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Biomedical subjects

L LeResche

Publications and source records attributed to L LeResche.

At least 19 recordsLinked to original sources
PubMed2004

Dimensions of oral-health-related quality of life.

Oral-health-related quality of life (OHRQoL) is expected to have multiple dimensions. It was the aim of this study to investigate the dimensional structure of OHRQoL measured by the Oral Health Impact Profile (German version) (OHIP-G) and to derive a summary score for the instrument. Subjects (N = 2050; age, 16-79 yrs) came from a national survey. We used rotated principal-components analysis to derive a summary score and to explore the dimensional structure of OHIP-G. The first principal component explained 50% of the variance in the data. The sum of OHIP-G item responses was highly associated with the first principal component (r = 0.99). This simple but informative OHIP-G summary score may indicate that simple sums are also potentially useful scores for other OHRQoL instruments. Four dimensions (psychosocial impact, orofacial pain, oral functions, appearance) were found. These OHIP-G dimensions may serve as a parsimonious set of OHRQoL dimensions in general.

Adolescent↗
PubMed2002

Risk factors for diagnostic subgroups of painful temporomandibular disorders (TMD).

Temporomandibular Disorders (TMD) encompass several entities, which may have differing etiologies. To test this hypothesis, we investigated risk factors for three diagnostic subgroups of painful TMD. Ninety-seven subjects with myofascial pain only, 20 with arthralgia only, 157 with both myofascial pain and arthralgia, and 195 controls without TMD pain met criteria for study eligibility. Investigated risk factors included both physical and psychological variables. Adjusted odds ratios were calculated by multiple logistic regression analyses. Myofascial pain occurring alone was significantly associated with trauma (Odds Ratio [OR] = 2.0), clenching (OR = 4.8), third molar removal (OR = 3.2), somatization (OR = 3.7), and female gender (OR = 4.2). Myofascial pain with arthralgia was significantly associated with trauma (OR = 2.1), clenching (OR = 3.3), third molar removal (OR = 4.0), somatization (OR = 5.1), and female gender (OR = 4.7). No significant associations were found for the small-arthralgia-only group.

Adolescent↗
PubMed2000

Gender differences in pain.

A review of the literature on gender and clinical pain reveals a disproportionate representation of women receiving treatment for many pain conditions and suggests that women report more severe pain, more frequent pain, and pain of longer duration than do men. Gender differences in pain perception have also been extensively studied in the laboratory, and ratings of experimentally induced pain also show some sex disparity, with females generally reporting lower pain thresholds and tolerance than males. However, there is little consensus on whether these apparent differences reflect the way men and women respond to pain, differing social rules for the expression of pain, or biologic differences in the way noxious stimuli are processed. In this paper, our working hypothesis is that the higher prevalence of chronic orofacial pain in women is a result of sex differences in generic pain mechanisms and of as-yet unidentified factors unique to the craniofacial system. We will review the evidence concerning gender differences in the prevalence of pain conditions, with a focus on orofacial pain conditions. Evidence and hypotheses concerning biologic and psychosocial factors that could influence prevalence rates will also be discussed.

Chronic Disease↗
PubMed1998

Back pain in primary care. Patient characteristics, content of initial visit, and short-term outcomes.

STUDY DESIGN: Prospective study of patients making primary care visits for back pain. OBJECTIVE: To examine the content of primary care visits for back pain in patients with little interference of pain with activities at the visit and 1 month later; high interference of pain with activities at the visit but not 1 month later; and high interference of pain with activities, both at the visit and 1 month later. SUMMARY OF BACKGROUND DATA: Advice about resumption of activities may be therapeutic for patients with back pain, but little is known about the extent to which primary care providers assess and respond to limitation of activities in patients. METHODS: Audiotapes of primary care visits for back pain were coded for content. Patients indicated their goals for the visit and completed measures of pain and the pain's interference with activities, just before the visit and 1 month later. RESULTS: In most visits, providers did not assess functional limitations related to pain and did not discuss how to resume normal activities, although this was a highly rated goal for most patients. Providers did not appear to assess or respond to patients differently according to how much pain interfered with their activities. However, in patients with high interference of pain with activities, there was more discussion of limitation of activities and how to return to usual activities among those who improved than there was among those who did not improve during the next month. CONCLUSIONS: Although back pain frequently is associated with limitation of activity, pain's interference with activities is assessed inconsistently in primary care visits.

Activities of Daily Living↗
PubMed1997

Use of exogenous hormones and risk of temporomandibular disorder pain.

Temporomandibular disorders (TMD) are common pain conditions that have their highest prevalence among women of reproductive age. The higher prevalence of TMD pain among women, pattern of onset after puberty and lowered prevalence rates in the post-menopausal years suggest that female reproductive hormones may play an etiologic role in TMD. Two epidemiologic studies were designed to assess whether use of exogenous hormones is associated with increased risk of TMD pain. Both used data from automated pharmacy records of women enrolled in a large health maintenance organization to identify prescriptions filled for post-menopausal hormone replacement therapies (Study 1) or for oral contraceptives (OCs) (Study 2). Study 1 employed an age-matched case-control design to compare post-menopausal hormone use among 1291 women over age 40 referred for TMD treatment and 5164 controls not referred. After controlling for health services use, the odds of being a TMD case were approximately 30% higher among those receiving estrogen compared to those not exposed (P = 0.002); a clear dose-response relationship was evident. The relationship of progestin use to TMD was not statistically significant. Study 2 used a similar design to examine the relationship of OC use to referral for TMD care, drawing on data from 1473 cases and 5892 controls aged 15-35. Use of OCs was also associated with referral for TMD care, with an increased risk of TMD of approximately 20% for OC users, after controlling for health services use (P < 0.05). These results suggest that female reproductive hormones may play an etiologic role in orofacial pain. This relationship warrants further investigation through epidemiologic, clinical and basic research.

Adult↗
PubMed1997

Assessment of physical and behavioral outcomes of treatment.

This article reviews the availability of reliable and valid measures for assessing treatment outcomes and discusses issues related to research design, with the goal of identifying design elements that enhance the quality of evidence produced by clinical studies of therapeutic interventions. Assessment of outcomes in temporomandibular disorders can draw on methods and measures used with other chronic or recurrent pain conditions as well as temporomandibular disorder-specific measures. Reliable outcome measures are available for assessing the following: clinical signs and symptoms of temporomandibular disorders; pain intensity; affective aspects of pain; pain-related coping; pain behaviors, including expressive behaviors, activity limitation and use of health services; as well as pain-related disability and life interference. Well-designed measures of self-efficacy for controlling pain, explanatory models of pain, and patient satisfaction with treatment outcomes are needed. Elements of research design necessary for proving the worth of a clinical intervention include randomization, blinding, control, low loss to follow up, and an adequate follow-up period.

Adaptation, Psychological↗
PubMed1997

Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors.

Epidemiology is the study of the distribution, determinants, and natural history of disease in populations. Epidemiology has several uses in addition to its traditional role of documenting the public health significance of a condition. Notably, epidemiologic methods and data can be used to identify and verify causes of disease. This article reviews the epidemiologic data on pain in the temporomandibular region, and on signs and symptoms associated with specific subtypes of temporomandibular disorders, with the aim of identifying possible etiologic factors for these conditions that deserve further study. Despite methodologic and population differences, several consistencies are apparent in the epidemiologic literature. Pain in the temporomandibular region appears to be relatively common, occurring in approximately 10% of the population over age 18; it is primarily a condition of young and middle-aged adults, rather than of children or the elderly, and is approximately twice as common in women as in men. This prevalence pattern suggests that etiologic investigations should be directed at biologic and psychosocial factors that are more common in women than in men, and diminish in older age groups. Most signs and symptoms associated with particular temporomandibular disorders (e.g., joint sounds, pain in the joint) also appear to be more prevalent in women than in men, although age patterns for these signs and symptoms are not as clear as for temporomandibular pain. The available data highlight the need for further research on etiologic factors associated with temporomandibular pain and with specific diagnostic subtypes of temporomandibular disorders.

Adolescent↗
PubMed1991

An epidemiologic evaluation of two diagnostic classification schemes for temporomandibular disorders.

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.

Adolescent↗
PubMed1991

Therapeutic effects of daily or weekly chlorhexidine rinsing on oral health of a geriatric population.

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.

Aged↗
PubMed1990

Multiple pains and psychiatric disturbance. An epidemiologic investigation.

We assessed multiple pain conditions and their association with affective disturbance, somatization, and psychological distress based on questionnaire data from a probability sample of 1016 enrollees of a large health maintenance organization. Respondents were asked about the presence of five pain conditions and were classified empirically in terms of dysfunctional chronic pain status based on pain severity, pain persistence, and pain-related disability days. Logistic regression analyses revealed a highly significant association between number of pain conditions reported and elevated levels of somatization as measured by the Symptom Checklist 90-Revised. Individuals with two or more pain conditions were at elevated risk of an algorithm diagnosis of major depression, while persons with a single pain condition did not differ from persons with no current pain conditions. Number of pain conditions reported was a better predictor of major depression than were important measures of pain experience, including pain severity and pain persistence.

Adolescent↗
PubMed1990

Assessing clinical signs of temporomandibular disorders: reliability of clinical examiners.

Data on interrater reliability in assessing a number of clinical signs commonly evaluated in the diagnosis and treatment of temporomandibular disorders (TMD) is presented in this article. Four experienced dental hygienists who were field examiners for a large epidemiologic study of TMD and three experienced clinical TMD specialists (dentists) who are coinvestigators in the same study followed carefully detailed specifications and criteria for examination of TMD patients and pain-free controls. Excellent reliability was found for vertical range of motion measures and for summary indices measuring the overall presence of a clinical sign that could arise from several sources (for example, summary indices of muscle palpation pain). However, many clinical signs important in the differential diagnosis of subtypes of TMD were not measured with high reliability. In particular, assessment of pain in response to muscle palpation and identification of specific temporomandibular joint sounds seemed to be possible only with modest, sometimes marginal, reliability. These modest reliabilities could arise from examiner error because the clinical signs are themselves unreliable, changing spontaneously over time and making it difficult to find the same sign on successive examinations. The finding that, without calibration, experienced clinicians showed low reliability with other clinicians suggests the importance of establishing reliable clinical standards for the examination and diagnostic classification of TMD.

Adult↗
PubMed1990

Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls.

An epidemiologic study of clinical signs and symptoms of temporomandibular disorders (TMD) was conducted with a probability sample of adults enrolled in a major health maintenance organization (HMO). This report presents data from a first wave field examination and interview conducted by trained, calibrated dental hygienist field examiners. Significant gender differences for vertical jaw opening measures were observed but no significant age differences were found for the distribution of clinically relevant findings. Clinic cases showed smaller amounts of vertical range of jaw motion but did not differ from community cases or controls on extent of lateral, protrusive, or retrusive mandibular movements; on classification of occlusion; or on dentally related variables. Clinic cases had more pain during all jaw excursions as well as during muscle and joint palpation. Joint clicking sounds were also observed more frequently in clinic cases.

Adolescent↗
PubMed1984

Facial expression accompanying pain.

The study of facial expression accompanying pain is of both practical and theoretical importance. It has been suggested that nonverbal behavior may provide accurate information on pain states to supplement self-report and that perhaps facial expressions could even serve as accurate measures of pain in the absence of verbal report. Recent studies of specific facial expressions accompanying pain have benefited greatly from the techniques and findings of earlier research on facial expressions of emotion. These research findings also raise a number of questions concerning relationships between pain and emotion expressions, and provide some tools (e.g. direct facial measurement systems) for answering them. A review of empirical research indicates that there are distinct facial expressions which accompany acute painful experiences with some regularity, and that these expressions occur in both infants and adults, at least in Western cultures. Important areas for future research include cross-cultural studies, investigations of the circumstances under which these facial expressions occur and the possibilities for masking or falsifying them and research into facial behaviors related to chronic pain.

Facial Expression↗
PubMed1984

Intraligamentary anesthesia: a double-blind comparative study.

Three local anesthetic agents (Xylocaine 2%, Xylocaine 2% with epinephrine 1:50,000, and Marcaine 0.5 with epinephrine 1:200,000) were injected intraorally using an intraligamentary injection technique. The study used a double-blind design and electrical tooth pulp stimulation to examine the duration of pulpal anesthesia. Patterns of recovery from each drug, subjective discomfort associated with each drug, pain of injection, and pain in comparison with local infiltration were also measured. The extent and duration of adjacent soft tissue anesthesia were recorded. Xylocaine 2% with epinephrine 1:50,000 produced the longest pulpal anesthesia. The decay pattern of this particular drug was less abrupt than that of the two others. No difference in discomfort or pain was found across the various drugs. There was no significant difference in pain at injection when intraligamentary anesthesia was compared with local infiltration. Post-injection pain was slightly lower with local infiltration. The extent of soft tissue anesthesia was significantly related to vasoconstrictor levels in the drugs. The study shows that duration of pulpal and soft tissue anesthesia can be tightly controlled by the operator and tailored specifically to planned dental procedures.

Adult↗