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Biomedical subjects

N D Mohl

Publications and source records attributed to N D Mohl.

At least 19 recordsLinked to original sources
PubMed1992

The dilemma of scientific knowledge versus clinical management of temporomandibular disorders.

The dilemma of scientific knowledge versus clinical management of TMD is discussed by focus on five questions; (1) What is scientific evidence and how is it transmitted? (2) What important evidence is lacking in the field of TMD? (3) What clinical concepts have been challenged by the scientific evidence? (4) Why is there adherence to concepts that appear to conflict with the evidence? (5) How does the clinician provide patient care in the face of uncertainty while retaining scientific integrity? It is concluded that no fundamental reason for a dilemma between scientific evidence and clinical practice need exist provided that (1) clinical investigators use appropriate research protocols and report results in refereed scientific journals and (2) dentists are familiar with the requirements of sound scientific evidence, interpret this evidence and its clinical implications, and apply it to the care of TMD patients.

Diffusion of Innovation↗
PubMed1992

Restoration of the vertical dimension of occlusion in the severely worn dentition.

The guidelines presented in this article for diagnosis and treatment of extreme tooth wear are not meant to be all inclusive. Every patient has unique treatment needs, and all of these needs may not be addressed specifically in this article. We believe, however, that careful adherence to the guidelines presented should facilitate a successful treatment of most if not all patients with moderate or severe tooth wear. The general guidelines for treatment of these patients include the following: 1. A comprehensive examination, including a thorough medical and dental history, orofacial and dental clinical examination, dental radiographs, TMD screening history and examination, impressions and jaw relation records for mounting casts in a semi-adjustable articulator, 2. A diagnostic wax-up and diagnostic occlusal adjustment on additional or duplicated mounted casts, 3. Careful planning and consultation regarding the need for preparatory treatment. Careful integration and sequencing of the different areas of treatment needed to enhance the finished result, 4. Discussion with the patient of the different treatment alternatives and sequences possible for his or her individual case, with presentation of advantages and disadvantages and prognosis for each, 5. Finally, careful execution of the agreed upon treatment plan by the dentist. Although not specifically mentioned, treatment success requires a highly motivated patient and skilled dental laboratory technicians. These "treatment partners" should be included in the planning stages of treatment as early as possible to enhance the possibility of having a successful treatment result.

Dental Occlusion, Traumatic↗
PubMed1992

Clinical decision making for temporomandibular disorders.

Temporomandibular Disorders (TMD) encompass a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ), or both. In any given patient, there exists the possibility of several overlapping TM disorders, an orofacial pain condition mimicking a TMD, or a concomitant TMD and non-TMD disorder. Since differential diagnosis involves the determination of which diseases or disorders a patient is suffering from by systematically contrasting the clinical characteristics, differentiation from among multiple possible conditions complicates the diagnostic process, which often must be approached with a certain degree of uncertainty. In addition, the therapeutic decisions that emanate from the diagnostic process have their own predictive uncertainties. These uncertainties can be ameliorated by coupling available clinical research data with structured clinical problem solving methods during the diagnostic-therapeutic decision making process. It is within this context that this article includes a discussion of the rationale for why the clinician should use decision making methods for TMD, a review of previous attempts at developing decision models for TMD, a discussion of the diagnosis of TMD with particular emphasis on the reliability and validity of their diagnostic criteria, a summary of the efficacy of therapeutic modalities and their application to treatment decisions, a sample decision tree analysis of a TM disorder, and some general recommendations for dental education.

Decision Making↗
PubMed1991

Variability of closest speaking space compared with interocclusal distance in dentulous subjects.

Variability of closest speaking space was compared with that of interocclusal distance in 30 dentulous subjects to the nearest 0.1 mm on the screen of a mandibular kinesiograph. Postural rest position was elicited by the subjects saying /M/ and relaxing the jaw. Closest speaking space was defined as the vertical difference in the position of the mandible from the immediate end of rapid counting from 60 to 66 to centric occlusion. The two variables were measured in random order 20 times each. The subjects were examined for two data collecting sessions. The variance of the closest speaking space was smaller than the variance for interocclusal distance for 26 of 30 subjects. The difference between the mean variances was statistically significant, p greater than 0.1 (t 3 and t 3.41, df 29).

Centric Relation↗
PubMed1991

Relationship of occlusal vertical dimension to the health of the masticatory system.

Changes in occlusal vertical dimension have been claimed to cause masticatory system disorders. Early articles on this subject were mainly limited to clinical case reports, and the more recent clinical studies have been flawed by the lack of control groups, blind evaluation, and by poor definition of criteria for evaluating the health of the masticatory system. Research with humans and animals has shown that if increases in occlusal vertical dimension are not extreme and the appliance used covers most of the dentition, there is a good possibility of adaptation. Current scientific knowledge does not support the hypothesis that moderate changes in occlusal vertical dimension are detrimental to the masticatory system.

Animals↗
PubMed1991

Electronic technology for clinical prosthodontics.

A review of the literature on electrodiagnostic devices indicates that current studies have not substantiated claims regarding the utility of these devices in clinical dentistry. Research design problems, such as inadequate control subjects and use of inappropriate statistical tests, limit the conclusions that can be drawn from the results of these studies. Further research, including measurements of sensitivity and specificity, is needed in order to indicate the diagnostic utility of jaw tracking or electromyography in clinical dentistry.

Diagnosis, Oral↗
PubMed1991

Evaluation of temporomandibular joint sounds. Diagnostic analysis and clinical implications.

This literature review and survey highlights the controversies surrounding the significance of joint sounds in general, the problems and pitfalls of joint sound analysis and interpretation, and the degree of importance given peripheral and temporomandibular joint sounds by physicians and dentists. The instrumentation and devices currently proposed for use in the detection and interpretation of joint sounds may not meet the standards of validity, reliability, sensitivity, and specificity, and as pointed out by one investigator, "The only objectivity currently associated with these instruments is their ability to record sounds of undetermined origin." In addition, no solid evidence is available that these particular sounds, when detected, are both repeatable over time and distinctly characteristic for particular disorders or significant pathologic changes. Some degree of caution should be used, therefore, when interpreting joint sounds in the absence of significant signs and symptoms of temporomandibular disorders. The clinical significance of these same sounds may become more or less apparent relative to the information obtained in a comprehensive temporomandibular disorder evaluation and examination including both subjective and objective pain assessments, mandibular range of motion measurements, and the interpretation of radiologic findings.

Humans↗
PubMed1990

Devices for the diagnosis and treatment of temporomandibular disorders. Part I: Introduction, scientific evidence, and jaw tracking.

This three-part series of articles summarizes the uses of several devices or groups of devices intended for the diagnosis or treatment of temporomandibular disorders (TMD) and compares their claimed clinical usefulness with the present scientific evidence. Part I of this review defines TMD; discusses the principal criteria for evaluating published scientific clinical evidence such as reliability, validity, sensitivity, and specificity; gives a rationale for the clinical "gold standard" against which diagnostic and therapeutic devices must be compared; and evaluates the status of jaw tracking for the diagnosis of TMD. This review and evaluation led to the conclusion that, at the present time, the claim that jaw-tracking devices have a diagnostic value for TMD is not well supported by the scientific evidence.

Evaluation Studies as Topic↗
PubMed1990

Devices for the diagnosis and treatment of temporomandibular disorders. Part II: Electromyography and sonography.

This second article in the three-part series on temporomandibular disorder (TMD) devices compares the claimed diagnostic usefulness of electromyography and sonography with the present scientific evidence. This review concludes that there is no evidence to support the use of either surface electromyography or silent period duration for the evaluation or diagnosis of TMD. Furthermore, in view of the available evidence, sonography and Doppler ultrasound have no particular advantage over a conventional stethoscope or direct auscultation.

Auscultation↗
PubMed1990

Devices for the diagnosis and treatment of temporomandibular disorders. Part III: Thermography, ultrasound, electrical stimulation, and electromyographic biofeedback.

This last article in the three-part series on devices for the diagnosis and treatment of temporomandibular disorders (TMD) compared the claimed diagnostic usefulness of thermography with the present scientific evidence. In a similar manner, the therapeutic efficacy of ultrasound, electrical stimulation, and electromyographic biofeedback was also reviewed. This evaluation concluded that the application of thermography to the diagnosis of TMD is limited by variations within and among subjects and by intrinsic problems with controls of the test environment. It also concluded that evidence that therapeutic ultrasound alone is useful for the treatment of TMD is lacking, that positive clinical results of electrical stimulation may not be due to specific therapeutic effects, and that it is doubtful that the use of electrical stimulation devices can produce a position of the mandible that has any diagnostic or therapeutic significance. There is evidence, however, that relaxation training, assisted by EMG biofeedback, can reduce daytime muscle activity.

Biofeedback, Psychology↗