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Clinical diagnoses and MRI findings in patients with TMD pain
Malmö högskola, Odontologiska fakulteten (OD).
Malmö högskola, Odontologiska fakulteten (OD).
Malmö högskola, Odontologiska fakulteten (OD).ORCID-id: 0000-0001-5635-1887
Malmö högskola, Odontologiska fakulteten (OD).
Visa övriga samt affilieringar
2007 (Engelska)Ingår i: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 34, nr 4, s. 237-245Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The aim of this study was to correlate clinical diagnoses in temporomandibular disorders patients suffering from pain diagnosed as arthralgia/osteoarthritis or myofascial pain according to the Research Diagnostic Criteria for temporomandibular disorders with findings made on magnetic resonance imaging. The temporomandibular joints of 60 consecutive patients, 41 with arthralgia/osteoarthritis and 19 with myofascial pain, were examined clinically and with magnetic resonance imaging. The most common magnetic resonance imaging findings were disc displacements and structural bone changes, which were found in both pain groups. However, disc displacements were found significantly (p = 0.002) more often in the arthralgia/osteoarthritis group. 104 joints were found to have no clinical diagnosis of disc displacements, but 64 of these joints had findings of disc displacements on magnetic resonance imaging. Joint fluid was found both in the arthralgia/osteoarthritis group (20 patients) and in the myofascial pain group (5 patients). Patients having a combination of disc displacement and joint fluid were significantly (p = 0.047) more common in the arthralgia/osteoarthritis group. In conclusion, the magnetic resonance imaging findings of disc displacement and structural bone changes were common in temporomandibular disorders patients with pain of both myogenous and arthrogenous origin. The clinical diagnoses for subdivision into myogenous and arthrogenous pain groups were not confirmed by magnetic resonance imaging.

Ort, förlag, år, upplaga, sidor
Wiley-Blackwell, 2007. Vol. 34, nr 4, s. 237-245
Nyckelord [en]
arthralgia, magnetic resonance imaging, myofascial pain, osteoarthritis, temporomandibular disorders, temporomandibular joint
Nationell ämneskategori
Odontologi
Identifikatorer
URN: urn:nbn:se:mau:diva-15428DOI: 10.1111/j.1365-2842.2006.01719.xISI: 000245628100001PubMedID: 17371560Scopus ID: 2-s2.0-33947309073Lokalt ID: 4621OAI: oai:DiVA.org:mau-15428DiVA, id: diva2:1418949
Tillgänglig från: 2020-03-30 Skapad: 2020-03-30 Senast uppdaterad: 2024-02-05Bibliografiskt granskad
Ingår i avhandling
1. Resilient Appliance Therapy of Temporomandibular Disorders. Subdiagnoses, Sense of Coherence and Treatment Outcome
Öppna denna publikation i ny flik eller fönster >>Resilient Appliance Therapy of Temporomandibular Disorders. Subdiagnoses, Sense of Coherence and Treatment Outcome
2010 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [sv]

Temporomandibulär dysfunktion (TMD) med käk- och/eller ansiktssmärta,med eller utan nedsatt käkfunktion, är vanligt förekommandetillstånd i befolkningen. Tandpressning och gnissling,som kan vara utlösta på grund av hög psykosocial stress, utgör tillsammanseller parallellt med bland annat käktrauma, orsaksfaktorersom kan ge upphov till TMD-symtom som smärta. Hos allmäntandläkarenär det vanligt att undersökningsfynd och symptom påTMD-besvär föranleder behandling med bettskena. Denna användsdå för att reducera sammanbitningskrafter och TMD-smärta, samtför att förbättra patientens käkfunktion. Bettskenebehandling pågårofta parallellt med andra bettfysiologiska behandlingsinsatserför att uppnå bästa smärtlindrande resultat. Innan behandlingenpåbörjas utförs en noggrann anamnesupptagning och klinisk undersökningför att komma fram till en behandlingsgrundande diagnos.Ibland bör den diagnostiska processen inbegripa någon typav radiologisk undersökning.Det övergripande målet med detta avhandlingsarbete var att studeraen grupp patienter med TMD-smärta och jämföra deras käkledsfyndpå magnetresonanstomografi (MRT) med diagnosen baseradpå den kliniska undersökningen och studera behandlingsutfalletav bettskenebehandling med mjuk bettskena (resiliensskena), iett korttids- och ett långtidsperspektiv. Ytterligare ett mål var attstudera “känsla av sammanhang” som påverkansfaktor på behandlingsutfallet.I artikel I var målet att jämföra MRT-fynd på käklederna, hospatienter med TMD smärta, med de kliniska diagnoserna myofascial smärta och myofascial smärta i kombination med artralgi ellerosteoartrit enligt diagnossystemet RDC/TMD, speciellt framtagetför diagnostik i forskningssammanhang. De vanligaste fynden påMRT-bilderna var diskdisplaceringar med eller utan återgång ochstrukturella benförändringar. Dessa fynd förekom i båda diagnosgrupperna,men diskdisplacering iakttogs oftare hos patienternamed myofascial smärta i kombination med artralgi eller osteoartrit.Att dela in de kliniska diagnoserna i grupperna myofascial smärtaoch myofascial smärta i kombination med artralgi eller osteoartrit,kunde inte bekräftas med MRT-fynden i denna studie.I artikel II utvärderades korttidseffekten av behandling med resiliensskenajämfört med en kontrollskena. 80 patienter med TMDsmärtarekryterades och randomiserades till behandlingsgrupperna.Efter 6- och 10 veckors behandling utvärderades behandlingseffekten.Det fanns inga statistiskt signifikanta skillnader mellan resiliensskenanoch kontrollskenan när det gällde att reducera TMDsmärtanhos patienterna i ett korttidsperspektiv.I artikel III studerades faktorer av betydelse för behandlingsutfallet,dessutom studerades förhållandet mellan TMD smärtpatienternas“känsla av sammanhang” och depressionsgrad, somatiseringsgradoch generella hälsa. Resultatet talar för att inga av destuderade bakgrundsfaktorerna hade betydelse för behandlingseffektenav resiliensskenan i ett korttidsperspektiv. Ingen relationmellan ”känsla av sammanhang” och depressionsgrad, somatiseringsgradeller generell hälsa, kunde konstateras.I artikel IV studerades långtidseffekten av resiliensskenan jämförtmed kontrollskenan hos patienter med TMD-smärta. Slitagetav skenorna efter användning studerades också i denna artikel.Precis som i korttidsuppföljningen fanns det inga statistiskt signifikantaskillnader i smärtlindrande behandlingseffekt mellan resiliensskenanoch kontrollskenan, i ett långtidsperspektiv.

Abstract [en]

Temporomandibular disorders (TMD) with orofacial pain with orwithout reduced jaw function, are frequent conditions in the generalpopulation. Different factors such as tooth clenching andgrinding, sometimes due to enhanced psychosocial stress, andtrauma to the jaws may be important as etiologic factors. Signs andsymptoms of TMD are a common cause for general practitionersto use different intraoral appliances as pain and bite-force reducingdevices and for improvement of a reduced jaw function. Intraoralappliances are often used parallel to other treatment modalities.Before treatment start a thorough history taking and clinical examinationis necessary for a relevant diagnosis. Sometimes the diagnosticprocess has to be complemented with proper radiographicimaging in order to support the diagnostic process.The overall aim of this thesis was to compare magnetic resonanceimaging (MRI) findings of the TMJ on the clinically assesseddiagnoses and to evaluate short- and long-term treatment outcomeof a resilient intraoral appliance, in patients with TMD pain. A furtheraim was to study Sense of Coherence as an influencing factoron treatment outcome, on these patients.In article I the aim was to compare findings on MRI in TMDpain patients with clinical diagnoses of myofascial pain or arthralgia/osteoarthritis in combination with myofascial pain accordingto the Research Diagnostic Criteria for TMD (RDC/TMD). Thetemporomandibular joints of 60 consecutive patients, 19 withmyofascial pain and 41 patients with arthralgia/osteoarthritis incombination with myofascial pain were examined clinically andwith MRI. The most common MRI findings were disc displacements with or without reduction and structural bone changes.These findings were found in both pain groups, however, disc displacementswere found significantly more often in patients with arthralgia/osteoarthritis in combination with myofascial pain. Jointfluid was found in both pain groups. The clinical diagnoses forsubdivision into myogenous only or combined arthrogenous andmyogenous pain groups were not confirmed by MRI findings.In article II the short-term efficacy of a resilient appliance comparedto a non-occluding control appliance was studied in a randomised,controlled trial with 80 recruited TMD pain patients.They were randomly allocated to one of two groups: treatmentwith a resilient appliance or treatment with a hard, palatal, nonoccludingappliance. After 6 and 10 weeks of treatment, characteristicpain intensity (CPI) decreased in both groups. There was nostatistically significant difference found between the resilient applianceand the non-occluding control appliance in reducing TMDpain in a short-term perspective.In article III possible factors of importance for treatment outcomewere studied as well as the association between Sense of Coherenceand grade of depression, and grade of non-specific physicalsymptoms and general health, in the TMD pain patients. A total of73 TMD pain patients participated; 36 were treated with a resilientappliance and 37 with a non-occluding control appliance. Thefindings indicated that none of the studied background variables(age, gender, SoC, depression, nonspecific physical symptoms orgeneral health) seemed to influence the short-term efficacy of intraoralappliances. In the TMD pain patients, no associations werefound between SoC and depression, non-specific physical symptomsor general health.In article IV the long-term efficacy was evaluated of the resilientappliance compared to the non-occluding control appliance in theTMD pain patients. Appliance wear was also studied in this article.As in the short-term follow-up, there was no statistically significantdifference between the resilient appliance and the non-occludingcontrol appliance in reducing TMD pain in the long-term perspective.

Ort, förlag, år, upplaga, sidor
Malmö University, Departments of Stomatognathic Physiology and Oral and Maxillofacial Radiology, 2010
Serie
Swedish Dental Journal : Supplement, ISSN 0348-6672 ; 206
Nyckelord
stomatognathic physiology, TMD-pain, resilient appliance treatment
Nationell ämneskategori
Odontologi
Identifikatorer
urn:nbn:se:mau:diva-7720 (URN)10171 (Lokalt ID)91-7104-311-X (ISBN)10171 (Arkivnummer)10171 (OAI)
Anmärkning

Note: The papers are not included in the fulltext online.

Paper IV in dissertation as manuscript.

Tillgänglig från: 2020-02-28 Skapad: 2020-02-28 Senast uppdaterad: 2024-03-01Bibliografiskt granskad
2. Magnetic resonance imaging in patients with temporomandibular disorders and pain
Öppna denna publikation i ny flik eller fönster >>Magnetic resonance imaging in patients with temporomandibular disorders and pain
2008 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Magnetic resonance imaging (MRI) is the method of choice for imaging disorders of the temporomandibular joint (TMJ) in patients with temporomandibular disorders (TMD) and pain. But the method is expensive, and wait times for MRI exams of the TMJ are long. So an evaluation of the diagnostic and therapeutic efficacy of MRI of the TMJ is valuable when estimating the imaging method’s use in treatment decisions and prognosis. To reduce cost to society, individual selection criteria for MRI of the TMJ need to be defined. The aim must be to minimize unnecessary examinations and to restrict use of MRI to patients who will benefit from the examination. To evaluate evidence for the efficacy of MRI in patients with TMD and pain, a systematic review of the literature was done (article I). The search yielded 494 titles, of which 22 were relevant. No publication had a high level of evidence; 12 and 10 publications had moderate and low levels of evidence, respectively. The evidence grade for diagnostic efficacy expressed as sensitivity, specificity, and predictive values was insufficient. No publication on diagnostic thinking efficacy or therapeutic efficacy met the inclusion criteria. The TMJs of 60 TMD patients were examined with MRI (article II). The patients were placed in one of two clinical diagnostic groups—(1) myofascial pain or (2) arthralgia/osteoarthritis—per the Research Diagnostic Criteria for TMD (RDC/TMD), a diagnostic classification system. This classification is widely used internationally, but further validation and development is needed. The most common MRI findings were various kinds of disc displacements; structural bone changes; and joint fluid, which occurred in both pain groups. The MRI findings did not support the RDC/TMD clinical diagnoses. In a randomized controlled trial of 80 patients suffering from TMD pain (article III), the short-term efficacy of a resilient appliance was compared with a control appliance consisting of a non-occlusal hard acrylic palatal appliance. After 10 weeks of treatment, 61% in the treatment group and 46% in the control group had at least a 30% reduction in TMD pain. Differences between groups were nonsignificant. Changes in condyle and disc position could be factors that are affected by appliance therapy and influence treatment outcome of TMD patients. MRI of the TMJ was performed in 48 of the 80 patients (article IV). The results showed that treatment outcome was not related to MRI-determined changes in condyle and disc position.

Ort, förlag, år, upplaga, sidor
Malmö University, 2008. s. 127
Serie
Doctoral Dissertation in Odontology
Nationell ämneskategori
Odontologi
Identifikatorer
urn:nbn:se:mau:diva-7670 (URN)7355 (Lokalt ID)9171042997 (ISBN)7355 (Arkivnummer)7355 (OAI)
Anmärkning

Paper III and IV in dissertation as manuscripts.

Tillgänglig från: 2020-02-28 Skapad: 2020-02-28 Senast uppdaterad: 2024-03-19Bibliografiskt granskad

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Ekberg, EwaCarinNilner, MariaPetersson, Arne

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