Can temporomandibular disorder symptoms and headaches be prevented in 13- to 15-year-old girls by information provided in a school setting?

OBJECTIVE: Temporomandibular 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. METHODS: Thirteen-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). RESULT: The 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). CONCLUSION: Standardized information in school settings can prevent development of TMD symptoms and headaches among young girls.

Saliva on the oral mucosa and whole saliva in women diagnosed with burning mouth syndrome.

OBJECTIVE: The aim of the study was to examine mucosal saliva and unstimulated (UWS) and stimulated (SWS) whole saliva secretion rates and associated factors, in 56 female patients diagnosed with BMS and age-matched control women. MATERIAL AND METHODS: Mucosal saliva was assessed using the Periotron® method and blood flow using laser Doppler flowmetry. Diseases, drug usage and xerostomia were registered using questionnaires. RESULTS: The patients with BMS displayed less lingual and whole saliva, and more hyposalivation, xerostomia diseases/disorders and drug usage, compared to the controls. Only a low SWS and xerostomia differed after adjusting for drugs and systemic diseases. Regression analyses suggested an importance of saliva affecting drugs for saliva on the tongue and for SWS, and the total number of drugs used for UWS. Lingual saliva and UWS were also associated with systemic diseases in the patients. Xerostomia was significantly associated with drug use and whole saliva for all subjects but not in separate analyses of the groups. CONCLUSION: Less saliva in patients with BMS could be related to more systemic diseases and medication and not to the syndrome per se. Xerostomia in the patients was not related to any of these factors.

Clinical characterization of women with burning mouth syndrome in a case-control study.

OBJECTIVE: Burning mouth syndrome (BMS) is a chronic orofacial pain disorder that is defined by a burning sensation in the oral mucosa. The aim of this study was to investigate the underlying factors, clinical characteristics and self-reported oral and general health factors associated with BMS. MATERIAL AND METHODS: Fifty-six women with BMS (mean age: 67.7) and their age-matched controls were included in the study. A general questionnaire, an OHRQL index and BMS-specific questionnaires were used. Each subject underwent an oral examination. RESULTS: The mean severity of the BMS symptoms (VAS, 0-100) was 66.2 (SD 19.7). Overall, 45% of the patients reported taste disturbances. More of the patients than the controls rated their general health, oral health and life situation as 'less satisfactory'. The patients also reported more frequently on-going medications, diseases/disorders, xerostomia, allergy and skin diseases. Except for more bruxofacets among the patients, there were no significant differences regarding signs of parafunction. In a multiple logistic regression analysis, xerostomia and skin diseases showed the strongest prediction for BMS and no significant effect was found for medication, allergy or bruxofacets. CONCLUSIONS: Skin diseases and xerostomia but not parafunction were strongly associated with BMS. Our findings provide the basis for additional studies to elucidate the causal factors of BMS.

Jaw symptoms and signs and the connection to cranial cervical symptoms and post-traumatic stress during the first year after a whiplash trauma.

PURPOSE: To estimate the prevalence of jaw symptoms and signs during the first year after a neck sprain in a car collision. Further, to determine their relationships to the localisation and grade of the initial neck symptoms and signs, headache, post-traumatic stress and crash characteristics. METHODS: One hundred and forty-six adult subjects and crash characteristics were prospectively investigated in an in-depth study during 1997-2001. Head, neck, and jaw symptoms and signs were recorded within 5 weeks and after 1 year. Acute post-traumatic stress was estimated with the Impact of Event Scale-Revised (IES-R). RESULTS: Jaw symptoms were initially reported by three men (5%) and three women (4%), and subsequently developed in eight women (10%) during the following year. Jaw signs were noted initially in 53 subjects (37%) and in 28 subjects (24%) after 1 year, without difference between sexes, and more often after low-speed impacts. Headache in females, cranial cervical symptoms, pronounced neck problems, post-traumatic stress and whiplash-associated disorders (WAD) grade II-III after rear-end impacts were related to jaw signs during the acute phase. After 1 year, jaw signs were related to residual neck problems, headache and post-traumatic stress. CONCLUSIONS: Jaw symptoms are seldom reported during the acute phase after a whiplash trauma. Women more often than men develop jaw symptoms during the first year. Jaw symptoms and signs may develop also after low-speed impacts, especially after rear-end collisions. Jaw symptoms and signs should be observed after whiplash trauma, especially in those with headache, pronounced neck problems, cranial neck symptoms and post-traumatic stress.

Comparison of individual prediction of treatment outcome made by a TMD specialist and a TMD-trained general dental practitioner in patients with temporomandibular disorders.

The aim of this study was to investigate if a TMD-trained general dental practitioner could individually predict actual treatment outcome in selected patients diagnosed with temporomandibular disorders (TMD) with similar results as a TMD specialist. The patients were examined, individually predicted, treatment planned, treated and had their treatment outcome evaluated by the therapist, respectively. Out of 2618 patients referred to a TMD specialist clinic, 1086 patients started treatment. They were all divided into Muscle or Mainly TMJ symptoms. Prediction of the treatment outcome as Good or Dubious was based on the patient's history, the clinical and, sometimes, radiological findings. The degree of improvement was graded using a Numeric Rating Scale 0-100. A clinical important improvement, defined as an improvement of initial complaints of 50% or more, was judged as a correct prediction of Good treatment outcome. Seven-hundred-sixty-nine patients treated by the TMD specialist (Sample 1) was compared with 164 patients treated by the TMD-trained general dental practitioner (Sample 2). For patients with Muscle symptoms in Sample 1, a 50% improvement or more was reached by 93% of those predicted Good and 57% of those predicted Dubious. The corresponding figures in Sample 2 were 100% and 82%, respectively. In Sample 1, patients with Mainly TMJ symptoms reached a 50% improvement or more in 94% of those with prediction Good and 73% of those predicted Dubious. In Sample 2 the figures were 100% and 87%, respectively. ATMD-trained general dental practitioner could individually predict treatment outcome with similar results as a TMD specialist in selected patients diagnosed with TMD. Whether the method is possible to generalize has to be investigated further.

Validation and improvement of a predictive model for treatment outcome in patients with temporomandibular disorders.

OBJECTIVE: To examine whether it was possible to improve individual prediction of treatment outcome in patients with temporomandibular disorders (TMD) through continuous quality improvement registrations and implementation of changes in clinical routines. MATERIAL AND METHODS: All 5777 patients referred to a specialist clinic for stomatognathic physiology; 2187 TMD patients started treatment. The patients were divided into Muscle or Mainly TMJ symptom groups. Actual treatment outcome was predicted as Good or Dubious based on patient history and clinical findings. The degree of improvement of initial symptoms was graded using a numeric rating scale 0-100. Improvement in initial complaints of 50% or more was judged as a clinically important difference (CID); 989 patients (76%) completed treatment 1992-1998 (Sample 1) and 769 (86%) treatment 1999-2004 (Sample 2). RESULTS: For patients with Muscle symptoms in Sample 1, CID was reached by 90% of those predicted Good and by 56% of those predicted Dubious. In Sample 2, the figures were Good 93% and Dubious 57%. In subgroup Mainly TMJ symptoms, CID was reached by 94% of those predicted Good and by 88% if predicted Dubious in Sample 1. In Sample 2, the figures were the same for those predicted Good, i.e. 94%, and Dubious, 73%. CONCLUSION: Continuous quality improvement registrations and implementation of changes in clinical routines improved the ability to predict individually the actual treatment outcome between patients predicted Good or Dubious, respectively. Rheumatic disease turned out not to be a negative predictor for treatment outcome.

Influence on the masticatory system in treatment of obstructive sleep apnea and snoring with a mandibular protruding device: a 2-year follow-up.

The aim was to identify the incidence and types of possible adverse events in the masticatory system after treatment with a mandibular protruding device (MPD) during a 2-year period in patients with obstructive sleep apnea (OSA) or snoring. The subjects comprised 65 middle-aged patients (44 OSA patients, 21 snorers). A clinical examination and a questionnaire concerning signs and symptoms from the masticatory system were performed before, after 6 months, and after 2 years of MPD use. The frequencies of registered signs from the masticatory system, such as muscle and joint tenderness, palpation, and pain during mandibular movement, decreased significantly between baseline and the 2-year follow-up. There were significant changes in the mandibular range of protrusion (+0.7 mm, P < .001), overjet (-0.5 mm, P < .001), and overbite (-0.6 mm, P < .001) compared with the initial examination. Nine patients developed a lateral open bite during treatment, and 2 of them experienced subjective symptoms related to the altered occlusion but still used the MPD every night. No patient reported pain on opening the mouth wide or during jaw movements. Two reported tiredness on jaw function. The reported frequency of headaches was also significantly reduced (P < .01). The high compliance rate in MPD use showed that the therapy is well tolerated, but there is a risk of minor alterations in the occlusion during MPD treatment.

Comparison between predicted and actual treatment outcome in patients with temporomandibular disorders treated by TMD-trained general dental practitioners.

Patients diagnosed with TMD at a specialist clinic were subgrouped as having muscular or mainly TMJ symptoms. The individual possibility to reach a significant improvement (improvement > 50%) was predicted as good, dubious or poor. The TMD treatment was performed by trained general practitioners following strict treatment routines comprising mainly occlusal appliances and/or occlusal adjustment. Treatment outcome was evaluated when a stable occlusion on the appliance and/or in the bite was established. Improvement was measured in per cent by using a Numeric Rating Scale. Agreement between predicted and actual treatment outcome was evaluated for 206 patients treated by the general practitioners. In patients with muscular symptoms and where the predicted treatment outcome was good, 89% of the treated patients reported an improvement of 50% or more. Among those with a dubious prognosis the figure was the same. In patients with mainly TMJ symptoms and where the treatment outcome was judged to be good, 97% fulfilled the criteria of a successful treatment outcome. Seventy-three per cent of those where the predicted treatment outcome was dubious, had an improvement of 50% or more. The possibility to predict individual treatment outcome, and the actual treatment outcome, in TMD patients treated by trained general practitioners, after examination and treatment planning by a TMD specialist, was good and comparable to the results obtained in patients treated by a TMD specialist.

Effects of a mandibular protruding device on the sleep of patients with obstructive sleep apnea and snoring problems: a 2-year follow-up.

OBJECTIVES: To evaluate subjective discomfort and somnographic measures of patients with obstructive sleep apnea and snoring problems who had been treated for 2 years with a mandibular protruding device (MPD). METHODS: The study population comprised 65 patients with a pretreatment diagnosis of obstructive sleep apnea (OSA) ( n = 44) or habitual snoring without apnea (n = 21). After a baseline medical and somnographic examination, a functional examination of the stomatognathic system, and a questionnaire focused on sleep-related qualities, each patient received an MPD. Two follow-ups were made 6 months and 2 years after MPD treatment had been initiated, and all initial examinations were repeated. RESULTS: At the 2-year follow-up, significant subjective improvements were registered in 90% of the patients regarding a reduction of snoring and apneas, in 76% regarding a reduction in daytime tiredness, and in 84% regarding an improvement in the quality of the night sleep (change of > or = 50% from baseline data). At the 2-year follow-up of the OSA group, the oxygen desaturation index (ODI) had dropped significantly from a mean value of 14.7 (SD, 12.7) to 3.1 (SD, 4.2) ( P < 0.001), and the mean SaO2 nadir rose from 78.2% (SD, 8.1) to 89.0% (SD, 4.7) ( P < 0.001). Only one of the snorers increased his ODI value; the others retained their initial healthy values. The OSA patients significantly reduced the amount of time they snored during their sleep. CONCLUSION: MPD treatment is associated with a significant reduction in subjective complaints such as disturbing snoring, apneas, daytime tiredness, and poor quality of night sleep, and with a significant reduction in ODI values in the OSA group. In addition, favorable 6-month results were unchanged after 2 years.

Validation of measurements of mandibular protrusion in the treatment of obstructive sleep apnoea and snoring with a mandibular protruding device.

The aims of this study were to compare the maximum range of protrusion determined with a ruler with measurements made using a George Gauge (GG) and to validate the methods of measurement (ruler and GG) of the advancement established by mandibular protruding devices (MPDs), using cephalograms as the gold standard. The study comprised 77 patients (63 males, 14 females, mean age 54 years, range 31-73 years) with obstructive sleep apnoea (OSA) (n = 50) or complaints of snoring (n = 27). After a medical examination that included an overnight somnographic registration and a dental and stomatognathic examination, each patient was given a MPD. Measurements of the maximum range of protrusion with the GG and a ruler were compared. Pairs of upright cephalograms were taken with and without the MPD. The position of the mandible on the cephalograms was compared with ruler measurements of the device-induced protrusion in the incisor and premolar regions, the vertical opening in the anterior region, and GG construction bite registration. The maximum range of protrusion was significantly greater with GG than ruler measurements, on average +1.2 mm (P < 0.001). The mandibular position as measured in the incisor or premolar region with a ruler or on the cephalogram was not significantly different. GG values, however, were higher and differed significantly from ruler and cephalometric measurements (P < 0.001). The degree of anterior mandibular advancement with a MPD measured with a ruler in the incisor or premolar regions compared well with corresponding cephalometric measurements. The ruler and cephalometric measurements of the vertical opening with the MPD coincided well in the incisor region. The GG overestimated the maximum range of protrusion compared with ruler measurements.

Radiographic signs in the temporomandibular joint in Reiter's disease.

AIMS: To investigate whether involvement of the temporomandibular joint (TMJ) can occur in men with Reiter's disease (RD). METHODS: Forty-nine men with RD and 49 individually matched (gender, age and dentition type) controls with no known general joint disease were screened for findings in the TMJ by panoramic tomography. RESULTS: Duration of subjective symptoms (e.g., pain) in the masticatory system correlated with duration of RD (P = .05). In the RD group, severity of clinical signs of symptoms correlated with the progressive form of RD (P = .01), number of affected joints (P = .0001), and involvement of the cervical (P = .0001) and lumbar spine (P = .05). Patients with RD more frequently had radiographic findings (33%) in the condyle of the TMJ than did controls (10%) (P = .002). The most characteristic radiographic sign in the condyle in the RD group was unilateral erosion (12%). CONCLUSION: Patients with RD often have erosion causing pain and dysfunction in the TMJ. Potential masticatory system problems for such patients should be brought to the attention of dentists and physicians.