ASSOCIATIONS BETWEEN SCREENING FOR FUNCTIONAL JAW DISTURBANCES AND PATIENT REPORTED OUTCOMES ON JAW LIMITATIONS AND ORAL BEHAVIORS.

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.

The Longitudinal Relationship between Jaw Catching/Locking and Pain.

Orofacial pain and joint-related dysfunction can negatively affect daily jaw function. A common cause for limitations in jaw movements is joint-related dysfunction such as various forms of catching and locking. However, knowledge is limited regarding the development and natural course of joint-related jaw dysfunction and its relationship to the onset and course of orofacial pain. Therefore, the aim was to evaluate the incidence, prevalence, and gender differences in jaw catching/locking over time and in relation to orofacial pain in the general population. Data from 3 validated screening questions on orofacial pain and jaw catching/locking were collected from all routine dental checkups in the Public Dental Health Services in Västerbotten, Sweden, from 2010 to 2017. Logistic generalized estimating equation was used to account for repeated observations and Poisson regression for incidence analysis. In total, 180,308 individuals (aged 5-104 y) were screened in 525,707 dental checkups. In 2010, based on 37,647 individuals, the prevalence of self-reported catching/locking was higher in women than in men (3.2% vs. 1.5%; odds ratio, 2.11; 95% confidence interval [CI], 1.83-2.43), and this relationship and magnitude remained similar throughout the study period. The annual incidence rate was 1.1% in women and 0.5% in men. Women were at a higher risk than men for reporting both first onset (incidence rate ratio [IRR], 2.29; 95% CI, 2.11-2.49) and persistent (IRR, 2.31; 95% CI, 2.04-2.63) catching/locking. For the onset subcohort (n = 135,801), an independent onset of orofacial pain or jaw catching/locking exclusively was reported by 84.1%, whereas a concurrent onset was reported by 13.4%. Our findings of higher incidence, prevalence, and persistence in women than in men indicate that the gender differences seen for orofacial pain are evident also for jaw catching/locking. The findings also suggest independent onset of self-reported catching/locking and orofacial pain, which reinforces the pathophysiological differences between these conditions.

The prognostic value of pre-treatment thrombocytosis in two cohorts of patients with non-small cell lung cancer treated with curatively intended chemoradiotherapy.

Chemoradiotherapy is the standard of care for inoperable stage III non-small cell lung cancer (NSCLC). This treatment, however, offers only a small chance of cure and is associated with many side effects. Little research has been made concerning which patients benefit most/least from the treatment. The present study evaluates the prognostic value of anemia, leukocytosis and thrombocytosis at diagnosis in this treatment setting. In the present study, data were collected retrospectively for 222 patients from two different phase II studies conducted between 2002-2007 in Sweden with patients treated with chemoradiotherapy for stage IIIA-IIIB NSCLC. Clinical data and the serum values of hemoglobin (Hgb), White blood cells (WBC) and Platelets (Plt) at enrollment were collected for all patients and studied in relation to overall survival using Kaplan-Meier product-limit estimates and a multivariate Cox proportional hazards regression model. The results showed that patients with thrombocytosis (Plt > 350 x 109/L) had a shorter median overall survival (14.5 months) than patients with normal Plt at baseline (23.7 months). Patients with leukocytosis (WBC > 9 x 109/L) had a shorter median survival (14.9 months) than patients with a normal WBC at baseline (22.5 months). However, in a multivariate model including all lab parameters and clinical factors, only thrombocytosis and performance status displayed a prognostic significance. In Conclusion, thrombocytosis showed to be an independent prognostic marker associated with shorter overall survival in stage III NSCLC treated with curatively intended chemoradiotherapy. This knowledge can potentially be used together with established prognostic factors, such as performance status when choosing the optimal therapy for the individual patient in this clinical setting.

Effects of growth and aging on the reference values of pulmonary nitric oxide dynamics in healthy subjects.

The lung just like all other organs is affected by age. The lung matures by the age of 20 and age-related changes start around middle age, at 40-50 years. Exhaled nitric oxide (FENO) has been shown to be age, height and gender dependent. We hypothesize that the nitric oxide (NO) parameters alveolar NO (CANO), airway flux (JawNO), airway diffusing capacity (DawNO) and airway wall content (CawNO) will also demonstrate this dependence. Data from healthy subjects were gathered by the current authors from their earlier publications in which healthy individuals were included as control subjects. Healthy subjects (n = 433) ranged in age from 7 to 78 years. Age-stratified reference values of the NO parameters were significantly different. Gender differences were only observed in the 20-49 age group. The results from the multiple regression models in subjects older than 20 years revealed that age, height and gender interaction together explained 6% of variation in FENO at 50 ml s-1 (FENO50), 4% in JawNO, 16% in CawNO, 8% in DawNO and 12% in CANO. In conclusion, in this study we have generated reference values for NO parameters from an extended NO analysis of healthy subjects. This is important in order to be able to use these parameters in clinical practice.