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Biomedical subjects

J R Fricton

Publications and source records attributed to J R Fricton.

At least 19 recordsLinked to original sources
PubMed2007

Randomized effectiveness study of four therapeutic strategies for TMJ closed lock.

For individuals with temporomandibular joint (TMJ) disc displacement without reduction with limited mouth opening (closed lock), interventions vary from minimal treatment to surgery. In a single-blind trial, 106 individuals with TMJ closed lock were randomized among medical management, rehabilitation, arthroscopic surgery with post-operative rehabilitation, or arthroplasty with post-operative rehabilitation. Evaluations at baseline, 3, 6, 12, 18, 24, and 60 months used the Craniomandibular Index (CMI) and Symptom Severity Index (SSI) for jaw function and TMJ pain respectively. Using an intention-to-treat analysis, we observed no between-group difference at any follow-up for CMI (p > or = 0.33) or SSI (p > or = 0.08). Both outcomes showed within-group improvement (p < 0.0001) for all groups. The findings of this study suggest that primary treatment for individuals with TMJ closed lock should consist of medical management or rehabilitation. The use of this approach will avoid unnecessary surgical procedures.

Adolescent↗
PubMed2000

SYM-2081 a kainate receptor antagonist reduces allodynia and hyperalgesia in a freeze injury model of neuropathic pain.

Cold-freeze injury at -4 degrees C to the rat sciatic nerve produces mechanical allodynia and thermal hyperalgesia [M.A. Kleive, P.S. Jungbluth, J.A. Uhlenkamp, K.C. Kajander, Cold injury to rat sciatic nerve induces thermal hyperalgesia or analgesia, 8th World Congress on Pain, Vancouver, BC, Canada, August 1996 (Abstract).]. The NMDA receptor, an excitatory amino acid (EAA) receptor, appears to be involved in the development of allodynia and hyperalgesia following nerve injury. The role, if any, of the kainate receptor, another EAA receptor, remains unknown. In the current study, we evaluated whether (2S,4R)-4-methylglutamic acid (SYM-2081), a recently developed kainate receptor antagonist, attenuates increased responsiveness following cold injury to the sciatic nerve. During baseline testing, Sprague-Dawley rats were evaluated for frequency of withdrawal from von Frey filaments and latency of withdrawal from a radiant thermal source. Animals were then anesthetized, the left sciatic nerve was exposed, and the nerve was cooled to -4 degrees C for 15 min (n=24). For control rats (n=24), all procedures were identical except that the nerve was maintained at 37 degrees C. Testing resumed on the third day following surgery. On the fifth post-operative day, SYM-2081 (150 or 100 mg/kg), fentanyl citrate (0. 04 mg/kg) or vehicle was injected intraperitoneally. Injury to the rat sciatic nerve induced a significant increase in withdrawal frequency and a significant decrease in withdrawal latency (ANOVA, p<0.05). SYM-2081 and fentanyl significantly reduced these responses (p<0.05). These results suggest that kainate and opioid receptors are involved in the mechanical allodynia and thermal hyperalgesia that develop following cold injury to the sciatic nerve.

Animals↗
PubMed2000

Atypical orofacial pain disorders: a study of diagnostic subtypes.

Atypical facial pain is a persistent pain in the face or intraoral region that does not fit into the diagnostic criteria associated with specific orofacial pain disorders. This article presents the results of a study, which showed that in most cases of presumed atypical facial pain, there is a specific physical diagnosis or multiple diagnoses that causes the persistent pain. These difficult to diagnose disorders are reviewed with discussion of future research that is needed in this area.

Adult↗
PubMed2000

Broad support sought for emerging specialty of orofacial pain.

The American Dental Association is considering giving the emerging field of orofacial pain full status as a new dental specialty. Many recent advances in the neuroscience of orofacial pain have lead to treatments by orofacial pain dentists that provide significant relief for patients with chronic disorders. However, access to this care has been limited, leaving many patients to continue to suffer. Recent efforts to improve this situation by developing the field into a specialty have received broad support among dentists and have increased awareness of the benefits this field can provide for dentists and their patients.

American Dental Association↗
PubMed2000

Broad support evident for the emerging specialty of orofacial pain.

The emerging field of Orofacial Pain is being considered by the American Dental Association for full status as a new dental specialty. Many recent advances in the neuroscience of orofacial pain have lead to treatments by orofacial pain dentists that provide significant relief for patients with chronic orofacial pain disorders. However, access to this care has been limited leaving many patients to continue to suffer. Subsequently, recent efforts to improve this by developing the field into a specialty have shown broad support among dentists and increased awareness of the benefits this field can provide for dentists and their patients. A recent survey of 805 individuals in the general population who reported having a persistent pain disorder revealed that more than four out of 10 people have yet to find adequate relief, saying their pain is out of control-despite having the pain for more than 5 years and switching doctors at least once. "This survey suggests that there are millions of people living with severe uncontrolled pain," says Russell Portenoy, MD, President of the American Pain Society. "This is a great tragedy. Although not everyone can be helped, it is very likely that most of these patients could benefit if provided with state-of-the-art therapies and improved access to pain specialists when needed." (1). Development of the field of Orofacial Pain into a dental specialty has been motivated primarily by this issue; patients with complex chronic orofacial pain disorders have not been historically treated well by any discipline of health care. Recent studies of chronic orofacial pain patients have found that these patients have a high number of previous clinicians and have endured many years with pain prior to seeing an orofacial pain dentist (2) (Fig. 1). Complex pain patients and the clinicians who see them are often confused about whom they should consult for relief of the painful disorder. Treatment for these patients within the existing structure of dental or medical specialties has been inadequate and millions of patients are left suffering. Insurers are also confused with regard to reimbursement and make decisions to exclude treatment for orofacial pain disorders under both dental and medical policies. However, Dentistry has taken a leading role in health care to address this national problem by developing the field of Orofacial Pain into a dental specialty. A study of dentists and dental specialists have shown that there is a recognized need and broad support for further development of this field into a new dental specialty(3).

Adult↗
PubMed2000

Broad support evident for the emerging specialty of orofacial pain.

The emerging field of orofacial pain is being considered by the American Dental Association for full status as a new dental specialty to improve the care for these patients. The broad support among dentists for this initiative stems from an awareness of the benefits the field can provide for dentists and their patients.

Adult↗
PubMed1996

[Diagnosis and treatment of myofascial pain].

Myofascial pain (MFP) is a regional muscle pain disorder characterized by localized muscle tenderness and pain and is the most common cause of persistent regional pain. MFP is frequently overlooked as a diagnosis because it is often accompanied by signs and symptoms in addition to pain, coincidental pathology conditions, and behavioral and psychosocial problems. Evaluation of myofascial pain includes locating the trigger points and muscles involved as well as recognition of these contributing factors. Management of the syndrome follows with palliative care, splint therapy, muscle exercises, therapy to the trigger points, and behavioral therapy that depends on complexity of the case. The short term goals is to restore the muscle tot normal length, posture, and full joint range of motion with exercises and trigger point therapy. The long term goals include reducing the symptoms and their negative effects while helping the patient return to normal function without need for further health care. The difficulty in managing MFP lies in the critical need to match the level of complexity of the management program with the complexity of the patient. Failure to address the entire problem through a team approach if needed, may lead to failure to resolve the pain and perpetuation of a chronic pain syndrome.

Chronic Disease↗
PubMed1996

Predictors of outcome for treatment of temporomandibular disorders.

Psychosocial factors have been frequently suggested as important risk factors that may delay recovery in patients with temporomandibular disorders. In this study, 94 subjects with chronic temporomandibular disorders were studied using IMPATH:TMJ prior to their entering an interdisciplinary treatment program to determine which factors were most predictive of outcome. Treatment outcome was determined based on significant decreases in the Craniomandibular Index and the Symptom Severity Index from pretreatment to posttreatment. The IMPATH:TMJ items were regressed on treatment outcome for a random sample of half of the subjects (n = 47) to isolate the psychosocial and demographic items most predictive of treatment response. Discriminant analysis was then employed to test the predictive utility of the identified items for these subjects (criterion group), followed by a cross-validation of the items on the remaining 47 subjects (cross-validation group). Low self-esteem, feeling worried, low energy, and sleep activity were identified as useful predictors of treatment outcome for the criterion group. Each are correlates of depression. The discriminant analysis employing these four items accounted for 49% of the variance in treatment response, was statistically significant (P < .0001), and correctly predicted treatment outcome for 41 of 47 subjects (87%) in the criterion group. The predictive utility of the identified items remained statistically significant when applied to the cross-validation group (P < .01). The discriminant function employing the items correctly predicted treatment outcome for 37 of 47 subjects (79%) and explained 28% of the variance in treatment response. Findings of this study suggest that pretreatment psychosocial information is important in predicting treatment outcome for chronic temporomandibular disorders, and that symptoms of depression mediate treatment response for chronic pain patients.

Adolescent↗
PubMed1995

Management of masticatory myofascial pain.

Masticatory myofascial pain is a relatively frequent occurrence in patients seen by the orthodontist. Thus it is important to understand the management of this condition. Treatment is generally directed toward the restoration of a more physiological state in the muscles of mastication and involves medications, appliances, various forms of behavioral modification, as well as the use of muscle exercises and trigger point therapy. This article focuses on the role of the latter modalities in the management of myofascial pain and dysfunction.

Behavior Therapy↗
PubMed1994

Myofascial pain.

MFP is a regional muscle pain disorder characterized by localized muscle tenderness and pain and is the most common cause of persistent regional pain. The affected muscles may also display an increased fatiguability, stiffness, subjective weakness, pain on movement and slightly restricted range of motion that is unrelated to joint restriction. MFP is frequently overlooked as a diagnosis because it is often accompanied by signs and symptoms in addition to pain, coincidental pathological conditions, and behavioural and psychosocial problems. Chronic pain characteristics often precede or follow the development of MFP. Evaluation of MFP includes locating the trigger points and muscles involved as well as recognition of the contributing factors. Management of the syndrome naturally follows with muscle exercises, therapy to the trigger points, and reduction of all the contributing factors. The short-term goal is to restore the muscle to normal length and posture and full joint range of motion with exercises and trigger point therapy. The long-term goals include reducing the symptoms and their negative effects while helping the patient return to normal function without the need for future health care. The difficulty in managing MFP lies in the critical need to match the level of complexity of the management programme with the complexity of the patient's situation. Failure to address the entire problem, through a team approach if needed, may lead to failure to resolve the pain and perpetuation of a chronic pain syndrome.

Fibromyalgia↗
PubMed1994

Evaluation of a training program intended to calibrate examiners of temporomandibular disorders.

The adequacy of a training program intended to calibrate examiners of temporomandibular disorders (TMD) was evaluated. Eight examiners blindly rated 12 subjects with various TMD signs and symptoms after participating in a 5-h intense training procedure. Some examiners had earlier experience of TMD examinations, and some were newly trained. The Craniomandibular Index was used as the assessment instrument. Agreement within the whole group of examiners was low. Training tended to increase the probability of correctly registering signs. It is concluded that the program was not sufficient to create reliability among multiple examiners. More extensive training, not only to a standard but also between the different examiners, appears necessary. Revision of the examination technique is suggested, and recommendations for strengthening the calibration procedures are made.

Adult↗
PubMed1992

Burning mouth syndrome. Critical review and proposed clinical management.

Burning mouth syndrome is characterized by a burning sensation in one or several oral structures. Multiple causal factors have been proposed, and reports on their relative importance are conflicting. Lack of diagnostic criteria, differences in sampling procedures, incomplete workups, and lack of controlled studies make the reliable interpretation of the importance of proposed causal factors and the efficacy of specific treatment modalities difficult. This article summarizes the available data, critically analyzes their scientific merit, and proposes a protocol for clinical management.

Burning Mouth Syndrome↗
PubMed1992

The relationship of occlusion, parafunctional habits and recent life events to mandibular dysfunction in a non-patient population.

This study investigated the association between occlusion, oral habits and stress relative to the level of mandibular dysfunction in the total population and in specific diagnostic subgroups (normal, joint disorder, muscle disorder and joint/muscle disorder). A total of 269 nursing students were given a questionnaire and examination. The questionnaire included items to calculate an oral habit index and a social readjustment rating scale. The examination included items to calculate an occlusal index, two craniomandibular indices and a diagnostic criteria for specific subgroups. In the total population there was a positive association between mandibular dysfunction and three postulated risk factors. The total population was then divided into diagnostic subgroups. There was a positive association between the degree of mandibular dysfunction and parafunctional habits for normals, muscle disorders and joint/muscle disorders. There was a positive association between mandibular dysfunction and occlusion for normals only. Finally there was a positive association between mandibular dysfunction and stress for muscle disorders only. The results suggest that associations between postulated aetiologic factors and mandibular dysfunction vary depending on whether the subjects have a muscle and/or joint disorder. Since all associations were weak, other possible risk factors need to be investigated.

Adult↗
PubMed1992

The relationship between level of mandibular pain and dysfunction and stage of temporomandibular joint internal derangement.

Temporomandibular joint internal derangement (TMJ ID) is the most common intra-articular TM disorder and can progress from TMJ ID with reduction to TMJ ID without reduction. It is not known whether this anatomical progression is associated with increasing levels of mandibular dysfunction. The objective of this study was to determine whether the level of clinically detectable mandibular dysfunction was related to the stage of TMJ ID. Two clinicians examined 42 subjects prior to bilateral TMJ arthrographic evaluation. The level of mandibular dysfunction was calculated by Helkimo's Clinical Dysfunction Index (Di) and the Craniomandibular Index (CMI). Statistical analysis revealed that the level of mandibular dysfunction as determined by the Di and CMI was not related to the arthrographic presence or absence of TMJ ID. Therefore, the clinician cannot assume that the level of mandibular dysfunction is directly related to the absence or presence of TMJ ID. Epidemiologically, the CMI and Di can be used only for estimation of the degree of mandibular dysfunction, since they do not provide direct information on a specific TM disorder.

Adolescent↗
PubMed1991

Normal movements of mandible at the mandibular incisor.

This study was conducted to investigate the range of mandibular movements in a normal population. Sixty-one male dental students were selected and a tracking device (Saphon Visi-Trainer [SVT] C-II) was used. The range of mandibular movements was measured in frontal, sagittal, and horizontal planes. Deviations of movements and angles between planes and path of movements were also measured. This study suggested that mandibular movement could be evaluated more comprehensively with these additional measurements. This information will provide more accurate monitoring of mandibular movements during the treatment of craniomandibular disorders.

Dental Occlusion↗