In a 21-year-old man with open bite, myogenic headache and internal derangement of the temporoman... more In a 21-year-old man with open bite, myogenic headache and internal derangement of the temporomandibular joint clinical examination was supplemented by radiographs of the joints, cephalometric analysis, electromyographic recordings of the masticatory muscles and tracking of mandibular movements. His condition was characterized by reduced occlusal stability with contact limited to posterior molars, and weak elevator muscles with increased strain during posture and chewing. The purpose of the treatment was to eliminate symptoms with a reflex-releasing stabilizing splint. Secondly, to increase occlusal stability, primarily with the splint and later through orthodontic treatment aiming at closing the bite in the premolar region because the reduced occlusal stability seemed to be a significant etiologic factor. Treatment with the splint reduced signs and symptoms of craniomandibular disorders. During the following orthodontic treatment, contact was established on both premolars and molars, mainly due to extrusion of mandibular premolars. Analysis showed greater elevator strength and decreased muscular loading after treatment. A splint was used for retention accompanied by muscle training with exercise gum. Permanent training with gum was recommended after the retention period.
In defining the principles of occlusal function it is possible to demonstrate how firmly the numb... more In defining the principles of occlusal function it is possible to demonstrate how firmly the number, the placement and the distribution of occlusal contacts control muscle activity and joint function during biting and chewing. This control implies that the intercuspal position is determined by positive feedback, that is by afferent activity that varies with occlusal stability. Conventional dental treatment involving occlusal surfaces alters this input and consequently alters the coordination of the muscles of mastication and the function of the temporomandibular joints. To assess and direct this input properly, quantitative parameters of electromyography and kinesiography are needed. Terms such as harmony and disharmony are irrelevant and must be abandoned.
In an almost full-grown male of 17 years, functional and morphological changes were followed duri... more In an almost full-grown male of 17 years, functional and morphological changes were followed during Herbst treatment and subsequent control. Retrognathism of the mandible was overcorrected, and then normalized by reverse headgear to the maxilla. Partial relapse due to insufficient cooperation during retention necessitated retreatment. Treatment resulted in marked dentoalveolar changes, increase in mandibular length and ramus height, apposition and remodelling of condylar heads and flattening of the temporal joint surface. After treatment masseter strength was 40 per cent reduced, probably due to prolonged hypofunction.
Background: Progressive weakness can affect bulbar muscles in individuals with moderate to severe... more Background: Progressive weakness can affect bulbar muscles in individuals with moderate to severe forms of spinal muscular atrophy (SMA). The paucity of standardized, valid bulbar assessments capturing clinically significant deficits in SMA impedes the ability to monitor function, facilitate intervention, or detect treatment response. Objective: To fill this void, an international multidisciplinary team gathered to develop an agreed upon consensus-derived assessment of bulbar function in SMA for inter-professional administration to enhance our ability to monitor disease progression, support clinical management, and evaluate treatment effects. Methods: Fifty-six international clinicians experienced in SMA were invited and engaged using the Delphi method over multiple rounds of web-based surveys to establish consensus. Results: Serial virtual meetings occurred with 42 clinicians (21 speech and language therapists, 11 physical therapists, 5 neurologists, 4 occupational therapists, and ...
Key Clinical MessageTardive dystonia is a risk factor in medical antipsychotic treatment. It ofte... more Key Clinical MessageTardive dystonia is a risk factor in medical antipsychotic treatment. It often begins with repetitive involuntary jaw and tongue movements resulting in impaired chewing and detrimental effect on the dentition. The orofacial dysfunction may go unrecognized in a neurological setting. The diagnosis may be difficult so we suggest interdisciplinary collaboration.
The effects of prolonged tooth-clenching on masticatory muscle pain have not been fully elucidate... more The effects of prolonged tooth-clenching on masticatory muscle pain have not been fully elucidated. We hypothesized that late-onset soreness may develop depending on the clenching force. Ten pain-free females were asked to endure sustained clenching tasks up to exhaustion in randomized sequences of 7.5%, 10%, 15%, 25%, and 40% of maximum clenching force. Perceived pain, fatigue, and pressure-pain thresholds of masseter and temporalis muscles were assessed before, immediately after, and one day after the tasks. Endurance times differed markedly among participants and force levels, ranging from 1.2 to 245.1 min. Masseter pressure-pain threshold decreased immediately after (-13.7%; p = 0.050) and one day after (-22.0%; p = 0.006) the 7.5% task. Temporalis pressure threshold decreased one day after the 7.5 % task (-14.6%; p = 0.003). It was concluded that prolonged low-level tooth-clenching in healthy young women induces a delayed soreness in the jaw elevator muscles.
In a 21-year-old man with open bite, myogenic headache and internal derangement of the temporoman... more In a 21-year-old man with open bite, myogenic headache and internal derangement of the temporomandibular joint clinical examination was supplemented by radiographs of the joints, cephalometric analysis, electromyographic recordings of the masticatory muscles and tracking of mandibular movements. His condition was characterized by reduced occlusal stability with contact limited to posterior molars, and weak elevator muscles with increased strain during posture and chewing. The purpose of the treatment was to eliminate symptoms with a reflex-releasing stabilizing splint. Secondly, to increase occlusal stability, primarily with the splint and later through orthodontic treatment aiming at closing the bite in the premolar region because the reduced occlusal stability seemed to be a significant etiologic factor. Treatment with the splint reduced signs and symptoms of craniomandibular disorders. During the following orthodontic treatment, contact was established on both premolars and molars, mainly due to extrusion of mandibular premolars. Analysis showed greater elevator strength and decreased muscular loading after treatment. A splint was used for retention accompanied by muscle training with exercise gum. Permanent training with gum was recommended after the retention period.
In defining the principles of occlusal function it is possible to demonstrate how firmly the numb... more In defining the principles of occlusal function it is possible to demonstrate how firmly the number, the placement and the distribution of occlusal contacts control muscle activity and joint function during biting and chewing. This control implies that the intercuspal position is determined by positive feedback, that is by afferent activity that varies with occlusal stability. Conventional dental treatment involving occlusal surfaces alters this input and consequently alters the coordination of the muscles of mastication and the function of the temporomandibular joints. To assess and direct this input properly, quantitative parameters of electromyography and kinesiography are needed. Terms such as harmony and disharmony are irrelevant and must be abandoned.
In an almost full-grown male of 17 years, functional and morphological changes were followed duri... more In an almost full-grown male of 17 years, functional and morphological changes were followed during Herbst treatment and subsequent control. Retrognathism of the mandible was overcorrected, and then normalized by reverse headgear to the maxilla. Partial relapse due to insufficient cooperation during retention necessitated retreatment. Treatment resulted in marked dentoalveolar changes, increase in mandibular length and ramus height, apposition and remodelling of condylar heads and flattening of the temporal joint surface. After treatment masseter strength was 40 per cent reduced, probably due to prolonged hypofunction.
Background: Progressive weakness can affect bulbar muscles in individuals with moderate to severe... more Background: Progressive weakness can affect bulbar muscles in individuals with moderate to severe forms of spinal muscular atrophy (SMA). The paucity of standardized, valid bulbar assessments capturing clinically significant deficits in SMA impedes the ability to monitor function, facilitate intervention, or detect treatment response. Objective: To fill this void, an international multidisciplinary team gathered to develop an agreed upon consensus-derived assessment of bulbar function in SMA for inter-professional administration to enhance our ability to monitor disease progression, support clinical management, and evaluate treatment effects. Methods: Fifty-six international clinicians experienced in SMA were invited and engaged using the Delphi method over multiple rounds of web-based surveys to establish consensus. Results: Serial virtual meetings occurred with 42 clinicians (21 speech and language therapists, 11 physical therapists, 5 neurologists, 4 occupational therapists, and ...
Key Clinical MessageTardive dystonia is a risk factor in medical antipsychotic treatment. It ofte... more Key Clinical MessageTardive dystonia is a risk factor in medical antipsychotic treatment. It often begins with repetitive involuntary jaw and tongue movements resulting in impaired chewing and detrimental effect on the dentition. The orofacial dysfunction may go unrecognized in a neurological setting. The diagnosis may be difficult so we suggest interdisciplinary collaboration.
The effects of prolonged tooth-clenching on masticatory muscle pain have not been fully elucidate... more The effects of prolonged tooth-clenching on masticatory muscle pain have not been fully elucidated. We hypothesized that late-onset soreness may develop depending on the clenching force. Ten pain-free females were asked to endure sustained clenching tasks up to exhaustion in randomized sequences of 7.5%, 10%, 15%, 25%, and 40% of maximum clenching force. Perceived pain, fatigue, and pressure-pain thresholds of masseter and temporalis muscles were assessed before, immediately after, and one day after the tasks. Endurance times differed markedly among participants and force levels, ranging from 1.2 to 245.1 min. Masseter pressure-pain threshold decreased immediately after (-13.7%; p = 0.050) and one day after (-22.0%; p = 0.006) the 7.5% task. Temporalis pressure threshold decreased one day after the 7.5 % task (-14.6%; p = 0.003). It was concluded that prolonged low-level tooth-clenching in healthy young women induces a delayed soreness in the jaw elevator muscles.
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