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Sökning: WFRF:(Wänman Anders)

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1.
  • Engström, Anna-Lena, et al. (författare)
  • Juvenile arthritis and development of symptoms of temporomandibular disorders: a 15-year prospective cohort study.
  • 2007
  • Ingår i: Journal of orofacial pain. - 1064-6655 .- 1945-3396. ; 21:2, s. 120-6
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: To compare the development of symptoms of temporomandibular disorders (TMD) in a sample of patients with juvenile arthritis (JA) and a matched control sample. METHODS: In 1986, 40 patients with JA (28 girls and 12 boys; mean age +/- SD, 18 +/- 4.5 years) and an age- and sex-matched control sample were examined for signs and symptoms of TMD. Fifteen years later in 2001, a questionnaire concerning symptoms of TMD was sent to these subjects. Twenty-eight individuals (68%) in the JA sample (20 women and 8 men; mean age +/- SD, 35 +/- 5.2 years) and 26 controls (19 women and 7 men; 34 +/- 4.0 years) were available for the follow-up. RESULTS: The overall prevalence of symptoms of TMD increased between the 2 examinations in both groups. The prevalence of reported TMD symptoms, such as jaw pain, fatigue in the jaws, and difficulty opening the jaws wide, as well as awareness of tooth clenching, headaches, neck and shoulder pains, was significantly greater among the JA sample than among the controls at the follow-up. CONCLUSION: The study indicates that prevalence of pain and dysfunction in the craniofacial or cervical regions of JA patients is increased more than 20 years after the onset of JA compared to healthy individuals.
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2.
  • Lindfors, Erik, et al. (författare)
  • Jaw Exercises in the Treatment of Temporomandibular Disorders : An International Modified Delphi Study
  • 2019
  • Ingår i: Journal of oral & facial pain and headache. - : Quintessence Publishing. - 2333-0376 .- 2333-0384. ; 33:4, s. 389-398
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: To investigate whether an international consensus exists among TMD experts regarding indications, performance, follow-up, and effectiveness of jaw exercises.Methods: A questionnaire with 31 statements regarding jaw exercises was constructed. Fourteen international experts with some geographic dispersion were asked to participate in this Delphi study, and all accepted. The experts were asked to respond to the statements according to a 5-item verbal Likert scale that ranged from “strongly agree” to “strongly disagree.” The experts could also leave free-text comments, which was encouraged. After the first round, the experts received a compilation of the other experts’ earlier responses. Some statements were then rephrased and divided to clarify the essence of the statement. Subsequently, the experts were then asked to answer the questionnaire (32 statements) again for the second round. Consensus was set to 80% agreement or disagreement.Results: There is consensus among TMD experts that jaw exercises are effective and can be recommended to patients with myalgia in the jaw muscles, restricted mouth opening capacity due to hyperactivity in the jaw closing muscles, and disc displacement without reduction. The patients should always be instructed in an individualized jaw exercise program and also receive both verbal advice and written information about the treatment modality.Conclusion: This Delphi study showed that there is an international consensus among TMD experts that jaw exercises are an effective treatment and can be recommended to patients with TMD pain and disturbed jaw function.
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5.
  • Wänman, Johan, et al. (författare)
  • Metastatic spinal cord compression as the first sign of malignancy : Outcome after surgery in 69 patients
  • 2017
  • Ingår i: Acta Orthopaedica. - : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 88:4, s. 457-462
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and purpose - Metastatic spinal cord compression (MSCC) as the initial manifestation of malignancy (IMM) limits the time for diagnostic workup; most often, treatment is required before the final primary tumor diagnosis. We evaluated neurological outcome, complications, survival, and the manner of diagnosing the primary tumor in patients who were operated for MSCC as the IMM.Patients and methods - Records of 69 consecutive patients (51 men) who underwent surgery for MSCC as the IMM were reviewed. The patients had no history of cancer when they presented with pain (n = 2) and/or neurological symptoms (n = 67).Results - The primary tumor was identified in 59 patients. In 10 patients, no specific diagnosis could be established, and they were therefore defined as having cancer of unknown primary tumor (CUP). At the end of the study, 16 patients were still alive (median follow-up 2.5 years). The overall survival time was 20 months. Patients with CUP had the shortest survival (3.5 months) whereas patients with prostate cancer (6 years) and myeloma (5 years) had the longest survival. 20 of the 39 patients who were non-ambulatory preoperatively regained walking ability, and 29 of the 30 ambulatory patients preoperatively retained their walking ability 1 month postoperatively. 15 of the 69 patients suffered from a total of 20 complications within 1 month postoperatively.Interpretation - Postoperative survival with MSCC as the IMM depends on the type of primary tumor. Surgery in these patients maintains and improves ambulatory function.
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6.
  • Borg, Tina, 1982-, et al. (författare)
  • Perceived muscular tension in healthy subjects : a cross-sectional study
  • 2016
  • Ingår i: PREMUS2016. - 9780969972679 ; , s. 411-411
  • Konferensbidrag (refereegranskat)abstract
    • Background. Perceived muscular tension (PMT) has been suggested to predict development of neck/shoulder pain. It has been hypothesized to be an early sign of musculoskeletal disorder and a possible mediator of stress on symptoms. However, the content of the concept of PMT is not clear. This study examined the association between PMT and physical and psychosocial factors and physical activity in a group of healthy students.Methods. This cross-sectional study was conducted on the baseline measurements of an ongoing longitudinal case-control study. A total of 63 healthy university students without complaints of neck/shoulder pain were included (21 males, 42 females, mean age 24 years). PMT was measured by asking the question “Have you, during the past month, experienced muscular tension (for example, wrinkled your forehead, ground your teeth, raised your shoulders)?” with the following response options: never, a few times, a few times per week, or one or several times per day. Self-reports on symptoms in the neck, anxiety, depression, stress, mental health, physical health, sleep and physical activity were collected with questionnaires, as well as by tenderness on palpation of neck muscles and trapezius pressure pain threshold. This produced a total of 15 variables. The relationship between these variables and PMT were analyzed using Spearman’s rank correlation coefficient.Results. Positive correlations were found between PMT and temporomandibular complaints (rho= .34, p < .001), neck crepitus (rho= .33, p < .001), anxiety (rho= .33, p < .001), depression (rho= .31, p < .05), tenderness on palpation (rho= .25, p < .05). There was a negative correlation between PMT and mental health (rho= -.26, p < .05). Frequent experience of PMT had weak to moderate correlations with frequency of symptoms and higher psychosocial strain, but not with stress. This suggests some covariance between PMT and both physical and psychosocial factors.
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7.
  • Bäckström, Esmeralda, et al. (författare)
  • The majority of patients report satisfaction more than 24 years after temporomandibular joint discectomy
  • 2024
  • Ingår i: Oral and Maxillofacial Surgery. - : Springer Nature. - 1865-1550 .- 1865-1569.
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To retrospectively evaluate long-term outcomes after temporomandibular joint (TMJ) discectomy.Methods: Included patients (n = 64) had undergone discectomy during 1989-1998 at Umeå University Hospital. A questionnaire was used to evaluate pre- and postoperative symptoms, postoperative complications, general pain, and subjective opinion about the outcome of the surgery.Results: The results are based on responses from 47 patients (40 women/7 men), including 36 (30 women/6 men) who completed the questionnaire and 11 (10 women/1 man) who were contacted by telephone and answered selected questions. Seventeen patients were excluded because of death, a move abroad, declining to participate, or no available patient information. Among the respondents, 41 (87%) were satisfied with the results, five (11%) were unsatisfied, and one (2%) patient did not answer the question. The results showed a significant long-term improvement in locking, clicking/crepitation, and pain when chewing or opening the jaw (p = 0.001). The prevalence of headaches had decreased significantly at follow-up (p = 0.001). Reported impaired jaw-opening capacity showed no significant improvement (p = 0.08). Of the 47 respondents, 19 (40%) had asked for additional treatment after the discectomy, and six of the 19 patients (13%) had undergone more surgery of the joint.Conclusion: The results of this retrospective long-term follow-up study indicate that TMJ discectomy has a high success rate, as most patients were satisfied with the postoperative results. Discectomy is thus an effective surgical intervention for patients with disabling TMJ pain and dysfunction when conservative interventions have been unsuccessful.
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8.
  • Böthun, Alicia, et al. (författare)
  • Clinical signs in the jaw and neck region following whiplash trauma : A 2-year follow-up
  • 2023
  • Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 27:6, s. 699-709
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Pain in the orofacial region is often reported after whiplash trauma. However, prospective studies evaluating clinical signs related to orofacial pain and disability in whiplash populations are rare. The aim of the present study was to evaluate clinical signs related to pain and dysfunction in orofacial and neck regions after whiplash trauma, in a short- and long-term perspective.Methods: In total, 84 cases (48 women) diagnosed with neck distortion after a car accident and 116 controls (68 women) were examined within 1 month, and 49 cases (27 women) and 71 controls (41 women) were re-examined 2 years later. Outcome measures were pain on palpation of jaw and neck muscles and maximal jaw opening. Analysis was performed using mixed-models.Results: Cases and women were at higher risk for pain on palpation of jaw muscles (OR:7.7; p < 0.001 and OR:3.2; p = 0.010 respectively) and neck muscles (OR:12.7; p < 0.001 and OR:2.9; p = 0.020 respectively) but with no significant effect of time. Cases and women also had lower maximal jaw opening (−3.1; p = 0.001 and −3.3; p = 0.001 respectively). There was no significant time effect, but a significant interaction between cases and time (2.2; p = 0.004).Conclusion: Individuals with a whiplash trauma present a higher risk for pain on palpation in jaw and neck muscles both in a short- and long-term perspective, but show normal jaw movements. No time effect suggests that cases do not spontaneously improve nor get worse. Investigating pain on palpation in the jaw and neck muscles after whiplash trauma can identify individuals at risk for developing long-term orofacial pain and dysfunction.Significance: Orofacial pain is often reported after whiplash trauma but most previous studies concerning orofacial pain in whiplash populations have been questionnaire studies. Cases with a previous whiplash trauma and women, in general, had higher risk for pain on palpation in the jaw and neck region. Investigating pain on palpation after a whiplash trauma can help to identify individuals at risk of developing long-lasting pain in the orofacial region.
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9.
  • Böthun, Alicia, et al. (författare)
  • Jaw–neck motor strategy during jaw‐opening with resistance load
  • 2022
  • Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 49:5, s. 514-521
  • Tidskriftsartikel (refereegranskat)abstract
    • Background:  The jaw and neck motor systems have a close functional integration but the effect of resistance load to the mandible during jaw opening on the jaw-neck integration is not known.Objectives:  To evaluate the effect of resistance load compared to no load on integrated jaw and neck motor function in individuals free from pain and dysfunction in the jaw and neck regions.Methods:  Jaw and head movements during continuous jaw opening were recorded with an optoelectronic system (MacReflex® ) in 26 pain-free individuals (14 women, 12 men, mean age 22 years). Jaw opening was performed with and without resistance load (1600 g) to the mandible. The relationship between jaw movement amplitude, head movement amplitude, head/jaw ratio (quotient of head and jaw movement amplitude) and resistance load were modelled using linear mixed-model analysis. A p-value <.05 was considered statistically significant.Results:  The expected head/jaw ratio mean was increased by 0.05 (95% CI: 0.03, 0.08, p < .001) with resistance load as compared to no load. This corresponds to an increase in expected mean by 55.6%. With resistance load, expected mean head movement amplitude increased by 1.4 mm (95% CI: 0.2, 2.5, p = .018), and expected mean jaw movement amplitude decreased by 3.7 mm (95% CI: -7.0, -0.5, p = .025).Conclusion:  There is a compensation and adaptation of integrated jaw-neck motor function with an altered jaw-neck motor strategy during jaw opening with resistance load compared to no load. The head/jaw ratio demonstrates increased proportional involvement of the neck during increased load on the jaw system.
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10.
  • Eklund, Anton, et al. (författare)
  • Jaw-neck motor function in the acute stage after whiplash trauma
  • 2020
  • Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 47:7, s. 834-842
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Jaw-neck motor function is affected in the chronic stage following whiplash trauma. It is not known whether motor function is affected also in the early stage after neck trauma.Objectives: To determine how jaw and head movement amplitudes and movement cycle times correlate with jaw and neck pain, and neck disability in the acute stage after whiplash trauma. Methods Jaw and head movements during jaw opening-closing were recorded with an optoelectronic system in 23 cases (4 men, 19 women, 18-66 years) within 1 month after whiplash trauma and compared with 27 controls without neck trauma (15 men, 12 women, 20-66 years). Jaw and head movement amplitudes, head/jaw ratio (quotient of head and jaw movement amplitude) and movement cycle times were evaluated in relation to jaw and neck pain (Numeric Rating Scale) and neck disability (Neck Disability Index). Analyses were performed with Mann-Whitney U test and Spearman's correlation.Results: Compared with controls, cases showed smaller jaw movement amplitudes (P = .006) but no difference in head movement amplitudes, head/jaw ratios or movement cycle times. There were no significant correlations between movement amplitudes or cycle times and jaw and neck pain, and neck disability. Cases with high neck pain intensity had smaller jaw movement amplitudes compared to cases with low neck pain intensity (P = .024).Conclusion: The results suggest that jaw-neck motor function may be affected in the acute stage after whiplash trauma and more so in cases with higher neck pain intensity.
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11.
  • Eklund, Anton, et al. (författare)
  • Jaw–neck motor function 2 years after whiplash trauma
  • 2024
  • Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X.
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: There is limited knowledge about the possible long-term effects on jaw motor function after whiplash trauma.Objectives: The primary aim was to evaluate integrated jaw and head–neck movement amplitudes during jaw function in individuals 2 years after whiplash trauma, compared to controls. The secondary aim was to evaluate changes between the acute stage and a 2-year follow-up in terms of jaw and head–neck movement amplitudes during jaw function.Methods: This study included 28 cases exposed to a whiplash trauma 2 years earlier (13 women) and 28 controls (13 women) without previous neck trauma. Head and jaw movement amplitudes were recorded during maximal jaw opening–closing movements using an optoelectronic 3D recording system. For a subpopulation of 12 cases and 15 controls, recordings had also been performed in the acute stage after the whiplash trauma. Jaw and head movement amplitudes were analysed using linear regression with group and sex as independent variables. The subpopulation longitudinal analysis was adjusted for movement amplitudes at baseline.Results: Jaw movement amplitudes were significantly associated with group (coefficient: −0.359: 95% CI: −10.70 to −1.93, p =.006) with smaller amplitudes of jaw movements for whiplash cases. Head movement amplitudes were not associated with group (coefficient: −0.051, 95% CI: −4.81 to 3.20, p =.687). In the longitudinal analysis, both jaw and head movement amplitudes showed significant associations between baseline and the 2-year follow-up.Conclusion: The present findings indicate that the effects on jaw function in terms of jaw opening capacity in the acute stage after whiplash trauma do not spontaneously recover.
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12.
  • Fjellman-Wiklund, Anncristine, et al. (författare)
  • Patients' perceived treatment need owing to temporomandibular disorders and perceptions of related treatment in dentistry : a mixed method study
  • 2019
  • Ingår i: Journal of Oral Rehabilitation. - : Wiley-Blackwell. - 1365-2842 .- 0305-182X. ; 46:9, s. 792-799
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: To easily identify patients who could benefit from a temporomandibular disorder (TMD) examination, three screening questions (3Q/TMD) have been introduced in large parts of Sweden. The questions are related to a TMD diagnosis. However, how the questions relate to a treatment need is unknown.Objectives: The first aim of the study was to identify predicting factors for perceived treatment need among adult individuals who screened positive to the 3Q/TMD. The second aim was to explore individuals' thoughts and experiences related to treatment of their TMD complaint.Methods: This mixed‐method study with a case‐control design was conducted in Västerbotten, Sweden, during 2014. Individuals who screened positive to at least one of the 3Q/TMD questions were allocated 3Q‐positives, whereas those with negative answers to all questions were allocated 3Q‐negatives. In total, 300 individuals (140 randomly selected 3Q‐positives, and 160 age‐ and gender‐matched 3Q‐negatives) were included. All individuals answered questions related to treatment need. The answers were analysed in a qualitative approach with qualitative content analysis.Results: In total, 81% of 3Q‐positives expressed a treatment need related to their TMD symptoms. The perceived treatment need was predicted by frequent pain (Q1) and frequent functional disturbances (Q3). Among the 3Q‐positives, 54% reported mistrust in dentists' ability to treat TMD symptoms. The informants expressed a need for information about their symptoms and possible treatment options.Conclusion: Affirmative answers to 3Q/TMD were associated with TMD treatment need. Dentists should give advice to patients with TMD symptoms and address their concerns.
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13.
  • Forsberg, Hans, et al. (författare)
  • Oral health in the adult population of Västerbotten, Sweden - a comparison between an epidemiological survery and data obtained from digital dental records
  • 2008
  • Ingår i: Swedish Dental Journal: Oral health in the adult population of Västerbotten, Sweden - a comparison between an epidemiological survey and data obtained from digital records.. ; 32, s. 17-25
  • Tidskriftsartikel (refereegranskat)abstract
    • The objective of this study was to analyse the possibilities and limitations of using data drawn from electronic dental patient records (EDPRs) in monitoring dental health among adults in a northern Swedish county. Material and Methods: The study population comprised all 35-, 50-, 65- and 75-year-old patients who were examined and, where required, received treatment at the Public Dental Service (PDS) in Västerbotten, Sweden, in 2003 and in 2004. In total 2,497 patients in 2003, and 2,546 patients in 2004 met the inclusion criteria. As controls, 779 subjects randomly drawn from the adult population in the same age groups and from the same county were used. They participated in an oral health survey and were examined clinically between October 2002 and March 2003. Results: When oral health was estimated based on EDPRs the prevalence of edentulous subject was significantly underestimated, while the mean numbers of teeth and the mean values of sound teeth were significantly overestimated. No statistically significant difference was found in prevalence of primary decayed tooth surfaces (DS). The prevalence of filled teeth (FT) was fairly similar between the study samples. Registrations of periodontal status were mainly missing in the EDPRs. Since registrations related to temporomandibular disorders are not included in the T4 system its prevalence could no be assessed and accordingly not compared with the epidemiological sample. Conclusion: The study shows that clinical registration based on EDPRs is at present not accurate enough to be used as indicators of oral health status among adults in a community.The objective of this study was to analyse the possibilities and limitations of using data drawn from electronic dental patient records (EDPRs) in monitoring dental health among adults in a northern Swedish county. Material and Methods: The study population comprised all 35-, 50-, 65- and 75-year-old patients who were examined and, where required, received treatment at the Public Dental Service (PDS) in Västerbotten, Sweden, in 2003 and in 2004. In total 2,497 patients in 2003, and 2,546 patients in 2004 met the inclusion criteria. As controls, 779 subjects randomly drawn from the adult population in the same age groups and from the same county were used. They participated in an oral health survey and were examined clinically between October 2002 and March 2003. Results: When oral health was estimated based on EDPRs the prevalence of edentulous subject was significantly underestimated, while the mean numbers of teeth and the mean values of sound teeth were significantly overestimated. No statistically significant difference was found in prevalence of primary decayed tooth surfaces (DS). The prevalence of filled teeth (FT) was fairly similar between the study samples. Registrations of periodontal status were mainly missing in the EDPRs. Since registrations related to temporomandibular disorders are not included in the T4 system its prevalence could no be assessed and accordingly not compared with the epidemiological sample. Conclusion: The study shows that clinical registration based on EDPRs is at present not accurate enough to be used as indicators of oral health status among adults in a community.
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14.
  • Holmström, Anna-Karin, et al. (författare)
  • Effect on orofacial pain in patients with chronic pain participating in a multimodal rehabilitation programme : a pilot study
  • 2023
  • Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 23:4, s. 656-661
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: Orofacial pain in patients taking part in a multimodal rehabilitation programme (MMRP) due to chronic bodily pain is common but it is not known whether such a rehabilitation programme can also have an effect on the presence of orofacial pain. The first aim of this study was to evaluate the effect of an MMRP on orofacial pain frequency. The second aim was to evaluate differences in the effect on quality of life and on psychosocial factors related to chronic pain.METHODS: MMRP was evaluated through validated questionnaires from the Swedish Quality Registry for Pain Rehabilitation (SQRP). Fifty-nine patients participating in MMRP filled out the two screening questions for orofacial pain in addition to the SQRP questionnaires before and after participation in MMRP during the period August 2016 to March 2018.RESULTS: Pain intensity decreased significantly after the MMRP (p=0.005). Fifty patients (69.4 %) reported orofacial pain before MMRP and no significant decrease after the programme (p=0.228). Among individuals with orofacial pain, the self-reported level of depression decreased after participation in the programme (p=0.004).CONCLUSIONS: Even though orofacial pain is common among patients with chronic bodily pain, participation in a multimodal pain programme was not enough to reduce frequent orofacial pain. This finding implies that specific orofacial pain management including information about jaw physiology could be a justified component of patient assessment prior to a multimodal rehabilitation programme for chronic bodily pain.
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15.
  • Häggman-Henrikson, Birgitta, et al. (författare)
  • Even mild catastrophic thinking is related to pain intensity in individuals with painful temporomandibular disorders
  • 2021
  • Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 48:11, s. 1193-1200
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: Temporomandibular disorders (TMD) are often associated with psychological comorbidities. One such comorbidity is pain catastrophising, that is, exaggeration of negative consequences of a painful event. The aim was to investigate catastrophising in individuals with painful TMD compared to controls and the association between catastrophising and pain intensity, number of pain sites and functional limitations.Methods: A community-based sample of 110 individuals (83 women; 20–69 yrs) with painful TMDs (myalgia/arthralgia as per Diagnostic Criteria for TMD) and 190 age- and gender-matched controls (119 women; 20–69 yrs) from the Public Dental services in Västerbotten, Sweden, participated. Associations between catastrophising and functional jaw limitations, respectively, and painful TMD were evaluated with ordinal regression adjusted for the effect of gender and age. Associations (Spearman's correlation) of the Pain catastrophising Scale (PCS) with Jaw Functional Limitation Scale (JFLS-20), pain site number (whole-body pain map), and characteristic pain intensity (CPI) and intergroup comparisons (Mann-Whitney U test) of these variables were also calculated.Results: Levels of catastrophising were associated with TMD pain (OR 1.6, 95%CI 1.1–2.6). Among individuals with painful TMD, catastrophising was correlated to pain intensity (r=0.458, p<0.01) and functional limitations (r=0.294–0.321, p≤0.002), but not to number of pain sites.Conclusion: Compared to controls, community-based individuals with painful TMD demonstrated higher levels of pain catastrophising, and this catastrophising was associated with increased pain intensity and jaw dysfunction. The relatively low scores of pain catastrophising suggest that even mild catastrophic thinking is associated with pain perception and jaw function, and should be considered in patient management.
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16.
  • Häggman-Henrikson, Birgitta, et al. (författare)
  • Pain and Disability in the Jaw and Neck Region following Whiplash Trauma
  • 2016
  • Ingår i: Journal of Dental Research. - : SAGE Publications. - 0022-0345 .- 1544-0591. ; 95:10, s. 1155-1160
  • Tidskriftsartikel (refereegranskat)abstract
    • The relationship between whiplash trauma and chronic orofacial pain is unclear, especially with regard to the time elapsed from trauma to development of orofacial pain. The aim was to analyze prevalence of jaw pain and disability, as well as the relationship between pain and disability in the jaw and neck regions in the early nonchronic stage after whiplash trauma. In this case-control study, 70 individuals (40 women, 30 men, mean age 35.5 y) who visited an emergency department with neck pain following a car accident were examined within 3 wk of trauma (group 1) and compared with 70 individuals (42 women, 28 men, mean age 33.8 y), who declined to attend a clinical examination but agreed to fill in questionnaires (group 2). The 2 case groups were compared with a matched control group of 70 individuals (42 women, 28 men, mean age 37.6 y) without a history of neck trauma. All participants completed questionnaires regarding jaw pain and dysfunction, rating pain intensity in jaw and neck regions on the Numerical Rating Scale, the Neck Disability Index, and Jaw Disability Checklist. Compared with controls, individuals with a recent whiplash trauma reported more jaw pain and dysfunction. Furthermore, there was a moderate positive correlation between jaw and neck pain ratings for group 1 (r = 0.61, P < 0.0001) and group 2 (r = 0.59, P < 0.0001). In the logistic regression analysis, cases showed higher odds ratios (range, 6.1 to 40.8) for jaw and neck pain and disability compared with controls. Taken together, the results show that individuals with a recent whiplash trauma report more jaw pain and disability compared with controls without a history of neck trauma. Furthermore, the correlation between jaw and neck pain intensity implies that intensity of neck pain in the acute stage after whiplash trauma might be a possible risk factor also for development of chronic orofacial pain.
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17.
  • Häggman-Henrikson, Birgitta, et al. (författare)
  • The effect of supervised exercise on localized TMD pain and TMD pain associated with generalized pain
  • 2018
  • Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 76:1, s. 6-12
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To evaluate the effect of a supervised exercise program in patients with localized/regional temporomandibular disorder (TMD) pain and with TMD associated with generalized pain.Material and methods: Consecutively referred patients with localized/regional TMD pain (n = 56; 46 women and 10 men, mean age 44 years) and TMD associated with generalized pain (n = 21; 21 women, mean age 41 years) participated. Patients underwent a 10-session structured supervised exercise program over 10-20 weeks that included relaxation, and coordination and resistance training of the jaw and neck/shoulders. The outcomes were jaw pain intensity on the Numerical Rating Scale, endurance time for jaw opening and protrusion against resistance and chewing, and effect of pain on daily activities.Results: After the exercise program, a reduction in jaw pain was reported by the local (p = .001) and general (p = .011) pain groups. There were no significant differences in jaw pain intensity between the groups, before (p = .062) or after treatment (p =.121). Endurance time increased for both groups for jaw opening/protrusion (both p <. 001) and chewing (both p = .002). The effect of jaw pain on daily activities decreased after exercise compared to baseline for both the local (p < .001) and general (p = .008) pain groups.Conclusions: Supervised exercise can reduce TMD pain and increase capacity in patients with TMD. The results suggest that activation of the jaw motor system with exercise has a positive effect in patients with localized/regional TMD pain and TMD associated with generalized pain.
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18.
  • Ilgunas, Aurelia, et al. (författare)
  • 'I was cracking more than everyone else' : young adults' daily life experiences of hypermobility and jaw disorders
  • 2020
  • Ingår i: European Journal of Oral Sciences. - : WILEY. - 0909-8836 .- 1600-0722. ; 128, s. 74-80
  • Tidskriftsartikel (refereegranskat)abstract
    • Most studies on general joint hypermobility (GJH) and temporomandibular disorders (TMD) are quantitative and have concluded that joint hypermobility is a risk factor for development of TMD. The present qualitative study aimed to explore young adults' daily life experiences of GJH, specifically these relating to jaw function, and their experiences of medical and dental care providers. Semi-structured interviews were conducted with nine young adults (18-22 yr of age) and data were analysed using qualitative content analysis. The overarching thematic category that emerged was 'Hypermobility in daily life', which was broken into six subthemes and three themes: 'emotional perception', 'dealing with symptoms', and 'outside influences'. Participants' narratives centred on experiences of complex symptoms, awkward jaw function and joint noises, feeling different, and a lack of support from general medical and dental care providers. The findings show that young adults with joint hypermobility need early support from medical and dental care providers for managing their symptoms and conditions related to GJH. Future studies are warranted to develop guidelines for professionals in medical and dental care to detect and prevent forthcoming problems and to offer relevant support to hypermobile youths.
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19.
  • Lampa, Ewa, et al. (författare)
  • Effects on jaw function shortly after whiplash trauma
  • 2017
  • Ingår i: Journal of Oral Rehabilitation. - : WILEY. - 1365-2842 .- 0305-182X. ; 44:12, s. 941-947
  • Tidskriftsartikel (refereegranskat)abstract
    • Normal jaw function involves muscles and joints of both jaw and neck. A whiplash trauma may disturb the integrated jaw-neck sensory-motor function and thereby impair chewing ability; however, it is not known if such impairment is present shortly after a neck trauma or develops over time. The aim was to evaluate jaw function after a recent whiplash trauma. Eighty cases (47 women) were examined within 1 month after a whiplash trauma and compared to 80 controls (47 women) without neck trauma. Participants completed the Jaw disability checklist (JDC) and Neck Disability Index (NDI) questionnaires and performed a 5-minute chewing test. Elicited fatigue and pain during chewing were noted, and group differences were evaluated with Fisher's exact test and Mann-Whitney U-test. Compared to controls, cases had higher JDC (P<.0001) and NDI scores (15% vs 2%, P<.0001), and reported more fatigue (53% vs 31%, P=.006) and pain (30% vs 10%, P=.003) during the chewing test. Cases also had a shorter onset time for fatigue and pain (both P=.001) Furthermore, cases reporting symptoms during chewing had higher JDC and NDI scores compared to cases not reporting symptoms (both P=.01). Symptoms mainly occurred in the trigeminal area for both groups, but also in spinal areas more often for cases than for controls. Taken together, the results indicate that jaw-neck sensory-motor function is impaired already within 1month after a whiplash trauma. The association between neck disability and jaw impairment underlines the close functional relationship between the regions, and stresses the importance of multidisciplinary assessment.
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20.
  • Lampa, Ewa, 1956- (författare)
  • Pain and disability in the jaw and neck regions after whiplash trauma : a short- and long-term perspective
  • 2018
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Whiplash trauma, a hyperextension-flexion trauma to the neck that is often related to a car accident, affects tens of thousands in Sweden every year. A significant proportion will develop long-term symptoms including neck pain and dysfunction – this is embraced as Whiplash associated disorders (WAD). Some individuals also develop pain and dysfunction in the orofacial region that is denoted as Temporomandibular disorder (TMD). TMD is common in the population with a prevalence of about 10% but the relation to whiplash trauma is still unclear. The limited number of prospective studies on TMD after whiplash trauma show diverging results, but it has been suggested that TMD develops over time and not in close proximity to the trauma. Prospective studies are needed to determine the course of jaw pain and disability after whiplash trauma.The general aim of this thesis was to evaluate the presence and course of pain and disability in the jaw and neck regions at the acute and chronic stages after whiplash trauma.This prospective cohort study included at baseline 176 cases with a recent whiplash trauma, and 116 age and gender matched controls without a history of neck trauma that were recruited from the general population. The cases had visited the emergency department at Umeå university hospital, Sweden, with neck pain within 72 hours following a car accident and had been diagnosed with neck distortion by a physician. The cases were examined within one month after the trauma (December 2010 to January 2016) and at a 2-year followup (December 2012 to January 2018). All participants completed questionnaires regarding pain and disability in the jaw and neck regions, physical symptoms (pain and non-pain items), and depression. At baseline, 80 of the cases and 80 of the controls also completed a 5-minute chewing capacity test. At the 2- year follow-up, 119 cases (68%) and 104 controls (90%) were re-examined with the same questionnaires.Compared to controls, within one month after a whiplash trauma cases reported significantly more pain in the jaw and neck regions with a positive correlation between the intensity of pain in these regions (Paper I). In the acute stage after trauma, cases, compared to controls, showed a reduced chewing capacity, and this was related to the severity of neck disability (Paper II). For cases, jaw and neck pain correlated positively to each other, to non-specific physical symptoms, and to depression at both the acute (Paper III) and chronic stages (Paper IV). About one third (34%) of the cases reported orofacial pain at baseline, and for a majority of these, the pain persisted at the 2-year follow-up (Paper IV).The presence of orofacial pain early after a whiplash trauma indicates involvement of central sensitization and spread of pain between the jaw and neck regions. The positive correlations between pain in the jaw and neck regions, and to psychosocial factors, underline the integration of these regions and the importance of a biopsychosocial perspective. The impaired jaw function shortly after a neck trauma further underlines the close sensorimotor relationship between the trigeminal and cervical regions. The finding that orofacial pain is common shortly after whiplash trauma, and often persists into the chronic stage, indicates that assessment in the acute stage should include both the neck and jaw regions. From this, it follows that multidisciplinary teams that entail both medical professions and dentists specialised in orofacial pain can be beneficial in the early assessment after whiplash trauma.
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21.
  • Lampa, Ewa, et al. (författare)
  • Relationship Between Psychosocial Factors and Pain in the Jaw and Neck Regions Shortly After Whiplash Trauma
  • 2019
  • Ingår i: Journal of Oral & Facial Pain and Headache. - : Quintessence Publishing Co., Inc.. - 2333-0384 .- 2333-0376. ; 33:2, s. 213-219
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: To assess jaw pain shortly after whiplash trauma in relation to neck pain, physical symptoms, depression, and jaw pain-related disability.Methods: A total of 181 cases (106 women and 75 men, mean ages 33.7 and 36.8 years, respectively) were examined within 1 month after a whiplash trauma and compared to 117 controls (68 women and 49 men, 34.2 and 30.9 years, respectively). Participants rated current jaw and neck pain intensity on a numeric rating scale and rated nonspecific physical symptoms and depression symptoms on subscales of the Symptom Checklist-90-Revised. The nonspecific physical symptoms were further analyzed with and without pain items. Disability related to jaw pain and neck pain was also assessed. Differences between groups were calculated using Mann-Whitney U test, and correlations were measured using Spearman correlation.Results: Compared to controls, cases reported higher current jaw and neck pain intensity (P < .0001), together with higher scores for physical nonpain and pain symptoms, depression, and jaw pain-related disability (P < .0001 for all). For cases, there were moderate correlations between nonspecific physical symptoms and jaw pain and neck pain, as well as between jaw pain-related disability and jaw pain and neck pain (r = 0.43 to 0.77, P < .0001 for all). Low correlations were observed between depression and jaw pain and neck pain (r = 0.34 to 0.39, both P < .0001).Conclusion: Shortly after a whiplash trauma, pain in the jaw and neck regions is associated with the severity of psychosocial factors. Thus, psychosocial factors may play a role in the development of pain in the jaw region after whiplash trauma.
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22.
  • Lampa, Ewa, et al. (författare)
  • The Course of Orofacial Pain and Jaw Disability after Whiplash Trauma : A 2-year Prospective Study
  • 2020
  • Ingår i: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159. ; 45:3, s. E140-E147
  • Tidskriftsartikel (refereegranskat)abstract
    • Study Design: Prospective cohort study.Objective: To evaluate the course of orofacial pain and jaw disability in relation to neck pain, neck disability and psychosocial factors at the acute stage and the chronic stage after whiplash trauma.Summary of Background Data: Many individuals report chronic pain in the orofacial region after whiplash trauma. The possible association between whiplash trauma and orofacial pain is debated. Prospective studies are therefore needed to evaluate the development of orofacial pain after whiplash trauma.Methods: Within one month following a whiplash trauma, 176 cases were examined and compared to 116 controls with questionnaires concerning neck and jaw pain and related disability, non-specific physical symptoms and depression. At the 2-year follow-up, 119 cases (68%) and 104 controls (90%) were re-examined.Results: Compared to controls, cases reported more jaw and neck pain, both at baseline and follow-up. A majority (68%) of cases with pain in the jaw region in the acute stage also reported jaw pain at the follow-up. The intensity of jaw and neck pain was correlated both at baseline and follow-up. Both neck pain and jaw pain was correlated to non-specific physical symptoms and to depression.Conclusion: Orofacial pain and jaw disability related to neck pain is often present already at the acute stage after whiplash trauma and persist into the chronic stage for most individuals. Assessment following whiplash trauma should therefore include both the neck and the orofacial regions. More studies are needed to further evaluate risk factors for development of orofacial pain after whiplash trauma.Level of Evidence: 3
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23.
  • Larsson, Johan, et al. (författare)
  • The feasibility of gym-based exercise therapy for patients with persistent neck pain
  • 2020
  • Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 20:2, s. 261-272
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and aims: Persistent neck pain is common and can be detrimental to the health of those who are affected. This is particularly common after neck trauma, where it poses a challenge to health care providers. In this paper, we present the design and results of a study aimed primarily at assessing the feasibility of a supervised exercise intervention for patients with persistent neck pain after trauma. As a secondary aim, we analyzed the results of the intervention.Methods: We designed and conducted a feasibility study using a mixed methods design. Ten patients with persistent neck pain (nine with a history of neck trauma and one with sudden onset of neck pain) were recruited from a specialized pain rehabilitation center and underwent a gym-based individual exercise therapy intervention, supervised by a physical therapist. We assessed the feasibility of the exercise therapy intervention based on the experiences of the patients and physical therapists. We analyzed both quantitative and qualitative results using descriptive statistics, content analysis, and questionnaires.Results: The study found the exercise therapy to be a feasible alternative for patients with persistent neck pain. Most of the practical aspects of the intervention and study were executed as planned, and the study was well received by the patients, who found it a valuable part of their rehabilitation. In the quantitative analysis, improvements were observed on the Neck Disability Index, numerical rating scale for pain, EuroQol 5D, and physical activity, with scores on the Neck Disability Index showing a statistically significant improvement. Scores on the Disability Rating Index showed a non-significant deterioration. The qualitative analysis uncovered one overarching theme and four themes for the patients and three themes for the physical therapist.Conclusions: The exercise therapy intervention seems to be feasible with favorable outcomes for the patients. The quantitative and qualitative analyses demonstrated exercise therapy to be beneficial from several different perspectives. However, although structured, the training needs customization and individual adaption from a clinical reasoning perspective in order to meet each patient’s individual needs.Implications: This study shows that supervised gym-based exercise therapy is feasible for patients with severe, persistent neck pain. It facilitates and motivates the execution of a larger, controlled trial, which might then lead to a new and potentially effective addition to the toolbox of all health care providers treating patients with persistent neck pain.
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24.
  • Lövgren, Anna, et al. (författare)
  • Associations between screening for functional jaw disturbances and patient reported outcomes on jaw limitations and oral behaviors
  • 2023
  • Ingår i: Journal of Evidence-Based Dental Practice. - : Elsevier. - 1532-3382 .- 1532-3390. ; 23:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Temporomandibular disorders (TMDs) is a collective term for pain and functional disturbances related to the jaw muscles and the temporomandibular joint. In contrast to screening for orofacial pain, knowledge is limited on the association between patient-reported outcomes and screening for joint-related functional jaw disturbances. Therefore, our aim was to evaluate the association between a screening question for functional jaw disturbances, and disease-specific outcome measures for functional jaw limitations and oral behaviors.Methods: This study included 299 individuals (201 women; 20-69 years, median 37.0) in a general population sample from Västerbotten, Northern Sweden in 2014. A single screening question for functional jaw disturbances “Does your jaw lock or become stuck once a week or more?” was used to categorize individuals as cases or controls. Patient-reported outcomes on functional jaw disturbances were assessed with the 20-item jaw functional limitation scale (JFLS-20) and oral behaviors with the 21-item Oral Behaviors Checklist (OBC-21).Results: The strongest predictive probability to have a positive screening outcome was functional jaw limitations related to mobility (AUCboot=0.78, 95 CI:0.71-0.86, P <.001), followed by limitations related to communication (AUCboot = 0.74, 95 CI:0.63-0.80, P <.001) and mastication (AUCboot = 0.73, 95 CI:0.66-0.81, P <.001). The frequency of oral behaviors was not significantly associated with a positive screening outcome (AUCboot = 0.65, 95 CI:0.55-0.72, P =.223).Conclusions: Self-reported functional limitations, but not oral behaviors, are strongly associated with a single screening question for frequent functional jaw disturbances. This finding provides support for incorporating a question on jaw catching/locking once a week or more in screening instruments for TMDs.
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25.
  • Lövgren, Anna, et al. (författare)
  • Decision-making in dentistry related to temporomandibular disorders : a 5-yr follow-up study
  • 2018
  • Ingår i: European Journal of Oral Sciences. - : John Wiley & Sons. - 0909-8836 .- 1600-0722. ; 126:6, s. 493-499
  • Tidskriftsartikel (refereegranskat)abstract
    • Temporomandibular disorders (TMDs) are common, but many patients with such disorders go undetected and under-treated. Our aim was to evaluate the outcome of using a screening tool (5 yr after it was first implemented), on the clinical decision-making for patients with TMDs. Adults who attended for a dental check-up at the Public Dental Health Services in Västerbotten, Sweden, answered three screening questions (3Q/TMD) on frequent jaw pain, pain on jaw function, and catching/locking of the jaw. The dental records of a random sample of 200 individuals with at least one positive response to 3Q/TMD (3Q screen-positive patients) and 200 individuals with all negative responses (3Q screen-negative patients) were reviewed for TMD-related treatment decisions. A clinical decision related to TMD was absent in 45.5% of 3Q screen-positive patients. Treatment of TMDs was associated with a positive response to the screening question on jaw pain (OR = 6.7, 95% CI: 3.2-14.0) and was more frequent among 3Q screen-positive patients (24%) than among 3Q screen-negative patients (2%; OR = 15.5, 95% CI: 5.5-43.9), just as a female examiner was associated with more frequent treatment of TMDs (OR = 3.1, 95% CI: 1.2-8.4). The results indicate under-treatment of TMD within general dental practice and that male clinicians are less likely to initiate TMD treatment.
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26.
  • Lövgren, Anna, et al. (författare)
  • Diagnostic accuracy of three screening questions (3Q/TMD) in relation to the DC/TMD in a specialized orofacial pain clinic
  • 2018
  • Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 76:6, s. 380-386
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To determine the diagnostic accuracy of three screening questions (3Q/TMD) in relation to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), in a specialized clinic.Material and methods: Consecutive patients, >18 years, referred with a possible TMD complaint to the Orofacial Pain and Dysfunction clinic, Academic Centre for Dentistry Amsterdam, the Netherlands, were included in the study. All patients (n = 449; mean age 44 years; 72% females), answered the 3Q/TMD and the DC/TMD questionnaire before a DC/TMD examination. The 3Q/TMD constitutes of two questions on weekly pain from the jaw, face and temple region (Q1), and on function (Q2), and one function-related question on weekly catching and/or locking of the jaw (Q3). Q1 and Q2 were evaluated in relation to a DC/TMD pain diagnosis and Q3 in relation to a subgroup of DC/TMD intra-articular diagnosis, referred to as the reference standard.Results: In total, 44% of patients received a pain-related DC/TMD diagnosis and 33% an intra-articular reference DC/TMD diagnosis. Sensitivity for the two pain screening questions was high (0.83–0.94), whereas specificity was low (0.41–0.55). For the function-related question, sensitivity was low (0.48), whereas specificity was high (0.96).Conclusions: In a specialized pain clinic, the two pain questions (Q1, Q2) are positive in most patients with pain-related TMD. Therefore, in case of a positive response, further diagnostic procedures for TMD pain are warranted. For the functional screening question (Q3), a positive response is indicative for an intra-articular DC/TMD diagnosis, while in case of a negative outcome, an intra-articular TMD might still be present.
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27.
  • Lövgren, Anna, et al. (författare)
  • Outcome of three screening questions for temporomandibular disorders (3Q/TMD) on clinical decision-making
  • 2017
  • Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 44:8, s. 573-579
  • Tidskriftsartikel (refereegranskat)abstract
    • Patients with temporomandibular disorders (TMD) seem to go undetected and not adequately managed within dentistry. To identify these patients, three screening questions (3Q/TMD) have been introduced within dentistry in parts of Sweden. It is not known whether 3Q/TMD affects the clinical decision-making for these patients. The aim of this study was to evaluate the outcome of 3Q/TMD on the clinical decision-making and to analyse whether gender, age and the fee system the individual was assigned to were related to prescribed TMD treatment. This cohort study was carried out within the Public Dental Health service in Vasterbotten, Sweden. As part of the routine dental check-up, a health declaration including 3Q/TMD was completed. The study population was randomly selected based on their 3Q/TMD answers. In total, 300 individuals with an affirmative answer to any of the 3Q/TMD, and 500 individuals with all negative answers were selected. The 3Q/TMD includes questions on weekly jaw-face-temple pain (Q1), pain on function (Q2) and catching/locking of the jaw (Q3). The 3Q/TMD was analysed in relation to prescribed treatment assessed from dental records. There was significantly more treatment performed or recommended for 3Q-positives (215%), compared to 3Q-negatives (22%) (P < 0001). The odds ratio for TMD-related treatment for 3Q-positives versus 3Q-negatives was 121 (95% CI: 63-234). Although affirmative answers to the 3Q/TMD was related to TMD treatment, the majority of individuals with a screen positive still did not, according to dental records, receive assessment or treatment. Further studies are needed to better understand the clinical decision-making process for patients with TMD.
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28.
  • Lövgren, Anna, 1979- (författare)
  • Recognition of Temporomandibular Disorders : validity and outcome of three screening questions (3Q/TMD)
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background Pain and dysfunction in the temporomandibular region (Temporomandibular Disorders, TMD) are common conditions in the general population with an estimated treatment need of 5-15% in the general population. However, in Sweden, traceable performed treatments are significantly lower. The reasons for this indicated under-treatment are not known. To easily detect patients with a potential TMD related condition, three screening questions, 3Q/TMD, have been introduced. The aim with this project was to evaluate the validity and outcome of the 3Q/TMD with the objective to recognize individuals with TMD and potential treatment need in the Public Dental Health service (PDHS).Methods The thesis is based on four study samples; three from the PDHS in the county of Västerbotten, Sweden and one sample from the specialized orofacial pain clinic at the Academic Centre for Dentistry, ACTA, Amsterdam, the Netherlands. The bases for all studies are individuals’ answers to the 3Q/TMD and quantitative approaches were used in the analyses. The prevalence of affirmative answers was evaluated in a large cross-sectional study over the lifespan. The validity of the 3Q/TMD in relation to the Diagnostic Criteria for TMD (DC/TMD) as reference standard was established in two case-control studies. The outcome of the 3Q/TMD on TMD treatment within general practice was evaluated in a cohort study.Results Affirmative answers to the 3Q/TMD increased during adolescence. Women answered affirmatively to the 3Q/TMD significantly more often compared to men for all age groups expect for the first and last parts of a one hundred-year lifespan. The highest prevalence was reported by women during their fertile period in life. In a general population sample, 74% of individuals with an affirmative answer qualified for a DC/TMD pain or dysfunctional diagnosis, as compared to 64% in a specialist patient sample. In the general population sample, for the individual 3Q/TMD questions, as well as combinations of questions, the negative predictive values were high (0.92-0.99). For the specialist sample, when at least one question was answered affirmatively the negative predictive value was high (0.90). The positive predictive value was high (0.89) when all three questions were positive. There was significantly more treatment performed or recommended for 3Q-positives (21.5%) compared to 3Q-negatives (2.2%) (P<0.001). The odds ratio for TMD-related treatment for 3Q-positives versus 3Q-negatives was 12.1 (95% CI: 6.3-23.4).Conclusion The 3Q/TMD is a convenient and valid tool to recognize individuals who would benefit from a further TMD examination within an adult, general population. Within specialized orofacial pain clinics, the questions are useful as guidance for further diagnostics. Although the 3Q/TMD was a factor related to TMD treatment, the majority of individuals with self-reported symptoms of TMD still did not receive traceable assessment or treatment. Factors associated with dentists’ clinical decision-making in relation to TMD warrants further research. The utilization of the 3Q/TMD as a part of a decision tree for the clinician can improve the health care for patients with TMD and is therefore recommended within dentistry. 
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29.
  • Lövgren, Anna, et al. (författare)
  • Temporomandibular pain and jaw dysfunction at different ages covering the lifespan - A population based study
  • 2016
  • Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 20:4, s. 532-540
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundTemporomandibular pain and jaw dysfunction can have a negative effect on daily life, but these conditions are not well recognized in the health care systems. The general aim was to examine the cross-sectional prevalence of frequent temporomandibular pain and jaw dysfunction in men and women across the lifespan.MethodsThe analysis was based on data from 137,718 individuals (mean age 35years, SD 22.7) who answered three questions (3Q/TMD) included in the digital health declaration in the Public Dental Health care in the county of Vasterbotten, Sweden; Q1: Do you have pain in your temple, face, jaw or jaw joint once a week or more?'; Q2: Does it hurt once a week or more when you open your mouth or chew?'; and Q3: Does your jaw lock or become stuck once a week or more?'ResultsThe prevalence of frequent temporomandibular pain (Q1) was 5.2% among women and 1.8% among men (p<0.0001). The prevalence of frequent pain on jaw movement (Q2) was 2.5% among women and 0.9% among men (p<0.0001). The prevalence of frequent locking of the jaw (Q3) was 2.7% among women and 1.2% among men (p<0.0001).ConclusionsThe study shows that the cross-sectional prevalence of temporomandibular pain and jaw dysfunction varies during the lifespan. For men and women, respectively, symptoms increase during adolescence, peak in middle age and then gradually diminish. The prevalence of these symptoms is significantly higher among women except from the first and last decades of a 100-year lifespan.
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30.
  • Lövgren, Anna, et al. (författare)
  • The association between myofascial orofacial pain with and without referral and widespread pain
  • 2022
  • Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 80:7, s. 481-486
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Pain referral on palpation has been suggested to be a clinical sign of central sensitization potentially associated with widespread pain conditions. Our aim was to evaluate if myofascial pain with referral is a better predictor for widespread pain when compared to no pain or local myofascial pain.Materials and methods: Individuals at the Public Dental services in Västerbotten, Sweden, were randomly invited based on their answers to three screening questions for temporomandibular disorders (TMD). In total, 300 individuals (202 women, 20–69 yrs) were recruited, and examined according to the Diagnostic Criteria for TMD (DC/TMD) after completion of a body pain drawing. Widespread pain was considered present when seven or more pain sites were reported on the widespread pain index. A binary logistic regression model, adjusted for the effect of age and gender were used to evaluate the association between myofascial orofacial pain and widespread pain.Results: Widespread pain was reported by 31.3% of the study sample. There was a 57.3% overlap with myofascial pain. Widespread pain was associated to myofascial orofacial pain with and myofascial orofacial pain (OR 4.83 95% CI 2.62–9.05 and OR 11.62 95% CI 5.18–27.88, respectively).Conclusion: These findings reinforce the existing knowledge on the overlap between painful TMD and other chronic pain conditions.
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31.
  • Lövgren, Anna, et al. (författare)
  • The outcome of a temporomandibular joint compression test for the diagnosis of arthralgia is confounded by concurrent myalgia
  • 2020
  • Ingår i: Clinical Oral Investigations. - : Springer. - 1432-6981 .- 1436-3771. ; 24, s. 97-102
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Pain in the orofacial region may originate from different structures, and one challenge for the clinician is to determine the primary origin of pain reported by the patient. In clinical practice, it is important to discriminate between a temporomandibular joint (TMJ) pain disorder and jaw muscle pain; therefore, tests that are proposed for such purposes warrant evaluation. The aim of the present study was to evaluate the outcome of a TMJ compression test in relation to a Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) arthralgia diagnosis.Methods: A study population (n = 300), randomly selected from the adult population in Västerbotten, Sweden, was examined according to the DC/TMD criteria and with a TMJ compression test. This test is comprised of forceful unilateral biting for 20 s on a wooden spatula in the first molar region. Familiar pain on the contralateral side to the clenching side was considered a positive test outcome.Results: Positive contralateral outcome of the TMJ compression test was associated with an arthralgia diagnosis (B = 1.737; OR 5.7, 95% CI 3.3–9.9). This association was confounded by concurrent myalgia (B = 1.737 → B = 0.996, 42.7%).Conclusion: In a general population, a negative TMJ compression test was strongly associated with the absence of a contralateral TMJ arthralgia diagnosis according to DC/TMD. The association between a positive TMJ compression test and a DC/TMD arthralgia diagnosis was confounded by the presence of myalgia.Clinical relevance: Concurrent myalgia renders the usefulness of the TMJ compression test for predicting an arthralgia diagnosis questionable.
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32.
  • Lövgren, Anna, et al. (författare)
  • Validity of three screening questions (3Q/TMD) in relation to the DC/TMD
  • 2016
  • Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 43:10, s. 729-736
  • Tidskriftsartikel (refereegranskat)abstract
    • Temporomandibular disorders (TMD) are common but seem to be largely undetected within general dental care. To improve dentists' awareness of these symptoms, three screening questions (3Q/TMD) have been introduced. Our aim was to validate 3Q/TMD in relation to the diagnostic criteria for TMD (DC/TMD), while taking into account the severity level of the symptoms. The study population consisted of 7831 individuals 20-69 years old, who had their routine dental check-up at the Public Dental Health Service in Västerbotten, Sweden. All patients answered a health declaration, including the 3Q/TMD regarding frequent temporomandibular pain, pain on movement and catching/locking of the jaw. All 3Q-positives (at least one affirmative) were invited for examination in randomised order. For each 3Q-positive, a matched 3Q-negative was invited. In total, 152 3Q-positives and 148 3Q-negatives participated. At examination, participants answered 3Q/TMD a second time, before they were examined and diagnosed according to DC/TMD. To determine symptom's severity, the Graded Chronic Pain Scale and Jaw Functional Limitation Scale-20 (JFLS-20) were used. In total, 74% of 3Q-positives and 16% of 3Q-negatives met the criteria for DC/TMD pain or dysfunction (disc displacements with reduction and degenerative joint disorder were excluded). Fifty-five per cent of 3Q-positives had a TMD diagnosis and CPI score ≥3 or a JFLS-20 score ≥5, compared to 4% of 3Q-negatives. The results show that the 3Q/TMD is an applicable, cost-effective and valid tool for screening a general adult population to recognise patients in need of further TMD examination and management.
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33.
  • Lövgren, Anna, et al. (författare)
  • Validity of three screening questions in relation to the DC/TMD in a specialized orofacial pain clinic
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Aims: To determine the validity of three screening questions (3Q/TMD) in relation to theDiagnostic Criteria for Temporomandibular Disorders (DC/TMD), in a specialized orofacial painclinic.Methods: Consecutive patients, >18 years, referred with a TMD complaint to the Orofacial painclinic, Academic Centre for Dentistry Amsterdam, ACTA, the Netherlands, were included in thestudy. The study sample, (n=449) with mean age 44 years (72% females) answered the3Q/TMD and the DC/TMD questionnaire before a clinical DC/TMD examination. The 3Q/TMDconstitutes of two questions on weekly pain from the jaw, face, and temple region, in rest (Q1)and on function (Q2), and one function-related question on weekly catching and/or locking of thejaw (Q3). Q1 and Q2 were evaluated in relation to a DC/TMD pain diagnosis and Q3 in relationto a subgroup of DC/TMD intra-articular diagnosis, referred to as the reference standard.Results: In total, 44% of patients received a pain-related DC/TMD diagnosis and 33% anintraarticular reference DC/TMD diagnosis. Sensitivity for the two pain screening questions washigh (0.83-0.94), whereas specificity was low (0.41-0.55). For the function-related question,sensitivity was low (0.48), whereas specificity was high (0.96).Conclusions: In most TMD-pain patients, the two pain screening questions are positive. Thehigh negative predictive values of the two questions on pain (Q1 and Q2) indicate that inpatients with negative responses, the presence of pain-related TMD is quite unlikely. For thefunctional screening question (Q3), a positive response is indicative for a subgroup of intra-articular DC/TMD diagnoses.
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34.
  • Marklund, Susanna, 1960-, et al. (författare)
  • Incidence and prevalence of myofascial pain in the jaw-face region : a one-year prospective study on dental students
  • 2008
  • Ingår i: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 66:2, s. 113-121
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. The aims of this study were to examine the 1-year period prevalence, incidence, and course of myofascial pain in the jaw-face region, and to analyze whether female gender, dental occlusion, and oral parafunctions have any influence on these signs and symptoms. Material aad methods. The study population comprised 308 dental students examined at the start of their dentistry course and re-examined after 1 year. Case histories were collected using a questionnaire. The clinical examination included palpation sites of muscles, a submaximal clenching test, measurements of maximal mandibular mobility, and classification of morphological and functional dental occlusion. Results. The 1-year period prevalence of frequent myofascial symptoms was 19%. The incidence of myofascial pain, according to the Research Diagnostic Criteria for TemporoMandibular Disorders (RDC/TMD), was 4%. The female students presented an almost 4-fold incidence rate of myofascial symptoms compared to the male students. Non-symptomatic subjects were found among those without awareness of bruxism and with simultanious bilateral contact in the retruded contact position (RCP), and among those with a stable intercuspal position (ICP). Variations in morphological occlusion did not show any relation to myofascial symptoms, nor did contact patterns in eccentric positions. Conclusions. Female dental students were more prone to developing frequent myofascial pain and to perceiving local muscle soreness than were male students during a 1-year period. Both self-reported bruxism and registered mandibular instability in ICP showed association with the 1-year period prevalence of myofascial signs and symptoms in the jaw-face region.
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35.
  • Marklund, Susanna, 1960-, et al. (författare)
  • Incidence and prevalence of temporomandibular joint pain and dysfunction : a one-year prospective study of university students
  • 2007
  • Ingår i: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 65:2, s. 119-127
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. The aims of this study were to investigate the incidence and recovery of temporomandibular joint (TMJ) pain and dysfunction during a 1-year period, and to examine factors associated with TMJ signs and symptoms. Material and Methods. The study population comprised 371 dental students examined at the start of education, out of which 308 were re-examined after 1 year. Case histories were collected with the aid of a questionnaire. The cinical examination involved TMJ mobility, TMJ pain, TMJ sounds, morhological and functional dental occlusion. Results. The 1-year incidence of TMJ signs and/or symptoms was 12%, with no statistically significant difference between men and women. Reported TMJ sounds (10%) and clinically registered TMJ pain (8%) reached the highest incidence rates. Approximately a quarter of those who had TMJ signs and/or symptoms at baseline had recovered at follow-up. Subjects with a non-symptomatic TMJ were significantly more often found among men and among those with bilateral contacts in centric relation, a normal transverse inter-maxillary relationship, and a stabile manadibular position in centric occlusion. Conclusion. The 1-year incidence of TMJ pain and/or dysfunction was high among 1st-year univerisity students. The persistence of signs and symptoms during the observation period was related to gender, while incidence and disappearance of symptoms were not. Dental occlusion was not rejected as a possible concurrent factor in relation to TMJ pain and/or dysfunction among university students.
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36.
  • Marklund, Susanna, 1960-, et al. (författare)
  • Reciprocal influence on the incidence of symptoms in trigeminally and spinally innervated areas
  • 2010
  • Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 14:4, s. 366-371
  • Tidskriftsartikel (refereegranskat)abstract
    • Temporomandibular disorders (TMD), headaches, and spinal pain show co-morbidity and may therefore influence each other. The hypothesis tested is that the presence of any of these conditions will increase the risk of onset of new symptoms within a 2-year period. The study population comprised 280 dental students, who were examined three times at 12-month intervals. The incidence was calculated for a 2-year period, based on subjects without the defined symptom at baseline. Each participant was classified into five different case-control groups, representing incidence cases or no incidence (controls) of: (1) nonpain TMD symptoms; (2) jaw pain; (3) headaches; (4) spinal pain; and (5) TMD pain. Presence of headaches and of spinal pain and signs and symptoms of TMD at baseline were used as independent variables in logistic regression analyses, controlling for age and sex. Incidence cases with TMD pain reported spinal pain at baseline significantly more often than the controls, and were mostly women. Incidence cases with headaches and incidence cases with jaw pain significantly more often had signs of TMD and reported spinal pain at baseline, compared to controls. Incidence cases with nonpain TMD symptoms or spinal pain significantly more often presented with signs of TMD at baseline. Our findings show that pain and dysfunction in trigeminally innervated areas and pain in spinally innervated areas mutually predict the onset of new symptoms in dental students, indicating common pathophysiological mechanisms and individual vulnerability. This may be of importance in risk assessment and treatment planning of individuals with musculoskeletal pain.
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37.
  • Marklund, Susanna, et al. (författare)
  • Risk factors associated with incidence and persistence of frequent headaches
  • 2014
  • Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 72:8, s. 788-794
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Headaches represent a significant public health problem, but the knowledge of factors specifically related to incidence and persistence of headaches is still limited. The aim of this study was to evaluate whether gender, self-reported bruxism and variations in the dental occlusion contribute to onset and persistence of frequent headaches. MATERIALS AND METHODS: The study population comprised 280 dental students, examined annually in a 2-year prospective study with a questionnaire and a clinical examination of the jaw function. In the analysis subjects were dichotomized into cases with frequent (once a week or more) or without frequent headaches (controls). The 2-year cumulative incidence was based on subjects without frequent headaches at baseline. Cases with 2-year persistent headaches reported such symptoms at all three examinations. Self-reported bruxism and factors in the dental occlusion at baseline were used as independent variables in logistic regression analyses. RESULTS: The 2-year cumulative incidence of frequent headaches was 21%. Female gender (OR = 2.6; CI = 1.3-5.4), self-reported bruxism (OR = 2.3; CI = 1.2-4.4) and mandibular instability in intercuspal position (OR = 3.2; CI = 1.4-7.5) were associated with incidence of frequent headaches. Persistent headaches during the observation period were present in 12 individuals (4%) and significantly related to mandibular instability in intercuspal position (OR = 6.1; CI = 1.6-22.6). CONCLUSIONS: The results indicate that female gender, self-reported bruxism and mandibular instability in intercuspal position are of importance in the development of frequent headaches. In management of these patients a multidisciplinary approach including dentists may be important and, thus, advocated.
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38.
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39.
  • Marklund, Susanna, 1960-, et al. (författare)
  • Risk factors associated with incidence and persistence of temporomandibular disorders
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Aims: The aim of this study was to analyze whether gender, reported bruxism, and variations in dental occlusion predicted incidence and persistence of temporomandibular disorders (TMD) during a 2 year period. Methods: The study population comprised 280 dental students at Umeå University, Sweden. The study design was that of a case-control study within a 2-year prospective cohort. The investigation comprised a questionnaire and a clinical examination at enrolment, and at 12 and 24 months. Cases (incidence) and controls (no incidence) were identified among those without signs and symptoms of TMD at start. Cases with persistent TMD were those with such signs and symptoms at all three examinations. Clinical registrations of baseline variables were used as independent variables. Odds ratio estimates and 95% confidence intervals of the relative risks of being a case or control in relation to baseline registrations were calculated using logistic regression analyses. Results: The analyses revealed that reported bruxism and crossbite, respectively, increased the risk of incidence and duration of temporomandibular joint (TMJ) signs or symptoms. Female gender was related to an increased risk to develop and maintain myofascial pain. Signs of mandibular instability increased the risk of long-standing signs and/or symptoms of TMD. Conclusion: This 2-year prospective observational study indicated that reported bruxism and variations in dental occlusion were linked to incidence and persistence of TMJ signs and symptoms to a higher extent than to myofascial pain.
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40.
  • Marklund, Susanna, 1960- (författare)
  • Temporomandibular disorders : incidence, course, and risk factors
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Temporomandibular disorders (TMD) embrace pain and dysfunction in the temporomandibular joint (TMJ) and jaw muscles. TMD is a prevalent condition in the population and constitutes a significant health problem. Knowledge of factors influencing the onset and course of TMD is important in preventive care and development of treatment strategies as well as in clinical decision making. The aim of this thesis was to gain knowledge of whether variations in dental occlusion, bruxism, spinal pain and gender predicted the development and course of TMD. The study population comprised 371 undergraduate dental students. A questionnaire was used to obtain case histories. Clinical examination included the function of the TMJ, jaw muscles, maximal jaw mobility, the morphological occlusion, and contact patterns in centric and eccentric positions. The examinations were performed at start, and after 12 and 24 months. In total, 280 subjects were examined at all three occasions. The incidence of TMJ pain and dysfunction was high among both males and females. The course composed onset, recovery and maintenance resulting in a fluctuating pattern. Females were more likely to have persistent TMJ pain and dysfunction than males. The incidence and persistence of jaw muscle signs and symptoms was high and significantly more common in females. A similar fluctuating pattern as for TMJ pain and dysfunction was found. Crossbite predicted onset and persistence of TMJ pain and dysfunction; mandibular instability in centric positions predicted persistent TMJ pain and dysfunction, as well as persistent jaw muscle signs or symptoms. Reported bruxism increased the risk for TMJ pain and dysfunction but did not significantly affect the course of jaw muscle signs and symptoms. Spinal pain at baseline predicted the onset of jaw pain, headaches, and TMD pain. Signs of TMD at baseline predicted the onset of non-pain symptoms of TMD, jaw pain, headaches, and spinal pain. In conclusion, the results in this thesis show high incidence rates for TMD, headaches, and spinal pain among dental students. Crossbite, mandibular instability, reported bruxism, as well as female gender were identified as contributing risk factors. Spinal pain and TMD mutually predicted each other, indicating common pathophysiological mechanisms and individual vulnerability. The findings support a multidisciplinary approach, and it is recommended that the status and function of the jaw system be considered in patients with spinal pain.
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41.
  • Mejersjö, Christina, et al. (författare)
  • Can temporomandibular disorder symptoms and headaches be prevented in 13-to 15-year-old girls by information provided in a school setting?
  • 2024
  • Ingår i: JOURNAL OF ORAL REHABILITATION. - : John Wiley & Sons. - 0305-182X .- 1365-2842.
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveTemporomandibular disorders (TMD) may develop, especially among girls, during the adolescence period. The aim of this study was to study if information and advice in a school setting could prevent development of TMD symptoms and headaches during the early teenage period.MethodsThirteen-year-old girls, at 19 upper elementary schools were invited to participate in a study with structured information about the jaw system, TMD symptoms and risk factors, as well as advice how to manage risk factor and TMD. Six hundred and fifty-one girls enrolled, of which 507 girls were followed for 2-2.5 years. Half received information on three occasions (cases), and the other half served as controls. Included in the analysis of incidence of TMD symptoms were those without frequently occurring TMD symptoms (not including headaches) at baseline (n = 396) and included in the analysis of incidence of headaches were those without frequent headaches at baseline (n = 297).ResultThe 2-year incidence of TMD symptoms was significantly lower in the information cohort (19%) compared to the controls (28%) (p = .03). The 2-year incidence of headaches was lower among those who were allocated to information (30%) compared to controls (40%), but the difference was not statistically significant (p = .099). Cases who had headaches at baseline reported a significantly lower prevalence at follow-up compared to controls (p = .03).ConclusionStandardized information in school settings can prevent development of TMD symptoms and headaches among young girls. The 2-year incidence of TMD symptoms was significantly lower in the information cohort (19%) compared to the controls (28%) (p = .03). Cases who had headaches at baseline reported a significantly lower prevalence at follow-up compared to controls (p = .03). Standardized information in school settings prevented development of TMD symptoms and headaches among young girls. image
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42.
  • Mejersjö, Christina, et al. (författare)
  • Impact of temporomandibular disorder symptoms among 15-year-old girls
  • 2024
  • Ingår i: Acta Odontologica Scandinavica. - : MJS Publishing, Medical Journals Sweden AB. - 0001-6357 .- 1502-3850. ; 83, s. 441-445
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Many adolescents, especially girls, report temporomandibular disorder (TMD) symptoms that may impact their daily life.Methods: At 19 different schools participating in the preventive program with dental nurses of FRAMM (Fluoride, Advise, Arena, Motivation, Food), at the Västra Götaland Region in Sweden, 15-year-old girls were invited to a cohort study about symptoms of TMD that also included headaches. Three hundred twenty-nine girls attended the study and answered a questionnaire regarding TMD symptoms and their consequences such as sick leave from school and consumption of analgesics. The girls were asked about the symptom’s influence on their daily life, about their general health, use of regular medication, physical activity, and they answered the PHQ4 regarding experienced symptoms of anxiety and depression.Results: There was a significant correlation between TMD symptoms and sick leave with 31% of the girls having stayed home due to symptoms. Of the girls who answered affirmative in the screening questions (3QTMD), nearly half the group had stayed at home due to their symptoms, 24% had consulted a physician, 42% had used analgesics weekly and 59% reported that they felt the symptoms negatively affected their school performance. The girls who had regular medication had more TMD symptoms. Anxiety and depression were associated with TMD symptoms.Conclusion: The study showed that TMD symptoms had a negative impact on the 15-year-old girls’ daily life resulting in sick leave from school, consumption of analgesics, and experiences of negative impacts on their behavior and performance at school.
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43.
  • Näsström, Anna, et al. (författare)
  • The implementation of a decision-tree did not increase decision-making in patients with temporomandibular disorders in the public dental health service
  • 2019
  • Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 77:5, s. 394-399
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Many patients with temporomandibular disorders (TMD) seem to go undetected within primary dental health care. Primarily we evaluated if the implemented intervention increased the clinical decision-making for TMD patients; secondarily we evaluated if other factors could be identified that predicted performed or recommended TMD treatment.Material and Methods: This case–control study was carried out within the Public Dental Health service in Västerbotten County, Sweden. An intervention based on a decision-tree with three screening questions for TMD (3Q/TMD) was implemented during 2015 in four clinics and compared with the remaining county. A total of 400 individuals were selected—200 3Q-positives and 200 3Q-negatives. The 3Q/TMD consists of Q1—frequent jaw pain, Q2—frequent pain on function, and Q3—frequent catching and/or locking of jaw. The 3Q/TMD answers were analyzed in relation to TMD treatment and any TMD related decision that was collected from the digital dental records.Results: The intervention did not increase the frequencies of traceable clinical decisions among patients with TMD.Conclusions: Despite the implemented intervention aimed, the indicated undertreatment of patients with TMD remains. Future studies are still needed to gain a deeper understanding of the clinical decision-making process for TMD patients in general practice dentistry.
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44.
  • Pihlgren, Karin, et al. (författare)
  • Changes in tooth mortality between 1990 and 2002 among adults in Västerbotten County, Sweden : influence of socioeconomic factors, general health, smoking, and dental care habits on tooth mortality
  • 2011
  • Ingår i: Swedish Dental Journal. - 0347-9994. ; 35:2, s. 77-88
  • Tidskriftsartikel (refereegranskat)abstract
    • The objectives of the study were to analyse changes in tooth mortality among adults in Västerbotten County, Sweden, between 1990 and 2002 and determine whether socioeconomic factors, general health, smoking, and dental care habits influenced tooth mortality. The study was based on samples drawn from the adult population in Västerbotten County in 1990 and 2002. The studied age groups were 35-, 50-, and 65-year-olds. In 2002 75-year-olds were included. The surveys comprised a clinical examination and a questionnaire.The latter focused on oro-facial symptoms, socioeconomic factors, general health, smoking, and dental care habits. Complete data were obtained from 715 individuals in 1990 and from 768 individuals in 2002.Variables used to depict tooth mortality were edentulousness, occlusal supporting zones (Eichner index), and number of teeth. The prevalence of edentulousness in Västerbotten County decreased from 12.7% in 1990 to 3.7% in 2002 (P < 0.001). The mean number of teeth increased in all age groups between 1990 and 2002, and so did the number of individuals with tooth contact in all occlusal supporting zones and no gaps between teeth. Low educational level, weak economic status, smoking, and irregular visits to the dental clinic were all significantly related to increased tooth mortality. Between 1990 and 2002 tooth mortality decreased significantly in the adult population of Västerbotten County, Sweden. Cross-sectional analysis identified socioeconomic factors, smoking, and irregular use of dental care services as being related to tooth mortality in both 1990 and 2002.
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45.
  • Storm Mienna, Christina, et al. (författare)
  • A two-year follow-up study of temporomandibular disorders in a female Sami population : validation of cases and controls as predicted by questionnaire
  • 2007
  • Ingår i: Acta Odontologica Scandinavica. - : Informa Healthcare. - 0001-6357 .- 1502-3850. ; 65:6, s. 341-347
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: The first aim of this study was to validate persistent, severe symptoms of temporomandibular disorders (TMD) among Sami females, as predicted by questionnaire. The second aim was to establish diagnoses according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis 1 among predicted cases and controls. The third aim was to compare subjects with severe TMD to controls in regard to dental occlusion, general health, and parafunctions.MATERIAL AND METHODS: The subjects, Sami females living in the Arctic region of northern Sweden, all with long-standing (>or=1 year), intense (>or=5 on NS), and frequent (>or=once a week) symptoms of pain and dysfunction in the jaw-face region, were invited for clinical examination; 22 (63%) agreed to participate. Forty-six subjects with no symptoms in the jaw-face region were matched to these cases in accordance with five age groups. The examiner was blind to subject affiliation.RESULTS: The positive predictive value of presenting with signs and symptoms of TMD at follow-up was 0.82; the negative value was 0.87. Cases reported impaired general health and awareness of parafunctions significantly more frequently than did controls. Registered dental occlusion factors did not distinguish cases from controls.CONCLUSIONS: Long-standing, intense, and frequent TMD symptoms remained essentially unchanged over the 2-year follow-up of females in a Sami population. Presence of severe TMD was related to impaired general health and awareness of oral parafunctions.
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46.
  • Storm Mienna, Christina, et al. (författare)
  • "Grin(d) and bear it" : narratives from Sami women with and without temporomandibular disorders. A qualitative study.
  • 2014
  • Ingår i: Journal of oral & facial pain and headache. - : Quintessence publishing. - 2333-0384. ; 28:3, s. 243-251
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: To explore thoughts, experiences, and beliefs regarding temporomandibular disorders (TMD) among Sami women with and without TMD in order to gain insights into their health care experiences and to generate a hypothesis regarding factors associated with long-standing TMD.METHODS: Qualitative thematic interviews were conducted with a strategic sample of 17 Sami women, of whom 10 had a TMD diagnosis according to the Research Diagnostic Criteria for TMD and 7 age-matched women who had no signs or symptoms of TMD. Their ages were between 23 and 58 years. The thematic interviews were audiotaped, transcribed verbatim, and analyzed based on Grounded Theory, a qualitative methodology aiming to generate hypotheses grounded in the gathered data.RESULTS: The core category that evolved was "Grin(d) and bear it," which summarizes the Sami participants' various ways and stages of processing and handling the interacting categories (triggers, strains, distrust, and reconciliation with pain and/or difficulties in life). They described divergent as well as similar understandings of triggering factors. Maintaining factors were described as mental-physical strain and stress, and also a jaw-clenching behavior. Women without TMD contributed with factors that helped them to handle strains, reconcile, and stay healthy. They relied on strong social support.CONCLUSION: Based on the analysis, the following hypothesis was generated: Women with TMD, associated headaches, and neck-shoulder pain may benefit from efforts aimed at empowering them to use their own abilities to reduce stress behavior, strain, and disuse of the jaw. Rehabilitation strategies in groups might increase their sense of coherence and increase social support, which seems to be more limited than in women with no symptoms of TMD.
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47.
  • Storm Mienna, Christina, et al. (författare)
  • Patients' experiences of supervised jaw-neck exercise among patients with localized TMD pain or TMD pain associated with generalized pain
  • 2019
  • Ingår i: Acta Odontologica Scandinavica. - Abingdon : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 77:7, s. 495-501
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To evaluate temporomandibular disorder (TMD) patients’ experiences of a supervised jaw-neck exercise programme.Materials and methods: The study used a mixed method design. All patients were diagnosed with myalgia according to the Research Diagnostic Criteria for TMD and divided into local myalgia (n = 50; 38 women, mean age 43 yrs, SD 14), and myalgia with generalized pain (n = 28; 27 women, mean age 43 yrs, SD 13). Patients participated in a ten-session supervised exercise programme that included relaxation, coordination and resistance training of the jaw, neck and shoulders. After the 10 sessions an evaluation form was filled out including both open- and closed-ended questions. The quantitative analysis was based on closed-ended questions concerned experience, adaptation and side-effects from the exercise programme. The qualitative analysis was employing inductive content analysis of open-ended questions.Results: Patients reported similar positive overall experiences of exercise regardless of diagnosis, although more individuals in the general pain group experienced pain during training (57%) compared to the local pain group (26%; p = .015). Patients in both groups shared similar experiences and acknowledged the possibility to participate in an individualized and demanding exercise programme. They expressed feelings of being noticed, taken seriously and respectful care management to be key factors for successful treatment outcome. The exercise programme was acknowledged as a valuable part of treatment.Conclusion: The hypothesis generated was that individualized and gradually demanding exercise in the rehabilitation process of TMD stimulates self-efficacy and confidence in chronic TMD patients regardless of whether the pain was localized or combined with wide-spread pain.
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48.
  • Storm Mienna, Christina, et al. (författare)
  • Self-reported impact on daily life activities related to temporomandibular disorders, headaches, and neck-shoulder pain among women in a Sami population living in Northern Sweden
  • 2012
  • Ingår i: Journal of Orofacial Pain. - Hanover Park, IL : Quintessence Publishing. - 1064-6655 .- 1945-3396. ; 26:3, s. 215-224
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: To analyze the influence of frequency, intensity, and duration of temporomandibular disorders (TMD), headaches, and neck-shoulder pain (NSP) on Sami women's daily life. A further aim was to analyze the relationship between these symptoms and age.Methods: All 751 Sami women 21 to 70 years old registered in either the Swedish Sami Parliament's electoral register or registered as reindeer owners or herders and living north of the Arctic Circle in Sweden were sent a questionnaire regarding TMD symptoms, NSP, and headaches. In total, 487 women (65%) participated. The questionnaire focused on symptom frequency, duration, and intensity and whether these symptoms influenced activities of daily life. The symptom's interference with daily life activities was measured, respectively, with a numerical rating scale (NRS). The statistical analyses included multiple logistic regression analysis and Chi-square test. A P value < .05 was considered statistically significant.Results: Seventeen percent of the women reported that symptoms in the jaw-face region to some degree disturbed their daily life, and for 6%, the interference was significant (>= 5 on NRS). Duration of jaw pain, troublesome impaired jaw opening, and neck pain, together with a low education level, affected reports of whether symptoms of TMD influenced daily life. Almost half of the study population reported that headaches had a negative impact on their life. A similar pattern was reported for NSP. The prevalence of frequent and troublesome symptoms of TMD and headaches, but not NSP, showed a declining trend with age.Conclusion: TMD symptoms, headaches, and NSP negatively influence many Sami women's daily life. Factors related to pain had the greatest influence when these Sami women rated the related impairment.
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49.
  • Storm Mienna, Christina (författare)
  • Temporomandibular disorders among Sami women : perspectives based on an epidemiological survey with mixed methods
  • 2014
  • 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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50.
  • Storm Mienna, Christina, et al. (författare)
  • Temporomandiular disorders, headaches, and cervical pain among females in a Sami population
  • 2006
  • Ingår i: Acta Odontologica Scandinavica. - : Informa Healthcare. - 0001-6357 .- 1502-3850. ; 64:5, s. 319-325
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. The aim of this study was to examine the prevalence and co-morbidity of long-standing, intense, and frequent symptoms of pain and dysfunction in the jaw-face, head, and cervical region among adult females drawn from the Sami population in northern Sweden.Methods. A total of 487 females, taken from the register of the Swedish Sami Parliament or registered as reindeer owners or reindeer herders in the Swedish Board of Agriculture and living in the Arctic region of northern Sweden, participated in a questionnaire study.Results. The prevalence of pain and/or dysfunction in the jaw-face region was 32%, of headaches 61%, and of pain in the cervical region 56%. When the criterion of frequent symptoms (once a week or more often) was used, prevalence dropped to 17%, 19%, and 30%, respectively, and when that of intense symptoms, defined as 5 or more on an 11-point numerical rating scale, was added, prevalence dropped further to 8%, 11%, and 20%, respectively. The majority reported long-standing symptoms (67-98% depending on symptom). A high statistically significant relationship was found between frequent symptoms of pain and/or dysfunction in the jaw-face, frequent headaches, and frequent cervical pain (p <0.0001).Conclusions. Symptoms in the jaw-face, headaches, and cervical pain were frequently reported among a sample of Sami females living in the Swedish Arctic region. The prevalence of symptoms was strongly dependent on criteria of frequency and intensity.
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