| 1. |
- Adèrn, Bengt, et al.
(författare)
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Orsaker till remisser till bettfysiolog : en jämförelse mellan fyra specialistkliniker
- 2003
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Ingår i: Tandläkartidningen. - 0039-6982. ; 95:10, s. 50-55
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Specialistinstanser i bettfysiologi möter i huvudsak patienter som har en långvarig och svårt smärtproblematik. Under 1900-talet har dock även behandling av obstruktiv sömnapné tillkommit. Ofta är det en läkare som remitterat patienten till den bettfysiologiska kliniken. Denna studie visar att bettfysiologen är en viktig länk mellan tandvården och sjukvården vid utredning och behandling av orofacial smärta. Syf-tet med studien var att jämföra orsakerna till remisser till bettfysiologi. En jämförelse gjordes mellan fyra specialistkliniker i bettfysiologi un-der en 4-månadersperiod år 2001. De flesta remitterade patienter var kvinnor i åldern 20 år och uppåt. Bland de remitterade kvinnorna var smärta den dominerande orsaken medan männen lika ofta remittera-des för sömnstörning som för smärta. 86 procent av patienterna som remitterats för smärta värderade smärtans intensitet som måttlig till väldigt svår. Hos 80 procent av dessa patienter var smärtan långvarig.
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| 2. |
- Adern, Bengt, et al.
(författare)
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Prevalence of temporomandibular dysfunction and pain in adult general practice patients
- 2014
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Ingår i: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 72:8, s. 585-590
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To analyse the prevalence of temporomandibular disorders and related pain (TMD-pain) among adult recall patients in general dental practice. Materials and methods. From November 2006 to September 2008, all adults attending a Swedish Public Dental Service (PDS) clinic for recall examination were asked two standardized questions about temporomandibular pain and dysfunction. Mouth-opening capacity was measured. The responses to the questions and mouth-opening capacity were combined to give a TMD-pain score, on a scale of 0-3. The patients' acceptance of their TMD condition was also noted. Results. The subjects comprised 2837 adults (53% females, 47% men). Of the total sample, 4.9% reported a TMD-pain score of 1-3. The gender difference was significant: women predominated (p < 0.003). Forty-three per cent of those with TMD-pain scores of 1-3 (36% men, 47% women) considered that the condition warranted treatment, especially those registering a pain score (significant difference between pain and dysfunction groups, p < 0.000). Conclusions. The TMD-pain score shows promise as a useful instrument for detecting and recording TMD-pain. The prevalence of TMD disclosed in the study is high enough to be considered a public health concern. Most of the subjects with lower scores on the TMD-pain scale accepted their condition as not severe enough to require treatment.
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| 3. |
- Adern, Bengt, et al.
(författare)
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Self-reportance of temporomandibular disorders in adult patients attending general dental practice in Sweden from 2011 to 2013
- 2018
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Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 76:7, s. 530-534
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The study aim was to evaluate the prevalence of self-reported temporomandibular disorders (TMD) and acceptance or nonacceptance of such disorders in adult patients attending all public dental health services in the County of Sormland, Sweden, during a 3-year period, 2011-2013. Methods: Two questions were asked about TMD and the voluntary mouth-opening capacity was measured. The results were registered in a score 0-3. The registration was completed with a question about each patient's acceptance or nonacceptance of their condition. Results: More than 73,000 registrations of the TMD condition were performed in general dental clinics from 2011 to 2013. The mean prevalence of a TMD score of 1-3 was 5% and was consistent over these years. Seventy percent of these patients were women. The peak prevalence of TMD was registered in patients aged 30-45years (38%), and the frequency declined in older age groups. Reduced voluntary mouth-opening capacity (<= 35 mm) was found in less than 2% of the participants. About one-fifth of the patients with a TMD-score of 1-3 did not accept their condition and wanted professional care. The frequency of nonacceptance of the condition increased with the severity of symptom score: 15%, 27%, and 49% for scores 1, 2, and 3, respectively. Conclusions: This study shows that the prevalence of self-reported TMD in adult patients was consistent from 2011 to 2013 and should be considered as a public health issue in Sweden. Patients with more severe TMD pain symptoms wanted care more frequent. The annual clinical calibrations should be continued to achieve an acceptable level of registration.
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| 4. |
- Ahonen, Hanna
(författare)
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The multifaceted concept of oral health : Studies on a Swedish general population and perspectives of persons with experience of long-term CPAP-treated obstructive sleep apnea
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Oral health is a multifaceted and changeable part of our overall health and well-being as it contributes to important everyday functions such as eating, talking, and conveying feelings. Our oral health can be affected by a range of determinants, one of which is obstructive sleep apnea [OSA] treated with continuous positive airway pressure [CPAP]. Even though xerostomia has been frequently reported upon, the possible relationship between oral health and CPAP-treated OSA is not clearly understood. The World Dental Federation [FDI] recently proposed a definition and theoretical framework of oral health, intended to be globally applicable and to move dentistry toward a more promotive approach. By using the FDI’s framework as a basis for exploration, studies in a general population can increase the understanding of different aspects of oral health and set the frame of reference for whether and how CPAP-treated OSA can be experienced to affect a person’s oral health.The overall aim of this thesis was to gain a deeper understanding of how the FDI’s theoretical framework of oral health can be applied in a general population and how oral health is experienced in a specific population of persons with increased risk for adverse oral health.The FDI’s framework was explored with empirical data from a general population (N=630) and a population of persons with experience of CPAP-treated OSA (N=18). In papers I and II, the FDI framework was tested and evaluated with quantitative methods (principal component analysis and structural equation modeling), using cross-sectional data from the Jönköping studies. In papers III and IV, qualitative methods (directed content analysis and critical incident technique) were used where personal views and experiences were explored using individual semi-structured interviews.The findings in paper I showed that factors such as dental caries, periodontal disease, experience of xerostomia, and aesthetic satisfaction can be included in the FDI’s component the core elements of oral health. In paper II, driving determinants and moderating factors were found to have direct effects on all core elements of oral health except aesthetic satisfaction. Three of the core elements of oral health (oral health-related quality of life, aesthetic satisfaction, and xerostomia) had direct effects on the latent variable overall health and well-being. Driving determinants and moderating factors had no direct effect on overall health and well-being, and no indirect effects were found. In paper III, the study participants’ views on oral health determinants were described and could be categorized into all the FDI framework dimensions. The component driving determinants could include a range of determinants affecting a person’s oral health such as CPAP treatment, age, the influence of family and social surroundings, interdental cleaning, willingness to change when needed, and relationship with oral healthcare professionals. In paper IV, the study participants described both negative and positive experiences occurring with or without their CPAP. The negative experiences included increased xerostomia, pain or discomfort, tooth wear, and negative feelings. The positive experiences included decreased xerostomia and improved oral health habits due to improved sleep. Many of the difficulties could be managed by easily accessible facilitators. The experiences the study participants described could be included in all the FDI framework components.In conclusion, the FDI’s framework can be applied in a general population to describe different components of oral health, and is also useful to describe a person’s views and experiences of oral health in a specific population. CPAP treatment could be considered an oral health determinant as it can affect a person’s oral health. Both positive and negative experiences can contribute to CPAP adherence as negative experiences often can be successfully managed.
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| 5. |
- Andren, Ann, et al.
(författare)
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Effects of treatment with oral appliance on 24-h blood pressure in patients with obstructive sleep apnea and hypertension : a randomized clinical trial
- 2013
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Ingår i: Sleep and Breathing. - : Springer Science and Business Media LLC. - 1520-9512 .- 1522-1709. ; 17:2, s. 705-712
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Tidskriftsartikel (refereegranskat)abstract
- Continuous positive airway pressure treatment has been shown to lower blood pressure (BP) in patients with obstructive sleep apnea (OSA). The aims of the present pilot study were to evaluate the potential effects of oral appliance (OA) therapy on BP, to assess various outcome BP measures, and to inform sample size calculation. Seventy-two patients with OSA and hypertension were randomly assigned to intervention with either an OA with mandibular advancement (active group) or an OA without advancement (control group). Before and after 3 months of treatment, the patients underwent nocturnal somnographic registration and 24-h ambulatory BP monitoring. Among the various BP measures, the largest trend toward effect of OA treatment was seen in 24-h mean systolic BP with a 1.8 mmHg stronger BP reduction in the active group compared with controls. A stronger trend toward effect was seen in a subgroup with baseline ambulatory daytime mean systolic BP > 135/85 mmHg where the mean systolic BP fell, on average, 2.6 mmHg. Additional exclusion of patients with baseline apnea hypopnea index (AHI) a parts per thousand currency sign15 gave a significant reduction in mean systolic BP of 4.4 mmHg (P = 0.044) in the active group compared with controls. In patients with OSA and hypertension, OA treatment had a modest trend toward effect on reducing BP. A stronger trend toward treatment effect was seen after excluding patients with normal baseline ambulatory BP. Additional exclusion of patients with baseline AHI a parts per thousand currency sign15 showed a significant treatment effect. Data to inform sample size for an adequately powered randomized study are provided.
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| 6. |
- Andrèn, A, et al.
(författare)
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Effects on blood pressure after treatment of obstructive sleep apnoea with a mandibular advancement appliance - a three-year follow-up
- 2009
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Ingår i: Journal of Oral Rehabilitation. - : Wiley. - 1365-2842 .- 0305-182X. ; 36:10, s. 719-725
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Tidskriftsartikel (refereegranskat)abstract
- P>Obstructive sleep apnoea (OSA) is a highly prevalent sleep disorder; it affects 4% of males and 2% of females. Hypertension has been shown to occur in 28-57% of OSA patients. There is a steady increase in evidence linking OSA to long-term cardiovascular morbidity including hypertension. The purpose of this study was to investigate whether mandibular advancement oral appliance (OA) treatment of OSA affects the patient's blood pressure (BP) in a 3-month and a 3-year perspective. Twenty-nine consecutive patients, with verified OSA defined as apnoea index (AI) > 5 per hour and/or apnoea/hypopnoea index (AHI) >= 10 per hour, received an OA as treatment. BP was measured on three occasions; before treatment, after 3 months of treatment, and after 3 years of treatment. BP was measured with an electronic blood pressure monitor. The treatment effect of OA was measured after 3 months by repeated somnographic registration while the patient was wearing the OA. A treatment response was defined as AHI < 10; this was achieved in 25 of 29 patients (86%) at the 3-month evaluation. Significant reductions in blood pressure were attained between baseline and the 3-month evaluation (P < 0 center dot 001) and these changes remained at the 3-year follow-up in both systolic BP of -15 center dot 4 +/- 18 center dot 7 mm Hg and diastolic BP of -10 center dot 3 +/- 10 center dot 0 mm Hg. OA therapy reduced blood pressure in both a 3-month and a 3-year perspective in patients with OSA.
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| 7. |
- 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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| 8. |
- Eriksson, Lars, et al.
(författare)
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Analgesic efficacy and clinical acceptability of adjunct pre-emptive intravenous tramadol in midazolam sedation for third molar surgery
- 2012
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Ingår i: Oral and Maxillofacial Surgery. - : Springer. - 1865-1550 .- 1865-1569. ; 17:3, s. 193-199
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Tidskriftsartikel (refereegranskat)abstract
- Introduction This study aims to compare two routine procedures of sedation, with and without intravenous adjunct analgesia, in third molar surgery regarding postoperative pain and consumption of analgesics. Material and methods In a randomized, controlled, single-blinded procedure, 87 men and women aged 18–44 years were divided into two treatment groups, midazolam + tramadol (M + T) and midazolam + saline (M + S), and one control group (C), with no additional medication. After removal of a third lower molar, patients recorded postoperative pain on a visual analog scale (VAS) and consumption of analgesics during the first day after surgery. Results Time from the end of operation until first rescue pill (400 mg Ibuprofen tablet) differed significantly between the M + S group (193 min) and the C group (110 min) (p = 0.001) as well as the M + T group (157 min) and the C group (p = 0.049). The study did not show any significant reduction of postoperative pain, VAS, after third molar surgery in patients who received adjunct pre-emptive intravenous administration of 1 mg/kg tramadol under midazolam sedation. Discussion and conclusion The lack of significant difference between the study and placebo groups indicates that tramadol at 1 mg/kg might be an insufficient dose, though the suitability for tramadol in oral and maxillofacial surgery has already been settled in other studies.
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| 9. |
- Eriksson, Lars B., et al.
(författare)
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Intravenous S-ketamine's analgesic efficacy in third molar surgery : A randomized placebo-controlled double-blind clinical trial
- 2023
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Ingår i: British Journal of Pain. - : Sage Publications. - 2049-4637 .- 2049-4645.
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn most cases, a combination of paracetamol and ibuprofen are the optimal treatment for postoperative pain in third molar surgery. If stronger analgesia is required, opioids are traditionally administered. In day-case, surgery; however, opioids should be avoided. Thus, the anaesthetic agent S-ketamine in analgesic doses might be preferred.MethodsThe study was designed as a randomized placebo-controlled double-blind clinical trial. The study enrolled healthy subjects according to the American Society of Anaesthesiologists classification; I or II (ASA), aged 18 to 44 years, with a body weight between 50 and 100 kg. The patients were randomized into three groups where two doses of S-ketamine were compared (high: 0.25 mg/kg or low: 0.125 mg/kg) with placebo (saline).ResultsA primary outcome of the study was that VAS at 4 h postoperatively, showed no significant difference between the placebo and high-dose S-ketamine group or in the low-dose group. We found a significant difference between the groups for the first 24 h, with a lower VAS-score in the high-dose S-ketamine group. The time to when 50% had taken their first rescue medication was 12 min later in the high-dose ketamine group.ConclusionsPre-emptive S-ketamine 0.25 mg/kg gave a global significant reduction of pain by VAS during the first 24 h postoperatively. The time from end of surgery to first rescue medication were longer in the high-dose ketamine group compared to both low-dose ketamine and placebo groups.
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| 10. |
- Eriksson, Lars B, et al.
(författare)
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Safety of adjunct pre-emptive intravenous tramadol with midazolam sedation for third molar surgery
- 2015
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Ingår i: Oral and Maxillofacial Surgery. - : Springer. - 1865-1550 .- 1865-1569. ; 19:4, s. 353-359
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this study was to evaluate patient safety, in terms of adverse events, alterations in blood pressure or oxygen saturation (SpO2) in two routine sedation procedures, with and without intravenous analgesia. METHODS: Patients referred for surgical removal of mandibular third molars were treated in a randomized, controlled, single-blinded procedure. Eighty-seven men and women, aged 18 to 44 years, were allotted to either of two treatment groups, midazolam + tramadol (M + T) and midazolam + saline (M + S) or to a control group (C), given no sedation. RESULTS: Tramadol at 1 mg/kg body weight resulted in a higher frequency of oxygen desaturation (SpO2 < 90 %) than a placebo (p = 0.002) but had no effect on mean SpO2 at the end point or at the end of surgery. In both the test groups, there was a significant decrease in diastolic blood pressure (p < 0.001) from baseline to the end of surgery. CONCLUSION: The results confirm that pre-emptive intravenous tramadol, administered at 1 mg/kg body weight as an adjunct to midazolam sedation for third molar surgery, offers a safe method. But, it should be noted that our previous study shows that it is not a particularly effective analgesic. Further testing is therefore warranted, using other doses or other drugs, to find a better intravenous protocol for postoperative analgesia, with maximum effect and minimal risk, in outpatient oral and maxillofacial surgery procedures.
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