| 1. |
- Benjamin, Daniel J., et al.
(författare)
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Redefine statistical significance
- 2018
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Ingår i: Nature Human Behaviour. - : Nature Research (part of Springer Nature). - 2397-3374. ; 2:1, s. 6-10
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 2. |
- Berlin, Henrik, et al.
(författare)
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Effects and cost-effectiveness of postoperative oral analgesics for additional postoperative pain relief in children and adolescents undergoing dental treatment: Health technology assessment including a systematic review
- 2019
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Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 14:12
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Forskningsöversikt (refereegranskat)abstract
- Background There is an uncertainty regarding how to optimally prevent and/or reduce pain after dental treatment on children and adolescents. Aim To conduct a systematic review (SR) and health technology assessment (HTA) of oral analgesics administered after dental treatment to prevent postoperative pain in children and adolescents aged 3-19 years. Design A PICO-protocol was constructed and registered in PROSPERO (CRD42017075589). Searches were conducted in PubMed, Cochrane, Scopus, Cinahl, and EMBASE, November 2018. The researchers (reading in pairs) assessed identified studies independently, according to the defined inclusion and exclusion criteria, following the PRISMA-statement. Results 3,963 scientific papers were identified, whereof 216 read in full text. None met the inclusion criteria, leading to an empty SR. Ethical issues were identified related to the recognized knowledge gap in terms of challenges to conduct studies that are well-designed from methodological as well as ethical perspectives. Conclusions There is no scientific support for the use or rejection of oral analgesics administered after dental treatment in order to prevent or reduce postoperative pain in children and adolescents. Thus, no guidelines can be formulated on this issue based solely on scientific evidence. Well-designed studies on how to prevent pain from developing after dental treatment in children and adolescents is urgently needed.
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| 3. |
- Berlin, Henrik, et al.
(författare)
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Postoperative pain profile in 10-15-year-olds after bilateral extraction of maxillary premolars
- 2019
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Ingår i: European Archives of Paediatric Dentistry. - : Springer. - 1818-6300 .- 1996-9805. ; 20:6, s. 545-555
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To study pain perception in 10-15-year-olds, during and after uncomplicated extractions of bilateral maxillary premolars. The study investigated pain's natural course and made comparisons between the first and second extractions. METHODS: 31 Swedish children in need of orthodontic treatment were identified and consecutively enrolled. Tooth extractions followed a standardised protocol and the two teeth were extracted with at least 10 days between. The participants rated pain intensity using visual analogue scale (VAS) at 14 different time points from treatment and 7 days forward. RESULTS: The pain intensity profile followed the same pattern for all patients. Pain intensity peaked 2 h after extractions (mean VASPI 27.3, SD 20.8; median 23.0) when moderate pain intensity (VASPI >/= 40) was registered for 16 (28%) of 57 cases. After that, there was a rapid decrease in pain intensity notable already at 4 h after extractions. There were no statistically significant differences in any VASPI measurements between the first and second extractions, sexes, or different age groups. CONCLUSIONS: The majority of the participants who undergo uncomplicated bilateral extraction of maxillary premolars experience mild to moderate levels of postoperative pain during a short period of time, with no differences between the first and second extractions. Bilateral tooth extractions is a suitable model for further studies on pain management.
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| 4. |
- Häggman Henrikson, Birgitta, et al.
(författare)
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Pharmacological treatment of oro-facial pain : health technology assessment including a systematic review with network meta-analysis
- 2017
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Ingår i: Journal of Oral Rehabilitation. - Hoboken : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 44:10, s. 800-826
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Forskningsöversikt (refereegranskat)abstract
- This health technology assessment evaluated the efficacy of pharmacological treatment in patients with oro-facial pain. Randomised controlled trials were included if they reported pharmacological treatment in patients >= 18 years with chronic (>= 3 months) oro-facial pain. Patients were divided into subgroups: TMD-muscle [ temporomandibular disorders (TMD) mainly associated with myalgia]; TMD-joint (TMD mainly associated with temporomandibular joint pain); and burning mouth syndrome (BMS). The primary outcome was pain intensity reduction after pharmacological treatment. The scientific quality of the evidence was rated according to GRADE. An electronic search in PubMed, Cochrane Library, and EMBASE from database inception to 1 March 2017 combined with a handsearch identified 1552 articles. After screening of abstracts, 178 articles were reviewed in full text and 57 studies met the inclusion criteria. After risk of bias assessment, 41 articles remained: 15 studies on 790 patients classified as TMD-joint, nine on 375 patients classified as TMD-muscle and 17 on 868 patients with BMS. Of these, eight studies on TMD-muscle, and five on BMS were included in separate network meta-analysis. The narrative synthesis suggests that NSAIDs as well as corticosteroid and hyaluronate injections are effective treatments for TMD-joint pain. The network meta-analysis showed that clonazepam and capsaicin reduced pain intensity in BMS, and the muscle relaxant cyclobenzaprine, for the TMD-muscle group. In conclusion, based on a limited number of studies, evidence provided with network meta-analysis showed that clonazepam and capsaicin are effective in treatment of BMS and that the muscle relaxant cyclobenzaprine has a positive treatment effect for TMD-muscle pain.
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| 5. |
- Al-Harthy, Mohammad, et al.
(författare)
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Cross-cultural differences in types and beliefs about treatment in women with temporomandibular disorder pain
- 2018
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 45:9, s. 659-668
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesWomen with temporomandibular disorder (TMD) pain from three cultures were assessed for type of treatment received and core illness beliefs. MethodsIn a clinical setting, 122 women patients with chronic TMD pain (39 Saudis, 41 Swedes and 42 Italians) were evaluated for patient characteristics, type of practitioner, type of treatment received and beliefs about TMD prior to consultation in TMD specialist centres. Measures included a survey of treatments received and a belief scale regarding contributing, aggravating and treatment-relevant factors related to the pain. All questionnaires were translated from English and culturally adapted. Comparisons among cultural groups were performed using a linear regression model for continuous variables and logistic regression model for dichotomous variables. A P-value
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| 6. |
- Al-Harthy, Mohammad, et al.
(författare)
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Influence of culture on pain comorbidity in women with and without temporomandibular disorder-pain
- 2017
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 44:6, s. 415-425
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Tidskriftsartikel (refereegranskat)abstract
- Evidence on cultural differences in prevalence and impact of common chronic pain conditions, comparing individuals with temporomandibular disorders (TMD) versus individuals without TMD, is limited. The aim was to assess cross-cultural comorbid pain conditions in women with chronic TMD pain. Consecutive women patients (n = 122) with the index condition of chronic TMD pain diagnosed per the research diagnostic criteria for TMD and TMD-free controls (n = 121) matched for age were recruited in Saudi Arabia, Italy and Sweden. Self-report questionnaires assessed back, chest, stomach and head pain for prevalence, pain intensity and interference with daily activities. Logistic regression was used for binary variables, and ancova was used for parametric data analysis, adjusting for age and education. Back pain was the only comorbid condition with a different prevalence across cultures; Swedes reported a lower prevalence compared to Saudis (P < 001). Saudis reported higher prevalence of work reduced >50% due to back pain compared to Italians or Swedes (P < 001). Headache was the most common comorbid condition in all three cultures. The total number of comorbid conditions did not differ cross-culturally but were reported more by TMD-pain cases than TMD-free controls (P < 001). For both back and head pain, higher average pain intensities (P < 001) and interference with daily activities (P < 001) were reported by TMD-pain cases, compared to TMD-free controls. Among TMD-pain cases, Italians reported the highest pain-related disability (P < 001). Culture influences the associated comorbidity of common pain conditions. The cultural influence on pain expression is reflected in different patterns of physical representation.
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| 7. |
- Al-Harthy, Mohammad, et al.
(författare)
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The effect of culture on pain sensitivity
- 2016
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 43:2, s. 81-88
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Tidskriftsartikel (refereegranskat)abstract
- Cross-cultural differences in pain sensitivity have been identified in pain-free subjects as well as in chronic pain patients. The aim was to assess the impact of culture on psychophysical measures using mechanical and electrical stimuli in patients with temporomandibular disorder (TMD) pain and pain-free matched controls in three cultures. This case-control study compared 122 female cases of chronic TMD pain (39 Saudis, 41 Swedes and 42 Italians) with equal numbers of age- and gender-matched TMD-free controls. Pressure pain threshold (PPT) and tolerance (PPTo) were measured over one hand and two masticatory muscles. Electrical perception threshold and electrical pain threshold (EPT) and tolerance (EPTo) were recorded between the thumb and index fingers. Italian females reported significantly lower PPT in the masseter muscle than other cultures (P < 0001) and in the temporalis muscle than Saudis (P = 0003). Swedes reported significantly higher PPT in the thenar muscle than other cultures (P = 0017). Italians reported significantly lower PPTo in all muscles than Swedes (P 0006) and in the masseter muscle than Saudis (P < 0001). Italians reported significantly lower EPTo than other cultures (P = 001). Temporomandibular disorder cases, compared to TMD-free controls, reported lower PPT and PPTo in all the three muscles (P < 0001). This study found cultural differences between groups in the PPT, PPTo and EPTo. Overall, Italian females reported the highest sensitivity to both mechanical and electrical stimulation, while Swedes reported the lowest sensitivity. Mechanical pain thresholds differed more across cultures than did electrical pain thresholds. Cultural factors may influence response to type of pain test.
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| 8. |
- Alkhateeb, Noor, et al.
(författare)
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Patient-perceived features and clinical characteristics of tooth pain : A comparison between apical periodontitis and persistent dento-alveolar pain disorder (PDAP) – preliminary results
- 2017
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Differential diagnosis between tooth pain of inflammatory and neuropathic origin is crucial since treatment strategies differ. Aim: Evaluate and compare self-reported and clinically observed pain characteristics in patients with SAP (symptomatic apical periodontitis) and PDAP (persistent dento-alveolar pain disorder). Methodology: Patients diagnosed with SAP and PDAP were recruited from Malmö University and Folktandvården Östergötland. Data collection included clinical examination and questionnaire (tooth pain characteristics, verbal pain description [short-form McGill Pain Questionnaire; SF-MPQ], factors affecting the pain). Results: Data from 24 patients with SAP and 20 with PDAP (24 females, mean age 53 years) were analyzed. Average pain intensity was 4.4 (0–10 numeric rating scale) and average duration 1527 days. 64% reported continuous and 27% recurrent pain. 58% of teeth were tender to percussion and 66% to apical palpation. 27% reported concurrent pain from jaw muscles/joints. Significant differences were found for gender (% females; PDAP>SAP;p=0.013), pain duration (PDAP>SAP;p<0.0001), pain frequency (PDAP>SAP;p<0.001), percussion tenderness (SAP>PDAP;p=0.012), muscle/joint pain (PDAP>SAP;p=0.021). SF-MPQ and affecting factors did not differ (p=0.096–1.000). Conclusion: Preliminary results indicate that pain intensity, pain description and factors affecting the pain are similar for SAP and PDAP. Female gender, long pain duration, high pain frequency, and concurrent muscle/joint pain presented more frequently in PDAP.
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| 9. |
- Alsafi, Z, et al.
(författare)
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Achieved competences in temporomandibular disorders/orofacial pain : a comparison between two dental schools in Europe
- 2015
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Ingår i: European journal of dental education. - : John Wiley & Sons. - 1396-5883 .- 1600-0579. ; 19:3, s. 161-168
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The aim was to study achieved competences in temporomandibular disorders (TMD)/orofacial pain (OP) at two universities by comparing student's knowledge and understanding, satisfaction with their education and confidence in their clinical competences of TMD/OP. METHODS: The study was conducted in collaboration between Malmö University, Sweden-which uses problem-based learning-and the University of Naples Federico II, Italy-which uses traditional educational methods. Final-semester dental students responded to a self-report questionnaire regarding their knowledge and understanding, interpretation of cases histories, clinical experience, satisfaction and confidence in clinical examination, management and treatment evaluation. RESULTS: No significant difference was found between the students regarding knowledge and understanding. Eighty-seven per cent of the Malmö students and 96% of the Naples students met the criterion on achieved competence. Malmö students had a higher per cent of correct diagnoses than Naples students in the interpretation of case histories. Overall, Malmö students reported most clinical experience and higher confidence than Naple students. CONCLUSIONS: The main findings were that students from Malmö and Naples were, similar in knowledge and understanding of TMD/OP and in satisfaction with their clinical competences. However, Malmö students perceived more confidence in clinical management of patients with TMD/OP. This may reflect that, besides the theoretical part of the programme, a sufficient level of clinical exposure to patients with TMD/OP is essential to gain competences in TMD/OP
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| 10. |
- Baad-Hansen, Lene, et al.
(författare)
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Differential changes in gingival somatosensory sensitivity after painful electrical tooth stimulation
- 2015
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Ingår i: Experimental Brain Research. - : Springer. - 0014-4819 .- 1432-1106. ; 233:4, s. 1109-1118
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to evaluate the effect of painful tooth stimulation on gingival somatosensory sensitivity of healthy volunteers in a randomized, controlled design. Thirteen healthy volunteers (six women, seven men; 28.4 ± 5.0 years) were included for two experimental sessions of electrical tooth stimulation: painful tooth stimulation and tooth stimulation below the sensory threshold (control). Eight of the human subjects participated in a third session without tooth stimulation. In all sessions, the somatosensory sensitivity of the gingiva adjacent to the stimulated tooth was evaluated with a standardized battery of quantitative sensory tests (QST) before, immediately after and 30 min after tooth stimulation. Painful tooth stimulation evoked significant decreases in warmth and heat pain thresholds (P < 0.001) as well as pressure pain thresholds (increased sensitivity) (P = 0.024) and increases in mechanical detection thresholds (decreased sensitivity) (P < 0.050). Similar thermal threshold changes (P < 0.019) but no mechanical changes were found after tooth stimulation below the sensory threshold (P > 0.086). No QST changes were detected in the session without tooth stimulation (P > 0.060). In conclusion, modest increased gingival sensitivity to warmth, painful heat and pressure stimuli as well as desensitization to non-painful mechanical stimulation were demonstrated after tooth stimulation. This suggests involvement of competing heterotopic facilitatory and inhibitory mechanisms. Furthermore, stimulation below the sensory threshold induced similar thermal sensitization suggesting the possibility of activation of axon-reflex-like mechanisms even at intensities below the perception threshold. These findings may have implications for interpretation of somatosensory results in patients with chronic intraoral pain.
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| 11. |
- Baad-Hansen, Lene, et al.
(författare)
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Reliability of intra-oral quantitative sensory testing (QST) in patients with atypical odontalgia and healthy controls : a multicentre study
- 2015
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 42:2, s. 127-135
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Tidskriftsartikel (refereegranskat)abstract
- The reliability of comprehensive intra-oral quantitative sensory testing (QST) protocol has not been examined systematically in patients with chronic oro-facial pain. The aim of the present multicentre study was to examine test-retest and interexaminer reliability of intra-oral QST measures in terms of absolute values and z-scores as well as within-session coefficients of variation (CV) values in patients with atypical odontalgia (AO) and healthy pain-free controls. Forty-five patients with AO and 68 healthy controls were subjected to bilateral intra-oral gingival QST and unilateral extratrigeminal QST (thenar) on three occasions (twice on 1 day by two different examiners and once approximately 1 week later by one of the examiners). Intra-class correlation coefficients and kappa values for interexaminer and test-retest reliability were computed. Most of the standardised intra-oral QST measures showed fair to excellent interexaminer (9-12 of 13 measures) and test-retest (7-11 of 13 measures) reliability. Furthermore, no robust differences in reliability measures or within-session variability (CV) were detected between patients with AO and the healthy reference group. These reliability results in chronic orofacial pain patients support earlier suggestions based on data from healthy subjects that intra-oral QST is sufficiently reliable for use as a part of a comprehensive evaluation of patients with somatosensory disturbances or neuropathic pain in the trigeminal region.
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| 12. |
- Berlin, Henrik, et al.
(författare)
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Dentists' attitudes towards acute pharmacological pain management in children and adolescents
- 2018
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Ingår i: International Journal of Paediatric Dentistry. - : John Wiley & Sons. - 0960-7439 .- 1365-263X. ; 28:2, s. 152-160
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Tidskriftsartikel (refereegranskat)abstract
- AIM: This study aimed to investigate Swedish dentists' attitudes regarding pain management strategies for treating children and adolescents. It assessed recommendations for pre- and postoperative analgesics, and use of local anaesthesia, and whether application of these strategies differs between general dental practitioners (GDPs) and specialists in paediatric dentistry (SPDs). DESIGN: We invited all GDPs (n = 807) in southern Sweden (Region Skåne), and all registered SPDs (n = 122) working in Sweden (929 actively practising dentists under age 65 years) to participate in a postal survey on pain management in paediatric dental care. RESULTS: The SPDs reported using all types of pain-reducing strategies more frequently than GDPs except local anaesthesia when extracting a permanent premolar, which SPDs and GDPs used equally often. Preoperative analgesic use was greater among SPDs than GDPs. GDPs used local anaesthesia less frequently for filling therapy in primary teeth than in permanent teeth. CONCLUSIONS: SPDs recommend preoperative analgesics more often than GDPs do. GDPs seem to underuse local anaesthetics when treating children and adolescents. SPDs also use pain management strategies more frequently than GDPs. Among GDPs, pain management is less frequent when treating primary teeth than permanent teeth.
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| 13. |
- Dawson, Andreas, et al.
(författare)
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Dopamine in plasma : a biomarker for myofascial TMD pain?
- 2016
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Ingår i: Journal of Headache and Pain. - : Springer. - 1129-2369 .- 1129-2377. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Dopaminergic pathways could be involved in the pathophysiology of myofascial temporomandibular disorders (M-TMD). This study investigated plasma levels of dopamine and serotonin (5-HT) in patients with M-TMD and in healthy subjects. METHODS: Fifteen patients with M-TMD and 15 age- and sex-matched healthy subjects participated. The patients had received an M-TMD diagnosis according to the Research Diagnostic Criteria for TMD. Perceived mental stress, pain intensity (0-100-mm visual analogue scale), and pressure pain thresholds (PPT, kPa) over the masseter muscles were assessed; a venous blood sample was taken. RESULTS: Dopamine in plasma differed significantly between patients with M-TMD (4.98 ± 2.55 nM) and healthy controls (2.73 ± 1.24 nM; P < 0.01). No significant difference in plasma 5-HT was observed between the groups (P = 0.75). Patients reported significantly higher pain intensities (P < 0.001) and had lower PPTs (P < 0.01) compared with the healthy controls. Importantly, dopamine in plasma correlated significantly with present pain intensity (r = 0.53, n = 14, P < 0.05) and perceived mental stress (r = 0.34, n = 28, P < 0.05). CONCLUSIONS: The results suggest that peripheral dopamine might be involved in modulating peripheral pain. This finding, in addition to reports in other studies, suggests that dopaminergic pathways could be implicated in the pathophysiology of M-TMD but also in other chronic pain conditions. More research is warranted to elucidate the role of peripheral dopamine in the pathophysiology of chronic pain.
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| 14. |
- Dawson, Andreas, et al.
(författare)
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Effects of Experimental Tooth Clenching on Pain and Intramuscular Release of 5-HT and Glutamate in Patients With Myofascial TMD
- 2015
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Ingår i: The Clinical Journal of Pain. - : Lippincott, Williams andamp; Wilkins. - 0749-8047 .- 1536-5409. ; 31:8, s. 740-749
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: It has been suggested that tooth clenching may be associated with local metabolic changes, and is a risk factor for myofascial temporomandibular disorders (M-TMD). This study investigated the effects of experimental tooth clenching on the levels of 5-HT, glutamate, pyruvate, and lactate, as well as on blood flow and pain intensity, in the masseter muscles of M-TMD patients. Methods: Fifteen patients with M-TMD and 15 pain-free controls participated. Intramuscular microdialysis was performed to collect 5-HT, glutamate, pyruvate, and lactate and to assess blood flow. Two hours after the insertion of a microdialysis catheter, participants performed a 20-minute repetitive tooth clenching task (50% of maximal voluntary contraction). Pain intensity was measured throughout. Results: A significant effect of group (P less than 0.01), but not of time, was observed on 5-HT levels and blood flow. No significant effects of time or group occurred on glutamate, pyruvate, or lactate levels. Time and group had significant main effects on pain intensity (P less than 0.05 and less than 0.001). No significant correlations were identified between: (1) 5-HT, glutamate, and pain intensity; or between (2) pyruvate, lactate, and blood flow. Discussion: This experimental tooth clenching model increased jaw muscle pain levels in M-TMD patients and evoked low levels of jaw muscle pain in controls. M-TMD patients had significantly higher levels of 5-HT than controls and significantly lower blood flow. These 2 factors may facilitate the release of other algesic substances that may cause pain.
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| 15. |
- Durham, Justin, et al.
(författare)
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Self-management programmes in temporomandibular disorders : results from an international Delphi process
- 2016
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 43:12, s. 929-936
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Forskningsöversikt (refereegranskat)abstract
- Self-management (SM) programmes are commonly used for initial treatment of patients with temporomandibular disorders (TMD). The programmes described in the literature, however, vary widely with no consistency in terminology used, components of care or their definitions. The aims of this study were therefore to construct an operationalised definition of self-management appropriate for the treatment of patients with TMD, identify the components of that self-management currently being used and create sufficiently clear and non-overlapping standardised definitions for each of those components. A four-round Delphi process with eleven international experts in the field of TMD was conducted to achieve these aims. In the first round, the participants agreed upon six principal concepts of self-management. In the remaining three rounds, consensus was achieved upon the definition and the six components of self-management. The main components identified and agreed upon by the participants to constitute the core of a SM programme for TMD were as follows: education; jaw exercises; massage; thermal therapy; dietary advice and nutrition; and parafunctional behaviour identification, monitoring and avoidance. This Delphi process has established the principal concepts of self-management, and a standardised definition has been agreed with the following components for use in clinical practice: education; self-exercise; self-massage; thermal therapy; dietary advice and nutrition; and parafunctional behaviour identification, monitoring and avoidance. The consensus-derived concepts, definitions and components of SM offer a starting point for further research to advance the evidence base for, and clinical utility of, TMD SM.
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| 16. |
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| 17. |
- Ekberg, Ewacarin, et al.
(författare)
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Can MRI Observations Predict Treatment Outcome of Lavage in Patients with Painful TMJ Disc Displacement without Reduction?
- 2015
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Ingår i: Journal of Oral & Maxillofacial Research. - : Kaunas University of Medicine. - 2029-283X. ; 30:1
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The purpose of this study was to examine magnetic resonance imaging findings in patients with painful disc displacement without reduction of the temporomandibular joint to determine whether the findings were able to predict treatment outcome of lavage and a control group treated with local anaesthesia without lavage in a short-term: 3-month perspective. MATERIAL AND METHODS: Bilateral magnetic resonance images were taken of 37 patients with the clinical diagnosis of painful disc displacement without reduction. Twenty-three patients received unilateral extra-articular local anaesthetics and 14 unilateral lavage and extra-articular local anaesthetics. The primary treatment outcome defining success was reduction in pain intensity of at least 30% during jaw movement at the 3-month follow-up. RESULTS: Bilateral disc displacement was found in 30 patients. In 31 patients the disc on the treated side was deformed, and bilaterally in 19 patients. Osteoarthritis was observed in 28 patients, and 13 patients had bilateral changes. Thirty patients responded to treatment and 7 did not, with no difference between the two treated groups. In neither the treated nor the contralateral temporomandibular joint did treatment outcome depend on disc diagnosis, disc shape, joint effusion, or osseous diagnoses. Magnetic resonance imaging findings of disc position, disc shape, joint effusion or osseous diagnosis on the treated or contralateral side did not give information of treatment outcome. CONCLUSIONS: Magnetic resonance imaging findings could not predict treatment outcome in patients treated with either local anaesthetics or local anaesthetics and lavage.
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| 18. |
- Forssell, Henrik, et al.
(författare)
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An update on pathophysiological mechanisms related to idiopathic oro-facial pain conditions with implications for management
- 2015
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Ingår i: Journal of Oral Rehabilitation. - : Wiley. - 0305-182X .- 1365-2842. ; 42:4, s. 300-322
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Forskningsöversikt (refereegranskat)abstract
- Chronic oro-facial pain conditions such as persistent idiopathic facial pain (PIFP), atypical odontalgia (AO) and burning mouth syndrome (BMS), usually grouped together under the concept of idiopathic oro-facial pain, remain a diagnostic and therapeutic challenge. Lack of understanding of the underlying pathophysiological mechanisms of these pain conditions is one of the important reasons behind the problems in diagnostic and management. During the last two decades, neurophysiological, psychophysical, brain imaging and neuropathological methods have been systematically applied to study the trigeminal system in idiopathic oro-facial pain. The findings in these studies have provided evidence for neuropathic involvement in the pathophysiology of PIFP, AO and BMS. The present qualitative review is a joint effort of a group of oro-facial pain specialists and researchers to appraise the literature on idiopathic oro-facial pain with special focus on the currently available studies on their pathophysiological mechanisms. The implications of the findings of these studies for the clinical diagnosis and treatment of idiopathic oro-facial pain conditions are discussed.
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| 19. |
- Hongxing, L, et al.
(författare)
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Prevalence of temporomandibular disorder pain in Chinese adolescents compared to an age-matched Swedish population.
- 2016
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons Ltd.. - 1365-2842 .- 0305-182X. ; 43:4, s. 241-248
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to (i) assess the prevalence and perceived need for treatment of TMD pain, and its association with socio-economic factors and gender, in adolescents in Xi᾽an, Shaanxi Province, China, and (ii) compare the prevalence and association with gender of TMD pain in Xi᾽an to an age-matched Swedish population. We surveyed Chinese adolescents aged 15 to 19 years in Xi'an, China (n = 5524), using a questionnaire with two-stage stratified sampling and the school as the sampling unit. The study included second-year students at selected high schools. It also included an age-matched Swedish population (n = 17,015) surveyed using the same diagnostic criteria for TMD pain as that used in the Chinese sample. The survey found TMD pain in 14·8% (n = 817) of the Chinese sample and 5·1% (n = 871) of the Swedish sample (P < 0·0001). Girls had significantly more TMD pain than boys in both the Chinese (P < 0·05) and Swedish (P < 0·001) samples. TMD pain increased with age in the Chinese population. Of the Chinese adolescents with TMD pain, 47% reported that they felt a need for treatment. Rural schools, low paternal education levels, poverty, living outside the home, poor general and oral health, and dissatisfaction with teeth all showed significant positive correlations with TMD pain. Prevalence of TMD pain in Chinese adolescents was significantly higher than in the Swedish sample.
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| 20. |
- Ikoma, Tomoko, et al.
(författare)
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Effects of Low-Intensity Contractions of Different Craniofacial Muscles in Healthy Participants : An Experimental Cross-Over Study
- 2018
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Ingår i: Headache. - : John Wiley & Sons. - 0017-8748 .- 1526-4610. ; 58:4, s. 559-569
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Tidskriftsartikel (refereegranskat)abstract
- Objective.-Repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible, ie, bruxism, is traditionally linked to pain and unpleasantness in the active muscles. The aim of this study was to investigate the effects of standardized craniofacial muscle contractions on self-reported symptoms. Methods.-Sixteen healthy volunteers performed six 5-minute bouts of 20% maximal voluntary contraction task of the jaw-closing (Jaw), the orbicularis-oris (O-oris), and the orbicularis-oculi (O-oculi) muscles. Participants rated their perceived pain, unpleasantness, fatigue, and mental stress levels before, during, and after the contraction tasks on 0-10 Numeric Rating Scales (NRS). Each muscle contraction task (= 1 session) was separated by at least 1 week and the order of the sessions was randomized in each subject. Results.-All muscle contraction tasks evoked significant increases in NRS scores of pain (mean +/- SD: Jaw; 3.8 +/- 2.7, O-oris; 1.9 +/- 2.2, O-oculi; 1.4 +/- 1.3, P < .014), unpleasantness (Jaw; 4.1 +/- 2.5, O-oris; 2.1 +/- 1.9, O-oculi; 2.9 +/- 1.8, P<.001), fatigue (Jaw; 5.8 +/- 2.0, O-oris; 3.2 +/- 2.3, O-oculi; 3.6 +/- 1.9, P<.001), and mental stress (Jaw; 4.1 +/- 2.1, O-oris; 2.2 +/- 2.7, O-oculi; 2.9 +/- 2.2, P<.001). The Jaw contractions were associated with higher NRS scores compared with the O-oris and the O-oculi contractions (P<.005) without differences between the O-oris and the O-oculi (P>.063). All symptoms disappeared within 1 day (P>.469). Conclusions.-The results showed that submaximal static contractions of different craniofacial muscle groups could evoke transient, mild to moderate levels of muscle pain and fatigue and increased stress scores. The fatigue resistance may differ between different muscle groups. Further studies are warranted to better understand the contribution of specific craniofacial muscle groups for the characteristic presentation of musculoskeletal pain conditions in the head.
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| 21. |
- Isacsson, Göran, et al.
(författare)
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Use of bibloc and monobloc oral appliances in obstructive sleep apnoea : a multicentre, randomized, blinded, parallel-group equivalence trial
- 2019
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 41:1, s. 80-88
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Tidskriftsartikel (refereegranskat)abstract
- Background: The clinical benefit of bibloc over monobloc appliances in treating obstructive sleep apnoea (OSA) has not been evaluated in randomized trials. We hypothesized that the two types of appliances are equally effective in treating OSA.Objective: To compare the efficacy of monobloc versus bibloc appliances in a short-term perspective.Patients and methods: In this multicentre, randomized, blinded, controlled, parallel-group equivalence trial, patients with OSA were randomly assigned to use either a bibloc or a monobloc appliance. One-night respiratory polygraphy without respiratory support was performed at baseline, and participants were re-examined with the appliance in place at short-term follow-up. The primary outcome was the change in the apnoea-hypopnea index (AHI). An independent person prepared a randomization list and sealed envelopes. Evaluating dentist and the biomedical analysts who evaluated the polygraphy were blinded to the choice of therapy.Results: Of 302 patients, 146 were randomly assigned to use the bibloc and 156 the monobloc device; 123 and 139 patients, respectively, were analysed as per protocol. The mean changes in AHI were -13.8 (95% confidence interval -16.1 to -11.5) in the bibloc group and -12.5 (-14.8 to -10.3) in the monobloc group. The difference of -1.3 (-4.5 to 1.9) was significant within the equivalence interval (P = 0.011; the greater of the two P values) and was confirmed by the intention-to-treat analysis (P = 0.001). The adverse events were of mild character and were experienced by similar percentages of patients in both groups (39 and 40 per cent for the bibloc and monobloc group, respectively).Limitations: The study shows short-term results with a median time from commencing treatment to the evaluation visit of 56 days and long-term data on efficacy and harm are needed to be fully conclusive.Conclusion: In a short-term perspective, both appliances were equivalent in terms of their positive effects for treating OSA and caused adverse events of similar magnitude.Trial registration: Registered with ClinicalTrials.gov (#NCT02148510).
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| 22. |
- Jounger, Sofia Louca, et al.
(författare)
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Influence of Polymorphisms in the HTR3A and HTR3B Genes on Experimental Pain and the Effect of the 5-HT3 Antagonist Granisetron
- 2016
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 11:12
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate experimentally if 5-HT3 single nucleotide polymorphisms (SNP) contribute to pain perception and efficacy of the 5-HT3-antagonist granisetron and sex differences. Sixty healthy participants were genotyped regarding HTR3A (rs1062613) and HTR3B (rs1176744). First, pain was induced by bilateral hypertonic saline injections (HS, 5.5%, 0.2 mL) into the masseter muscles. Thirty min later the masseter muscle on one side was pretreated with 0.5 mL granisetron (1 mg/mL) and on the other side with 0.5 mL placebo (isotonic saline) followed by another HS injection (0.2 mL). Pain intensity, pain duration, pain area and pressure pain thresholds (PPTs) were assessed after each injection. HS evoked moderate pain, with higher intensity in the women (P = 0.023), but had no effect on PPTs. None of the SNPs influenced any pain variable in general, but compared to men, the pain area was larger in women carrying the C/C (HTR3A) (P = 0.015) and pain intensity higher in women with the A/C alleles (HTR3B) (P = 0.019). Pre-treatment with granisetron reduced pain intensity, duration and area to a lesser degree in women (P < 0.05), but the SNPs did not in general influence the efficacy of granisetron. Women carrying the C/T & T/T (HTR3A) genotype had less reduction of pain intensity (P = 0.041) and area (P = 0.005), and women with the C/C genotype (HTR3B) had less reduction of pain intensity (P = 0.030), duration (P = 0.030) and area compared to men (P = 0.017). In conclusion, SNPs did not influence experimental muscle pain or the effect of granisetron on pain variables in general, but there were some sex differences in pain variables that seem to be influenced by genotypes. However, due to the small sample size further research is needed before any firm conclusions can be drawn.
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| 23. |
- Lampa, Ewa, et al.
(författare)
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Relationship Between Psychosocial Factors and Pain in the Jaw and Neck Regions Shortly After Whiplash Trauma
- 2019
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Ingår i: Journal of Oral & Facial Pain and Headache. - : Quintessence Publishing Co., Inc.. - 2333-0384 .- 2333-0376. ; 33:2, s. 213-219
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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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| 24. |
- List, Thomas, et al.
(författare)
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Diagnostics of Orofacial Pain and Temporomandibular Disorders
- 2017
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Ingår i: Clinical cases in orofacial pain. - : John Wiley & Sons. - 9781119194798 ; , s. 1-13
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Expand your knowledge and put it into practice with this unique, case-based guide Clinical Cases in Orofacial Pain is a valuable resource for undergraduate dental students as well as residents working towards board certification. Individual cases cover temporomandibular joint disorders, masticatory muscle disorders, headache, neuropathic pain, dental pain, tooth wear, and dystonia. Following the popular Clinical Cases series style, cases are presented with associated academic commentary, including background information, diagnostic criteria and fundamental points that might influence the diagnosis, treatment planning or management of the case. Well-illustrated throughout, each chapter features self-assessment study questions to help foster independent learning. Clinical Cases in Orofacial Pain is an excellent primer for undergraduate dental students and an invaluable study guide for postgraduate students and residents. Dental practitioners will also want to keep this unique, case-based guide as a ready reference in their working libraries.
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| 25. |
- List, Thomas, et al.
(författare)
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Temporomandibular disorders : Old ideas and new concepts
- 2017
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Ingår i: Cephalalgia. - : Sage Publications. - 0333-1024 .- 1468-2982. ; 37:7, s. 692-704
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Forskningsöversikt (refereegranskat)abstract
- Background: Temporomandibular disorders (TMD) is an umbrella term for pain and dysfunction involving the masticatory muscles and the temporomandibular joints (TMJs). TMD is the most common orofacial pain condition. Its prominent features include regional pain in the face and preauricular area, limitations in jaw movement, and noise from the TMJs during jaw movements. TMD affects up to 15% of adults and 7% of adolescents. Chronic pain is the overwhelming reason that patients with TMD seek treatment. TMD can associate with impaired general health, depression, and other psychological disabilities, and may affect the quality of life of the patient. Assessment: Evaluations indicate that the recently published Diagnostic Criteria for TMD (DC/TMD) are reliable and valid. These criteria cover the most common types of TMD, which include pain-related disorders (e.g., myalgia, headache attributable to TMD, and arthralgia) as well as disorders associated with the TMJ (primarily disc displacements and degenerative disease). As peripheral mechanisms most likely play a role in the onset of TMD, a detailed muscle examination is recommended. The persistence of pain involves more central factors, such as sensitization of the supraspinal neurons and second-order neurons at the level of the spinal dorsal horn/trigeminal nucleus, imbalanced antinociceptive activity, and strong genetic predisposition, which also is included in DC/TMD. Conclusion: The etiology is complex and still not clearly understood, but several biological and psychosocial risk factors for TMD have been identified. Several studies indicate that patients with TMD improve with a combination of noninvasive therapies, including behavior therapy, pharmacotherapy, physical therapy, and occlusal appliances. More stringently designed studies, however, are needed to assess treatment efficacy and how to tailor treatment to the individual patient.
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| 26. |
- Louca Jounger, Sofia, et al.
(författare)
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Increased levels of intramuscular cytokines in patients with jaw muscle pain
- 2017
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Ingår i: Journal of Headache and Pain. - : Springer. - 1129-2369 .- 1129-2377. ; 18:30
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to investigate cytokine levels in the masseter muscle, their response to experimental tooth-clenching and their relation to pain, fatigue and psychological distress in patients with temporomandibular disorders (TMD) myalgia. Methods: Forty women, 20 with TMD myalgia (Diagnostic Criteria for TMD) and 20 age-matched healthy controls participated. Intramuscular microdialysis was performed to sample masseter muscle cytokines. After 140 min (baseline), a 20-minute tooth-clenching task was performed (50% of maximal voluntary contraction force). Pain (Numeric rating scale 0-10) and fatigue (Borg's Ratings of Perceived Exertion 6-20) were assessed throughout microdialysis, while pressure-pain thresholds (PPT) were assessed before and after microdialysis. Perceived stress (PSS-10) and Trait Anxiety (STAI) were assessed before microdialysis. Results: The levels of IL-6, IL-7, IL-8 and IL-13 were higher in patients than controls (Mann Whitney U-test; P's < 0. 05) during the entire microdialysis. IL-6, IL-8 and IL-13 changed during microdialysis in both groups (Friedman; P's < 0.05), while IL-1 beta, IL-7 and GM-CSF changed only in patients (P's < 0.01). IL-6 and IL-8 increased in response to tooth-clenching in both groups (Wilcoxon test; P's < 0.05), while IL-7, IL-13 and TNF increased only in patients (P's < 0.05). Patients had higher pain and fatigue than controls before and after tooth-clenching (P < 0.001), and lower PPTs before and after microdialysis (P < 0.05). There were no correlations between cytokine levels, pain or fatigue. Also, there were no differences in stress or anxiety levels between groups. Conclusions: In conclusion, the masseter levels of IL-6, IL-7, IL-8 and IL-13 were elevated in patients with TMD myalgia and increased in response to tooth-clenching. Tooth-clenching increased jaw muscle pain and fatigue, but without correlations to cytokine levels. This implies that subclinical muscle inflammation may be involved in TMD myalgia pathophysiology, but that there is no direct cause-relation between inflammation and pain.
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| 27. |
- Lu, Shengyi, et al.
(författare)
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Effect of Experimental Periodontal Ligament Pain on Gingival Somatosensory Sensitivity
- 2017
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Ingår i: JOURNAL OF ORAL & FACIAL PAIN AND HEADACHE. - : Quintessence. - 2333-0384. ; 31:1, s. 72-79
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To use a randomized, blinded, crossover design to evaluate the possible heterotopic effects of experimental periodontal ligament pain on adjacent gingival somatosensory sensitivity. Methods: A total of 12 healthy volunteers (8 female, 4 male; mean age standard error in means (SEM): 28 1 years) participated in two randomized experimental quantitative sensory testing (QST) sessions, one in which capsaicin (experimental) was injected into the periodontal ligament and one in which isotonic saline (control) was injected. A total of 13 standardized QST measures were obtained on the buccal attached gingiva of a maxillary central incisor before, immediately after, and 30 minutes after injection of 30 mu L of 5% capsaicin or isotonic saline into the periodontal ligament of the same incisor. The injection-evoked pain was evaluated on a 0-10 numeric rating scale (NRS). QST data were analyzed with two-way repeated measurement analysis of variance. Results: Capsaicin injected into the periodontal ligament evoked moderate levels of pain (mean peak NRS SEM: capsaicin: 5.5.7; control: 0.6 0.5 [P < .001]). Capsaicin injected into the periodontal ligament significantly modulated gingival somatosensory sensitivity: increased sensitivity to warmth and painful heat stimuli occurred immediately and 30 minutes after the injection (P < .025), whereas decreased sensitivity to both tactile and painful mechanical stimuli (P < .011) occurred immediately after the injection and to painful mechanical stimuli only after 30 minutes (P = .016). No somatosensory changes were detected following the injection of isotonic saline (P > .050). Conclusion: Capsaicin injected into the periodontal ligament caused gain of heterotopic somatosensory sensitivity toward warmth and painful heat stimuli as well as reduction in mechanical sensitivity of the gingiva adjacent to the injected tooth. These findings may have implications for interpretation of somatosensory functions in patients with chronic intraoral pain, where gingival somatosensory profiles similar to those detected after capsaicin injection in the present study may be interpreted as signs of nerve damage.
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| 28. |
- Michelotti, A, et al.
(författare)
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Next steps in development of the diagnostic criteria for temporomandibular disorders (DC/TMD) : Recommendations from the International RDC/TMD Consortium Network workshop
- 2016
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 43:6, s. 453-467
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Tidskriftsartikel (refereegranskat)abstract
- The development of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) (1) involved expanding the taxonomy for all TMDs (2) in order to propose for future validation DC for empirically supported TMDs that were not part of the DC/ TMD structure. This expanded taxonomy offers an integrated approach to clinical diagnosis and provides a framework for operationalising and testing the proposed taxonomy and diagnostic criteria in future research. During expansion of the taxonomy, researchers identified several challenges in the diagnosis of some disorders, so the International RDC/TMD Consortium Network planned a workshop to discuss criterion improvements for five of the disorders and the biobehavioural domain.
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| 29. |
- Mikkilä, Hanna, et al.
(författare)
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A comparison of two different methods to measure pressure pain thresholds : An experimental study
- 2017
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Assessment of somatosensory function is recommended in orofacial pain investigations. Quantitative Sensory Testing (QST) is a comprehensive method in which pressure pain threshold (PPT) measurement is included. PPT is usually obtained with a conventional Algometer Type II. A new computer-controlled and potentially more user-friendly algometer, the SENSEBox, could replace the conventional device provided that threshold values and other properties are similar between devices. Aim: Compare two algometers regarding absolute PPT, variability, time, and test-retest-reliability. Materials and methods: PPT was measured with both devices on thenar, masseter muscle and gingiva (upper premolar region) in twenty healthy adults. For each anatomic site and device, the mean value of three registrations was calculated. Paired t-test and Wilcoxon sign-rank test compared mean PPT, variability and time duration. Intraclass Correlation Coefficient (ICC) analyzed test-retest reliability. Results: The SENSEBox showed overall lower PPTs (p<0.05). No significant differences in variability and time duration were found (p>0.05). Both devices showed very good to excellent test-retest-reliability (ICC 0.75–0.88) for thenar and masseter. On gingiva, Algometer Type II showed poor (ICC 0.38) and SENSEBox good reliability (ICC 0.43). Conclusion: The Algometer Type II and SENSEBox are not readily interchangeable in PPT assessment and QST in orofacial pain investigations.
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| 30. |
- Oghli, Ibrahim, et al.
(författare)
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Prevalence and normative values for Jaw Functional Limitations in the general population in Sweden
- 2019
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Ingår i: Oral Diseases. - : John Wiley & Sons. - 1354-523X .- 1601-0825. ; 25:2, s. 580-587
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: For jaw functional limitations measured by the Jaw Functional Limitation Scale (JFLS), (a) determining prevalence in the Swedish general adult population, (b) investigating the influence of demographic factors and self-reported dental status and (c) deriving normative values. METHODS: A random sample of the general adult population in Sweden was approached (response rate: 46%, N = 1,372). Prevalence was determined for the JFLS summary score and individual items. The influence of age, gender and dental status was investigated with regression analyses and normative values presented. RESULTS: The JFLS median score was 0, and all items had prevalences ≤30%. Age and gender did not influence jaw functional limitations but dental status did. Normative JFLS scores were 1, 9 and 28 for the 7th, 8th and 9th deciles, respectively. In dental status-stratified norms, 9th deciles were 20, 43 and 100, for subjects with natural teeth only, removable and complete dentures, respectively. CONCLUSIONS: The Swedish general adult population had excellent jaw function, but dental status was major determinant. In the absence of information linking JFLS scores to important patient concerns, the score distribution can serve as a reference with the 9th decile as threshold for functional limitation.
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| 31. |
- Oghli, Ibrahim, et al.
(författare)
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Prevalence and oral health-related quality of life of self-reported orofacial conditions in Sweden
- 2017
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Ingår i: Oral Diseases. - : John Wiley & Sons. - 1354-523X .- 1601-0825. ; 23:2, s. 233-240
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo (i) determine the prevalences of self-report in a Swedish adult population, of temporomandibular disorders, burning mouth syndrome, dry mouth, and bad breath and (ii) determine oral health-related quality-of-life impairment in subjects reporting these conditions. Subjects and methodsA cross-sectional, randomized sample of the adult Swedish population (response rate: 46%, N=1309 subjects) self-reported their condition from the preceding month to assess prevalences of self-report for the studied conditions together with comorbidity group of subjects who reported more than one condition. The 49-item Oral Health Impact Profile (OHIP) used to assess oral health-related quality of life. ResultsThe most prevalent condition was bad breath (39%), followed by dry mouth (22%), temporomandibular disorders (18%) and burning mouth syndrome (4%). High comorbidity of conditions occurred in 27% of the population. Quality-of-life impairment increased with the number of comorbid conditions. Among individual conditions, burning mouth syndrome and temporomandibular disorders (57% and 40% OHIP points) presented higher impairment than dry mouth and bad breath (32% and 26% OHIP points). ConclusionsOrofacial conditions were common and often coexist. The comorbidity group experienced the highest impact on oral health-related quality of life: the more the comorbid conditions, the greater the negative impact.
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| 32. |
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| 33. |
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| 34. |
- Reissman, Daniel, et al.
(författare)
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Impact of dentists' years since graduation on management of temporomandibular disorders
- 2015
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Ingår i: Clinical Oral Investigations. - : Springer. - 1432-6981 .- 1436-3771. ; 19:9, s. 2327-2336
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aims were to assess the impact of the number of years since dentists' graduation on appraisement of diagnostic needs and utilization of treatment options for temporomandibular disorders (TMD) and to investigate whether increased knowledge in TMD is sufficiently considered in today's dentist's undergraduate curricula and, therefore, represented in more evidence-based TMD management in dentists with less years since graduation. MATERIAL AND METHODS: A questionnaire regarding knowledge and management of TMD was developed and was subsequently applied in a random sample of 400 dentists in a region in Northern Germany. RESULTS: Of the 222 dentists (response rate 55.6 %), participating in the study, the frequency of TMD treatment need in the general population was estimated at 21.5 %, with lower values in dentists with more years passed since graduation. Measures regarding utilization of standardized examination forms, perceptions of insufficient specialization, and referrals of patients to TMD specialists indicated a lower quality and certainty in TMD management in participants with less time since graduation. While the provision of splints was a well-established treatment option in initial TMD management of all participants, additional TMD treatment options were mentioned less often, with lower proportions of participants making use of these options within the first decade since graduation. CONCLUSIONS: Evidence-based TMD management is not fully represented in dental practitioners in Germany. This might be due to an insufficient consideration of TMD management in the dentist's undergraduate curricula. CLINICAL RELEVANCE: Effective interventions to increase dentists' knowledge and to change dentists' practices in TMD management are required.
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| 35. |
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| 36. |
- Vilanova, Larissa, et al.
(författare)
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Diagnostic criteria for temporomandibular disorders : self-instruction or formal training and calibration?
- 2015
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Ingår i: Journal of Headache and Pain. - : Springer. - 1129-2369 .- 1129-2377. ; 16:26, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To investigate the difference in diagnostic reliability between self-instructed examiners and examiners taught in a Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) course and if the reliability of self-instructed examiners improves after the course. METHODS: Six examiners were divided into three groups: (1) formal two-day training and calibration course at a DC/TMD training center (Course group), (2) self-teaching through documents and movie (Self group) with three examiners on each and the Self group later participated in the course (Self + course group). Each group examined sixteen subjects, total of 48 volunteers (36 patients with TMD and 12 asymptomatic) and the reliabilities in relation to the diagnoses derived by a Reference Standard Examiner were compared by Cohen's Kappa coefficient. RESULTS: The reliability was good to excellent in all three groups of examiners for all DC/TMD diagnoses, except for Myofascial pain with referral in the Self + course group. The course seemed to improve the reliability regarding Myalgia and Arthralgia at the same time as the examiners experienced the course to be valuable for self-perceived ability and confidence. CONCLUSIONS: This study shows that the diagnostic reliability of formal DC/TMD training and calibration and DC/TMD self-instruction are similar, except for subgroups of Myalgia. Thus, self-instruction seems to be possible to use to diagnose the most common TMDs in general dental practice. The course further improves the reliability regarding Myalgia and Arthralgia at the same time as the examiners experienced the course to be valuable for self-perceived ability and confidence.
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