial pain on registration of maxillomandibular relationships and treatment planning: a synthesis of the literature.

STATEMENT OF PROBLEM: A significant number of patients exist who are in need of prosthodontic rehabilitation and who at the same time report musculoskeletal pain in the facial area. PURPOSE: This article, which is based on an assessment of both the past and the most recent basic science and clinical literature, evaluates the effect of musculoskeletal facial pain on two static (physiologic rest position and centric relation) and two dynamic (protrusive border and lateral border movements) maxillomandibular relationships. MATERIAL AND METHODS: To find the relevant studies addressing the association between musculoskeletal facial pain and maxillomandibular relationships, a MEDLINE search was conducted, which was complemented by a hand search in selected journals. RESULTS AND CONCLUSIONS: Musculoskeletal facial pain seems to variably affect the aforementioned positions and movements. Hence, the validity of maxillomandibular registrations in patients with existing facial pain is questioned. In those patients with facial pain who simultaneously are in need of a prosthodontic rehabilitation, clinicians should be cautious with regard to the timing of the restorative procedures.

Centric Relation↗
PubMed1998

Fibrosarcoma misdiagnosed as a temporomandibular disorder: a cautionary tale.

Because of the abundance of articles on temporomandibular disorders in the dental literature, other sources of facial pain and mandibular dysfunction do not receive adequate diagnostic attention. The case report in this article describes a female patient who appeared for treatment with symptoms and signs similar to those encountered in subsets of temporomandibular disorders. Her condition was misdiagnosed, and she was treated for a temporomandibular disorder over an extended period before the correct diagnosis of high-grade pharyngeal fibrosarcoma was established. Once diagnosed, the tumor was treated aggressively with preoperative and postoperative combinations of chemotherapy and radiation. Despite the intensive therapy, the patient died. This case should remind the clinician that nonmusculoskeletal sources of persistent facial pain and dysfunction, including tumors, may be masked by or mimic temporomandibular disorders. If therapy does not produce the expected outcome, the diagnosis should be reexamined.

Adult↗
PubMed1998

Mandibular condyles and rami are asymmetric structures.

The purpose of this study was to determine the degree of bony asymmetry between the right (R) and left (L) mandibular condyles and rami. On 25 dry skulls, condylar height, breadth and length, as well as ramus height and breadth were assessed. On each skull the average of the three measurements on the right and left sides, respectively, were calculated with the corresponding reference points being redetermined for each measurement. The raw absolute differences magnitude of R - L as well as the relative absolute differences magnitude of R - L/R + L were computed. The relative absolute differences showed that asymmetries were of similar magnitude (between 1.20% and 2.58%) for all variables except for condylar height (11.06%). After taking three additional measurements with reference points chosen only once, the intra-individual measurement error, consisting of reproducibility of the reference points and accuracy in measuring the distance between the chosen points, was assessed with the help of a statistical variance component technique. Estimates of the 95% range of the absolute differences were computed. Between 60% and 88% of the measured differences were outside the predicted 95% range, thus much too large to be explained by random measurement error; hence, they were due to real individual asymmetries. We concluded that asymmetries of mandibular condyles and rami are part of the biologic variation of humans. It still remains unclear, however, when such asymmetries should be considered "unphysiological."

Adult↗
PubMed1998

Pain maps from facial pain patients indicate a broad pain geography.

Two hundred consecutive female patients, who were referred to a university-based facial pain clinic, were asked to mark all painful sites on sketches showing the contours of a human body in the frontal and rear views. The drawings were analyzed with transparent templates containing 1875 (frontal view) and 1929 (rear view) square cells of equal size. The average patient scored 71.8 cells in the frontal and 99.7 cells in the rear view (corresponding to 3.8% and 5.2% of the maximum possible scores). In individual patient drawings, however, up to 42.7% and 44.9% of all cells were marked. Only 37 cases (18.5%) exhibited pain that was limited to the trigeminal system. An analysis of the pain distribution according to the arrangements of dermatomes revealed three distinct clusters of patients: (1) pain restricted to the region innervated by the trigeminal nerves (n = 37); (2) pain in the trigeminal dermatomes and any combination involving the spinal dermatomes C2, C3, and C4, but no other dermatomes (n = 32); and (3) pain sites involving dermatomes in addition to the ones listed above (n = 131). Mean ages in the three clusters were 38.7, 35.5, and 37.5 years, respectively (p = 0.62, n.s.). Widespread pain existed for longer durations (median, 48 months) than conditions involving local and regional pain (median, 24 months) (p = 0.02, s.). Our findings showed that among a great percentage of persistent facial pain patients the pain distribution is more widespread than commonly assumed, and that the persistence of pain in the regional and widespread pain presentations is significantly greater than in cases with pain limited to the trigeminal system.

Adolescent↗
PubMed1998

Treatment-seeking patterns of facial pain patients: many possibilities, limited satisfaction.

Knowledge about the different kinds of treatment provided to patients with nonmalignant musculoskeletal facial pain is limited. The present study was based on 206 consecutive patients who were referred to a university-based tertiary care clinic for the diagnosis and management of persistent facial pain. Its purpose was to get information about the number and specialty of providers consulted by patients prior to their referral, and to follow the underlying treatment-seeking patterns. The results showed that on average 4.88 providers from 44 different categories were consulted. A general dentist or a dental specialist was seen by about 70% of patients. For patients whose first provider was a dentist, the most likely subsequent provider was another dentist. Conversely, if the first provider was a physician, chances were greater that the subsequent provider was a physician rather than a dentist. Among the nondental therapies patients received, physical therapy was chosen most frequently (42.2%). More than 60% of patients had at least one nondental treatment; however, the majority of these patients experienced two or more different types of such therapy (e.g., chiropractic, osteopathic, relaxation training). Patients' satisfaction with care and treatment was moderate, since only 18.5% of the patients were very satisfied, while 27.7% were dissatisfied or very dissatisfied. The present findings, which corroborate a recent study from the Kansas City, Missouri, region, indicate that patients with persistent facial pain see a large number of different providers, and that nonmedical/nondental treatment approaches are common. The moderate satisfaction experienced with any of the therapies points out that much needs to be done before this patient population is served satisfactorily.

Adolescent↗
PubMed1997

Orthodontic treatment and temporomandibular disorder: is there a relationship? Part 2: Clinical implications.

Although a review of the current literature does not reveal compelling evidence for the claim that orthodontic treatment prevents, causes, or cures temporomandibular disorders (TMD), the currently available clinical studies devoted to this topic share some methodological weaknesses, some of which are discussed in the present article. Another purpose of this paper is to extend the current understanding about the relationship between orthodontics and TMD to situations occurring in routine clinical practice. By doing so, we provide suggestions that are intended to help the orthodontist in decision-making when he or she deals with a patient who is in need of orthodontic treatment for dental or skeletal reasons, but has a history of TMD, or who develops TMD signs and symptoms during or after treatment.

Adolescent↗
PubMed1997

Temporomandibular disorders--pain outside the head and face is rarely acknowledged in the chief complaint.

STATEMENT OF PROBLEM: With diagnostic and therapeutic procedures being heavily influenced by the patient's chief complaint, the question arises whether this information alone represents a solid basis for clinical action. PURPOSE: The aim of this investigation was to assess the agreement between pain complaints and patient generated paper-and-pencil drawings of the distribution of pain in patients suffering from temporomandibular disorders. METHODS: The study included 140 adult female patients with temporomandibular disorders. Pain drawings served as a standard, against which the oral reports were compared. In 40 (29%) of the patients, pain was limited to the head and face; in the remaining subjects, it exceeded the boundaries of these regions. Nine potential pain sites were distinguished (head, face, neck, shoulders, arms, chest, abdomen, back, and legs). Whenever one of these regions was part of the drawing or the pain complaint, it was counted. Sensitivity, specificity, and kappa indices were computed for each site. RESULTS: Patients with pain limited to the head and face showed a close correspondence between pain report and drawing. On the other hand, patients with temporomandibular disorders with concomitant pain sites outside the head and face frequently did not mention these additional pain locations. This was reflected in low sensitivities (minimum: 0.00; maximum: 0.48) and low kappa values (minimum: -0.02; maximum: 0.19). CONCLUSIONS: This study showed that the chief complaint frequently underestimates the real extent of pain involvement.

Abdominal Pain↗
PubMed1997

Media hype: musculus sphenomandibularis.

The report of an allegedly so far unknown craniomandibular muscle ('the sphenomandibularis') in 1996 by Dunn and co-workers provoked much comment in journals and newspapers. The authors' hypothesized role of the 'm. sphenomandibularis' in temporomandibular disorders and headaches created hopes and expectations. The present article examines whether two detailed descriptions by Ramalho and co-workers [1978, in Portuguese], and by Zenker [1954, 1955, and 1956, in German] deal with the very same muscle. From the comparison of these descriptions it becomes evident that the 'm. sphenomandibularis' is not a new muscle, but corresponds to the 'medial portion' [Zenker], or 'deep portion' [Ramalho et al.] of the temporalis muscle. Further directed search identified descriptions of the muscle in question back into the 19th century.

Classification↗
PubMed1997

Orthodontic treatment and temporomandibular disorders: is there a relationship? Part 1: Clinical studies.

The relationship between orthodontic treatment and temporomandibular disorders (TMD) has long been of interest to the practicing orthodontist, but only during the last decade or so have a significant number of methodologically-sound clinical studies been conducted that have investigated this association. The aim of this paper is to critically review particularly those studies that have been published since 1989 and to answer the following questions: 1. Does orthodontic treatment with fixed or removable appliances lead to a greater incidence of TMD? 2. Does the extraction of premolars as part of an orthodontic treatment plan result in a greater incidence of TMD? 3. Does orthodontic treatment prevent or cure TMD? For this purpose, we conducted a MEDLINE search, complemented by a hand search in selected journals. We found 21 publications of studies related to the orthodontic-TMD interface. Based on these studies, the following statements can be made: 1. Orthodontic treatment performed during adolescence does not increase or decrease the chances of developing TMD later in life. There is no evidence of an elevated risk for TMD associated with any particular type of orthodontic mechanics. 2. The extraction of teeth as part of an orthodontic treatment plan does not increase the risk of TMD. 3. Thus far, there is no compelling evidence that orthodontic treatment prevents TMD, although the role of unilateral posterior crossbite correction in children may warrant further investigation. Likewise, there is no convincing evidence that TMD can be cured by orthodontic treatment.

Adolescent↗
PubMed1997

Richard Owen and the comparative anatomy of teeth.

One hundred fifty years ago, Richard Owen published the first detailed monograph on the comparative anatomy of teeth entitled Odontography; or, A Treatise on the Comparative Anatomy of the Teeth; their Physiological Relations, Mode of Development, and Microscopic Structure, in the Vertebrate Animals. The treatise is considered to be the first fundamental work of odontology. The 150th anniversary of its publication is an appropriate time to rediscover the roots and development of this scientific discipline, as well as the life and work of its author.

Anatomy, Comparative↗
PubMed1997

Pain descriptors characteristic of persistent facial pain.

The McGill Pain Questionnaire is an instrument that is widely used to assess the multidimensional experience of pain. Although it was introduced more than 20 years ago, limited information is available about its use in patients suffering from persistent facial pain. The aim of this study was to investigate the response patterns of persistent facial pain patients to the McGill Pain Questionnaire, to correlate these patterns with patients' beliefs about the seriousness of the condition, and to compare the findings with data reported from other painful conditions. The study sample consisted of 200 consecutive female patients referred to a tertiary care facial pain clinic. The Pain Rating Index scores of the McGill Pain Questionnaire subscales and the total number of words chosen by these patients closely matched the summary scores reported by Wilkie et al, who pooled data from seven pain conditions (cancer, chronic back, mixed chronic, acute/postoperative, labor/gynecological, dental, and experimentally induced) in their meta-analysis. On the other hand, when the data collected in this study were compared with those from specific clinical subsets, such as cancer patients, chronic back pain patients, or dental patients, differences in McGill Pain Questionnaire scores could be identified. Differences were also found in the choice of specific pain descriptors. More than 20% of the facial pain patients selected "radiating" and "pressing"; this was not the case for those suffering from other pain conditions. Facial pain patients who felt that their condition was more serious or different from what the treatment providers had told them had a greater likelihood of choosing specific word categories of the McGill Pain Questionnaire.

Adolescent↗
PubMed1996

Prosthetic rehabilitation in patients with temporomandibular disorders.

Decision-making in prosthetic dentistry and in the management of patients suffering from temporomandibular disorders is strongly influenced by the clinical and educational background of the dentist. The prosthetic rehabilitation of patients affected by one of the various subsets of temporomandibular disorders is a particularly challenging task, and the literature about this topic is limited. This article reviews the current situation and gives suggestions on how the dentist should proceed in the prosthetic treatment of these patients.

Decision Making↗
PubMed1996

Computerized axiographic evaluation of condylar movements in cases with fractures of the condylar process: a follow up over 19 years.

The treatment of fractures of the mandibular condylar process(es) can be conservative or surgical. However, in many cases, a definitive judgment on the functional long-term outcome of the chosen therapy can only be given many years after the intervention. As a result, it is clearly useful to be able to review the effects of treatment undertaken at least 15 years previously. Even so, only two such studies have been identified. Therefore, the aim of the present study is to evaluate the current functional capacity of the mandibular condyles of 20 subjects who had had an uni- or bilateral fracture of the condylar process, on average 19 years ago. The individuals, who all had been treated conservatively, were compared with a control group of healthy volunteers matched for gender and age. Besides measuring maximum mouth opening (MMO), computerized axiographies in the sagittal plane were made for each condyle during MMO, maximum protrusion and maximum mediotrusion. In spite of the high degree of inter-individual variability in both groups, the data showed that the amount of condylar movement was in most cases greater in the control group. In general, it appears that the risk of developing functional problems after conservative treatment is highest in the case of a fracture of the condylar process accompanied by condylar luxation, rather than by a condylar dislocation or without it.

Adult↗
PubMed1996

Trigeminal neuralgia versus atypical facial pain. A review of the literature and case report.

Trigeminal neuralgia and atypical facial pain are common conditions of facial pain. Although these two pain conditions are classically well separated in textbooks, a straightforward diagnosis may not always be possible because of the overlapping clinical signs and symptoms. In this article, a comparison and differentiation between the clinical and diagnostic features of these two pain conditions are presented. The general characteristics, etiologic characteristics, pathophysiology, differential diagnostic criteria, and therapeutic options of trigeminal neuralgia and atypical facial pain are described. A case report demonstrates the difficulties that can arise in the diagnosis and differentiation between the two disease entities. The article underscores the responsibility clinicians have in correctly diagnosing and managing patients with facial pain conditions.

Aged↗