Somatic complaints, psychologic distress, and treatment outcome in two groups of TMD patients, one previously subjected to whiplash injury.

The aim of this study was to compare somatic complaints and psychologic distress in a group of whiplash patients with temporomandibular disorders (TMD) and a group of patients with TMD only, and to assess the outcome after conservative TMD treatment consisting of counseling, muscle exercises, and a stabilization splint. Each group consisted of 16 patients (12 women and 4 men) with a mean age of 42 years. The duration of the symptoms was from 1 to 3 years. In addition to a functional clinical examination and a recording of headache frequency and intensity, the patients answered three questionnaires: a Somatic Complaints Questionnaire (SCQ); the trait portion of Spielberger's State-Trait Anxiety Inventory; and the Symptom Checklist-90-Revised (SCL-90-R). The whiplash patients had higher scores than the TMD patients on the SCQ muscle score and on the following subscores of SCL-90-R: obsession, somatization, depression, and anger/hostility. The treatment outcome as assessed by the change of self-reported frequency of headache, number of tender muscles upon palpation, and change of values on a visual analogue scale for headache intensity showed that the whiplash patients obtained only a decrease in the proportion of tender muscles, while those in the TMD only group showed improvement on all treatment criteria.

The reporting of pain, somatic complaints, and anxiety in a group of patients with TMD before and 2 years after treatment: sex differences.

The aim of this study was to assess possible gender differences regarding the reporting of pain, somatic complaints, and anxiety in a group of patients suffering from temporomandibular disorders (TMD). The group consisted of 40 females and 13 males who received conservative TMD treatment comprising counseling, muscle exercises, and a stabilization splint. Before and 2 years after treatment, the patients answered three questionnaires (McGill Pain Questionnaire [Norwegian version] including a six-point scale, the Present Pain Intensity; a Somatic Complaints Questionnaire; and the trait part of Spielberger's State-Trait Anxiety Inventory. Before treatment, females reported greater present pain intensity than did males. Two years after treatment, females reported less sensory and emotional pain than at the initial stage; males presented no reduction in these pain scores. There were no gender differences at either stage regarding somatic complaints or anxiety level scores.

Relationships between risk factors and treatment outcome in a group of patients with temporomandibular disorders.

The aim of this study was to compare somatic complaints, anxiety, and pain related to temporomandibular disorders (TMD) in a group of TMD patients who had high scores for headache and muscle palpation compared with that of a group of TMD patients who had low or medium scores for headache and palpation before and 2 years after conservative TMD treatment, consisting of counseling, muscle exercises, and a stabilization splint. The high-score group consisted of 23 patients who had headaches several times a week or daily and had more than three muscles graded as severely tender to palpation. The low/medium-score group comprised 28 patients who had headaches hardly ever, once or twice a month, or several times a month, and with muscles graded as slightly or medium tender to palpation. The patients answered three questionnaires (McGill Pain Questionnaire [Norwegian version], a somatic complaints questionnaire, and the trait part of Spielberger Stait-Trait Anxiety Inventory) before and 2 years after treatment. The findings showed differences between the two groups concerning pain description, general muscle complaints, and anxiety both before and after the treatment, with the high-score group showing the highest values. In general, the treatment outcome had improved in the low/medium-score group but remained unchanged in the high-score group.

Negative affectivity, somatic complaints, and symptoms of temporomandibular disorders.

This study examined the relationship between trait anxiety, subjective somatic symptoms, and pain associated with temporomandibular disorders (TMD) in a combined cross-sectional and prospective study. Compared with the initial measurements, a significant reduction in anxiety and pain was observed in the follow-up phase (two years after evaluation and therapy). No change in general somatic complaints was found. In both the initial phase and the follow-up phase, a consistent relationship between anxiety, somatic complaints, and TMD-related pain was demonstrated. The results are in agreement with a conceptualization of negative affectivity (e.g., anxiety, distress, tension) as a general dimension of somatopsychic distress. The best predictors of later TMD pain were general somatic complaints, followed by initial pain, and trait anxiety. Significant moderate correlations between anxiety, somatic complaints, and response to muscle palpation (feelings of tenderness) were also found. It is concluded that studies of TMD should incorporate measures of negative affectivity and general somatic complaints because these factors are important predictors of TMD pain, response to treatment, and chronicity.

Sex differences in signs and symptoms from masticatory and other muscles in 19-year-old individuals.

Pain and tenderness of masticatory muscles are often related to muscle tenderness elsewhere in the body. It has been shown that women are more prone to musculoskeletal disorders than men. We sought to determine whether sex differences of muscular symptoms were established by the age of 19. The subjects comprised 51 boys and girls who received a questionnaire regarding the function of their masticatory system, frequency of headache, and neck, shoulder and low back pain. Their masticatory system was examined, and neck and shoulders were palpated. For all variables in the questionnaire girls reported symptoms more often than the boys. Of the subjects 50% had tender chewing muscles upon palpation. Again the girls had the most. There was good correlation between reports of pain in one area as compared to others. The number of clinically tender neck and shoulder muscles correlated with the number of tender masticatory muscles. It was concluded that girls presented more muscular symptoms than boys.

Transcutaneous nerve stimulation in a group of patients with rheumatic disease involving the temporomandibular joint.

The effect of transcutaneous nerve stimulation (TNS) was evaluated and compared with placebo TNS in 19 patients (17 women, mean age 33 years) with orofacial functional pain and rheumatic disease involving the temporomandibular joint. In two double-blind noncrossover experiments, high frequency TNS (100 Hz) and low frequency TNS (2 Hz) were evaluated by comparison of the patients' functional and rest pain, muscle and joint tenderness, and jaw function. A significant treatment effect was obtained for all treatment methods regarding functional and rest pain and muscle and joint tenderness. None of the parameters except functional pain, which improved significantly more after high frequency TNS than placebo TNS, revealed any difference between the methods. Jaw function, however, revealed a few differences between high frequency TNS and placebo TNS.

Differences in functional variables, fillings, and tooth wear in two groups of 19-year-old individuals.

Fifty-one individuals (28 girls and 23 boys) who had received orthodontic treatment were compared with 47 subjects (19 girls and 28 boys) without such treatment as to maximal mandibular mobility, chewing muscle tenderness, morphologic occlusion, occlusal/incisal state, and degree of tooth wear. All were 19 years old. There were no statistically significant differences between the groups except for the number of teeth present and maximal mouth opening, which were both smallest in those who had received treatment. The first finding is evident, extraction of premolars being an accepted mode of orthodontic treatment. The reduced mouth opening capacity was related to an increased number of individuals with four or more palpably tender muscle sites in that group of individuals.

Signs and symptoms of craniomandibular disorders in two groups of 19-year-old individuals, one treated orthodontically and the other not.

Fifty-one individuals (28 girls and 23 boys) who had received orthodontic treatment were compared as to signs and symptoms of craniomandibular disorders with 47 individuals (19 girls and 28 boys) without such treatment. All were 19 years old. An average of 5 years had elapsed since the termination of the treatment. The examinations enabled calculations of the anamnestic, the clinical dysfunction, and the occlusal indices of Helkimo. There were no statistically significant differences between the groups except with regard to the anamnestic index. Subjects who had not received orthodontic treatment reported most symptoms, but none were severe. In conclusion, there were no substantial differences as to signs and symptoms of craniomandibular disorders in these two groups of individuals.

A multiprofessional study of patients with myofascial pain-dysfunction syndrome. I.

A research team comprising a dentist, a psychiatrist and two physiotherapists examined 113 female patients consecutively referred because of myofascial pain-dysfunction (MPD) syndrome and, for comparison, 46 female patients who attended the dental clinic for a positively diagnosed dental problem. In both groups all subjects were Norwegians, nearly all in the age of reproduction and belonging to the upper social strata. Every second subject in the Comparison group had perceived some MPD-symptoms. The dentist's main findings in the MPD-patient group were high scores on the Anamnestic index and on the Dysfunction index, and moderate scores on the Occlusal index. The psychiatrist's main findings were high scores on restrained aggression and on anxiety, and tense control of emotions generally. The physiotherapists' findings were general muscular tension and inadequate respiratory function in an upright position.

The myofascial pain dysfunction: dental symptoms and psychological and muscular function. An overview. A preliminary study by team approach.

Patients with myofascial pain dysfunction (MPD) are traditionally seen by dentists. No organic lesions are found, and there is accumulating evidence that psychological factors influence both the onset and the development of the disorder, thus calling for a multiprofessional investigation approach. This report presents a preliminary study by a team consisting of a psychiatrist, a dentist and a physiotherapist. 25 patients with MPD diagnosis were examined. Almost all of the patients had tense muscles in neck and back, indicating that muscular tension is not a local phenomenon in the masticatory muscles. It was possible to distinguish two main categories of MPD patients, the 'typical MPD patients' and the 'multiproblem patients'. Problems that need further investigation are pointed out.