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  • Eskafi, Mahmoud, et al. (författare)
  • The effect of mandibular advancement device on pharyngeal airway dimension in patients with congestive heart failure treated for sleep apnoea.
  • 2004
  • Ingår i: Swedish Dental Journal. - Swedish Dental Association. - 0347-9994. ; 28:1, s. 41283
  • Tidskriftsartikel (refereegranskat)abstract
    • Continues positive airway pressure (CPAP) is recommended for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) but is not easily tolerated resulting in poor patient compliance. Mandibular advancement device (MAD) is designed to inhibit pharyngeal airway (PAW) obstruction and may be a valuable alternative. It has been proposed that MAD exerts its effect by increasing PAW dimensions. This has not, however, been clearly demonstrated. The aim of this study was to examine the effect of MAD on PAW dimensions and SA in patients with CHF. Seventeen CHF-patients with mild to moderate heart failure, aged 68 +/- 6 years, (mean +/- SD), range 54-75 years, with sleep apnoea-hypopnea index (AHI) > or = 10 were evaluated. PAW dimensions were studied with and without the MAD, using lateral radiographs in supine position. Nocturnal breathing patterns were studied using a portable polysomnographic device during a single night with and without MAD. A reduction of AHI > or = 30% (arbitrary level) for each individual was regarded as a successful treatment. Mean AHI was reduced from 25.1 +/- 9.4 to 14.7 +/- 9.7 (p = 0.003). The PAW increased in its inferior section in 13 patients (p = 0.0001). AHI decreased > or = 30% in 9 patients (p = 0.003) of whom 8 showed increased PAW dimensions. Reduction of AHI was not significantly related to increased PAW dimensions. In conclusion MAD increased PAW dimensions and reduced SA in patients with CHF. The results may indicate that MAD reduces SA by other mechanism than increasing PAW dimensions.
  • Eskafi, Mahmoud, et al. (författare)
  • Treatment of sleep apnea in congestive heart failure with a dental device - The effect on brain natriuretic peptide and quality of life
  • 2006
  • Ingår i: Sleep and Breathing. - Springer. - 1520-9512 .- 1522-1709. ; 10:2, s. 90-97
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of the present study was to investigate the effect of a mandibular advancement device (MAD) for the treatment of sleep apnea (SA) on plasma brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), and health-related qualify of life (HRQL) in patients with mild to moderate stable congestive heart failure (CHF). Seventeen male patients aged 68.4 +/- 5.5 with an apnea-hypopnea index (AHI) = 10 were equipped with an individually fitted MAD. SA was evaluated using a portable respiratory multirecording system before and after the initiation of treatment. Eleven patients completed follow-up and were evaluated after 6 months of treatment. The AHI reduced from 25.4 +/- 10.3 to 16.5 +/- 10.0 (p = 0.033) compared to baseline and mean plasma BNP levels decreased from 195.8 +/- 180.5 pg/ml to 148.1 +/- 139.9 pg/ml (p = 0.035). SA-related symptoms, e. g., excessive daytime sleepiness, were also reduced (p = 0.003). LVEF and HRQL were unchanged. We conclude that SA treatment with a MAD on patients with mild to moderate stable CHF appears to result in the reduction of plasma BNP levels. Further studies to investigate if the observed reduction in BNP concentrations also result in improved prognosis are warranted.
  • Christidis, N, et al. (författare)
  • Effectiveness of a prefabricated occlusal appliance in patients with temporomandibular joint pain : a randomized controlled multicenter study
  • 2014
  • Ingår i: Journal of oral & facial pain and headache. - Quintessence. - 2333-0384. ; 28:2, s. 128-137
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: To evaluate the effectiveness of a prefabricated appliance and compare it to the effectiveness of a stabilization appliance in patients with temporomandibular joint (TMJ) pain. METHODS: This randomized, controlled multicenter study comprised 48 patients diagnosed with TMJ arthralgia according to the Research Diagnostic Criteria for Temporomandibular Disorders. The effectiveness of a prefabricated appliance (Relax), worn by half of the patients (referred to as the R group), was compared to the effectiveness of a stabilization appliance, worn by the other half of patients (S group). Treatment outcome was assessed according to the recommendations by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) on an intent-to-treat basis. To analyze the differences between groups, the chi-square test and the Mann-Whitney U test were used, while the Friedman analysis of variance (ANOVA) on ranks was used for the analyses between baseline data and follow-up measurements, all with a significance level set at P < .05. RESULTS: There were no differences between the groups at baseline. A 30% reduction of pain intensity was reported by 62.5% of the R group and 58.3% of the S group at the 10-week follow-up; 58% and 50.3%, respectively, at the 6-month follow-up; and 41.7% in both groups at 12 months. At the 12-month follow-up, pain intensity had decreased and physical function had improved in both groups (P < .005 and P < .016, respectively), without significant group differences. Emotional function (depression and nonspecific physical symptoms) did not change. Overall improvement of "better" to "symptom-free" was observed in 67% of the R group and 58% of the S group. No side effects occurred. CONCLUSION: The effectiveness of the prefabricated appliance seems to be similar to that of the stabilization appliance in alleviating TMJ pain. Since the prefabricated appliance requires only one visit for construction, it is convenient for both the general practitioner and for the patient
  • Limchaichana, Napat, et al. (författare)
  • Clinical diagnoses and MRI findings in patients with TMD pain
  • 2007
  • Ingår i: Journal of Oral Rehabilitation. - 0305-182X. ; 34:4, s. 237-245
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to correlate clinical diagnoses in temporomandibular disorders patients suffering from pain diagnosed as arthralgia/osteoarthritis or myofascial pain according to the Research Diagnostic Criteria for temporomandibular disorders with findings made on magnetic resonance imaging. The temporomandibular joints of 60 consecutive patients, 41 with arthralgia/osteoarthritis and 19 with myofascial pain, were examined clinically and with magnetic resonance imaging. The most common magnetic resonance imaging findings were disc displacements and structural bone changes, which were found in both pain groups. However, disc displacements were found significantly (p = 0.002) more often in the arthralgia/osteoarthritis group. 104 joints were found to have no clinical diagnosis of disc displacements, but 64 of these joints had findings of disc displacements on magnetic resonance imaging. Joint fluid was found both in the arthralgia/osteoarthritis group (20 patients) and in the myofascial pain group (5 patients). Patients having a combination of disc displacement and joint fluid were significantly (p = 0.047) more common in the arthralgia/osteoarthritis group. In conclusion, the magnetic resonance imaging findings of disc displacement and structural bone changes were common in temporomandibular disorders patients with pain of both myogenous and arthrogenous origin. The clinical diagnoses for subdivision into myogenous and arthrogenous pain groups were not confirmed by magnetic resonance imaging.
  • Eskafi, Mahmoud, et al. (författare)
  • Use of a mandibular advancement device in patients with congestive heart failure and sleep apnoea.
  • 2004
  • Ingår i: Gerodontology. - Blackwell Publishing. - 1741-2358 .- 0734-0664. ; 21:2, s. 100-7
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To evaluate the practical use of the mandibular advancement device (MAD) for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) over 1 year. Subjects: Twentyfive patients aged 66 ± 8 years (mean ± SD) met the inclusion criteria and were included in the study. Design: In a prospective, clinical trial, the apnoea-hypopnoea index (AHI), a measure of SA, was determined with a portable device. Failure to enter treatment and compliance, adverse events and signs and symptoms of temporomandibular disorders (TMD) were examined before intervention and 4-6 weeks, 6 months and 1 year after intervention. Results: Six patients had removable dentures of whom four had complete dentures. Before treatment, eight patients reported minor symptoms of TMD. The AHI fell from 19.3 ± 12.1 to 11.8 ± 9.5 (p = 0.004) with use of the device. In most patients, use of the MAD had no severe effects on the signs and symptoms of TMD. Adverse events such as pain in the temporomandibular joints, soreness in the teeth, and tiredness in the jaws were reported by ten patients. Dental complications were observed in two patients. Sixtyfour per cent of the patients were still using the MAD at the 1-year follow-up. Conclusion: both the general and oral health of CHF patients were important in treatment with a MAD. The MAD therapy had no severe effect on the masticatory system and edentulous patients could be treated.
  • Wolf, Eva, et al. (författare)
  • Nonspecific Chronic Orofacial Pain: Studying Patient Experiences and Perspectives with a Qualitative Approach
  • 2008
  • Ingår i: Journal of Orofacial Pain. - Quintessence Publishing. - 1064-6655. ; 22:4, s. 349-358
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: To analyze the nonspecific chronic orofacial pain patient&#39;s experience of the pain condition and to gain knowledge on the complexity of the problem. Methods: Fourteen patients (1 I female, 3 male) aged 21 to 77 years were selected among those referred to a specialist clinic. All selected patients agreed to participate. Data were obtained through thematic in-depth interviews that exposed the context of the orofacial pain condition. The 2 interviews with each patient were audiotaped and transcribed verbatim. The text material was analyzed using a qualitative research strategy based on phenomenology. Results: The essence of the chronic orofacial pain was expressed by the patients as something that eludes perception and comprehension. The pain was difficult to grasp and to communicate, The consequence of the pain was experienced by the patients as to be stricken by the pain and was expressed as living a life permeated by hopelessness, resignation, and a lack of faith. Conclusion: The patients in this study experienced their chronic orofacial pain to have no limits and to repressively permeate all aspects of their existence: social, practical, and emotional. J OROFAC PAIN 2008;22:349-358
  • Wolf, Eva, et al. (författare)
  • Patients' experiences of consultations for nonspecific chronic orofacial pain: A phenomenological study
  • 2006
  • Ingår i: Journal of Orofacial Pain. - Quintessence Publishing. - 1064-6655. ; 20:3, s. 226-233
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: To use a qualitative research study to analyze the experiences of patients with nonspecific chronic orofacial pain with respect to consultations for their pain condition. Methods: Fourteen patients (11 women and 3 men; age range, 21 to 77 years) were strategically selected through a purposive sampling of the chronic orofacial pain patients referred to the Orofacial Pain Unit at the Faculty of Odontology, Malmo University, Malmo, Sweden. A qualitative research strategy based on phenomenological philosophy was chosen. Thematic in-depth interviews were conducted twice with each patient in order to expose the context of the orofacial pain condition. The interviews were audiotaped and transcribed verbatim. The text material was analyzed to determine the attitude of the patients concerning their experience from the consultations. Results: All selected patients consented to participate. The patients expressed dissatisfaction with the consultations and related many examples of poor communication and understanding. The patients also felt a great need to be taken care of and expressed contradictory statements concerning pain improvement. Conclusion: The results suggest that the communication between the patients and the care providers was unsatisfactory and that the patients were limited in their ability to develop a personal coping strategy.
  • Abrahamsson, Cecilia, et al. (författare)
  • TMD before and after correction of dentofacial deformities by orthodontic and orthognathic treatment
  • 2013
  • Ingår i: International journal of oral and maxillofacial surgery. - Elsevier. - 0901-5027. ; 46:6, s. 752-8
  • Tidskriftsartikel (refereegranskat)abstract
    • Abstract The aims of the study were to investigate the alteration of temporomandibular disorders (TMD) after correction of dentofacial deformities by orthodontic treatment in conjunction with orthognathic surgery; and to compare the frequency of TMD in patients with dentofacial deformities with an age and gender matched control group. TMD were evaluated in 121 consecutive patients (treatment group), referred for orthognathic surgery, by a questionnaire and a clinical examination. 18 months after treatment, 81% of the patients completed a follow-up examination. The control group comprised 56 age and gender matched subjects, of whom 68% presented for follow-up examination. TMD were diagnosed according to research diagnostic criteria for TMD. At baseline examination, the treatment group had a higher frequency of myofascial pain (P=.035) and arthralgia (P=.040) than the control group. At follow-up, the frequencies of myofascial pain, arthralgia and disc displacement had decreased in the treatment group (P=.050, P=.004, P=.041, respectively). The frequency of TMD was comparable in the two groups at follow-up. Patients with dentofacial deformities, corrected by orthodontic treatment in conjunction with orthognathic surgery, seem to have a positive treatment outcome in respect of TMD pain
  • Abrahamsson, Cecilia, et al. (författare)
  • TMD in consecutive patients referred for orthognathic surgery
  • 2009
  • Ingår i: Angle Orthodontist. - 0003-3219. ; 79:4, s. 621-7
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To answer the question whether temporomandibular disorders (TMD) were more common in a group of individuals referred for orthognathic surgery than in a control group. The null hypothesis was that neither the frequency of signs and symptoms of TMD or diagnosed TMD would differ between the patient group and a control group. MATERIALS AND METHODS: A sample of 121 consecutive patients referred for orthognathic surgery at the Department of Oral Maxillofacial Surgery, Malmö University Hospital, Sweden, was interviewed and examined regarding signs and symptoms of TMD and headaches. A control group was formed by 56 age- and gender-matched individuals attending the Department of Oral Diagnosis, Faculty of Odontology, Malmö University, Sweden, and Public Dental Health Clinic in Oxie, County of Skane, Sweden. TMD diagnoses were used according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). RESULTS: The patient group showed more myofascial pain without limited opening, disc displacement with reduction, and arthralgia according to RDC/TMD than the control group. The patient group also had more symptoms and signs of TMD in general. CONCLUSIONS: The null hypothesis was rejected because patients who were to be treated with orthognathic surgery had more signs and symptoms of TMD and higher frequency of diagnosed TMD compared with the matched control group.
  • Al-Harthy, Mohammad, et al. (författare)
  • Pain related temporomandibular disorders in adult Saudi arabians referred for specialized dental treatment.
  • 2007
  • Ingår i: Pain related temporomandibular disorders in adult Saudi arabians reffered for specialized dental treatment..
  • Tidskriftsartikel (populärvet., debatt m.m.)abstract
    • The aim of the present study was to examine the frequencies of pain-related symptoms of TMD in patients in the age of 20-40 years referred for specialized dental treatments in Makkah, Saudi Arabia by using Research Diagnostic Criteria for TMD (RDC/TMD). Three hundred and twenty-five consecutive Saudi patients in the age of 20-40 years: 135 males and 190 females were interviewed according to the RDC/TMD history questionnaire. The results revealed that pain related TMD and orofacial pain were found among 58 (18%) patients. All other patients formed the non-pain group (267,82%). In the pain group, there were 79% females compared to 21% males (P<0.01). Both genders in the pain group reported high frequencies of both migraines in the last six months and headache moderately to extremely in the last month showing significant difference in comparison with the non-pain group (P<0.01). Symptoms of TMD were significantly more prevalent in the pain group than in the non-pain group. The most common pain related TMD symptoms were TMJ clicking, TMJ crepitation, TMJ locking, stiff jaw, tinnitus, bruxism and uncomfortable bite. Regarding Graded Chronic Pain severity in the pain group, most patients reported their pain to be grade I and II. Jaw disability checklist according to RDC/TMD showed that four or more disturbed jaw activities were found in 31 patients (53%) while 13 patients (22%) had not affected mandibular functions. In conclusion, the findings of the present study showed high frequencies of pain related TMD in this Saudi arabian patient population.
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