STUDIES CONDUCTED AT TUFTS SCHOOL OF DENTAL MEDICINE.

STUDIES CONDUCTED AT TUFTS SCHOOL OF DENTAL MEDICINE

Maxillomandibular Relationships in TMD Patients Before and After Short Term Bite Plate Therapy

T.M.Disorders and Orofacial Pains

Fu, A., Mehta, N., Forgione, A. Clark, E. Hayes,C, Kugel,G.and Abdallah,E.

J.Dent.Res. Vol 76 1997 I.A.D.R.Abst # 2363

T.M.Disorders and Orofacial Pains Maxillo- mandibular relationship in TMD patients

after short term bite plate therapy Mandibular shifts in all patients. 9 subjects

to the left and 11 to the rightAfter 4 weeks of bite plate therapy and

second set of registrations takenA binominal test performed to evaluate the

rate of occurrence of mandibular shift

All subjects shifted to the frenal midline position following the 4 week period

( Binomial p < 0.001 )

T.M.Disorders and Orofacial Pains Appliance Therapy on Symptom Sites

Effect of Appliance therapy on Specific Symptom sites on TMD: E. Abdallah, A. Aboushala, N. Mehta and A. Forgione. Presented I.A.D.R. Abst.# 1688,March 1995

Retrospective study of 55 patients of the Gelb

Pain Center

Only flat plane bite appliance therapy in three dimensions

V.A.S. score over 8 weeks. First and fourth visit

Symptom Sites were weighted by number of areas

T.M.Disorders and Orofacial Pains: Update 2001 . Appliance Therapy on Symptom Sites

Symptom 1st Visit 4th visit reduction N of 55Headache 39.65 13.79 65% 29Neck 66.07 30.35 57% 28TMJ pain 73.21 21.42 71% 28TMJ sound 70.83 18.75 74% 24

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HeadachesNeckTMJ painTMJ sounds

1st 4th


Quantitative Assessment of Head and Body Posture and Range of Neck Motion in Craniomandibular Disorders Patients and Asymptomatic Women

Wu.H, Mehta. N, Forgione,A. Clark.E, and El- Bermani.WJ Dent Res. Vol. 75,1996 Abst. # 1608

T.M.Disorders and Orofacial PainsQuantitive Assessment of Posture and Cervical

Function

To find if differences exist between head, body posture, leg length and neck function in symptomatic CMD female patients and asymptomatic female controls.

To assess differences in muscle pain and headaches in the two groups

T.M.Disorders and Orofacial Pains Quantitive Assessment of Posture and Cervical Function

Static head posture, shoulder and pelvic balance as well as neck ROM evaluated

Light emitting diodes and a computer assisted video digitizing posture analysis system used

Muscle palpation and questionnaires

40 female subjects. Ages 18 -5520 CMD with chronic orofacial pain and

headaches. 3 or more a month.20 age matched asymptomatic controlsNo history of trauma in past 10 month

T.M.Disorders and Orofacial PainsQuantitive Assessment of Posture and Cervical Function


Quantitive Assessment of Posture and Cervical Function CMD patients had significantly more foreword head

posture than controls (P<0.001)CMD patients had significantly more pelvis imbalance

than controls (P< 0.001) CMD patients had more functional leg length

discrepancy than controls.(P<0.017)CMD patients had significantly less cervical

ROM in all movements than the controls. (P<0.001)

CMD patients had multiple muscle pains in masticatory and cervical muscles and significantly more headaches than controls.( 8.8 a month)

EFFECT OF VERTICAL DIMENSION AND MANDIBULAR POSITION ON ISOMETRIC STRENGTH OF THE CERVICAL FLEXURES

AL - ABBASI , H . , MEHTA , N . R . ,

FORGIONE , A . , CLARK , E .

J. of Cranio. Vol 17 # 2: April 1999

T.M.Disorders and Orofacial Pains Effect of intraoral Appliances on neck flexures in deep bite patients

T.M.Disorders and Orofacial PainsEffect of intraoral Appliances on neck

flexures in deep bite patientsMean Peak Strength of neck flexors biting with or without Intra-oral appliance (N=15)

0

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80

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120

140

mea

n ne

wto

ns

Habitual Retruded LateralShift

Edge-to-Edge

without appliancewith appliance


Effect of Altering Vertical Dimension of Occlusion on Isometric Strength of Cervical Flexors and Deltoid Muscles in a Normal Female Group

Chafka. A, Mehta.N, Kugel. G, Hayes, C. Forgione, A

J. Dent. Res. Vol 77Special issue 1998 Abst # 735

T.M.Disorders and Orofacial PainsEffect of Altering Vertical Dimension of Occlusion on Isometric Strength of Cervical Flexors and Deltoid Muscles in a Normal Female Group

20 female staff and students 20 – 40 years of age

Full complement of teeth , no major restorative, no TMJ

Deep Bite Subjects as assessed by anterior incisal overlap

All subjects had 2,4,6,10mm acrylic bite plates in same occlusal position by mounting in C.O. on a Whipmix

Assigned to groups randomly. Two independent examiners

Testing pre (habitual), with height and post (habitual)

Cervical muscle and Deltoids tested with Kinesiometer


(Fig 1 & 2)Comparison between isometric strenght of three muscles in three bite positions: pre-experimental habitual occlusion, vertical dimension

associated with maximum isometric strenght and post-experimental habitual occlusion

9.78

6.9 6.38

12

8.62 8.579.28

6.5 6.26

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14

Cervical flexors Right Deltoids Left Deltoids

mu

scle

iso

me

tric

str

en

gth

(kg

)

Pre-Experiment Habitual Occlusion

Vertical Dimension Associated w ithMaximum Isometric Strenght

Post-Experiment Habitual Occlusion


(Fig 2) Mean percent diference from baseline (pre-experimental habitual occlusion) of cervical flexors, right and left deltoids strenghts pf pre-

maximum, maximum and post-maximum and post-experimental strenghts

0

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-30

6

25

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-6

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33

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-10

-5

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rce

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nc

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line Cervical Flexors

Right Deltoids

Left Deltoids


ABOUSHALA ,A., MEHTA, N., FORGIONE,

A.,KUGEL,G.,CHAPMAN, R.,CLARK,E.

EFFECT OF VERTICAL DIMENSION ON STERNOCLEIDOMASTOID STRENGTH IN DENTURE PATIENTS

J. Dent. Res, Vol 77 IADR Abst# 456, 1998

T.M.Disorders and Orofacial PainsVertical Dimension and SCM strength in Complete

Denture patients

Means of Isometric Strengths of Cervical Flexors ( kg )

T.M.Disorders and Orofacial PainsVertical Dimension and SCM strength in Complete Denture

patients

Means and Standard Deviations of Resistance ( Kg ) of the Cervical Flexors in six conditions


Treatment Effectiveness of a multidisciplinary pain center .

524 out of 5000 patients. A Retrospective Outcomes Study

N. Mehta, J. Al- Ghamdi, A. Forgione presented IADR 2000

T.M.Disorders and Orofacial PainsTreatment Effectiveness of a multidisciplinary pain center . 524 out of 5000 patients. A Retrospective Outcomes study

524 patients selected randomly from a pool of 5000. Pain for 48 weeks.

At least 3 visits. Pretreatment, penultimate and ultimate. 80% had mean of 7 visits, 20% had mean of 12 visits

Assessments done by 0 to 10

V.A.S.

SCL 90 and SF 36 and Chronic Graded Pain Scales

for psychological

10 Symptom sites left and right sides

T.M.Disorders and Orofacial PainsTreatment Effectiveness of a multidisciplinary pain center . 524 out of 5000 patients. A Retrospective outcomes study

Interdisciplinary Treatments Commonly Used

• Medications .Neurological agents, muscle relaxants, anti inflammatory, narcotics, anxiolytics, antidepressants

•Psychological treatments : short term , biofeedback

• Physical medicine. PT., Chiropractic, OT, Osteopathic

• Acupuncture, Integrative medicine , Nutritional supplements

• Maxillomandibular Reorientation therapy

T.M.Disorders and Orofacial PainsTreatment Effectiveness of a multidisciplinary pain center . 524 out of 5000 patients. A Retrospective

outcomes study

0

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10E

arA

che

Ear

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J P

ain

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ain

Arm

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ain

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r B

ack

Low

Bac

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Mean Pain Rating Pre and Post-Treatment

Pre Treat Post Treat

P < 0.001

T.M.Disorders and Orofacial Pains Treatment Effectiveness of a multidisciplinary pain center .

524 out of 5000 patients. A Retrospective outcomes study

Symptom #Patients #Improved # Same # Worse

Earache 270 235 9 26

Earstuff. 246 208 17 21

TMJPain 454 403 23 28

TMJClick 384 332 21 31

FacePain 372 322 19 31

HeadPain 391 337 24 30

ArmPain/Ting 168 140 7 21

NeckPain/Stiff 399 347 19 33

Upper Back 299 247 19 33

Lower Back 245 209 17 19

P< 0.001




Total Number of Patients 524

Number of patients improved 488 ( 93% )

Number of Patients worse 31

Number of patients same 5

P< 0.001

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140

Nu

mb

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ati

ents

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170

Total Pain Distribution Pre and Post-Treatment N = 524, 200 Maximum Pain

Pre Treat Post Treat

T.M.Disorders and Orofacial PainsTreatment Effectiveness of a multidisciplinary pain center . 524 out of 5000 patients. A Retrospective outcomes study

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pre treat post treat control

TMJ PainTMJ soundHeadacheFace Painneck pain




VAS

Mark. O, Mehta.N. Forgione.A. Self Reported TMD Symptoms in 200 American Dental Students. IADR Abs # 826 1997

T.M.Disorders and Orofacial Pains: Update 2002 Treatment Effectiveness of a multidisciplinary pain center . 524 out of 5000 patients. A Retrospective outcomes study

Total Number of Patients 524

Number of patients improved 488 ( 93% )

Number of Patients worse 31

Number of patients same 5

P< 0.001

STUDIES CONDUCTED AT TUFTS SCHOOL OF DENTAL MEDICINE.

Documents

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cervical function slide

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body posture

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foreword head posture