Bengt Wenneberg

The relationship between maximal bite force, bite force endurance, and facial morphology during growth: A cross-sectional study

The aims of this investigation were to study the relation between facial morphology and bite force at different ages during growth and to investigate possible relations between bite force and the variables age, finger force, stature, and sex in growing healthy individuals. One hundred and thirty-six individuals were included, consisting of six groups of males and females, 7-9, 10-12, and 20-24 years old. Standardized photographs were taken to determine the facial type. The occlusal relationship, body height, finger force, maximal bite force, and bite force endurance amplitude were recorded. All bite force variables and finger force increased with age in both sexes. A positive correlation was found between the maximal bite force in the incisor region and the ratio of upper to lower facial height; this is, subjects with a high bite force had a relatively short lower anterior height. The maximal bite force for molars and endurance amplitude were positively correlated to stature and finger force but not to facial characteristics. A longitudinal study to follow each individual child during growth would be of interest to evaluate the importance of muscular influence on facial growth.

Acupuncture in treatment of facial muscular pain

Forty-five individuals with long-standing facial pain or headache of muscular origin were randomly allocated into three groups. The first group was treated with acupuncture, the second group received an occlusal splint, and the third group served as controls. Both acupuncture and occlusal splint therapy significantly reduced subjective symptoms and clinical signs from the stomatognathic system. No differences between these two groups were found with regard to treatment effects. It is concluded that acupuncture is an alternative method to conventional stomatognathic treatment for individuals with craniomandibular disorders of muscular origin.

Long-term effect of intra-articular injections of sodium hyaluronate and corticosteriod on temporomandibular joint arthritis☆

The long-term effect of intra-articular injections of sodium hyaluronate and corticosteroid (betamethasone) was compared in a sample of 24 patients who had pain and tenderness to palpation in the temporomandibular joint (TMJ arthritis) of at least six months duration, and who had not responded to conservative treatment. The two drugs were randomly allocated to the patients. The drugs, 0.5 ml, were injected twice into the superior joint compartment of the TMJ with a two-week interval between injections. The effect on subjective symptoms, clinical signs, and bite force was assessed. At the one and two-year follow-ups both the hyaluronate-and the corticosteroid-group had significantly reduced subjective symptoms as well as clinical signs, and the maximum voluntary bite force was significantly increased. The differences in effect between treatments were not statistically significant. It was concluded that both drugs have a significant long-term effect on chronic arthritis of the TMJ and that either of the drugs can be helpful; however, sodium hyaluronate might be the best alternative due to the least risk for side effects.

Craniofacial structure in children with juvenile chronic arthritis (JCA) compared with healthy children with ideal or postnormal occlusion

The aim of the present study was to evaluate the influence of condylar destruction on the craniofacial growth of children with juvenile chronic arthritis (JCA) and to compare their craniofacial structure with that of healthy children with ideal or postnormal occlusion. Thirty-five children (7 to 16 years) affected by JCA were compared with 136 children (7 to 16 years) with normal facial structure and occlusion (ideal group) and 62 children (7 to 12 years) with postnormal occlusion (postnormal group). Panoramic radiographs and lateral cephalograms were taken to detect condylar lesions and analyze facial structure. Multiple regression analysis was applied to test the possible relationships between the groups. The present study largely confirms earlier findings that the JCA group has a characteristic craniofacial structure. Their structure differed not only from the facial characteristics of children with ideal, but also to some extent, from children with postnormal occlusion. Furthermore, the craniofacial structure of children with JCA varied greatly, and radiographs showed that the most extreme craniofacial changes, particularly the mandibular structure, were associated with condylar lesions. In conclusion, the arthritic condylar lesions seem to be the main etiologic reason for the altered facial structure and changes in the occlusion in children with JCA. Influences of other factors, such as masticatory muscular function, are also discussed.

Effects of a mandibular protruding device on the sleep of patients with obstructive sleep apnea and snoring problems: A 2-year follow-up

Objectives: To evaluate subjective discomfort and somnographic measures of patients with obstructive sleep apnea and snoring problems who had been treated for 2 years with a mandibular protruding device (MPD). Methods: The study population comprised 65 patients with a pretreatment diagnosis of obstructive sleep apnea (OSA) (n = 44) or habitual snoring without apnea (n = 21). After a baseline medical and somnographic examination, a functional examination of the stomatognathic system, and a questionnaire focused on sleep-related qualities, each patient received an MPD. Two follow-ups were made 6 months and 2 years after MPD treatment had been initiated, and all initial examinations were repeated. Results: At the 2-year follow-up, significant subjective improvements were registered in 90% of the patients regarding a reduction of snoring and apneas, in 76% regarding a reduction in daytime tiredness, and in 84% regarding an improvement in the quality of the night sleep (change of ≥ 50% from baseline data). At the 2-year follow-up of the OSA group, the oxygen desaturation index (ODI) had dropped significantly from a mean value of 14.7 (SD, 12.7) to 3.1 (SD, 4.2) (P < 0.001), and the mean SaO2 nadir rose from 78.2% (SD, 8.1) to 89.0% (SD, 4.7) (P < 0.001). Only one of the snorers increased his ODI value; the others retained their initial healthy values. The OSA patients significantly reduced the amount of time they snored during their sleep. Conclusion: MPD treatment is associated with a significant reduction in subjective complaints such as disturbing snoring, apneas, daytime tiredness, and poor quality of night sleep, and with a significant reduction in ODI values in the OSA group. In addition, favorable 6-month results were unchanged after 2 years.

Occlusal equilibration and other stomatognathic treatment in patients with mandibular dysfunction and headache

Thirty patients with craniomandibular disorders and headache were randomly divided into two groups. One received occlusal equilibration (O group) and the other (S group) routine stomatognathic treatment, including an occlusal splint. The outcome of treatment was evaluated by means of a questionnaire, visual analogue scales, and clinical examination. In both groups, the patients reported reduction of symptoms, but the clinical dysfunction score used was significantly diminished only in the S group. A combined treatment regimen, including an occlusal splint, was more effective than occlusal adjustment alone, especially with regard to clinical signs of dysfunction.

Effects of Occlusal Treatment and Intraarticular Injections on Temporomandibular Joint Pain and Dysfunction

The long-term effect (2 years) of occlusal treatment and intra-articular injections of a mixture of corticosteroid and local anaesthetic was investigated in two groups of patients with pain and dysfunction in the temporomandibular joint (TMJ). Fifteen patients were treated with injections and eighteen patients with occlusal adjustment. The TMJ was tender to palpation in all patients. The intra-articular injections were given once a week for three weeks. The occlusal treatment included splints, grinding on natural teeth and occlusal correction of complete dentures. The severity of the subjective symptoms and clinical signs was estimated before and after treatment. Both sorts of treatment reduced the subjective symptoms and the clinical signs significantly, but the reduction was significantly greater after the intra-articular injections. The effect of the injections was less efficient in patients with radiographic signs of remodelling of the TMJ and general joint symptoms. It was concluded that both intra-articular injections of corticosteroid combined with local anaesthetic and occlusal treatment have a long palliative effect on TMJ pain and dysfunction. The intraarticular treatment, however, had a greater effect on the clinical signs.

Diclofenac sodium and occlusal splint therapy in TMJ osteoarthritis: a randomized controlled trial

The aim of the study was to compare treatment with diclofenac sodium (Voltaren 3 x 50 mg) to occlusal splint therapy in a randomized, single-blind controlled trial of patients with a diagnosis of temporomandibular joint (TMJ) osteoarthritis (OA) in accordance with Research Diagnostic Criteria for temporomandibular disorders. Patients with general joint disorders or restrictions against medication with non-steroidal anti-inflammatory drug were not included. Twenty-seven females and two males (aged 36-76 years) included, answered a standardized questionnaire and were clinically examined and they underwent TMJ tomography. The treatment was randomized to either splint (n = 15) or diclofenac (n = 14). The temperatures over the TMJs were determined. The patients were re-examined 1 week, 1 month and 3 months after the start of treatment. A 1-year follow-up was carried out using questionnaires. After 1 week of treatment with diclofenac, significant reductions of pain and discomfort, TMJ tenderness and joint pain on jaw movements were noted. The splint therapy gave a significant reduction of reported symptoms after 1 month of treatment. Both treatments gave few adverse effects and were on an equal level. Estimation of the degree of inflammation by measuring the surface temperature over the TMJ was not reliable. Structural changes of the symptomatic TMJs were radiographically found in 82%, the contralateral, symptom-free TMJ had changes in 36%. There was a discrepancy between the clinical and the radiographical findings. Diclofenac gave a more rapid improvement, but both treatments gave a significant reduction of symptoms of TMJ OA within 3 months which remained at the one-year follow-up.

Subjective symptoms from the stomatognathic system in ankylosing spondylitis

One hundred individuals with ankylosing spondylitis (AS) and 57 individuals a comparison group responded to a questionnaire concerning subjective symptoms from the stomatognathic system and general joint symptoms. It was concluded that the individuals with AS have more subjective symptoms from the stomatognathic system, especially difficulties in wide mouth opening, than the comparison group. Specific temporomandibular joint (TMJ) involvement in AS was difficult to determine but pain in the TMJ region, stiffness/tiredness in the jaws and with AS. TMJ involvement was also correlated to the severity and extension of the AS. In the comparison group awareness of parafunctions such as tooth-clenching and tooth-grinding were important subjective factors correlated to their symptoms from the stomatognathic system.

Jaw symptoms and signs and the connection to cranial cervical symptoms and post-traumatic stress during the first year after a whiplash trauma.

Purpose. To estimate the prevalence of jaw symptoms and signs during the first year after a neck sprain in a car collision. Further, to determine their relationships to the localisation and grade of the initial neck symptoms and signs, headache, post-traumatic stress and crash characteristics. Methods. One hundred and forty-six adult subjects and crash characteristics were prospectively investigated in an in-depth study during 1997–2001. Head, neck, and jaw symptoms and signs were recorded within 5 weeks and after 1 year. Acute post-traumatic stress was estimated with the Impact of Event Scale-Revised (IES-R). Results. Jaw symptoms were initially reported by three men (5%) and three women (4%), and subsequently developed in eight women (10%) during the following year. Jaw signs were noted initially in 53 subjects (37%) and in 28 subjects (24%) after 1 year, without difference between sexes, and more often after low-speed impacts. Headache in females, cranial cervical symptoms, pronounced neck problems, post-traumatic stress and whiplash-associated disorders (WAD) grade II–III after rear-end impacts were related to jaw signs during the acute phase. After 1 year, jaw signs were related to residual neck problems, headache and post-traumatic stress. Conclusions. Jaw symptoms are seldom reported during the acute phase after a whiplash trauma. Women more often than men develop jaw symptoms during the first year. Jaw symptoms and signs may develop also after low-speed impacts, especially after rear-end collisions. Jaw symptoms and signs should be observed after whiplash trauma, especially in those with headache, pronounced neck problems, cranial neck symptoms and post-traumatic stress.