Journal of Craniomandibular Function, 02/2011

The German Agency for Health Technology Assessment (HTA) of the DIMDI (German Institute of Medical Documentation and Information) recently published its HTA report on "Dental indications for standardised procedures of instrumental functional analysis under consideration of health economic aspects"a (Report 101). The authors' aim was to evaluate "the currently available evidence of the instrumental functional analysis as diagnostic procedures [sic] for craniomandibular or temporomandibular dysfunctions in comparison to the classic clinical functional analysis"a. The report thus claimed that the included statements should be viewed within the context of healthcare policy-or that the report may even be capable of giving counsel or directions on health policy.

Objective: To look for correlations between occlusal patterns and posture disorders in a group of children with cerebral palsy (CP). Materials and methods: 117 (93) representative children (12 years ± 5 years) were examined for dental, occlusal (117) and orthopedic (93) findings. The oral results were compared with a control group (6-12 years, > 12 years) and the correlations between posture disorders and occlusal findings were evaluated statistically (Chi square). Results: A gender-matched sample (64 male, 53 female) was divided into three groups (3-6 years, 6-12 years, >12 years) and did not show any significant differences in occlusal findings in comparison to the control group, with the exception of the anterior open bite. Significant correlations between posture and occlusal patterns could not be detected, although for all 93 children marked posture disorders were diagnosed. Conclusions: The occlusal findings did not correlate to posture and children with CP have no higher risk for orthodontic diseases. Keywords: cerebral palsy, occlusal patterns, posture

Objective: A pathophysiologic link between malocclusions and temporomandibular disorders (TMD) is still being debated. This study correlates pain, joint sounds, and limited opening with a subset of orthodontic findings in different age groups. Patients and methods: A case-control study employing 697 patients was conducted. Patients were subdivided into three age groups: 1 (n = 297): 7-12 years; 2 (n = 302): 13-18 years; 3 (n = 98): > 18 years. Orthodontic and TMD diagnostics were performed. A multivariate logistic regression approach was used to correlate malocclusions with TMD. Results: A correlation between mandibular skeletal midline deviation and joint/muscle pain was found in group 1 (P < 0.001), 2 (P < 0.001) and 3 (P = 0.008). Furthermore, mandibular skeletal midline deviation was an independent predictor of joint sounds (P = 0.009) and limited opening (P = 0.014) in group 3. Conclusion: Further longitudinal studies employing a group of patients with orthodontic treatment and a control group without treatment are needed to verify the potential of TMD prevention by early treatment for lateral force bite. Keywords: malocclusion, multivariate analysis, temporomandibular disorders

The results obtained by an integrated approach to a case presenting a complex and disabling postural problem shows the importance of teamwork within posturology. A correct understanding of human biomechanics sees the body behaving as a vortex on a transverse plane and, at the feet, a frontal plane. This interconnected tensegrity structure has allowed humans, the only bipedal mammal, to move most effectively within the gravitational field. As the ultimate cybernetic system, humans need to sense at every moment the surrounding environment. Because of the substantial environmental changes "imposed" by modern society, ergonomics become an integral and crucial part of a program of postural re-education. Since plantar and dental occlusal supports seem to be critical for posture, using ergonomic devices such as splints and insoles, in synergistic combination with techniques acting on the myofascial system (bodywork, gymnastics), may lead to important results. These results can be detectable and quantifiable as in the present case study. Keywords: bodywork, cervicalgia, ergonomics, gymnastics, insoles, migraine, postural analysis, postural re-education, scoliosis, splints