Biomedical subjects

Lloyd A Mancl

Publications and source records attributed to Lloyd A Mancl.

16 recordsLinked to original sources

PubMed2006

Predictors of onset of facial pain and temporomandibular disorders in early adolescence.

There are few prospective studies assessing risk factors for onset of temporomandibular (TMD) pain disorders in any age group. The aim of this prospective cohort study was to identify risk factors for onset of clinically significant TMD pain (i.e., pain meeting research diagnostic criteria for myofascial pain and/or arthralgia) during early adolescence. Subjects were 1,996 boys and girls, initially 11 years old, randomly selected from a large nonprofit health care system. Subjects completed a baseline telephone interview and were followed up with mailed questionnaires every 3 months for 3 years. At baseline and all follow ups, subjects were asked to report the presence of facial pain in the past 3 months. Subjects reporting a first onset of facial pain received a standardized clinical examination. In multivariate analyses, baseline predictors of clinically significant pain included female gender [Odds Ratio (OR)=2.0, 95% Confidence Interval (CI)=1.2-3.3] and negative somatic and psychological symptoms including somatization (OR=1.8, CI=1.1-2.8), number of other pain complaints (OR=3.2, CI=1.7-6.1) and life dissatisfaction (OR=4.1, CI=1.9-9.0). Many of the risk factors for onset of clinically significant TMD pain in adolescents are similar to risk factors for onset of TMD and other pain problems in adults, as well as risk factors for onset of other pain conditions in adolescents. These findings suggest that the development of TMD pain in adolescence may reflect an underlying vulnerability to musculoskeletal pain that is not unique to the orofacial region.

Adolescent↗

PubMed2006

Sonic tooth brushing reduces gingival overgrowth in renal transplant recipients.

Cyclosporine (CSA) is a commonly used immunosuppressive medication in pediatric transplantation. Drug-induced gingival overgrowth (DIGO) is a frequent side effect associated with CSA use and can impair the patient's ability to achieve good oral hygiene. This study tested the hypothesis that sonic tooth brushing and oral hygiene instruction can reduce the occurrence or severity of DIGO in CSA-treated pediatric renal transplant recipients. Twenty-three pediatric renal transplant patients with DIGO were randomly allocated to treatment or control groups. The treatment group received oral hygiene instruction and use of a sonic toothbrush, while the control group continued their usual home care with manual brushes. Dental impressions and photographs of all subjects were taken at baseline and every 3 months for a year. The casts and photographs were evaluated by a dental panel to compare the DIGO levels from baseline until the end of the study. After 12 months the control group had significantly more severe DIGO than did the sonic tooth brushing and oral hygiene instruction group (OR=4.5, 95%CI=1.2-16.0, P=0.03). Of the risk factors considered, only male gender was significantly associated with worse outcome (OR=6.1, 95%CI=2.3-16.1, P=0.03). The use of a powered toothbrush, together with oral hygiene instruction, may be an important component of health maintenance for pediatric transplant patients on CSA.

Adolescent↗

PubMed2006

Daily pain coping among patients with chronic temporomandibular disorder pain: an electronic diary study.

AIMS: To describe patients' daily coping with the pain of chronic temporomandibular disorders (TMD), the conservative treatment received, and the self-care strategies used, and to examine the relationships between these strategies and daily pain intensity, activity interference, and jaw use limitations. METHODS: TMD clinic patients (n = 137, 88% women) completed electronic diary measures of pain, interference, jaw use limitations, and use of 20 strategies 3 times daily for 2 weeks. RESULTS: Reliability and validity were demonstrated for 4 scales of related coping items: cognitive coping, relaxation, activity reduction, and emotional support. Average scores were higher on the relaxation and activity reduction scales than on the cognitive coping and emotional support scales. Among the coping items not included in the scales, "did something to try to reduce pain" (direct action) was endorsed most frequently (reported in a median of 74% of interviews). Heat, cold, and seeking spiritual support were used least (< or = 5%). At times of increased pain, patients were more likely to use almost all types of strategies. Pain intensity was associated strongly with concurrent activity interference and jaw use limitations. When the design controlled for pain intensity, activity reduction and seeking emotional support were associated positively within-subjects with interference and jaw use limitations. CONCLUSION: TMD clinic patients use a variety of treatment, self-care, and coping strategies to contend with daily pain. Inquiring about a broad range of strategies might help clinicians better understand how individual patients approach pain management. Research is needed to examine whether decreasing activity reduction and emotional support coping results in improved outcomes.

Activities of Daily Living↗

PubMed2005

Relationship of pain and symptoms to pubertal development in adolescents.

Temporomandibular disorder (TMD) pain, abdominal pain, migraine and tension-type headache are more prevalent in women than in men. This study assessed the relationship of back pain, headache, abdominal pain, TMD pain, and the presence of multiple pain conditions to gender and pubertal development in a cross-sectional, population-based survey of adolescents. We also examined the association between pubertal development and depressive and somatic symptoms, factors often associated with pain in adults. We hypothesized that prevalence of all pain conditions, as well as rates of other symptoms, would increase as puberty progresses in females, but not males. Subjects (3,101 boys and girls, 11-17 years old, selected from an HMO population) reported on the presence of each pain condition in the prior 3 months and completed scales assessing pubertal development, and depressive and somatic symptoms. Data were analyzed using descriptive statistics and multivariate logistic regression. Prevalence rates were weighted for factors affecting response. Prevalence of back pain, headache and TMD pain increased significantly (odds ratios, OR=1.4-2.0, P<0.001) and stomach pain increased marginally with increasing pubertal development in girls. Rates of somatization, depression and probability of experiencing multiple pains also increased with pubertal development in girls (P<0.0001). For boys, prevalence of back (OR=1.9, P<0.0001) and facial pain (OR=1.5, P<0.01) increased, stomach pain decreased somewhat and headache prevalence was virtually unchanged with increasing maturity. For both sexes, pubertal development was a better predictor of pain than was age. Thus it appears that pain, other somatic symptoms and depression increase systematically with pubertal development in girls.

Adolescent↗

PubMed2005

Reliability of clinical temporomandibular disorder diagnoses.

Temporomandibular disorders (TMD) diagnoses can be viewed as the most useful clinical summary for classifying subtypes of TMD. The Research Diagnostic Criteria for TMD (RDC/TMD) is the most widely used TMD diagnostic system for conducting clinical research. It has been translated into 18 languages and is used by a consortium of 45 RDC/TMD-based international researchers. While reliability of RDC/TMD signs and symptoms of TMD has been amply reported, the reliability of RDC/TMD diagnoses has not. The aim of the study was to determine the reliability of clinical TMD diagnoses using standardized methods and operational definitions contained in the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Data came from reliability assessment trials conducted at 10 international clinical centers, involving 30 clinical examiners assessing 230 subjects. Intraclass correlation coefficients (ICC) were calculated to characterize the reliability. The reliability of the diagnoses was fair to good. Median ICCs for the diagnoses myofascial pain with and without limited opening were 0.51 and 0.60, respectively. Median ICC for arthralgia was 0.47 and 0.61 for disc displacement with reduction. RDC/TMD diagnoses of disc displacement without reduction, osteoarthritis and osteoarthrosis were not prevalent enough to calculate ICC's, but percent agreement was always >95%. The reliability of diagnostic classification improved when diagnoses were grouped into pain versus non-pain diagnoses (ICC=0.72) and for detecting any diagnosis versus no diagnosis (ICC=0.78). In clinical decision-making and research, arriving at a reliable diagnosis is critical in establishing a clinical condition and a rational approach to treatment. The RDC/TMD demonstrates sufficiently high reliability for the most common TMD diagnoses, supporting its use in clinical research and decision making.

Algorithms↗

PubMed2005

Clinical effects of scaling and root planing on untreated teeth.

OBJECTIVE: The aim of this report is to examine whether scaling and root planing (SRP) in one area of the mouth may affect periodontal improvement in untreated areas in the same patient, possibly through systemic effects of treatment. MATERIAL AND METHODS: Twenty patients diagnosed with generalized aggressive periodontitis were randomized into treatment (n=11) and no treatment (n=9) groups. Within the treatment group, three quadrants were treated by SRP at week 0, 3, 12, and 24, while a single experimental quadrant remained untreated throughout the study. The outcome for all teeth was assessed using clinical parameters, subtraction radiography, and pathogenic bacteria levels in the subgingival flora over the 24-week study period. RESULTS: Compared with sites in no treatment patients, the treated sites in the treated patients showed a 1 mm decrease in probing depth (PD) (p<0.01) and a 0.5 mm increase in bone height (p<0.01) by 24 weeks. In untreated sites within treated subjects, however, PDs tended to improve (p=0.09) but at a reduced rate compared with treated sites. The levels of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythensis (Bacteroides forsythus) remained unchanged in untreated sites while levels of Prevetolla intermedia and Treponema denticola tended to decrease as compared with controls but did not reach significance. CONCLUSIONS: This study indicates that untreated sites in treated periodontitis patients show a trend towards clinical improvement and exhibit reductions in some but not all periodontopathic bacterial species tested.

Adolescent↗

PubMed2005

Group sequential testing in dental clinical trials with longitudinal data on multiple outcome variables.

In this article, methods are proposed for design and analysis of clinical trials that gather longitudinal data on multiple outcome variables. A valid test of the null hypothesis of no treatment group differences can be obtained for any choice of a working alternative hypothesis and a working covariance matrix for the outcome variables. Increased power can be achieved by accurate modeling of the true treatment effect and covariance structure. Implementation of the procedure is simple using existing software for generalized estimating equations. The procedure is an extension of the 'derived variable' technique (univariate analysis applied to a linear combination of the outcome variables) and also of O'Brien's generalized least squares test. The procedure is extended to allow sequential testing using an arbitrary division of the total type I error rate among repeated hypothesis tests. The methods are illustrated by the design of a study on the safety of dental amalgam fillings, which served as the motivation for the research.

Clinical Trials as Topic↗

PubMed2005

A three-year clinical evaluation of two-bottle versus one-bottle dentin adhesives.

BACKGROUND: The authors conducted an in vivo investigation to compare the clinical performance of two commercial one-bottle adhesives and a two-bottle adhesive for restoration of noncarious cervical lesions (NCCLs). METHOD: The patient pool consisted of 57 patients and 171 teeth (three teeth per patient), with one NCCL per tooth. Each patient received three resin-based composite restorations, each with a different adhesive: one tooth with a two-bottle, water-based adhesive as the control; another tooth with a one-bottle, ethanol-based adhesive; and a third tooth with a one-bottle, solvent-free adhesive. The authors assessed restorations in terms of retention, marginal integrity, margin discoloration and air sensitivity at baseline, six months, one year, two years and three years after initial placement. RESULTS: The retention rates at 36 months were 88 percent for the first adhesive, 81 percent for the second adhesive and 90 percent for the third adhesive. No statistically significant differences in retention rates could be shown, with 86 percent of restorations retained overall. Measures of marginal integrity, marginal discoloration and sensitivity also had no statistically significant differences between the three adhesives (P > .05). CONCLUSIONS: All three adhesives performed with acceptable outcomes after a 36-month period, with small differences between the one- and two-bottle systems and between the various solvents. Retention rate was moderately high and air sensitivity was markedly reduced; however, superficial marginal discoloration and marginal degradation was notable. Certain lesion, tooth and patient characteristics may predispose restorations to retention failure. CLINICAL IMPLICATIONS: The type of solvent may not be a major factor in retention of Class V restorations in NCCLs. Both single-bottle adhesives and conventional two-bottle adhesives performed acceptably.

Adhesives↗

PubMed2005

Cyclic effects on experimental pain response in women with temporomandibular disorders.

AIMS: Since cyclic effects on experimental pain response in women with temporomandibular disorders (TMD) have not been adequately studied, the aim of this study was to assess variations in experimental pain response at 4 phases of the menstrual cycle. METHODS: Eighteen normally cycling women with TMD, 25 women with TMD and taking oral contraceptives (OC), 25 normally cycling pain-free controls, and 26 pain-free controls taking OC underwent 3 experimental pain procedures at 4 phases during each of 3 menstrual cycles. These procedures included algometer palpations at fixed amounts of pressure and pressure pain thresholds at several body sites, and an ischemic arm pain task. Repeated measures analysis of variance was used to compare cycle phase, TMD group, and OC status differences in experimental pain response. RESULTS: Significant phase-related differences were seen for palpation intensity measures (P values < .05). Normally cycling women with TMD showed higher palpation pain intensity at menses and midluteal phases, while women with TMD taking OC showed stable palpation pain intensity ratings at menses, ovulatory, and midluteal phases, with increased intensity at the late luteal phase. TMD subjects had greater palpation pain and ischemic pain intensity and lower pressure pain thresholds compared to controls. CONCLUSION: Phase-related differences in experimental pain response were not strong and were more often found for experimental stimuli with greater clinical relevance (ie, palpation pain) compared with an ischemic pain task.

Adolescent↗

PubMed2005

Musculoskeletal orofacial pain and other signs and symptoms of temporomandibular disorders during pregnancy: a prospective study.

AIMS: To describe the course of reported musculoskeletal pain in the temporomandibular region and other signs and symptoms of temporomandibular disorders (TMD) as well as psychological distress over the course of pregnancy and 1 year postpartum. METHODS: Women with musculoskeletal orofacial pain (n = 19) and pain-free comparison subjects (n = 16) in the first trimester of pregnancy were selected through records review from the population of a large health maintenance organization. Subjects completed a self-administered questionnaire assessing pain, depression, and somatic symptoms; provided a sample of whole unstimulated saliva; and underwent a standardized clinical examination during the third, sixth, and ninth months of pregnancy and 1 year postpartum. RESULTS: At baseline (third month of pregnancy), 16 of the 19 patients with musculoskeletal orofacial pain met criteria for an RDC/TMD diagnosis. Reported musculoskeletal orofacial pain diminished significantly during the second or third trimester of pregnancy and increased again postpartum. Measures of mandibular opening increased over pregnancy in both cases and comparison subjects and remained high postpartum. Depression and somatic symptoms changed little over the course of pregnancy but were substantially lowered at 1 year postpartum for both groups. As expected, subjects with pain had higher levels of palpation pain, diminished mandibular range of motion, and higher levels of psychological distress compared to subjects without orofacial pain. CONCLUSION: Musculoskeletal orofacial pain and related symptoms appear to improve over the course of pregnancy. This improvement occurs in the presence of increased joint laxity and is not paralleled by improvements in psychological distress. Thus, it was concluded that the improvement in pain is most likely associated with the dramatic hormonal changes occurring during pregnancy.

Adult↗

PubMed2005

Relationship between overbite/overjet and clicking or crepitus of the temporomandibular joint.

AIMS: Since occlusal variables such as overbite and overjet have been thought to be associated with temporomandibular disorders (TMD), and joint sounds are some of the most prevalent signs of TMD, the aim of this study was to determine whether overbite and overjet are risk factors for temporomandibular joint (TMJ) sounds. METHODS: A population-based cross-sectional study of 3,033 subjects (age range, 10 to 75 years; 53% female) was conducted in Germany. Overbite/overjet, reproducible reciprocal clicking (RRC) during open-close jaw movements that did not occur in the protrusive jaw position, and joint crepitus were assessed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). RESULTS: When age and gender were controlled for, high or low values of overbite and overjet were not associated with a greater risk of RRC and crepitus as compared to a reference category of a normal overbite and overjet of 2 to 3 mm (multiple logistic regression; odds ratios 0.7 to 1.3; P > .05 for all). CONCLUSION: This study showed that higher or lower overbite or overjet jaw relationships, even extreme values, are not risk factors for TMJ sounds as assessed by clinical examination.

Adolescent↗

PubMed2004

Topical polyene antifungals in hematopoietic cell transplant patients: tolerability and efficacy.

PURPOSE: The effectiveness of amphotericin B oral suspension versus nystatin oral suspension for the prevention of oral colonization by Candida in hematopoietic cell transplant (HCT) patients was examined. METHODS: Prior to hematopoietic cell infusion, 40 patients receiving systemic fluconazole for prophylaxis were randomized to receive either amphotericin B oral suspension or nystatin oral suspension, q.i.d. The study continued to day 21 or until the patient was discharge from the hospital or withdrawn from the study. Oral examinations were conducted twice weekly, and adverse events and compliance were recorded. Cultures were taken for quantitative counts and species identification. Candida isolates were assessed for resistance to the oral antifungal agents. Blood was collected for assessment of amphotericin B levels. RESULTS AND DISCUSSION: Ulcerative mucositis occurred in 84.6% of patients undergoing HCT, and no correlation was observed between the severity of mucositis and the presence of oral Candida and the severity of mucositis. Systemic and topical antifungal treatment resulted in a decrease in the number of colonized patients (54.8% before treatment; 23.1% during treatment); however, oral colonization was not eliminated. Tolerability of the oral rinse products was limited, with greater noncompliance in the amphotericin B than the nystatin group. Reports of altered taste appeared to be greater in the amphotericin B group. Minimal absorption of amphotericin B was seen following oral rinsing (serum levels 0.12-0.50 microg/ml), and no consistent changes in organism susceptibility to polyenes were seen. The results suggest that topical antifungal rinses may further control oropharyngeal colonization by Candida in patients on systemic antifungals receiving HCT, but the effect is limited by tolerability and reformulation and should be considered in order to increase compliance.

Administration, Oral↗

PubMed2004

Periodontitis vaccine decreases local prostaglandin E2 levels in a primate model.

Interleukin-1beta, tumor necrosis factor alpha, prostaglandin E2 (PGE2), and Porphyromonas gingivalis-specific immunoglobulin G levels in gingival crevicular fluid were measured in primates immunized with a P. gingivalis vaccine followed by ligature-induced periodontitis. Only PGE2 levels were dramatically suppressed (P < 0.0001) in immunized animals versus controls. A significant correlation (P < 0.027) was also found between PGE2 levels and decreased bone loss scores. This study presents the first evidence of a potential mechanism involved in periodontitis vaccine-induced suppression of bone loss in a nonhuman primate model and offers insight into the role of PGE2 in periodontal destruction.

Animals↗

PubMed2003

Assessing periodontal disease risk: a comparison of clinicians' assessment versus a computerized tool.

BACKGROUND: The authors conducted a study to compare risk scores assigned by subjective expert clinician opinion with quantitative scores generated for the same subjects using the Periodontal Risk Calculator, or PRC. METHODS: The authors assembled a group of 107 subjects and performed standard periodontal examinations. The authors entered the resulting information into the PRC and calculated risk scores for two and four years, assuming no treatment would be performed. Using the same subject records, three groups of expert clinicians assigned risk scores for years 2 and 4. The authors analyzed the data to reveal the extent of interevaluator variation and the level of agreement between expert clinician scores and PRC scores. RESULTS: The extent of variation among scores assigned by individual expert clinicians was greater than the authors had expected. Expert clinicians consistently assigned more subjects to PRC risk group 2 and fewer to risk group 5 than did the PRC. The authors observed very high heterogeneity in the risk scores expert clinicians assigned to patients in each of the PRC-assigned groups. Thus, expert clinicians varied greatly in evaluating risk and, relative to the PRC, they appeared to underestimate periodontitis risk, especially for high-risk patients. CONCLUSIONS AND PRACTICE IMPLICATIONS: The authors' observations suggest that use of risk scores generated for individual patients by subjective expert clinician opinion about risk in periodontal clinical decision making could result in the misapplication of treatment for some patients and support the use of an objective tool such as the PRC. Use of the PRC over time may be expected to result in more uniform and accurate periodontal clinical decision making, improved oral health, reduction in the need for complex therapy and reduction in health care costs.

Adult↗

PubMed2002

Serum IgG to heat shock proteins and Porphyromonas gingivalis antigens in diabetic patients with periodontitis.

BACKGROUND: Past studies have reported a correlation between the presence and severity of periodontitis and serum antibody titers to species-specific antigens of Porphyromonas gingivalis or to cross-reactive antigens, such as lipopolysaccharide (LPS) and heat shock proteins (HSP), shared between P. gingivalis and other bacteria. Our recent study of periodontal treatment outcome in insulin-dependent (type 1) diabetes mellitus patients with severe periodontitis (IDDMI/periodontitis) resulted in two key findings: 1. serum glutamic acid decarboxylase autoantibody (GAD65 Ab) levels were significantly associated with periodontal pocket depth change (PDC) and 2. serum IgG titers to P. gingivalis cells were positively associated with GAD65 Ab level in seropositive (GAD65 Ab +) patients. We have therefore hypothesized that profiles of serum autoantibody levels and IgG titers, to P. gingivalis-specific antigens may be useful in assessing risk for refractory periodontitis in such patients. AIM: To determine whether PDC resulting from non-surgical periodontal treatment can be predicted using profiles of baseline IgG titers to P. gingivalis-specific antigens, human HSP, and GAD65. METHODS: PDC was assessed two months after non-surgical periodontal treatment of 7 GAD65 Ab + and 11 GAD65 AbIDDM/periodontitis patients. Pretreatment titers to GAD65, recombinant human heat shock proteins (HSP90, HSP70, and HSP60), and various P. gingivalis antigens were measured using radioligand precipitation or enzyme-linked immunosorbent (ELISA) assays and compared to the same measurements for 154 recent-onset IDDM patients and 46 non-diabetic controls. RESULTS: Median titers (ELISA units) to HSP90 and HSP70 were significantly higher than non-diabetic controls for GAD65 Ab + (p degrees = 0.002) and GAD65 Ab- (p = 0.034) IDDM/periodontitis patients, respectively. Multivariate regression analysis indicated significant partial correlation of PDC with log-transformed titers to HSP90 (r = - 0.62, p = 0.008), HSP70 (r = + 0.62, p = 0.009), GAD65 (r = - 0.60, p = 0.01) and P. gingivalis LPS (r = - 0.5 1, p = 0.04). Furthermore, hierarchical clustering of baseline profiles of log-transformed HSP90, HSP70, and GAD65 Ab titers sorted patients into two distinct clusters with significantly different median PDC (1.45 min, n = 10 vs. 0.65 min, n = 8; p = 0.016, Mann-Whitney). CONCLUSION: Pretreatment profiles of serum antibody titers to HSP90, HSP70, GAD65, and P. gingivalis LPS may be useful for predicting which patients with IDDM/periodontitis will have a poor response to non-surgical periodontal therapy.

Antibodies, Bacterial↗

PubMedDate not supplied

The relationship of somatization and depression to experimental pain response in women with temporomandibular disorders.

OBJECTIVE: Patients with temporomandibular pain disorders (TMD) have greater experimental pain perception when compared with pain-free controls. Common psychological features of TMD include somatization and depression. The impact of depression on experimental pain perception has received considerable attention. However, the role of somatization on experimental pain in a chronic pain population has not been explored. METHODS: Fifty-six women with TMD and 59 pain-free controls underwent three experimental pain procedures, including palpation at fixed amounts of pressure, pressure pain thresholds, and an ischemic pain task. Levels of depression and somatization were assessed using the Research Diagnostic Criteria for TMD. Multiple regression analyses were performed to determine the extent to which depression and somatization were associated with experimental pain response. RESULTS: After controlling for characteristic pain intensity and depression, somatization explained a significant proportion of variance in numbers of masticatory sites rated as painful (R2 change = 6.7%, p = .046) with the full model explaining 16.4% of the variance (p = .024). This did not meet an adjusted level of statistical significance (p = .008). After controlling for characteristic pain, only depression added significantly to the model predicting ischemic pain threshold and tolerance. The full models including characteristic pain and depression explained 49% and 20% of the variance in ischemic pain threshold and tolerance, respectively. CONCLUSIONS: These findings suggest that depression and somatization are associated with different measures of experimental pain. Somatization may be related to more attentional and perceptual measures of clinically relevant pain while depression may be related to more behavioral measures of pain.

Adolescent↗