| 1. |
- Leksell, Eva, et al.
(författare)
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Perceived Oral Health and Care of Children with Juvenile Idiopathic Arthritis : A Qualitative Study
- 2015
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Ingår i: Journal of Oral & Facial Pain and Headache. - : Quintessence Publishing. - 2333-0384 .- 2333-0376. ; 29:3, s. 223-230
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To increase knowledge about how children diagnosed with juvenile idiopathic arthritis (JIA) perceive their oral health and dental care. Methods: Fifteen interviews with children diagnosed with JIA, aged 6 to 16 years, were analyzed according to classical grounded theory. Results: The children's main concern about their oral health was identified as creating a positive identity after being diagnosed with JIA and learning to live with oral health problems. While attempting to cope with this concern, the children often endured in silence, the core category in the analysis. A variety of aspects were found of this core coping strategy, which were categorized as differentiating from the disease, working on personal caretaking and positive attitude, fighting fears and sadness, control of professional aid, and building supportive relationships. The results emphasize the importance for caregivers to show empathy and interest in the child as a person, to ask precise questions when taking case histories so the child does not remain silent, to provide psychosocial support and suggest positive coping strategies, to describe and administer treatments, and to give hope for the future. Conclusion: Awareness of the social interaction between a child diagnosed with JIA and health professionals as well as awareness of how to approach a child with longstanding illness are crucial for disclosing and treating the child's orofacial symptoms.
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| 2. |
- Barjandi, Golnaz, et al.
(författare)
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Comorbid Conditions in Temporomandibular Disorders Myalgia and Myofascial Pain Compared to Fibromyalgia
- 2021
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Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 10:14
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Tidskriftsartikel (refereegranskat)abstract
- The impact of comorbidities in fibromyalgia (FM) and temporomandibular disorders (TMD) have been well documented, but whether TMD sub-diagnoses myalgia (MYA) and myofascial pain with referral (MFP) differ regarding comorbidity is unclear. We aimed to elucidate this by studying the presence and associations of comorbidities in FM, MFP and MYA. An extended version of the Diagnostic Criteria for TMD axis II questionnaire was used to examine demographics, pain and comorbidities in 81 patients with FM, 80 with MYA, and 81 with MFP. Patients with MFP and FM reported a higher percentage of irritable bowel syndrome (IBS), depression, anxiety, somatic symptoms, perceived stress, and insomnia compared to MYA. Patients with FM had more IBS, depression, and somatic symptom disorder versus MFP. After adjusting for confounding variables, participants with anxiety, somatic symptoms disorder, pain catastrophizing, and perceived stress, as well as a greater number of comorbidities, were more likely to have MFP than MYA, whereas FM participants were more associated with IBS, somatic symptoms and insomnia compared to MFP. The number of comorbidities was significantly associated with widespread pain but not pain duration, body mass index or being on sick leave. In conclusion, patients with MFP were more similar to those with FM regarding comorbidity and should be differentiated from MYA in clinical settings and pain management.
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| 3. |
- Cedströmer, Anna-Lena, 1974, et al.
(författare)
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Temporomandibular signs, symptoms, joint alterations and disease activity in juvenile idiopathic arthritis – an observational study
- 2013
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Ingår i: Pediatric Rheumatology. - : Springer Science and Business Media LLC. - 1546-0096. ; 11:37
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Juvenile idiopathic arthritis (JIA) is a heterogeneous disease that frequently affects also the temporomandibular joint (TMJ) and associated structures. The main aim of this observational study was to describe systematically orofacial clinical signs and subjective symptoms in JIA patients, classified according to the International League of Associations for Rheumatology (ILAR) criteria, and to relate the findings to disease activity and radiological TMJ condyle lesions. METHODS: The study was a retrospective evaluation of dental and medical records in consecutive JIA patients referred to one of three dental specialist clinics in Sweden during an eight-year period. Data concerning temporomandibular signs, symptoms and general disease activity were collected and condylar alterations were judged on panoramic radiographs. RESULTS: All ILAR categories of JIA were represented among the 266 referrals included in the study. The distribution of patients among categories resembled the pattern seen in epidemiological studies. Persistent oligoarthritis was the largest category with 36.5 % of the patients. Temporomandibular clinical signs (mild, moderate or severe) occurred in 57.7 % to 92.0 %, and subjective symptoms (mild or severe) in 32.0 % to 76.0 % of the patients in all categories. Patients in the juvenile psoriatic arthritis category had the largest number of orofacial signs and symptoms, and patients in the persistent oligoarthritis category had the fewest signs and symptoms. There were significant associations between clinical signs as well as subjective symptoms and overall disease activity. Half of all the patients had undergone panoramic examinations and 37.9 % of those were judged to have condylar alterations after a mean of 2.9 years after onset. No associations between radiological findings and variables, such as signs, symptoms or disease activity, were found. CONCLUSIONS: Temporomandibular signs and symptoms can be expected to a varying degree, including severe cases, in all JIA categories. Clinical and subjective orofacial involvement appears to be related to disease activity but not to condylar lesions.
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| 4. |
- Collin, Malin, et al.
(författare)
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Salivary biomarkers in children with juvenile idiopathic arthritis and healthy age-matched controls : a prospective observational study.
- 2022
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Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Monitoring the immune system's regulation and signaling using saliva could be of interest for clinicians and researchers. Saliva, a biofluid with close exchange with serum, is influenced by circadian variance and oral factors such as masticatory function. This study investigated the detectability and concentration of cytokines and chemokines in saliva in children with juvenile idiopathic arthritis (JIA) as well as saliva flow and the influence of orofacial pain on saliva flow. Of the 60 participants (7-14 years old) enrolled, 30 had a diagnosis of JIA and active disease, and 30 were sex- and age-matched healthy controls. Demographic data and three validated questions regarding presence of orofacial pain and dysfunction were recorded. Stimulated whole saliva was collected and analyzed using a customized R&D bead-based immunoassay with 21 targeted biomarkers. Fourteen of these were detectable and showed similar levels in both children with JIA and controls: TNF-alpha, TNFRSF1B, MMP-2, MMP-3, IL-1alpha, IL-1beta, IL-6R alpha, IL-8, S100A8, CCL2, CCL3, IL-10, CCL11, and CXCL9. In addition, there was no difference in salivary flow rate between groups, but there was an association between orofacial pain and reduced saliva flow rate for both groups.Trial registration: ClinicalTrials.gov Protocol id: 2010/2089-31/2.
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| 5. |
- Ernberg, Malin, et al.
(författare)
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Efficacy of botulinum toxin type A for treatment of persistent myofascial TMD pain : a randomized, controlled, double-blind multicenter study
- 2011
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Ingår i: Pain. - : Elsevier. - 0304-3959 .- 1872-6623. ; 152:9, s. 1944-1945
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Tidskriftsartikel (refereegranskat)abstract
- Evidence of an effect by botulinum toxins is still lacking for most pain conditions. In the present randomized, placebo-controlled, crossover multicenter study, the efficacy of botulinum toxin type A (BTX-A) was investigated in patients with persistent myofascial temporomandibular disorders (TMD). Twenty-one patients with myofascial TMD without adequate pain relief after conventional treatment participated. A total of 50 U of BTX-A or isotonic saline (control) was randomly injected into 3 standardized sites of the painful masseter muscles. Follow-up was performed after 1 and 3 months, followed by a 1-month washout period, after which crossover occurred. Pain intensity at rest was the primary outcome measure, while physical and emotional function, global improvement, side effects, and clinical measures were additional outcome measures. There was no main difference between drugs (ANOVA; P=.163), but there was a significant time effect (P<.001), so BTX-A reduced mean (SD) percent change of pain intensity by 30 (33%) after 1 month and by 23 (30%) after 3 months compared to 11 (40%) and 4 (33%) for saline. The number of patients who received a 30% pain reduction was not significantly larger for BTX-A than after saline at any follow-up visit. The number needed to treat was 11 after 1 month and 7 after 3 months. There were no significant changes after treatment in any other outcome measures, with the exception of pain on palpation, which decreased 3 months after saline injection (P<.05). These results do not indicate a clinical relevant effect of BTX-A in patients with persistent myofascial TMD pain.
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| 6. |
- Hedenberg-Magnusson, Britt
(författare)
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Masseter muscle pain and its relation to pain mediators in fibromyalgia and local myalgia
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this investigation was to study chronic jaw muscle pain in fibromyalgia, local myalgia and healthy individuals in relation to the pain mediators PGE2, LTB4 and NPY and to study the effects of glucocorticoid administration and repetitive isometric contraction. A questionnaire showed presence of symptoms from the temporomandibular region in almost all fibromyalgia patients and the local pain was correlated to the general pain but on a lower level. The clinical part comprised patients with fibromyalgia and local myalgia in the orofacial region as well as healthy individuals. The subjects were examined for local spontaneous pain, palpatory tenderness, pressure pain threshold and tolerance levels of the superficial masseter muscle, bite force, intramuscular temperature and mobility of the mandible. Both patient groups showed low values of pain threshold as well as intramuscular temperature and maximum voluntary mouth opening compared to the healthy individuals. The number of tender mandibular muscles was higher than the pressure pain threshold lower in fibromyalgia than in local myalgia. This result and the high frequency of temporomandibular disorders in the fibromyalgia patients indicates that involvement of the temporomandibular system is common in fibromyalgia. Microdialysis was used to sample PGE2 and LTB4 from the superficial masseter muscle in patients with fibromyalgia and local myalgia as well as in healthy individuals and venous blood was collected for analysis of plasma levels of these substances. Intramuscular PGE2 and LTB4 were found in all groups. LTB4 levels increased upon the trauma created by microdialysis in patients with fibromyalgia and local myalgia, but not in the healthy individuals. PGE2 levels were related to muscular pain in the fibromyalgia patients and was negatively correlated to pressure pain threshold in the healthy individuals. Masseter muscle pain therefore seems to be partly of peripheral inflammatory origin. To evaluate the effects of glucocorticoid administration into the painful masseter muscle microdialysis and clinical examination was performed two weeks before and after its local administration in fibromyalgia and local myalgia. Both groups showed a similar response regarding clinical parameters but only the patients with local myalgia reported a positive subjective treatment result. In the patients with fibromyalgia a reduction of masseter muscle level of PGE2 was associated with a decrease of spontaneous pain, while the masseter muscle level of LTB4 increased in both patient groups after the intramuscular glucocorticoid administration. In an experimental microdialysis study the intramuscular levels of NPY and its relation to development of pain was determined during rest and during repetitive isometric contraction of the superficial masseter and trapezius muscles in healthy females. The NPY level in the masseter muscle at rest was higher than the corresponding levels of the trapezius muscle and plasma. In the trapezius muscle NPY increased during isometric contraction, while development of pain was associated with a high precontraction plasma level of NPY. High precontraction level of NPY in the masseter muscle was associated with development of pain after isometric contraction of this muscle.
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| 7. |
- Jasim, Hajer, et al.
(författare)
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Altered levels of salivary and plasma pain related markers in temporomandibular disorders
- 2020
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Ingår i: Journal of Headache and Pain. - : BMC. - 1129-2369 .- 1129-2377. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Different pain syndromes may be characterized by different profiles of mediators reflecting pathophysiological differences, and these alterations may be measured in a simple saliva sample. The aims of the current study were to compare concentration of glutamate, serotonin (5-HT), nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and substance P (SP) in saliva and plasma from a well-defined group of patients with chronic temporomandibular disorders myalgia (TMD-myalgia) with a group of pain-free controls, and further investigate the relationship between these markers and clinical characteristics. Methods Patients diagnosed according to the diagnostic criteria for TMD (n = 39), and matched healthy pain-free controls (n = 39) were included. Stimulated whole saliva and plasma samples were collected in the morning. Glutamate was analysed using a colorimetric assay, and 5-HT and SP were analysed by commercially available ELISA. Levels of NGF and BDNF were determined using multiplex electrochemiluminescence assay panel. Results Patients expressed higher salivary and plasma levels of glutamate (saliva: 40.22 +/- 13.23 mu mol/L; plasma: 30.31 +/- 18.73 mu mol/L) than controls (saliva: 33.24 +/- 11.27 mu mol/L; plasma: 20.41 +/- 15.96 mu mol/L) (p < 0.05). Salivary NGF (0.319 +/- 0.261 pg/ml) and BDNF (3.57 +/- 1.47 pg/ml) were lower in patients compared to controls (NGF: 0.528 +/- 0.477 pg/ml; BDNF 4.62 +/- 2.51 pg/ml)(ps < 0.05). Contrary, plasma BDNF, was higher in patients (263.33 +/- 245.13 pg/ml) than controls (151.81 +/- 125.90 pg/ml) (p < 0.05). 5-HT was undetectable in saliva. Neither plasma 5-HT, nor SP levels differed between groups. BDNF and NGF concentrations correlated to levels of psychological distress (p < 0.0005). Conclusion The higher levels of salivary and plasma glutamate in patients with TMD-myalgia compared to controls strengthens its importance in the pathophysiology of TMD-myalgia. However, the lack of correlation to pain levels question its role as a putative biomarker. Patients with TMD-myalgia further had lower levels of salivary NGF and BDNF, but higher plasma BDNF. These results and their correlations to psychological distress warrant further investigations.
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| 8. |
- Jasim, Hajer, et al.
(författare)
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Daytime changes of salivary biomarkers involved in pain
- 2020
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Ingår i: Journal of Oral Rehabilitation. - : WILEY. - 1365-2842 .- 0305-182X. ; 47:7, s. 843-850
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Tidskriftsartikel (refereegranskat)abstract
- The study aimed to investigate salivary levels of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), substance P (SP) and glutamate at five time points from morning to afternoon in a well-characterised healthy and pain-free individuals. Ten young adults were included. Unstimulated and stimulated whole saliva were collected from each participant repeatedly across the day. Blood samples were drawn in connection with the first and last saliva sample as reference standard. Levels of NGF and BDNF were determined using gel-free Western blot technology, glutamate levels were analysed using a colorimetric assay, and SP was determined using a commercially available ELISA. Salivary NGF and BDNF showed significant differences between the different collection times in both unstimulated (NGF; P = .006; BDNF; P = .026) and stimulated whole saliva (NGF; P = .006; BDNF; P = .019). The highest concentrations of the neuropeptides were expressed in the early morning, and they thereafter decreased across the day. In contrast, the expression of salivary glutamate and SP did not show any significant changes across the day. Plasma levels of NGF were higher in the evening sample (P = .028); otherwise, there were no significant differences for any of the other markers between morning and evening samples. NGF and BDNF in whole saliva showed a significant variation across the day. On the contrary, no variation in the levels of SP and glutamate was detected. These findings highlight the importance of consistency in the collection time and approach in biomarker studies using saliva.
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| 9. |
- Jasim, Hajer, et al.
(författare)
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Saliva as a medium to detect and measure biomarkers related to pain
- 2018
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Ingår i: Scientific Reports. - : NATURE PUBLISHING GROUP. - 2045-2322. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Saliva is often neglected as a body fluid of diagnostic or prognostic value, even though generally well accepted by the patients. This is due to lack of a standardized collection procedure. The aim of this study was to identify the ideal saliva collection technique and develop new sensitive methods to detect and analyse markers related to pain in healthy pain-free subjects. Plasma and five different saliva collection approached was evaluated during strictly controlled conditions. Levels of nerve growth factor (NGF), calcitonin gene-related peptide (CGRP) and brain derived neurotropic factor (BDNF) were determined using novel western blotting based technology. Glutamate and substance P (SP) was determined using commercial available methods. Several new isoforms were found for NGF, CGRP and BDNF in saliva. The isoform pattern showed significant variation in both expression and chemiluminescence levels between different collection methods. New sensitive methods to study pain related markers in saliva were developed in this study. Furthermore, we are first to demonstrate a correlation between the Glutamate concentration in stimulated whole saliva and blood. However, the fundamental conclusion drawn is the importance of consistency in the collection method.
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| 10. |
- Jasim, Hajer, et al.
(författare)
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The proteomic profile of whole and glandular saliva in healthy pain-free subjects
- 2016
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Ingår i: Scientific Reports. - : NATURE PUBLISHING GROUP. - 2045-2322. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Determination of the variability in the salivary proteome is a prerequisite for the development of saliva as a diagnostic and prognostic tool in particular physiological states. In this context, it is important that technical variability induced by sample collection and processing is kept at minimum to be able to reproducibly assess variability in states of health and disease. In the current study, the proteome profile in unstimulated and stimulated whole, parotid and sublingual saliva was investigated using two-dimensional gel electrophoresis. Saliva samples were structurally collected from ten examined and characterized healthy individuals during the exactly same conditions. The results demonstrated that different collection methods provide clear differences in the snapshot of the salivary proteome and also in the relative amount of specific proteins. The variable nature of the salivary proteome suggests that different approaches may have to be adopted when studying its composition or its possible role as an indicator for particular physiological states. The results emphasize the importance of consistency when collecting saliva samples for proteomic analysis.
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| 11. |
- Jounger, Sofia Louca, et al.
(författare)
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Influence of Polymorphisms in the HTR3A and HTR3B Genes on Experimental Pain and the Effect of the 5-HT3 Antagonist Granisetron
- 2016
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 11:12
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate experimentally if 5-HT3 single nucleotide polymorphisms (SNP) contribute to pain perception and efficacy of the 5-HT3-antagonist granisetron and sex differences. Sixty healthy participants were genotyped regarding HTR3A (rs1062613) and HTR3B (rs1176744). First, pain was induced by bilateral hypertonic saline injections (HS, 5.5%, 0.2 mL) into the masseter muscles. Thirty min later the masseter muscle on one side was pretreated with 0.5 mL granisetron (1 mg/mL) and on the other side with 0.5 mL placebo (isotonic saline) followed by another HS injection (0.2 mL). Pain intensity, pain duration, pain area and pressure pain thresholds (PPTs) were assessed after each injection. HS evoked moderate pain, with higher intensity in the women (P = 0.023), but had no effect on PPTs. None of the SNPs influenced any pain variable in general, but compared to men, the pain area was larger in women carrying the C/C (HTR3A) (P = 0.015) and pain intensity higher in women with the A/C alleles (HTR3B) (P = 0.019). Pre-treatment with granisetron reduced pain intensity, duration and area to a lesser degree in women (P < 0.05), but the SNPs did not in general influence the efficacy of granisetron. Women carrying the C/T & T/T (HTR3A) genotype had less reduction of pain intensity (P = 0.041) and area (P = 0.005), and women with the C/C genotype (HTR3B) had less reduction of pain intensity (P = 0.030), duration (P = 0.030) and area compared to men (P = 0.017). In conclusion, SNPs did not influence experimental muscle pain or the effect of granisetron on pain variables in general, but there were some sex differences in pain variables that seem to be influenced by genotypes. However, due to the small sample size further research is needed before any firm conclusions can be drawn.
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| 12. |
- Louca Jounger, Sofia, et al.
(författare)
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Polymorphisms in the HTR2A and HTR3A Genes Contribute to Pain in TMD Myalgia
- 2021
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Ingår i: Frontiers in Oral Health. - : Frontiers Media S.A.. - 2673-4842. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to investigate if single nucleotide polymorphisms (SNPs) related to monoaminergic neurotransmission, in particular the serotonergic pathway, contribute to pain perception in patients with temporomandibular disorder (TMD) myalgia and if there is a correlation to jaw function as well as psychosocial factors such as stress, anxiety and depression.Materials and Methods: One hundred and seventeen individuals with TMD myalgia were included. A venous blood or saliva sample was taken for genetic analyses and genotyped regarding HTR2A (rs9316233) HTR3A (rs1062613), HTR3B (rs1176744), SERT (5-HTTLPR) and COMT (rs4680). A clinical examination according to Diagnostic Criteria for TMD (DC/TMD) was performed and axis II data (psychosocial factors) were compared between participants with different genotypes for each gene using Kruskall–Wallis test. The characteristic pain intensity (CPI) was tested for correlations to scores for the Perceived Stress Scale, Generalized Anxiety Disorder, and Patient Health Questionnaires using Spearman's rank correlation test with Bonferroni correction for multiple testing. To further explore data factor analysis was performed to identify latent factors associated to the outcome variables.Results: Participants carrying at least one copy of the rare allele of the HTR2A (rs9316233) and HTR3A (rs1062613) had higher CPI compared with the participants with the homozygous common genotype (P = 0.042 and P = 0.024, respectively). Correlation analyses showed several significant positive correlations between CPI on one hand, and self-reported psychosocial distress and jaw function on the other hand for several genotypes that mostly were weak to moderate. The factor analysis identified two latent variables. One was positively correlated to the HTR3B gene, jaw function and self-reported parafunctions, and the other was positively correlated to psychological distress and negatively correlated to SERT.Conclusion: Taken together, the polymorphism rs1062613 in the HTR3A gene contributes to pain intensity in TMD myalgia. This together with positive interactions between pain variables and psychological factors in genotypes strengthens that pain and psychological distress are related. Further research is needed to explore this as well as the influence of gene-to-gene interactions on pain and psychological distress.
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| 13. |
- Salinas Fredricson, Adrian, et al.
(författare)
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Diseases of the musculoskeletal system and connective tissue in relation to temporomandibular disorders : A SWEREG-TMD nationwide case-control study
- 2022
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:10, s. e0275930-
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Temporomandibular disorders (TMD) are comprised by a heterogenous group of diagnoses with multifaceted and complex etiologies. Although diseases of the musculoskeletal system and connective tissue (MSD) have been reported as risk factors for developing TMD, no nationwide population-based registry studies have been conducted to investigate this possible link. The aim of this study was to investigate the association between MSD and TMD in a population-based sample using Swedish registry data, and to further investigate the difference in such association between patients diagnosed with TMD in a hospital setting and patients surgically treated for the condition.MATERIALS AND METHODS: Population based case-control study using Swedish nationwide registry data. Data was collected between 1998 and 2016 from 33 315 incident cases and 333 122 controls aged ≥18, matched for sex, age, and living area. Cases were stratified into non-surgical (NS), surgically treated once (ST1) and surgically treated twice or more (ST2). Information on MSD exposure (ICD-10 M00-M99) was collected between 1964 and 2016. Odds ratios were calculated using conditional logistic regression, adjusted for country of birth, educational level, living area, and mental health comorbidity.RESULTS: A significant association between MSD and the development of TMD was found for all diagnostic categories: arthropathies (OR 2.0, CI 1.9-2.0); systemic connective tissue disorders (OR 2.3, CI 2.1-2.4); dorsopathies (OR 2.2, CI 2.1-2.2); soft tissue disorders (OR 2.2, CI 2.2-2.3); osteopathies and chondropathies (OR 1.7, CI 1.6-1.8); and other disorders of the musculoskeletal system and connective tissue (OR 1.9, CI 1.8-2.1). The associations were generally much stronger for TMD requiring surgical treatment. The diagnostic group with the strongest association was inflammatory polyarthropathies, M05-M14 (OR 11.7, CI 8.6-15.9), which was seen in the ST2 group.CONCLUSIONS: Patients with MSD diagnoses have a higher probability of being diagnosed with TMD, in comparison to individuals without MSD. This association is even stronger for TMD that requires surgery. The results are in line with earlier findings, but present new population-based evidence of a possible causal relationship between MSD and TMD, even after adjusting for known confounders. Both dentists and physicians should be aware of this association and be wary of early signs of painful TMD among patients with MSD, to make early referral and timely conservative treatment possible.
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| 14. |
- Salinas Fredricson, Adrian, et al.
(författare)
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Sick leave and disability pension among TMD patients with musculoskeletal diseases, mental and behavioural disorders : A SWEREG-TMD population-based cohort study
- 2023
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Temporomandibular disorders (TMD) are associated with musculoskeletal diseases (MSD), mental and behavioural disorders (MBD), and patients with TMD have been shown to have 2-3 times more days of sick leave (SL) and disability pension (DP) than the general population. MSD and MBD are two of the most common causes for SL and DP, and the association between TMD and the influence of comorbidities on the need for SL and DP among TMD patients need further clarification. This study investigates the impact of MSD and MBD comorbidity on SL and DP among TMD patients diagnosed in a hospital setting and/or surgically treated.METHODS: All incident TMD patients diagnosed or treated in a hospital setting between 1998 and 2016 and aged 23-59 were included. A non-exposed comparison cohort was collected from the general population. The cohorts were grouped based on the presence of comorbidity: No comorbidity (Group I); MSD comorbidity (Group II); MBD comorbidity (Group III); and combined MSD and MBD comorbidity (Group IV). Main outcomes were mean annual days of SL and DP, and statistical analysis was conducted using generalized estimated equations.RESULTS: TMD subjects with no comorbidities (Group I) and with MSD/MBD comorbidity (Group II and III) were 2-3 times more often on SL and DP than the corresponding groups from the general population. However, in the group with both MSD and MBD comorbidity (Group IV), the difference between the TMD subjects and the general population was diminishing, suggesting an additive effect.CONCLUSION: TMD patients are more dependent on SL and DP benefits compared to general population and the difference remains even after considering MSD and MBD comorbidity. In individuals with combined MSD and MBD comorbidity, concurrent TMD has less impact on the need for social insurance benefits. The results accentuate the impact TMD has on the patients' impaired ability to return to work and why TMD should be recognized as having a substantial impact on individual and economic suffering as well as on societal costs, with emphasis on the influence of comorbidities on patient suffering.
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| 15. |
- Salinas Fredricson, Adrian, et al.
(författare)
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Sick leave and disability pension in a cohort of TMD-patients : The Swedish National Registry Studies for Surgically Treated TMD (SWEREG-TMD)
- 2022
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Temporomandibular disorders (TMD) are common and affect approximately 10% of the adult population. TMD is usually associated with headache, pain in the masticatory muscles and/or the temporomandibular joint, clicking or crepitations during mandibular movement as well as painful and/or reduced mouth opening. This study aimed to investigate the level TMD-patients use social insurance benefits before and after their first time of diagnosis or first surgical event, compared to the general population. Furthermore, the aim was to investigate the differences in the use of social insurance benefits between surgically and non-surgically treated TMD-patients that were diagnosed in a hospital setting.METHODS: All Swedish citizens aged 23-59 diagnosed with TMD in a hospital setting and/or surgically treated for the condition during 1998-2016 were identified via the Swedish National Board of Health and Welfare. A non-exposed comparison cohort was collected via the Total Population Registry. Outcome and sociodemographic data were collected via Statistics Sweden. Main outcome was annual net days on sick leave and disability pension five years before (-T5) and five years after (T5) diagnosis and/or surgical treatment (T0). Regression analysis was conducted with generalized estimated equations.RESULTS: The study included 219 255 individuals (73% female) - 19 934 in the exposed cohort and 199 321 in the comparison cohort. The exposed group was classified into three subgroups: non-surgical, surgically treated once, and surgically treated twice or more. The mean annual net days of sick leave and disability pension combined during the ten-year follow-up was 61 days in the non-surgical group, 76 days in the surgically treated once group, and 104 days in the surgically treated twice or more subgroup. The corresponding number for the non-exposed comparison cohort was 32 days.CONCLUSION: Patients diagnosed with TMD in a hospital setting are 2-3 times more dependent on the use of social benefits than the general population. The reliance on sick leave and disability pension is seen as early as five years before diagnosis, and the reliance remains after surgical treatment. The reliance is stronger in patients with several surgical interventions. These findings indicate that patients diagnosed with TMD constitute a patient group with a high burden of health issues causing long-term dependence on social security benefits.
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| 16. |
- Salinas Fredricson, Adrian, et al.
(författare)
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The role of mental health and behavioral disorders in the development of temporomandibular disorder : A SWEREG-TMD nationwide case-control study
- 2022
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Ingår i: Journal of Pain Research. - : Dove Press. - 1178-7090. ; 15, s. 2641-2655
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: There is a well-known association between mental and behavioral disorders (MBD) and temporomandibular disorder (TMD), although the association has not been established in population-based samples. This study aimed to investigate this relationship using national population-based registry data.Patients and Methods: This case-control study used prospectively collected data from Swedish national registries to investigate exposure to MBD and the probability of developing TMD in all Swedish citizens with hospital-diagnosed or surgically treated TMD between 1998 and 2016. Odds ratios were calculated using conditional logistic regression adjusted for educational level, living area, country of birth, musculoskeletal comorbidity, and history of orofacial/neck trauma.Results: A statistically significant association between MBD and TMD was found for mood affective disorders (OR 1.4), neurotic, stress-related and somatoform disorders (OR 1.7), behavioral syndromes associated with psychological disturbances and physical factors (OR 1.4), disorders of adult personality and behavior (OR 1.4), disorders of psychological development (OR 1.3), behavioral and emotional disorders with onset usually occurring in childhood and adolescence (OR 1.4), and unspecified mental disorder (OR 1.3). The association was stronger for TMD requiring surgery, with the strongest association in patients with disorders of psychological development (OR 2.9). No significant association was found with schizophrenia, schizotypal and delusional disorders, or mental retardation.Conclusion: The findings indicate an increased probability of TMD among patients with a history of certain MBD diagnoses, and a stronger association with TMD requiring surgery, specifically repeated surgery. This highlights the need for improved preoperative understanding of the impact of MBD on TMD, as TMD and chronic pain itself may have a negative impact on mental health.
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