OOOOE Volume 99, Number 4

or the placebo. The VAS scores did not show a tendency towards improvement when the treatments were compared at the 2 study periods (P [ .05). The stress level was noncontributory, because it did not change in any of the groups. It is important to mention that this therapy did not cause additional stress and was considered easy to follow by all participants. According to the questionnaire, adherence to protocol was accomplished, no side effects were reported, and the patients were willing to use this therapy again. Conclusions. The null hypothesis stated at the beginning of the study is accepted, and there is no difference between the Naxen gel and placebo when applied as part of a home protocol for the management of myofascial pain. Although easy to use, and accomplishing an adequate compliance from the patients, this therapy did not show any real benet when compared with placebo. However, in our previous studies, topical NSAIDs showed some advantages. Further studies are encouraged to dene the future of the topical NSAIDs when used for the management of myofascial pain.

Abstracts 443
The EMG activities of the supercial masseter were higher on habitual closing than on the other closing types in both head postures, but the ring time of the muscle was slightly shorter on habitual closing. Firing sequences among these masticatory muscles were not signicant in all the closing types. Conclusions. Among the 3 closing types, closing on CR splint, which had no or little slide in CR, showed the shortest contact time, the least contact force, and with less EMG activity and more ring time in the supercial masseter in both head postures. It is concluded that closing on CR position without slide renders less impact on the dental arch and masticatory muscles, which could be a major component for the health of masticatory system in view of occlusion.

THE MAXIMAL BITE AND HANDS GRIP FORCE, IN PATIENTS WITH MOLECULAR DIAGNOSIS OF MYOTONIC DYSTROPHY. A. S. Guimaraes, and S. K. N. Marie, o Paulo and University of Sa o Paulo Federal University of Sa o Paulo, Brazil. School of Medicine, Sa
Objective. To investigate the condition of the masticatory muscles, evaluated by measuring the maximal bite and hands grip force, in patients with molecular diagnosis of myotonic dystrophy (MD) and to compare this with a matched group of healthy individuals. Study design. The bite and hands grip force of 34 patients with molecular diagnosis of MD were evaluated. An electronic dynamometer was employed for the bite force and a mechanical dynamometer for the hands grip force evaluation. For comparison among sides of the same group (related) Wilcoxons proof and between the same side of different groups (independent) Mann-Whitney U test (a = 0.05) was used. Results. The mean bite force in the patient group was 127.5 N (both sides) and in the control group 441 N (both sides). Regarding the hands force, this was 59 N in the patient group (both sides) and 343 N on the right and 314 N on the left side in the control group. Conclusion. The bite and hands grip forces were signicantly lower in the patient group when compared to the normal controls, without there being signicant difference regarding gender, preferential side of mastication, or hands. The presence of the anticipation phenomenon was observed where the bite and hands grip forces were lower in subsequent generations of the same family.

REFERENCES
1. Padilla M, Villalobos A, Arguello E, Jimenez F, Rojas A. Topical NSAIDs for orofacial myofascial pain: a double blind study. Poster in: 10th IASP, San Diego, California, August 17-22, 2002. 2. Topical NSAIDs may be useful for treating soft tissue injuries. Drug and therapy perspectives 1999;13:11-3. 3. Goulet JP, Clark GT, Flack VF, Liu C. The reproducibility of muscle and joint tenderness detection methods and maximum mandibular movement measurement for the temporomandibular system. J Orofac Pain 1998;12:17-26.

EFFECT OF SLIDE IN CENTRIC RELATION AND HEAD POSTURE ON OCCLUSAL CONTACT AND MASTICATORY MUSCLE ACTIVITY. S. -A. Jung, and K. -S. Han, Wonkwang University School of Dentistry, Jeonbuk, South Korea.
Objectives. This study was performed to investigate that change of the occlusal contact status including time, force, and balance between left- and right-side dental arch and of the electromyographic activity in the anterior temporalis and the supercial masseter related to amount, ring time, and sequence by habitual or guided contact closing. Methods. Twenty-eight dental students without any signs and symptoms of temporomandibular disorders (TMD) were selected. The observation and measuring was carried out synchronously using T-Scan II (Tekscan, Boston, Mass) and BioEMG (Bioresearch, Milwaukee, Wisc) in 2 head postures, natural and downward, and on 3 different closing types: habitual closing, self-guided centric relation (CR) closing, and closing on maxillary CR splint. The occlusal contact process was analyzed by contact timing, namely, rst, maximum, and endpoint of contact, and the data obtained were statistically processed with SPSS for Windows 10.0 (SPSS, Chicago, Ill). Results. The whole contact time was the longest on habitual closing, and the shortest on closing on CR splint without regard to head posture, and this pattern was also shown for the occlusal contact force, with the biggest force on habitual closing. The data of habitual closing and of CR closing, that is, of natural tooth contact, showed highly signicant correlation between them but did not correlate with the data of closing on CR splint. The relative contact force (%) to maximum contact force and the occlusal contact balance did not show any consistent features and/or signicant difference by closing types and contact timing.

TREATMENT OF PATIENTS WITH FIBROMYALGIA AND TMJ DISORDERS. F. Zugaib, S. Silveira, V. Kech, F. Paulino, and A. S. Guimaraes, Federal Medical School of o Paulo, Sa o Paulo, Brazil. Sa
Objective. The aim of this study was to evaluate how effective conservative therapy was after a 3-month treatment. Two groups of patients were compared: group 1, muscular TMJ disorder and bromyalgia patients; group 2, muscular TMJ disorder patients. Study design. Sixty patients were selected at the Head Institute between May and August 2004. We selected only women aged around 40 years old. The patients were then distributed into 2 groups: group 1: bromyalgia patients undergoing treatment for at least 5 years also presenting muscular TMJ disorder symptoms; group 2: patients presenting only muscular TMJ disorder.

444 Abstracts
The bromyalgia patients were diagnosed and recruited at o Paulo according to the the Rheumatology Clinic in Hospital Sa criteria established by the American College of Rheumatology in 1990. The diagnosis of TMJ disorder took place in the Head Institute in the same hospital according to axis 1 of RDC. Both groups underwent a conservative treatment for muscular TMJ disorder: cognitive behavioral (to control diurnal parafunction and poor jaw posture), thermotherapy (applying a heated compress for 20 minutes, 3 times a day), and a nocturnal splint or bite plate. Three months after the beginning of the treatment, patients were evaluated again. Results. We observed that in group 1, 17% presented no symptoms, 61% had their symptoms improved, 18% did not present any changes, and 4% had their condition worsened. In group 2, 52% did not present any symptoms, 43% had their symptoms improved, 3% presented no changes, and 2% had their condition worsened. Conclusions. When we compare the results, we realize that the basic disease interfered with the treatment, because the percentage of patients who presented no symptoms at the end of the 3-month period was 36% lower in group 1 (bromyalgia and muscular TMJ disorder) than in group 2 (muscular TMJ disorder only).

OOOOE April 2005

Conclusions. We conclude from this study that nontrauma patients are more likely to both complain of joint symptoms (ie, locking and noises) and demonstrate these symptoms by MRI than nontrauma patients. In patients who have suffered a whiplash-related injury, pain complaints are more common and widespread, whereas positive MRI ndings occur less often, suggesting that posttraumatic pain has a neuromuscular origin rather than being the effect of a disc displacement or inammation in the joints. The study also suggests that posttrauma TMD patients may require a different approach to treatment compared to nontrauma TMD in view of the differing etiology of their complaints.

CONDYLAR RESORPTION OF THE TEMPOROMANDIBULAR JOINT FOLLOWING ARTHROSCOPY IN A PATIENT WITH ESSENTIAL THROMBOCYTHEMIA. R. Balsubramaniam, D. Falace, and J. Van Sickels, University of Kentucky College of Dentistry, Lexington, Ky.
Condylar resorption of the temporomandibular joint (TMJ) is a poorly understood phenomenon that is the subject of much controversy. The etiology, diagnosis, and management of this condition have yet to achieve consensus. This case report describes a unique case of condylar resorption of uncertain etiology. The patient was a 49-year-old white female with complaints of left temporomandibular joint pain and numbness associated with reduced opening (35 mm). Over the previous 5 months, following abdominal surgery with oral endotracheal intubation, she noted increasing difculty opening her jaw and pain. On a visual analog scale she reported a constant sharp aching (7/10) pain of the left joint that increased with function and decreased with resting the jaw. Her past medical history was signicant for essential thrombocythemia, hypertension, hypothyroidism, and depression. Her medications included anagrelide, aspirin, hydrochlorothiazide/spironolactone, levothyroxine, and sertraline. An MRI revealed left disc displacement without reduction as well as a sound bony condyle consistent with TMJ plain lms. She was unresponsive to 10 weeks of treatment provided by her general dentist consisting of a biteguard and analgesics. Given the refractory nature of the patients complaint to this treatment, she was given the options of further nonsurgical or surgical management. In consultation with an oral and maxillofacial surgeon, she elected to undergo arthroscopy of the left joint. Under general anaesthesia, arthroscopy was performed. During the procedure, excessive intra-articular hemorrhage was repeatedly encountered, resulting in obliteration of the entry lumen of the arthroscope and outow port. Initially following surgery the patient was able to open 32 mm with stretch to 38 mm, but with deviation to the left and heavy anterior occlusion. Two months following the procedure, the patient continued to experience dysfunction and pain. A course of physical therapy with gentle mobilization of the left TMJ was prescribed. The patient was lost to follow-up owing to a family members illness. Five months later, she presented to the ofce not having pursued physical therapy, but was completely pain free with normal mandibular opening (45 mm). She complained that her bite was off and had progressively worsened. Clinically, a right posterior openbite was present accompanied by marked facial asymmetry. She had no pain upon palpation or with function of the left TMJ but deviated to the left upon opening. TMJ plain lms, tomograms, and CT scan revealed marked resorption and surface irregularities of the left condylar head. The patient declined further treatment and was followed for 3 years. She remained clinically stable with no further deterioration. It is hypothesized

RETROSPECTIVE STUDY: CLINICAL PRESENTATION AND MRI RESULTS OF TMD PATIENTS WITH AND WITHOUT HISTORY OF MVA. V. Ching, M. Grushka, J. E. Epstein, and M. Gorsky, University of Illinois, Chicago, Ill.
Background. The clinical diagnosis of TMD includes observation of several key signs and symptoms, including joint noises, pain to palpation over the TM joints, and restriction of movement. The literature has demonstrated the efcacy of MRI in conrming the presence of joint effusions, disc displacements, and osteoarthritic joint changes. MRI ndings in posttrauma whiplash patients, however, appear to be less helpful in understanding the origin of posttrauma TMJ pain compared to MRI ndings in nontrauma patients. Study design. In order to understand the origin of pain in posttrauma vs nontrauma TMD patients, a retrospective study was undertaken in this context to compare both clinical complaints and MRI and bone scan data in 57 posttrauma patients and in 98 nontrauma TMD patients. Not all patients had both imaging studies, but all patients had at least one. Data concerning clinical presentation and self-reported symptoms were also collected. Results. Signicant differences were found in the frequency of self-reported symptoms. Posttrauma patients reported more ear symptoms (P \ .01), dizziness (P \ .0001), headache (P \ .001), neck and shoulder stiffness (P \ .001), backache (P \ .001), sore jaw (P = .03), facial pain (P = .001), stress (P = .001), and difculty sleeping (P \ .001) but not joint noises. Joint noises and locking were more frequently the primary complaint of the nontrauma group than the trauma group (23% to 2%, 12% to 4%, respectively) compared to facial pain (45% to 32%) which was more frequently the chief complaint of the trauma group. No differences were found in objective measures of mouth opening and joint noises of both groups. MRI ndings of disc displacements occurred signicantly more often in the nontrauma group (69% to 48%, P \ .05). Bone scan results showed no differences between the trauma and nontrauma groups (40% to 48%, P [ .05).