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Biomedical subjects

M W McKinney

Publications and source records attributed to M W McKinney.

17 recordsLinked to original sources
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↗
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↗
PubMed1994

Appropriate use of predictive values in clinical decision making and evaluating diagnostic tests for TMD.

Temporomandibular disorder literature contains serious misunderstandings and misapplications of statistical concepts, including predictive values, in evaluating diagnostic modalities and in clinical decision making. The use of general population prevalence data for temporomandibular disorders to evaluate positive predictive values of diagnostic modalities is shown to be invalid. The positive predictive value of a diagnostic tool should not be used to evaluate the efficacy of the tool or to confirm the presence of temporomandibular disorders when the pretest likelihood of temporomandibular disorder is low (eg, 10%). In such a situation, the TMJ Scale's negative predictive value of 98% supports the dentist's clinical impression of the absence of temporomandibular disorders. When the pretest likelihood of TMD is high (eg, 90%), the TMJ Scale's positive predictive value of 97% supports the dentist's clinical impression of the presence of temporomandibular disorders. The predictive values of the subscales of the TMJ Scale that measure joint dysfunction and stress may be used to further refine the diagnostic impression. When the dentist is unsure of the presence of TMD and makes a pretest estimate of 50%, the TMJ Scale's positive predictive value of 81% and negative predictive value of 83% substantially improve the accuracy of clinical decisions.

Decision Support Techniques↗
PubMed1994

Validating the TMJ scale in a national sample of 10,000 patients: demographic and epidemiologic characteristics.

The accuracy and reliability of the TMJ Scale were originally determined in cross-validation studies on large, research-based patient samples. It had been assumed that the demographic characteristics and test responses of these research-based samples would be representative of the clinical population in which the TMJ Scale would ultimately find use. The present study on more than 10,000 patients that were evaluated for temporomandibular disorders in clinical practice demonstrates that the test scores, demographic variables, and the patterns of symptom severity that characterize the original TMJ Scale research sample accurately represent the general temporomandibular disorder patient population in which the TMJ Scale is now being used. The results suggest a high degree of confidence in the clinical efficacy of this assessment tool. The overall symptom severity of temporomandibular disorders was found to be normally distributed in the patient population. Women with temporomandibular disorders report a higher level of severity of all physical and psychological symptoms than men. This may explain the high female-to-male ratio in patients seeking treatment. However, a higher percentage of male temporomandibular disorder patients has clinically significant psychological and stress-related problems than do women. The severity and prevalence of symptoms associated with joint dysfunction and range of motion limitation are lower in older age groups, and the overall symptom severity of temporomandibular disorders is not higher in older age groups. However, the severity and prevalence of symptoms associated with joint dysfunction are greater in groups in which temporomandibular disorders have existed for longer durations, although pain levels do not follow this trend. There is also an association between time duration of the temporomandibular disorder and the severity of psychological problems and chronicity. Patients with chronic problems are symptomatically more impaired than those with acute problems.

Acute Disease↗
PubMed1993

Measuring the impact of a dental practice on TM disorder symptoms.

This article describes a practical, quantitative method of measuring changes in temporomandibular disorder (TMD) symptoms in a dental practice. It applies the TMJ Scale to produce a number of clinically important measures of treatment effectiveness. Those measures include pre- and post-treatment symptom severity, percent of patients improved, level of improvement, and percent of patients converting to non-symptomatic after treatment. All of these outcome parameters were applied to a sample of the practice and to subgroups based on age, sex and problem length. The treated patients were compared to a group of diagnosed but untreated patients. The specific target symptoms of TMD are analyzed including pain, palpation pain, joint dysfunction and limited range of motion of the mandible. In addition, the overall symptom severity of the TM disorder, psychological factors and stress are studied, leading to an assessment of symptom change. The results support the concept that patients with acute problems are more treatment responsive than are patients with chronic problems. This suggests that careful screening and earlier detection of TMD may have an important impact on ultimate treatment outcome.

Adolescent↗
PubMed1993

Cloning of a DNA sequence unique to Clostridium botulinum group I by selective hybridization.

Nucleic acid sequences were isolated from a strain of Clostridium botulinum type A by a selective hybridization method known as deletion enrichment. Nontoxigenic C. sporogenes was used to produce a C. botulinum type A sequence-enriched library. A probe, pCBM44, which showed specific hybridization to a 4.0-kb HindIII fragment present in all of the C. botulinum type A strains tested was isolated, and there was no hybridization to any strains of C. sporogenes. Upon further investigation, pCBM44 was found to hybridize to all of the group I proteolytic C. botulinum strains tested (toxin types A, B, and F) but not to hybridize to groups II, III, and IV (toxin types B, C, D, or E). The probe did not cross-react with nine other Clostridium spp. Such a probe, which differentiates between nontoxigenic C. sporogenes and neurotoxigenic C. botulinum group I strains, should prove extremely useful.

Botulinum Toxins↗
PubMed1992

Temporomandibular-related pressure thresholds: a model for establishing baselines.

The use of pressure threshold measurement to quantify tender spots and trigger points in muscles is well established. Its application to the field of temporomandibular disorders, however, has been more recent and less widely published. Pressure threshold measurement may be useful to define values for dysfunctional muscles or structures so that changes in muscle condition through a course of treatment can be quantified. Normal values for many muscles in the body have been established, but studies of this type in the masticatory system are limited and have often used a fixed, pre-determined pressure cutoff, rather than measuring thresholds across a number of patients. This pilot study seeks to determine whether normal values exist for the anterior temporalis muscles, the masseter muscles, and the lateral capsules of the temporomandibular joints. Intrarater and interrater reliability in measuring thresholds was also studied with the aim of contributing toward a methodological model for further study.

Adolescent↗
PubMed1990

Chronic TM disorder and non-TM disorder pain: a comparison of behavioral and psychological characteristics.

The purpose of this paper is to determine whether patients with chronic temporomandibular disorder (TMD) pain manifest behavioral, experimental, and psychological characteristics similar to patients with other chronic pain illnesses. The Chronic Pain Battery (CPB), a multidimensional assessment tool for chronic pain patients, was used to compare several important variables between 78 TM disorder (TMD) patients and 98 non-TMD chronic pain patients. The study found that chronic TMD patients had lower "usual" pain intensity and suffering levels, fewer vegetative symptoms associated with depression, higher pain tolerance, less impairment of activity, more hope about treatment outcome, lower health care system utilization, but higher reported stress levels than non-TMD chronic pain patients. The two groups manifested no significant differences in use of narcotics, sedatives, and sleeping pills; levels of depression, anxiety, somatization, hostility, or psychoticism; illness behavior reinforcement in their social surroundings; or ratings of problems with work, family, self-esteem, or suicidal impulses. These findings suggest that chronic TMD pain patients (with a symptom duration of over six months) are behaviorally and psychologically similar to non-TMD chronic pain patients, but that they differ in their perceptions of their disorder, rendering them less handicapped by their problems. Psychological, social, and behavioral treatment methods useful for treating chronic pain syndrome may thus also be applied along with dental therapy for optimal treatment of TMD associated with chronic pain.

Adult↗
PubMed1990

TMD symptomology among denture patients.

The relationship between denture wearing and symptoms of temporomandibular disorder (TMD) was assessed with a psychometric test specifically developed to measure TMD symptoms. The subjects were 278 denture patients and 36 elderly patients with a diagnosed TMD. Denture wearers were found to have a higher prevalence of TMD symptoms than the normal population, but the average level of symptoms was of low intensity and not clinically significant. Denture wearers reported fewer TMD symptoms and less stress and psychological distress than TMD patients. Responses to test items assessing perceived malocclusion apparently were not affected by denture wearing.

Adolescent↗