Therapie bei Arthralgie der Kiefergelenke

Quality appraisal of clinical practice guidelines for temporomandibular joint disorders using the AGREE II instrument

OBJECTIVE

We sought to systematically assess the quality of all clinical practice guidelines (CPGs) describing diagnosis and management of temporomandibular joint disorders (TMDs) using the Appraisal of Guidelines for Research and Evaluation instrument.

STUDY DESIGN

CPGs detailing all aspects of diagnosis and management (both conservative and nonconservative) for TMDs were reviewed.

RESULTS

Thirteen guidelines met inclusion criteria. The highest-scoring domain across guidelines was clarity of presentation (68.3%); the lowest-scoring domain was editorial independence (31.9%). The highest-scoring guideline described traditional Korean medicine approaches to the management of TMDs, earning a mean score of 79.2% across the six quality domains. Only three CPGs met a quality threshold of >60% in at least five domains, qualifying as 'high' per the Appraisal of Guidelines for Research and Evaluation criteria: these guidelines were the Korean medicine guidelines, Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guidelines for diagnostic classification of TMDs, and the Japanese Society for the Temporomandibular Joint guidelines. An average intraclass correlation coefficient of 0.79 was calculated across all domains, denoting very strong agreement between independent reviewers.

CONCLUSION

We identified a significant lack of quality in multiple areas of CPG development for the diagnosis and therapeutic management of TMDs, suggesting a need for new comprehensive and rigorously developed guidelines addressing TMDs.

Impact of dentists' years since graduation on management of temporomandibular disorders

OBJECTIVES

The aims were to assess the impact of the number of years since dentists' graduation on appraisement of diagnostic needs and utilization of treatment options for temporomandibular disorders (TMD) and to investigate whether increased knowledge in TMD is sufficiently considered in today's dentist's undergraduate curricula and, therefore, represented in more evidence-based TMD management in dentists with less years since graduation.

MATERIAL AND METHODS

A questionnaire regarding knowledge and management of TMD was developed and was subsequently applied in a random sample of 400 dentists in a region in Northern Germany.

RESULTS

Of the 222 dentists (response rate 55.6 %), participating in the study, the frequency of TMD treatment need in the general population was estimated at 21.5 %, with lower values in dentists with more years passed since graduation. Measures regarding utilization of standardized examination forms, perceptions of insufficient specialization, and referrals of patients to TMD specialists indicated a lower quality and certainty in TMD management in participants with less time since graduation. While the provision of splints was a well-established treatment option in initial TMD management of all participants, additional TMD treatment options were mentioned less often, with lower proportions of participants making use of these options within the first decade since graduation.

CONCLUSIONS

Evidence-based TMD management is not fully represented in dental practitioners in Germany. This might be due to an insufficient consideration of TMD management in the dentist's undergraduate curricula.

CLINICAL RELEVANCE

Effective interventions to increase dentists' knowledge and to change dentists' practices in TMD management are required.

Effect of β-hydroxy-β-methylbutyrate in masticatory muscles of rats

The aim of this research was to examine the influence of β-hydroxy-β-methylbutyrate (HMB) on changes in the profile of muscle fibers, whether these alterations were similar between the elevator and depressor muscles of the jaw, and whether the effects would be similar in male and female animals. Fifty-eight rats aged 60 days (29 animals of each gender) were divided into four groups: the initial control group (ICG) was sacrificed at the beginning of the experiment; the placebo control group (PCG) received saline and was fed ad libitum; the experimental group (EG) received 0.3 g kg(-1) of HMB daily for 4 weeks by gavage as well as the same amount of food consumed by the PCG in the previous day; and the experimental ad libitum group (EAG) received the same dose of the supplement along with food ad libitum. Samples included the digastric and masseter muscles for the histoenzymological analysis. Data were subjected to statistical analysis with a significance level of P < 0.05. Use of HMB caused a decrease in the percentage of fast twitch glycolytic (FG) fibers and an increase in fast twitch oxidative glycolytic (FOG) fibers in males in both experimental groups (EG and EAG). However, it produced no increase in the muscle fiber area, in either gender, in the masseter muscle. In the digastric muscle, the HMB did not change the frequency or the area of any muscle fiber types in either gender. Our data suggest that the use of HMB caused small changes in the enzymological profile of fibers of the mastication muscles; the changes were different in the elevator and depressor muscles of the jaw and the results were different depending on gender.

[Clinical management of masticatory muscle pain: an update of the recommendations]

Besides the different forms of odontalgia, myalgias of the masticatory muscles are the most frequent noninfectious complaints in the orofacial region. After summarizing the recommendations set forth by the Interdisciplinary Working Group of Orofacial Pain within the German Chapter of the IASP (German Pain Society), we present the current state of knowledge regarding the etiology, diagnosis, and therapeutic options, based on an extensive literature search. A systematic literature search was carried out in PubMed, the Cochrane Library, and the database of the Deutsche Zahnärztliche Zeitschrift. The results corroborate our previous recommendations that for the majority of patients pain reduction or pain relief can be achieved with noninvasive, reversible methods. Short- and long-term trials have added more evidence to the fact that different therapeutic measures have similar efficacy. In patients with chronic myalgias of the jaw muscles, involvement of a psychotherapist is crucial. Patient education, oral appliances, physiotherapeutic exercises, and acupuncture are recommended therapeutic measures, while physical therapy, pharmacotherapy, and psychological therapy received a limited recommendation.

[Improvement of diagnosis and treatment of glossopharyngeal neuralgia]

Differential diagnosis of neuralgias affecting the cranial nerves and of facial pain is often difficult. Glossopharyngeal neuralgia is much less common than trigeminal neuralgia and is not well known. Idiopathic neuralgia of the glossopharyngeal nerve sometimes occurs in association with neurovascular compression syndrome of the vagus and trigeminal nerves. High-resolution MRI of the brain stem with three-dimensional visualization allows a secure diagnosis of neurovascular compression and is useful in the planning of appropriate microsurgical decompression (Jannetta's operation).