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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.
  • Abrahamsson, Cecilia, et al. (författare)
  • TMD in Consecutive Patients Referred for Orthognathic Surgery
  • 2009
  • Ingår i: Swedish dental journal. - Stockholm : 45th Annual Congress of the Swedish Dental Society. - 0347-9994. ; 33:4, s. 201-226 Abstract 25
  • Konferensbidrag (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.
  • Ekberg, EwaCarin, et al. (författare)
  • Effectiveness of a prefabricated occlusal appliance, Relax, in the long-term (Miami)
  • 2009
  • Konferensbidrag (övrigt vetenskapligt)abstract
    • Objectives: To compare the long-term effectiveness of a prefabricated occlusal appliance with a stabilization appliance in myofascial pain patients. Methods: Sixty-five patients with the diagnosis myofascial pain at two centres for Stomatognathic Physiology in Sweden and Finland were included in a randomized controlled trial. Patients were randomly assigned to a prefabricated appliance (R-group, 27 women, 5 men, mean age 38 years) or a stabilization group (S-group, 31 women 2 men, mean age 37 years). General practitioners performed the treatment. History and clinical examination was performed according to RDC/TMD. At the 6 months- and 1 year follow-up the treatment outcome regarding pain according to the visual analogue scale and overall rating of pain according to the verbal scale was evaluated. Results: At baseline there were no differences between the groups regarding frequency of myofascial pain, number of years suffering from the pain, worst or mean pain during the last six months. At the 12-months follow-up 30% and 50% pain relief in the R- and S-groups were reported in 24 and 21 patients and 23 and 17 patients respectively. According to a verbal scale 26 and 21 patients in the two groups reported themselves to be better, much better or symptom-free. All calculations were done per protocol. An increased open bite was registered in one patient. Conclusions: In a long-term perspective both appliances seemed to have an equal effectiveness in the treatment of patients suffering from myofascial pain. The prefabricated appliance, Relax, can be recommended as a long-term treatment modality when used night time only. Frontal open bite should be regarded as a contraindication.
  • 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'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
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