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Resilient Appliance Therapy of Temporomandibular Disorders. Subdiagnoses, Sense of Coherence and Treatment Outcome
Malmö högskola, Faculty of Odontology (OD).
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Malmö University, Departments of Stomatognathic Physiology and Oral and Maxillofacial Radiology , 2010.
Series
Swedish Dental Journal : Supplement, ISSN 0348-6672 ; 206
Keywords [en]
stomatognathic physiology, TMD-pain, resilient appliance treatment
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-7720Local ID: 10171ISBN: 91-7104-311-X (print)OAI: oai:DiVA.org:mau-7720DiVA, id: diva2:1404660
Note

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

Paper IV in dissertation as manuscript.

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-01Bibliographically approved
List of papers
1. Clinical diagnoses and MRI findings in patients with TMD pain
Open this publication in new window or tab >>Clinical diagnoses and MRI findings in patients with TMD pain
Show others...
2007 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 34, no 4, p. 237-245Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2007
Keywords
arthralgia, magnetic resonance imaging, myofascial pain, osteoarthritis, temporomandibular disorders, temporomandibular joint
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-15428 (URN)10.1111/j.1365-2842.2006.01719.x (DOI)000245628100001 ()17371560 (PubMedID)2-s2.0-33947309073 (Scopus ID)4621 (Local ID)4621 (Archive number)4621 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
2. Short-term treatment of a resilient appliance in TMD pain patients: a randomized controlled trial
Open this publication in new window or tab >>Short-term treatment of a resilient appliance in TMD pain patients: a randomized controlled trial
2009 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 36, no 8, p. 547-555Article in journal (Refereed) Published
Abstract [en]

To investigate the short-term efficacy of a resilient appliance in patients with temporomandibular disorders (TMD) suffering from pain, a randomized, controlled trial was performed in 80 recruited TMD pain patients. They were randomly allocated to one of two groups: treatment with a resilient appliance or treatment with a hard, palatal, non-occluding appliance. The primary treatment outcome measure was judged positive when patients' TMD pain at worst, according to the Visual Analog Scale (VAS), decreased by at least 30%. One additional treatment outcome was reduction of characteristic pain intensity. Number needed to treat was measured on the basis of primary treatment outcome at 10 weeks. At baseline, patient characteristics and TMD pain did not differ between the groups. There were no significant differences between groups regarding a 30% reduction in VAS-reported TMD pain at worst at 10 weeks' follow-up; 61% in the treatment group and 46% in the control group. After 6 and 10 weeks of treatment, CPI decreased in both groups. Number needed to treat was 9.1 for both the resilient and the control appliance therapy during 10 weeks. There was no statistically significant difference between the resilient appliance and the non-occluding control appliance in reducing TMD pain from a short-term perspective.

Place, publisher, year, edition, pages
Blackwell Publishing, 2009
Keywords
resilient appliance, temporomandibular disorders, occlusal appliance, orofacial pain, randomized controlled trial
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-6862 (URN)10.1111/j.1365-2842.2009.01973.x (DOI)000267754500001 ()19604318 (PubMedID)2-s2.0-67650912267 (Scopus ID)9906 (Local ID)9906 (Archive number)9906 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved
3. Do psychological factors and general health influence the short-term efficacy of resilient appliance therapy in patients with temporomandibular disorder pain?
Open this publication in new window or tab >>Do psychological factors and general health influence the short-term efficacy of resilient appliance therapy in patients with temporomandibular disorder pain?
2010 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 68, no 3, p. 141-147Article in journal (Refereed) Published
Abstract [en]

Objectives. To study how sense of coherence (SOC), grade of depression and non-specific physical symptoms and general health influence the efficacy of intraoral appliance therapy in patients with temporomandibular disorder (TMD) pain. A second objective was to study the association between SOC, grade of depression, grade of non-specific physical symptoms and general health. Material and methods. A total of 73 TMD pain patients participated; 36 were treated with a resilient appliance and 37 with a non-occluding control appliance in a randomized controlled trial for a period of 10 weeks. All patients had at least one pain diagnosis according to the research diagnostic criteria for TMD, including both the Symptom Checklist-90-Revised (Axis II) measuring grade of depression and non-specific physical symptoms, and general health (physical characteristics). Patients also filled in the 29-item SOC questionnaire. Results. A low grade of SOC was found in eight of the patients in the treatment group and in 17 of the control group at baseline, with a statistically significant difference between the groups. Logistic regression analyses revealed that, after correcting for the background variables, the resilient appliance did not differ from the non-occluding control appliance in terms of treatment outcome. No statistically significant differences were found when correlating mean SOC with grade of depression, grade of non-specific physical symptoms and general health. Conclusions. These findings indicate that none of the studied background variables (age, gender, SOC, depression, non-specific physical symptoms or general health) seemed to influence the short-term efficacy of intraoral appliances. No association was found between SOC and depression, non-specific physical symptoms or general health in TMD pain patients.

National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-7025 (URN)10.3109/00016350903514418 (DOI)000276555000003 ()20113145 (PubMedID)2-s2.0-77951112836 (Scopus ID)11184 (Local ID)11184 (Archive number)11184 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved
4. Long-term efficacy of resilient appliance therapy in TMD pain patients: a randomised, controlled trial
Open this publication in new window or tab >>Long-term efficacy of resilient appliance therapy in TMD pain patients: a randomised, controlled trial
2011 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 38, no 10, p. 713-721Article in journal (Refereed) Published
Abstract [en]

Summary  The aim was to investigate long-term efficacy of a resilient appliance in patients with pain due to temporomandibular disorders (TMD). A randomised, controlled trial was performed in 80 recruited TMD pain patients. They were randomly allocated to one of two groups: treatment with a resilient appliance or treatment with a hard, palatal, non-occluding appliance. The primary treatment outcome was judged positive when patients' characteristic pain intensity decreased by at least 30%. Additional treatment outcomes were physical functioning, emotional functioning and headache. At the 12-month follow-up 50% of the patients in the treatment group and 42% in the control group had a 30% reduction of characteristic pain intensity, when calculated in an intent-to-treat analysis. Jaw function improved in both groups at the 6- and 12-month follow-up. Emotional functioning improved in both groups at the 6-month follow-up; an improvement concerning grade of depression was found in the control group at 12 months. Headache decreased in both groups at both follow-ups. There were no statistically significant differences found regarding primary and additional outcomes between groups at the 6- and 12-months follow-up. There was no statistically significant difference between the resilient appliance and the non-occluding control appliance in reducing TMD pain, physical functioning, emotional functioning and headache in a 12 months perspective.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011
Keywords
occlusal splints, orofacial pain, randomised controlled trial, resilient appliance, temporomandibular disorders
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-6543 (URN)10.1111/j.1365-2842.2011.02210.x (DOI)000295003500001 ()21434963 (PubMedID)2-s2.0-80052592684 (Scopus ID)12623 (Local ID)12623 (Archive number)12623 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved

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