[Nocturnal bruxism with severe facial and neck pain].
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Biomedical subjects
Publications and source records attributed to Y Le Bell.
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This study compared the stress reports of Finnish craniomandibular disorder patients and nonpatients by using the Symptoms of Stress Inventory as a screening device. A comparison of Finnish and American craniomandibular disorder patients' stress reports was made in the same manner. The overall stress level of craniomandibular disorder patients was higher than that of nonpatients. The patients had elevated scores on somatic subscales, with muscle tension symptoms being the most characteristic. These results are in accordance with American results. However, statistically significant differences were not found for emotional symptoms.
Thirty-two subjects were interviewed about their pre- and post-treatment symptoms of craniomandibular disorders (CMD) and examined for signs of CMD at follow up 2-5 years after surgical-orthodontic treatment for maxillomandibular discrepancies. Symptoms of CMD were among the main reasons for seeking treatment in 31% of the patients. Patients with retrognathic mandibles had significantly more severe symptoms than patients with mandibular prognathism before treatment. After treatment, the severity of subjective symptoms had decreased for the patients as a whole, and significantly in the subjects with originally severe symptoms. Ten subjects out of 12 reported a decrease in the occurrence of headache. The clinical findings of CMD after surgery were usually mild. The importance of occlusal adjustment and rehabilitation as final steps after surgical-orthodontic treatment is stressed.
Twenty-two subjects with clinically diagnosed unilateral anterior disk displacement were followed up for two years. Seventeen of the patients were women and five were men, with ages ranging from 17 to 68 years (median 27 years). In 20 cases the duration of locking at the time of the examination was less than 6 months; the other two cases had experienced locking for more than 6 months but less than one year. Case histories were recorded and clinical examinations performed according to accepted principles, followed by calculation of Helkimo's anamnestic dysfunction index Ai and clinical dysfunction index Di. The patients were treated using full coverage splints combined with occlusal adjustment. Follow-up examinations were made after 6 months, one year and two years. At the time of the first visit, 17 patients had severe subjective symptoms such as difficulty in opening the mouth wide and pain on movement of the mandible, while five experienced locking without subjective symptoms. All patients apart from one belonged to Di III and had a maximal mouth opening capacity ranging from 24 to 38 mm. During follow-up, one patient was treated surgically because of continuous severe symptoms; in one case, spontaneous disk reduction was confirmed by MR imaging. At the last examination the rest of the patients (n = 20) had a mouth opening capacity ranging from 31 to 60 mm and belonged to Di II. However, eight patients were completely symptom free and 12 had only mild symptoms. All patients regarded their condition and good as were able to manage well.(ABSTRACT TRUNCATED AT 250 WORDS)
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Great variations reported in the frequency distribution of buffer capacity values may partly be due to methodological differences in saliva sampling. In this study we wanted to see to what extent these variations are due to repetition and prestimulation. 9-yr-old schoolchildren (n: 41, 23 girls and 18 boys), who had never had saliva samples taken before, participated in the present study. The repetition tests were carried out between 9 and 11 a.m. on three subsequent days. The effect of prestimulation was tested 4 days later with the same subjects. The buffer capacity of the samples was determined electrometrically immediately after sampling using the commercial Dentobuff-test. The intraindividual analysis revealed a significant increase in flow rate but not in buffer capacity along with repetition of the sampling. The analysis further showed that the buffer capacity of children accustomed to saliva sampling increased significantly through prestimulation of 1 min. The use of prestimulation resulted in substantial changes also in the frequency distribution of the buffer capacity values. Our results emphasize the importance of proper sampling conditions in saliva collection when screening children for high caries risk.
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A follow-up study was performed on 12 subjects with unilateral and five subjects with bilateral reciprocal clicking and symptoms of craniomandibular disorders. After treatment for, on average, three months with a repositioning appliance, followed by occlusal adjustment, patients were examined every six months initially and, after the first two years, once a year. During the follow-up period, occlusal stability was maintained by readjustment and use of full occlusal splints at night, when needed. After four years there was a 57% success rate with regard to treated joints. After six years, the success rate had decreased to 41%. However, even the eight unsuccessful cases, with persistent clicking and adjusted occlusion, managed well with regard to other clinical findings and subjective symptoms. It is concluded that repositioning splint therapy followed by occlusal adjustment seems appropriate for elimination of subjective symptoms and clinical signs even though repositioning may subsequently fail. Results seem to remain relatively unchanged for several years but some decline in the success rate may occur with time.
Sixty-two dental students judged not to be in need of treatment for craniomandibular disorder (CMD) were randomly divided into two groups, one receiving occlusal adjustment and the other mock adjustment. A double-blind study design was applied. After 2 years of education in dentistry, including courses in stomatognathic physiology, the increase in the subjective symptoms of CMD was significantly greater in the placebo control group than in the treatment group. The difference between the groups in the increase of sites tender to palpation was less clear, showing only a trend. However, the increase was statistically significant within the placebo group but not within the treatment group. Prophylactic occlusal adjustment thus appears to be effective in reducing the occurrence of symptoms of CMD, and possibly also the occurrence of clinical signs.
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The efficiency of dietary instructions was tested in a group of 7-8-year-old schoolchildren. The instructions were given in the presence of the child's mother either verbally (control group n = 14) or both verbally and written (test group n = 12). For this purpose the salivary status of the first grade pupils (n = 79) of a primary school in Turku was screened. Salivary flow, buffer capacity, sucrase activity, lactobacillus, yeast and S. mutans counts were determined. Children whose salivary lactobacillus count was over 10(4) CFU/ml (n = 32) were selected for the present study. The efficiency of the dietary instructions was measured as a reduction of salivary lactobacilli. There were no differences in the number of children with reduced LB counts or in the caries increment of 1 yr between the test and the control groups. However, children who succeeded in reducing the number of salivary lactobacilli (42%) within 4 wk revealed a significantly (P less than 0.05) lower caries increment after 1 yr than the rest of the subjects. We concluded that children whose lactobacillus counts were reduced by the dietary instructions developed significantly less caries than children whose lactobacillus counts remained high after the instruction. No additional effect on lactobacillus counts and caries increment could be demonstrated by supplementing the verbal dietary counseling with written instructions.
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