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Biomedical subjects

P A Steed

Publications and source records attributed to P A Steed.

9 recordsLinked to original sources
PubMed2001

Temporomandibular disorders--traumatic etiology vs. nontraumatic etiology: a clinical and methodological inquiry into symptomatology and treatment outcomes.

The purpose of this research is to investigate the distinctions relating to Presenting Symptoms and Treatment Outcomes between patients suffering temporomandibular disorder (TMD) as a result of traumatic versus nontraumatic etiology. A geographically diverse cohort of 1,842 patients diagnosed with TMD was investigated with special emphasis placed on the following criteria: 1. The distribution of demographic and symptom characteristics of patients with trauma as an immediate precipitating factor versus those with other nontraumatic etiologies; 2. The relationship between nontrauma status and treatment outcomes; 3. The interrelationships between nontrauma status, psychosocial factors, and treatment outcomes. Trauma patients tended to be younger, less educated, and more likely to be male than the nontrauma patients. For this group the reported length of the TMD problem was, as expected, of shorter duration when compared to the nontrauma patient group. Length of treatment did not differ between the two groups. In comparison, trauma patients reported higher initial overall symptoms including pain and range of motion limitations. However, symptoms related to joint dysfunction did not vary appreciably. Treatment outcomes are complicated by the fact that TMD encompasses several different diagnostic entities. Trauma patients reported significantly higher percentages of improvement in palpation pain and perceived malocclusion. No significant differences were found for pain report, joint dysfunction, stress, and overall TMD symptomatology, as measured by the TMJ Scale's Global domain. Trauma patients manifested higher psychological dysfunction levels (excepting stress) and showed significantly more improvement in both psychosocial function and stress than the nontrauma group.

Adult↗
PubMed1998

Psychological factors and temporomandibular outcomes.

This study examines the effect of psychological dysfunction as an etiological factor in temporomandibular disorder (TMD). It employs a thoroughly validated psychometric measurement system, the TMJ Scale (Pain Resource Center, Inc., Durham, North Carolina), to determine the effects of pretreatment stress and psychological dysfunction upon presenting symptom levels. The study also addresses these parameters for the eventual treatment outcome. During the course of this study, 2,074 patients were evaluated. Seven hundred and fifty-four by Dr. Steed and 1,320 by Dr. Wexler. Both practices address essentially identical patient populations and focus special interest in craniofacial pain and the diagnosis and Phase I treatment of temporomandibular dysfunction. Of the patients in the study who were found to have clinically treatable temporomandibular disorders, 561 consecutive patients completed treatment and were deemed to have reached Maximum Medical Improvement (MMI). The TMJ Scale was re-administered to this post-treatment population. This study summarized findings pertinent to the four primary issues: 1. pre-treatment psychological factors and stress, which seem to be moderately related to presenting pain levels and overall TMD levels (excepting joint function); 2. treatment outcomes which appeared to be unrelated to the initial psychosocial symptom severity; 3. physical symptoms outcomes and psychosocial outcomes which appeared to be significantly related and; 4. intracapsular symptom improvement which appeared to be unrelated to psychological functioning changes but mildly related to stress.

Adult↗
PubMed1998

TMD treatment outcomes: a statistical assessment of the effects of psychological variables.

This study analyzes the degree to which pretreatment psychosocial factors (psychological dysfunctions and stress) effect outcome in 269 consecutive temporomandibular disorder (TMD) patients at the completion of treatment. Employing the TMJ Scale, a validated measure of TMD symptoms, it is found that pretreatment TMD pain and overall symptom levels (excluding internal derangement symptoms) are weakly but nevertheless, significantly related to pretreatment psychological dysfunction and stress. However, the latter appeared totally unrelated to four treatment outcome measures. Additionally, the data supports the hypothesis that both initial and post-treatment intrascapular symptoms (TMJ Scale, Joint Dysfunction sub-scale) are unrelated to psychosocial factors. Data from this study call into question the value of categorizing the TMD patients by means of psychosocial "profiling" and "dual-axis" classification methods proposed by some researchers.

Adult↗
PubMed1991

The utilization of contact liquid crystal thermography in the evaluation of temporomandibular dysfunction.

A previously diagnosed patient population of 109 volunteers having temporomandibular dysfunction agreed to undergo pretreatment and post-treatment thermographic examination. In 1988, at the time of this study, a contact liquid crystal thermographic unit was utilized in accordance with the protocol advocated by the Academy of Neuro-Muscular Thermography. The examination consisted of pretreatment and post-treatment thermograms repeated in a series of three sets, i.e., in triplicate, incorporating four different views per set, namely, frontal face, right lateral face, left lateral face, and posterior cervical. This study revealed that the application of contact liquid thermography in the evaluation of temporomandibular dysfunction was a reliable, valid, and efficacious diagnostic tool in approximately 95% of the cases. Resolution of thermographic asymmetry and/or decrease in Delta T was demonstrated in approximately 81% of the post-treatment population. Thermography also proved to be a reliable indicator of pretreatment duration of dysfunction (chronicity pattern) in approximately 78% of the cases.

Adolescent↗
PubMedDate not supplied

Clinical application of psychometric analysis for temporomandibular dysfunction.

The proper diagnostic modalities needed for detecting a temporomandibular dysfunction should include testing procedures from three distinct arenas of data. Those encompass anatomic diagnostic imaging, physiologic testing and psychometric analysis. This article addresses the clinical pretreatment uses and benefits, as well as the post treatment application of a specific psychometric analysis, the TMJ Scale. Additionally, medical-legal issues and case studies are provided.

Adolescent↗
PubMedDate not supplied

Facial asymmetry: recognition of TMD.

For many years researchers and clinicians have been aware of the varying presenting signs and symptoms common in the TMD patient. The symptom-complex frequently includes preauricular pain; cephalgia (predominantly frontal, temporal, occipital, vertex, retro- and periorbital); cervicalgia (immobility/stiffness); otalgia (congestion, vertigo, tinnitus). The most prominent signs are those of joint sounds (popping, click and crepitus due to disc displacement with reduction and/or osseous breakdown); restricted mandibular excursion (disc displacement without reduction); and mandibular deviation/deflection (disc(s) displacement).

Adult↗
PubMedDate not supplied

Etiological factors and temporomandibular treatment outcomes: the effects of trauma and psychological dysfunction.

This paper examines the effect of trauma and psychological dysfunction as etiological factors in temporomandibular disorder (TMD). It employs a thoroughly validated measurement system, the TMJ Scale, to determine the effects of traumatic temporomandibular joint injury as well as pre-treatment stress and psychological dysfunction levels upon presenting symptom levels. It also addresses these parameters for the eventual treatment outcome. During the course of the study, 754 patients were evaluated at the author's practice, which is limited to the diagnosis and Phase I treatment of temporomandibular dysfunction. Of those individuals, 693 (91.9%) were found to have clinically treatable temporomandibular disorders. At the time of this study, 201 consecutive patients (29%) have completed treatment and were deemed to have reached Maximum Medical Improvement (MMI). The validated measurement system of the TMJ Scale was readministered to this post treatment population. Data analysis revealed that trauma patients did not differ from non-trauma patients in initial symptom levels, nor in levels of symptom improvement (with the exception of a higher palpation pain level reported by the trauma patients). Stress and psychological dysfunction were predictive of higher initial symptom perception levels, but were not significantly related to treatment outcomes. These findings have important implications for practitioners in the field of temporomandibular studies. If it can be confirmed that psychological variables have no impact on treatment outcome, it would be difficult to justify the now frequently employed "dual axis" classifications and major emphasis placed on psychological treatment for temporomandibular patients.

Adult↗