Aune M. Raustia

Head Posture and Cervicovertebral and Craniofacial Morphology in Patients with Craniomandibular Dysfunction

A relationship between particular characteristics of dental occlusion and craniomandibular disorders (CMD) has been reported, while less attention has been focused on the possible effect of dysfunction of the masticatory system on head posture or cervicovertebral and craniofacial morphology. Natural head position roentgen-cephalograms of 16 young adults with complete dentition taken before and after stomatognathic treatment displayed an extended head posture, smaller size of the uppermost cervical vertebrae, decreased posterior to anterior face height ratio, and a flattened cranial base as compared with age- and sex-matched healthy controls. The lordosis of the cervical spine straightened after stomatognathic treatment. The results are an indication of the close interrelationship between the masticatory muscle system and the muscles supporting the head, and lead to speculation on the principles of treating craniomandibular disorders.

Association Between Symptoms of Temporomandibular Disorders and Depression: An Epidemiological Study of the Northern Finland 1966 Birth Cohort

ABSTRACT Facial pain and other symptoms of temporomandibular disorders (TMD) are rather common in the adult population. According to clinical studies, psychological factors play an important role in the etiology and maintenance of these symptoms. On the other hand, chronic pain can cause depression. The aim of this study was to evaluate the association between symptoms of TMD and depression in a large population sample of young adults. The study was a part of the 31-year follow-up study of the Northern Finland Birth Cohort consisting of 12,058 live births from the year 1966. Questionnaire information concerning TMD symptoms was collected from a subsample of 5,696 subjects. Depression was measured with a question about reported depression (diagnosed by a doctor) and with the Symptom Checklist depression subscale (SCL-25 DS). Of the TMD symptoms, those related to pain had the most significant relations to indicators of depression. In both genders, the proportion of depression indicated with the SCL-25 DS was significantly higher in subjects with pain-related symptoms of TMD, i.e., facial pain and “pain at jaw rest”, and in men with “pain on jaw movement”, compared with non-pain subjects (p<0.05). Other symptoms of TMD also associated significantly with SCL-25 DS (p>0.05), except “difficulties in mouth opening” among women. Among women, the prevalence of recognized depression was also significantly higher in subjects with pain-related symptoms of TMD, compared with subjects with no pain (p≤0.05). Almost all the associations remained significant after adjusting for marital status, education, and self-rated general health. In conclusion, the results show that depression has an association with TMD symptoms, especially those related to pain. When treating patients with facial pain, dentists should consider the possible presence of psychopathology and, if necessary, consult appropriate mental health professionals.

Facial pain and temporomandibular disorders: an epidemiological study of the Northern Finland 1966 Birth Cohort.

ABSTRACT Recent clinical studies have shown an association between temporomandibular disorders (TMD) and facial pain. The aim of this epidemiological study was to investigate the prevalence of facial pain and TMD, their relation to each other, and also their relation to previous traumas, occlusal factors and pain in other areas of the body. The study is a part of the Well-Being and Health Research of the Northern Finland Birth Cohort 1966 using questionnaires where data on facial pain, TMD symptoms, occlusal divergencies, traumas in the face and other pain areas of the body were registered. Data were obtained from 5696 subjects born in the year 1966 in northern Finland. Twelve percent of the men and 18% of the women had suffered from facial pain during the last year. The most often reported symptom of TMD was clicking of the temporomandibular joints (TMJs) (21% in men, 28% in women), while prevalence of more severe symptoms was 13% or under. Facial pain was related to symptoms of TMD, as well as to traumas in the face or TMJs, distal occlusion and other pain areas (neck, shoulders, arms, lower back, jaws, tooth). The results suggest that facial pain is a usual symptom in adult population, and has an association with TMD, as well as with other musculoskeletal pain symptoms. Traumas to face and TMJs, certain occlusal factors and dental pathology may have a remarkable role in the etiology.

Changes in electric activity of masseter and temporal muscles after mandibular sagittal split osteotomy

The functioning of the masseter and anterior temporal muscles was assessed by electromyography in 18 patients before orthognathic surgery and 6 weeks, 3 months, 1 year, and 2 years afterwards. Electromyogram (EMG) recordings were made during maximal bite in intercuspal position and chewing. The mean electric activity in the masseter and anterior temporal muscles decreased markedly 6 weeks after surgery but increased clearly for 1 year in both functions. Only a slight further increase was observed at 2-year follow-up during chewing, but not during maximal bite in intercuspidation. The mean changes in electric activity increased more clearly in patients with hyperplastic mandible than in patients with hypoplastic mandible and in those with long shift of the mandible. The same finding was also more visible in men and older patients than in women and younger patients.

Acupuncture compared with stomatognathic treatment for TMJ dysfunction. Part I: A randomized study.

12. Schendel SA, Eisenfeld J, Bell WT, Epker BN, Mishelevich DJ: The long face syndrome: Vertical maxillary excess. Am J Orthod 70~398, 1967. Rugh JD, Sims DB: Electrode placement effects on recording electromyographic rest positions. Presented at the International Association for Dental Research, 1981. Drago C: Anatomy of the facial musculature and electrode placement. Prc~c Ann MeeGng Biofeedback Sot Am, San Diego, 1979. Troendle R, Troendle K, Rugh JD: Electromyographic and phonetic rest pxition changes with head posture. Presented at the International Association for Dental Research, 1980. Mohl N: Head posture and Its role in occlusion. NY Dent J 42~17, 1916. Mohl ND, Drinnan AJ: Anatomy and physiology of edentulous mouth. In Winkler S, editor: Essentials of Complete Denture Prosthodontic!. Philadelphia, 1979, WB Saunders Co. Solow B, Tallgren ‘1: Head posture and craniofacial morphology. Am J Phys Anthropol 44:417, 1976. 13.

Temporomandibular disorders, occlusion, and neck pain in subjects with facial pain: a case-control study.

ABSTRACT The etiology of facial pain is multifactorial. Based on the results of a questionnaire included in the study of the 1966 Northern Finland Birth Cohort, performed in 1997–98, we found an association of facial pain with subjective symptoms of temporomandibular disorders (TMD), neck pain and with occlusal factors reported by 5,696 subjects. The aim of the present study was to examine these associations clinically. In the year 2000, a new inquiry was sent to the following subjects living in Oulu: 1. all subjects who had reported facial pain in the former questionnaire (n=162) (case group); and 2. to a randomly selected group of nonpain controls (n=200), group matched for gender. Those who reported willingness to participate were invited to a clinical examination. Finally, the total number of subjects was 104, including 52 (10 men, 42 women) cases and 52 (10 men, 42 women) controls. Anamnestic data were collected, and clinical stomatognathic and musculoskeletal examinations were performed, both the clinicians and the subjects being unaware of the case-control status. Anamnestically, stress was the most often reported provoking factor for facial pain. Facial pain associated significantly with reported TMD symptoms and allergies. Based on clinical findings, most of the cases were classified in the myogenous subgroup of TMD. The risk for facial pain was six-fold in subjects with clinically assessed TMD, defined as moderate (Dill) or severe (Dilll) by Helkimos clinical dysfunction index, almost six-fold in subjects with protrusion interferences and approximately three-fold in subjects with clinically assessed tenderness of distinct fibromyalgia (FM) points in the neck. According to the adjusted logistic regression analyses, TMD had the strongest influence on facial pain, followed by protrusion interferences, anamnestically reported allergies and “other headaches”. The present study shows that as well as being connected with TMD, facial pain is associated with pain and muscle tenderness in the neck area.

Longevity of fixed metal ceramic bridge prostheses: a clinical follow‐up study

The aim of this study was to evaluate the factors that influence the longevity of fixed metal ceramic bridge prostheses, including the length of the bridge as well as the basic circumstances of the mouth. A total of 132 patients attended the clinical examination. There were 84 women (64%) and 48 men (36%). Patients had altogether 195 bridges, which included 157 short bridges (3-5 units) and 47 long bridges (6 and more units). The overall clinical examination was performed including the intra-oral radiographs. The salivary findings of the patient at baseline [flow rate of stimulated saliva, scores of mutans streptococci (SM) and lactobacilli (LB)] were registered from the patient files. In addition, the patient files were examined to receive further information concerning the complications treated in our clinic. On the basis of severe and extensive complications, the overall survival after 10 years was 84%. Long bridges had lower survival than the shorter ones (P=0.04). A low secretion of saliva recorded before the prosthetic treatment decreased the survival of the bridges (P=0.12) and the survival of the bridges was likewise reduced by high scores of LB and SM (P=0.07). Age of the patient did not influence the survival. It was shown here that long bridges (5 and more units) have a lower survival than the short bridges. It can be concluded, however, that the low secretion of saliva and the high scores of lactobacilli and SM have a remarkable influence on complications and these facts should therefore be taken into careful consideration in choosing the patients for the prosthetic treatment with fixed prosthodontics.

Role of Temporomandibular Disorders (TMD) in Facial Pain: Occlusion, Muscle and TMJ Pain

Temporomandibular disorders (TMD) which comprise myogenic and arthralgic components have been reported to predispose subjects to headache and facial pain. The aim of this study was to evaluate the role of these components in patients with facial pain and to investigate the influence of treatment of TMD on pain of these patients. The subject group consisted of 25 patients suffering from facial pain. The clinical stomatognathic examination was performed before conservative treatment of TMD, and one-two weeks, three months and one year after treatment. The severity of TMD was assessed using the anamnestic (AI) and clinical dysfunction (DI) indices of Helkimo. The intensity of pain was evaluated on a numerical rating scale (NRS). According to clinical findings the patients were classified to following diagnostic subgroups: TMD myo (mainly myogenic), TMD arthro (mainly arthrogenous) and TMD comb (both myogenic and arthrogenous components involved). Fifteen patients were classified in the TMD myo group, nine in the TMD comb group and one in the TMD arthro group. The DI index decreased significantly one-two weeks after treatment and remained at this level at three month and one year follow-up examinations. At the first examination the TMD myo group had the highest level of NRS index, which decreased significantly during the time of follow-up, while no significant changes were found in other groups. Bruxism reported by the patient had a positive correlation with the amount of painful muscles on the right side at first examination. The results show that facial pain combined with TMD may be mostly of myogenic origin, and myogenic pain seems to have most favorable response to conservative treatment of TMD.

Effect of complete denture renewal on oral health--a survey of 42 patients.

The effect of complete denture renewal on oral health was evaluated both subjectively and clinically at follow-up 30 months (range 19-36 months) after completion of treatment in 42 edentulous patients (31 women and 11 men, aged 34-76 years) treated by dental students during 1989-1992. Ninety per cent of the patients were satisfied with the new appearance of their dentures and 71% with the way they functioned. When comparing the base data and results from follow-up it seems that general health and medication, anatomical circumstances, salivary flow rates and denture wearing habits in edentulous subjects do not change significantly over a few years. The main effects of denture renewal are seen in patient satisfaction, and clinically in the improved condition of oral mucosa and better fit and acceptable occlusion of dentures.

Efficacy of stabilisation splint treatment on temporomandibular disorders

The evidence supporting the use of stabilisation splints in the treatment of temporomandibular disorders (TMD) is scarce and a need for well-controlled studies exists. The aim of this randomised, controlled trial study was to assess the efficacy of stabilisation splint treatment on TMD. The sample consisted of 80 consecutive referred patients who were randomly assigned to the splint group (n = 39) and the control group (n = 41). Subjects in the splint group were treated with a stabilisation splint, whereas subjects in the control group did not receive any treatment except counselling and instructions for masticatory muscle exercises which were given also to the subjects in the splint group. Outcomes were visual analogue scale (VAS) on facial pain intensity and clinical findings for TMD which were measured at baseline and after 1-month follow-up. The differences in change between the groups were analysed using regression models. Facial pain decreased and most of the clinical TMD findings resolved in both of the groups. The differences in changes in VAS or clinical TMD findings between the groups were not statistically significant. The findings of this study did not show that stabilisation splint treatment in combination with counselling and masticatory muscle exercises has additional benefit in relieving facial pain and increasing the mobility of the mandible than counselling and masticatory muscle exercises alone in a short time-interval.