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BACKGROUND: Sialorrhoea, the symptom of apparent excessive secretion of saliva is a relatively uncommon complaint. Some authors consider that in the absence of clinical findings, then these patients have a psychiatric disorder masquerading as a physical illness. However, there is little evidence in the literature to support this conclusion and a detailed psychological assessment of this population has not previously been reported. METHODS: In total, 18 patients and 18 age- and sex-matched controls were studied. All had a history of a complaint of excess salivation in the absence of any oral mucosal or systemic abnormality. All patients completed an Eysenck Personality Questionnaire. RESULTS: There were no differences in the extroversion of psychoticism scores between the study and control group. However, the result showed significant increases in the neuroticism and Lie Scale score in the patient group. CONCLUSIONS: The overall results of this study indicate that the complaint of sialorrhoea in otherwise healthy individuals does not have an organic basis and suggest that sialorrhoea is associated with high levels of neuroticism and a tendency to dissimulate.

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OBJECTIVE: To evaluate clinical procedures and chair time required to seat and adjust hard, heat-cured acrylic occlusal splints and an alternative laminated appliance developed to simplify construction of migraine prevention appliances. DESIGN AND SETTING: Single-centre study in the Oral Medicine Clinic, The Royal Hospitals, Belfast, Northern Ireland. METHOD: Questionnaires were distributed, January-May 2003, to operators fitting occlusal splints for 100 consecutive patients selected for migraine prevention therapy. Half the appliances were made in heat-polymerised acrylic with the remainder using a novel combination of ethylene vinyl acetate and light-curing urethane dimethacrylate. Information on operator experience, the nature of any fitting surface and occlusal adjustments together with an estimate of the time taken to make alterations was recorded. KEY FINDINGS: The need for adjustment to seat appliances intraorally was significantly less for migraine prevention appliances made using an experimental laminating technique. Where modifications were necessary, there was no significant difference in the chair time required to fit either the heat-cured hard or experimental laminated migraine prevention appliance. CONCLUSION: Provision of migraine prevention appliances may be more time efficient if the dental practitioner considers a laminated approach to construction.

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AIMS: (1) To measure the prevalence of burnout, psychological morbidity, job satisfaction, job stress, and consideration of alternate work among multidisciplinary hospital based child and youth protection (CYP) professionals; (2) to understand the relations between these variables; and (3) to understand the reasons for leaving among former programme members. METHODS: Mailed survey of current and former members of all Canadian academic hospital based CYP programmes. Surveys for current members contained validated measures of burnout, psychological morbidity, job satisfaction/stress, and questions about consideration of alternate work. Surveys for former members examined motivation(s) for leaving. RESULTS: One hundred and twenty six of 165 current members (76.4%) and 13/14 (92.9%) former members responded. Over one third (34.1%) of respondents exhibited burnout while psychological morbidity was present in 13.5%. Job satisfaction was high, with 68.8% finding their job "extremely" or "quite" satisfying, whereas 26.2% found their job "extremely" or "quite" stressful. Psychological morbidity, job satisfaction, and job stress were not associated with any of the demographic variables measured, but burnout was most prevalent among non-physician programme members. Almost two thirds of current members indicated that they had seriously considered a change in work situation. Former members indicated that burnout and high levels of job stress were most responsible for their decision to leave and that increasing the number of programme staff and, consequently, reducing the number of hours worked would have influenced their decision to stay. CONCLUSIONS: Current levels of burnout and the large proportion of individuals who have contemplated leaving the service suggest a potential crisis in Canadian hospital based CYP services.

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Information on presenting complaints, diagnosis and initial management strategy was recorded on a proforma for 114 consecutive patients referred to a hospital tooth wear clinic over a two-year period. Over twice as many male patients were referred as females. Twenty percent of patients had no presenting complaint and the others shared the common complaints concerning appearance, sensitivity and their deteriorating dentitions. The assessment of aetiology identified attrition as the most common cause of tooth wear in the subject group studied. About half the group were prescribed preventative treatment only and the other half were deemed to require restorative dental treatment.

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The purpose of this investigation was to compare the masticatory muscle volume, bite force, and craniofacial morphology of migrainous subjects with age- and sex-matched controls. Ten adult dentate migraineurs were matched with 10 dentate age- and sex-matched controls. The groups consisted of nine women and one man (mean age, 43 years; range, 29 to 51 years). Volumetric analysis of the masseter and medial pterygoid muscles was performed using magnetic resonance imaging. Craniofacial morphology was analyzed from standard cephalometric radiographs using 30 angular and linear variables. Recordings of bite force were made using a strain gauge transducer. There was a significant difference in the volume of both masseter and medial pterygoid muscles between the two subject groups (P<.0001), with the muscles of the migraineurs nearly 70% larger. The migraineurs recorded significantly higher maximal bite forces (P<.0001) than did the controls. No significant differences for any craniofacial morphological measurement were demonstrated between the two groups. It was concluded that the migraineurs had larger masseter and medial pterygoid muscle volumes, and greater bite forces than the controls, which could not be explained by any change in craniofacial morphology.

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OBJECTIVE: To study the surgical outcome of outpatient percutaneous microdecompressive endoscopic cervical discectomy with lower energy laser for shrinkage of disc material (thermodiskoplasty). METHOD: Since 1994, 200 patients with herniated cervical discs have presented at the authors' clinic, with unilateral radicular pain. The diagnosis was confirmed by MRI or CT, and EMG. RESULTS: At an average follow-up of 25 months, 94.5% of the cases had good-to-excellent results. Eleven patients (5.5%) remained symptomatic, with persistent neck and upper extremity pain associated with paresthesias. There were no significant postoperative complications. Average time before returning to work was 10 days. CONCLUSIONS: Percutaneous microdecompressive endoscopic cervical discectomy with laser thermodiskoplasty has proven to be a safe and efficacious minimally invasive procedure.

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PURPOSE: The purpose of this study was to describe a mandibular envelope of motion during speech for 2 subject groups. One subject group had experienced no tooth wear and the other had incisal tooth wear. The speech envelope was to be described with regard to its maximal dimensions in the vertical, anteroposterior, and lateral directions, and its most superior and anterior positions in relation to intercuspal position. MATERIALS AND METHODS: An electromagnetic method of jaw tracking was employed to record mandibular speech movements for 60 subjects whose teeth exhibited no tooth wear and 30 subjects with incisal dental attrition. The test speech exercise contained all of the word sounds that occur in the English language. The test was recorded 3 times, and mean values for parameters were reported. RESULTS: The speech envelope of the tooth wear group was significantly smaller (Student's t test, P < 0.01) in all 3 dimensions than that of the normal group. The tooth wear group speech envelope was also located closer to the intercuspal position in the vertical dimension (P < 0.01) and was not as anteriorly placed (P < 0.01). In the normal group, correlations were found between the vertical incisor overlap and the most superior speech position (r = 0.48, P < 0.0001), and between the horizontal incisor overlap and the most anterior mandibular speaking position (r = 0.63, P < 0.0001). CONCLUSION: The envelope of mandibular movement during speech differed in dimension and position between the 2 groups investigated.

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OBJECTIVE: The purpose of the study was to determine the prevalence of burning mouth (BM) in a population of Parkinson's Disease (PD) sufferers and also to assess the use of pain profiles in identifying the type of burning sensation experienced. DESIGN: Subjects were surveyed by means of a one shot postal questionnaire for which ethical approval had previously been granted. Anonymity was guaranteed and therefore no attempt was made to follow up non-respondents. MAIN OUTCOME: BM was reported by 24% of respondents. The pain profiles were completed by 17 BM sufferers. CONCLUSION: Burning mouth is reported to occur in 24% of PD sufferers which is 5 times greater than that of the general population. The reason for this is uncertain but the result has implications for the future care of PD patients and indicates the need for increased dental input at PD outpatient clinics.

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This study investigated 84 patients with burning mouth syndrome (BMS), who were asked to complete a hospital anxiety and depression (HAD) scale questionnaire. A control group of 69 patients was also included. All patients were interviewed regarding parafunctional habits and were subjectively examined for signs of occlusal wear of the natural teeth or dentures. The results demonstrated that parafunctional habits were present in 61% of patients with BMS. There was a statistically significantly relationship between parafunctional habits and anxiety as indicated by the HAD scale, but not with depression.

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This investigation aimed to examine the practice of the members of The Consultants in Restorative Dentistry Group (UK) in relation to routine cross-infection control when handling impressions and items of prosthetic laboratory work. A questionnaire was sent to one hundred and twenty six members of the Group. A response rate of 63% was recorded. Seventy percent of respondents routinely rinsed and disinfected dental impressions. Twenty four percent routinely rinsed items of laboratory work and 44% routinely disinfected items of laboratory work. The results of this study demonstrate a lack of uniformity in the practice of members of the group in routine infection control for impressions and laboratory work.

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This investigation aimed to examine the effect of verbal and written education on the denture wearing and cleansing regimens of a group of patients scheduled to have replacement complete dentures. Current denture habits were elicited by questionnaire prior to treatment. Each patient received verbal and written instruction on a standardised denture wearing and cleaning regimen. Six months after completion of treatment each patient was posted a repeat questionnaire. The response rate was 68%. There was no notable alteration in the denture care regimens of the patients after treatment. It was concluded that verbal and written education did not change the denture habits of the subject group.

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The purpose of this investigation was to determine whether the production of sibilant sounds involved adopting a jaw position that corresponded to the closest vertical speaking space (CSS), by analysis of the smallest vertical excursion of the mandible during the performance of different phonetic exercises. A further objective was to establish the variability in the CSS produced by individual sibilant phonemes. Thirty young adult subjects had their CSS determined during three separate phonetic tests, using a kinesiograph (Sirognathograph, Siemens A.G., Benshiem, Germany) and a Bio-Pak (BioResearch Associates Inc., Milwaukee, WI) jaw-tracking software program. The first test was a general phonetic articulation test containing all the sounds of the English language and specifically including all six sibilant word sounds. The second phonetic test contained the six sibilant sound making up a short sentence. The third test included six single words, each expressing a different sibilant sound. No statistically significant difference among the mean CSS determined in each of three exercises was demonstrable. A phonetic test containing all sibilant sounds produced a CSS equivalent to that of a test containing all speech sounds. The vertical component of the CSS was also independent of the form or duration of the phonetic tests containing the sibilant word sounds used in this investigation. The CSS determined for 5 of the individual sibilant phonemes in the third exercise differed (p < 0.05) from that calculated for the three complete exercises. It was concluded that voicing sibilant phonemes, or word sounds, does cause the subject to adopt the CSS.(ABSTRACT TRUNCATED AT 250 WORDS)

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Current methods of determining whether a patient will accommodate to an increased occlusal vertical dimension rely on a largely subjective assessment of the mandibular rest position and capacity to adapt whilst wearing a temporary appliance. The purpose of this preliminary study was to establish if mandibular movement during speech may provide an objective criterion in the assessment of adaptation to increases in occlusal vertical dimension. The closest speaking space, measured as the vertical distance between an incisor point and centric occlusion, as determined during pronunciation of sibilant speech sounds was chosen to depict mandibular movement. The closest speaking space was determined using a Sirognathograph for six young adult subjects and varied from a mean of 1.0 to 3.3 mm. An acrylic splint covering the entire occlusal surface of the lower arch, designed to increase the occlusal vertical dimension by 4 mm in the incisor region, was then cemented on each subject's mandibular arch. The closest speaking space was again determined after 5 days continuous wear of the splint and the mean values found to have decreased to a range of 0.0-1.0 mm. The differences between the mean values for the closest speaking space for each subject before and after splint wear were statistically significant. It was postulated that this method may lead towards an objective basis for deciding if patients will adapt to an increase in occlusal vertical dimension.

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