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  • 1. Baad-Hansen, Lene
    et al.
    Leijon, Göran
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Comparison of Clinical Findings and Psychosocial Factors in Patients with Atypical Odontalgia and Temporomandibular Disorders2008In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 22, no 1, p. 7-14Article in journal (Refereed)
    Abstract [en]

    Aims: To systematically compare clinical findings and spychosocial factors between patients suffering from atypical odontalgia (AO) and an age- and gender-matched group of patients with temporomandibular disorders (TMD). Methods: Forty-six AO patients (7 men and 39 women; mean age, 56 years) were compared with 41 TMD patients (8 men and 33 women, mean age 58 years). Results: Mean pain intensity at the time of inclusion in the study was similar between the groups (TMD: 5.3±0.4, AO: 5.0±0.3), but pain duration was longer in AO patients (AO: 7.7±1.1 years, TMD: 4.5±0.1 years). Eighty-three percent of the AO patients and 15% of TMD patients reported pain onset in relation to dental/surgical procedures. Episodic tension-type headache (TTH) occurred equally in both groups (TMD: 46%, AO: 46%) but TMD patients more frequently experienced chronic TTH (TMD: 35%, AO: 18%), myofascial TMD (TMD: 93%, AO: 50%), and temporomandibular joint disorders (TMD: 66%, AO: 2%). Overall, TMD patients had lower pressure pain thresholds and poorer jaw function than AO patients. Mean depression and somatization scores were moderate to severe in both groups, and widespread pain was most common in TMD patients. Conclusion: AO and TMD share some characteristics but differ significantly in report of dental trauma, jaw function, pain duration, and pain site.

  • 2. Baad-Hansen, Lene
    et al.
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Jensen, Troels S
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Increased Pain Sensitivity to Intraoral Capsaicin in Patients with Atypical Odontalgia2006In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 20, no 2, p. 107-114Article in journal (Refereed)
    Abstract [en]

    AIMS: To use 2 well-characterized stimuli, the intraoral capsaicin model and the "nociceptive-specific" electrode, to compare superficial nociceptive function between patients with atypical odontalgia (AO) and matched healthy controls. Furthermore, the authors aimed to describe the sensitivity, specificity, and positive predictive values (PPV) of the techniques if group differences could be established. METHODS: Thirty-eight patients with AO and 27 matched healthy controls participated in this study. Thirty microliters of 5% capsaicin was applied to the gingiva on the left and right sides of all participants as a pain-provocation test. The participants scored the capsaicin-evoked pain continuously on a 0-to-10 visual analog scale (VAS). Furthermore, individual electrical sensory and pain thresholds to stimulation with a "nociceptive-specific" electrode on the facial skin above the infraorbital or mental nerve were determined. RESULTS: AO patients had higher VAS pain scores for capsaicin application than healthy controls (ANOVA: F > 4.88; P < .029). No differences between the painful sides and the nonpainful sides of the patients were found (ANOVA: F < 1.26; P > .262). No main effects of group or stimulation side on the electrical sensory and pain thresholds were detected (ANOVA: F < 0.309; P > .579). Sensitivity was 0.51; specificity, 0.81; and PPV, 0.77 when a VAS value of > or = 8 for capsaicin-evoked pain was used. CONCLUSION: AO patients show increased sensitivity to intraoral capsaicin but normal sensitivity to "nociceptive-specific" electrical stimulation of the face in an area proximal to the painful site. The use of the intraoral pain-provocation test with capsaicin as a possible adjunct to the diagnostic workup is hampered by the only moderately good sensitivity and specificity.

  • 3. Baad-Hansen, Lene
    et al.
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Jensen, Troels Staehelin
    Leijon, Göran
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Blink reflexes in patients with atypical odontalgia2005In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 19, no 3, p. 223-247Article in journal (Other academic)
    Abstract [en]

    Aim: To examine the blink reflex (BR) evoked by stimulation of the trigeminal (V) nerve branches, to examine the painful V branch before and during a pain provocation test, and to compare the painful and the contra lateral non-painful branch in patients with atypical odon-talgia (AO). Methods: In thirteen patients with AO, the BR was elicited with the use of a concentric electrode and recorded bilaterally with surface EMG electrodes on both orbicularis oculi muscles. Electrical stimuli were applied to the skin above the V1, V2 and V3 nerve branches and to the V branch contralateral to the painful branch. The sensory and pain thresholds were determined. The BR examination of the painful V branch was repeated during a capsaicin pain provocation test. The data were analysed with use of non-parametric statistics. Results: The BR responses evoked by stimulation of the V3 were significantly lower than the BR responses evoked by stimulation of the V1 and V2 (P < 0.004). There were no differences in BR between the painful and non-painful side (P > 0.569), and the BR was not significantly modulated by experimental pain (P > 0.080). The sensory thresholds were significantly lower on the painful side compared to the non-painful side (P = 0.017). The pain thresholds were not different between sides (P > 0.910). Conclusion: These preliminary findings did not indicate major differences in the V nociceptive pathways between sides in AO patients. Future studies comparing the BR in AO patients with healthy volunteers are needed to provide further knowledge on the pain mechanisms in AO.

  • 4. Baad-Hansen, Lene
    et al.
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Elmasry Ivanovic, Susanne
    Faris, Hanan
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Chairside intraoral qualitative somatosensory testing: reliability and comparison between patients with atypical odontalgia and healthy controls2013In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 27, no 2, p. 165-170Article in journal (Refereed)
    Abstract [en]

    AIMS: To assess intraoral inter- and intraexaminer reliability of three qualitative measures of intraoral somatosensory function and to compare these measures between patients with atypical odontalgia (AO) and healthy controls. METHODS: Thirty-one AO patients and 47 healthy controls participated. Inter- and intraexaminer reliability was tested on a subgroup of 46 subjects (25 AO; 21 healthy). Sensitivity to touch, cold, and pinprick stimuli was evaluated on the painful gingival site and the corresponding contralateral site in AO patients, and bilaterally on the gingiva of the first maxillary premolars in controls. Patients were asked to report hypersensitivity, hyposensitivity, or normal sensitivity to stimuli on the painful site compared with the nonpainful site. Kappa values were calculated, and chi-square and Fisher's exact tests were used to compare frequencies between groups. RESULTS: Kappa values ranged between 0.63 and 0.75. The frequency of hypersensitivity to either modality was significantly higher in patients (29% to 61%) than in controls (9% to 17%) (P < .015), whereas reports of hyposensitivity were similar between groups (2% to 16%) (P > .057). Only 3.2% of the AO patients had no reports of abnormal sensitivity on any of the tests, compared with 59.6% of the healthy subjects (P < .001). CONCLUSION: Intraoral qualitative somatosensory testing can detect intraoral sensory disturbances in AO patients, and the reliability is sufficient for initial screening of orofacial somatosensory function.

  • 5.
    Dawson, Andreas
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Ernberg, M
    Svensson, P
    Assessment of Proprioceptive Allodynia After Tooth-Clenching Exercises2012In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 26, no 1, p. 39-48Article in journal (Refereed)
    Abstract [en]

    AIMS: To (A) evaluate test-retest reliability of vibrotactile sensitivity in the masseter muscle and (B) test if (1) the vibration threshold is decreased after experimental tooth clenching, (2) intense vibrations exacerbate pain after tooth clenching, (3) pain and fatigue are increased after tooth clenching, and (4) pressure pain thresholds are decreased after tooth clenching. METHODS: In part A, 25 healthy female volunteers (mean age: 42 ± 12 years) participated, and 16 healthy females (mean age 32 ± 10 years) participated in three 60-minute sessions, each with 24- and 48-hour follow-ups in part B. Participants were randomly assigned tooth-clenching exercises with clenching levels of 10%, 20%, or 40% of maximal voluntary clenching. A Vibrameter applied to the right masseter muscle measured perceived intensity of vibration and perceived discomfort, which were assessed on 0-50-100 numeric rating scales. An electronic algometer measured pressure pain threshold (PPT). Two 0- to 100-mm visual analog scales measured pain intensity (VASpain) and fatigue (VASfatigue). Measurements were made on the right masseter muscle. Interclass correlation coefficient (ICC) was used to calculate test-retest reliability of VT measurements. Outcome variables were tested with two-way ANOVAs for repeated measures and Dunnett's post-hoc test. RESULTS: Moderate long-term (ICC 0.59) and good short-term (ICC 0.92) reliability was found for VT on the masseter muscle. Clenching level had no main effect on perceived intensity of vibration; time effects (P < .05) were only observed at 40 minutes (Dunnett's test: P < .01). Clenching level and time had no effect on perceived discomfort. Only time effects were significant for PPT (P < .01), with reductions at 50 and 60 minutes compared to baseline (Dunnett's test: P < .05). Clenching level and time had main effects for VASpain and VASfatigue (P < .001). Conclusion: Experimental tooth clenching appears to evoke moderate levels of pain and fatigue and short-lasting hyperalgesia to mechanical stimulation, but not proprioceptive allodynia. The absence of proprioceptive allodynia does not necessarily exclude delayed onset muscle soreness (DOMS) but warrants further studies on the clinical manifestations of DOMS in jaw muscles.

  • 6.
    Dawson, Andreas
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Raphael, Karen G
    Glaros, Alan
    Axelsson, Susanna
    Arima, Taro
    Ernberg, Malin
    Farella, Mauro
    Lobbezoo, Frank
    Manfredini, Daniele
    Michelotti, Ambra
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Development of a quality-assessment tool for experimental bruxism studies: reliability and validity2013In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 27, no 2, p. 111-122Article in journal (Refereed)
    Abstract [en]

    AIMS: To combine empirical evidence and expert opinion in a formal consensus method in order to develop a quality-assessment tool for experimental bruxism studies in systematic reviews. METHODS: Tool development comprised five steps: (1) preliminary decisions, (2) item generation, (3) face-validity assessment, (4) reliability and discriminitive validity assessment, and (5) instrument refinement. The kappa value and phi-coefficient were calculated to assess inter-observer reliability and discriminative ability, respectively. RESULTS: Following preliminary decisions and a literature review, a list of 52 items to be considered for inclusion in the tool was compiled. Eleven experts were invited to join a Delphi panel and 10 accepted. Four Delphi rounds reduced the preliminary tool-Quality-Assessment Tool for Experimental Bruxism Studies (Qu-ATEBS)- to 8 items: study aim, study sample, control condition or group, study design, experimental bruxism task, statistics, interpretation of results, and conflict of interest statement. Consensus among the Delphi panelists yielded good face validity. Inter-observer reliability was acceptable (k = 0.77). Discriminative validity was excellent (phi coefficient 1.0; P < .01). During refinement, 1 item (no. 8) was removed. CONCLUSION: Qu-ATEBS, the seven-item evidence-based quality assessment tool developed here for use in systematic reviews of experimental bruxism studies, exhibits face validity, excellent discriminative validity, and acceptable inter-observer reliability. Development of quality assessment tools for many other topics in the orofacial pain literature is needed and may follow the described procedure.

  • 7. de Boever, Jan A
    et al.
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Orthlieb, Jean-Daniel
    Steenks, Michel
    Recommendations by the EACD for examination, diagnosis, and management of patients with temporomandibular disorders and orofacial pain by the general dental practitioner2008In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 22, no 3, p. 268-278Article in journal (Refereed)
    Abstract [en]

    The Council fo the European Academy of Craniomandibular Disorders charged the Educational Committee with the task of establishing Guidelines and Recommendations for the examination, diagnosis, and management of patients with temporomandibular disorders and orofacial pain by the general dental practitioner. It was not their purpose to present a thorough and critical review of the vast amount of literature avaliable but to summarize the at-present generally accepted clinical approach. These recommendations are based as much as possible on scientific evidence and on sound clinical judgement in cases where only partial evidence or contradictory data were found.

  • 8.
    Ekberg, EwaCarin
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Vallon, Danila
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    The Efficacy of Appliance Therapy in Patients with Temporomandibular Disorders of Mainly Myogenous Origin. A Randomized, Controlled, Short-term Trial2003In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 17, no 2, p. 133-139Article in journal (Refereed)
    Abstract [en]

    Aims: To compare the short-term efficacy of treatment with a stabilization appliance compared with that of a non-occlusal, control appliance in patients with temporomandibular disorders (TMD) of mainly myogenous origin. Methods: A randomized, controlled trial was performed with 60 patients suffering from myofascial pain. Patients were randomly assigned to a treatment or a control group. The treatment group was treated by means of a stabilization appliance and the control group by means of a non-occlusal appliance. Symptoms and signs were registered before and after 10 weeks of treatment. Results: Improvement of overall subjective symptoms was reported in both groups, but significantly more often in the treatment group than in the control group (P = .000). The prevalence of daily or constant pain showed a significant reduction in the treatment group (P = .028) compared with the control group. There was a significant decrease in the number of tender masticatory muscles in the treatment group (P = .018) compared with the control group. Conclusion: The results of this short-term evaluation suggest that the stabilization appliance is more effective in alleviating symptoms and signs in patients with TMD of mainly myogenous origin than a control, non-occlusal appliance. The stabilization appliance can therefore be recommended for the therapy of these patients.

  • 9.
    Häggman-Henrikson, Birgitta
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Westergren, Hans
    Axelsson, Susanna
    Temporomandibular disorder pain after whiplash trauma: a systematic review2013In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 27, no 3, p. 217-226Article in journal (Refereed)
    Abstract [en]

    AIMS: To assess, by systematic review of the literature, (1) the prevalence and incidence of temporomandibular disorder (TMD) pain after whiplash trauma, and (2) whether treatment modalities commonly used for TMD are equally effective in patients with solely TMD pain and those with TMD/whiplash-associated disorders (WAD) pain. METHODS: A systematic literature search of the PubMed, Cochrane Library, and Bandolier databases was conducted from January 1966 through October 2012. The systematic search identified 125 articles. After an initial screening of abstracts, 45 articles were reviewed in full text. Two investigators evaluated the methodological quality of each identified study. RESULTS: Eight studies on prevalence/incidence of TMD pain in WAD and four studies on interventions in TMD pain and WAD met the inclusion criteria. The reported median prevalence of TMD pain after whiplash trauma was 23% (range 2.4% to 52%) and the incidence ranged from 4% to 34%. For healthy controls, the reported median prevalence was 3% (range 2.5% to 8%) and the incidence ranged from 4.7% to 7%. For patients with a combination of TMD pain and WAD, treatment modalities conventionally used for TMD, such as jaw exercises and occlusal splints, had less of an effect (median improvement rate of 48%, range 13% to 68%) compared to TMD patients without a whiplash injury (75%, range 51% to 91%). CONCLUSION: There is some evidence that prevalence and incidence of TMD pain is increased after whiplash trauma. The poorer treatment outcome suggests that TMD pain after whiplash trauma has a different pathophysiology compared to TMD pain localized to the facial region.

  • 10. Johansson, Anders
    et al.
    Unell, Lennart
    Malmö högskola, Faculty of Odontology (OD).
    Carlsson, Gunnar E
    Söderfeldt, Björn
    Malmö högskola, Faculty of Odontology (OD).
    Halling, Arne
    Gender difference in symptoms related to temporomandibular disorders in a population of 50-year-old subjects2003In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 17, no 1, p. 29-35Article in journal (Other academic)
    Abstract [en]

    Aims: To investigate, by means of a mail questionnaire, the prevalence of symptoms related to temporomandibular disorders (TMD) in 50-year-old subjects living in the counties of Örebro and Östergötland, Sweden. Methods: The total population comprised 8,888 individuals, and the overall response rate was 71%. A clinical evaluation of the masticatory system was performed in subgroups to validate the responses to the questionnaire. There was satisfactory correspondence between self-reports and welldefined clinical conditions. Results: Women reported, more often than men, pain from the temporomandibular joints (TMJs), TMJ sounds, bruxism, sensitive teeth, and burning mouth symptoms. The prevalences of difficulties in jaw opening, loss of anterior teeth due to trauma, and masticatory problems were greater in men than in women. No gender difference was found in the number of remaining teeth. Logistic regression analysis with pain from the TMJ as the dependent variable identified bruxism, impaired chewing efficiency, and gender (women) as the most significant risk factors. With reduced chewing ability as the dependent variable, several missing teeth constituted the highest risk, followed by pain from the TMJ, bruxism, gender (men), and loss of anterior teeth due to trauma. Conclusion: There were significant gender differences in reported TMD-related symptoms in 50-year-old Swedes. Bruxism was a significant risk factor for pain from the TMJ. Reduced number of teeth and pain from the TMJ were significant risk factors for impaired chewing ability.

  • 11. Koh, Kwang-Joon
    et al.
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Petersson, Arne
    Malmö högskola, Faculty of Odontology (OD).
    Rohlin, Madeleine
    Malmö högskola, Faculty of Odontology (OD).
    Relationship between clinical and magnetic resonance imaging diagnoses and findings in degenerative and inflammatory temporomandibular joint diseases: a systematic literature review2009In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 23, no 2, p. 123-139Article in journal (Refereed)
    Abstract [en]

    AIM: To describe evidence for a relationship between diagnoses and findings of clinical examination and diagnoses and findings of magnetic resonance imaging (MRI) examination for degenerative and inflammatory temporomandibular joint diseases. METHODS: PubMed and the Cochrane Library were searched using specific indexing terms and reference lists were hand-searched. Included publications satisfied pre-established criteria. Primary studies were interpreted using a modification of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. RESULTS: The literature search yielded 219 titles and abstracts. Eighty-two studies were selected and read in full-text. After data extraction and interpretation with the QUADAS tool, 23 studies remained. There was a vast heterogeneity in study design, clinical examination methods, and diagnostic criteria. No clear evidence was found for a relationship between clinical and MRI diagnoses and findings. Several studies reported a relationship between clinical pain and internal derangements diagnosed with MRI, but the calculated odds ratio (OR) for this relationship was generally low (1.54-2.04). ORs for the relationship between pain and disc displacement without reduction (4.82) or between crepitation and disc displacement without reduction (3.71) were higher. CONCLUSION: This review reveals a need for studies with improved quality in reporting of samples, examination techniques, findings, and definitions and rationales for cutoffs, categories, and diagnoses. We recommend that standardized protocols such as the Research Diagnostic Criteria for temporomandibular disorders (RDC/TMD) and the Standards for Reporting of Diagnostic Accuracy (STARD) statement be implemented in future studies.

  • 12.
    List, Thomas
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Axelsson, Susanna
    Leijon, Göran
    Pharmacologic interventions in the treatment of temporomandibular disorders, atypical facial pain, and burning mouth syndrome. A qualitative systematic review2003In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 17, no 4, p. 301-310Article, review/survey (Other academic)
    Abstract [en]

    AIMS: To carry out a systematic review of the literature in order to assess the pain-relieving effect and safety of pharmacologic interven-tions in the treatment of chronic temporomandibular disorders (TMD), including rheumatoid arthritis (RA), as well as atypical facial pain (AFP), and burning mouth syndrome (BMS). METHODS: Study selection was based on randomized clinical trials (RCTs). Inclusion criteria included studies on adult patients (> or = 18 years) with TMD, RA of the temporomandibular joint (TMJ), AFP, or BMS and a pain duration of > 3 months. Data sources included Medline, Cochrane Li-brary, Embase, and Psych Litt. RESULTS: Eleven studies with a total of 368 patients met the inclusion criteria. Four trials were on TMD patients, 2 on AFP, 1 on BMS, 1 on RA of the TMJ, and 3 on mixed groups of patients with TMD and AFP. Of the latter, amitriptyline was effective in 1 study and benzodiazepine in 2 studies; the effect in 1 of the benzodiazepine studies was improved when ibuprofen was also given. One study showed that intra-articular injection with glucocorti-coid relieved the pain of RA of the TMJ. In 1 study, a combination of paracetamol, codeine, and doxylamine was effective in reducing TMD pain. No effective pharmacologic treatment was found for BMS. Only minor adverse effects were reported in the studies. CONCLUSION: The common use of analgesics in TMD, AFP, and BMS is not sup-ported by scientific evidence. More large RCTs are needed to deter-mine which pharmacologic interventions are effective in TMD, AFP, and BMS.

  • 13.
    List, Thomas
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    John, Mike T
    Ohrbach, Richard
    Schiffman, Eric L
    Truelove, Edmond L
    Anderson, Gary C
    Influence of temple headache frequency on physical functioning and emotional functioning in subjects with temporomandibular disorder pain2012In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 26, no 2, p. 83-90Article in journal (Refereed)
    Abstract [en]

    AIMS: To investigate the relationship of headache frequency with patient-reported physical functioning and emotional functioning in temporomandibular disorder (TMD) subjects with concurrent temple headache. METHODS: The Research Diagnostic Criteria for TMD (RDC/TMD) Validation Project identified, as a subset of 614 TMD cases and 91 controls (n = 705), 309 subjects with concurrent TMD pain diagnoses (RDC/TMD) and temple headache. The temple headaches were subdivided into infrequent, frequent, and chronic headache according to the International Classification of Headache Disorders, second edition (ICHD-II). Study variables included self-report measures of physical functioning (Jaw Function Limitation Scale [JFLS], Graded Chronic Pain Scale [GCPS], Short Form-12 [SF-12]) and emotional functioning (depression and anxiety as measured by the Symptom Checklist-90R/SCL-90R). Differences among the three headache subgroups were characterized by increasing headache frequency. The relationship between ordered headache frequency and physical as well as emotional functioning was analyzed using linear regression and trend tests for proportions. RESULTS: Physical functioning, as assessed with the JFLS (P < .001), SF-12 (P < .001), and GCPS (P < .001), was significantly associated with increased headache frequency. Emotional functioning, reflected in depression and anxiety, was also associated with increased frequency of headache (both P < .001). CONCLUSION: Headache frequency was substantially correlated with reduced physical functioning and emotional functioning in subjects with TMD and concurrent temple headaches. A secondary finding was that headache was precipitated by jaw activities more often in subjects with more frequent temple headaches.

  • 14.
    List, Thomas
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Leijon, Göran
    Helkimo, Martti
    Öster, Anders
    Dworkin, Samuel
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Clinical findings and psychosocial factors in patients with atypical odontalgia: a case-control study2007In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 21, no 2, p. 89-98Article in journal (Refereed)
    Abstract [en]

    AIM: To provide a systematic description of clinical findings and psychosocial factors in patients suffering from atypical odontalgia (AO). METHODS: Forty-six consecutive AO patients (7 men and 39 women; mean age, 56 years; range, 31 to 81 years) were compared with 35 control subjects (11 men and 24 women; mean age, 59 years; range, 31 to 79 years). RESULTS: The pain of the AO patients was characterized by persistent, moderate pain intensity (mean, 5.6 +/- 1.9) with long pain duration (mean, 7.7 +/- 7.8 years). Eighty-three percent reported that onset of pain occurred in conjunction with dental treatment. No significant difference was found between the groups in number of remaining teeth or number of root fillings. Temporomandibular disorder (TMD) pain (P < .001), tension-type headache (P < .002), and widespread pain (P < .001) were significantly more common among AO patients than controls. Significantly higher scores for somatization (P < .01) and depression (P < .01) and limitations in jaw function (P < .001) were found for the AO group compared with the control group. Significant differences between groups were found in 4 general health domains: role-physical (P < .001), bodily pain (P < .001), vitality (P < .004), and social functioning (P < .001). CONCLUSION: A majority of the AO patients reported persistent, moderately intense intraoral pain that in most cases had an onset in conjunction with dental treatment. AO patients had more comorbid pain conditions and higher scores for depression and somatization. Significant limitation in jaw function and significantly lower scores on quality of life measures were found for AO patients compared with controls.

  • 15.
    Nilner, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Doepel, Marika
    Andersson, Johanna
    Selovuo, Kirsti
    Le Bell, Yrsa
    Short-term Effectiveness of a Prefabricated Occlusal Appliance in Patients with Myofascial Pain2008In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 22, no 3, p. 209-218Article in journal (Refereed)
    Abstract [en]

    Aims: To compare the short-term effectiveness of a stabilization appliance with a prefabricated occlusal appliance in myofascial pain patients in a randomized controlled trial. Methods: Sixty-five patients at 2 centres were assigned to a stabilization appliance group (S group, n = 33) or a prefabricated appliance (Relax) group (R group, n = 32). The patients had been suffering from temporomandibular disorder (TMD) pain for 3 months to 40 years. The patients were examined for symptoms and signs of temporomandibular disorders according to the Research Diagnostic Criteria for TMD and treated by a general practitioner. Treatment outcomes regarding pain, registered on a visual analogue scale, and overall ratings of pain, registered on a verbal scale, were evaluated at 6- and 10- week follow-up appointments, and the data from the groups were compared statistically, results: The main treatment outcome in the 2 groups was a positive improvement of overall symptoms without any statistically significant differences between groups at either 6 or 10 weeks. At the 6-week follow-up, 72% of ala patients reported a 30% reduction of the worst pain, and 55% of the patients reported a 50% reduction of the worst pain, whereas at the 10-week follow-up, the percentages were 69% and 61%, respectively. According to the verbal scale, 85% of all patients reported themselves to be “better,” “much better,” or “symptom-free” at the 6-week follow-up, and 83% reported this at the 10-week follow-up. Conclusion: The effectiveness of the prefabricated occlusal appliance seemed to be the same as that of the stabilization appliance. The prefabricated appliance can therefore be recommended as a short-term therapy in adult patients with myofascial pain.

  • 16.
    Nilner, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Steenks, Michel
    de Boever, Jan A
    Ciancaglini, Riccardo
    Könönen, Mauno
    Orthlieb, Jean-Daniel
    Guidelines for curriculum of undergraduate and postgraduate education in orofacial pain and temporomandibular disorders in Europe2003In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 17, no 4, p. 359-362Article in journal (Other academic)
  • 17.
    Nilsson, Ing-Marie
    et al.
    Specialist Center for Oral Rehabilitation, Linköping, Sweden.
    Drangsholt, Mark
    Oral Medicine, Dental Public Health Sciences, University of Washington, Seattle, WA, United States.
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Impact of temporomandibular disorder pain in adolescents: differences by age and gender2009In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 23, no 2, p. 115-122Article in journal (Refereed)
    Abstract [en]

    AIMS: To evaluate the impact of temporomandibular disorder (TMD) pain by age and gender in adolescents, with assessments of this impact specifically on school absence, medication consumption, perceived need for treatment, jaw function limitation, depressive symptoms scores and somatic complaints, and graded chronic pain scale. METHODS: In a population-based sample, a mailed questionnaire was sent to 350 patients with self-reported TMD pain (group 1) and 350 healthy age- and sex-matched individuals (group 2) aged 12 to 19 years 2 to 4 weeks after their annual dental examination. The groups were divided into younger (age 12 to 15) and older (age 16 to 19) groups. Descriptive statistics and 95% confidence intervals were used, and chi-square and t-tests were calculated for analyzing group differences. Odds ratios were estimated using logistic regression. RESULTS: As expected, groups 1 and 2 differed significantly in most variables related to psychosocial and behavioral factors. For adolescents reporting TMD pain once a week or more, no gender or age differences in pain intensity were seen. Jaw function limitation, depressive symptoms scores, somatic complaints, graded chronic pain, and perceived need for TMD treatment were all significantly higher in girls than in boys. Older girls reported higher analgesic consumption and school absences than older boys. CONCLUSION: Girls reporting TMD pain had significantly greater impact on behavioral and psychosocial factors than boys. Almost one third of older girls, compared to one out of 10 older boys, reported school absences and analgesic consumption because of their TMD pain.

  • 18.
    Nilsson, Ing-Marie
    et al.
    Public Dental Service, Skarptorp, Norrköping, Sweden.
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Departments of Oral Medicine and Dental Public Health Services, School of Dentistry, University of Washington, Seattle, WA, United States.
    Incidence and temporal patterns of temporomandibular disorder pain among Swedish adolescents2007In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 21, no 2, p. 127-32Article in journal (Refereed)
    Abstract [en]

    AIMS: To estimate the incidence of temporomandibular disorder (TMD) pain among Swedish adolescents by age and gender and to describe the temporal patterns of TMD pain.

    METHODS: This 3-year longitudinal study was carried out at all Public Dental Service clinics in a Swedish county from 2000 to 2003. All individuals aged 12 to 19 years in the county who visited the clinics for annual examinations were eligible for the study.

    RESULTS: Overall, the incidence of TMD pain among all adolescents was 2.9% annually among 2,255 participating adolescents. Incidence among girls was significantly higher than in boys, 4.5% versus 1.3%, respectively. Incidence increased with age in girls and boys, although less so in boys (3.0% to 6.9% versus 1.7% to 2.6%). These adolescents were re-examined annually for 3 years, and a fluctuating pattern of TMD pain was common. Overall, 11.4% of all subjects reported TMD pain on at least 1 occasion; 88.6% of the cohort remained pain-free. Of those reporting TMD pain, 4.7% could be defined as intermittent cases, 3.1% were single-incident cases, 0.9% were recurrent cases, and 0.9% had continuing pain for 1 or 2 years.

    CONCLUSION: The incidence of self-reported TMD pain among Swedish adolescents aged 12 to 19 years increased with age, particularly among girls. The pattern of pain in most adolescents fluctuated over time. Less than 1% of the cohort had continued pain over each year, and the majority of these subjects were girls.

  • 19. Nilsson, Ing-Marie
    et al.
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Incidence of temporomandibular disorders and pain among adolescents in a Swedish county2007In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 21, no 2, p. 127-132Article in journal (Refereed)
    Abstract [en]

    AIMS: To estimate the incidence of temporomandibular disorder (TMD) pain among Swedish adolescents by age and gender and to describe the temporal patterns of TMD pain. METHODS: This 3-year longitudinal study was carried out at all Public Dental Service clinics in a Swedish county from 2000 to 2003. All individuals aged 12 to 19 years in the county who visited the clinics for annual examinations were eligible for the study. RESULTS: Overall, the incidence of TMD pain among all adolescents was 2.9% annually among 2,255 participating adolescents. Incidence among girls was significantly higher than in boys, 4.5% versus 1.3%, respectively. Incidence increased with age in girls and boys, although less so in boys (3.0% to 6.9% versus 1.7% to 2.6%). These adolescents were re-examined annually for 3 years, and a fluctuating pattern of TMD pain was common. Overall, 11.4% of all subjects reported TMD pain on at least 1 occasion; 88.6% of the cohort remained pain-free. Of those reporting TMD pain, 4.7% could be defined as intermittent cases, 3.1% were single-incident cases, 0.9% were recurrent cases, and 0.9% had continuing pain for 1 or 2 years. CONCLUSION: The incidence of self-reported TMD pain among Swedish adolescents aged 12 to 19 years increased with age, particularly among girls. The pattern of pain in most adolescents fluctuated over time. Less than 1% of the cohort had continued pain over each year, and the majority of these subjects were girls.

  • 20.
    Nilsson, Ing-Marie
    et al.
    Public Dental Service, Skarptorp, Norrköping, Sweden.
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Oral Medicine, Dental Public Health Sciences, University of Washington, Seattle, WA, United States.
    Prevalence of temporomandibular pain and subsequent dental treatment in Swedish adolescents2005In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 19, no 2, p. 144-150Article in journal (Refereed)
    Abstract [en]

    Aim: To assess the prevalence of temporomandibular disorder (TMD) pain in Swedish adolescents and related TMD treatment by dentists. Methods: All youth aged 12–19 years in Östergötland County were eligible to participate in the investigation, which took place at public dental clinics during annual examinations in 2000. The subjects were asked two questions: 1) Do you have pain in your temples, face, jaw joint, or jaws once a week or more? or 2) Do you have pain when you open your mouth wide or chew, once a week or more? Two hundred dental records of patients with TMD pain and 100 records of patients with documented dental caries were randomly selected from the population. A comparison of treatment for TMD pain and caries was assessed from these records. Results: Among the 28,899 youths participating, 4.2% reported TMD pain. The prevalence increased with age, and a significant difference was seen between boys (2.7%) and girls (6.0%) (P<0.001). In 43% of the patients with TMD pain, the TMD condition was noted in the record. TMD-related treatment was given to 34% of patients with TMD pain in dental clinics, whereas 100% of the patients with caries received restorative treatment. The most common treatment modalities for the TMD group were information about TMD and occlusal splints. Conclusion: The prevalence of self-reported TMD pain was relatively low, increased in age, and was more common in girls than boys. One-third of the patients with TMD pain received some form of TMD treatment in the dental clinics.

  • 21.
    Nilsson, Ing-Marie
    et al.
    Public Dental Service, Skarptorp, Norrköping, Sweden.
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Department of Oral Medicine, School of Dentistry, University of Washington, Seattle, WA, United States.
    The reliability and validity of self-reported temporomandibular disorder pain in adolescents2006In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 20, no 2, p. 138-44Article in journal (Refereed)
    Abstract [en]

    AIMS: To evaluate the reliability and validity of self-reported pain associated with temporomandibular disorders (TMD) in adolescents and to determine how this validity may change over time. The authors' hypothesis was that self-reported pain can be used to reliably and accurately detect adolescents with TMD pain.

    METHODS: One hundred twenty adolescents, 60 with self-reported TMD pain and 60 age- and gender-matched controls without TMD pain, were examined twice. At the first examination at a Public Dental Service clinic, self-reported TMD pain was recorded for each patient. At the second examination, a clinical examination was completed, blind to the patients' self-report of pain symptoms, after which self-reported TMD pain was again recorded. The clinical examination was based upon the Research Diagnostic Criteria for TMD (RDC/TMD). Self-reported TMD pain in this investigation was based upon the subjects' responses to 2 questions: (1) Do you have pain in your temples, face, temporomandibular joint (TMJ), or jaws once a week or more? and (2) Do you have pain when you open your mouth wide or chew once a week or more?

    RESULTS: Test-retest reliability of .83 (kappa) was found for the 2 questions. The sensitivity was .98 (95% CI, .90 to 1.0) and specificity was .90 (95% CI, .81 to .95) for comparison of assessments made on the same day. Sensitivity was .96 (95% CI, .85 to .99) and specificity .83 (95% CI, .72 to .90) for assessments made 2 to 4 weeks apart.

    CONCLUSION: Very good reliability and high validity were found for the self-reported pain questions. A short time interval between the screening question and examination slightly increased the accuracy of the measure. In adolescent populations, the questions in this study can be used to screen for TMD pain.

  • 22. Nilsson, Ing-Marie
    et al.
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Willman, Ania
    Adolescents with Temporomandibular Disorder Pain - The Living with TMD Pain Phenomenon2011In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 25, no 2, p. 107-116Article in journal (Refereed)
    Abstract [en]

    AIMS: To acquire a deeper understanding of adolescents' experiences of living with temporomandibular disorder (TMD) pain. METHODS: Twenty-one adolescents with TMD pain, aged 15 to 19, were strategically selected from a group of patients referred to an orofacial pain clinic. The patients were examined and received diagnoses per the Research Diagnostic Criteria for TMD. One-on-one interviews that followed a semistructured protocol focused on the patient's experiences of living with TMD pain. The interviews were recorded and transcribed verbatim, followed by content analysis to obtain a deeper understanding of adolescents' experiences living with TMD pain. RESULTS: Content analysis led to the overall theme "Adolescents with TMD live with recurrent pain; physical problems and daily demands form a vicious circle that causes adolescents to oscillate between hope and despondency." The latent content forming the theme is grounded in three categories that evolved from 13 subcategories. For instance, five subcategories-headache; headache on awakening; jaw and tooth pain; constant thoughts of pain; and popping, cracking, clicking, and locking-formed the category that was labeled TMD pain is recurrent. The latent interpretation, ie, the meaning, of this category was that adolescents with TMD pain constantly thought about the pain, even when it was absent. CONCLUSION: TMD pain is a substantial problem for affected adolescents and has consequences for all aspects of their lives. In this study, the adolescents were able to talk openly and introduce issues outside of the interview protocol. Qualitative analysis deepens our understanding of the adolescent patient with TMD pain.

  • 23. Ohrbach, Richard
    et al.
    Larsson, Pernilla
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    The Jaw Functional Limitation Scale: Development, Reliability, and Validity of 8-Item and 20-Item Versions2008In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 22, no 3, p. 219-230Article in journal (Refereed)
    Abstract [en]

    Aims: To develop the Jaw Functional Limitation Scale (JFLS), comprising 3 constructs and a global scale, based on a preliminary instrument, and to investigate content validity of the overall functional limitation construct, reliability, and generalizability. A temporomandibular disorders (TMD) patient group, compared to other diagnostic groups, was hypothesized to report futher limitation in each of the 3 new proposed constructs. Methods: One hundred thirty-two consecutive patients from 5 diagnostic groups (TDM, primary Sjögren syndrome, burning mouth syndrome, skeletal malocclusion, and healthy controls) participated in a known-groups validity design. Fifty-two jaw functional limitation items were identified by an expert panel for content validity. Rasch methodology was used for item reduction and assessment of model fit. The instrument was retested 1 to 2 weeks later. Results: Three constructs (mastication, vertical jaw mobility, and emotional and verbal expression) comprising a total of 20 items were identified along with a global scale (the JFLS-20), and each exhibited excellent psychometric properties with respect to modeled variance, item fit, reliability, and internal consistency. The psychometric properties of each construct remained satisfactory when analyzed separately among the 5 diagnostic groups. Temporal stability was satisfactory. A shorter 8-item form (JFLS-8) also proved useful for assessing global functional jaw limitation. Conclusion: The JFLS-20 is an organ-specific instrument comprising 3 constructs for assessing functional status of the masticatory system; the 3 scales exhibit properties that are ideal for both research and patient evaluation in patient groups with a range of functional limitations of the jaw. The JFLS-8 emerged as a short form for measuring global functional limitation of the jaw.

  • 24.
    Pigg, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Seven-year follow-up of patients diagnosed with atypical odontalgia: a prospective study2013In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 27, no 2, p. 151-164Article in journal (Refereed)
    Abstract [en]

    AIMS: To examine the long-term prognosis of 46 previously examined atypical odontalgia (AO) patients. METHODS: In 2002 and 2009, AO patients completed validated instruments measuring pain characteristics (pain frequency and intensity), physical functioning (Graded Chronic Pain Severity, GCPS) and emotional functioning (Symptoms Checklist, SCL-90R). The main outcome was global improvement. Baseline data on quantitative somatosensory testing and responsiveness to lidocaine injection were available for a subgroup of patients. Paired tests compared baseline and follow-up data, and logistic regression explored the possible prognostic value of baseline data. RESULTS: Data from 37 patients (80%) were obtained. Thirteen patients (35%; 95% confidence intervals [CI] 20.2%-52.5%) rated their overall pain status as significantly improved, 22 (60%; 95% CI 42.1%-75.3%) as a little improved or unchanged, and two patients (5%; 95% CI 0.7%-18.2%) as worse. Five patients (14%; 95% CI 4.5%-28.8%) were pain-free, indicated by a characteristic pain intensity score of 0. Average pain intensity decreased (from 5.7 ± 2.0 to 3.5 ± 2.4; P < .001). Pain frequency (P < .001) and GCPS (P < .001) also decreased, whereas SCL-90R scores remained unchanged and 26 of the 37 patients reported ongoing treatment. Low baseline pain intensity was the only factor predictive of favorable outcome. CONCLUSION: A third of the AO patients improved considerably over time, but for many of the patients, AO was a persistent and treatment-resistant condition.

  • 25.
    Pigg, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Orofacial thermal thresholds: time-dependent variability and influence of spatial summation and test site2011In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 25, no 1, p. 39-48Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate time-dependent variability and influence of test site and stimulation area size on intraoral cold detection, warmth detection, and heat pain thresholds. Methods: Thirty healthy volunteers (15 women and 15 men) participated. Six extra- and intraoral sites were examined, and cold detection, warmth detection, and heat pain thresholds were measured. Time variability and influence of spatial summation were also studied at one site-the tip of the tongue-three times over a 6-week period. One-way ANOVA for repeated measures and paired sample t test compared mean values and SD within and between sites for all thresholds. Results: Several between-site differences were significant (P < .05). Lowest intraoral thresholds for all stimuli were measured at the tongue site, and at the tongue, thresholds for warmth detection and heat pain, but not cold detection, decreased with increasing size of stimulation area (P < .05). Overall, thresholds at the tongue site varied nonsignificantly over time (P > .05). Conclusion: Test site affects orofacial thermal thresholds substantially, whereas time variability and spatial summation on the tongue appear to be modest.

  • 26. Rudin, Åsa
    et al.
    Eriksson, Lars
    Malmö högskola, Faculty of Odontology (OD).
    Liedholm, Rolf
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Werner, Mads U
    Prediction of postoperative pain after mandibular third molar surgery2010In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 24, no 2, p. 189-196Article in journal (Refereed)
    Abstract [en]

    Aims: To evaluate the predictive potential of preoperative psychological and psychophysiological variables in estimating severity of postoperative pain following mandibular third molar surgery (MTMS). Methods: Following ethical committee approval and informed consent, 40 consecutive patients scheduled for MTMS were included. Preoperative psychometric indicators of anxiety, depression, and vulnerability were evaluated by patient questionnaires. Thermal thresholds and heat pain perception (1 second phasic stimuli: 44°C to 48°C) were evaluated with quantitative sensory testing techniques. Standardized surgery was performed during local anesthesia. Postoperative pain management was with rescue paracetamol and ibuprofen. The patients were instructed to record each day their pain at rest and during dynamic conditions, and their requirement of analgesics for 14 days following surgery. Results: Thirty-eight patients completed the study. Eight patients were readmitted because of pain. During the postoperative period, one or more episodes of moderate to severe pain (> 30 on a visual analog scale) was reported by 60% (23/38) at rest, 63% (24/38) during mouth-opening, and 73% (28/38) during eating. In a multiple regression model, the combination of psychological vulnerability and heat pain perception rendered a predictive model that could account for 15 to 30% of the variance in postoperative pain during resting and dynamic conditions (P = .03 to .001).Conclusion: Implementation of clinically relevant preoperative screening methods may offer more efficacious postoperative pain therapies to pain-susceptible individuals undergoing mandibular third molar surgery.

  • 27.
    Schiffman, Eric
    et al.
    Department of Diagnostic and Biological Sciences, University of Minnesota, United States.
    Ohrbach, Richard
    Department of Oral Diagnostic Sciences, University at Buffalo, United States.
    Truelove, Edmund
    Department of Oral Medicine, University of Washington, United States.
    Tai, Feng
    Division of Biostatistics, University of Minnesota, United States.
    Anderson, Gary
    Department of Diagnostic and Biological Sciences, University of Minnesota, United States.
    Wei, Pan
    Division of Biostatistics, University of Minnesota, United States.
    Gonzalez, Yoly
    Department of Oral Diagnostic Sciences, University at Buffalo, United States.
    John, Mike T
    Department of Diagnostic and Biological Sciences, University of Minnesota, United States.
    Sommers, Earl
    Department of Oral Medicine, University of Washington, United States.
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Velly, Ana
    University of Minnesota, United States; McGill University, Canada.
    Kang, Wenjun
    Institute for Health Informatics, University of Minnesota, United States.
    Look, John
    Department of Diagnostic and Biological Sciences, University of Minnesota, United States.
    The Research Diagnostic Criteria for Temporomandibular Disorders. V: methods used to establish and validate revised Axis I diagnostic algorithms2010In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 24, no 1, p. 63-78Article in journal (Refereed)
    Abstract [en]

    Aims: To derive reliable and valid revised Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms for clinical TMD diagnoses. Methods: The multisite RDC/TMD Validation Project’s dataset (614 TMD community and clinic cases, and 91 controls) was used to derive revised algorithms for Axis I TMD diagnoses. Validity of diagnostic algorithms was assessed relative to reference standards, the latter based on consensus diagnoses rendered by two TMD experts using criterion examination data, including temporomandibular joint imaging. Cutoff points for target validity were sensitivity ≥ 0.70 and specificity ≥ 0.95. Reliability of revised algorithms was assessed in 27 study participants. Results: Revised algorithm sensitivity and specificity exceeded the target levels for myofascial pain (0.82, 0.99, respectively) and myofascial pain with limited opening (0.93, 0.97). Combining diagnoses for any myofascial pain showed sensitivity of 0.91 and specificity of 1.00. For joint pain, target sensitivity and specificity were observed (0.92, 0.96) when arthralgia and osteoarthritis were combined as “any joint pain.” Disc displacement without reduction with limited opening demonstrated target sensitivity and specificity (0.80, 0.97). For the other disc displacement diagnoses, osteoarthritis and osteoarthrosis, sensitivity was below target (0.35 to 0.53), and specificity ranged from 0.80 to meeting target. Kappa for revised algorithm diagnostic reliability was ≥ 0.63. Conclusion: Revised RDC/TMD Axis I TMD diagnostic algorithms are recommended for myofascial pain and joint pain as reliable and valid. However, revised clinical criteria alone, without recourse to imaging, are inadequate for valid diagnosis of two of the three disc displacements as well as osteoarthritis and osteoarthrosis.

  • 28. Schiffman, Eric
    et al.
    Truelove, Edmund
    Ohrbach, Richard
    Anderson, Gary
    John, Mike
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Look, John
    The Research Diagnostic Criteria for Temporomandibular Disorders. I: overview and methodology for assessment of validity2010In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 24, no 1, p. 7-24Article in journal (Refereed)
    Abstract [en]

    AIMS: The purpose of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Validation Project was to assess the diagnostic validity of this examination protocol. The aim of this article is to provide an overview of the project's methodology, descriptive statistics, and data for the study participant sample. This article also details the development of reliable methods to establish the reference standards for assessing criterion validity of the Axis I RDC/TMD diagnoses. METHODS: The Axis I reference standards were based on the consensus of two criterion examiners independently performing a comprehensive history, clinical examination, and evaluation of imaging. Intersite reliability was assessed annually for criterion examiners and radiologists. Criterion examination reliability was also assessed within study sites. RESULTS: Study participant demographics were comparable to those of participants in previous studies using the RDC/TMD. Diagnostic agreement of the criterion examiners with each other and with the consensus-based reference standards was excellent with all kappas > or = 0.81, except for osteoarthrosis (moderate agreement, k = 0.53). Intrasite criterion examiner agreement with reference standards was excellent (k > or = 0.95). Intersite reliability of the radiologists for detecting computed tomography-disclosed osteoarthrosis and magnetic resonance imaging-disclosed disc displacement was good to excellent (k = 0.71 and 0.84, respectively). CONCLUSION: The Validation Project study population was appropriate for assessing the reliability and validity of the RDC/TMD Axis I and II. The reference standards used to assess the validity of Axis I TMD were based on reliable and clinically credible methods.

  • 29. Visscher, Corine M
    et al.
    Naeije, Machiel
    De Laat, Antoon
    Michelotti, Ambra
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Craane, Bart
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Farella, Mauro
    Lobbezoo, Frank
    Diagnostic accuracy of temporomandibular disorder pain tests: a multicenter study2009In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 23, no 2, p. 108-114Article in journal (Refereed)
    Abstract [en]

    AIMS: To estimate the diagnostic accuracy of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) clinical examination and of the dynamic/static tests for the recognition of TMD pain. Since the diagnosis of TMD pain is especially complicated in persistent orofacial pain patients, the test outcomes in persistent TMD pain patients were contrasted to those in two control groups: a group of persistent dental pain patients and a group of pain-free subjects. METHODS: In 125 persistent TMD pain patients, 88 persistent dental pain patients, and 121 pain-free subjects, a blind and standardized clinical examination was performed. RESULTS: For the RDC/TMD, sensitivity (88%) was high and specificity was low (pain-free group: 71%; dental pain group: 45%). For the dynamic/static tests, sensitivity was 65% and specificities were 91% and 84%, respectively. Comparing the outcomes of the two examinations showed higher positive likelihood ratios for dynamic/static tests (P < .001), and lower negative likelihood ratios for the RDC/TMD examination (P < .01). CONCLUSION: For the confirmation of a suspicion of TMD pain, it is better to rely on positive dynamic/static tests. To confirm the absence of TMD pain, it is better to rely on a negative RDC/TMD examination.

  • 30. Wiese, Mie
    et al.
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Bakke, Merete
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Hintze, Hanne
    Petersson, Arne
    Malmö högskola, Faculty of Odontology (OD).
    Knutsson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Wenzel, Ann
    Association Between Temporomandibular Joint Symptoms, Signs, and Clinical Diagnosis Using the RDC/TMD and Radiographic Findings in Temporomandibular Joint Tomograms2008In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 22, no 3, p. 239-251Article in journal (Refereed)
    Abstract [en]

    Aim: To identify associations between clinical symptoms of temporomandibular joint disorders and radiographic findings. Methods: Two hundred four adult patients (156 women, 48 men, mean age 40 years) with temporomandibular joint (TMJ) pain/sounds or changes in mandibular motion were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Bilateral sagittal corrected TMJ tomograms in closed and open positions were assessed fo the presence of flattening, erosion, osteophytes, and sclerosis in the joint components and the range of mandibular motion. Logistic regression analyses were performed with the radiographic findings as the dependent variables and the following clinical variables as independent variables: opening pattern, maximal jaw opening, TMJ sounds, number of painful muscle/TMJ sites, duration of pain, presence of arthritic disease, depression and somatisation scores, graded chronic pain, and age and gender. Resluts: Coarse crepitus on opening/closing (odds ratio [OR] ≥ 3.12), on lateral excursions (odds ratio ≥ 4.06), and on protrusion (OR ≥ 5.30) was associated with increased risk of degenerative findings in tomograms. A clinical diagnosis of osteoarthritis increased the risk of radiographic findings (OR ≥ 2.95) and so did increasing age (OR ≥ 1.03 per year) and the female gendera (OR ≥ 2.36). Maximal assisted opening and maximal opening without pain (< 40 mm) was associated with a posterior condyle-to-articular tubercle position (OR ≥ 2.60). No other significant associations were observed. Conclusion: Age, gender, and coarse crepitus, but no pain-related variables, were associated with increased risk of degenerative findings in TMJ tomograms. Maximal opening < 40 mm was associated with at posterior condyle-to-articular tubercle relation on opening.

  • 31. Wiese, Mie
    et al.
    Wenzel, Ann
    Hintze, Hanne
    Petersson, Arne
    Malmö högskola, Faculty of Odontology (OD).
    Knutsson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Bakke, Merete
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Influence of cross-sectional temporomandibular joint tomography on daignosis and management decisions of patients with temporomandibular joint disorders2011In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 25, p. 223-231Article in journal (Refereed)
    Abstract [en]

    AIM: To assess whether changes in diagnoses and management of temporomandibular joint disorder (TMJD) patients are influenced by radiographic findings and if there is an association between specific radiologic alterations and management strategy changes. METHODS: A total of 204 patients with TMJ symptoms were examined using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Diagnoses and management were first decided without the aid of radiographs. Management categories were: pharmacology, physiotherapy, counseling and behavioral treatment, occlusal stabilization, surgery, additional examinations, and referrals, each with subcategories. Sagittal TMJ tomograms were assessed for the presence of flattening, erosion, osteophyte, and sclerosis in the TMJ components. Diagnoses and management were reevaluated after gaining access to the radiographs and radiographic classifications. Logistic regression analyses were performed with changes in management as the dependent variable and age and radiographic findings as the independent variables. RESULTS: Diagnosis was changed for 56 patients, mainly from arthralgia to osteoarthritis. Management was changed for 55 patients. Most changes occurred in pharmacology and physiotherapy followed by counseling and behavioral treatment, occlusal stabilization, referrals, additional examinations, and surgery. Changes were mostly within the categories, and the highest number of changes was seen in pharmacology, physiotherapy, and counseling and behavioral treatment. Radiographic degenerative findings increased the chance of change (any change) (odds ratio [OR] ⋝ 2.03) and the chance of change in pharmacology (OR ⋝ 2.56) and physiotherapy (OR = 2.48) separately. No other significant associations were found. CONCLUSION: Radiographic degenerative findings increased the chance of changes in management strategy. However, 73% of the TMJD patients had no changes in management after radiographic examination. In cases with changes, these were mainly adjustments within management categories.

  • 32.
    Wolf, Eva
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Birgerstam, Pirjo
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Petersson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Nonspecific chronic orofacial pain: Studying patient experiences and perspectives with a qualitative approach2008In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 22, no 4, p. 349-358Article in journal (Refereed)
    Abstract [en]

    Aims: To analyze the nonspecific chronic orofacial pain patient’s experience of the pain condition and to gain knowledge on the complexity of the problem. Methods: Fourteen patients (11 female, 3 male) aged 21–77 years were selected among those referred to a specialist clinic. All selected patients agreed to participate. Data were obtained through thematic in-depth interviews that exposed the context of the orofacial pain condition. The 2 interviews with each patient were audiotaped and transcribed verbatim. The text material was analyzed using a qualitative research strategy based on phenomenology. Results: The essence of the chronic orofacial pain was expressed by the patients as something that eludes perception and comprehension. The pain was difficult to grasp and to communicate. The consequence of the pain was experienced by the patients as to be stricken by the pain and was expressed as living a life permeated by hopelessness, resignation, and a lack of faith. Conclusion: The patients in this study experienced their chronic orofacial pain to have no limits and to repressively permeate all aspects of their existence: social, practical, and emotional.

  • 33.
    Wolf, Eva
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Birgerstam, Pirjo
    Institution of Psychology, Lund University, Lund, Sweden.
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Petersson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Patients' experiences of consultations for nonspecific chronic orofacial pain: A phenomenological study2006In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 20, no 3, p. 226-233Article in journal (Refereed)
    Abstract [en]

    Aims: To use a qualitative research study to analyze the experiences of patients with nonspecific chronic orofacial pain with respect to consultations for their pain condition. Methods: Fourteen patients (11 women and 3 men; age range, 21 to 77 years) were strategically selected through a purposive sampling of the chronic orofacial pain patients referred to the Orofacial Pain Unit at the Faculty of Odontology, Malmö University, Malmö, Sweden. A qualitative research strategy, based on phenomenological philosophy was chosen. Thematic in-depth interviews were conducted twice with each patient in order to expose the context of the orofacial pain condition. The interviews were audiotaped and transcribed verbatim. The text material was analyzed to determine the attitude of the patients concerning their experience from the consultations. Results: All selected patients consented to participate. The patients expressed dissatisfaction with the consultations and related many examples of poor communication and understanding. The patients also felt a great need to be taken care of and expressed contradictory statements concerning pain improvement. Conclusion: The results suggest that the communication between the patients and the care providers was unsatisfactory and that the patients were limited in their ability to develop a personal coping strategy.

  • 34. Yap, Adrian
    et al.
    Dworkin, Samuel
    Chua, E K
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Tan, Keson
    Tan, H H
    Prevalence of temporomandibular disorder subtypes, psychologic distress, and psychosocial dysfunction in Asian patients2003In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 17, no 1, p. 21-28Article in journal (Refereed)
    Abstract [en]

    AIMS: To use the Research Diagnostic Criteria for Temporomandibu-lar Disorders (RDC/TMD) to investigate the physical diagnoses, psy-chologic distress, and psychosocial dysfunction in Asian TMD pa-tients. The RDC/TMD Axis I and II findings were compared to those of Swedish and American TMD patients. METHODS: One hundred ninety-one patients (53 male and 138 female) referred to 2 institution-alized TMD clinics in Singapore were enrolled in the study. The mean age of the predominantly Chinese population (83.2%) was 33.6 +/- 9.3 years. Data from a RDC/TMD history questionnaire and clinical examination were fed directly by patients and clinicians into a com-puterized diagnostic system (NUS TMDv1.1). Axis I and II findings were generated on-line, based on RDC/TMD rule engines. Data were automatically exported to SPSS for statistical analysis. RESULTS: Group I (muscle) disorders were found in 31.4% of the patients; Group II (disc displacement) disorders were found in 15.1% and 15.7% of the patients in the left and right temporomandibular joints, respectively; and Group III (arthralgia, arthritis, and arthrosis) disor-ders were found in 12.6% and 13.0% of the patients in the left and right joints, respectively. Axis II assessment of psychologic status showed that 39.8% of patients experienced moderate to severe depres-sion and 47.6% had moderate to severe nonspecific physical symptom scores. Psychosocial dysfunction was observed in only 4.2% of pa-tients based on graded chronic pain scores. CONCLUSION: Axis I and II findings of Asian TMD patients were generally similar to their Swedish and American cohorts. In all 3 populations, women of child-bearing age represented the majority of patients. Muscle disorders were the most prevalent type of TMD. A substantial portion of TMD patients were depressed and experienced moderate to severe somatiza-tion.

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