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- Lindfors, Erik, et al.
(författare)
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Treatment of temporomandibular disorders with a combination of hard acrylic stabilisation appliance and a soft appliance in the opposing jaw : A retro- and prospective study
- 2008
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Ingår i: Swedish Dental Journal. - : Swedish Dental Association. - 0347-9994. ; 32:1, s. 9-16
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the treatment effect of a combined treatment with a stabilisation appliance and a soft appliance in the opposing jaw in patients refractory to previous TMD treatment. During a 5-year-period, 2001-2005, a total of 98 patients received the combined treatment at the Department of Stomatognathic Physiology, the Institute for Postgraduate Dental Education, Jonkoping, Sweden. Before the patients received the combined treatment, they had already been given several different TMD treatments during a long period of time, either before referral or at the specialist clinic, with only minor or no effect on their TMD symptoms. The patients were followed prospectively (n =10), or analysed retrospectively (n =88). The data registered were gender, age, main indication for TMD treatment, number of visits to the clinic before and after the introduction of the combined treatment, as well as according to a clinical (Di) and anamnestic (Ai) dysfunction index. The most common causes for treatment in the retrospective material were problems of muscular origin and problems of both muscular and TMJ origin. In the prospective material, most of the patients had mainly muscular symptoms. Both the clinical and anamnestic dysfunction index decreased statistically significantly in the retrospective material after the introduction of the combined treatment. There was a numerical improvement of both indices also in the prospective material. In conclusion, the present investigation showed that a combined treatment with a hard acrylic stabilisation appliance and a soft appliance in the opposing jaw seems to give a remarkable improvement of TMD signs and symptoms in apparently therapy resistant TMD patients. General conclusions should, however, be made with caution due to the fact that the study did not include any control group. There is an obvious need for randomized controlled studies concerning the efficacy and effectiveness of the combined treatment presented in this study.
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- List, Thomas, et al.
(författare)
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Clinical findings and psychosocial factors in patients with atypical odontalgia : A case-control study
- 2007
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Ingår i: Journal of Orofacial Pain. - : Quintessence. - 1064-6655 .- 1945-3396. ; 21:2, s. 89-98
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To provide a systematic description of clinical findings and psychosocial factors in patients suffering from atypical odontalgia (AO). Methods: Forty-six consecutive AO patients (7 men and 39 women, mean age, 56 years, range, 31 to 81 years) were compared with 35 control subjects (11 men and 24 women, mean age, 59 years, range, 31 to 79 years). Results: The pain of the AO patients was characterized by persistent, moderate pain intensity (mean, 5.6 +/- 1.9) with long pain duration (mean, 7.7 +/- 7.8 years). Eighty-three percent reported that onset of pain occurred in conjunction with dental treatment. No significant difference was found between the groups in number of remaining teeth or number of root fillings. Temporomandibular disorder (TMD) pain (P < .001), tension-type headache (P < .002), and widespread pain (P < .001) were significantly more common among AO patients than controls. Significantly higher scores for somatization (P < .01) and depression (P < .01) and limitations in jaw function (P < .001) were found for the AO group compared with the control group. Significant differences between groups were found in 4 general health domains: role-physical (P < .001), bodily pain (P < .001), vitality (P < .004), and social functioning (P < .001). Conclusion: A majority of the AO patients reported persistent, moderately intense intraoral pain that in most cases had an onset in conjunction with dental treatment. AO patients had more comorbid pain conditions and higher scores for depression and somatization. Significant limitation in jaw function and significantly lower scores on quality of life measures were found for AO patients compared with controls.
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- List, Thomas, et al.
(författare)
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Effect of local anesthesia on atypical odontalgia - A randomized controlled trial
- 2006
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Ingår i: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0304-3959 .- 1872-6623. ; 122:3, s. 306-314
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to evaluate the analgesic effect of lidocaine in a double-blind, controlled multi-center study on patients with atypical odontalgia (AO) - a possible orofacial neuropathic pain condition. Thirty-five consecutive AO patients (range 31-81 years) with a mean pain duration of 7.2 years (range 1-30 years) were recruited from four different orofacial pain clinics in Sweden. In a randomized cross-over design, 1.5 ml local anesthesia (20 mg/ml lidocaine and 12.5 μg/ml adrenaline) or 1.5 ml saline (9 mg/ml NaCl solution) (placebo) was injected to block the painful area. The VAS pain scores showed an overall effect of time (ANOVA: P < 0.001) and treatment (ANOVA: P = 0.018) with a significant interaction between the factors (ANOVA: P < 0.001). Overall, VAS pain relief was significantly greater at 15-120 min following the lidocaine injections compared to the placebo injections (Tukey: P < 0.05). All patients demonstrated significant disturbances in somatosensory function on the painful side compared to the non-painful side as revealed by quantitative sensory tests, however, only one significant inverse correlation was found between percentage pain relief and the magnitude of brush-evoked allodynia (Spearman: P < 0.01). In conclusion, AO patients experienced significant, but not complete, pain relief from administration of local anesthetics compared with placebo. The findings indicate that the spontaneous pain in AO patients only to some extent is dependent on peripheral afferent inputs and that sensitization of higher order neurons may be involved in the pathophysiology of AO. © 2006 International Association for the Study of Pain.
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- Storm Mienna, Christina
(författare)
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Temporomandibular disorders among Sami women : perspectives based on an epidemiological survey with mixed methods
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction The aim of the research project was to examine prevalence, co-morbidity, and impact on daily life of pain and dysfunction in the jaw-face, head, and neck-shoulder regions among adult Sami women in northern Sweden. The aim of the qualitative part of the study was to explore, thoughts, experiences, and beliefs regarding temporomandibular disorders (TMD) among Sami women with and without TMD, to gain insights into their health care experiences.Methods The research project used a mixed methods approach including questionnaire analysis, a case-control study, and thematic interviews. The study population (Papers I and III) included 487 women living in the Arctic region of northern Sweden and enrolled in the register of the Swedish Sami Parliament or registered as reindeer owners or reindeer herders in the Swedish Board of Agriculture. Two years after the questionnaire study, 22 women (cases) with longstanding, intense, and frequent symptoms indicative of TMD, together with 46 age-matched women (controls) without any symptoms in the jaw–face region, underwent a clinical examination of the function of the temporomandibular joint, jaw- and neck muscles, mandibular mobility, and dental occlusion. The examiner was blind to the women’s affiliation (Paper II). Thematic interviews with a strategic subsample of 17 Sami women (Paper IV) were thereafter conducted and analyzed with a grounded theory approach.Results The prevalence of frequent symptoms indicative of TMD was 17%, of headaches 19%, and of neck-shoulder pain (NSP) 30%. Seventeen percent reported that their TMD affected daily life. Duration of jaw pain, troublesome impaired jaw opening, and neck pain, together with a low education level, affected the statement of whether TMD influenced daily life or not. Factors related to pain had the greatest influence when these Sami women rated the related impairment. There was a statistically significant relationship between TMD, frequent headaches, and frequent NSP (P <0.0001). Longstanding, intense, and frequent symptoms indicative of TMD remained essentially unchanged over the two-year follow-up period. Cases reported impaired general health and awareness of clenching teeth significantly more frequently than did controls. Variations in dental occlusion did not distinguish cases from controls. In the qualitative part of the project the core category, “Grin(d) and bear it,” summarizes the participants’ various ways and stages of processing and handling the interacting categories: (1) triggers, (2) strains, (3) distrust, and (4) reconciliation with pain and/or difficulties in life. Perpetuating factors were described as mental-physical strain and stress, and also a tooth clenching behavior. Women without TMD expressed factors that helped them to handle strains, reconcile, and stay healthy. They relied on helpful social support.Conclusion Disabling TMD, headaches, and NSP are common in Sami women. Women with TMD commonly expressed that tooth clenching was a familiar habit related to strains in life; they described an impaired general state of health and distrust in the care providers’ competence and ability to manage their problems. Women without TMD expressed confidence in their self-efficacy and were generally less concerned with strains in their lives. Rehabilitation strategies aiming at empowerment and improved self-efficacy may be a successful approach in women with disabling TMD.
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