bluuebunny/crossref_metadata_2025 huggingface dataset:
Six‐year follow‐up of titanium and high‐gold porcelain‐fused‐to‐metal fixed partial dentures
Authors: Walter M. , Reppel P. ‐D. , Böning K. , Freesmeyer W. B.
Published: March 2003

In a randomized clinical study 47 titanium and gold‐alloy fixed partial dentures (FPDs) were placed during a 1‐year period. In the titanium group (n=22) all metal substructures were made of unalloyed titanium. The titanium substructures were fabricated by copy milling, spark erosion and laser welding (Procera®, Nobelpharma). Ceramic veneering was carried out with Duceratin® titanium ceramics (Ducera, Germany). In the control group (n=25) the high‐gold alloy Degudent U® (Degussa, Germany) and Vita VMK 68® ceramics (Vita, Germany) were used. The longest observation time was 6 years. Only one FPD had to be removed due to metal–ceramic failure (titanium group). The clinical performance of all 125 porcelain‐fused‐to‐metal (PFM) veneers with respect to the longevity of the metal–ceramic compound was described by Kaplan–Meyer survivor analyses. Relating survival to a completely intact ceramic veneer, the 5‐year survivor rate was 84% for titanium and 98% for the high‐gold alloy. PFM titanium restorations exhibited a significantly increased risk of metal–ceramic failure. However, concerning defects requiring removal, no significant differences in titanium versus high‐gold alloy occurred. There were no significant differences in the survival distributions between crowns and pontics within the two groups.
The reinforcement of dentures
Authors: Jagger D. C. , Harrison A. , Jandt K. D.
Published: March 2003

The material most commonly used for the fabrication of complete dentures is poly (methyl methacrylate) (PMMA). This material is not ideal in every respect and it is the combination of virtues rather than one single desirable property that accounts for its popularity and usage. Despite its popularity in satisfying aesthetic demands it is still far from ideal in fulfilling the mechanical requirements of a prosthesis. The fracture of dentures may be due to the mechanical properties of the acrylic resin or may be due to a multiplicity of factors leading to failure of the denture base material. Generally, there are three routes which have been investigated to improve the impact properties of PMMA: the search for, or development of, an alternative material to PMMA; the chemical modification of PMMA such as by the addition of a rubber graft copolymer; and the reinforcement of PMMA with other materials such as carbon fibres, glass fibres and ultra‐high modulus polyethylene. The following review of attempts to improve the mechanical properties of denture base material takes account of papers published during the last 30 years.
Electromyographic study of the activity of jaw depressor muscles before initiation of opening movements
Authors: Uchida S. , Inoue H. , Maeda T.
Published: March 2003

The authors attempted to clarify the primary factors affecting the timing of the initial electromyographic discharges in the jaw depressor muscles (EMG onset). The changes in EMG onset in the inferior head of the lateral pterygoid (Lpt) and the anterior belly of the digastric muscles (Dig) were measured by varying duration of the open–close movement or occlusal force during the open–close–clench cycle (OCC). EMG onset tended to precede the beginning of the opening movement during OCC. The duration of opening and closing phase and the duration of occluding phase showed no significant correlation with the time‐lag between EMG onset and the beginning of the opening movement (onset time).The mean EMG activity of the masseter muscle (Mm), corresponding to the occlusal force, showed a highly significant correlation with the onset time. The maximal opening velocity was highly correlated with the mean EMG activity of the jaw depressors before jaw opening. In conclusion, it was found that occlusal force is a major factor in EMG onset in the jaw depressors. It is suggested that smooth opening needs tooth contact with some degree of occlusal force.
Comparative wear ranking of dental restoratives with the BIOMAT wear simulator. Part II. An SEM evaluation
Authors: Yap A. U. J. , Ong L. F. K. L. , Teoh S. H. , Hastings G. W.
Published: March 2003

The qualitative wear of amalgam alloys and composite resins opposing cast chromium alloys after impact–sliding wear simulation with the BIOMAT wear simulator was assessed. An impact stress of 28 MPa was adopted to allow for stresses generated during parafunctional activities. The worn specimens were examined using SEM at both impact sites and region of sliding wear. For amalgam alloys, ranking from the smoothest to the roughest surface under SEM observation was as follows: unicompositional alloy>admixed alloy>gallium alloy. For composite resins the ranking was: microfilled composite>small particle composite>hybrid composite. The qualitative SEM assessment results were consistent with our earlier volumetric wear results and supports the hypothesis that surface microstructure affects wear. Composite selection for teeth opposing cast chrome prostheses should be done with caution and knowledge of the composition of the material as three‐body wear may occur.
Degradation of repaired denture base materials in simulated oral fluid
Authors: Lin C.‐T. , Lee S.‐Y. , Tsai T.‐Y. , Dong D.‐R. , Shih Y.‐H.
Published: March 2003

This in vitro study evaluates the degradation of repaired denture bases upon immersion in a simulated oral fluid. Denture base materials (Luciton 199®), after being repaired by Repair Material® and Triad®, using three different joint surface designs (butt, round and 45 ° bevel), were immersed onto 99·5 vol.% ethanol/water solution (with similar solubility parameter) for various amounts of time (0–72 h). The flexural loads of the six combination of groups were measured by the three‐point bending tests using a universal testing machine. Acoustic emission (AE) during sample fracturing were processed using the MISTRA 2001 system. The fracture pattern and surface details of the interface were examined with a scanning electronic microscope (SEM). Data were analysed using three‐way
anova and Tukey LSD tests. SEM micrographs of the fracture interface were used to differentiate the fracture mode. The flexural loads (2·72±0·51 Kgf) of the round joint specimens were significantly higher (P<0·05) than those (butt: 1·66±0·38 Kgf, 45 ° bevel: 1·93±0·41 Kgf) of the other two designs. This corresponds to the microscopic examination in which more cohesive failure mode was found for the round joint group after storage. The flexural loads (2·54±0·39 Kgf) of the specimens repaired with Triad® were significantly higher (P<0·05) than those (1·59±0·40 Kgf) of specimens repaired with Repair Material®. Significant progressive reduction of the flexural load and/or AE signals of the specimens was noted in proportion to the length of time of the immersion in the simulated oral fluid. Mechanical strength of a denture base repaired with a round joint design and light‐cured material is significantly higher after immersion in simulated oral fluid.
Influence of clenching level on intercuspal contact area in various regions of the dental arch
Authors: Gurdsapsri W. , Ai M. , Baba K. , Fueki K.
Published: March 2003

The purpose of this study was to evaluate the relationship between the clenching level and the intercuspal contact area in different regions of the dental arch. Twenty‐five healthy subjects with natural normal dentitions and good occlusal support performed clenching tasks in the intercuspal position at four different levels (10, 30, 70 and 100% levels of maximum voluntary contraction) through EMG visual feedback from bilateral masseter and anterior temporal muscles. Simultaneously, the occlusal contacts were recorded with a silicone occlusal contact checking material (Black Silicone, GC Dental Industrial Corp., Tokyo, Japan). The occlusal records were analysed by an image analyser. Every area of the thickness less than 50 μm was determined to be an occlusal contact area. The occlusal contact areas on the anterior teeth (incisors and canines), the premolars (first and second premolars) and the molars (first and second molars) were calculated separately. The posterior occlusal contact area increased with an increase in the clenching levels but that of the anterior did not. The results of this study indicate that the increase in clenching forces affects the anterior and posterior occlusal contact areas differently.
Effects of aging on repair of resin‐modified glass–ionomer cements
Authors: Yap A. U. J. , Lye K. W. , Sau C. W.
Published: March 2003

The effects of aging on the repair bond strengths of resin‐modified glass–ionomer cements after different methods of surface conditioning were studied. Surface conditioning methods included the following: maleic acid; maleic acid with resin application; polyacrylic acid; polyacrylic acid with resin application. Shear bond testing between the aged and new material was carried out with an Instron Universal testing machine. Surface conditioning with maleic acid and resin application gave the highest repair bond strengths at 3 and 6 months. There was, however, no statistically significant difference in bond strengths between the different treatment groups after both 3 and 6 months storage. Intergroup comparisons revealed no significant difference in failure modes after both storage periods. For all treatment groups, no significant difference in repair bond strengths was noted between storage after 1 week, 3 and 6 months. There appears to be a general decrease in repair bond strengths for all treatment groups after 3 months storage. The clinical repair of resin‐modified glass–ionomer cements after this period of time is therefore not recommended.
Effect of prefabricated metal post‐head design on the retention of various core materials
Authors: Zalkind M. , Shkury S. , Stern N. , Heling I.
Published: March 2003

Retention of various post heads to core restorative materials is an important factor in the selection of prefabricated post systems and restorative materials for the restoration of endodontically treated teeth. This study examines the retention of a post–core prefabricated system in relation to core material and post‐head design. A total of 60 samples were prepared using two different post systems (ParaPost Plus® (PP) and ParaPost Unity® (PU), with amalgam, composite or glass–ionomer as one of the core materials. The samples were tested using the Instron testing machine. The PP was superior to the PU prefabricated post with respect to the retention of various core materials. Retention values in descending order of magnitude were found to be: composite, amalgam and glass–ionomer (significantly lower). The rhomboid serrated design of PP was superior in retention to the rounded smooth UP system. Composite material proved to be superior in retention, closely followed by amalgam, with glass–ionomer significantly less retentive.
Need for occlusal therapy and prosthodontic treatment in the management of temporomandibular disorders.
Authors: De Boever J. A. , Carlsson G. E. , Klineberg I. J.
Published: March 2003

The second part of this review, evaluating the literature on the relationship between dental occlusion and temporomandibular disorders (TMDs), focuses on the aetiological importance of tooth loss and the place of prosthodontic replacement in the treatment of TMD. Loss of teeth and lack of posterior occlusal support seem to have little influence on the development of TMD, which calls into question the use of prosthodontic restoration as prevention or treatment for TMD. In addition, there are practically no studies assessing the benefit of instrumental analysis in diagnosis or comparing the outcome of prosthodontic treatment with simple reversible methods in the management of TMD. There is a trend in the current literature to abandon any treatment, including positioning appliances and prosthodontic measures, to ‘recapture the disk’ in patients with disk displacements because of the favourable, long‐term results achieved after using more simple methods. It is concluded that prosthetic therapy in TMD patients is not appropriate for initial TMD treatment and should only be carried out on prosthodontic indications after reversible treatment has alleviated pain and dysfunction.
An in vitro wear study of posterior denture tooth materials on human enamel
Authors: Abe Y. , Sato Y. , Taji T. , Akagawa Y. , Lambrechts P. , Vanherle G.
Published: March 2003

This in vitro study evaluated the wear effects of five posterior denture tooth materials on human enamel. The tooth specimen was cusp shaped and enamel specimen was formed as a 10 Ç 10 Ç 5 mm plate. All material‐enamel combinations were tested using a machine designed to produce sliding contact 20 Ç 104 times at 60 cycles min–1 and a 4‐mm sliding distance per stroke in the bucco‐lingual direction under a load of 1 kg. Wear analysis was measured as the total height loss of each combination. In addition, the surface roughness (Ra) of each worn specimen was also evaluated. The least total height loss occurred with poly (methyl methacrylate) (PMMA) enamel pair, and the greatest did with porcelain (Po)‐enamel pair. The lowest compound Ra value was measured in high‐strength resin (HR)‐enamel pair, and the highest in Po‐enamel pair. These findings suggest that the best combination is PMMA‐enamel, and the poorest combination is Po‐enamel.
The influence of selective grinding on the thickness discrimination threshold of patients wearing complete dentures
Authors: Schierano G. , Arduino E. , Bosio E. , Preti G.
Published: March 2003

The influence of selective grinding on the ability of patients wearing complete dentures to discriminate thicknesses occlusally was evaluated. The study included two groups of white Caucasian patients, matched for age, sex and duration of edentulism; 12 wearing traditional complete dentures and 12 wearing maxillary complete denture and mandibular implant‐retained overdenture (MIR‐OVD). The ability to discriminate thickness was evaluated before and after selective grinding. In both groups, sensitivity improved after selective grinding. Subjects wearing MIR‐OVD showed a better ability to discriminate thickness than those rehabilitated with traditional complete dentures. The thickness discrimination threshold might be a suitable method to evaluate complete dentures fit.
Mycological and cytological examination of oral candidal carriage in diabetic patients and non‐diabetic control subjects: thorough analysis of local aetiologic and systemic factors
Authors: Kadir T. , Pisiriciler R. , Akyüz S. , Yarat A. , Emekli N. , Ipbüker A.
Published: March 2003

In this study, 55 diabetic patients and 45 non‐diabetic control subjects were examined to determine oral candidal carriage state. The influence of some local aetiologic and systemic factors such as: salivary flow rate and pH, heredity, alcohol drinking, smoking habits, antimicrobial therapy, wearing of denture, burning sensation, dry mouth, taste alteration and tooth brushing habit on candidal carriage rate were investigated. Imprint culture, cytological smears and biochemical tests were used. Oral carrier rate and density of Candida species were non‐significantly higher in the diabetic patients than in the non‐diabetic control subjects. This increase was confirmed cytologically too. In both groups, Candida albicans was found to be a predominant species on tongue dorsum. Cigarette and alcohol habits of men were higher while tooth brushing habit was less than in women in diabetic and control groups. Salivary flow rate and pH values of diabetic patients were significantly lower while serum glucose values were significantly higher than of non‐diabetic controls. The rate of diabetic patients suffering from dry mouth and having diabetic heredity in the family were significantly higher than control subjects. The candidal colonization was higher and keratinization was lower while diabetic treatment tended from diet and oral antidiabetic towards insulin. The decrease in salivary pH, the increase in serum glucose and wearing denture were correlated with the increased rate and density of C. albicans in both groups. Keratinization was also accompanied with the increase in leucocytes. In diabetic group, positive correlations were found between antimicrobial therapy and C. glabrata carriage; the increase in leucocytes and C. albicans carriage; the increase in keratinization and alcohol habit; serum glucose and smoking habit; dry mouth complaint and antimicrobial therapy. There was a negative correlation between salivary flow rate and C. albicans carriage. In control group a positive correlation was found between antimicrobial therapy and keratinization.
The influence of the location of load transfer on strains around implants supporting four unit cement‐retained fixed prostheses: in vitro evaluation of axial versus off‐set loading
Authors: Çehreli M. C. , İpli̇kçi̇oğlu H. , Bi̇li̇r Ö. G.
Published: March 2003

Prudent control of the biomechanical load on dental implants is imperative to achieve long‐term clinical success. The design of the final prosthesis and location of force transmission have a definitive influence on the quantification of induced strains and load partitioning among implants. While axial loading of implants generate an even distribution of stresses in the bone around implants, off‐set loading, which is particularly observed in screw retained prosthesis increases the stresses at the bone–implant interface. This study evaluated the cervical strains on dental implants supporting four unit cement retained fixed prostheses under 50 N static axial and off‐set loading conditions. As the type of strains are also dependent on the point of load transfer, design of the prosthesis and implant positioning, the study comprised the evaluation of induced strains through a simulation of five cement retained prosthetic options. The results revealed that off‐set loading increases the magnitude of strains. However, it was not significant for all configurations (P < 0Ã05). This finding emphasizes the accompanying effect of implant location, angulation and macrogeometry of the prosthesis and, that the biomechanical evaluation of affecting factors is a multifaceted phenomenon.
Effect of tooth brushing and thermal cycling on a surface change of ceromers finished with different methods
Authors: CHO L.‐R. , YI Y.‐J. , HEO S.‐J.
Published: March 2003

Summary This in vitro study evaluated the effect of tooth brushing and thermal cycling on the surface lustre and surface roughness of three ceromer systems treated with different surface finishing methods. The ceromers studied were: (1) Artglass, (2) Targis, (3) Sculpture and (4) the control group, Z100. Half of the Targis and Sculpture groups were polished and the rest were coated with staining and glazing solution, respectively. All specimens were subjected to thermocycling 10 000 times. Tooth brushing abrasion tests were performed in a customized tooth‐brushing machine with 500 g weight applied on a back‐and‐forth cycle for 20 000 repetitions. The lustre determined by measuring the light reflection area and the average roughness was compared between groups and between pre‐ and post‐test values. All materials showed a lower lustre and rougher surface after thermocycling and tooth brushing (P < 0·05). All ceromer specimens, except glazed Sculpture, showed a higher lustre and similar roughness to the control group. The post‐brushing results revealed that glazed Sculpture presented discretely fallen out glaze coatings and had maximum change. However, stained Targis showed minimum change (P < 0·05) and polished Targis presented more changes than that of the staining treatment. It is therefore concluded that the glaze coatings for Sculpture don't exhibit long‐term durability, while stain coatings for Targis acted like a protective layer.
Tooth contacts at the mandibular retruded position, comparison of two different methods for bite registration
Authors: YAMASHITA S. , IGARASHI Y. , AI M.
Published: March 2003

Summary Occlusal conditions at the retruded contact position (RCP) have been thought to be among the aetiological factors for temporomandibular disorders. However, the role of these occlusal factors remains still unclear. The purpose of this series of studies was to investigate the locations of RCP contacts and to discuss their meaning. In this part of the study, two different methods for bite registration at the RCP have been compared. Twenty dentists were selected as subjects for this study. One expert operator moved the subject's mandible up and down while guiding it gently backward until rotating on its retruded axis. Once the initial tooth contacts were established, the operator checked them using a thin articulating paper (direct method). Silicone‐based impression material was used for bite registration while the subject kept the jaw at this contact position (indirect method). Differences between the two registration methods regarding locations of tooth contacts were evaluated. Results from the direct method showed that tooth contact at the first premolar was most frequently observed. Statistical difference was not shown between the two registration methods regarding locations of RCP contacts.
Fracture resistance of pressable glass–ceramic fixed partial dentures
Authors: Nakamura T. , Ohyama T. , Imanishi A. , Nakamura T. , Ishigaki S.
Published: March 2003

summary  The aim of the present study was to evaluate the mechanical strength of the Empress2 system, which is based on the use of a high‐strength glass‐‐ceramic core of lithium disilicate, and the fracture resistance of fixed partial dentures fabricated with this material. To evaluate mechanical strength, four types of ceramic materials were tested for four‐point flexural strength and diametral tensile strength: Empress2 core material, Empress2 layering porcelain, conventional Empress material and Dicor. Then, using Empress2, conventional Empress and Dicor, actual clinical type anterior fixed partial dentures were fabricated for fracture testing. The results showed that the Empress2 core material, at 329 MPa, has more than twice the flexural strength of conventional materials and at 271 MPa, more than four times the diametral tensile strength of conventional materials. Furthermore, fixed partial dentures fabricated with Empress2 had a fracture resistance of 1424 N. That is, they were more than twice as fracture resistant as fixed partial dentures made with conventional materials.
Effects of a bleaching agent containing 35% carbamide peroxide on the immunolocalization of cyclin D and p16
Authors: GOMEZ R. S. , De CASTRO ALBUQUERQUE R. , DUTRA R. A. , VASCONCELLOS W. A. , REIS D. A. , GOMEZ R. S. , GOMEZ M. V.
Published: March 2003

Summary The evidences that p16 and cyclin D alterations occur in the earlier stages of many human cancers and that its immunolocalization can be used to study the cell cycle regulation, coupled with the possibility that chronic use of carbamide peroxide would induce DNA damage and cell cycle alteration, prompted us to analyse the effect of carbamide peroxide on the immunolocalization of these proteins in rat oral mucosa. Ten male Wistar rats were selected and submitted to topical application of 35% carbamide peroxide over buccal mucosa. The procedures were carried out twice a week for 3 months consecutively. The animals were killed after the last treatment and the buccal mucosa was removed and stored at −70 °C. Only distilled water was applied over the buccal mucosa of the control animals. The biotin–streptavidin amplified system was used for identification of cyclin D and p16 antigens and the percentage of basal and suprabasal cells positive for each one were obtained. The results did not show any difference between the experimental and control groups regarding the immunolocalization of cyclin D and p16. In conclusion, the present study showed that chronic use of carbamide peroxide does not induce cell cycle alteration in the oral mucosa of rats.
Evaluation of mastication‐induced change in sympatho‐vagal balance through spectral analysis of heart rate variability
Authors: Shiba Y. , Nitta E. , Hirono C. , Sugita M. , Iwasa Y.
Published: March 2003

summary  Mastication modulates the autonomic nervous activity of the digestive glands and the heart. The autonomic nervous balance is evaluated with spectral analysis of heart rate variability. In the present study, we investigated the effects of mastication of chewing gum base on heart rate variability to clarify the role of mastication in the sympatho‐vagal balance for the regulation of the heart rate. Mastication of a chewing gum base stimulated the salivary secretion and shortened the R‐R intervals in the electrocardiogram of healthy young subjects without swallowing of saliva at a fixed rate of respiration. Based on the analysis of heart rate variability, mastication increased the low‐frequency band spectral power (LF), and decreased the high‐frequency band spectral power (HF). The LF/HF was markedly increased by the mastication. Mastication enhances the sympathetic nervous activity and/or suppresses the parasympathetic nervous activity for the heart. Feeding behaviour with mastication might play a role in the modulation of the autonomic nervous activity.
Life quality and psychosomatic conditions of patients wearing complete dentures
Authors: GRUNERT I. , KAPELLER P. , SCHÜßLER G.
Published: March 2003

Along with denture related factors (for instance poor‐fitting denture bases inadequate vertical and horizontal jaw relationships) personality conditions such as depression or psychosomatic disorders pre‐existing during treatment of an edentulous patient may affect the treatment outcome and the possibility of successful adaptation of the full dentures. Muller‐Fahlbusch termed this a ‘psychogenic full dentures disability’. This is not an uncommon problem, up to 15% individuals from a not selected aged population may present psychosomatic disorders (Hinterhuber & Fleischhacker, 1997).

The aim of this study was to explore the suitability of special questionnaires, to identify these difficulties to treat and in the follow ups time intensive patients before treatment.

Twenty‐five patients wearing complete dentures for many years and classified as ‘average’ were recruited for this study. A group of 220 patients with psychosomatic diseases of the University of Münster and a healthy German population served as control groups using the same questionnaires.

First the personality profile was explored (general health condition and specific dental problems). Further questionnaires were used to determine the psychosomatic condition of the patient: the Hospital Anxiety and Depression Scale‐Deutsche Version (HADS‐D), the Münster and Gießener Beschwerdebogen, the SF‐36 Health Surveys and at least a questionnaire for the common dental case history.

Life quality of the investigated edentulous patients was not restricted by full denture wearing. This patient group showed surprisingly, with regard to vitality, significant higher scores (P=0·015) than the healthy control group with the own dentition. This indicates that life quality must not be restricted by wearing full dentures. Comparing this patient group with psychosomatic patients, we found highly significant differences (P < 0·000) when using the Münster and the Gießener questionnaire. Comparing the edentulous patients with the healthy group no differences were found. Concerning anxiety and depression there were no differences between edentulous patients and the control group. Furthermore, the ‘Münster Beschwerdebogen’ and ‘Hospital Anxiety and Depression Scale – Deutsche Version’ proved to be a good screening instrument for use in practice to identify patients with psychosomatic disorders before dental treatment.
Tongue and hyoid movements in feeding and speech
Authors: HIIEMAE K. , PALMER J. B.
Published: March 2003

Feeding and speech depend on integrated movements of the jaws, tongue surface and tongue base–hyoid complex. Phylogenetically and ontogenetically, the movements of feeding antedate those required for speech. The hypothesis that speech movements would fall within the range used in feeding was tested.

Lateral projection videofluorographic records were made for 10 subjects eating 8 g samples of three foods and reading a standard diagnostic speech text (Grandfather Passage). Radiopaque markers were glued to the upper and lower canines and tongue. Marker positions (Cartesian coordinates) for each video frame were plotted relative to the upper occlusal plane (X axis) and to a perpendicular dropped from that plane at the upper canine (Y axis). A plot of all coordinates per record gives the spatial domain (in the sagittal plane) within which a given marker moved.

Tongue marker domains showed an extraordinary range of movement in feeding with extensive palatal contact. In speech, there was little palatal contact, and markers moved within a smaller sagittal domain. Although speech domains fell within the range for feeding, their centroids were highly statistically different, P < 0·001 (Hald test for differences in bivariate populations). In contrast, the hyoid domain for speech was anterior to that used in feeding and had almost no overlap with it (P < 0·0001). Our hypothesis is confirmed for the tongue surface markers but not for the hyoid. We conclude that patterns of hyoid movement in speech are a specific adaptation for speech.

This research was supported by USPHS NIDCD Award 02123.
Psychological factors and adaptation to artificial interferences in healthy subjects with and without TMD history
Authors: LEBELL Y. , NIEMI P. M. , JÄMSÄ T. , ALANEN P. , KROOK K.
Published: March 2003

It has often been suggested that psychological factors play a role in temporomandibular disorders (TMD). However, reports on psychopathology and personality characteristics in TMD patients and controls have been equivocal. We have reported in a double‐blind RCT (LeBell et al., 2000) that subjects with a previous TMD history react differently in terms of TMD signs and symptoms to artificial interferences than subjects with no earlier TMD history. In the present study, we compared the psychological characteristics of these subjects and analysed the role of psychological factors in the adaptation process.

The study sample of 47 women consisted of two groups: 26 women (mean age 24) without and 21 women (mean age 31) with TMD history. The subjects with TMD history had been treated earlier and they felt healthy when the intervention started. The groups were divided into true interference and placebo interference subgroups. Before the intervention, the subjects were interviewed. They also filled in questionnaires dealing with psychological and somatic symptoms, daily stress, coping strategies, personality characteristics, health hardiness and illness beliefs. During the 2‐week follow‐up period, the subjects rated the intensity of 10 symptoms on the visual analogue scale (VAS) scale and their impact on vocational and leisure time functioning. In addition, daily stress, life changes, somatic and psychological symptoms and coping with pain were explored.

In general, the groups were similar in their psychological characteristics. There were, however, some differences in coping strategies. At the end of the intervention, the subjects with TMD history and exposed to true interferences reported more frequently than the other subjects muscle tension and neurological symptoms, thus indicating greater sensitivity to artificial interferences. This difference cannot be attributed to the observed base‐line personality characteristics as the groups did not differ in them. However, differences in coping strategies may play a role in the impaired adaptation.

The financial support of Finska Läkaresäliskapet is gratefully acknowledged.
Is self‐reported jaw pain on mouth opening associated with a reduced bruxism time index?
Authors: VAN DER ZAAG J. , LOBBEZOO F. , WICKS D.J. , HAMBURGER H.L. , NAEIJE M.
Published: March 2003

Sleep‐related bruxism (SB) is a frequently encountered problem in the dental office, for which evidence‐based causal therapy possibilities are not yet available. We are currently performing a large‐scale double‐blind placebo‐controlled randomized clinical trial to evaluate several management strategies for SB. So far, we have measured 35 participants, all of them clinically diagnosed bruxers (11 men; 24 women; mean age=39·2 ± 11·4 years). A first (baseline) night in the sleep laboratory confirmed their clinical diagnosis, i.e. all had more than four bruxism episodes per hour of sleep; (> 4 EpiH). The baseline recordings were preliminarily analysed to establish a cut‐off criterion for a polysomnographical SB diagnosis that, in addition to the previously established criterion (i.e. > 4 EpiH), also respects the time spent bruxing. We therefore calculated an index that expresses this aspect as a percentage of the total sleep time: the bruxism time index (BTI). The BTI was highly correlated with the number of EpiH (Pearson's correlation coefficient=0·92; P=0·000). Linear regression analysis revealed that a BTI of > 0·4% corresponds with the > 4 EpiH criterion (F‐value for the significance of the overall model=146·2; P=0·000). Future analyses may yield an additional intensity (power) cut‐off criterion as well. As the relationship between SB and jaw pain is still unclear, we also determined, in 28 of the 35 participants, the influence of self‐reported (VAS) jaw pain during mouth opening before and after the first night on the BTI. BTIs in bruxers whose evening and/or morning VASs ≥ 10 mm (n=10) tended to be lower than those in bruxers whose VASs were less than 10 mm (n=18) (1·4 ± 1·0 and 2·7 ± 2·5%, respectively; Two sample t‐test; T=1·98; P=0·059).

This finding confirms previous suggestions in the literature that jaw pain might be associated with a reduced bruxism activity. This can be understood as a protective mechanism that prevents (further) overloading of the masticatory system. (Supported by the IOT.)
Association between masticatory performance and maximal occlusal force in young men
Authors: Okiyama S. , Ikebe K. , Nokubi T.
Published: March 2003

summary  The purpose of this study was to examine the relationship between masticatory performance and maximal occlusal force in dentate subjects, using test foods of varying hardness. Subjects were 20 young males with natural dentitions. Gummy jellies with two different degrees of hardness have been used as test foods to evaluate masticatory performance. Masticatory performance was evaluated by the increase of the surface area of expectorated pieces of comminuted gummy jelly that was calculated from the concentration of gelatin. Maximal occlusal force was measured with pressure sensitive sheets (DENTAL PRESCALE™ 50H R type). The results suggested that maximal occlusal force had a significant positive correlation to the masticatory performance both with soft gummy jelly and hard gummy jelly. The correlation coefficient (r) with hand gummy jelly tended to be larger than with soft gummy jelly.
1. Absconding: why patients leave
Authors: Davis Bryn , BOWERS L. , JARRETT M. , CLARK N. , KIYIMBA F. , MCFARLANE L.
Published: March 2003

Absconding by patients from acute psychiatric care poses a significant problem to professional staff, and can involve significant risks for patients and others. This paper describes the methodology of a major prospective study of absconding recently completed in the East End of London, and reports the findings on why patients abscond from hospital. Interviews with 52 patients who returned to their wards showed that they abscond because they are bored, frightened of other patients, feel trapped and confined, have household responsibilites they feel they must fulfil, feel cut off from relatives and friends, or are worried about the security of their home and property. Psychiatric symptoms also contribute to the decision to leave, but in nearly every case patients can give additional and rational reasons for their abscond. Some patients leave impulsively and in anger following unwelcome news about delayed permission for leave or discharge. Others leave specifically in order to carry out some activity outside the hospital. In order to reduce absconding and rejection of care, nurses may need to carefully consider the meaning admission has for patients, and the impact it can have upon their everyday lives.
Anti oppressive practice: a route to the empowerment of people with dementia through communication and choice
Authors: Martin Geoffrey W. , Younger Dennis
Published: March 2003

This short study looks at the issue of anti oppressive practice and the way that it relates to the care of people with dementia. In particular it considers ways in which people can be empowered and given choices around aspects of day‐to‐day living in a care setting. The study took place over a period of 6 months and utilized the Dementia Care Mapping (DCM) observation process to assess the level of well being of residents in the setting studied. The results can only be seen as a first stage in the process of understanding ways in which people with dementia may be empowered. It is demonstrated that a change of practice developed over the 6 months between the two observation periods. Areas such as communications and day‐to‐day activities are examined to identify both problems and strategies for such change. The conclusion highlights the need to continue the mapping exercise as a way of ensuring that change is not only maintained but also advanced.
Psychiatric nurses' lived experiences of working with inpatient care on a general team psychiatric ward
Authors: Berg A. , Hallberg I. R.
Published: March 2003

To reveal the meaning of being a nurse working with inpatient care on a team psychiatric ward in Sweden, 22 psychiatric nurses were interviewed and the transcribed texts were analysed by means of latent content analysis. Three themes emerged from the analysis: developing a working relationship with the patient in everyday caregiving; encountering and handling the unforseeable in daily living; and struggling with professional independence and dependency. Developing a working relationship with the patient in everyday caregiving meant that the nurse–patient relationship was the foundation of the caregiving and included being with, as well as doing for, and with, the patient. Four different approaches in daily caregiving were revealed: networking, teaching, containing and protecting. The nurses' approaches in the nurse–patient relationship alternated between being an ‘expert’ and a ‘collaborator’. Encountering and handling unforeseeable situations meant that the nurses were exposed to and had to be prepared for unpredictable situations where they were on their own, handling sometimes strong emotional reactions and relying on their own ability to act. Struggling with professional independence and dependency meant that the nurses seemed to lack professional confidence, although they had many responsibilities, but also less authority to decide about overall care planning. Contextual aspects such as organizational hindrance, unsatisfactory work‐environment and co‐operation difficulties were illuminated. The result indicates the need for a stable and predictable organizational structure if nurses are to manage the demanding nurse–patient relationships that everyday caregiving requires. A question highlighted by this study is whether multidisciplinary team organization has been effectively developed in Sweden, as uncertainty about the roles and responsibilities of nurses was apparent.
The resources of parents with a child in psychiatric inpatient care
Authors: PUOTINIEMI T. A. , KYNGÄS H. A. , NIKKONEN M. J.
Published: March 2003

The purpose of this study was to analyse and describe the resources of parents with a child in psychiatric inpatient care. The factors associated with parental coping were also assessed. The data were collected from 19 hospitals with a child psychiatry unit. At the time of data collection, all the parents of the children in psychiatric inpatient care in these hospitals were invited to participate in the study (N = 268). The method of data collection was a questionnaire including
open‐ended questions. The response percentage was 30% (N = 79). The data were analysed using SPSS software. The replies to the open‐ended questions were analysed utilizing data‐based content analysis. The findings indicated that the parents received more emotional than instrumental support. Few got financial support. The parents got support from their spouses, families, friends and fellow‐workers and the health care personnel. Nearly half of the parents wanted more support from health care personnel. Of the different kinds of social support reported, emotional support, support in the care and rearing of the child in inpatient care, love and acceptance correlated most strongly with parental coping.
Assertive community treatment: development of the team, selection of clients, and impact on length of hospital stay
Authors: Jones A.
Published: March 2003

Mental health services have been criticized for the lack of focus and response to people suffering from a serious mental illness (SMI). Assertive community treatment (ACT) offers the potential for greater partnership working between the user and provider of mental health services. The author describes one approach in developing ACT in the UK. Four criteria were developed to identify the most appropriate service users for ACT: those with SMI, illness instability, illness disability and risk to self or others. Fifty‐five clients were identified using these criteria and tracked for their length of hospital stay and frequency of admission 2 years before acceptance to an ACT team and for 12 months after. Duration of hospital stay was unchanged although both the frequency and total numbers of bed days were reduced.
Principles and strategies for teaching therapeutic responses to self‐harm
Authors: McAllister M. , Estefan A.
Published: March 2003

This paper explains the educational principles and strategies underpinning a nursing course offered at an Australian university. The course is entitled ‘Self‐harm and therapeutic responses’ and explores contemporary theories and practices to improve understanding and responses to people who self‐harm. The course aims to shape the practices of nurses in developing healthier clinical and social environments for people who self‐harm.
Patients’ experience of involuntary psychiatric care: good opportunities and great losses
Authors: JOHANSSON I. M. , LUNDMAN B.
Published: March 2003

Patients who are involuntary admitted to psychiatric care are extremely vulnerable as a consequence of the control from others, and of the personal limitations due to a psychiatric disease that can influence their own control of their lives. This group of patients are seldom asked about their experiences of being cared for. In this study five involuntary hospitalized psychiatric patients narrated their experience of being subjected to involuntary psychiatric care. The aim of the study was to obtain a deeper understanding of this experience. The interview text was analysed by means of a phenomenological hermeneutic method. The result of the analysis gave a complex picture of both support and violation. On the one hand experiences of not being seen or heard, of loss of liberty and of violation of integrity were found. On the other hand, there were experiences of respect and caring and opportunities to take responsibility for oneself were offered. Being treated involuntarily in psychiatric care was interpreted as a balancing act between good opportunities and great losses.
Forced medication in psychiatric care: patient experiences and nurse perceptions
Authors: HAGLUND K. , VON KNORRING L. , VON ESSEN L.
Published: March 2003

The aims of this study were to describe: patient experiences of and nurse perceptions of patient experiences of forced medication before, during and after forced medication; patient and nurse perceptions of alternatives to forced medication; and whether patients, according to patients and nurses, retrospectively approved of forced medication. Eleven patients and nurses were interviewed about a certain situation of forced medication. Data were analysed by content analysis. The findings demonstrate that forced medication evokes a number of patient experiences according to patients and nurses. These are related to the disease, the situation of being forcibly medicated and the drug. Patients mentioned several alternatives to the forced medication, whereas nurses mentioned no alternatives. A minority of the patients, and not as many patients as the nurses’ thought, retrospectively approved of the use of forced medication. It can be concluded that patients and nurses do not share the same perceptions about what patients experience when forcibly medicated.
Impairment of daytime cerebrovascular reactivity in patients with obstructive sleep apnoea syndrome
Authors: PLACIDI FABIO , DIOMEDI MARINA , CUPINI LETIZIA MARIA , BERNARDI GIORGIO , SILVESTRINI MAURO
Published: March 2003

Several studies have demonstrated a clear association between snoring, sleep apnoea and increased risk of stroke. However, the possible role of sleep apnoea in the pathophysiogenetic mechanisms of cerebrovascular disease is still unknown. Our aim in this study was to investigate cerebral haemodynamic changes during the waking state in eight patients with sleep apnoea syndrome (OSAS) by means of transcranial Doppler (TCD). In particular, we studied cerebral vascular reactivity (CVR) to hypercapnia calculated by means of the breath holding index (BHI). The investigation was performed in the early morning, soon after awakening, and in the late afternoon. Data were compared with those of eight healthy subjects matched for age and vascular risk factors. OSAS patients showed significantly lower BHI values with respect to controls both in the morning (0.56 vs. 1.36; P< 0.0001) and in the afternoon (1.12 vs. 1.53; P< 0.0001). In patients, BHI values in the afternoon were significantly higher than in the morning (P< 0.0001). These data demonstrate a diminished vasodilator reserve in OSAS patients, particularly evident in the morning. This reduction of the possibility of cerebral vessels to adapt functionally in response to stimulation could be linked to hyposensitivity of cerebrovascular chemoreceptors after the continuous stress caused by nocturnal hypercapnia.