Wednesday, September 12, 2012

Dentists treating Tourette syndrome

J Neurol Neurosurg Psychiatry 83:e1 doi:10.1136/jnnp-2012-303538.24

Abstract

Objective In contradiction to current neurobiological concepts of Tourette syndrome (TS) there is a small dental literature suggesting abnormalities of temporomandibular joint alignment cause tics via reflexes of the spinal trigeminal nucleus, without involvement of the brain. Treatments to correct this model of pathophysiology by using implants are being offered by dentists and are becoming well publicised in the patient population. No controlled clinical trial data are currently available. We conducted a pilot survey of patients and dentists in the UK to assess the current situation.
Method Members of the national charity Tourettes Action were contacted to find out whether they had tried or were considering dental therapies, and what the effects had been. A modified self-report version of the Yale Global Tic Severity Score impairment subscale was used. Dentists known to offer the treatment were also asked to complete a questionnaire about their work.
Results Nine people who have had the therapy (or their parents) completed the survey. The majority of respondents were male and aged under 15 years old and had been treated in the previous year. Five had pure TS whereas the other four also had co-morbidities. All had received a formal diagnosis from a specialist and four were taking medication. Four people reported that their dentists offered a complete cure although none of the three out of four dentists who responded made this claim. On average between 2 and 3 visits to the dentist were required, although one case required 24. None of the dentists discussed the treatment with the person's doctor. Two patients were reasonably happy with the implant (most of the tics disappeared but some remained), one person was satisfied (approximately half of the tics disappeared but the other half remained), two people were completely dissatisfied (all of the tics remained) and the other four reported that it was too early to tell whether the splint was effective due to complications. None of the participants were completely cured or tic-free. The cost ranged from £3600 to over £10 000.
Conclusion There is not a sound theoretical basis for dental intervention for TS and furthermore good clinical evidence to support use has not been presented. Our small survey suggests the treatment is less successful than sometimes claimed. A rigorous clinical trial is now being planned by the Tourette Syndrome Association, USA.

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