Showing satisfactory psychometric properties, DREEM proved suitable for assessing educational environments among dental students. Given the right circumstances, e.g., small and early clinically oriented classes, traditional curricula can generate positive environments.
Background
The diagnosis and management of patients suffering from occlusal dysesthesia (OD) remain a major challenge for dental practitioners and affected patients.
Objectives
To present the results of a literature‐based expert consensus intended to promote better understanding of OD and to facilitate the identification and management of affected patients.
Methods
In 2018, electronic literature searches were carried out in PubMed, Cochrane Library and Google Scholar as well as in the archives of relevant journals not listed in these databases. This approach was complemented by a careful assessment of the reference lists of the identified relevant papers. The articles were weighted by evidence level, followed by an evaluation of their contents and a discussion. The result represents an expert consensus.
Results
Based on the contents of the 77 articles identified in the search, the current knowledge about clinical characteristics, epidemiology, aetiology, diagnostic process, differential diagnosis and management of OD is summarised.
Conclusions
Occlusal dysesthesia exists independently of the occlusion. Instead, it is the result of maladaptive signal processing. The focus should be on patient education, counselling, defocusing, cognitive behavioural therapy, supportive drug therapy and certain non‐specific measures. Irreversible, specifically an exclusively dental treatment approach must be avoided.
This study was to compare the short-term therapeutic efficacy of device-supported sensorimotor training with that of standard splint therapy for patients with myofascial temporomandibular disorder (TMD) pain over a treatment period of 3 months. We tested the hypothesis that both types of intervention are equally effective for pain reduction. In addition, the electromyographic (EMG) activity of the temporal and masseter muscles was recorded under conditions of force-controlled submaximum and maximum biting in intercuspation. Of consecutive patients seeking treatment for non-odontogenic oro-facial pain, 45 patients with myofascial TMD pain (graded chronic pain status, GCPS, I and II) were randomly assigned to 2 treatment groups (sensorimotor training and conventional splint treatment). Patients were evaluated 4 times (initial examination, 2, 6 and 12 weeks later) by use of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Electromyographic activity was recorded at the initial session and after 3 months. Ease-of-use of the treatment options was also evaluated. Significant (P < .0001) pain reduction (sensorimotor training 53%, splint therapy 40%) was achieved for both groups, with no significant differences (P > .05) between the groups. Force-controlled sub-maximum normalized electromyographic activity was significantly different between T0 and T3 for group A (sensorimotor training, P < .05) but was not significantly different for group B (splint, P > .05). For normalized maximum-biting EMG activity in intercuspation, however, a significant increase in EMG activity was observed for group A for the masseter and temporal muscles (P < .001) and for group B for the masseter muscle only (P < .001). Moreover, sensorimotor training was significantly (P < .05) less easy to use than the splint. The results of this study confirm the pain-reducing effect of sensorimotor training for patients with myofascial TMD pain (GCPS I and II). This innovative active treatment might be a promising option for TMD pain patients.
The recommendations reflect the current state of pain medicine. Therefore, they should be considered among practitioners who diagnose and manage patients suffering from temporomandibular disorders.
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