Practitioner/Practice- and Patient-Based Factors Contributing to Dental Practitioner Treatment Recommendations for Patients with Pain-Related TMDs: Findings from the National Dental PBRN

AIMS

To document National Dental Practice-Based Research Network (PBRN) practitioner treatment recommendations for patients with painful temporomandibular disorders (TMDs) and to identify practitioner/practice- and patient-related factors contributing to treatment recommendations made at the initial clinical visit.

METHODS

This prospective single-sample cohort study formed groups based on treatment recommendations made by 185 dental practitioners who treated 1,901 patients with painful TMDs. At the baseline visit, which this article describes, practitioners provided patients with their diagnoses and a treatment plan and then completed a comprehensive questionnaire.

RESULTS

Self-care, an intraoral appliance, medication, and practitioner-recommended jaw exercises were the most frequently recommended treatments. Practitioners recommended multiple treatments to most patients. TMD signs, symptoms, and diagnoses were primary considerations in treatment planning, but the practitioner's expectations for improvement were only significant for intraoral appliances and self-care. Female practitioners and those with expertise in TMDs more frequently recommended patient-directed and multidisciplinary treatments compared to their counterparts.

CONCLUSIONS

Practitioners used a wide range of treatments for patients with few consistent patterns. The propensity to use TMD signs, symptoms, and diagnoses when making treatment recommendations suggests a tendency to conceptualize patients using the biomedical model. Infrequent referral to nondental providers suggests a lack of availability of these providers, a misunderstanding of the complexity of TMDs, and/or discomfort with assessment of psychosocial factors. Implications include the need for comprehensive training in the assessment and management of TMD patients during dental school and participation in TMD continuing education courses following evidence-based guidelines.

Effects of facemasks versus intraoral appliances in treating maxillary deficiency in growing patients: A systematic review and meta-analysis

BACKGROUND

Class III malocclusion is one the most challenging types of orthodontic problems.

OBJECTIVES

The aim of this study was to compare the dentoskeletal effects of facemasks and intraoral appliances in treating class III maxillary deficiency in growing patients through a systematic review of the available literature.

MATERIAL AND METHODS

Electronic and manual searches were performed in the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR), MEDLINE (PubMed), Embase (OVID), and Scopus to find all the relevant studies published by January 2018. All randomized controlled trials (RCTs) recruiting 5-12-year-old patients who received maxillary protraction treatment with any type of facemask and comparing the facemasks with any type of intraoral appliance were included. The primary outcome measure was changes in the A point-nasion-B point angle (ANB), and the secondary outcomes included changes in the overjet, upper-1 (U1) inclination, the mandibular plane angle, and treatment time. The meta-analysis was carried out using the inverse variance-weighted random effects model.

RESULTS

Out of 1,629 articles found in the initial search, 5 studies met the inclusion criteria. The meta-analysis showed no differences in the duration of treatment or in any of the cephalometric variables, with the exception of the overjet.

CONCLUSIONS

It seems that intraoral appliances and facemasks are similar in terms of dentoskeletal effects in the treatment of class III malocclusion as well as treatment duration. However, due to a lack of a sufficient number of high-quality studies, these results should be viewed with caution. Further high-quality, long-term studies are recommended.

A progressive approach for the use of occlusal devices in the management of temporomandibular disorders

Temporomandibular disorders (TMDs) represent a broad spectrum of conditions associated with the temporomandibular joints and the neuromuscular system. Evidence-based diagnostic criteria for various TMDs are emerging, while corresponding treatment procedures remain less clear. As a result, the clinician may be uncertain how to best care for TMD patients. The objectives of this evidence-based review were to outline the various types of occlusal devices, assess the efficacy of occlusal splints in treating TMD patients, and create a treatment rubric based on diagnostic criteria and condition severity. A select literature review as to the effectiveness and efficacy of occlusal device TMD therapy revealed that stabilization splint intervention and control treatments had a positive effect in reducing TMD-related symptoms; minimal statistically significant differences were noted between intervention and control treatments. Stabilization splints are effective as a reversible treatment for patients with TMD. Other therapies and occlusal devices may be beneficial when used for a specific TMD diagnostic protocol. A treatment rubric based on diagnostic criteria and condition severity may assist the clinician.

Early Orthopedic Retraction of the Premaxilla in Bilateral Complete Cleft Lip and Palate: An Innovative Approach to a Difficult Problem

Bilateral cleft lip and palate occurs in 9.2% of cleft patients. Many approaches have been adopted to manage the protrusive premaxillary segment in patients with bilateral cleft lip and palate. Some advocate the use of intraoral appliances, occasionally combined with invasive surgery, which often requires revision at a later date. The authors describe the case of a 3-year-old child born with bilateral cleft lip and palate presenting with a protuberant premaxilla and an overjet greater than 25 mm. Prompt intervention was warranted in this case due to the potential for traumatic compromise to the dentition of the premaxillary segment and a distinct lack of social integration reported by the parents. The patient was managed with a novel, innovative approach using orthodontic traction and minimally invasive surgery. The literature has been reviewed and the patient's subsequent physiological and psychosocial development has been monitored. He has since undergone successful alveolar bone grafting.