Anders Wänman

Longitudinal course of symptoms of craniomandibular disorders in men and women: A 10-year follow-up study of an epidemiologic sample

An epidemiologic sample (n = 285) drawn from the population of Skellefteå, Sweden, was examined to evaluate the prevalence of signs and symptoms of craniomandibular disorders (CMD) at the age of 17 years. The sample was then followed up prospectively at the ages of 18 and 19 years. The year they reached 28 years of age a questionnaire concerning prevalence, incidence, frequency, duration, location, and intensity of symptoms of CMD was sent to the same subjects. Two hundred and thirty-four subjects responded (82%). The number of subjects who participated in all examinations (at the ages of 17, 18, 19, and 28 years) was 215 (107 women and 108 men). During the 10-year period from the late teens onwards a significant increase in reported symptoms of CMD occurred in both men and women. For the whole sample the prevalence increased from approximately 20% to 37%. The incidence of CMD symptoms at the age of 28 years was 6% in both sexes. Although fluctuations of symptoms during the period from the age of 17 to 28 occurred in both sexes, the course of CMD in men and women differed significantly. All women who consistently reported symptoms at the age of 17-19 years also reported symptoms at the age of 28 years; the corresponding figure for men was 60%. At the age of 17 years 25 women reported CMD; 23 of these reported CMD at the age of 28 years (92%). At the age of 17 years 17 men reported CMD; 5 of these reported CMD at the age of 28 (29%). The result indicates different courses for CMD in men and women.

Back pain in relation to musculoskeletal disorders in the jaw-face: A matched case–control study

Abstract Back pain and temporomandibular disorders are both common conditions in the population with influence on the human motor system, but a possible co‐morbidity between these conditions has not been fully investigated. The aim of this study was to test the hypothesis of an association between long‐term back pain and pain and/or dysfunction in the jaw‐face region. Back pain was defined as pain in the neck, shoulders and/or low back. The study‐population comprised 96 cases with long‐term back pain and 192 controls without back pain. We used a screening procedure, a questionnaire and a clinical examination of the jaw function. The questionnaire focused on location, frequency, duration, intensity and impact on daily life of symptoms in the jaw‐face and back regions. The analysis was conducted on 16 strata, matched by age and sex for case vs. control, using Mantel–Haenszel estimates of matched odds ratio (OR) and 95% confidence interval (CI) as well as the corrected Mantel–Haenszel χ2 test. The overall prevalence of frequent symptoms in the jaw‐face region, as reported in the questionnaire, was 47% among cases and 12% among controls. The difference was statistically significant (P < 0.0001) with a sevenfold odds ratio (CI: 3.9–13.7). Moderate to severe signs from the jaw region were clinically registered among 49% of the cases and 17% of the controls (P < 0.0001, OR: 5.2, CI: 2.9–9.2). The results showed statistically significant associations between long‐term back pain and musculoskeletal disorders in the jaw‐face and indicate co‐morbidity between these two conditions.

Mandibular dysfunction in adolescents Prevalence of symptoms

The prevalence of symptoms of mandibular dysfunction was studied in 285 17-year-old adolescents living in the municipality of Skellefteå. They answered a questionnaire concerning general state of health and occurrence of headache, facial pain, or temporomandibular problems. A fifth of the subjects reported some symptoms involving the masticatory system. There was no statistically significant difference between sexes. Of the sample 13% had mild symptoms and 7% had severe symptoms of dysfunction. The most frequent symptoms were clicking sounds from the temporomandibular joint (13%) and a feeling of fatigue in the jaws (6%). Recurrent headache (once a week or more) was reported by 12% and appeared significantly more often among the girls (p less than 0.001). Three-quarters used both sides for chewing, and oral parafunctional habits were reported by 68%. Since mild and moderate symptoms of mandibular dysfunction and headache obviously make an early appearance, a routine dental examination should include screening of these symptoms to identify patients who should be observed more closely.

Mandibular dysfunction in adolescents II. Prevalence of signs

The prevalence of signs of mandibular dysfunction was studied in 285 17-year-old adolescents living in the municipality of Skellefteå. They were subjected to a functional examination of the masticatory system. The commonest clinical signs were tenderness to palpation of the masticatory muscles (41%) and clicking sounds from the temporomandibular joints (22%). The tenderness to palpation was generally located to the lateral pterygoid muscle and the insertion of the temporal tendon. Girls were tender to palpation oftener (p less than 0.05) than boys. Unilateral contact in the retruded position was recorded in 77% of the subjects. Mediotrusion interferences were found in 30% of the subjects. Signs of clinical dysfunction were found in 56% and were significantly commoner in girls than in boys (p less than 0.01). Since mild and moderate signs of mandibular dysfunction obviously make an early appearance, a routine dental examination should include a functional evaluation of the stomatognathic system, to identify patients who should be observed more closely.

Signs of osteoarthrosis of the temporomandibular joints in young patients: a clinical and radiographic study.

OBJECTIVE The aims of this study were to investigate the occurrence of osteoarthrosis of the temporomandibular joints among young patients referred for consultation and treatment because of pain and dysfunction of the jaws and to study the relationship between signs and symptoms of temporomandibular disorders and osteoarthrosis in these patients. STUDY DESIGN This was a retrospective study based on case histories, clinical examinations, and temporomandibular joint tomography. A total of 131 patients ranging in age from 12 to 30 years were included in the study. The null-hypothesis tested was that no significant differences in signs and symptoms of temporomandibular disorders would be found between joints with and joints without signs of osteoarthrosis. RESULTS Osteoarthrosis of the temporomandibular joints was found in 87 patients (66%) and 151 joints (58%). The null-hypothesis was not rejected. CONCLUSION A high prevalence of temporomandibular joint osteoarthrosis among the studied sample was found. The study did not allow us to draw any conclusions about the cause of temporomandibular joint osteoarthrosis in these patients. The result provided a basis for a subsequent follow-up study.

Does a dose-response relation exist between spinal pain and temporomandibular disorders?

BackgroundThe aim of this study was to test whether a reciprocal dose-response relation exists between frequency/severity of spinal pain and temporomandibular disorders (TMD).MethodsA total of 616 subjects with varying severity of spinal pain or no spinal pain completed a questionnaire focusing on symptoms in the jaw, head and spinal region. A subset of the population (n = 266) were sampled regardless of presence or absence of spinal pain. We used two different designs, one with frequency/severity of spinal pain, and the other, with frequency/severity of TMD symptoms as independent variable. All 616 participants were allocated to four groups, one control group without spinal pain and three spinal pain groups. The subjects in the subset were allocated to one control group without TMD symptoms and three TMD groups. Odds ratios (ORs) were calculated for presence of frequent TMD symptoms in the separate spinal pain groups as well as for frequent spinal pain in the separate TMD groups.ResultsThe analysis showed increasing ORs for TMD with increasing frequency/severity of spinal pain. We also found increasing ORs for spinal pain with increasing frequency/severity of TMD symptoms.ConclusionThis study shows a reciprocal dose-response-like relationship between spinal pain and TMD. The results indicate that these two conditions may share common risk factors or that they may influence each other. Studies on the temporal sequence between spinal pain and TMD are warranted.

Risk factors associated with incidence and persistence of signs and symptoms of temporomandibular disorders

Abstract Objective. To analyze whether gender, self-reported bruxism, and variations in dental occlusion predicted incidence and persistence of temporomandibular disorder (TMD) during a 2-year period. Material and methods. The study population comprised 280 dental students at Umeå University in Sweden. The study design was that of a case-control study within a 2-year prospective cohort. The investigation comprised a questionnaire and a clinical examination at enrolment and at 12 and 24 months. Cases (incidence) and controls (no incidence) were identified among those without signs and symptoms of TMD at the start of the study. Cases with 2-year persistence of signs and symptoms of TMD were those with such signs and symptoms at all three examinations. Clinical registrations of baseline variables were used as independent variables. Odds ratio estimates and 95% confidence intervals of the relative risks of being a case or control in relation to baseline registrations were calculated using logistic regression analyses. Results. The analyses revealed that self-reported bruxism and crossbite, respectively increased the risk of the 2-year cumulative incidence and duration of temporomandibular joint (TMJ) signs or symptoms. Female gender was related to an increased risk of developing and maintaining myofascial pain. Signs of mandibular instability increased the risk of maintained TMD signs and symptoms during the observation period. Conclusion. This 2-year prospective observational study indicated that self-reported bruxism and variations in dental occlusion were linked to the incidence and persistence of TMJ signs and symptoms to a higher extent than to myofascial pain.

Incidence and prevalence of myofascial pain in the jaw-face region. A one-year prospective study on dental students.

Objective. The aims of this study were to examine the 1-year period prevalence, incidence, and course of myofascial pain in the jaw–face region, and to analyze whether female gender, dental occlusion, and oral parafunctions have any influence on these signs and symptoms. Material and methods. The study population comprised 308 dental students examined at the start of their dentistry course and re-examined after 1 year. Case histories were collected using a questionnaire. The clinical examination included palpation sites of muscles, a submaximal clenching test, measurements of maximal mandibular mobility, and classification of morphological and functional dental occlusion. Results. The 1-year period prevalence of frequent myofascial symptoms was 19%. The incidence of myofascial pain, according to the Research Diagnostic Criteria for TemporoMandibular Disorders (RDC/TMD), was 4%. The female students presented an almost 4-fold incidence rate of myofascial symptoms compared to the male students. Non-symptomatic subjects were found predominantly among men, among those unaware of bruxism with bilateral contact in the retruded contact position (RCP), and among those with a stable intercuspal position (ICP). Variations in morphological occlusion did not show any relation to myofascial symptoms, nor did contact patterns in eccentric positions. Conclusions. Female dental students were more prone to developing frequent myofascial pain and to perceiving local muscle soreness than were male students during a 1-year period. Both self-reported bruxism and registered mandibular instability in ICP showed association with the 1-year period prevalence of myofascial signs and symptoms in the jaw–face region.

Temporomandibular joint sounds in adolescents: a longitudinal study.

A 2-year longitudinal study on signs and symptoms of mandibular dysfunction was performed with 285 17-year-old adolescents living in a certain geographic area in Skellefteå, Sweden. Crepitation was neither reported nor recorded in any subject. Both reports and recordings of TMJ clicking sounds fluctuated with time. The 2-year period prevalence was 24%, and 5.8% consistently reported TMJ clicking sounds. The corresponding figures for clinically recorded clickings were 36% and 9.3%, respectively. Both reported and recorded joint sounds were significantly more frequently found in 19-year-old girls than in boys. No consistent pattern of relationships between reported and recorded clicking sounds and single factors obtained by the questionnaire or clinically recorded variables could be found. Palpation tenderness in three muscle sites was to a varying degree related to both reports and recordings of clicking. Each year, significant relationships were found between reports of TMJ sounds and symptom indices. Recorded sounds were significantly related to a clinical index in the two oldest age groups. The prevalence of TMJ clicking sounds increases with age, and girls are more prone to have them than boys. In view of the natural longitudinal fluctuations, most clickings only need to be supervised, and when there is a demand for treatment, reversible methods are advocated in adolescents.

Reciprocal influence on the incidence of symptoms in trigeminally and spinally innervated areas

Temporomandibular disorders (TMD), headaches, and spinal pain show co‐morbidity and may therefore influence each other. The hypothesis tested is that the presence of any of these conditions will increase the risk of onset of new symptoms within a 2‐year period. The study population comprised 280 dental students, who were examined three times at 12‐month intervals. The incidence was calculated for a 2‐year period, based on subjects without the defined symptom at baseline. Each participant was classified into five different case‐control groups, representing incidence cases or no incidence (controls) of: (1) nonpain TMD symptoms; (2) jaw pain; (3) headaches; (4) spinal pain; and (5) TMD pain. Presence of headaches and of spinal pain and signs and symptoms of TMD at baseline were used as independent variables in logistic regression analyses, controlling for age and sex. Incidence cases with TMD pain reported spinal pain at baseline significantly more often than the controls, and were mostly women. Incidence cases with headaches and incidence cases with jaw pain significantly more often had signs of TMD and reported spinal pain at baseline, compared to controls. Incidence cases with nonpain TMD symptoms or spinal pain significantly more often presented with signs of TMD at baseline. Our findings show that pain and dysfunction in trigeminally innervated areas and pain in spinally innervated areas mutually predict the onset of new symptoms in dental students, indicating common pathophysiological mechanisms and individual vulnerability. This may be of importance in risk assessment and treatment planning of individuals with musculoskeletal pain.