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Halitosis, an offensive breath odour, has multiple sources and negative impacts on people's social interactions and quality of life. It is important for health care professionals, including general physicians and dental professionals, to understand its aetiology and risk factors in order to diagnose and treat patients appropriately. In this study, we have reviewed the current literature on halitosis regarding its prevalence, classification, risk factors, sources, measurement and treatment. [ABSTRACT FROM AUTHOR]

Aims: To estimate the diagnostic accuracy of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) clinical examination and of the dynamic/static tests for the recognition of TMD pain. Since the diagnosis of TMD pain is especially complicated in persistent orofacial pain patients, the test outcomes in persistent TMD pain patients were contrasted to those in two control groups: a group of persistent dental pain patients and a group of pain-free subjects. Methods: In 125 persistent TMD pain patients, 88 persistent dental pain patients, and 121 pain-free subjects, a blind and standardized clinical examination was performed. Results: For the RDC/TMD, sensitivity (88%) was high and specificity was low (pain-free group: 71%; dental pain group: 45%). For the dynamic/static tests, sensitivity was 65% and specificities were 91% and 84%, respectively. Comparing the outcomes of the two examinations showed higher positive likelihood ratios for dynamic/static tests (P < .001), and lower negative likelihood ratios for the RDC/TMD examination (P < .01). Conclusion: For the confirmation of a suspicion of TMD pain, it is better to rely on positive dynamic/static tests. To confirm the absence of TMD pain, it is better to rely on a negative RDC/TMD examination. [ABSTRACT FROM AUTHOR]

AIMS: To compare the tactile detection threshold, the filament-prick pain detection threshold, the pressure pain threshold, and the pressure pain tolerance detection threshold at multiple measuring points in the orofacial region and at the thenar muscle of symptom-free subjects and patients with myofascial pain of the masticatory muscles. METHODS: Twenty patients (age range: 25 to 55 years) and 20 healthy subjects (age range: 25 to 55 years) were recruited. The tactile detection threshold and the filament prick-pain detection threshold were measured at the cheek skin overlying the central part of the left and right masseter muscles, at the right thenar muscle and at the tip of the tongue, using Semmes-Weinstein monofilaments. The pressure pain threshold and the pressure pain tolerance threshold were measured at the central part of the masseter muscle and on the thenar muscle, using a pressure algometer. The intensity of pain perceived during the assessment of filament prick-pain detection threshold, pressure pain threshold, and the pressure pain tolerance threshold was scored on visual analog scales. RESULTS: The tongue tip had the lowest filament prick-pain detection thresholds as compared to the other sites. Filament prick-pain detection thresholds of the tongue and thumb sites were significantly lower in myofascial pain patients than in controls. Pressure pain thresholds of the masseter and thenar muscles were significantly lower in patients with myofascial pain than in control subjects whereas pressure pain tolerance thresholds did not differ significantly between patients and controls. CONCLUSIONS: The findings of the present study show topographic variations in the pain responses to different stimulus modalities. Different pain responses were also found between patients with myofascial pain and control subjects and were interpreted to support theories of centrally mediated pain for temporomandibular disorders. [ABSTRACT FROM AUTHOR]

AIMS: To determine the reliability and the validity of visual leg measurements used in dental kinesiology, which suggests that a masticatory dysfunction, such as occurs in temporomandibular disorders (TMD), can influence the length and the internal rotation of lower limbs. METHODS: The leg-length inequality test and the internal foot-rotation test were performed independently by 3 different examiners on 41 subjects who were also screened for TMD. Data were analyzed by means of kappa statistics and by calculation of sensitivity and specificity values. RESULTS: Chance-corrected reliability was generally poor for both the leg-length inequality test (0.33 < or = k < or = 0.39) and the internal foot-rotation test (0.15 < or = k < or = 0.27). Sensitivity and specificity values of the tests to differentiate TMD and healthy subjects were below acceptable thresholds; they ranged from 0.41 to 0.57. CONCLUSION: Visual evaluations of leg-length inequality and internal foot rotation were unreliable and are not valid for TMD diagnoses. The results of chiropractic visual leg measurement procedures in dentistry should be interpreted with caution, particularly when clinical decisions may lead to nonreversible dental treatment. [ABSTRACT FROM AUTHOR]

AIMS: To compare the short-term efficacy of patient education only versus the combination of patient education and home exercises for the treatment of myofascial pain of the jaw muscles. MATERIALS AND METHODS: Seventy myogenous temporomandibular disorder patients were assigned to 2 treatment groups. One group received patient education supplemented by general information about self-care of the jaw musculature. The other group received both education and a home physical therapy program. Treatment contrast, calculated from the mean normalized relative changes in anamnestic and clinical scores, was used to determine treatment success. Clinical outcome measures included pressure pain threshold (PPT) of the masseter, anterior temporalis, and Achilles tendon; pain-free maximal jaw opening; and pain on chewing, spontaneous muscle pain, and headache as rated on visual analog scales. RESULTS: After 3 months the success rate was 57% for the group that received education only and 77% for the group that received both education and home physical therapy (P = .157). The patients were then redivided into 2 groups: successfully treated patients and unsuccessfully treated patients. In the unsuccessfully treated group, pain-free maximal jaw opening increased significantly more among those who had been in the education and physical therapy group than among those who had been in the education-only group (P = .019). The change in PPT was significantly greater in successfully treated patients than in unsuccessfully treated patients (.009 < P < .039), independent of the treatment modality, with higher PPTs among successful patients. There were no significant differences between the successfully and unsuccessfully treated groups or between treatment modalities for any other variable. CONCLUSION: Over a period of 3 months, the combination of education and a home physical therapy regimen, as used in this protocol, is slightly more clinically effective than education alone for the treatment of myofascial pain of the jaw muscles. [ABSTRACT FROM AUTHOR]

Temporomandibular disorders can usually be diagnosed on the basis of a thorough history and a comprehensive examination of the patient. Additional diagnostic tests, such as imaging of the temporomandibular joint (TMJ) area, are mandatory and must be flawless in case of atypical findings. The aim of this report is to illustrate pitfalls in clinical reasoning and in imaging procedures in the diagnosis of temporomandibular pain and dysfunction. A case report of a patient with osteocartilaginous exostosis of the mandibular condyle, which was erroneously diagnosed and treated as an internal derangement of the TMJ for half a year, is presented. [ABSTRACT FROM AUTHOR]

AIMS: To investigate the effects of a natural emotional stressor on pressure-pain thresholds (PPTs) of the masticatory muscles of symptom-free subjects. METHODS: Sixteen healthy dental students were selected before they undertook an academic examination. Sixteen gender-matched students who were not exposed to an examination served as controls. The 2 groups of students were monitored in parallel on 5 separate days over a 1-month period: 2 days before the examination (T1), on the day of the examination (T2), 2 days after (T3), 1 month after (T4), and again after another 2 days (T5). On the day of the examination (T2), the control students were only required to complete a brief, non-demanding questionnaire. On each day, the following parameters were assessed: PPTs of the masseter, the anterior temporalis, and the Achilles tendon; state anxiety; and present stress (measured on a visual analog scale [VAS]). Furthermore, in the students undergoing the examination, venous blood samples for assessment of beta-endorphin levels were obtained at T2 and T5. RESULTS: In the stressed students, the PPTs of the masticatory muscles and the Achilles tendon were significantly lower (analysis of variance [ANOVA], P < or = 0.02) on the day of the examination (T2) and on the days nearest the exam (T1, T3), and state anxiety and present stress were significantly higher (ANOVA, P < or = 0.003). No significant change was found in beta-endorphin plasma levels (P > 0.05). In the control group, PPTs, state anxiety, and present stress did not change significantly (ANOVA, P > 0.05). CONCLUSION: The results support a relationship between psychologic stress and pressure-pain sensitivity of the masticatory muscles. [ABSTRACT FROM AUTHOR]

AIMS: To test the hypothesis that the ovarian cycle influences the pressure-pain threshold of the masticatory muscles. METHODS: Eighteen healthy women with a regular menstrual cycle (28 +/- 2 days), ranging in age from 18 to 35 years, participated in the study. For each subject, pressure-pain thresholds (PPTs) of the masseter and temporalis muscles were assessed at 4 muscular sites by means of an electronic algometer. Measurements were taken at 4 separate sessions across the menstrual cycle corresponding to the following phases: menstrual, follicular, periovulatory, and luteal. Menstrual cycle phases were determined by a pelvic ultrasonographic screening. The study was carried out in a single-blind design, and the initial session was randomly determined for each individual. Data collected were analyzed by repeated-measures analysis of variance. RESULTS: The findings suggest that the PPTs of several masticatory muscles (2 of 4) are influenced by the ovarian cycle, but to a minor extent (P < 0.05), and the influence is of limited clinical relevance. CONCLUSION: In healthy subjects, there is a link between mechanical sensitivity of the masticatory muscles and fluctuation of the ovarian hormones. The relationship between PPTs of the masticatory muscles and the ovarian cycle should be also investigated in patients with temporomandibular disorders and/or orofacial pain conditions. [ABSTRACT FROM AUTHOR]

Background and objective: Enameloplasty is a common clinical procedure that involves removing small amounts of tooth enamel to change a tooth's shape and surface, resulting in an increased surface roughness. The relationship between enamel surface roughness and caries, however, is still a matter of debate. The aim of the study was to assess the adhesion of bacteria to enamel after enameloplasty and the effect of polishing enamel after enameloplasty on bacterial adhesion. Materials and Methods: Thirty-two human premolar teeth were either subjected to enameloplasty with diamond burs (n=8), diamond discs (n=8), Soflex polishing discs (n=8), or served as controls with no enameloplasty (n=8). The roughness of enamel surfaces was assessed using atomic force microscopy (AFM). Streptococcus sanguinis cells were incubated with enamel samples and colony-forming units (CFUs) adhering to the enamel were counted. Results: The CFUs were highest on the roughest enamel surfaces that were created with the medium bur (CFUs = 12.3 ± 0.5 x 105), followed by the mesh disc (CFUs = 4.0 ± 0.5 x 10s). The control surface had the next highest cell count (CFUs = 1.2 ± 0.1 x 105). The smoothest surfaces, created by Soflex polishing discs, had the lowest number of adhering bacteria (CFUs = 0.3 ± 0.05 x 105) (p < 0.001 for all). A significant positive relationship was found between the enamel surface roughness and number of bacteria adhered (p < 0.001). Conclusions: There was a positive relationship between the adherence of S. sanguinis cells to tooth enamel and the enamel surface roughness. Polishing enamel after enameloplasty produced surfaces to which fewer bacteria adhered compared to untreated enamel. [ABSTRACT FROM AUTHOR]