| 1. |
- Bondemark, Lars, et al.
(författare)
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Funktionsstörningar och smärta
- 2008
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Ingår i: Tandläkartidningen. - 0039-6982. ; 100:9-10, s. 64-68
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Orofaciala funktionsstörningar och smärta är en sammanfattning av kliniska problem och sjukdomar som involverar bett, käkar, tuggmuskulatur, käkleder och omgivande strukturer. Orsakerna är oftast multifaktoriella för de barn, ungdomar och vuxna som drabbas.
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| 2. |
- Pigg, Maria, et al.
(författare)
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A comparative analysis of MRI, CBCT and conventional radiography in patients with atypical odontalgia and symptomatic apical periodontitis : preliminary results
- 2006
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Ingår i: Swedish Dental Journal. - 0347-9994. ; 30:4, s. 173-174
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Aim: Atypical odontalgia(AO) is a chronic pain condition located in the teeth and jaws. It has been suggested, that AO is best regarded as a neuropathic pain condition, but knowledge regarding the etiology, diagnostics, and management of AO is not yet satisfactory. This pilot study evaluates the clinical usefulness of more recently developed imaging methods for intraoral pain conditions. The aim is to compare the diagnostic findings using magnetic resonance imaging(MRI) and cone beam computed tomography(CBCT) with the findings from conventional radiography in patients with atypical odontalgia(AO) and symptomatic apical periodontitis(SAP). Material and methods: 12 patients (9 F, 3 M) mean age 50,25 years, range 36 - 63 years participated in the study. The patients were referred to the Orofacial Pain Unit or the Department of Endodontics, Faculty of Odontology, Malmö University. Inclusion criteria for AO were chronic pain (>6 months) located in a region where a tooth had been endodontically or surgically treated, pain with no pathological cause detectable in clinical or radiological examinations. For SAP, the inclusion criteria were recurrent pain from a tooth diagnosed with apical periodontitis in a clinical and radiographic examination. Ten of the patients in the study were diagnosed with AO and two with SAP. The patients were clinically assessed with a qualitative somatosensory examination, a dental examination, an examination of the masticatory system(RDC/TMD), and panoramic and intraoral radiographs. A questionnaire was used to gather information about pain characteristics, psychosocial status(SCL-90), and quality of life. Besides these measures, each patient underwent a CBCT(3D-Accuitomo, J Morita Co) examination and a MRI(Siemens Sonata Vision 1.5 T) examination with and without contrast enhancement. Contrast was enhanced by injections of Magnevist (469 mg/ml, Schering Nordiska). Bone destruction, sclerosis, and signs of inflammation were the main parameters studied. Results: In the preliminary results, average pain intensity was 6.3 on a numerical rating scale(NRS) and average pain duration was 3,6 years. 83% exhibited somatosensory abnormalities. Bone destruction not visible in the intraoral and panoramic radiographs was detected with CBCT in 40% (4/10) of the patients diagnosed with AO, and signs of inflammation were detected in the MRIs of 20% (2/10) of the patients diagnosed with AO. Conclusion: Preliminary findings indicate that CBCT and MRI can provide additional information to conventional radiography in the diagnosis of intraoral orofacial pain. Further studies with larger sample sizes of AO and SAP patients are necessary to determine the clinical relevance of these findings.
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| 3. |
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| 4. |
- Pigg, Maria, et al.
(författare)
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Diagnostic yield of conventional radiographic and cone-beem computed tomographic images in patients with atypical odontalgia
- 2011
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Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 12:44, s. 1092-1101
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Tidskriftsartikel (refereegranskat)abstract
- Abstract AIM: To investigate whether the additional diagnostic yield of a cone-beam computed tomography (CBCT) examination over conventional radiographs in patients primarily suspected of having atypical odontalgia (AO) improves differentiation between AO and symptomatic apical periodontitis (SAP) in patients with severe chronic intraoral pain. METHODOLOGY: In this clinical study, 25 patients (mean age 54 ± 11 years, range 34-72) participated; 20 were diagnosed with AO and 5 with SAP. All patients were recruited from the clinics of the Faculty of Odontology, Malmö University. AO inclusion criteria were chronic pain (>6 months) in a region where a tooth had been endodontically or surgically treated, with no pathological cause detectable in clinical or radiologic examinations. SAP inclusion criteria were recurrent pain from a tooth diagnosed with apical periodontitis in clinical and radiographic examinations. Assessments comprised a self-report questionnaire on pain characteristics, a comprehensive clinical examination and a radiographic examination including panoramic and intraoral radiographs and CBCT images. The main outcome measure was periapical bone destruction. RESULTS: Sixty per cent of patients with AO had no periapical bone destructions detectable with any radiographic method. Overall, CBCT rendered 17% more periapical bone destructions than conventional radiography. Average pain intensity in patients with AO was 5.6 (± 1.8) on a 0-10 numerical rating scale, and average pain duration was 4.3 (± 5.2) years. CONCLUSION: Cone-beam computed tomography improves identification of patients without periapical bone destruction, which may facilitate differentiation between AO and SAP.
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| 5. |
- Wolf, Eva, et al.
(författare)
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Long-term follow-up by means of a questionnaire of 109 patients with long-lasting orofacial pain.
- 2002
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Ingår i: Swedish Dental Journal. - : Swedish Dental Association. - 0347-9994. ; 26:3, s. 125-34
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Tidskriftsartikel (refereegranskat)abstract
- The aims were to follow-up, analyse and compare the pain status after 4-9 years with that at the baseline examination of 109 consecutive patients referred to the Pain Group at the Faculty of Odontology in Malmö, Sweden during the period 1988-1993 due to long-lasting orofacial pain. A further aim was to identify predictive factors of significance for pain alteration. 85 (78%) women with a median age of 51 years and 24 (22%) men with a median age of 60 years were included in the study. A survey of the pain status at the follow-up was conducted by means of a mailed questionnaire. The questionnaire covered the following aspects: pain alteration, pain intensity, pain location, medication and education. After one reminder, the non-responding patients were called for a telephone interview. A response level of 85% was obtained. Significant improvements were noted by the patients in the answers of the questionnaire in mainly three areas; the patients answered individually that pain relief had occurred, pain intensity rated on the VAS was lower at follow-up compared to the baseline examination and a decrease in drug use was reported. The responses indicated pain relief for 75% of the patients. However, only 27% of the patients experienced total disappearance of pain. Medication at baseline with opioids, muscle relaxants with central effect, antidepressants, neuroleptics, hypnotics or sedatives was found to be a predictive factor for persistent pain.
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| 6. |
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| 7. |
- Rohlin, Madeleine, et al.
(författare)
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Systematic reviews - avenues to improved quality in oral health care and research
- 2009
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Ingår i: Programme and abstract book. ; , s. 70-70
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction Systematic reviews comprise a synthesis of scientific evidence that is a key in three approaches to improve the quality of care - evidence-based medicine, health technology assessment, and clinical guidelines. Analysis of the scientific literature also reveals issues that require further research as knowledge gaps will be identified. These can be used to improve the research agenda in health care. Objectives To analyse evidence from systematic reviews on imaging methods in oral health care. Materials and methods Common features of five systematic reviews, which we performed, were analysed. The reviews elucidated methods used to diagnose chronic periodontitis (one review), jaw bone tissue in dental implant planning (two reviews), and temporomandibular joint disorders (two reviews). Our analysis of original studies included and excluded in the reviews focussed on the study design and outcomes using the Thornbury's ladder (1). Results Overall there is room for improvement. There was a wide heterogeneity in study design and reported outcome variables. Most studies reported outcomes on the level of diagnostic ability. No study presented how any diagnostic method influenced patient care in terms of changed treatment and change in patient outcome. Evidence was limited also on outcomes of combinations of imaging methods with other diagnostic methods as used in clinical care. Conclusions and discussion To improve the accuracy and completeness of studies on diagnostic methods, the Standards for Reporting of Diagnostic Accuracy (STARD) statement should be applied. Evidence to support clinical effectiveness of imaging methods is required to improve oral health care. (1) Fryback DG, Thornbury JR. The efficacy of diagnostic imaging. Med Decis Making 1991;11:88-94. Rohlin M1, Knutsson K1, Lindh C1, Petersson A1 1 Malmö University, Malmö, Sweden Introduction Systematic reviews comprise a synthesis of scientific evidence that is a key in three approaches to improve the quality of care - evidence-based medicine, health technology assessment, and clinical guidelines. Analysis of the scientific literature also reveals issues that require further research as knowledge gaps will be identified. These can be used to improve the research agenda in health care. Objectives To analyse evidence from systematic reviews on imaging methods in oral health care. Materials and methods Common features of five systematic reviews, which we performed, were analysed. The reviews elucidated methods used to diagnose chronic periodontitis (one review), jaw bone tissue in dental implant planning (two reviews), and temporomandibular joint disorders (two reviews). Our analysis of original studies included and excluded in the reviews focussed on the study design and outcomes using the Thornbury's ladder (1). Results Overall there is room for improvement. There was a wide heterogeneity in study design and reported outcome variables. Most studies reported outcomes on the level of diagnostic ability. No study presented how any diagnostic method influenced patient care in terms of changed treatment and change in patient outcome. Evidence was limited also on outcomes of combinations of imaging methods with other diagnostic methods as used in clinical care. Conclusions and discussion To improve the accuracy and completeness of studies on diagnostic methods, the Standards for Reporting of Diagnostic Accuracy (STARD) statement should be applied. Evidence to support clinical effectiveness of imaging methods is required to improve oral health care. (1) Fryback DG, Thornbury JR. The efficacy of diagnostic imaging. Med Decis Making 1991;11:88-94.
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| 8. |
- Wiese, Mie, et al.
(författare)
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Association Between Temporomandibular Joint Symptoms, Signs, and Clinical Diagnosis Using the RDC/TMD and Radiographic Findings in Temporomandibular Joint Tomograms
- 2008
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Ingår i: Journal of Orofacial Pain. - : Quintessence. - 1064-6655 .- 1945-3396. ; 22:3, s. 239-251
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To identify associations between clinical symptoms of temporomandibular joint disorders and radiographic findings. Methods: Two hundred four adult patients (156 women, 48 men, mean age 40 years) with temporomandibular joint (TMJ) pain/sounds or changes in mandibular motion were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Bilateral sagittal corrected TMJ tomograms in closed and open positions were assessed fo the presence of flattening, erosion, osteophytes, and sclerosis in the joint components and the range of mandibular motion. Logistic regression analyses were performed with the radiographic findings as the dependent variables and the following clinical variables as independent variables: opening pattern, maximal jaw opening, TMJ sounds, number of painful muscle/TMJ sites, duration of pain, presence of arthritic disease, depression and somatisation scores, graded chronic pain, and age and gender. Resluts: Coarse crepitus on opening/closing (odds ratio [OR] ≥ 3.12), on lateral excursions (odds ratio ≥ 4.06), and on protrusion (OR ≥ 5.30) was associated with increased risk of degenerative findings in tomograms. A clinical diagnosis of osteoarthritis increased the risk of radiographic findings (OR ≥ 2.95) and so did increasing age (OR ≥ 1.03 per year) and the female gendera (OR ≥ 2.36). Maximal assisted opening and maximal opening without pain (< 40 mm) was associated with a posterior condyle-to-articular tubercle position (OR ≥ 2.60). No other significant associations were observed. Conclusion: Age, gender, and coarse crepitus, but no pain-related variables, were associated with increased risk of degenerative findings in TMJ tomograms. Maximal opening < 40 mm was associated with at posterior condyle-to-articular tubercle relation on opening.
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| 9. |
- Wiese, Mie, et al.
(författare)
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Influence of cross-sectional temporomandibular joint (TMJ) tomography on diagnosis and management of patients with temporomandibular disorders (TMD)
- 2008
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Konferensbidrag (refereegranskat)abstract
- Objectives: To describe changes in diagnosis and management of TMD patients after radiographic examination and to evaluate the associations between specific TMJ tomographic findings and changes in management. Methods: 204 adult patients (48 males, 156 females, mean age 40 years) with TMJ pain/sounds or problems with mandibular motion were examined according to the Research Diagnostic Criteria (RDC/TMD) by one of six calibrated orofacial pain specialists. Diagnoses and management strategy reached without the aid of radiographs were recorded. It was possible to select from seven management categories (pharmacology, physiotherapy, psychological, occlusal stabilization, surgical, other examinations and referrals) each with a number of sub-categories. Bilateral sagittal corrected TMJ tomograms in closed position were obtained using conventional film in a Cranex Tome or a Scanora tomographic X-ray unit. The tomograms were assessed for the presence of flattening, erosion, osteophyte and sclerosis in the TMJ components and the condyle-to-mandibular fossa relation by one of five calibrated oral radiologists blinded to the clinical diagnosis and initial management strategy. After gaining access to the results from the radiographic examination the orofacial pain specialists re-evaluated their diagnoses and management strategy. All changes were calculated. Logistic regression analyses (with odds ratio (OR) and significance level (p)) were performed with changes in management as the dependent variable and with age and radiographic findings as the independent variables. Results: 41% of the clinical arthralgia diagnoses were changed into osteoarthritis after radiographic examination and the number of osteoarthrosis diagnoses increased with 200% (from 13 to 39). One or more changes in the management strategy were found for 27% (55) of the patients. Most often changes occurred in pharmacology and physiotherapy (29 and 28 patients respectively) followed by changes in psychological (13 patients), occlusal stabilization (8 patients), referrals (7 patients), other examinations (6 patients) and surgical (2 patients). For pharmacology, physiotherapy and psychological the changes were adjustments within the sub-categories in 51 out of 70 patients. For the other management categories most of the changes were addition or omission of the management category (in 20 out of 23 patients). The chance of “any change” in management (removal or addition of one or more sub-categories in one or more management categories) was more than twice as high with a finding of flattening (OR=2.28) and erosion (OR=2.03) compared to not having these radiographic findings. Increased chance of “any change” in management was also found with >1 radiographic finding (regardless of type) (OR=2.64) compared to having no radiographic findings. The chance of change in pharmacology was increased more than three times with erosion (OR=3.60) and more than two times with flattening (OR=2.56). The chance of change in physiotherapy was increased with >1 radiographic finding (OR=2.79). No statistically significant (p≤0.05) associations between osteophyte, sclerosis and age and changes in management were found. Conclusion: 27% of the patients had changes in management after radiographic examination. Radiographic findings did increase the chance of changes in management. However, as the changes were mostly adjustments in sub-categories radiography may have a minor impact on management of most TMD patients.
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| 10. |
- Wiese, Mie, et al.
(författare)
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Influence of cross-sectional temporomandibular joint tomography on daignosis and management decisions of patients with temporomandibular joint disorders
- 2011
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Ingår i: Journal of Orofacial Pain. - : Quintessence. - 1064-6655 .- 1945-3396. ; 25, s. 223-231
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To assess whether changes in diagnoses and management of temporomandibular joint disorder (TMJD) patients are influenced by radiographic findings and if there is an association between specific radiologic alterations and management strategy changes. METHODS: A total of 204 patients with TMJ symptoms were examined using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Diagnoses and management were first decided without the aid of radiographs. Management categories were: pharmacology, physiotherapy, counseling and behavioral treatment, occlusal stabilization, surgery, additional examinations, and referrals, each with subcategories. Sagittal TMJ tomograms were assessed for the presence of flattening, erosion, osteophyte, and sclerosis in the TMJ components. Diagnoses and management were reevaluated after gaining access to the radiographs and radiographic classifications. Logistic regression analyses were performed with changes in management as the dependent variable and age and radiographic findings as the independent variables. RESULTS: Diagnosis was changed for 56 patients, mainly from arthralgia to osteoarthritis. Management was changed for 55 patients. Most changes occurred in pharmacology and physiotherapy followed by counseling and behavioral treatment, occlusal stabilization, referrals, additional examinations, and surgery. Changes were mostly within the categories, and the highest number of changes was seen in pharmacology, physiotherapy, and counseling and behavioral treatment. Radiographic degenerative findings increased the chance of change (any change) (odds ratio [OR] ⋝ 2.03) and the chance of change in pharmacology (OR ⋝ 2.56) and physiotherapy (OR = 2.48) separately. No other significant associations were found. CONCLUSION: Radiographic degenerative findings increased the chance of changes in management strategy. However, 73% of the TMJD patients had no changes in management after radiographic examination. In cases with changes, these were mainly adjustments within management categories.
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