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  • 1. Ahmed, Naveen
    et al.
    Anca, Catrina I.
    Alyamani, Ahmed O
    Mustafa, Hamid
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Deficient cytokine control modulates temporomandibular joint pain in rheumatoid arthritis2015In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 123, no 4, p. 235-241Article in journal (Refereed)
    Abstract [en]

    The aim was to investigate how endogenous cytokine control of tumor necrosis factor (TNF) influences temporomandibular joint (TMJ) pain in relation to the role of anti-citrullinated peptide antibodies (ACPA) in patients with rheumatoid arthritis (RA). Twenty-six consecutive patients with TMJ RA were included. Temporomandibular joint pain intensity was assessed at rest, on maximum mouth opening, on chewing, and on palpation. Mandibular movement capacity and degree of anterior open bite (a clinical sign of structural destruction of TMJ tissues) were also assessed. Systemic inflammatory activity was assessed using the Disease Activity Score in 28 joints (DAS28) for rheumatoid arthritis. Samples of TMJ synovial fluid and blood were obtained and analyzed for TNF, its soluble receptor, soluble TNF receptor II (TNFsRII), and ACPA. A high concentration of TNF in relation to the concentration of TNFsRII in TMJ synovial fluid was associated with TMJ pain on posterior palpation on maximum mouth opening. The ACPA concentration correlated significantly to the TNF concentration, but not to the TNFsRII concentration, indicating that increased inflammatory activity is mainly caused by an insufficient increase in anti-inflammatory mediators. This study indicates that TMJ pain on palpation in patients with RA is related to a deficiency in local cytokine control that contributes to increased inflammatory activity, including sensitization to mechanical stimuli over the TMJ.

  • 2. Ahmed, Naveen
    et al.
    Petersson, Arne
    Malmö högskola, Faculty of Odontology (OD).
    Anca, Catrina I.
    Mustafa, Hamid
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Tumor necrosis factor mediates temporomandibular joint bone tissue resorption in rheumatoid arthritis2015In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 73, no 3, p. 232-240Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate if TNF, IL-1 or their endogenous controls, in relation to ACPA, are associated with radiological signs of ongoing temporomandibular joint (TMJ) bone tissue resorption and disc displacement in RA patients. METHODS: Twenty-two consecutive outpatients with TMJ of RA were included. Systemic inflammatory activity was assessed by DAS28. The number of painful regions in the body and ESR, CRP, RF and ACPA were analyzed. TMJ synovial fluid and blood samples were obtained and analyzed for TNF, TNFsRII, IL-1ra, IL-1sRII and ACPA. The ratios between the mediators and their endogenous control receptors were used in the statistical analysis. Magnetic resonance imaging was performed in closed- and open-mouth positions and evaluated regarding disc position and presence of condylar and temporal erosions of the TMJ. RESULTS: A high TNF level in relation to TNFsRII in TMJ synovial fluid correlated to the degree of TMJ condylar erosion. A high IL-1ra level in relation to TNF in TMJ synovial fluid was also correlated to the degree of TMJ condylar erosion. The total degree of TMJ condylar erosion was correlated with the number of painful regions. CONCLUSION: This study indicates that TNF in TMJ synovial fluid mediates TMJ cartilage and bone tissue resorption in RA. The study also suggests that the degree of endogenous cytokine control is of importance for development of bone tissue destruction.

  • 3. Al-Khotani, Amal A
    et al.
    Naimi-Akbar, Aron
    Björnsson, Olof
    Christidis, Nikolaos
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Professional knowledge among Swedish and Saudi healthcare practitioners regarding oro-facial pain in children and adolescents2016In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 43, no 1, p. 1-9, article id 43Article in journal (Refereed)
    Abstract [en]

    Oro-facial pain (OFP) and temporomandibular disorders (TMD) in children and adolescents are a growing problem. To meet patients' healthcare needs, professionals must perform their work intuitively and with quality. Therefore, a high degree of professional knowledge is necessary. To investigate the professional knowledge regarding OFP/TMD in children and adolescents among Swedish and Saudi Arabian dental and medical specialists compared with Swedish OFP specialists. One questionnaire including the four domains Chronic pain and behaviour; Aetiology; Diagnosis and classification; Treatment and prognosis was distributed to 383 potential participants, that is physicians and dentists in Sweden and Saudi Arabia. The Swedish OFP/TMD specialists were used as a reference group. The response rates from Sweden and Saudi Arabia were 49% and 86%, respectively. The degree of agreement was highest in the domain Chronic pain and behaviour, especially for the Swedish groups. Regarding the other three domains, the agreement was modest to poor. In general, Swedish groups showed a higher agreement with Swedish OFP/TMD specialists than Saudi Arabian groups. This study shows that professional knowledge regarding OFP/TMD in children and adolescents is limited among Swedish and Saudi Arabian dental and medical professionals compared to Swedish OFP/TMD specialists. In Swedish groups, the professional knowledge is more accurate than in the corresponding Saudi Arabian. With these results in mind, and the frequent prevalence of OFP/TMD in children and adolescents, one can draw the conclusion that there is a need for modern medical education regarding OFP/TMD among both physicians and dentists, especially in Saudi Arabia.

  • 4. Al-Khotani, Amal
    et al.
    Björnsson, Olof
    Naimi-Akbar, Aron
    Christidis, Nikolaos
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Study on self-assessment regarding knowledge of temporomandibular disorders in children/adolescents by Swedish and Saudi Arabian dentists2015In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 73, no 7, p. 522-529Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate the degree of self-assessed knowledge among dentists in Sweden and Saudi Arabia regarding temporomandibular disorders (TMD) in children and adolescents using a summative form of assessment and further to investigate the possible factors that may influence the self-assessed knowledge. MATERIALS AND METHODS: A questionnaire survey covering four domains (Etiology; Diagnosis and classification; Chronic pain and pain behavior; Treatment and prognosis) regarding TMD knowledge was used. Out of 250 questionnaires (125 in each country) a total of 65 (52%) were returned in Sweden and 104 (83%) in Saudi Arabia. RESULTS: Self-assessed individual knowledge was significantly associated to the level of actual knowledge among the Swedish groups in the domains Etiology; Diagnosis and classification and Treatment and prognosis (p < 0.05). However, in the Saudi Arabian groups a corresponding significant association was only found in the domain Diagnosis and classification (p < 0.05). CONCLUSIONS: This study showed that there is a difference in the accuracy of self-assessment of own knowledge between the dentists in Sweden and Saudi Arabia. The Swedish dentists have a better ability to assess their level of knowledge compared to Saudi Arabian dentists regarding TMD in children and adolescents. This difference could be related to several factors such as motivation, positive feedback, reflection, psychomotor, and interpersonal skills, which all are more dominant in the Swedish educational tradition.

  • 5.
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Arthralgia2017In: Clinical Cases in Orofacial Pain / [ed] Malin Ernberg, Per Alstergren, John Wiley & Sons, 2017, p. 15-19Chapter in book (Other academic)
    Abstract [en]

    Expand your knowledge and put it into practice with this unique, case-based guide Clinical Cases in Orofacial Pain is a valuable resource for undergraduate dental students as well as residents working towards board certification. Individual cases cover temporomandibular joint disorders, masticatory muscle disorders, headache, neuropathic pain, dental pain, tooth wear, and dystonia. Following the popular Clinical Cases series style, cases are presented with associated academic commentary, including background information, diagnostic criteria and fundamental points that might influence the diagnosis, treatment planning or management of the case. Well-illustrated throughout, each chapter features self-assessment study questions to help foster independent learning. Clinical Cases in Orofacial Pain is an excellent primer for undergraduate dental students and an invaluable study guide for postgraduate students and residents. Dental practitioners will also want to keep this unique, case-based guide as a ready reference in their working libraries.

  • 6.
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Arthritis2017In: Clinical Cases in Orofacial Pain / [ed] Malin Ernberg, Per Alstergren, John Wiley & Sons, 2017, p. 19-26Chapter in book (Other academic)
    Abstract [en]

    Expand your knowledge and put it into practice with this unique, case-based guide Clinical Cases in Orofacial Pain is a valuable resource for undergraduate dental students as well as residents working towards board certification. Individual cases cover temporomandibular joint disorders, masticatory muscle disorders, headache, neuropathic pain, dental pain, tooth wear, and dystonia. Following the popular Clinical Cases series style, cases are presented with associated academic commentary, including background information, diagnostic criteria and fundamental points that might influence the diagnosis, treatment planning or management of the case. Well-illustrated throughout, each chapter features self-assessment study questions to help foster independent learning. Clinical Cases in Orofacial Pain is an excellent primer for undergraduate dental students and an invaluable study guide for postgraduate students and residents. Dental practitioners will also want to keep this unique, case-based guide as a ready reference in their working libraries.

  • 7.
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Degenerative Joint Disease2017In: Clinical Cases in Orofacial Pain / [ed] Malin Ernberg, Per Alstergren, John Wiley & Sons, 2017, p. 61-66Chapter in book (Other academic)
    Abstract [en]

    Expand your knowledge and put it into practice with this unique, case-based guide Clinical Cases in Orofacial Pain is a valuable resource for undergraduate dental students as well as residents working towards board certification. Individual cases cover temporomandibular joint disorders, masticatory muscle disorders, headache, neuropathic pain, dental pain, tooth wear, and dystonia. Following the popular Clinical Cases series style, cases are presented with associated academic commentary, including background information, diagnostic criteria and fundamental points that might influence the diagnosis, treatment planning or management of the case. Well-illustrated throughout, each chapter features self-assessment study questions to help foster independent learning. Clinical Cases in Orofacial Pain is an excellent primer for undergraduate dental students and an invaluable study guide for postgraduate students and residents. Dental practitioners will also want to keep this unique, case-based guide as a ready reference in their working libraries.

  • 8.
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Molecular Temporomandibular Joint Pain Biomarkers2017In: Orofacial Pain Biomarkers / [ed] Jean-Paul Goulet, Ana Miriam Velly, Springer, 2017, p. 95-105Chapter in book (Other academic)
    Abstract [en]

    This chapter covers immunological markers for inflammatory types of temporomandibular joint (TMJ) pain. The specific biological relevance or clinical value of biomarkers in TMJ pain is, however, so far insufficiently investigated. There are studies that indicate candidate biomarkers for diagnostic or prognostic purposes in diseases like rheumatoid arthritis and psoriatic arthritis. This chapter discusses available knowledge regarding cytokines, cytokine receptors, serotonin, prostaglandin E2, and glutamate in relation to diagnosis, prognosis, and treatment of TMJ inflammatory pain.

  • 9.
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Rheumatoid Arthritis with Temporomandibular Joint Involvement2017In: Clinical Cases in Orofacial Pain / [ed] Malin Ernberg, Per Alstergren, John Wiley & Sons, 2017, p. 67-73Chapter in book (Other academic)
    Abstract [en]

    Expand your knowledge and put it into practice with this unique, case-based guide Clinical Cases in Orofacial Pain is a valuable resource for undergraduate dental students as well as residents working towards board certification. Individual cases cover temporomandibular joint disorders, masticatory muscle disorders, headache, neuropathic pain, dental pain, tooth wear, and dystonia. Following the popular Clinical Cases series style, cases are presented with associated academic commentary, including background information, diagnostic criteria and fundamental points that might influence the diagnosis, treatment planning or management of the case. Well-illustrated throughout, each chapter features self-assessment study questions to help foster independent learning. Clinical Cases in Orofacial Pain is an excellent primer for undergraduate dental students and an invaluable study guide for postgraduate students and residents. Dental practitioners will also want to keep this unique, case-based guide as a ready reference in their working libraries.

  • 10.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Vill se jämlik vård: Ansikte, mun och käkarna tillhör kroppen2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, no 30-32, article id E9P3Article in journal (Other (popular science, discussion, etc.))
  • 11.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    What and how: Workflow of the management of joint disorders in the clinical practice2023In: Seminars in orthodontics, ISSN 1073-8746Article in journal (Refereed)
    Abstract [en]

    This narrative review isl describing the most common TMJ conditions and suggest a straightforward, clinically relevant and feasible treatment workflow for each of these. The suggestions for treatment will be based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), the Swedish National Board of Health and Welfare National guidelines for general dentistry as well as the Swedish Academy for Temporomandibular Disorders’ National guidelines for TMD screening, diagnosis and treatment with the target audience of general practitioners.

  • 12.
    Alstergren, Per
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Baad-Hansen, Lene
    Johansson, Anders
    Le Bell, Yrsa
    Kroniska orofaciala smärtor i allmänpraktiken2016In: Tandläkartidningen, ISSN 0039-6982, Vol. 108, no 3, p. 78-83Article in journal (Refereed)
    Abstract [en]

    The focus of this article is to draw together the conclusions drawn in the associated articles in this series. It is designed to provide a hands-on check-list approach to diagnosis of the most common chronic orofacial pain conditions. The article therefore covers chronic orofacial pain, risk factors, diagnosis of the most common musculoskeletal and neuropathic pain conditions in the orofacial region and management principles. In summary, the majority of TMD patients can be treated by general practitioners. Presence of several of the known risk factors for development of chronic orofacial pain, such as comorbid pain conditions and psychological distress, hamper the prognosis for obtaining long-lasting pain-relief in more complicated cases. Often it will be necessary for the patient to seek concurrent care for the comorbidities in order to improve the prognosis for the management of orofacial pain. Importantly, the longer time the pain has been present, the poorer the prognosis is for relief, due to the possibility of a permanently sensitized nociceptive processing system.

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  • 13.
    Alstergren, Per
    et al.
    Malmö University, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Kopp, S.
    Clinical diagnosis of temporomandibular joint arthritis2018In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 45, no 4, p. 269-281Article in journal (Refereed)
    Abstract [en]

    Evidence-based clinical diagnostic criteria for temporomandibular joint (TMJ) arthritis are not available. To establish (i) criteria for clinical diagnosis of TMJ arthritis and (ii) clinical variables useful to determine inflammatory activity in TMJ arthritis using synovial fluid levels of inflammatory mediators as the reference standard. A calibrated examiner assessed TMJ pain, function, noise and occlusal changes in 219 TMJs (141 patients, 15 healthy individuals). TMJ synovial fluid samples were obtained with a push-pull technique using the hydroxycobalamin method and analysed for TNF, TNFsRII, IL-1, IL-1ra, IL-1sRII, IL-6 and serotonin. If any inflammatory mediator concentration exceeded normal, the TMJ was considered as arthritic. In the patient group, 71% of the joints were arthritic. Of those, 93% were painful. About 66% of the non-arthritic TMJs were painful to some degree. Intensity of TMJ resting pain and TMJ maximum opening pain, number of jaw movements causing TMJ pain and laterotrusive movement to the contralateral side significantly explained presence of arthritis (AUC 0.72, P<.001). Based on these findings, criteria for possible, probable and definite TMJ arthritis were determined. Arthritic TMJs with high inflammatory activity showed higher pain intensity on maximum mouth opening (P<.001) and higher number of painful mandibular movements (P=.004) than TMJs with low inflammatory activity. The combination TMJ pain on maximum mouth opening and Contralateral laterotrusion <8mm appears to have diagnostic value for TMJ arthritis. Among arthritic TMJs, higher TMJ pain intensity on maximum mouth opening and number of mandibular movements causing TMJ pain indicates higher inflammatory activity.

  • 14.
    Carlsson, Alexandra Dimitrijevic
    et al.
    Malmö University, Faculty of Odontology (OD). Linkoping Univ, Ctr Oral Rehabil Linkoping, Linkoping, Sweden.;Linkoping Univ, Dept Biomed & Clin Sci, Linkoping, Sweden.;Scandinavian Ctr Orofacial Neurosci, Malmo, Sweden..
    Wahlund, Kerstin
    Kalmar Cty Hosp, Dept Stomatognath Physiol, Kalmar, Sweden..
    Kindgren, Erik
    Vasterv Hosp, Dept Pediat, Vastervik, Sweden.;Linkoping Univ, Dept Clin & Expt Med, Div Pediat, Linkoping, Sweden.;Skaraborg Hosp, Dept Pediat, Skovde, Sweden..
    Skogh, Thomas
    Linkoping Univ, Dept Clin & Expt Med, Div Neuro & Inflammat Sci, Linkoping, Sweden..
    Johansson, Carin Starkhammar
    Linkoping Univ, Ctr Oral Rehabil Linkoping, Linkoping, Sweden.;Linkoping Univ, Dept Biomed & Clin Sci, Linkoping, Sweden..
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD). Scandinavian Ctr Orofacial Neurosci, Malmo, Sweden.;Skane Univ Hosp, Specialized Pain Rehabil, Lund, Sweden.;Malmo Univ, Orofacial Pain Unit, Malmo, Sweden..
    Orofacial pain in juvenile idiopathic arthritis is associated with stress as well as psychosocial and functional limitations2019In: Pediatric Rheumatology, E-ISSN 1546-0096, Vol. 17, no 1, article id 83Article in journal (Refereed)
    Abstract [en]

    Background The aim of this study was to investigate relations between psychosocial factors, signs and symptoms of orofacial pain and jaw dysfunction in patients with juvenile idiopathic arthritis (JIA). Methods Forty-five patients with JIA (median age 12 years) and 16 healthy matched controls (median age 13 years) were examined according to the diagnostic criteria for temporomandibular disorders (DC/TMD). The subjects answered the DC/TMD questionnaires regarding psychosocial factors (pain intensity, pain-related disability, depression, stress, catastrophizing, pain locations and jaw function). Results JIA patients with orofacial pain had higher degree of stress, depression, catastrophizing and jaw dysfunction compared to subjects without. In turn, these factors were associated with orofacial pain intensity. Also, patients with orofacial pain had higher systemic inflammatory activity. Conclusions Orofacial pain in patients with JIA is associated with stress, psychological distress, jaw dysfunction and loss of daily living activities. Pain intensity seems to be the major pain aspect related to these factors. In addition, systemic inflammatory activity appears to be an important factor contributing to orofacial pain in JIA.

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  • 15.
    Cederhag, Josefine
    et al.
    Malmö University, Faculty of Odontology (OD).
    Iskanderani, Durer
    Malmö University, Faculty of Odontology (OD). Department of Oral & Maxillofacial Radiology, KingAbdulaziz University, Jeddah, Saudi Arabia;.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD). Specialized Pain Rehabilitation, Skåne University Hospital, Lund, Sweden.
    Shi, Xie-Qi
    Malmö University, Faculty of Odontology (OD). Section of Oral and Maxillofacial Radiology, Department ofClinical Dentistry, University of Bergen, Bergen, Norway.
    Hellén-Halme, Kristina
    Malmö University, Faculty of Odontology (OD).
    Visibility of anatomical landmarks in the region of the mandibular third molar, a comparison between a low-dose and default protocol of CBCT2023In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 81, no 6, p. 449-455Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Optimization of radiographic examinations is essential for radiation protection. The objective of the study was to investigate the clinical applicability of a low-dose CBCT protocol as compared to the default for pre-surgical evaluation of mandibular third molars.

    MATERIAL & METHODS: Forty-eight patients (62 teeth) referred for pre-surgical mandibular third molar investigation were recruited after justification for CBCT. Two CBCT scans of each site were made using a default protocol and a low-dose protocol (Veraviewepocs 3D F40, J Morita Corp, Kyoto, Japan). The low-dose protocol had the same tube potential (90 kV) and exposure time (9.4 s) as the default, but with reduced tube current, from 5 mA to 2 mA. Four observers evaluated the visibility of five relevant anatomical variables. Image quality was ranked on a 3-point scale as diagnostically acceptable, doubtful, or unacceptable. The Wilcoxon signed-rank test compared differences between the two protocols. The significance level was set at p ≤ .05.

    RESULTS: No significant differences were found between the two protocols for any observer regarding the visibility of the relationship and proximity between the roots and the mandibular canal; root morphology; and possible root resorption of the second molar. The periodontal ligament differed significantly in visibility between the two protocols (p ≤ .05).

    CONCLUSIONS: This study indicates that a low-dose CBCT protocol with a 60% reduction of the tube current provides, in most cases, acceptable image quality for pre-surgical assessment of mandibular third molars. Optimization of CBCT protocols should be a priority according to recommended guidelines.

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  • 16.
    Cederhag, Josefine
    et al.
    Malmö University, Faculty of Odontology (OD).
    Kadesjö, Nils
    Medical Radiation Physics, Karolinska University Hospital, Stockholm, Sweden.
    Nilsson, Mats
    Department of Medical Radiation Physics, Lund University, Malmö, Sweden.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD). Specialized Pain Rehabilitation, Skåne University Hospital, Lund, Sweden; Scandinavian Center for orofacial Neurosciences, Malmö University, Malmö, Sweden.
    Shi, Xie-Qi
    Malmö University, Faculty of Odontology (OD). Section of Oral and Maxillofacial Radiology, Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
    Hellén-Halme, Kristina
    Malmö University, Faculty of Odontology (OD).
    Comparison of absorbed doses and organ doses measured with thermoluminescent dosimeters and Gafchromic film for cone beam computed tomography examination of the posterior mandibular region in a head phantom2023In: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, E-ISSN 2212-4411, Vol. 136, no 6, p. 769-776Article in journal (Refereed)
    Abstract [en]

    Objectives: We aimed to map the correlation between thermoluminescent dosimeters (TLDs) and Gafchromic film for measuring absorbed doses and to compare minimum, maximum, and mean absorbed doses over larger regions of interest and at various craniofacial organs and tissues during cone beam computed tomography (CBCT) exposure of the mandibular third molar region.

    Study design: We positioned TLDs at 75 measurement points in a head phantom. Gafchromic film was cut to the same shape as the 5 levels of the phantom and was placed on top of the TLDs. Both dosimetry methods thus included the surface of each level simultaneously. CBCT scans were made using a 5 × 5 cm field of view and a rotation angle of 200°. Measurements included absorbed dose distributions, doses at all 75 points, and minimum, maximum, and mean doses within organs and tissues.

    Results: The correlation of point-dose measurements at all TLD sites with doses measured on film was strong (R2 = 0.9687), with greatest correlation at lower doses (<2 mGy). Large deviations between TLD and film measurements of minimum and maximum doses and absorbed doses to the organs occurred at all 5 levels. TLD positioning failed to cover several organ sites; for these, only absorbed dose measurements from the film were available.

    Conclusions: TLDs were unable to sample dose distributions and gradients accurately. The characteristics of Gafchromic LD-V1 film make it a favorable alternative in dental CBCT dosimetry.

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  • 17.
    Cederhag, Josefine
    et al.
    Malmö University, Faculty of Odontology (OD).
    Lundegren, Nina
    Malmö University, Faculty of Odontology (OD).
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Shi, Xie-Qi
    Malmö University, Faculty of Odontology (OD).
    Hellén-Halme, Kristina
    Malmö University, Faculty of Odontology (OD).
    Evaluation of Panoramic Radiographs in Relation to the Mandibular Third Molar and to Incidental Findings in an Adult Population2021In: European journal of dentistry, ISSN 1305-7456, Vol. 15, no 2, p. 266-272Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:  The aim was to evaluate the characteristics of the mandibular third molars, especially in relation to the inferior alveolar nerve. Further aims were to investigate incidental findings in panoramic radiographs in an adult population, and to investigate image quality related to patient positioning.

    MATERIALS AND METHODS:  From a previous study with 451 randomly selected adult participants who lived in Sweden, 442 panoramic radiographs from four dental public health clinics were used. The third molars' characteristics and relation to inferior alveolar nerve were evaluated. Incidental findings and patient positioning were recorded.

    STATISTICAL ANALYSIS:  Frequency analysis was used to investigate the occurrence of all findings and their possible interconnections. Whether the patients' age or gender had an impact or not was also analyzed.

    RESULTS:  The third molars were erupted in vertical position among 73% regardless of age. When retained or semi-retained, they were most commonly in mesioangular positions. The inferior alveolar nerve was located inferior to the roots in 52%, whereas an overlapped position was most common if the third molar was retained (90%), semi-retained (83%) or the age was less than 30 years (66%). Common incidental findings were apical radiolucencies, idiopathic osteosclerosis, and tooth fragments. Suboptimal patient positioning was found in one-third of the radiographs.

    CONCLUSIONS:  Panoramic radiography is a useful method to evaluate third molar prior to surgical removal and may be the only image required. Most incidental findings on panoramic radiographs does not seem to require any further odontological management.

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  • 18.
    Cederhag, Josefine
    et al.
    Malmö University, Faculty of Odontology (OD).
    Truedsson, Anna
    Malmö University, Faculty of Odontology (OD).
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Shi, Xie-Qi
    Malmö University, Faculty of Odontology (OD). University of Bergen, Norway.
    Hellén-Halme, Kristina
    Malmö University, Faculty of Odontology (OD).
    Radiographic imaging in relation to the mandibular third molar: a survey among oral surgeons in Sweden2022In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 26, p. 2073-2083Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To query the experience of oral surgeons concerning referral routines and preferences for radiographic imaging modality before surgical removal of mandibular third molars and investigate factors that influence imaging modality preferences.

    MATERIALS AND METHODS: Members of the Swedish Association of Oral and Maxillofacial Surgeons (n = 280) were invited to participate in a web-based digital survey concerning their experiences and use of three imaging modalities in pre-surgical assessment of mandibular third molar removal. The survey comprised multiple-choice questions and four cases depicted in images; respondents reported whether they would supplement the cases with other images and, if so, from which modality.

    RESULTS: The response rate was 64%. Panoramic radiographs were most commonly used in pre-surgical planning (response options: always or often), significant difference between professions (p = 0.039), and considered to facilitate treatment planning (87%), as was CBCT (82%); for 51%, CBCT reduced post-operative complications. Preferred modality for localizing the mandibular canal was fairly evenly distributed and for non-complex case, significant difference between subgroups of OMFS surgeons was found (p = 0.003) as to preference for intraoral radiographs.

    CONCLUSIONS: A majority of respondents received a report within 2 weeks of their referral for CBCT and would read the report and view the images before surgery. Image modality preference differed depending on case complexity, with a greater perceived need for CBCT. Profession and practical experience affected choice.

    CLINICAL RELEVANCE: Choice of imaging modality in mandibular third molar assessment is also important from dose delivery and social economy standpoints.

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  • 19.
    Dimitrijevic Carlsson, Alexandra
    et al.
    Malmö University, Faculty of Odontology (OD).
    Ghafouri, Bijar
    Starkhammar Johansson, Carin
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Unstimulated Parotid Saliva Sampling in Juvenile Idiopathic Arthritis and Healthy Controls: A Proof-of-Concept Study on Biomarkers2020In: Diagnostics (Basel), ISSN 2075-4418, Vol. 10, no 4, article id 251Article in journal (Refereed)
    Abstract [en]

    The aims of this proof-of-concept study were to develop a collecting method for unstimulated parotid saliva in juvenile idiopathic arthritis (JIA) patients and healthy children and to investigate if inflammatory biomarkers could be detected in these samples. Forty-five children with JIA (median age of 12 years and 25th-75th percentile of 10-15 years; 33 girls and 12 boys) and 16 healthy children as controls (median age of 13 years and 25-75th percentile of 10-13 years; 11 girls and 5 boys) were enrolled in this study. Unstimulated parotid saliva was collected with a modified Carlson-Crittenden collector. The salivary flow rate and salivary concentrations of total protein and inflammatory mediators were assessed. The Meso Scale Discovery electrochemiluminescence immunoassay was used for analyzing protein concentrations and the inflammatory biomarkers. Sufficient parotid saliva volumes to be analyzed could be collected with the collection device. JIA patients had a lower sampling saliva volume (p = 0.008) and saliva flow rate (p = 0.039) than controls. The total protein concentrations and inflammatory biomarkers were measured in the last six healthy subjects. The median protein concentration was 1312 mu g/mL (25th percentile: 844 mu g/mL and 75th percentile: 2062 mu g/mL; n = 6) and quantifiable concentrations of 39 inflammatory proteins could be assessed in these samples. In conclusion, this study indicates that the saliva sampling method, as used in the present study, is able to collect sufficient sample volumes in children, and that it is possible to analyze various inflammatory biomarkers in the collected saliva.

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  • 20.
    Dimitrijevic Carlsson, Alexandra
    et al.
    Malmö University, Faculty of Odontology (OD). 2 Center for Oral Rehabilitation, in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, ; Scandinavian Center for Orofacial Neurosciences, Malmö.
    Wahlund, K
    Department of Orofacial Pain and Jaw Function, Kalmar County Hospital, Kalmar.
    Klintstrom, E
    Center for Medical Image Science and Visualization (CMIV) and Department of Radiology in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University.
    Salé, H
    Department of Neuroradiology, Center of Medical imaging and Physiology, Skåne University Hospital, Lund.
    Kindgren, E
    Department of Pediatrics, Västervik Hospital, Västervik; Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Pediatrics, Skaraborg Hospital, Skövde.
    Starkhammar Johansson, C
    Center for Oral Rehabilitation, in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping,.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD). Scandinavian Center for Orofacial Neurosciences, Malmö; Skåne University Hospital, Specialized Pain Rehabilitation, .
    Juvenile idiopathic arthritis and the temporomandibular joint: a case-control study of magnetic resonance imaging findings in relation to clinical and psychosocial factors.2023In: European Journal of Paediatric Dentistry, ISSN 1591-996X, E-ISSN 2035-648X, Vol. 24, no 1, p. 69-76Article in journal (Refereed)
    Abstract [en]

    AIM: In juvenile idiopathic arthritis (JIA), the temporomandibular joint (TMJ) is a particularly challenging joint to assess both clinically and with imaging. The aim of this article is to investigate TMJ magnetic resonance imaging (MRI) findings in relation to clinical and psychosocial factors in patients with JIA and healthy individuals related to TMJ arthritis in JIA.

    MATERIALS: In total, 45 patients (6-16 years) with JIA and 16 healthy age- and sex-matched controls were examined according to the diagnostic criteria for temporomandibular disorders (DC/TMD). The subjects answered questionnaires about psychosocial factors (pain intensity, pain-related disability, depression, stress, catastrophising, pain locations, and jaw function) and underwent bilateral MRI of the TMJ.

    RESULTS: There were no significant differences between JIA patients and healthy individuals in any of the TMJ MRI findings. Moderate/severe changes among JIA patients were found only for effusion, synovial thickening, condylar flattening, and erosion, with no moderate/severe changes in healthy individuals. In JIA patients, orofacial pain intensity was related to TMJ bone marrow oedema, and pain in jaw muscles during jaw function was related to TMJ bone marrow oedema and erosion. There were no significant correlations between psychosocial aspects and MRI findings.

    CONCLUSION: This study indicates a substantial overlap of TMJ MRI findings in both the inflammatory domain and the damage domain between JIA patients and healthy individuals. In JIA patients, the inflammatory MRI sign of bone marrow oedema seems to influence orofacial pain intensity.

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  • 21.
    Durham, Justin
    et al.
    School of Dental Sciences Newcastle University Newcastle UK;Newcastle Hospitals' NHS Foundation Trust Newcastle UK.
    Ohrbach, Richard
    Oral Diagnostic Sciences University at Buffalo School of Dental Medicine Buffalo New York USA.
    Baad‐Hansen, Lene
    Department of Dentistry and Oral Health, Section for Orofacial Pain and Jaw Function Aarhus University Aarhus Denmark.
    Davies, Stephen
    Division of Dentistry University of Manchester UK Manchester UK.
    De Laat, Antoon
    Department Oral health Sciences KU Leuven and Department Dentistry UZ Leuven Belgium.
    Goncalves, Daniela Godoi
    School of Dentistry, Araraquara São Paulo State University (Unesp) Araraquara Brazil.
    Gordan, Valeria V.
    Restorative Dental Sciences Department University of Florida College of Dentistry Gainesville Florida USA.
    Goulet, Jean‐Paul
    Faculty of Dental Medicine Laval University Quebec Quebec Canada.
    Häggman-Henrikson, Birgitta
    Malmö University, Faculty of Odontology (OD).
    Horton, Michael
    College of General Dentistry UK (CGDent) London UK.
    Koutris, Michail
    Department of Orofacial Pain and Dysfunction Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands.
    Law, Alan
    Endodontist, The Dental Specialists Woodbury Minnesota USA;Research Professor, Division of Endodontics University of Minnesota Minneapolis Minnesota USA.
    List, Thomas
    Malmö University, Faculty of Odontology (OD). Skåne University Hospital, Specialized Pain Rehabilitation Lund Sweden.
    Lobbezoo, Frank
    Department of Orofacial Pain and Dysfunction Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands.
    Michelotti, Ambra
    Department of Neurosciences, School of Orthodontics, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy.
    Nixdorf, Donald R.
    Division of TMD &amp; Orofacial Pain, School of Dentistry and Department of Radiology, Medical School University of Minnesota Minneapolis Minnesota USA.
    Oyarzo, Juan Fernando
    TMD and Orofacial Pain Program, Faculty of Odontology Universidad Andres Bello Santiago Chile.
    Peck, Chris
    Faculty of Dentistry National University of Singapore Singapore Singapore.
    Penlington, Chris
    School of Dental Sciences Newcastle University Newcastle UK;Newcastle Hospitals' NHS Foundation Trust Newcastle UK.
    Raphael, Karen G.
    Department of Oral and Maxillofacial Pathology, Radiology &amp; Medicine New York University College of Dentistry New York New York USA.
    Santiago, Vivian
    Department of Oral and Maxillofacial Pathology, Radiology &amp; Medicine New York University College of Dentistry New York New York USA.
    Sharma, Sonia
    Oral Diagnostic Sciences University at Buffalo School of Dental Medicine Buffalo New York USA.
    Svensson, Peter
    Department of Dentistry and Oral Health, Section for Orofacial Pain and Jaw Function Aarhus University Aarhus Denmark.
    Visscher, Corine M.
    Department of Orofacial Pain and Dysfunction Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands.
    Yoshiki, Imamura
    Department of Oral Diagnostic Sciences Nihon University School of Dentistry Tokyo Japan.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD). Skåne University Hospital, Specialized Pain Rehabilitation Lund Sweden.
    Constructing the brief diagnostic criteria for temporomandibular disorders (bDC/TMD) for field testing2023In: Journal of Oral Rehabilitation, E-ISSN 1365-2842Article in journal (Refereed)
    Abstract [en]

    Background: Despite advances in temporomandibular disorders' (TMDs) diagnosis, the diagnostic process continues to be problematic in non-specialist settings.

    Objective: To complete a Delphi process to shorten the Diagnostic Criteria for TMD (DC/TMD) to a brief DC/TMD (bDC/TMD) for expedient clinical diagnosis and initial management.

    Methods: An international Delphi panel was created with 23 clinicians representing major specialities, general dentistry and related fields. The process comprised a full day workshop, seven virtual meetings, six rounds of electronic discussion and finally an open consultation at a virtual international symposium.

    Results: Within the physical axis (Axis 1), the self-report Symptom Questionnaire of the DC/TMD did not require shortening from 14 items for the bDC/TMD. The compulsory use of the TMD pain screener was removed reducing the total number of Axis 1 items by 18%. The DC/TMD Axis 1 10-section examination protocol (25 movements, up to 12 sets of bilateral palpations) was reduced to four sections in the bDC/TMD protocol involving three movements and three sets of palpations. Axis I then resulted in two groups of diagnoses: painful TMD (inclusive of secondary headache), and common joint-related TMD with functional implications. The psychosocial axis (Axis 2) was shortened to an ultra-brief 11 item assessment.

    Conclusion: The bDC/TMD represents a substantially reduced and likely expedited method to establish (grouping) diagnoses in TMDs. This may provide greater utility for settings requiring less granular diagnoses for the implementation of initial treatment, for example non-specialist general dental practice.

  • 22. Ernberg, Marie
    et al.
    Alstergren, PerMalmö högskola, Faculty of Odontology (OD).
    Clinical Cases in Orofacial Pain2017Collection (editor) (Other academic)
    Abstract [en]

    Expand your knowledge and put it into practice with this unique, case-based guide Clinical Cases in Orofacial Pain is a valuable resource for undergraduate dental students as well as residents working towards board certification. Individual cases cover temporomandibular joint disorders, masticatory muscle disorders, headache, neuropathic pain, dental pain, tooth wear, and dystonia. Following the popular Clinical Cases series style, cases are presented with associated academic commentary, including background information, diagnostic criteria and fundamental points that might influence the diagnosis, treatment planning or management of the case. Well-illustrated throughout, each chapter features self-assessment study questions to help foster independent learning. Clinical Cases in Orofacial Pain is an excellent primer for undergraduate dental students and an invaluable study guide for postgraduate students and residents. Dental practitioners will also want to keep this unique, case-based guide as a ready reference in their working libraries.

  • 23. Forssell, Heli
    et al.
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Bakke, Merete
    Bjørnland, Tore
    Jääskeäinen, Satu K
    Kroniska smärttillstånd i ansiktsregionen2016In: Tandläkartidningen, ISSN 0039-6982, Vol. 108, no 2, p. 58-65Article in journal (Refereed)
    Abstract [en]

    Considerable progress has been made during the last decades in the understanding of the processes involved in facial pain. The complexity and multidimensionality of pain is increasingly comprehended, and more insights have been gained into the risk factors predisposing to chronic pain. In addition, improved and more reliable diagnostic systems and approaches have been introduced, and some advances have been made in the treatment of certain facial pain entities, such as neuropathic facial pains. However, many aspects of facial pain are still poorly understood, and much needs to be done to validate many of the methods used to treat facial pain, and to develop new improved, more effective treatment approaches with fewer side effects. Science is advancing rapidly in the field of pain, including facial pain. The special areas of interest in facial pain research include molecular biology, biomarkers, imaging, genetics, and pain and psychological comorbidities, amongst others. It is to be expected that increased understanding of pain mechanisms and other aspects of facial pain will in the future bring some novel therapeutic possibilities. For our patients a correct treatment is of uttermost importance. Treatment of chronic pain disorders have to be based on correct diagnosis and evidence based treatment modalities. The future will most probably also witness the rise of personalized pain medicine, whereby treatments are customized to fit each patient’s pain and psychosocial, as well as genetic characteristics. In the light of rapid advances in the field of pain, much more emphasis should be put on pain education in the dental curriculums.

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  • 24.
    Harfeldt, Kristin
    et al.
    Malmö University, Faculty of Odontology (OD).
    Alexander, Louise
    Malmö University, Faculty of Odontology (OD).
    Lam, Julia
    Malmö University, Faculty of Odontology (OD).
    Mansson, Sven
    Westergren, Hans
    Svensson, Peter
    Sundgren, Pia C.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Spectroscopic differences in posterior insula in patients with chronic temporomandibular pain2018In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 18, no 3, p. 351-361Article in journal (Refereed)
    Abstract [en]

    Background and aims: Chronic pain including temporomandibular disorder (TMD) pain involves a complex interplay between peripheral and central sensitization, endogenous modulatory pathways, cortical processing and integration and numerous psychological, behavioral and social factors. The aim of this study was to compare spectroscopic patterns of N-Acetyl-aspartate (NAA), total creatine (tCr), choline (Cho), myo-inositol (MI), glutamate (Glu), and the combination of Glu and glutamine in the posterior insula in patients with chronic generalized or regional chronic TMD pain (gTMD and rTMD, respectively) compared to healthy individuals (HI) in relation to clinical findings of TMD pain. Methods: Thirty-six female patients with chronic rTMD or gTMD with at least 3 months duration were included in the study. Ten healthy women were included as controls. All participants completed a questionnaire that comprised assessment of degrees of depression, anxiety, stress, catastrophizing, pain intensity, disability and locations. A clinical Diagnostic Criteria for Temporomandibular Disorders examination that comprised assessment of pain locations, headache, mouth opening capacity, pain on mandibular movement, pain on palpation and temporomandibular joint noises was performed. Pressure-pain threshold (PPT) over the masseter muscle and temporal summation to pressure stimuli were assessed with an algometer. Within a week all participants underwent non-contrast enhanced MRI on a 3T MR scanner assessing T1-w and T2-w fluid attenuation inversion recovery. A single-voxel H-1-MRS examination using point-resolved spectroscopy was performed. The metabolite concentrations of NAA, tCr, Cho, MI, Glu and Glx were analyzed with the LC model. Metabolite levels were calculated as absolute concentrations, normalized to the water signal. Metabolite concentrations were used for statistical analysis from the LC model if the Cramer-Rao bounds were less than 20%. In addition, the ratios NAA/tCr, Cho/tCr, Glu/tCr and MI/tCr were calculated. Results: The results showed significantly higher tCr levels within the posterior insula in patients with rTMD or gTMD pain than in HI (p = 0.029). Cho was negatively correlated to maximum mouth opening capacity with or without pain (r(s) = -0.42, n = 28, p = 0.031 and r(s) = -0.48, n = 28, p = 0.034, respectively) as well as pressure-pain threshold on the hand (r(s) = -0.41, n = 28, p = 0.031). Glu was positively correlated to temporal summation to painful mechanical stimuli (r(s) = 0.42, n = 26, p = 0.034). Conclusions: The present study found that increased concentrations of Cho and Glu in the posterior insular cortex is related to clinical characteristics of chronic TMD pain, including generalized pain. These findings provide new evidence about the critical involvement of the posterior insular cortex and the neurobiology underlying TMD pain in both regional and generalized manifestations. Implications: The findings in this study have indirect implications for the diagnosis and management of TMD patients. That said, the findings provide new evidence about the critical involvement of the posterior insular cortex and the neurobiology underlying TMD pain in both regional and generalized manifestations. It is also a further step towards understanding and accepting chronic pain as a disorder in itself.

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  • 25.
    Häggman-Henrikson, Birgitta
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Davidson, T
    Malmö högskola, Faculty of Odontology (OD).
    Högestätt, ED
    Östlund, Pernilla
    Malmö högskola, Faculty of Odontology (OD).
    Tranaeus, Sofia
    Vitols, S
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Pharmacological treatment of oro-facial pain: health technology assessment including a systematic review with network meta-analysis.2017In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 44, no 10, p. 800-826Article in journal (Refereed)
    Abstract [en]

    This health technology assessment evaluated the efficacy of pharmacological treatment in patients with oro-facial pain. Randomised controlled trials were included if they reported pharmacological treatment in patients ≥18 years with chronic (≥3 months) oro-facial pain. Patients were divided into subgroups: TMD-muscle [temporomandibular disorders (TMD) mainly associated with myalgia]; TMD-joint (TMD mainly associated with temporomandibular joint pain); and burning mouth syndrome (BMS). The primary outcome was pain intensity reduction after pharmacological treatment. The scientific quality of the evidence was rated according to GRADE. An electronic search in PubMed, Cochrane Library, and EMBASE from database inception to 1 March 2017 combined with a handsearch identified 1552 articles. After screening of abstracts, 178 articles were reviewed in full text and 57 studies met the inclusion criteria. After risk of bias assessment, 41 articles remained: 15 studies on 790 patients classified as TMD-joint, nine on 375 patients classified as TMD-muscle and 17 on 868 patients with BMS. Of these, eight studies on TMD-muscle, and five on BMS were included in separate network meta-analysis. The narrative synthesis suggests that NSAIDs as well as corticosteroid and hyaluronate injections are effective treatments for TMD-joint pain. The network meta-analysis showed that clonazepam and capsaicin reduced pain intensity in BMS, and the muscle relaxant cyclobenzaprine, for the TMD-muscle group. In conclusion, based on a limited number of studies, evidence provided with network meta-analysis showed that clonazepam and capsaicin are effective in treatment of BMS and that the muscle relaxant cyclobenzaprine has a positive treatment effect for TMD-muscle pain.

  • 26.
    Iskanderani, Durer
    et al.
    Malmö University, Faculty of Odontology (OD).
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Ekberg, Ewa Carin
    Malmö University, Faculty of Odontology (OD).
    Shi, Xie-Qi
    Malmö University, Faculty of Odontology (OD).
    Hellén-Halme, Kristina
    Malmö University, Faculty of Odontology (OD).
    Web-based educational programme for temporomandibular joint assessment with cone-beam computed tomography.2020In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 47, no 11, p. 1330-1336Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To develop and evaluate an educational web-based program for temporomandibular joint (TMJ) assessment using cone-beam computed tomography (CBCT).

    METHODS: A web-based educational program was designed for TMJ assessment using CBCT images. Fifteen CBCT cases of the TMJ (three-dimensional reconstructed volumes) and an assessment module based on image analysis criteria in the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were added to the program. Thirty-six undergraduate dental students were invited to test the program by assessing all cases twice: before and after 2 months of training. Participants submitted written subjective evaluations of the program.

    RESULTS: The web-based program can be accessed on Malmö University webpage (www.cbct-tmj.mau.se). Despite limited CBCT learning in their undergraduate training and not using the program in the 2-month interval, the students were able to correctly diagnose 80% of the cases at the second assessment. Their diagnoses, however, did not differ significantly from the first assessment. Overall, the students were satisfied with the program and considered it user friendly.

    CONCLUSION: The web-based educational program that was developed in the present study and tested by dental students could be a useful educational tool for TMJ assessment using CBCT.

  • 27.
    Iskanderani, Durer
    et al.
    Malmö University, Faculty of Odontology (OD).
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Hellén-Halme, Kristina
    Malmö University, Faculty of Odontology (OD).
    Assessment of a training programme on detection of temporomandibular joint osseous changes applying pre-defined 2D multiplane cone beam computed tomography reconstructions2018In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 45, no 4, p. 282-288Article in journal (Refereed)
    Abstract [en]

    Objectives Osseous changes in temporomandibular joint disorders (TMD) are common indications for cone beam computed tomography (CBCT). The number of such cases is increasing while a number of qualified oral radiologists is limited. This study investigated the usefulness of a training programme for general dental practitioners (GDPs) regarding temporomandibular joint (TMJ) osseous changes detection in CBCT images. Methods We selected CBCT images of 35 TMD cases and chose 5 of them to use in training 7 GDPs on detecting osseous changes in the TMJ. In evaluation directly following training, GDPs assessed the 30 remaining cases. Three qualified radiologists served as reference standard. A 2-month follow-up of training comprising evaluation of the same cases. The cases are assessed according to Ahmad etal (Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 107, 2009, 844) protocol of TMJ osseous changes in CBCT images. ResultsSensitivity and specificity of the CBCT protocol were high, except for some criteria that did not appear in the cases. Average observer sensitivity was 65% while specificity was 87%. Average correct individual response rate was 84%. Mean agreement among the GDPs was 73%. Observer performance had improved at the 2-month follow-up. Conclusion The present educational programme could be a helpful material on recognising possible osseous changes of TMJ and it can be used as a part of a training programme for GDP and for specialist candidates.

  • 28.
    Iskanderani, Durer
    et al.
    Malmö University, Faculty of Odontology (OD).
    Nilsson, Mats
    Malmö University, Faculty of Odontology (OD).
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Hellén-Halme, Kristina
    Malmö University, Faculty of Odontology (OD).
    Absorbed dose distributions for cone beam computed tomography examinations of the temporomandibular joint in phantoms of an adult and child2018Conference paper (Other academic)
    Abstract [en]

    Introduction To measure absorbed dose with high spatial resolution we have used Gafchromic film which gives an analog-looking dose distribution image compared to point measurements, e.g. TLDs. CBCT examinations of TMJs will produce dose distributions with very steep dose gradients. Over a distance of 2 mm, the absorbed dose can increase/decrease more than a factor of 10. Point measurements using 3x3 mm TLDs will give dose values with high uncertainty when placed in areas with steep dose gradients. Aim The aim was to map the absorbed dose distributions with Gafchromic film, for TMJ investigations using adult and child phantoms. Another aim was to analyze the difference of dose distributions in sensitive organs/tissues between the phantoms. Material and methods Gafchromic films were placed between selected layers of the two head phantoms. The number of films was chosen to well cover the height of the CBCT volume used. The films were scanned in a flatbed scanner and the net pixel values were converted to absorbed dose using a calibration curve. Clinically used examination protocols were applied for three different CBCT units. Outlines of organs/tissues considered at risk were superimposed on the dose distributions. Maximum, minimum and mean doses were calculated. Also, the integrated dose in the phantom was calculated to reflect the total radiation load. Preliminary results and conclusion For CBCT examinations, dose gradients are steep in many organs/tissues considered at risk. Measuring dose distributions with high spatial resolution will give a solid foundation for calculating mean doses in those organs/tissues both for children and adults and will also facilitate comparisons of different examination protocols and of different CBCT units.

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  • 29.
    Iskanderani, Durer
    et al.
    Malmö University, Faculty of Odontology (OD).
    Nilsson, Mats
    Malmö University, Faculty of Odontology (OD).
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Hellén-Halme, Kristina
    Malmö University, Faculty of Odontology (OD).
    Dose distributions in adult and child head phantoms for panoramic and cone beam computed tomography imaging of the temporomandibular joint2020In: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, E-ISSN 2212-4411, Vol. 130, no 2, p. 200-208, article id S2212-4403(20)30017-1Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to map and compare the distributions of absorbed doses with Gafchromic film for panoramic radiography and cone beam computed tomography (CBCT) examinations of the temporomandibular joint (TMJ) by using adult and child phantoms.

    STUDY DESIGN: Gafchromic films were placed at 5 selected levels of anthropomorphic head phantoms of an adult and a child. Clinical protocols for panoramic and CBCT imaging of the TMJ were used for three 2-dimensional or 3-dimensional dental x-ray units. Mean absorbed doses in a set of radiosensitive tissues within the oral and maxillofacial regions were estimated.

    RESULTS: The absorbed doses varied considerably among and within radiosensitive tissues. The bone surface and the salivary glands received the highest absorbed doses compared with other tissues, in both panoramic and CBCT examinations of the TMJ. The radiation burden to the adult phantom was generally higher than that to the child phantom. Small right and left fields of view were associated with lower amounts of radiation, in contrast to a single larger field of view.

    CONCLUSIONS: The absorbed dose within all radiosensitive tissues varied considerably in relation to examination type, x-ray unit, clinical settings, and patient age. The mean doses were smaller when using 2 (bilateral) 4 × 4 cm volumes than with use of one 14 × 5 cm volume.

  • 30.
    Iskanderani, Durer
    et al.
    Malmö University, Faculty of Odontology (OD).
    Nilsson, Mats
    Malmö University, Faculty of Odontology (OD).
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Shi, Xie-Qi
    Malmö University, Faculty of Odontology (OD).
    Hellén-Halme, Kristina
    Malmö University, Faculty of Odontology (OD).
    Evaluation of a low-dose protocol for cone beam computed tomography of the temporomandibular joint2021In: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 50, no 1Article in journal (Other academic)
  • 31.
    Iskanderani, Durer
    et al.
    Malmö University, Faculty of Odontology (OD).
    Nilsson, Mats
    Malmö University, Faculty of Odontology (OD).
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Shi, Xie-Qi
    Malmö University, Faculty of Odontology (OD).
    Hellén-Halme, Kristina
    Malmö University, Faculty of Odontology (OD).
    Evaluation of a low-dose protocol for cone beam computed tomography of the temporomandibular joint.2020In: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 49, no 6, article id 20190495Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Evaluation of cone beam CT (CBCT) examination with a low-dose scanning protocol for assessment of the temporomandibular joint (TMJ).

    METHODS: 34 adult patients referred for CBCT imaging of the TMJ underwent two examinations with two scanning protocols, a manufacturer-recommended protocol (default) and a low-dose protocol where the tube current was reduced to 20% of the default protocol. Three image stacks were reconstructed: default protocol, low-dose protocol, and processed (using a noise reduction algorithm) low-dose protocol. Four radiologists evaluated the images. The Sign test was used to evaluate visibility of TMJ anatomic structures and image quality. Receiver operating characteristic analyzes were performed to assess the diagnostic accuracy. κ values were used to evaluate intraobserver agreement.

    RESULTS: ) averaged for the low-dose and processed protocols, according to all observers, were 0.931 and 0.941, respectively. Intraobserver agreement was good to very good.

    CONCLUSION: For the CBCT unit used in this study, the low-dose CBCT protocol for TMJ examination was diagnostically comparable to the manufacturer-recommended protocol, but delivered a five times lower radiation dose. There is an urgent need to evaluate protocols for CBCT examinations of TMJ in order to optimize them for a radiation dose as low as diagnostically acceptable (the as low as diagnostically acceptable principle recommended by NCRP).

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  • 32. Kristensen, Kasper Dahl
    et al.
    Stoustrup, Peter
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Küseler, Annelise
    Herlin, Troels
    Pedersen, Thomas Klit
    Signs and symptoms after temporomandibular joint washing and cannula placement assessed by cone beam computerized tomography2015In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 73, no 6, p. 454-460Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Analyses of temporomandibular joint synovial fluid using the hydroxocobalamin push-pull technique are increasingly used. However, objective complications and subjective experiences from this procedure have not been described. Firstly, this study aimed to describe discomfort and potential side-effects of this method with special emphasis on symptoms related to the arthrocentesis to be used for future patient information and Ethical Committee applications. Secondly, this study aimed to evaluate the use of cone beam computed tomography (CBCT) as control of intra-capsular cannula placement. METHODS: Twenty healthy, young adult volunteers were included. Extensive objective and subjective questionnaires were completed before and 14 days after the synovial fluid sampling. With the cannula inside the joints a CBCT was done to investigate if this procedure can be used to verify intra-capsular cannula position. RESULTS: The subjective findings: Most subjects did experience mild pain or discomfort post-operatively. In 12 of 20 subjects symptoms had resolved after 2 days and no subjects had symptoms for more than a week. The longer lasting symptoms were mainly transient joint sounds on mandibular movement. Objective findings: 14 days after the sampling mandibular protrusion had improved 1 mm, but all other objective measures were equal compared to baseline. CBCT showed a large variation in cannula position and no conclusions could be drawn from this. CONCLUSION: The hydroxocobalamin push-pull synovial fluid sampling may cause minor, transient symptoms. CBCT does not seem to provide any clinical benefits concerning the correct cannula position in relation to the upper joint compartment and disc

  • 33. Kristensen, KD
    et al.
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Stoustrop, P
    Kuseler, A
    Herlin, T
    Pedersen, TK
    Cytokines in healthy temporomandibular joint synovial fluid2014In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 41, no 4, p. 250-256Article in journal (Refereed)
    Abstract [en]

    Analysis of temporomandibular joint (TMJ) synovial fluid may elucidate the aetiology of temporomandibular disorders and arthritic conditions, as well as the inflammatory mechanisms involved. Knowledge about healthy synovial fluid is necessary to understand TMJ pathologies. We aimed to quantify the proinflammatory cytokines interleukin (IL)-1β, IL-2, IL-6 and tumour necrosis factor (TNF), and the anti-inflammatory cytokines IL-10 and interferon (IFN)-γ in healthy TMJ synovial fluid to serve as reference values for future studies on TMJ pathologies. Twenty healthy, young adult volunteers without temporomandibular dysfunction were included. Bilateral synovial fluid samples were obtained using the push-pull technique with hydroxocobalamin described by Alstergren in 1999. Cytokines were quantified with Luminex multiplex assays and compared using nonparametric statistical analysis. No serious adverse effects were reported. Of 40 possible samples, 14 fulfilled the strict sampling criteria and were included in the analysis. Cytokine values (reported as medians with interquartile ranges) were as follows: TNF, 23 (13-37) pg mL(-1) ; IL-2, 1·8 (0-22) pg mL(-1) ; and INF-γ, 10 (0-47) pg mL(-1) . IL-1β, IL-6 and IL-10 were almost undetectable. In addition, TNF and INF-γ cytokine levels correlated. We demonstrated that TNF was consistently detected and IFN-γ and IL-2 sporadically detected in the TMJ synovial fluid of healthy individuals using the hydroxocobalamin method and a multiplex assay. The cytokines IL-10, IL-1β and IL-6 were barely detectable in this sample of healthy TMJs

  • 34.
    Kroese, Johanna Margaretha
    et al.
    University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Kopp, Sigvard
    Karolinska Institutet.
    Lobbezoo, Frank
    University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD). Scandinavian Center for Orofacial Neurosciences (SCON); Skåne University Hospital.
    Corticosteroid injections in the temporomandibular joint temporarily alleviate pain and improve function in rheumatoid arthritis2021In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 40, p. 4853-4860Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the effect of corticosteroid injections in the painful temporomandibular joint (TMJ) of patients with rheumatoid arthritis (RA) in relation to systemic inflammatory activity. Method: Examination of 35 patients (median age 54 years; 89% female) included maximum mouth opening capacity, degree of anterior open bite (AOB), TMJ pain intensity at rest, and crepitus. Serum levels of rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serotonin, and plasma levels of interleukine-1 beta (IL-1 beta) were determined. Out of the 70 examined joints, 53 joints received a corticosteroid (methylprednisolone) injection after the clinical examination at baseline (T0). The examination was repeated for all patients at T1 (median 3.1 weeks after T0), and for 21 patients at T2 (median 6.3 weeks after T1), of whom 20 patients received a second injection at T1. Results: Maximum mouth opening capacity significantly increased, and TMJ pain intensity significantly decreased between T0 and T1, but these improvements were no longer present at T2. No differences were found in AOB between the time points. Of the joints that received an injection at T0, 19 joints had pretreatment crepitus, which resolved in eight joints at T1. No correlations were found between the change in mouth opening capacity or TMJ pain intensity and ESR, CRP, serotonin, or IL-1 beta. Conclusions: Methylprednisolone injections in the TMJ alleviate pain and improve mouth opening capacity for approximately 3 weeks, allowing patients to perform jaw exercises during this timeframe of temporary relief. It thus seems useful for the short-term management of TMJ involvement in RA.

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  • 35.
    Lam, Julia
    et al.
    Malmö University, Faculty of Odontology (OD).
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD).
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Internet-Based Multimodal Pain Program With Telephone Support for Adults With Chronic Temporomandibular Disorder Pain: Randomized Controlled Pilot Trial2020In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 22, no 10, article id e22326Article in journal (Refereed)
    Abstract [en]

    Background: Chronic pain from temporomandibular disorders remains an undertreated condition with debate regarding the most effective treatment modalities. Objective: The aim of the study was to investigate the treatment effect of an internet-based multimodal pain program on chronic temporomandibular disorder pain and evaluate the feasibility of a larger randomized controlled trial. Methods: An unblinded randomized controlled pilot trial was conducted with 43 participants (34 females, 9 males; median age 27, IQR 23-37 years) with chronic temporomandibular pain. Participants were recruited within the Public Dental Health Service and randomized to intervention (n=20) or active control (n=23). The intervention comprised a dentist-assisted internet-based multimodal pain program with 7 modules based on cognitive behavior therapy and self-management principles. The control group received conventional occlusal splint therapy. Primary outcomes included characteristic pain intensity, pain-related disability, and jaw functional limitation. Secondary outcomes were depression, anxiety, catastrophizing, and stress. Outcomes were self-assessed through questionnaires sent by mail at 3 and 6 months after treatment start. Feasibility evaluation included testing the study protocol and estimation of recruitment and attrition rates in the current research setting. Results: Only 49% of participants (21/43) provided data at the 6-month follow-up (internet-based multimodal pain program: n=7; control: n=14). Of the 20 participants randomized to the internet-based multimodal pain program, 14 started treatment and 8 completed all 7 modules of the program. Between-group analysis showed no significant difference for any outcome measure at 3- or 6-month follow-up-characteristic pain intensity (3 months: P=.58; 6 months: P=.41), pain-related disability (3 months: P=.51; 6 months: P=.12), jaw functional limitation (3 months: P=.45; 6 months: P=.90), degree of depression (3 months: P=.64; 6 months: P=.65), anxiety (3 months: P=.93; 6 months: P=.31), stress (3 months: P=.66; 6 months: P=.74), or catastrophizing (3 months: P=.86; 6 months: P=.85). Within-group analysis in the internet-based multimodal pain program group showed a significant reduction in jaw functional limitation score at the 6-month follow-up compared to baseline (Friedman: chi 2=10.2, P=.04; Wilcoxon: z=-2.3, P=.02). In the occlusal splint group, jaw function limitation was also reduced at the 6-month follow-up (Friedman: chi 2=20.0, P=.045; Wilcoxon: z=-2.3, P=.02), and there was a reduction in characteristic pain intensity at the 3- and 6-month follow-up (Friedman: chi 2=25.1, P=.01; Wilcoxon 3 months: z=-3.0, P=.003; Wilcoxon 6 months: z=-3.3, P=.001). Conclusions: This study was not able to demonstrate a difference in treatment outcome between an internet-based multimodal pain program and occlusal splint therapy in patients with chronic temporomandibular pain. However, the findings suggested that the internet-based multimodal pain program improves jaw function. The results also confirmed the treatment effect of occlusal splint therapy for chronic temporomandibular pain. Furthermore, because of the high attrition rate, this pilot study showed that a randomized controlled trial with this design is not feasible.

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  • 36. Leskinen, J.
    et al.
    Suvinen, T.
    Teerijoki-Oksa, T.
    Kemppainen, P.
    Napankangas, R.
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Le Bell, Y.
    Forssell, H.
    Myllykangas, R.
    Tolvanen, M.
    Doepel, M.
    Sipila, K.
    Diagnostic criteria for temporomandibular disorders (DC/TMD): interexaminer reliability of the Finnish version of Axis I clinical diagnoses2017In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 44, no 7, p. 493-499Article in journal (Refereed)
    Abstract [en]

    Recently, updated diagnostic criteria for temporomandibular disorders (DC/TMD) were published to assess TMD in a standardised way in clinical and research settings. The DC/TMD protocol has been translated into Finnish using specific cultural equivalency procedures. To assess the interexaminer reliability using the Finnish translations of the DC/TMD-FIN Axis I clinical diagnostic assessment instruments. Reliability assessment data were collected during a 1-day DC/TMD Examiner Training Course at the University of Turku, Finland, in collaboration with the International DC/TMD Training and Calibration Center in Malmo University. Clinical TMD examinations according to the Finnish pre-final version of the DC/TMD Axis I assessment protocol were performed by four experienced TMD specialists on altogether 16 models. Kappa coefficient, overall percentage agreement (%A) as well as positive (PA) and negative (NA) agreements were used to define the reliability. Myofascial pain with referral, headache attributed to TMD and disc displacement (DD) without reduction without limited opening showed excellent kappa values (range 087-100). Fair-to-good reliability was observed for diagnoses of myalgia (k = 067), arthralgia (k = 071) and DD with reduction (k = 064). The PA was high for all pain-related diagnoses and DD without reduction without limited opening (medians 83%), and acceptable for DD with reduction (median 67%). The NA was high (medians 87%) for all DC/TMD diagnoses, except for myalgia which showed acceptable NA (median 75%). The %A was high for all assessed diagnoses (medians >85%). The findings of this study showed DC/TMD-FIN Axis I to demonstrate sufficiently high reliability for pain-related TMD diagnoses.

  • 37. Lövgren, Anna
    et al.
    Visscher, Corine M
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Lobbezoo, Frank
    Häggman-Henrikson, Birgitta
    Malmö University, Faculty of Odontology (OD).
    Wänman, Anders
    The outcome of a temporomandibular joint compression test for the diagnosis of arthralgia is confounded by concurrent myalgia2020In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 24, p. 97-102Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Pain in the orofacial region may originate from different structures, and one challenge for the clinician is to determine the primary origin of pain reported by the patient. In clinical practice, it is important to discriminate between a temporomandibular joint (TMJ) pain disorder and jaw muscle pain; therefore, tests that are proposed for such purposes warrant evaluation. The aim of the present study was to evaluate the outcome of a TMJ compression test in relation to a Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) arthralgia diagnosis. METHODS: A study population (n = 300), randomly selected from the adult population in Vasterbotten, Sweden, was examined according to the DC/TMD criteria and with a TMJ compression test. This test is comprised of forceful unilateral biting for 20 s on a wooden spatula in the first molar region. Familiar pain on the contralateral side to the clenching side was considered a positive test outcome. RESULTS: Positive contralateral outcome of the TMJ compression test was associated with an arthralgia diagnosis (B = 1.737; OR 5.7, 95% CI 3.3-9.9). This association was confounded by concurrent myalgia (B = 1.737 --> B = 0.996, 42.7%). CONCLUSION: In a general population, a negative TMJ compression test was strongly associated with the absence of a contralateral TMJ arthralgia diagnosis according to DC/TMD. The association between a positive TMJ compression test and a DC/TMD arthralgia diagnosis was confounded by the presence of myalgia. CLINICAL RELEVANCE: Concurrent myalgia renders the usefulness of the TMJ compression test for predicting an arthralgia diagnosis questionable.

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  • 38. Michelotti, A
    et al.
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Goulet, JP
    Lobbezoo, F
    Ohrbach, R
    Peck, C
    Schiffman, E
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Next steps in development of the diagnostic criteria for temporomandibular disorders (DC/TMD): Recommendations from the International RDC/TMD Consortium Network workshop2016In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 43, no 6, p. 453-467Article in journal (Refereed)
    Abstract [en]

    The development of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) (1) involved expanding the taxonomy for all TMDs (2) in order to propose for future validation DC for empirically supported TMDs that were not part of the DC/ TMD structure. This expanded taxonomy offers an integrated approach to clinical diagnosis and provides a framework for operationalising and testing the proposed taxonomy and diagnostic criteria in future research. During expansion of the taxonomy, researchers identified several challenges in the diagnosis of some disorders, so the International RDC/TMD Consortium Network planned a workshop to discuss criterion improvements for five of the disorders and the biobehavioural domain.

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  • 39. Neveen, Ahmed
    et al.
    Hamid Masoud, Mustafa
    Anca Irinel, Catrina
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Impact of Temporomandibular Joint Pain in Rheumatoid Arthritis2013In: Mediators of Inflammation, ISSN 0962-9351, E-ISSN 1466-1861, Vol. 2013, article id 597419Article in journal (Refereed)
    Abstract [en]

    To investigate the impact of temporomandibular joint (TMJ) pain on daily activities and quality of life in relation to systemic inflammatory activity in patients with rheumatoid arthritis (RA), thirty-three consecutive outpatients with RA were included. TMJ pain intensity at rest, on maximum mouth opening, and on chewing was assessed on a 0–10 numerical rating scale. TMJ palpatory tenderness, degree of anterior open bite, the impact of TMJ pain on daily activities and quality of life were also assessed. The systemic inflammatory activity was estimated by the disease activity score 28 (DAS28), blood levels of inflammatory markers and number of painful musculoskeletal regions. TMJ pain at rest, on maximum mouth opening, and on chewing as well as DAS28 was correlated with the impact of the TMJ pain on daily activities and quality of life. Partial correlations showed a significant interaction between TMJ pain on movement and DAS28 that explained the TMJ pain impact on daily activities and quality of life to a significant degree. This study indicates that both current TMJ pain intensity and systemic inflammatory activity play roles in the impact of TMJ pain on daily living and quality of life in RA.

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  • 40.
    Nilsson, Ing-Marie
    et al.
    Malmö University, Faculty of Odontology (OD). Center for Oral Rehabilitation, FTV Östergötland, Norrköping, Sweden.
    Ekberg, EwaCarin
    Malmö University, Faculty of Odontology (OD).
    Michelotti, Ambrosina
    School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy.
    Al-Khotani, Amal
    Dental Department, East Jeddah Hospital, Ministry of Health, Jeddah, Saudi Arabia.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD). Dental Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Conti, Paulo Cesar Rodrigues
    Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, Brazil; Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.
    Durham, Justin
    Newcastle School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
    Goulet, Jean-Paul
    Faculty of Dental Medicine, Laval University, Quebec, Canada.
    Hirsch, Christian
    Clinic of Pediatric Dentistry, University of Leipzig, Leipzig, Germany.
    Kalaykova, Stanimira
    Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
    Kapos, Flavia P
    Center for Child Health, Behavior and Development, Seattle Children's Research Institute , Seattle, Washington, USA.
    King, Christopher D
    Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
    Komiyama, Osamu
    Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, Japan.
    Michail, Koutris
    Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    List, Thomas
    Malmö University, Faculty of Odontology (OD).
    Lobbezoo, Frank
    Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Ohrbach, Richard
    Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA.
    Palermo, Tonya M
    Center for Child Health, Behavior and Development, Seattle Children's Research Institute , Seattle, Washington, USA; Department of Anesthesiology and Pain Medicine, University of Washington School of MedicineSeattle, Washington, USA .
    Peck, Christopher C
    Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
    Penlington, Chris
    Newcastle School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
    Restrepo, Claudia
    CES-LPH Research Group, Universidad CES, Medellin, Colombia.
    Rodrigues, Maria Joao
    Institute for Occlusion and Orofacial Pain, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
    Sharma, Sonia
    Malmö University, Faculty of Odontology (OD).
    Svensson, Peter
    Section for Orofacial Pain and Jaw Function, School of Dentistry and Oral Health, Aarhus, Denmark.
    Visscher, Corine
    Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Wahlund, Kerstin
    Department of Orofacial Pain and Jaw Function, Kalmar County Hospital, Kalmar, Sweden.
    Rongo, Roberto
    School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy.
    Diagnostic Criteria for Temporomandibular Disorders - INfORM recommendations: Comprehensive and short-form adaptations for children2023In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 50, no 2, p. 99-112Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) are used worldwide in adults. Until now, no adaptation for use in children has been proposed.

    OBJECTIVE: To present comprehensive and short-form adaptations of Axis I and II of the DC/TMD for adults that are appropriate for use with children in clinical and research settings.

    METHODS: Global Delphi studies with experts in TMDs and in pain psychology identified ways of adapting the DC/TMD for children.

    RESULTS: The proposed adaptation is suitable for children aged 6-9 years. Proposed changes in Axis I include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for children, (ii) adding a general health questionnaire for children and one for their parents, (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire, and (iv) modifying the clinical examination protocol. Proposed changes in Axis II include (i) for the Graded Chronic Pain Scale, to be developmentally appropriate for children, and (ii) adding anxiety and depression assessments that have been validated in children, and (iii) adding three constructs (stress, catastrophizing, and sleep disorders) to assess psychosocial functioning in children.

    CONCLUSION: The recommended DC/TMD, including Axis I and Axis II, for children aged 6-9 years, is appropriate for use in clinical and research settings. This adapted first version for children includes changes in Axis I and Axis II changes requiring reliability and validity testing in international settings. Official translations to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

  • 41. Peck, CC
    et al.
    Goulet, JP
    Lobbezoo, F
    Schiffman, EL
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Anderson, GC
    Malmö högskola, Faculty of Odontology (OD).
    de Leuw, R
    Jensen, R
    Michelotti, A
    Orbach, R
    Petersson, Arne
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Expanding the taxonomy of the diagnostic criteria for temporomandibular disorders2014In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 41, no 1, p. 2-23Article in journal (Refereed)
    Abstract [en]

    There is a need to expand the current temporomandibular disorders' (TMDs) classification to include less common but clinically important disorders. The immediate aim was to develop a consensus-based classification system and associated diagnostic criteria that have clinical and research utility for less common TMDs. The long-term aim was to establish a foundation, vis-à-vis this classification system, that will stimulate data collection, validity testing and further criteria refinement. A working group [members of the International RDC/TMD Consortium Network of the International Association for Dental Research (IADR), members of the Orofacial Pain Special Interest Group (SIG) of the International Association for the Study of Pain (IASP), and members from other professional societies] reviewed disorders for inclusion based on clinical significance, the availability of plausible diagnostic criteria and the ability to operationalise and study the criteria. The disorders were derived from the literature when possible and based on expert opinion as necessary. The expanded TMDs taxonomy was presented for feedback at international meetings. Of 56 disorders considered, 37 were included in the expanded taxonomy and were placed into the following four categories: temporomandibular joint disorders, masticatory muscle disorders, headache disorders and disorders affecting associated structures. Those excluded were extremely uncommon, lacking operationalised diagnostic criteria, not clearly related to TMDs, or not sufficiently distinct from disorders already included within the taxonomy. The expanded TMDs taxonomy offers an integrated approach to clinical diagnosis and provides a framework for further research to operationalise and test the proposed taxonomy and diagnostic criteria

  • 42.
    Pigg, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Björnsson, Olof
    Kopp, Sigvard
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Clinical diagnosis of temporomandibular joint arthritis2014In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 93, no Special Issue B, article id 110Article in journal (Other academic)
  • 43. Rongo, Roberto
    et al.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Ammendola, Lucia
    Bucci, Rosaria
    Alessio, Maria
    D'Anto, Vincenzo
    Michelotti, Ambra
    Temporomandibular joint damage in juvenile idiopathic arthritis: Diagnostic validity of diagnostic criteria for temporomandibular disorders2019In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 46, no 5, p. 450-459Article in journal (Refereed)
    Abstract [en]

    BackgroundDiagnostic criteria reported in the expanded taxonomy for temporomandibular disorders include a standardised clinical examination and diagnosis (DC/TMD 3.B) of temporomandibular joint (TMJ) damage in patients with juvenile idiopathic arthritis (JIA); however, their validity is unknown. ObjectivesTo assess the validity of DC/TMD 3.B for the identification of TMJ damage in JIA-patients, using magnetic resonance imaging (MRI) as gold standard, and to investigate the relation between clinical findings and TMJ damage. MethodsFifty consecutive JIA patients (9-16years) were recruited. DC/TMD 3.B were compared with TMJs MRI (100TMJs) performed maximum at 1month from the visit. The severity of TMJ damage was scored in four grades. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), logistic regression models with odds ratio of DC/TMD 3.B and clinical findings respect to MRI were calculated. ResultsThe DC/TMD 3.B were inadequate in the identification of TMJ damage (sensitivity=0.15, specificity=0.92, PPV=0.85, NPV=0.28, P=0.350). Chin deviation and TMJ crepitus were associated with worse TMJ damage (P=0.006; P=0.034). Reduced mouth opening (OR=3.91, P=0.039) and chin deviation (OR=13.7, P=0.014) were associated with the presence of TMJ damage. Combining pain (history of pain, TMJ pain, pain during movements) and function (TMJ crepitus, reduced mouth opening, chin deviation) clinical findings, the sensitivity and the specificity were 0.88 and 0.54. ConclusionDC/TMD 3.B present a low sensitivity to diagnose TMJ damage. Chin deviation, reduced mouth opening and TMJ crepitus are associated with TMJ damage. We suggest combining pain and function findings for the evaluation of TMJ damage in JIA patients.

  • 44.
    Rongo, Roberto
    et al.
    School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy.
    Ekberg, EwaCarin
    Malmö University, Faculty of Odontology (OD).
    Nilsson, Ing-Marie
    Malmö University, Faculty of Odontology (OD).
    Al-Khotani, Amal
    Scandinavian Center for Orofacial Neurosciences, Sweden.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Conti, Paulo Cesar Rodrigues
    Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
    Durham, Justin
    School of Dental Sciences, Newcastle University, Newcastle-Upon-Tyne, UK.
    Goulet, Jean-Paul
    Faculty of Dental Medicine, Laval University, Quebec, Canada.
    Hirsch, Christian
    Clinic of Pediatric Dentistry, University of Leipzig, Leipzig, Germany.
    Kalaykova, Stanimira I
    Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
    Kapos, Flavia P
    Department of Epidemiology, University of Washington, Seattle, United States.
    King, Christopher D
    Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, United States.
    Komiyama, Osamu
    Division of Oral Function and Rehabilitation, Nihon University School of Dentistry at Matsudo, Japan.
    Koutris, Michail
    Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    List, Thomas
    Malmö University, Faculty of Odontology (OD).
    Lobbezoo, Frank
    Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Ohrbach, Richard
    Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, United States.
    Palermo, Tonya M
    Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, United States.
    Peck, Christopher C
    Faculty of Medicine and Health, University of Sydney, Westmead, Australia.
    Penlington, Chris
    School of Dental Sciences, Newcastle University, Newcastle-Upon-Tyne, UK.
    Restrepo, Claudia
    CES-LPH Research Group, Universidad CES, Medellin, Colombia.
    Rodrigues, Maria Joao
    Institute for Occlusion and Orofacial Pain Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
    Sharma, Sonia
    Malmö University, Faculty of Odontology (OD).
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD).
    Visscher, Corine M
    Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Wahlund, Kerstin
    Department of Stomatognathic Physiology, Kalmar County Hospital, Kalmar, Sweden.
    Michelotti, Ambrosina
    School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy.
    Diagnostic criteria for temporomandibular disorders (DC/TMD) in children and adolescents: an international Delphi study-Part 2-Development of Axis II2022In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 49, no 5, p. 541-552Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Unlike the psychosocial assessment established for adults in the diagnostic criteria for temporomandibular disorders (DC/TMD), a standardized psychosocial assessment for children and adolescents with TMD complaints has not yet been established.

    OBJECTIVES: To develop a new standardized instrument set to assess the psychosocial functioning in children and adolescents by adapting the psychosocial status and pain-related disability (Axis II) of the adult DC/TMD and by including new instruments.

    METHODS: A modified Delphi method was used to survey 23 international TMD experts and four international experts in pain-related psychological factors for consensus regarding assessment tools for psychosocial functioning and pain-related disability in children and adolescents. The TMD experts reviewed 29 Axis II statements at round 1, 13 at round 2, and 2 at round 3. Agreement was set at 80% for first-round consensus level and 70% for each of the second and third rounds. The psychological experts completed a complementary Delphi survey to reach a consensus on tools to use to assess more complex psychological domains in children and adolescents. For the psychological experts, the first round included 10 open-ended questions on preferred screening tools for depression, anxiety, catastrophizing, sleep problems, and stress in children (ages 6-9 years old) and adolescents (ages 10-19 years old) as well as on other domains suggested for investigation. In the second round, the psychological experts received a 9-item questionnaire to prioritize the suggested instruments from most to least recommended.

    RESULTS: The TMD experts, after three Delphi rounds, reached consensus on the changes of DC/TMD to create a form to evaluate Axis II in children and adolescents with TMD complaints. The psychological experts added tools to assess depression and anxiety, sleep disorders, catastrophizing, stress, and resilience.

    CONCLUSION: Through international expert consensus, this study adapted Axis II of the adult DC/TMD to assess psychosocial functioning and pain-related disability in children and adolescents. The adapted Axis II protocols will be validated in the target populations.

  • 45.
    Rongo, Roberto
    et al.
    Department of Neurosciences, Reproductive Sciences and Oral Sciences School of Orthodontics University of Naples Federico II Naples Italy.
    Ekberg, EwaCarin
    Malmö University, Faculty of Odontology (OD).
    Nilsson, Ing-Marie
    Malmö University, Faculty of Odontology (OD). Center for Oral Rehabilitation FTV Östergötland Norrköping Sweden.
    Al‐Khotani, Amal
    Scandinavian Center for Orofacial Neurosciences Sweden;East Jeddah Hospital, Ministry of Health Jeddah Saudi Arabia.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD). Scandinavian Center for Orofacial Neurosciences Sweden;Department of Dental Medicine Karolinska Institute Huddinge Sweden.
    Conti, Paulo Cesar Rodrigues
    Department of Prosthodontics and Periodontology Bauru School of Dentistry – University of São Paulo Bauru Brazil;Bauru Orofacial Pain Group University of São Paulo Bauru Brazil.
    Durham, Justin
    School of Dental Sciences Newcastle University Newcastle Upon Tyne UK;Newcastle Upon Tyne Hospitals NHS Foundation Trust Newcastle Upon Tyne UK.
    Goulet, Jean‐Paul
    Faculty of Dental Medicine Laval University Quebec QC Canada.
    Hirsch, Christian
    Clinic of Pediatric Dentistry University of Leipzig Leipzig Germany.
    Kalaykova, Stanimira I.
    Department of Oral Function and Prosthetic Dentistry College of Dental Sciences Radboud University Medical Center Nijmegen The Netherlands.
    Kapos, Flavia P.
    Department of Epidemiology University of Washington Seattle WA USA.
    Komiyama, Osamu
    Division of Oral Function and Rehabilitation Nihon University School of Dentistry at Matsudo Matsudo Japan.
    Koutris, Michail
    Department of Orofacial pain and Dysfunction Academic Centre for Dentistry Amsterdam (ACTA University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands.
    List, Thomas
    Malmö University, Faculty of Odontology (OD). Scandinavian Center for Orofacial Neurosciences Sweden.
    Lobbezoo, Frank
    Department of Orofacial pain and Dysfunction Academic Centre for Dentistry Amsterdam (ACTA University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands.
    Ohrbach, Richard
    Department of Oral Diagnostic Sciences University at Buffalo Buffalo NY USA.
    Peck, Christopher C.
    Faculty of Medicine and Health The University of Sydney Sydney NSW Australia.
    Restrepo, Claudia
    CES‐LPH Research Group Universidad CES Medellin Colombia.
    Rodrigues, Maria Joao
    Institute for Occlusion and Orofacial Pain Faculty of Medicine University of Coimbra Coimbra Portugal.
    Sharma, Sonia
    Malmö University, Faculty of Odontology (OD). Department of Oral Diagnostic Sciences University at Buffalo Buffalo NY USA.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Scandinavian Center for Orofacial Neurosciences Sweden;Department of Dental Medicine Karolinska Institute Huddinge Sweden;Section of Orofacial Pain and Jaw Function School of Dentistry and Oral Health Aarhus Denmark.
    Visscher, Corine M.
    Department of Orofacial pain and Dysfunction Academic Centre for Dentistry Amsterdam (ACTA University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands.
    Wahlund, Kerstin
    Department of Stomatognathic Physiology Kalmar County Hospital Kalmar Sweden.
    Michelotti, Ambra
    Department of Neurosciences, Reproductive Sciences and Oral Sciences School of Orthodontics University of Naples Federico II Naples Italy.
    Diagnostic criteria for temporomandibular disorders (DC/TMD) for children and adolescents: An international Delphi study—Part 1‐Development of Axis I2021In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 48, no 7, p. 836-845Article in journal (Refereed)
    Abstract [en]

    AIM: To develop new instruments and to adapt the diagnostic criteria for temporomandibular disorders (DC/TMD) for the evaluation of TMD in children and adolescents.

    METHOD: A modified Delphi method was used to seek international consensus among TMD experts. Fourteen clinicians and researchers in the field of orofacial pain and TMD worldwide were invited to participate in a workshop initiated by the International Network for Orofacial Pain and Related Disorders Methodology (INfORM scientific network) at the General Session of the International Association for Dental Research (IADR, London 2018), as the first step in the Delphi process. Participants discussed the protocols required to make physical diagnoses included in the Axis I of the DC/TMD. Thereafter, nine experts in the field were added, and the first Delphi round was created. This survey included 60 statements for Axis I, and the experts were asked to respond to each statement on a five-item Likert scale ranging from "Strongly disagree" to "Strongly agree". Consensus level was set at 80% agreement for the first round, and at 70% for the next.

    RESULTS: After three rounds of the Delphi process, a consensus among TMD experts was achieved and two adapted DC/TMD protocols for Axis I physical diagnoses for children and adolescents were developed.

    CONCLUSION: Through international consensus among TMD experts, this study adapted the Axis I of the DC/TMD for use in evaluating TMD in children and adolescents.

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  • 46.
    Stoustrup, Peter
    et al.
    Section of Orthodontics, Aarhus University, Aarhus, Denmark.
    Resnick, Cory M
    Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts.
    Abramowicz, Shelly
    Division of Oral and Maxillofacial Surgery, Departments of Surgery and Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
    Pedersen, Thomas K
    Section of Orthodontics and Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.
    Michelotti, Ambra
    University of Naples Federico II, Naples, Italy.
    Küseler, Annelise
    Section of Orthodontics and Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.
    Koos, Bernd
    Department of Orthodontics, University Hospital Tübingen, Tübingen, Germany.
    Verna, Carlalberta
    Department of Pediatric Oral Health and Orthodontics, UZB University Center for Dentistry Basel, University of Basel, Basel, Switzerland.
    Nordal, Ellen B
    Department of Pediatrics, University Hospital of North Norway and the Pediatric Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
    Granquist, Eric J
    Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Pennsylvania, Philadelphia.
    Halbig, Josefine Mareile
    The Public Dental Health Competence Centre of North Norway, and the Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Kristensen, Kasper D
    Section of Orthodontics, Aarhus University, Aarhus, Denmark.
    Kaban, Leonard B
    Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts.
    Arvidsson, Linda Z
    Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway.
    Spiegel, Lynn
    The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
    Stoll, Matthew L
    University of Alabama at Birmingham.
    Lerman, Melissa A
    Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
    Glerup, Mia
    Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
    Defabianis, Patrizia
    Section of Paediatric Dentistry, Dental School, University of Turin, Turin, Italy.
    Frid, Paula
    Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital of North Norway, Public Dental Service Competence Centre of North Norway, and Department of Clinical Dentistry, UiT The Arctic University of Norway, Tromsø, Norway.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Cron, Randy Q
    University of Alabama at Birmingham.
    Ringold, Sarah
    Seattle Children's Hospital, Seattle, Washington.
    Nørholt, Sven Erik
    Section of Orthodontics and Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.
    Peltomaki, Timo
    Faculty of Medicine and Health Technology, and Department of Ear and Oral Diseases, Tampere University, Tampere, Finland, and Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland and Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.
    Larheim, Tore A
    Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway.
    Herlin, Troels
    Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
    Peacock, Zachary S
    Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts.
    Kellenberger, Christian J
    Department of Diagnostic Imaging, University Children's Hospital Zürich, Zürich, Switzerland.
    Twilt, Marinka
    Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada.
    Management of orofacial manifestations of juvenile idiopathic arthritis: Interdisciplinary consensus-based recommendations.2023In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 75, no 1, p. 4-14Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVES: Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, dysfunction and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management.

    OBJECTIVES: 1) To develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA. 2) To create a future research agenda related to management of TMJ arthritis in children with JIA.

    METHODS: The recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during two consensus-meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: Pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study.

    RESULTS: Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to: diagnosis (n=4), treatment of TMJ arthritis (active TMJ inflammation) (n=2), treatment of TMJ dysfunction and symptoms (n=3), treatment of arthritis-related dentofacial deformity (n=2), and other related aspects to JIA (n=1). Additionally, a future interdisciplinary research agenda was developed.

    CONCLUSIONS: These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA. This article is protected by copyright. All rights reserved.

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  • 47. Stoustrup, Peter
    et al.
    Resnick, Cory M.
    Pedersen, Thomas Klit
    Abramowicz, Shelly
    Michelotti, Ambra
    Kueseler, Annelise
    Verna, Carlalberta
    Kellenberger, Christian J.
    Nordal, Ellen Berit
    Caserta, Giuliana
    Jankovska, Iveta
    Halbig, Josefine Mareile
    Kristensen, Kasper Dahl
    Arvidsson, Linda Z.
    Spiegel, Lynn
    Stoll, Mathew L.
    Lerman, Melissa
    Glerup, Mia
    Defabianis, Patrizia
    Frid, Paula
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Cron, Randy Q.
    Ringold, Sarah
    Norholt, Sven Erik
    Peltomaeki, Timo
    Herlin, Troels
    Peacock, Zachary S.
    Twilt, Marinka
    Standardizing Terminology and Assessment for Orofacial Conditions in Juvenile Idiopathic Arthritis: International, Multidisciplinary Consensus-based Recommendations2019In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 46, no 5, p. 518-522Article in journal (Refereed)
    Abstract [en]

    Objective. To propose multidisciplinary, consensus-based, standardization of operational terminology and method of assessment for temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA). Methods. Using a sequential expert group-defined terminology and methods-of-assessment approach by (1) establishment of task force, (2) item generation, (3) working group consensus, (4) external expert content validity testing, and (5) multidisciplinary group of experts final Delphi survey consensus. Results. Seven standardized operational terms were defined: TMJ arthritis, TMJ involvement, TMJ arthritis management, dentofacial deformity, TMJ deformity, TMJ symptoms, and TMJ dysfunction. Conclusion. Definition of 7 operational standardized terms provides an optimal platform for communication across healthcare providers involved in JIA-TMJ arthritis management.

  • 48. Stoustrup, Peter
    et al.
    Twilt, Marinka
    Spiegel, Lynn
    Dahl Kristensen, Kasper
    Koos, Bernd
    Klit Pedersen, Thomas
    Küseler, Annelise
    Cron, Randy Q.
    Abramowicz, Shelly
    Verna, Carlalberta
    Peltomäki, Timo
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Petty, Ross
    Ringold, Sarah
    Nørholt, Sven Erik
    Saurenmann, Rotraud K.
    Herlin, Troels
    Clinical Orofacial Examination in Juvenile Idiopathic Arthritis: International Consensus-based Recommendations for Monitoring Patients in Clinical Practice and Research Studies2017In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 44, no 3, p. 326-333Article in journal (Refereed)
    Abstract [en]

    Objective. To develop international consensus-based recommendations for the orofacial examination of patients with juvenile idiopathic arthritis (JIA), for use in clinical practice and research. Methods. Using a sequential phased approach, a multidisciplinary task force developed and evaluated a set of recommendations for the orofacial examination of patients with JIA. Phase 1: A Delphi survey was conducted among 40 expert physicians and dentists with the aim of identifying and ranking the importance of items for inclusion. Phase 2: The task force developed consensus about the domains and items to be included in the recommendations. Phase 3: A systematic literature review was performed to assess the evidence supporting the consensus-based recommendations. Phase 4: An independent group of orofacial and JIA experts were invited to assess the content validity of the task force’s recommendations. Results. Five recommendations were developed to assess the following 5 domains: medical history, orofacial symptoms, muscle and temporomandibular joint function, orofacial function, and dentofacial growth. After application of data search criteria, 56 articles were included in the systematic review. The level of evidence for the 5 recommendations was derived primarily from descriptive studies, such as cross-sectional and case-control studies. Conclusion. Five recommendations are proposed for the orofacial examination of patients with JIA to improve the clinical practice and aid standardized data collection for future studies. The task force has formulated a future research program based on the proposed recommendations.

  • 49.
    Ulmner, Mattias
    et al.
    Unit of Cranio- and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Sugars, Rachael
    Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Naimi-Akbar, Aron
    Malmö University, Faculty of Odontology (OD). Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD). Specialised Pain Rehabilitation, Skåne University Hospital, Lund, Sweden.
    Lund, Bodil
    Unit of Cranio- and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway.
    Cytokines in temporomandibular joint synovial fluid and tissue in relation to inflammation2022In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 49, no 6, p. 599-607Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Synovial tissue is known to be the origin of inflammation in joint disease. Despite this, synovial fluid is the main biological specimen of choice in temporomandibular joint (TMJ) inflammation and pathology biomarker research. No comparison of TMJ protein content between synovial fluid and synovial tissue has been made.

    OBJECTIVES: To investigate if cytokine concentrations in synovial fluid can be related to cytokine concentrations in synovial tissue, and to analyse correlation of clinical parameters reflecting local inflammation to cytokine concentrations.

    METHODS: Synovial tissue and fluid samples were obtained during the same surgical procedure from a cohort of 101 patients with TMJ disorders. Interleukin (IL) 1β, IL-6, IL-8, IL-10, and tumor necrosis factor α (TNF-α) were analysed in the samples and an intraindividual correlation made. Various patient-specific factors relating to TMJ inflammation were associated to the cytokine concentrations in synovial fluid and tissue.

    RESULTS: No correlation between cytokine concentration in synovial fluid and synovial tissue was found, except for IL-8 (ρ=.284, P=.024). Synovial tissue cytokines correlated strongly to inflammation-related factors: diagnosis (IL-1β, P=.001; TNF-α, P=.000; IL-10, P=.000), TMJ palpation pain (IL-1β, P=.024; TNF-α, P=.025), synovitis score (IL-1β, P=.015), and subjective TMJ pain (TNF-α, P=.016). Synovial fluid cytokines showed no significant relations to inflammation.

    CONCLUSIONS: The investigated cytokine concentrations showed weak correlations between synovial fluid and synovial tissue, besides IL-8. Synovial tissue appeared to reflect inflammation to a higher extent than synovial fluid. Thus, suggesting that synovial tissue research should complement synovial fluid in future explorations of TMJ pathology and inflammation.

  • 50. Valentino, Roberta
    et al.
    Rongo, Roberto
    Alessio, Maria
    Alstergren, Per
    Malmö University, Faculty of Odontology (OD).
    Bucci, Rosaria
    Leone, Giovanna
    D'Antò, Vincenzo
    Michelotti, Ambrosina
    Pressure pain threshold over masticatory muscles and temporomandibular joint in patients with juvenile idiopathic arthritis2020In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 47, no 8, p. 944-950Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Juvenile idiopathic arthritis (JIA) is an autoimmune, chronic, inflammatory joint disease, affecting children and adolescents. Patients with JIA may have pain and fatigue in muscles. There are not studies evaluating the pressure pain thresholds (PPTs) of both masticatory muscles and temporomandibular joint (TMJ) in patients with JIA.

    OBJECTIVE: This study aimed to investigate PPTs of masticatory muscles and TMJ in subjects with JIA.

    METHODS: Fifty-one JIA patients and fifty-two healthy subjects were recruited. JIA group was assessed for with a standardised clinical examination for Temporomandibular disorders. In all subjects the PPT was evaluated in the following sites: anterior temporalis (AT) and masseter (MM) muscles, TMJ and thenar (TH) eminence. Comparisons between groups were assessed with unpaired t test and ANOVA (P<0.05).

    RESULTS: PPTs were significantly lower among JIA patients compared to controls (P<0.001) for all analysed sites. The presence of TMJ pain at palpation was significantly associated with a lower PPT at TMJ (P=0.031).

    CONCLUSIONS: Patients with JIA have generally lowered pain threshold to mechanical stimulus, which suggests an effect of JIA on nocicepton-modulating processes.

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