Biomedical subjects
Publications and source records attributed to S E Mohamed.
Temporomandibular (TM) disorders among children are uncommon. Their many etiologies include interferences with the formative process, malocclusion, and muscle disharmony. Facial pain, earache, headache, difficulty with chewing, and joint noise during mandibular function are symptoms. The two year course of a TM disorder that first became symptomatic in a six month old child is described.
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An overview is presented of the mandibular reference positions of centric occlusion, centric relation and centric relation occlusion, and the position of rest. Clinical applications of the different positions are discussed on the basis of the physiology of the mandibular locomotor system.
Three human subjects performed teeth clenching at maximum voluntary contraction strength (MVC) of the mandibular elevator muscles. At intervals of 10s, ten successive bouts of MVC clenching were exercised until total exhaustion of the contracting muscles (isometric endurance). Isometric endurance time decreased exponentially from 59 to 12s. The curve of the decrease showed a monotone power function (y = x-1). Electromyographic recordings from masseter muscles suggested that fatigable motor units, possibly fast glycolytic units, dropped out during the initial stages of maintained MVC isometric activity. The silent period of the monosynaptic jaw jerk reflex was increased by about 35% following exhaustion of the masseter muscle.
Six adult males performed tooth clenching for 10 and 80 s at maximum voluntary contraction strength (MVC). Motor activity in the right and left masseter muscles was monitored by surface electromyography. Local temperatures of both cheeks were monitored by a thermocouple. MVC activity for 80 s induced pain and fatigue in both muscles; 10 s of clenching caused no muscle discomfort. Ice, subsequently applied to the right cheek for 30 min, lowered the temperature of the cheek and masseter muscle. The isometric MVC exercises were then repeated. During 10 s of isometric contraction, MVC motor activity in the cooled masseter muscle was significantly increased by 29 per cent; that of the non-cooled contralateral muscle was insignificantly reduced by 12 per cent. During 80 s of clenching, MVC motor activity in the cooled muscle was significantly increased by 30 per cent; that of the non-cooled muscle was insignificantly reduced by 4 per cent. MVC activity for 80 s by the cooled muscle caused no pain and fatigue, but the discomforts continued in the non-cooled muscle. Increased MVC alpha motor activity in the cooled masseter muscle might have resulted from motor facilitation that was mediated by cutaneous, muscular or mucosal cold receptors, or it might have been due to the absence of pain and fatigue.
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Six human subjects exercised maximum voluntary tooth clenching and right-sided tooth grinding to determine the onset of fatigue in the right and left masseter muscle. Static and dynamic contractile activity of the two muscles was determined by surface electromyography. Muscle fatigue appeared after about 30 s of isometric contractions (clenching), while 30 s of combined concentric and eccentric contractions (grinding) induced no fatigue. In the right muscle the contractile activity of negative work (eccentric contractions of mandibular laterotrusion) was about 50% of that of positive work (concentric contractions of mandibular mediotrusion). During clenching an increased number of contacting teeth might have facilitated the contractile activity of the two muscles. During grinding the height of the cusps of the working side teeth might have contributed to a decrease of tension production by the right masseter muscle. Non-working side tooth contacts and peripheral receptors might have facilitated the contractile activity of the left masseter muscle during tooth grinding. Static contractile activity of the mandibular elevator muscles produced high levels of isometric tension and led to masseter muscle fatigue in about 30 s. The same duration of dynamic contractile activity, resulting in low levels of tension during positive and negative work, did not induce fatigue.
An evaluation was made of the effects of the application of an increasing number of coats of cyanoacrylate on die stone. The application of one coat of cyanoacrylate adhesive on the surface of trimmed and marked dies increases the surface hardness, increases the scratch resistance, will not change the dimensions of the die appreciably, and renders the margin marking more permanent. Excess resin should be removed immediately by compressed air. The use of hardener instead of water is recommended for mixing Type IV dental stone. Use of the cyanoacrylate method will aid the dentist and the technician in achieving an accurate crown fit.
The pattern of molar and canine contacts and the contractile activity of the masseter and anterior temporal muscle were studied, through integrated electromyography, during right-sided mastication of banana and apple in ten healthy male subjects. Tooth contacts occurred on both the chewing and the non-chewing side. This study does not support the clinical concept that non-chewing side contacts are necessarily detrimental to the jaw muscles and the temporomandibular joints. The activity of the elevator jaw muscles and the tooth contact patterns suggest that the mandible tilted around a sagittal axis, and rotated around a vertical axis, during the phase of elevation of a masticatory cycle.
Eight human subjects exercised maximum voluntary tooth clenching until there was complete exhaustion of the contracting jaw muscles (isometric endurance time). During the isometric muscle contractions the myoelectrical currents of the masseter and anterior temporalis muscle were sampled by bipolar surface electrodes, integrated, and cumulatively stored. The myoelectrical activity was studied at recording thresholds of 1 microV and 40 microV, i.e. all action potentials below threshold level were ignored. The observations suggested that the number of fast glycolytic and fast oxidative glycolytic motor units in the masseter muscle might have exceeded that in the anterior temporalis muscle; and/or the size of the masseter muscle units might have been larger than that of the anterior temporalis muscle units.
At 100% and about 50% of maximum voluntary isometric contraction strength of the masseter muscle, six healthy human subjects exercised tooth clenching until there was onset of muscle pain in 42 and 146 sec, respectively. Onset of pain, at maximum contraction strength, might have been due to the cumulative amount of activity in relatively large motor units. The delayed onset of pain might have been associated with a decline in the quantity and quality of contracting large motor units. The Clinical implications of this study suggest that an increase of the vertical dimension of the face will delay the onset of muscle pain in patients suffering from tooth clenching.
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This study showed that only a small percentage of students continued to use or prescribe articulators after beginning their practices. Yet many restorative teaching programs have utilized semiadjustable articulators with the intent to stimulate a continued use of the instrument in practice. Perhaps the emphasis of instruction should not be placed upon a certain type of articulator for all restorative dentistry but instead upon the selection of an articulator dependent upon the degree of difficulty encountered with each patient. For example, a simple articulator may be used for simple treatment such as a single full gold crown in an otherwise healthy mouth with physiologic occlusion. This does not obviate the need for properly related master and opposing full-arch casts of high quality. Also, instruction is required which will assure that the new crown does not introduce occlusal interferences in centric relation, the intercuspal position, or laterotrusive and mediotrusive excursions. Emphasis should be taken away from teaching use of only one instrument. It should instead be directed toward an understanding of the basic principles of occlusion, cultivating an ability to differentiate the complexity of treatment, and then selecting an instrument which will provide the most practical and suitable result. An effort should be made to compensate for the instrument's limitations by careful clinical examination and correction.
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