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PURPOSE: To examine whether there is a gender-dependent risk profile for signs of temporomandibular disorders (TMD) in a population-based sample. MATERIALS AND METHODS: Sociodemographic, behavioral, and medical factors were checked for associations with TMD in a cross-sectional study of 3,567 subjects aged 25 to 74 years in Germany. Data were collected from clinical examinations, interviews, and questionnaires. Logistic regression analyses were used to estimate factors associated with signs of TMD across gender. TMD signs included tenderness or pain on palpation of 3 or more masticatory muscles and tenderness or pain on palpation in 1 or both temporomandibular joints (TMJs). RESULTS: In women, muscle tenderness or pain was found to be significantly associated with general arthrosis/arthritis and lower back pain. In men, muscle tenderness or pain was significantly associated with school education > 11 years, various categories of loss of occlusal support, lip/tongue/cheek biting, and general arthrosis/arthritis. In women, TMJ tenderness or pain was associated with widowed status, bruxism, general arthrosis/arthritis, lower back pain, and sex-hormone replacement. In men, TMJ tenderness or pain was associated with multiple losses of posterior supporting zones, gout, and lower back pain. In women, there were inverse associations between loss of occlusal support in 3 posterior zones and muscle and TMJ tendernes. CONCLUSION: Except for some general health conditions and bruxism, the hypothesis of a gender-dependent risk profile for signs of TMD is partly supported. The results of this study indicate that TMD is a complex disorder associated with mixed etiologic factors between genders. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Since fine-motor movements and complex procedures, which are often necessary in dental practice, can be compared to those used by professional athletes, the purpose of this study was to determine the impact of the mental training technique, established in sport science, on dentistry. METHOD AND MATERIALS: In a randomized, controlled study, 2 groups of 20 and 21 dental students in their second semester (experimental group with mental training, and control group with conventional training, respectively), were evaluated at 2 time points (pre- and posttest) by measuring the effect of training by the criteria 'knowledge,' 'process,' and 'quality' of a crown preparation on the computer-assisted Dental-Simulator (DenX). RESULTS: The improvements of the experimental group and of the control group from pre- to posttest could be distinguished for all criteria in favor of the experimental group, in which improvements of knowledge (F1,39 = 72.674, P <.001) and process (F1,39 = 6.63, P = .01) were statistically significantly better. CONCLUSION: The significantly greater improvements of the experimental group regarding knowledge and process compared to the control group indicate that the improvement in learning and performance caused by mental training is detectable in dental education, especially with regard to cognitive aspects of dental procedures. [ABSTRACT FROM AUTHOR]

AIMS: To test in vitro and in vivo the reliability and accuracy of a new algometer, the pressure algometer for palpation (PAP), for measuring pressure pain thresholds (PPTs) and to compare its features with those of a commercially available pressure algometer. METHODS: For in vitro accuracy testing, 6 repeated measurements were made at 8 defined test weights from 0.5 to 5 lb. In vivo validity testing compared the PAP to a standard instrument, the hand-held Somedic algometer, at 16 sites including the masticatory muscles, the temporomandibular joints, and the frontalis (as the control site) in 15 temporomandibular disorder (TMD) cases and 15 controls. Intraexaminer reliability was also assessed for both algometers. RESULTS: In vitro reliability was high, with coefficients of variation of < 5% and a single-measurement standard deviation of 2.1 kPa. Accuracy was also high, with PAP measurements correlating with test weights at r = .99 (P < .001). Repeated measures reliability in vivo was high, with intraclass correlation estimates of 0.73 to 0.96 for the PAP and 0.78 to 0.99 for the Somedic algometer. PPT values correlated moderately between the 2 devices (r ranged from 0.38 to 0.66; P < or = .05) and were consistently higher for the PAP at all sites (P < .001). Differences between controls and TMD cases were also significant for both algometers (P < .006). CONCLUSION: Both the PAP and the Somedic algometer showed high reliability. Concurrent validity was demonstrated by statistically significant correlations between the devices. Both showed equally high capacity for differentiating TMD cases from controls. The PAP yielded significantly higher PPTs than the Somedic algometer. [ABSTRACT FROM AUTHOR]

PURPOSE: It is important to know whether tooth loss has an impact on an individual's quality of life, since tooth loss is common. The aim of this study was to determine whether oral status is associated with general health and related to quality of life. MATERIALS AND METHODS: Data of 1,406 subjects aged 60 to 79 years were taken from the Study of Health in Pomerania (SHIP). Sociodemographic (age, sex, and education level) and medical information (including the most common diseases in Germany) were gathered through an interview, and income data were obtained from a self-administered questionnaire. The prosthetic status in the maxilla and mandible was classified into complete denture or removable partial denture or with > or = 10 natural teeth including teeth replaced with fixed prosthodontics (> or = 10T) or with < or = 9 natural teeth including fixed prosthodontics (< or = 9T). The health-related quality of life was measured using the Short Form (SF-12) questionnaire. Multiple linear logistic regression analyses were used to identify the nonstandardized beta coefficient using physical and psychologic indices from the SF-12 as dependent variables and sociodemographic information, prosthetic status, and disease state as independent variables. RESULTS: Prosthetic status is related to the physical scale of the SF-12. Additionally, we found that < or = 9T had a significant effect on the physical index of general health-related quality of life. CONCLUSION: Reduced dentition without replacement of missing teeth by removable or fixed prosthodontics reduces the physical index of quality of life to the same extent as cancer or renal diseases. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Previous studies have shown that endotoxins are located on the periodontally diseased root cementum and not within it. To what extent a Teflon-tubed sonic scaler was capable of removing bacterial deposits in comparison to conventional scaling instruments, and the resulting root surface roughness and root surface topography, were recently assessed. The objective of the present study was to evaluate how much root cementum is removed with these instruments. METHODS AND MATERIALS: Eighty-two teeth were treated subgingivally on one approximal site either with a Teflon-coated sonic scaler insert (tSS), a Gracey curette, a conventional sonic scaler (SS), a piezoelectric ultrasonic scaler insert (US), or an oscillating Periotor insert (PT) before extraction. The untreated site served as control. The width and length of cementum removal were compared histomorphometrically. Nonparametric analyses were carried out for statistical comparison. RESULTS: The US, PT, and tSS inserts removed less substance than the curettes or SS inserts. The cementum removed was 40 microm for root surfaces treated with the curette or SS, 30 microm for those treated with US, 20 microm for PT, and 17 microm for tSS. CONCLUSION: The Teflon-coated sonic scaler inserts can be a reasonable choice for gentle maintenance treatment of compliant patients with good plaque control, and little or no subgingival deposits. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this investigation was to evaluate the role of various signs and symptoms of temporomandibular disorders (TMD), among other potential risk factors, in developing frequent headache in a population-based sample of the cross-sectional epidemiologic Study of Health in Pomerania (SHIP). The impact of headache and of myogenous and arthrogenous signs of TMD on the quality of life of this sample was evaluated. METHOD AND MATERIALS: Medical history and dental and sociodemographic parameters of 4,255 subjects were checked for correlations with frequent headache using a multivariate logistic regression model. The quality of life of the headache sufferers was evaluated with a questionnaire on mental and physical health. RESULTS: Of the sample, 9% reported suffering from frequent headache. Significant values for the odds ratios for the whole sample were found for pain on palpation of the masticatory muscles; the anamnestic question on masticatory muscle pain; ear noises; lateral palpation pain of the temporomandibular joints (TMJ); several sleep disorders; psychosomatic complaints; and risk for women. Palpation pain of the muscles showed a dose/response effect. Subjects with a higher education level had a significantly reduced risk for developing frequent headache. Anamnestic questions for pain in the TMJ area, TMJ clicking, smoking, alcohol abuse, contraceptives, income, and chronic diseases did not correlate significantly with frequent headache. Subjects who reported frequent headache exhibited a significant reduction of physical and mental health scores. Pain upon muscle palpation showed significantly reduced scores on both scales for both genders. CONCLUSION: Within the limitations of this study, in addition to sensitive TMJs, mainly palpation-sensitive masticatory muscles showed a significant relation to the occurrence of frequent headache. Because of the number of tested covariates originally included in the model, this relation seems essential. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Based on a randomized, population study (Study of Health in Pomerania [SHIP]), the objective of the present study was to determine incidence of signs and symptoms of temporomandibular disorders (TMD) in adults 20 years or older and to compare the data with TMD prevalence of other exclusively random sample studies that fulfilled criteria similar to those of this study (age > or = 20 years, age range > or = 40 years, sample size > or = 500 subjects, equal gender distribution). METHOD AND MATERIALS: Men and women (n = 7,008) 20 to 79 years of age from mid- and small-sized towns in a rural region in northeast Germany were randomly sampled from resident registry office files. The response rate was 68.8%. Adults between the ages of 20 and 81 years (n = 4,289) were clinically and anamnestically examined. RESULTS: Half of the subjects (49.9%) had one or more clinical signs of TMD, but only 2.7% were subjectively aware of temporomandibular joint (TMJ) pain symptoms. Women showed higher frequency for all signs and symptoms of TMD than men. However, these differences were not significant for all signs and symptoms in all age groups. The influence of age on TMD signs and symptoms was less pronounced. The prevalence for the following variables found in the present study compared to those of other comparable, random sample studies was: clinical examination; (TMJ) tenderness to palpation (5% versus 2% to 6%); masticatory muscle tenderness (15% versus 19% to 21%); joint sounds (25% versus 15% to 25%); limited maximum mouth opening < 40 mm (9% versus 5% to 8%); pain upon movement of the mandible (1% versus 1% to 3%); irregular jaw movements (deviation, deflection) (28% versus 28%); interview: subjective joint sounds (9% versus 11% to 13%); and subjective TMJ pain (3% versus 4% to 7%). CONCLUSION: The TMD incidence in the current study agreed quite well with the other studies based on random samples with similar subjects and design. The large range of prevalence for signs and symptoms of TMD documented in reviews and meta-analyses could therefore not be confirmed. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to evaluate associations among the dental status, socioeconomic factors, and general health of 1,877 subjects between the ages of 55 and 79. METHOD AND MATERIALS: Socioeconomic information (age, sex, education level) and questions on smoking and alcohol abuse were taken from an interview; income and medical information (number of diseases) were taken from a self-administered questionnaire; and HbA1C and CDT (diabetes and alcoholism markers) were taken from blood analyses. RESULTS: Of the subjects, 73% had a low education level, and 27% of the subjects had a monthly income of < 1,000 Euro and 13% of > 2,000 Euro. Twenty-six percent of the subjects were edentulous, and 29% had 20 or more teeth. The odds ratio of edentulism increased to 9.0 (95% confidence interval = 7.0-11.5) at the ages of 75 to 79 years compared to ages 55 to 79. Logistic regression analyses showed that edentulism was significantly associated with age, low education level, low income, smoking, and alcohol abuse. However, the retention of more than 20 teeth was associated with age. CONCLUSIONS: Age, low income, low education level, smoking, and alcohol abuse seemed to be risk markers for edentulism; whereas, the number of diseases, diabetes, and gender were not. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The microflora around and beneath restorations is an important factor of restoration failure. The aim of this pilot study was to determine and compare the microbial spectrum under composite and amalgam restorations with special attention to the anaerobic flora. METHOD AND MATERIALS: Ten composite and five amalgam restorations scheduled for replacement were clinically evaluated for marginal gaps, fractures, and secondary caries. After their removal and caries diagnosis, a dentin sample just below the restoration was taken under sterile conditions, stored in a prereduced transport medium for anaerobic bacteria, and immediately transferred to a laboratory for microbial diagnosis. RESULTS: The clinical parameters showing mostly moderate marginal imperfections and the ratios of aerobic to anaerobic flora were comparable for composite and amalgam restorations (11.4%:88.6% and 15.4%:84.5%, respectively). The microbial variety under composite restorations was much greater compared to amalgam, and it was similar to that of infected root canals including anaerobic gram-negative rods, such as Fusobacterium species or Porphyromonas species. Beneath amalgam, the microbial flora was similar to the one found in carious dentin and plaque, with anaerobic and facultatively anaerobic gram-positive rods dominating. Quantitatively, there were up to eight times more microorganisms under composite restorations. The number of bacterial strains correlated with the caries activity and the filling material, the number of anaerobic rods correlated highly with caries activity and localization. In a linear regression, caries activity and the filling material had statistically significant influence on the bacterial load. CONCLUSION: Although caries activity and location had the greatest influence on the microbial flora under the restorations, the kind of restoration material seemed to have an additional effect on the composition of the microflora. This pilot study indicates that inadequate composite restorations may promote the growth of cariogenic, as well as obligate anaerobic and potentially pulpopathogenic bacteria, which should be confirmed by further studies. [ABSTRACT FROM AUTHOR]

The goal of the Study of Health in Pomerania (SHIP) was to estimate the prevalence of diseases, identify potential risk factors in a defined region in northeast Germany, and examine the particular living situation of this population after the reunification of East and West Germany. One of the main concerns of the SHIP design is the analysis of the relationships between dental, medical, social, and environmentally and behaviorally determined health factors. SHIP is a cross-sectional study (clinical findings and sociologic interviews). The sample was drawn in two steps: Thirty-two communities in the region were selected, and within these communities, a simple random sample was drawn from residence registries, stratified by gender and age. The final sample included 4,310 males and females, aged 20 to 79 years. This is equivalent to a participation rate of 68.8%. Data collection was completed in May 2001. The data collection and items comprised four parts: oral health examination, medical examination, health-related interview, and a health- and risk-factor-related questionnaire. The oral health examination included the teeth, periodontium, oral mucosa, morphology and function of the craniomandibular system, and prosthodontics. The medical examination included blood pressure measurements; electrocardiography; echocardiography; carotid, thyroid, and liver ultrasound examinations; neurologic screening; and blood and urine sampling. The computer-assisted interview consisted of questions on symptoms of disease, utilization of medical and dental services, self-assessment of general and oral health, health behavior and knowledge, and socioeconomic variables. The self-administered questionnaire comprised housing conditions, social network, work conditions, subjective well-being, and individual consequences of the German reunification. [ABSTRACT FROM AUTHOR]

PURPOSE: The aim of the study was to evaluate associations among prosthetic status, socioeconomic factors, and general health of subjects aged 55 to 79 years. The data were taken from the Study of Health in Pomerania (SHIP). MATERIALS AND METHODS: Socioeconomic information (age, sex, education level), medical information (number of diseases), and details on smoking and alcohol consumption were obtained. Prosthetic status in the maxilla and mandible was classified into complete denture (CD), removable partial denture (RPD), > or = 10 natural teeth or teeth replaced with fixed prosthodontics (10T+), and < or = nine natural teeth including fixed prosthodontics (9T-). RESULTS: The data of 1,877 subjects were evaluated. CDs in the maxilla were more frequent than in the mandible. RPDs were more frequent in the mandible and in the group aged 65 to 74 years. Of the individuals with a low education level, 47% had a CD in the maxilla, and only 21% had 10T+. However, of subjects with a high education level, 22% had a CD in the maxilla, and 54% had 10T+. The odds ratio of having a CD in the maxilla increased to 11.9 at the age of 75 to 79 years, compared to 0.6 at the age of 55 to 59 years. Logistic regression analyses showed that the risk of wearing a CD was significantly associated with old age, low education level, low income, smoking, and alcohol abuse, whereas the number of diseases (used as an indicator of general health) was not. CONCLUSION: Alcohol abuse, smoking, low education level, low income, and old age were significant predictors of wearing CDs. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess the caries prevalence in the adult population of Pomerania, Germany in comparison to national and international data.Materials and Methods: The study sample comprised 4,022 randomly selected subjects who were examined from October 1997 to May 2001 within the "Study of Health in Pomerania" (medical and dental, population-based cross-sectional study in Pomerania, Northeast Germany. Response rate: 69%. Age range of subjects: 25-79 yrs). Carious defects, fillings and missing teeth were diagnosed and the DMFT/S scores were calculated according to WHO guidelines (1997). These figures were compared to other German, Swedish and US data.Results: Women exhibited higher mean DMFT and DMFS values in all age groups than men. The mean DMFT/S scores were slightly higher than the values for the only two available nationally representative age groups in Germany. The prevalence of primary carious lesions or secondary caries was very low, resulting in minor treatment needs (decayed surfaces: mean 0.95 +/- 3.3) and high care indices (FS/DFS) for all age groups (90-95%). In contrast to this, the mean numbers of fillings in adults and especially of missing teeth in seniors were much higher in Pomerania for all age groups than in the Swedish and US adult population, where a caries decline was demonstrated.Conclusion: In spite of a very low prevalence of primary carious lesions and secondary caries, the mean number DMFT/S and especially MT/S scores in the Pomeranian adult population are high in comparison with Swedish and US data, but differed only slightly from the limited available national data for Germany. [ABSTRACT FROM AUTHOR]

The article presents the study which examined the safety and efficacy of onabotulinum toxin-A (BoNT-A) injections in the masseter and temporalis muscles in patients with symptomatic sleep bruxism. It offers details on the method of the study which involved a randomized, placebo-controlled study on a number of patients aged between 18 and 85 years with clinically diagnosed sleep bruxism confirmed by polysomnography.

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