Study Examines Treatment Responses in TMD Patients

Tempromandibular pain disorders (TMDs) are characterized by a dysfunction of the TMD joint and cause orofacial pain, masticatory dysfunction or both. A new study published in The Journal of Pain showed that standard treatment approaches yield modest to large improvement in pain, but the addition of cognitive behavioral therapy may be helpful. The Journal of Pain is published by the American Pain Society, www.americanpainsociety.org.

Some 10 to 36 million U.S. adults, primarily women, have TMD pain, making this condition the second most frequent pain disorder following low-back pain. MD pain usually can be managed with conservative treatment with non-steroidal anti-inflammatory pain medications (NSAIDS), supportive patient education, diet modifications and an intraoral splint and/or occlusal therapy. Not all patients benefit, however, and previous research has shown that many TMD patients benefit from cognitive behavioral therapy (CBT). But the reasons behind CBT treatment success or failure are unclear.

Researchers from the University of Connecticut Health Center evaluated 101 TMD patients on a daily basis for three months. Study subjects reported having TMD pain for an average of 6.7 years. They were randomly assigned to one of two treatment groups: standard conservative care and standard care with CBT added, which included coping skills training. The purpose of the study was to determine if specific subtypes of treatment nonresponsive TMD patients could be identified to determine if CBT could be helpful.

The authors hypothesized that certain CBT treatment-related outcomes, such as lower retention in treatment and less adaptive changes in coping, self efficacy and catastrophizing, might be predictive of treatment non-response.

Results showed that nonresponders scored higher on depression scores, exhibited lower self efficacy and coping ability, and catastrophized more than more adaptive patients. It was noted that nonresponsive patients did not show more joint pathology than patients who responded well to treatment. Despite lack of joint pathology, the nonresponsive subjects were more likely to report being disabled by their TMD pain.

The study concluded it is important to recognize the importance of the heterogeneous nature of TMD pain, and that treating TMD patients as a homogeneous group is likely to result in suboptimal therapy for many patients. Even though no treatment is successful for all TMD patients, certain psychosocial factors can make some patients unresponsive to CBT.

Buck Teeth: Correct Them Once In Early Adolescence

Courtesy of Health Behavior News Service, part of the Center for Advancing Health

KEY POINTS

* A review finds few benefits to a two-stage orthodontic correction for buck teeth in children versus treatment done in one-stage during early adolescence.__* A two stage correction requires treatment over a longer period of time, which typically increases the cost.

Newswise — Children with prominent front teeth, colloquially known as buck teeth, often require orthodontic work to straighten their teeth and improve both their bite and appearance. This can be done in one stage during early adolescence (age 10 to 16) or two stages with the first stage between age 7 and 11 and the second in early adolescence. A new Cochrane review finds few benefits to the two-stage correction.

Upper front teeth that stick out are more likely to be broken or knocked out in an accident. In addition, their appearance can lead to a child being made fun of or being bullied. But orthodontists, parents, and children are faced with deciding whether to treat in two stages, early and late, or in just one later stage.

The research team analyzed data from 17 randomized controlled trials of children treated for Class II malocclusion, which is one cause of prominent front teeth. The trials included 721 children.

They concluded that providing treatment early slightly reduced the risk of a child damaging their front teeth if they had an accident while playing or participating in sports, but offered few other benefits. "There was no other benefit for having treatment early, age 8, as opposed to having treatment during adolescent age," according to Kevin O'Brien, professor of orthodontics at the University of Manchester in England.

"The results of this review will provide information to allow the orthodontist to explain fully the potential risks of not having treatment when the child is 8 years old," O'Brien stated. This can help orthodontists, parents and their children make an informed decision, he said.

The study also looked at evaluations of several types of orthodontic braces and appliances, including fixed and removable devices and head-braces. One type, the Twin-Block, was shown to be more effective in reducing the protrusion of the upper front teeth at an early age.

There is no official standard of care when it comes to treating prominent front teeth, David L. Turpin, D.D.S., Moore/Riedel Professor in the department of orthodontics at the University of Washington School of Dentistry in Seattle. "Teeth come in all types of bite and jaw relationships and children come in all shapes and sizes," he said. "Orthodontists should know all the different ramifications and should be good at treating problems in differing ways to meet the child's needs."

"In general, the earlier that treatment starts the longer it lasts, which in turn increases the cost," Turpin said.

TERMS OF USE: This story is protected by copyright. When reproducing any material, including interview excerpts, attribution to the Health Behavior News Service, part of the Center for Advancing Health,

Junk food and poor oral health increase risk of premature heart disease

The association between poor oral health and increased risk of cardiovascular disease should make the reduction of sugars such as those contained in junk food, particularly fizzy drinks, an important health policy target, say experts writing in the Journal of the Royal Society of Medicine. Poor oral hygiene and excess sugar consumption can lead to periodontal disease where the supporting bone around the teeth is destroyed. It is thought that chronic infection from gum disease can trigger an inflammatory response that leads to heart disease through a process called atherosclerosis, or hardening of the arteries. Despite convincing evidence linking poor oral health to premature heart disease, the most recent UK national guidance on the prevention of CVD at population level mentions the reduction of sugar only indirectly.

Dr Ahmed Rashid, Department of Public Health and Primary Care, University of Cambridge, who co-wrote the paper, said: "As well as having high levels of fats and salt, junk foods often contain a great deal of sugar and the effect this has on oral health may be an important additional mechanism by which junk food elevates risk of CVD." He added: "Among different types of junk food, soft drinks have raised particular concerns and are the main source of free sugar for many individuals." The authors refer to the well-publicised New York 'soda ban' controversy which has brought the issue to the attention of many. Yet, they point out, in the UK fizzy drinks remain commonly available in public areas ranging from hospitals to schools. Dr Rashid said: "The UK population should be encouraged to reduce fizzy drink intake and improve oral hygiene. Reducing sugar consumption and managing dental problems early could help prevent heart problems later in life."