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  • 1.
    Abrahamsson, Cecilia
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Henrikson, Thor
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Sunzel, Bo
    Bondemark, Lars
    Malmö högskola, Faculty of Odontology (OD).
    TMD in Consecutive Patients Referred for Orthognathic Surgery2009In: Swedish Dental Journal, ISSN 0347-9994, Vol. 33, no 4, p. 201-226, article id 25Article in journal (Other academic)
    Abstract [en]

    Objective: To answer the question whether temporomandibular disorders (TMD) were more common in a group of individuals referred for orthognathic surgery than in a control group. The null hypothesis was that neither the frequency of signs and symptoms of TMD or diagnosed TMD would differ between the patient group and a control group. Materials and Methods: A sample of 121 consecutive patients referred for orthognathic surgery at the Department of Oral Maxillofacial Surgery, Malmö University Hospital, Sweden, was interviewed and examined regarding signs and symptoms of TMD and headaches. A control group was formed by 56 age- and gender-matched individuals attending the Department of Oral Diagnosis, Faculty of Odontology, Malmö University, Sweden, and Public Dental Health Clinic in Oxie, County of Skane, Sweden. TMD diagnoses were used according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Results: The patient group showed more myofascial pain without limited opening, disc displacement with reduction, and arthralgia according to RDC/TMD than the control group. The patient group also had more symptoms and signs of TMD in general. Conclusions: The null hypothesis was rejected because patients who were to be treated with orthognathic surgery had more signs and symptoms of TMD and higher frequency of diagnosed TMD compared with the matched control group.

  • 2.
    Abrahamsson, Cecilia
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Henrikson, Thor
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Sunzel, Bo
    Bondemark, Lars
    Malmö högskola, Faculty of Odontology (OD).
    TMD in consecutive patients referred for orthognathic surgery2009In: Angle orthodontist, ISSN 0003-3219, E-ISSN 1945-7103, Vol. 79, no 4, p. 621-627Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To answer the question whether temporomandibular disorders (TMD) were more common in a group of individuals referred for orthognathic surgery than in a control group. The null hypothesis was that neither the frequency of signs and symptoms of TMD or diagnosed TMD would differ between the patient group and a control group. MATERIALS AND METHODS: A sample of 121 consecutive patients referred for orthognathic surgery at the Department of Oral Maxillofacial Surgery, Malmö University Hospital, Sweden, was interviewed and examined regarding signs and symptoms of TMD and headaches. A control group was formed by 56 age- and gender-matched individuals attending the Department of Oral Diagnosis, Faculty of Odontology, Malmö University, Sweden, and Public Dental Health Clinic in Oxie, County of Skane, Sweden. TMD diagnoses were used according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). RESULTS: The patient group showed more myofascial pain without limited opening, disc displacement with reduction, and arthralgia according to RDC/TMD than the control group. The patient group also had more symptoms and signs of TMD in general. CONCLUSIONS: The null hypothesis was rejected because patients who were to be treated with orthognathic surgery had more signs and symptoms of TMD and higher frequency of diagnosed TMD compared with the matched control group.

  • 3.
    Abrahamsson, Cecilia
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Henrikson, Thor
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Sunzel, Bo
    Bondemark, Lars
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    TMD before and after correction of dentofacial deformities by orthodontic and orthognathic treatment2013In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 46, no 6, p. 752-758Article in journal (Refereed)
    Abstract [en]

    Abstract The aims of the study were to investigate the alteration of temporomandibular disorders (TMD) after correction of dentofacial deformities by orthodontic treatment in conjunction with orthognathic surgery; and to compare the frequency of TMD in patients with dentofacial deformities with an age and gender matched control group. TMD were evaluated in 121 consecutive patients (treatment group), referred for orthognathic surgery, by a questionnaire and a clinical examination. 18 months after treatment, 81% of the patients completed a follow-up examination. The control group comprised 56 age and gender matched subjects, of whom 68% presented for follow-up examination. TMD were diagnosed according to research diagnostic criteria for TMD. At baseline examination, the treatment group had a higher frequency of myofascial pain (P=.035) and arthralgia (P=.040) than the control group. At follow-up, the frequencies of myofascial pain, arthralgia and disc displacement had decreased in the treatment group (P=.050, P=.004, P=.041, respectively). The frequency of TMD was comparable in the two groups at follow-up. Patients with dentofacial deformities, corrected by orthodontic treatment in conjunction with orthognathic surgery, seem to have a positive treatment outcome in respect of TMD pain

  • 4.
    Al-Harthy, Mohammad
    et al.
    Malmö högskola, Faculty of Odontology (OD). Al Noor Specialist Hosp, Specialist Dent Ctr, Holy Makkah, Saudi Arabia.
    Al-Bishri, Awwad
    Al Noor Specialist Hosp, Specialist Dent Ctr, Holy Makkah, Saudi Arabia.
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Temporomandibular disorder pain in adult Saudi Arabians referred for specialised dental treatment2010In: Swedish Dental Journal, ISSN 0347-9994, Vol. 34, no 3, p. 149-158Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to determine the frequency of Temporomandibular Disorders (TMD) pain in Saudi Arabians,aged 20-40, who were referred to the Specialist Dental Centre in Makkah. The material included 325 patients (135 males,190 females) who answered a history questionnaire. Patients reportingTMD pain in the last month were offered a clinical examination. History questionnaires and clinical examinations were done according to the Arabic version of the Research Diagnostic Criteria for TMD (RDC/TMD). Fifty-eight patients (18%) reported TMD pain; 46 were clinically examined. Mean age of clinically examined TMD pain patients was 30 +/- 7 years with a male-female ratio of 1:6 (P < 0.001). All TMD pain patients had a diagnosis of myofascial pain, and 65% had diagnoses of arthralgia or osteoarthritis. Headaches or migraines in the last 6 months and headaches in the last month were reported in high frequencies in the TMD pain group, 93% and 71% respectively, with differences (P < 0.001) between the TMD pain and non-TMD pain groups. Graded Chronic Pain Scale assessments classified 45% of the TMD pain patients in grade 1, 53% in grade II, 2% in grade III, and 0% in grade IV. Severe depression scores were found in 38% of the TMD pain patients and severe somatisation scores in 60% with differences (P < 0.001) between the TMD pain and non-TMD pain groups. In conclusion, the study found a frequency of TMD pain in this Saudi Arabian cohort of 18%. The TMD pain group presented high scores of depression and somatisation but low disability grades on the Graded Chronic Pain Scale.

  • 5.
    Al-Harthy, Mohammad
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Al-Bishri, Awwad
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Temporomandibular Disorders per RDC/TMD in Adult Saudi Arabians Referred for Specialized Dental Treatment2008Conference paper (Other academic)
    Abstract [en]

    Objective: The aim of this study was to determine frequency of Temporomandibular Disorders (TMD) pain in Saudi Arabians, ages 20 to 40, which were referred to a dental specialist clinic in Makkah. Materials and Methods: 325 referred patients (135 males, 190 females) answered history questionnaires. Patients reporting TMD pain in these questionnaires were clinically examined. History questionnaires and clinical examinations were done per Axis I and Axis II of the Arabic version of Research Diagnostic Criteria for TMD (RDC/TMD). Results: The male-female ratio of the study group was 1:1.4. Fifty-eight patients (18%) had TMD pain; 46 were clinically examined. Mean age of examined TMD pain patients was 30 years (±7) with a male-female ratio of 1:6. All TMD pain patients had a diagnosis of myofascial pain and 65% had diagnoses of arthralgia or osteoarthritis. Graded chronic pain severity was reported to be grade I in 45%, grade II in 53%, grade III in 2% and grade IV in none of the patients. Psychological status assessment showed that 38% of the TMD pain patients had severe depression scores and 60% severe somatization scores. Conclusion: The present study showed a high frequency of TMD pain in this Saudi Arabian cohort, and 18% of the patients met criteria for subdiagnoses of TMD. Depression and somatization per Axis II had significantly higher scores in the TMD pain group compared to the non-pain group.

  • 6. Al-Harthy, Mohammad
    et al.
    Al-Bishri, Awwad
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    TMD in Adult Saudi Arabians According to RDC/TMD2008Conference paper (Refereed)
    Abstract [en]

    Objective: To examine the frequency of pain-related TMD in Saudi Arabians 20 to 40years old referred to a d specialist clinic in Makka. Materials and Methods: 325 referred patients (135 males, 190 females) filled in history questionnaires. Patients reporting pain-related TMD were clinically examined. The history and clinical examinations were performed according to an Arabic version of RDC/TMD Axis I and Axis II (Dworkin et al 1992). Results: All patients had a male-female ratio of 1:1.4. TMD pain patients were found to be 18% (n=58), out of which 46 were clinically examined. The 46 TMD pain patients had a mean age of 30 years (±7) with a male-female ratio of 1:6. All TMD pain patients had a diagnosis of myofascial pain and 66% had diagnoses of arthrogenous origin. The graded chronic pain was reported to be grade I in 45%, grade II in 53%. Axis II assessment of psychological status showed that 38% of the TMD pain patients yielded severe depression scores and 60% high nonspecific physical symptom scores. Conclusion: The present study showed a high frequency of TMD pain in this Saudi Arabian cohort and 18% of the patients met criteria for subdiagnoses of TMD. Depression and somatization according to SCL-90R had significantly higher scores in the pain group compared to the non-pain group. The high frequency of pain-related TMD found among the patients referred to specialized dental clinics should make health planners considering TMD/orofacial pain as specialty in dentistry in Saudi Arabia.

  • 7. Al-Harthy, Mohammad
    et al.
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Pain related temporomandibular disorders in adult Saudi arabians referred for specialized dental treatment2007In: Pain related temporomandibular disorders in adult Saudi arabians reffered for specialized dental treatment.Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    The aim of the present study was to examine the frequencies of pain-related symptoms of TMD in patients in the age of 20-40 years referred for specialized dental treatments in Makkah, Saudi Arabia by using Research Diagnostic Criteria for TMD (RDC/TMD). Three hundred and twenty-five consecutive Saudi patients in the age of 20-40 years: 135 males and 190 females were interviewed according to the RDC/TMD history questionnaire. The results revealed that pain related TMD and orofacial pain were found among 58 (18%) patients. All other patients formed the non-pain group (267,82%). In the pain group, there were 79% females compared to 21% males (P<0.01). Both genders in the pain group reported high frequencies of both migraines in the last six months and headache moderately to extremely in the last month showing significant difference in comparison with the non-pain group (P<0.01). Symptoms of TMD were significantly more prevalent in the pain group than in the non-pain group. The most common pain related TMD symptoms were TMJ clicking, TMJ crepitation, TMJ locking, stiff jaw, tinnitus, bruxism and uncomfortable bite. Regarding Graded Chronic Pain severity in the pain group, most patients reported their pain to be grade I and II. Jaw disability checklist according to RDC/TMD showed that four or more disturbed jaw activities were found in 31 patients (53%) while 13 patients (22%) had not affected mandibular functions. In conclusion, the findings of the present study showed high frequencies of pain related TMD in this Saudi arabian patient population.

  • 8.
    Alsafi, Z
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Michelotti, A
    Orbach, R
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Achieved competences in temporomandibular disorders/orofacial pain: a comparison between two dental schools in Europe2015In: European journal of dental education, ISSN 1396-5883, E-ISSN 1600-0579, Vol. 19, no 3, p. 161-168Article in journal (Refereed)
    Abstract [en]

    AIMS: The aim was to study achieved competences in temporomandibular disorders (TMD)/orofacial pain (OP) at two universities by comparing student's knowledge and understanding, satisfaction with their education and confidence in their clinical competences of TMD/OP. METHODS: The study was conducted in collaboration between Malmö University, Sweden-which uses problem-based learning-and the University of Naples Federico II, Italy-which uses traditional educational methods. Final-semester dental students responded to a self-report questionnaire regarding their knowledge and understanding, interpretation of cases histories, clinical experience, satisfaction and confidence in clinical examination, management and treatment evaluation. RESULTS: No significant difference was found between the students regarding knowledge and understanding. Eighty-seven per cent of the Malmö students and 96% of the Naples students met the criterion on achieved competence. Malmö students had a higher per cent of correct diagnoses than Naples students in the interpretation of case histories. Overall, Malmö students reported most clinical experience and higher confidence than Naple students. CONCLUSIONS: The main findings were that students from Malmö and Naples were, similar in knowledge and understanding of TMD/OP and in satisfaction with their clinical competences. However, Malmö students perceived more confidence in clinical management of patients with TMD/OP. This may reflect that, besides the theoretical part of the programme, a sufficient level of clinical exposure to patients with TMD/OP is essential to gain competences in TMD/OP

  • 9. Alsafi, Z
    et al.
    Michelotti, Ambra
    Ohrbach, Richard
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Achieved competences in TMD/ Orofacial Pain. A comparison between dental schools in Europe and USA2009Conference paper (Other (popular science, discussion, etc.))
  • 10.
    Bengmark, Daniel
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Rohlin, Madeleine
    Malmö högskola, Faculty of Odontology (OD).
    Dentists reflect on their problem-based education and professional satisfaction2012In: European journal of dental education, ISSN 1396-5883, E-ISSN 1600-0579, Vol. 16, no 1, p. e137-e145Article in journal (Refereed)
    Abstract [en]

    AIM: To determine the way in which Malmö University dental graduates perceive their problem-based dental education and evaluate their professional satisfaction. METHOD: The first five cohorts (graduating in years 1995-1999) of the problem-based curriculum were invited to participate. Of 166 graduates, 77% responded to a questionnaire comprising 20 questions on aspects of their dental education, professional situations and interest in postgraduate education. They were asked to rank their perception of their dental education and satisfaction with their professional situation on a visual analogue scale (VAS) with endpoints ranging from 'Not at all' (1) to 'Very well' (10). For other statements, the markings were made on a Likert scale from 1 (not important/not satisfied) to 5 (very important/very satisfied). There were also open-ended questions. RESULTS: Most respondents perceived their education to prepare them well for a career in dentistry (median score VAS 8), and 90% rated above six on a VAS for their professional satisfaction as dentists. Importance and satisfaction were highly correlated with principles of the curriculum: holistic view, oral health, lifelong learning, integration between theory and clinic, and clinical competence. Forty-five per cent of the graduates noted the problem-based learning approach as the most valuable asset of their education, and 19% cited training in oral surgery as a deficit. Of the respondents, 77% expressed interest in specialist training and 55% in research education

  • 11.
    Bengmark, Daniel
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Rohlin, Madeleine
    Malmö högskola, Faculty of Odontology (OD).
    Graduates' characteristics and professional situation: a follow-up of five classes graduated from the Malmö model2007In: Swedish Dental Journal, ISSN 0347-9994, Vol. 31, no 31, p. 129-135Article in journal (Refereed)
    Abstract [en]

    This study describes some characteristics of graduates of the five first classes from the Malmö dental programme, their overall experience of the programme, and their professional situation. Of 166 graduates (graduated 1995-1999) who were invited to participate, 128 responded (response rate 77%). The questionnaire queried participant characteristics, undergraduate education, and professional situation. The median age of the respondents at graduation was 26 years (range: 24-43 years, female: 56%). One-fourth of the respondents were born outside Sweden.Two-thirds of the respondents answered that they enrolled in the dental education because they wanted to become a dentist. Most respondents (97%) were working as a dentist, and a majority (82%) worked full-time. The respondents thought their dental education had prepared them well for their profession. About one-third of the respondents worked outside Sweden; the majority had been born outside of Sweden. The respondents' satisfaction with their professional situation, which was high overall, correlated to how much they were able to influence their work situation. About one-fourth expressed interest in specialist training. Respondents differed on the topic of research education: 64% of the female graduates and 42% of the male graduates were interested. We conclude that the respondents were satisfied with their professional situation as a dentist and that most were interested in postgraduate education.

  • 12.
    Bondemark, Lars
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Eriksson, Lars
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Petersson, Arne
    Malmö högskola, Faculty of Odontology (OD).
    Petersson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Tegelberg, Åke
    Malmö högskola, Faculty of Odontology (OD).
    Wolf, Eva
    Malmö högskola, Faculty of Odontology (OD).
    Funktionsstörningar och smärta2008In: Tandläkartidningen, ISSN 0039-6982, Vol. 100, no 9-10, p. 64-68Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Orofaciala funktionsstörningar och smärta är en sammanfattning av kliniska problem och sjukdomar som involverar bett, käkar, tuggmuskulatur, käkleder och omgivande strukturer. Orsakerna är oftast multifaktoriella för de barn, ungdomar och vuxna som drabbas.

  • 13. Christidis, N
    et al.
    Doepel, M
    Ekberg, Ewacarin
    Malmö högskola, Faculty of Odontology (OD).
    Ernberg, M
    Le Bell, Y
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Effectiveness of a prefabricated occlusal appliance in patients with temporomandibular joint pain: a randomized controlled multicenter study2014In: Journal of oral & facial pain and headache, ISSN 2333-0384, Vol. 28, no 2, p. 128-137Article in journal (Refereed)
    Abstract [en]

    AIMS: To evaluate the effectiveness of a prefabricated appliance and compare it to the effectiveness of a stabilization appliance in patients with temporomandibular joint (TMJ) pain. METHODS: This randomized, controlled multicenter study comprised 48 patients diagnosed with TMJ arthralgia according to the Research Diagnostic Criteria for Temporomandibular Disorders. The effectiveness of a prefabricated appliance (Relax), worn by half of the patients (referred to as the R group), was compared to the effectiveness of a stabilization appliance, worn by the other half of patients (S group). Treatment outcome was assessed according to the recommendations by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) on an intent-to-treat basis. To analyze the differences between groups, the chi-square test and the Mann-Whitney U test were used, while the Friedman analysis of variance (ANOVA) on ranks was used for the analyses between baseline data and follow-up measurements, all with a significance level set at P < .05. RESULTS: There were no differences between the groups at baseline. A 30% reduction of pain intensity was reported by 62.5% of the R group and 58.3% of the S group at the 10-week follow-up; 58% and 50.3%, respectively, at the 6-month follow-up; and 41.7% in both groups at 12 months. At the 12-month follow-up, pain intensity had decreased and physical function had improved in both groups (P < .005 and P < .016, respectively), without significant group differences. Emotional function (depression and nonspecific physical symptoms) did not change. Overall improvement of "better" to "symptom-free" was observed in 67% of the R group and 58% of the S group. No side effects occurred. CONCLUSION: The effectiveness of the prefabricated appliance seems to be similar to that of the stabilization appliance in alleviating TMJ pain. Since the prefabricated appliance requires only one visit for construction, it is convenient for both the general practitioner and for the patient

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

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

  • 15. Doepel, M.
    et al.
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Le Bell, Y.
    Long-term effectiveness of a prefabricated oral appliance for myofascial pain2012In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 39, no 4, p. 252-260Article in journal (Refereed)
    Abstract [en]

    Summary  The long-term effectiveness of a prefabricated oral appliance (R) was compared with a stabilisation appliance (S) in patients with myofascial pain. Sixty-five patients diagnosed with myofascial pain at two centres for Stomatognathic Physiology in Sweden and Finland were included in a randomised controlled trial using Research Diagnostic Criteria for Temporomandibular Disorders, with history questionnaires and clinical examinations performed by blinded examiners at baseline and at 6- and 12-month follow-ups. Patients were randomly assigned either to the R or the S group. Treatment outcome was measured according to IMMPACT for four chronic pain outcome domains: pain intensity, overall improvement, physical functioning and emotional functioning. Physical functioning was classified for Graded Chronic Pain severities and assessed by the Jaw Functional Limitation scale. Emotional functioning composed of scores of non-specific physical symptoms and depression. There were no differences between groups at baseline. At both follow-ups, all outcome domains showed significant within-group improvement, without significant differences between groups. At 12 months, 72% of all patients reported a 30% reduction in worst pain and 63% of the patients a 50% reduction in worst pain. Overall improvement ‘better’ to ‘symptom-free’ was observed in 81% in the R and 64% in the S group at the 12-month follow-up. Graded Chronic Pain, Functional Limitation of the Jaw, non-specific physical symptoms and depression showed statistically significant reduction at 12-month follow-up. Results support the hypothesis that the effectiveness of the prefabricated appliance is similar to that of the stabilisation appliance in the long-term when treating patients with myofascial pain.

  • 16. Doepel, Marika
    et al.
    Le Bell, Yrsa
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Effectiveness of Prefabricated Occlusal Appliance in TMD Patients with Headache2010Conference paper (Other academic)
    Abstract [en]

    Objectives: To compare the short- and long-term effectiveness of a prefabricated occlusal appliance with a stabilization appliance for the treatment of headache in myofascial pain patients. Methods: Sixty-five myofascial pain patients of whom 57 reported headache were included in a randomized controlled trial at two centres for Stomatognathic Physiology in Sweden and Finland. Patients were randomly assigned to a prefabricated appliance (R-group, 27 women, 5 men, mean age 38 years) or a stabilization appliance group (S-group, 31 women 2 men, mean age 37 years). RDC/TMD was used for history-taking and clinical examination. Frequency and intensity of headache were assessed using a verbal scale (1=continuous, 2=recurrent, 3=rarely) and a numeric rating scale (NRS) respectively at baseline, 10-week, 6-and 12-month follow-ups. Results: At baseline there were no differences between the groups regarding frequency and intensity of headache. At the follow-ups a statistically significant decrease in both frequency and intensity was observed within the two groups without any differences between the groups. At baseline 72% and 70% in the R and S groups reported recurrent or continuous headache which decreased significantly (p< .01) within both groups to 44% and 31% at 10-week and to 26% and 18% at the 12-month follow-up. Mean intensity (NRS) of headache at baseline decreased within both groups from 6 to 3 at 10-week follow-up and to 2 and 3 in the R and S groups respectively (p< .001) at 12-month follow-up. Conclusions: In both short- and long-term the prefabricated appliance seemed to have a similar effectiveness in the treatment of headache in myofascial pain patients.

  • 17.
    Doepel, Marika
    et al.
    Institute of Dentistry , University of Turku , Turku , Finland.
    Nilner, Maria
    Malmö University, Faculty of Odontology (OD).
    Vahlberg, Tero
    Department of Biostatistics , University of Turku , Turku , Finland.
    Le Bell, Yrsa
    Institute of Dentistry , University of Turku , Turku , Finland.
    Similar treatment outcome in myofascial TMD patients with localized and widespread pain.2018In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, no 3, p. 175-182Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the outcome of oral appliance treatment in myofascial Temporomandibular disorder (TMD) patients with and without comorbid pain using pain site drawings. MATERIAL AND METHODS: This randomized, controlled multicentre study comprised 65 myofascial TMD patients diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders. Pain-site drawings were filled in at the baseline examination. The patients were treated with oral appliances. Treatment outcome was followed up for 1 year and analysed according to the recommendations by the Initiative on Methods, Measurement and Pain assessment in Clinical Trials (IMMPACT) on an intent-to-treat basis. The data were analysed for two pain profiles, localized pain (face and head, n = 26) versus widespread pain group (pain sites outside the face and head, n = 39). RESULTS: Statistically significant improvement was registered within both groups for all outcome variables (characteristic pain intensity, 30% pain reduction of worst reported pain, graded chronic pain, depression, and somatization scores) during the follow-up with only small differences between the groups. CONCLUSIONS: Oral appliance treatment had a positive effect on all outcome measures during the 1-year follow-up in patients suffering from myofascial TMD pain, regardless of whether the pain was localized or widespread. Multiple pain sites seemed to have surprisingly little influence on the outcome variables. However, some indications of more challenges when treating patients with widespread pain compared to local pain could be observed. Pain-site drawings seem to be useful in the clinical situation and could support the clinicians in decision-making regarding treatment planning.

  • 18. Doepel, Marika
    et al.
    Söderling, Elin
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Le Bell, Yrsa
    Salivary cortisol and IgA levels in myofascial pain patients treated with occlusal appliances in a short term perspective (Stockholm)2008Conference paper (Other academic)
    Abstract [en]

    Objectives: In many studies the endocrinological response of individuals to different kind s of stresses has been tested. There seems to be widespread agreement that stress, depression, disability and dysfunctional illness behaviors are critical aspects of patients suffering from TMD (temporomandibular disorders) symptoms like pain. We wanted to explore treatment-induced changes in salivary cortisol, IgA and flow rate values in TMD patients suffering from myofascial pain. Methods: TMD paitents (n=39) were randomized into two groups and treated with two different occlusal appliances. Percieved stress regarding family work, economy, relationships, general health and stress in general was wvaluated at baseline according to a verbal scale. Paraffin stimulated saliva samples were collected before treatment and during follow-up at 6 and 10 weeks. Flow rate was measured immediately after the saliva collection while salivary sortisol, and IgA were determined from -70° C-stored samples. Results: No clear association between reported stress and cortisol or IgA values could be observed at baseline. At 10 weeks´ follow-up 92% of the patients felt better-much better-symptom free and no difference was found between the two appliance groups. Cortisol, IgA and flow-rate values showed no systematic between-appliance groups differences. All salivary parameters showed interindividual differences but stayed intraindividually on a similar level throughout the study and no statistically significant changes could be observed when comparing before and after treatment levels. Conclusion: To conclude, there were no treatment induced changes in saliva parameters despite successful appliance therapy in myofascial pain patients.

  • 19.
    Ekberg, EwaCarin
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Doepel, Marika
    Le Bell, Yrsa
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Effectiveness of a prefabricated occlusal appliance, Relax, in the long-term (Helsinki)2009Conference paper (Other academic)
    Abstract [en]

    Objectives: To compare the long-term effectiveness of a prefabricated occlusal appliance with a stabilization appliance in myofascial pain patients. Methods: Sixty-five patients with the diagnosis myofascial pain at two centres for Stomatognathic Physiology in Sweden and Finland were included in a randomized controlled trial. Patients were randomly assigned to a prefabricated appliance (R-group, 27 women, 5 men, mean age 38 years) or a stabilization group (S-group, 31 women 2 men, mean age 37 years). General practitioners performed the treatment. History and clinical examination was performed according to RDC/TMD. At the 6 months- and 1 year follow-up the treatment outcome regarding pain according to the visual analogue scale and overall rating of pain according to the verbal scale was evaluated. Results: At baseline there were no differences between the groups regarding frequency of myofascial pain, number of years suffering from the pain, worst or mean pain during the last six months. At the 12-months follow-up 30% and 50% pain relief in the R- and S-groups were reported in 24 and 21 patients and 23 and 17 patients respectively. According to a verbal scale 26 and 21 patients in the two groups reported themselves to be better, much better or symptom-free. All calculations were done per protocol. An increased open bite was registered in one patient. Conclusions: In a long-term perspective both appliances seemed to have an equal effectiveness in the treatment of patients suffering from myofascial pain. The prefabricated appliance, Relax, can be recommended as a long-term treatment modality when used night time only. Frontal open bite should be regarded as a contraindication.

  • 20.
    Ekberg, EwaCarin
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Doepel, Marika
    Le Bell, Yrsa
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Effectiveness of a prefabricated occlusal appliance, Relax, in the long-term (Miami)2009Conference paper (Other academic)
    Abstract [en]

    Objectives: To compare the long-term effectiveness of a prefabricated occlusal appliance with a stabilization appliance in myofascial pain patients. Methods: Sixty-five patients with the diagnosis myofascial pain at two centres for Stomatognathic Physiology in Sweden and Finland were included in a randomized controlled trial. Patients were randomly assigned to a prefabricated appliance (R-group, 27 women, 5 men, mean age 38 years) or a stabilization group (S-group, 31 women 2 men, mean age 37 years). General practitioners performed the treatment. History and clinical examination was performed according to RDC/TMD. At the 6 months- and 1 year follow-up the treatment outcome regarding pain according to the visual analogue scale and overall rating of pain according to the verbal scale was evaluated. Results: At baseline there were no differences between the groups regarding frequency of myofascial pain, number of years suffering from the pain, worst or mean pain during the last six months. At the 12-months follow-up 30% and 50% pain relief in the R- and S-groups were reported in 24 and 21 patients and 23 and 17 patients respectively. According to a verbal scale 26 and 21 patients in the two groups reported themselves to be better, much better or symptom-free. All calculations were done per protocol. An increased open bite was registered in one patient. Conclusions: In a long-term perspective both appliances seemed to have an equal effectiveness in the treatment of patients suffering from myofascial pain. The prefabricated appliance, Relax, can be recommended as a long-term treatment modality when used night time only. Frontal open bite should be regarded as a contraindication.

  • 21.
    Ekberg, EwaCarin
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    A 6- and 12-month follow-up of appliance therapy in TMD patients: a follow-up of a controlled trial2002In: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 15, no 6, p. 564-570Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This study compared the long-term effects of treatment with a stabilization appliance and treatment with a control appliance in patients with temporomandibular disorders (TMD). MATERIALS AND METHODS: In a controlled trial, 60 TMD patients with tem-poromandibular joint (TMJ) pain were evaluated after 10 weeks of treatment with either a stabilization appliance or a control appliance. At the 10-week follow-up, the 60 patients were assigned to one of three groups according to their demand for treatment. Group T, the treatment group, comprised 30 patients treated with a stabilization appliance; group C, the control group, comprised nine patients treated with a control appliance; and group M, the mixed treatment group, comprised 21 patients treated with first a control appliance and then a stabilization appliance. Signs and symptoms were evaluated in all three groups at 6- and 12-month follow-ups. RESULTS: At the 6- and 12-month follow-ups, a significant reduction in TMJ pain as measured on a visual analogue scale was found in all three groups, and a significant decrease in signs and symptoms was found in groups T and M. CONCLUSION: After 6 and 12 months of use, the stabilization appli-ance was found to still be effective in the alleviation of signs and symptoms in patients with TMD. Many patients in group C changed to a stabilization appliance at the 1 0-week follow-up, which significantly reduced the number of patients in this group. Most patients reported positive change in overall subjective symptoms in this trial. The stabilization appliance can therefore be recommended for patients with TMD.

  • 22.
    Ekberg, EwaCarin
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Treatment Outcome of Appliance Therapy in Temporomandibular Disorder Patients with Myofascial Pain after 6 and 12 Months2004In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 62, no 6, p. 343-349Article in journal (Refereed)
    Abstract [en]

    Aim: To compare the long-term effect of treatment with a stabilization appliance (group T) and treatment with a control appliance (group C) in temporomandibular disorder (TMD) patents with myofascial pain. Methods: In this controlled trial, 60 patients (mean age 29 years) with myofascial pain were evaluated after 10 weeks of treatment with either a stabilization appliance or a control appliance. All 60 patients were then assigned to 1 of 3 groups according to demand for treatment. Seventeen patients from group C requested another appliance and were given a stabilization appliance, thus creating a mixed group (group M). Results: A significant difference was found between groups T and C. at the 6- and 12-months follow-ups, a significant reduction in myofascial pain, as measured on a visual analogue scale, was found in all three groups. A significant decrease in frequency and intensity of myofascial pain was found in group T at the follow-ups. A significant decrease in number of tender sites on the masticatory muscles was found in group T at the follow-ups. Conclusion: The results support the conclusion that the positive treatment outcome obtained by use of a stabilization appliance to alleviate the signs and symptoms in patients with myofascial pain persisted after 6 and 12 months. Most patients in groups T and M reported positive changes in overall subjective symptoms in this trial. We therefore recommend user of the stabilization appliance in the treatment of TMD patients with myofascial pain.

  • 23.
    Ekberg, EwaCarin
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Treatment outcome of short- and long-term appliance therapy in patients with TMD of myogenous origin and tension-type headache2006In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 33, no 10, p. 713-721Article in journal (Refereed)
    Abstract [en]

    The aim was to compare the short- and long-term effect of a stabilization appliance with a control appliance in myofascial pain patients suffering from episodic or chronic tension-type headache. Sixty patients (mean age 29 +/- 12 years) with temporomandibular disorders (TMD) of myogenous origin and headache were studied in this prospective controlled study. Seventy-seven per cent of the patients reported episodic and 23% chronic tension-type headache at the start of the study. The 60 patients were randomly assigned to a treatment group (stabilization appliance) or to a control group (control appliance). The patients were interviewed regarding symptoms of headache and myofascial pain and clinically examined for masticatory muscle tenderness. At the 10-week and the 6- and 12-month evaluations of appliance therapy, the treatment outcome of tension-type headache was studied. At the 10-week evaluation, 17 patients dropped-out from the control group by requesting another appliance and receiving a stabilization appliance. Another patient in the control group dropped out later during the trial. In an intent-to-treat analysis, significant differences in improvement of headache between treatment and control groups were found at the follow-ups. A 30% reduction of muscles tender to palpation correlated significantly to improvement of headache at all follow-ups. The stabilization appliance seems to have a positive effect on tension-type headache, both in a short- and in a long-term perspective in patients with TMD with pain of myogenous origin.

  • 24.
    Ekberg, EwaCarin
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Doepel, M
    Le Bell, Y
    The effectiveness of a prefabricated occlusal appliance in a long-term perspective (Finland)2007Conference paper (Other (popular science, discussion, etc.))
  • 25.
    Ekberg, EwaCarin
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Doepel, M
    Le Bell, Y
    The effectiveness of a prefabricated occlusal appliance in a long-term perspective (Sweden)2007Conference paper (Other (popular science, discussion, etc.))
  • 26.
    Ekberg, EwaCarin
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Doepel, M
    Söderling, E
    Selovuo, K
    Le Bell, Y
    Salivary cortisol and lgA levels in myofascial pain patients treated with occlusal appliances in a short term perspective (Naantali)2007Conference paper (Refereed)
  • 27.
    Ekberg, EwaCarin
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Visscher, CM
    Lobbezoo, F
    de Laat, A
    Michelotti, A
    Farella, M
    Naeije, M
    A multicenter study to the concurrent validity of diagnostic TMD tests in TMD-pain patients, dental pain patients and pain-free subjects2007Conference paper (Other (popular science, discussion, etc.))
  • 28.
    Ekberg, EwaCarin
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Vallon, Danila
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    The Efficacy of Appliance Therapy in Patients with Temporomandibular Disorders of Mainly Myogenous Origin. A Randomized, Controlled, Short-term Trial2003In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 17, no 2, p. 133-139Article in journal (Refereed)
    Abstract [en]

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

  • 29.
    Ekberg, EwaCarin
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Vallon, Danila
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Treatment Outcome of Headache After Occlusal Appliance Therapy in a Randomised Controlled Trial Among Patients with Temporomandibular Disorders of Mainly Arthrogenous Origin2002In: Swedish Dental Journal, ISSN 0347-9994, Vol. 26, no 3, p. 115-124Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate headaches before and after treatment with a stabilisation appliance and a control appliance in a randomised controlled trial in patients having temporomandibular disorders (TMD) of mainly arthrogenous origin. The effect of treatment was evaluated both in a short and in long-term perspective. 60 patients (mean age 30 years) with TMD of mainly arthrogenous origin were studied. The patients were selected from patients referred for treatment of TMD during a 3-year period to the Department of Stomathognathic Physiology, Faculty of Odontology, Malmo University. The 60 patients included in the study were randomly assigned to a treatment (T) or a control (C) group. The study was performed as a randomised controlled trial including evaluation of treatment effect on tension-type headache after 10 weeks, 6 and 12 months. At the 10 weeks follow-up, the patients who reported a negative treatment outcome and/or discomfort associated with the use of the appliances had their appliances readjusted. Patients who demanded further treatment received a stabilisation appliance (21 patients from the C-group), creating a new mixed (M) group. All the 60 patients reported frequency of headache from rarely up to daily at the start of the study. In the T-group 76% and in the C-group 83% of the patients reported headache at least once a week or more before treatment. At the 10 weeks follow-up, a statistically significant difference was found regarding headache several times a week or more between the T- and C-groups and within the T-group. At the 6 months follow-up, a statistically significant reduction was found in headache several times a week or more in the T- and M-groups. The number of patients with headache once a week or more decreased significantly in the T- and M-groups at the 12 months follow-up. We conclude that the stabilisation appliance seems to have an effect on the frequency of tension-type headache both in a short and in a long-term perspective in patients with TMD of mainly arthrogenous origin.

  • 30.
    Eskafi, Mahmoud
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Cline, Charles
    Department of Cardiology, University Hospital, Malmö, Sweden.
    Israelsson, Bo
    Department of Cardiology, University Hospital, Malmö, Sweden.
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    A Mandibular Advancement Device Reduces Sleep Disordered Breathing in Patients with Congestive Heart Failure2004In: Swedish Dental Journal, ISSN 0347-9994, Vol. 28, no 4, p. 155-163Article in journal (Other academic)
    Abstract [en]

    Sleep disordered breathing (SDB) including obstructive and central sleep apnoea/hypopnoea as well as periodic breathing (PB) is common and is believed to increase risk for mortality in patients with congestive heart failure (CHF). Mandibular advancement device (MAD) has widely been recommended for treatment of obstructive sleep apnoea but the method has never been investigated for treatment of SDB in the patients with CHF. The aim with the present study was to examine the effect of MAD intervention on SDB in patients with CHF. The study included 17 male patients, aged 68.4+/-5.7 (mean+/-SD) with stable, mild to moderate CHF due to left ventricular systolic dysfunc-tion and with SDB, expressed as apnoea/hypopnoea index (AHI) > or = 10. The SDB was examined during a single night using an unattended, portable polysomnographic device in the patients home, prior to and following intervention with a individually adjusted MAD. The SDB was evaluated by calculating AHI, PB expressed as the percentage of the total registration time, oxygen desaturation index (ODI) and snoring time. The AHI was reduced by MAD intervention from 25.1+/-9.4 to 14.7+/-9.7 (p=0.003). ODI reduced from 21.1+/-9.0 to 10.5+/-7.8 (p=0.007) and snoring time decreased from 53+/-111 to 18+/-47 seconds (p=0.02). PB was reduced from 55.7+/-25.6 to 40.4+/-26.4 per cent without statistical significance. In conclusion, the MAD intervention may be a feasible method for reducing SDB in patients with stable, mild to moderate CHF and left ventricular systolic dysfunction.

  • 31.
    Eskafi, Mahmoud
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Cline, Charles
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Israelsson, Bo
    Treatment of sleep apnea in congestive heart failure with a dental device2006In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 10, no 2, p. 90-97Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to investigate the effect of a mandibular advancement device (MAD) for the treatment of sleep apnea (SA) on plasma brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), and health-related qualify of life (HRQL) in patients with mild to moderate stable congestive heart failure (CHF). Seventeen male patients aged 68.4±5.5 with an apnea–hypopnea index (AHI) ≥10 were equipped with an individually fitted MAD. SA was evaluated using a portable respiratory multirecording system before and after the initiation of treatment. Eleven patients completed follow-up and were evaluated after 6 months of treatment. The AHI reduced from 25.4±10.3 to 16.5±10.0 (p=0.033) compared to baseline and mean plasma BNP levels decreased from 195.8±180.5 pg/ml to 148.1±139.9pg/ml (p=0.035). SA-related symptoms, e.g., excessive daytime sleepiness, were also reduced (p=0.003). LVEF and HRQL were unchanged. We conclude that SA treatment with a MAD on patients with mild to moderate stable CHF appears to result in the reduction of plasma BNP levels. Further studies to investigate if the observed reduction in BNP concentrations also result in improved prognosis are warranted.

  • 32. Eskafi, Mahmoud
    et al.
    Cline, Charles
    Petersson, Arne
    Malmö högskola, Faculty of Odontology (OD).
    Israelsson, Bo
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    The Effect of Mandibular Advancement Device on Pharyngeal Airway Dimension in Patients with Congestive Heart Failure Treated for Sleep Apnea2004In: Swedish Dental Journal, ISSN 0347-9994, Vol. 28, no 1, p. 1-9Article in journal (Other academic)
    Abstract [en]

    Continues positive airway pressure (CPAP) is recommended for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) but is not easily tolerated resulting in poor patient compliance. Mandibular advancement device (MAD) is designed to inhibit pharyn-geal airway (PAW) obstruction and may be a valuable alternative. It has been proposed that MAD exerts its effect by increasing PAW dimensions. This has not, however, been clearly demonstrated. The aim of this study was to examine the effect of MAD on PAW dimensions and SA in patients with CHF. Seventeen CHF-patients with mild to moderate heart failure, aged 68 +/- 6 years, (mean +/- SD), range 54-75 years, with sleep apnoea-hypopnea index (AHI) > or = 10 were evaluated. PAW dimensions were studied with and without the MAD, using lateral radiographs in supine position. Nocturnal breathing patterns were studied using a portable polysomnographic device during a single night with and without MAD. A reduction of AHI > or = 30% (arbitrary level) for each individual was regarded as a successful treatment. Mean AHI was reduced from 25.1 +/- 9.4 to 14.7 +/- 9.7 (p = 0.003). The PAW increased in its inferior section in 13 patients (p = 0.0001). AHI decreased > or = 30% in 9 patients (p = 0.003) of whom 8 showed increased PAW dimensions. Reduction of AHI was not significantly related to increased PAW dimensions. In conclusion MAD increased PAW dimensions and reduced SA in patients with CHF. The results may indicate that MAD reduces SA by other mechanism than increasing PAW dimensions.

  • 33. Eskafi, Mahmoud
    et al.
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Cline, Charles
    Israelsson, Bo
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Use of a Mandibular Advancement Device in Patients with Con-gestive Heart Failure and Sleep Apnoea2004In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 21, no 2, p. 100-107Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the practical use of the mandibular advancement device (MAD) for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) over 1 year. Subjects: Twentyfive patients aged 66 ± 8 years (mean ± SD) met the inclusion criteria and were included in the study. Design: In a prospective, clinical trial, the apnoea-hypopnoea index (AHI), a measure of SA, was determined with a portable device. Failure to enter treatment and compliance, adverse events and signs and symptoms of temporomandibular disorders (TMD) were examined before intervention and 4-6 weeks, 6 months and 1 year after intervention. Results: Six patients had removable dentures of whom four had complete dentures. Before treatment, eight patients reported minor symptoms of TMD. The AHI fell from 19.3 ± 12.1 to 11.8 ± 9.5 (p = 0.004) with use of the device. In most patients, use of the MAD had no severe effects on the signs and symptoms of TMD. Adverse events such as pain in the temporomandibular joints, soreness in the teeth, and tiredness in the jaws were reported by ten patients. Dental complications were observed in two patients. Sixtyfour per cent of the patients were still using the MAD at the 1-year follow-up. Conclusion: both the general and oral health of CHF patients were important in treatment with a MAD. The MAD therapy had no severe effect on the masticatory system and edentulous patients could be treated.

  • 34. Henrikson, T
    et al.
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Temporomandibular disorders, occlusion and orthodontic treat-ment2003In: Journal of orthodontics, ISSN 1465-3125, E-ISSN 1465-3133, Vol. 30, no 2, p. 129-137Article in journal (Other academic)
    Abstract [en]

    OBJECTIVES: To prospectively and longitudinally study symptoms and signs of temporomandibular disorders (TMD) and occlusal changes in girls with Class II malocclusion receiving orthodontic fixed appliance treatment in comparison with untreated Class II malocclusions and with normal occlusion subjects. DESIGN: Prospective observational cohort. SUBJECTS: Sixtyfive girls with Class II malocclusion who received orthodontic treatment, 58 girls with no treatment, and 60 girls with normal occlusion. METHOD: The girls were examined for symptoms and signs of TMD and re-examined 2 years later. Additional records were taken in the orthodontic group during active treatment and 1 year after treatment RESULTS: All three groups included subjects with more or less pronounced TMD, which showed individual fluctuation during the ongoing study. In the orthodontic group, the prevalence of muscular signs of TMD was significantly less common post-treatment. Temporomandibular joint clicking increased in all three groups over the 2 years, but was less common in the normal group. The normal group also had a lower overall prevalence of TMD than the orthodontic and the Class II group at both registrations. Functional occlusal interferences decreased in the orthodontic group, but remained the same in the other groups over the 2 years. CONCLUSIONS: (i) Orthodontic treatment either with or without extractions did not increase the prevalence or worsen pre-treatment symptoms and signs of TMD. (ii) Individually, TMD fluctuated sub-stantially over time with no predictable pattern. However, on a group basis, the type of occlusion may play a role as a contributing factor for the development of TMD. (iii) The large fluctuation of TMD over time leads us to suggest a conservative treatment approach when stomatog-nathic treatment in children and adolescents is considered.

  • 35.
    Henrikson, Thor
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Can orthodontic treatment improve mastication? A controlled, prospective and longitudinal study2009In: Swedish Dental Journal, ISSN 0347-9994, Vol. 33, no 2, p. 59-65Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To prospectively and longitudinally evaluate the self-perceived masticatory ability and the tested masticatory efficiency in orthodontically treated and untreated groups. DESIGN: Prospective observational cohort. SUBJECTS AND METHODS: Three groups of age matched adolescent girls were included. Sixty-five Class II subjects received orthodontic treatment fixed appliance treatment (Orthodontic group), 58 subjects were orthodontically untreated (Class II group) and 60 subjects had a normal occlusion (Normal group).The self-perceived masticatory ability was assessed on a visual analogue scale while the masticatory efficiency was evaluated with a masticatory efficiency test using round silicon tablets. Registrations were performed at the start and after two years when all subjects in the Orthodontic group had finished orthodontic treatment. RESULTS: Over the two-year period the self-perceived masticatory ability increased significantly in the Orthodontic group. After treatment, the Orthodontic group perceived their masticatory ability as high as the Normal group did. The masticatory efficiency increased significantly, during the two years, in all three groups. However,the normal occlusion group presented a significantly better masticatory efficiency than both the Orthodontic group and the Class II group on both registrations. CONCLUSIONS: Orthodontic treatment was beneficial for the self-perceived masticatory ability. The masticatory efficiency increases with age during adolescence. Normal occlusion subjects had a better masticatory efficiency than subjects with orthodontically treated as well as untreated Class II malocclusion.

  • 36.
    Limchaichana, Napat
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Petersson, Arne
    Malmö högskola, Faculty of Odontology (OD).
    Nilsson, Håkan
    Malmö högskola, Faculty of Odontology (OD).
    Is there an agreement between clinical diagnoses and MRI findings in patients with TMD pain?2006Conference paper (Refereed)
    Abstract [en]

    Is there an agreement between clinical diagnoses and MRI findings in patients with TMD pain?

  • 37.
    Limchaichana, Napat
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Nilsson, Håkan
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Petersson, Arne
    Malmö högskola, Faculty of Odontology (OD).
    Clinical diagnoses and MRI findings in patients with TMD pain2007In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 34, no 4, p. 237-245Article in journal (Refereed)
    Abstract [en]

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

  • 38.
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Does Splint Therapy Work for Temporomandibular Pain?2004In: Evidence-Based Dentistry, ISSN 1462-0049, E-ISSN 1476-5446, Vol. 5, no 3, p. 65-66Article in journal (Other academic)
    Abstract [en]

    Data sources: The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Library Issue 2 from 2003, Medline and Embase were all data sources. Relevant journals were also searched by hand and the reference lists of chosen studies were screened. Experts in the field were contacted and there were no language restrictions. Study selection: To be selected, the studies had to be randomised controlled trials (RCT) or quasi-RCT, in which splint therapy was compared concurrently with no treatment, other occlusal appliances or any other active intervention. Data Extraction and synthesis: Data extraction was carried out independently and in duplicate. Validity assessment of the chosen trials was carried out at the same time as data extraction. Discrepancies were discussed and a third reviewer consulted. The author of the primary study was contacted where necessary. The studies were grouped according to treatment type and duration of follow-up. Results: Twenty potentially relevant RCT were identified. Eight were later excluded, leaving 12 trials for analysis. Stabilisation splint therapy (SS) was compared with: acupuncture, bite plates, biofeedback/stress management, visual feedback, relaxation, jaw exercises, non-occluding appliance and minimal/no treatment. There was no evidence of a statistically significant difference in the effectiveness of SS in reducing symptoms in patients with pain dysfunction syndrome (PDS) compared with other active treatments. There was weak evidence to suggest that the use of SS for the treatment of PDS may be beneficial for reducing pain severity, at rest and on palpation, compared with no treatment. Conslusions: There is insufficient evidence either for or against the use of SS for the treatment of temporomandibular PDS. This review suggests the need for further, rigorous RCT that consider the method of allocation and outcome assessment, have large sample size and sufficient duration of follow-up. A standardisation of the outcomes of the treatment of PDS should be established in the RCT.

  • 39.
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Musculoskeletal Disorders and the Occlusal Interface2005In: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 18, no 4, p. 297-299Article in journal (Refereed)
  • 40.
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Musculoskeletal disorders and the occlusal interface: II2003In: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 16, no 7, p. 85-87Article in journal (Refereed)
  • 41.
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Profylaktisk bettslipning - dags för diskussion? Ingen accepterad behandlingsform.2007In: Tandläkartidningen, ISSN 0039-6982, no 4, p. 54-56Article in journal (Other academic)
  • 42.
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Reflections on Ulf Posselt: His Contribution to Bite Physiology2006In: The past, present and future of temporomandibular disorders and orofacial pain / [ed] S Chang Chung, J Friction, Shinhung International , 2006, p. 207-217Chapter in book (Other academic)
  • 43.
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    The Past, Present and Future of TMD and Orofacial Pain in Scandinavian Countries2006In: The Past, Present and Future of temporomandibular disorders and orofacial pain / [ed] S Chang Chung, J Friction, Shinhung International , 2006, p. 155-174Chapter in book (Other academic)
  • 44.
    Nilner, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Doepel, M
    Andersson, J
    Selovuo, K
    The effectiveness of a prefabricated occlusal appliance in patients with myofascial pain (Helsinki)2006Conference paper (Other (popular science, discussion, etc.))
  • 45.
    Nilner, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Doepel, M
    Le Bell, Y
    Effectiveness of a prefabricated appliance in patients with myofascial pain2006Conference paper (Other (popular science, discussion, etc.))
  • 46.
    Nilner, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Doepel, M
    Le Bell, Y
    Andersson, J
    Selovuo, K
    The effectiveness of a prefabricated occlusal appliance in patients with myofascial pain (Naantali)2007Conference paper (Other (popular science, discussion, etc.))
  • 47.
    Nilner, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Doepel, M
    Söderling, E
    Le Bell, Y
    Salivary cortisol and IgA levels in myofascial pain patients treated with occlusal appliances in a short term perspective2007Conference paper (Other (popular science, discussion, etc.))
  • 48.
    Nilner, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Doepel, Marika
    Department of Prosthodontics, Faculty of Medicine, University of Turku, Turku, Finland.
    Andersson, Johanna
    Public Dental Health, Malmö, Sweden.
    Selovuo, Kirsti
    Le Bell, Yrsa
    Docent Graduate Programme in Clinical Dentistry, Faculty of Medicine, University of Turku, Turku, Finland.
    Short-term Effectiveness of a Prefabricated Occlusal Appliance in Patients with Myofascial Pain2008In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 22, no 3, p. 209-218Article in journal (Refereed)
    Abstract [en]

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

  • 49.
    Nilner, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Steenks, Michel
    de Boever, Jan A
    Ciancaglini, Riccardo
    Könönen, Mauno
    Orthlieb, Jean-Daniel
    Guidelines for curriculum of undergraduate and postgraduate education in orofacial pain and temporomandibular disorders in Europe2003In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 17, no 4, p. 359-362Article in journal (Other academic)
  • 50.
    Nilsson, H
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Känsla av sammanhang (Kasam) hos patienter med TMD smärta2006Conference paper (Other (popular science, discussion, etc.))
12 1 - 50 of 67
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