Jari Ahlberg

Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings.

OBJECTIVES The aim of this study was to summarize and systematically review the literature on the prevalence of different research diagnostic criteria for temporomandibular disorders (RDC/TMD) version 1.0 axis I diagnoses in patient and in the general populations. STUDY DESIGN For each of the relevant papers, the following data/information were recorded for meta-analysis and discussion: sample size and demographic features (mean age, female-to-male ratio); prevalence of the assigned diagnoses; prevalence of the diagnoses assigned to the left and right joints, if available; prevalence of the diagnoses assigned to the 2 genders, if available; prevalence of the different combinations of multiple diagnoses, if available; and prevalence of TMD (only for community studies). RESULTS Twenty-one (n = 21) papers were included in the review (15 dealing with TMD patient populations and 6 with community samples). The studies on TMD patients accounted for a total of 3,463 subjects (mean age 30.2-39.4 years, female-to-male ratio 3.3), with overall prevalences of 45.3% for group I muscle disorder diagnoses, 41.1% for group II disc displacements, and 30.1% for group III joint disorders. Studies on general populations accounted for a total of 2,491 subjects, with an overall 9.7% prevalence for group I, 11.4% for group IIa, and 2.6% for group IIIa diagnoses. CONCLUSIONS Prevalence reports were highly variable across studies. Myofascial pain with or without mouth opening limitation was the commonest diagnosis in TMD patient populations, and disc displacement with reduction was the commonest diagnosis in community samples.

Psychosocial impairment in temporomandibular disorders patients. RDC/TMD axis II findings from a multicentre study

OBJECTIVES The relationship between the rate of chronic pain-related disability and depression and somatization levels as well as the influence of pain duration on Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis II findings were assessed in a three centre investigation. METHODS The study sample (N=1149; F:M 4.1:1, m.a. 38.6 years) consisted of patients seeking for TMD treatment and undergoing RDC/TMD axis II psychosocial assessment to be rated in chronic pain-related disability (Graded Chronic Pain Scale, GCPS), depression (Symptoms Checklist-90[SCL-90] scale for depression, DEP) and somatization levels (SCL-90 scale for non-specific physical symptoms, SOM). The null hypotheses to be tested were that (1) no correlation existed between GCPS categories and DEP and SOM scores, and (2) no differences emerged between patients with pain from more or less than 6 months as for the prevalence of the different degrees of pain-related impairment, depression, and somatization. RESULTS In the overall sample, the prevalence of high pain-related disability (GCPS grades III or IV), severe depression and somatization was 16.9%, 21.4%, and 28.5%, respectively. A correlation was shown between GCPS and both DEP and SOM categories (Spearmans correlation test, p<0.001). A significant association between pain lasting from more than 6 months and high GCPS scores was shown (chi(2), p<0.001), while no association was found between DEP and SOM scores and pain duration in the overall sample (chi(2), p=0.742 and p=0.364, respectively). CONCLUSIONS Pain-related disability was found to be strongly related with depression and somatization levels as well as associated with pain duration. Depression and somatization scores were not associated with pain duration.

Temporomandibular joint related painless symptoms, orofacial pain, neck pain, headache, and psychosocial factors among non-patients

The aims of this study were to assess the prevalence of temporomandibular joint related (TMJ) painless symptoms, orofacial pain, neck pain, and headache in a Finnish working population and to evaluate the association of the symptoms with psychosocial factors. A self-administered postal questionnaire concerning items on demographic background, employment details, perceived general state of health, medication, psychosocial status, and use of health-care services, was mailed to all employees with at least 5 years at their current job. The questionnaire was completed by 1339 subjects (75%). Frequent (often or continual) TMJ-related painless symptoms were found in 10%, orofacial pain in 7%, neck pain in 39%, and headache in 15% of subjects. Females reported all pain symptoms significantly more often than men (P < 0.001). Frequent pain and TMJ-related symptoms were significantly associated with self-reported stress, depression, and somatization (P < 0.001). Perceived poor general state of health (P < 0.001), health care visits (P < 0.001), overload at work (P < 0.001), life satisfaction (P < 0.05), and work satisfaction (P < 0.05) were also significantly associated with pain symptoms, but the work duty was not (P > 0.05). Our findings are in accordance with earlier studies and confirm the strong relationship between neck pain, headache, orofacial pain, TMJ-related painless symptoms, and psychosocial factors. Furthermore, TMJ-related symptoms and painful conditions seem to be more associated with work-related psychosocial factors than with type of work itself.

Maximal bite force and its association with signs and symptoms of TMD, occlusion, and body mass index in a cohort of young adults.

ABSTRACT The purpose of this population-based cohort was to measure maximal bite force (MBF) in the molar and incisal regions and to examine whether MBF was associated with TMD, gender, occlusion (in terms of overjet, overbite, and total number of occluding contacts), and body mass index (BMI). MBF in the molar and incisal regions was measured using a calibrated method in 384 (196 males, 188 females) and 357 (181 males, 176 females) subjects, respectively. Two attempts in each region (right molar, left molar, and incisal) were made in random order. The subjects completed a multiple-choice questionnaire including subjective symptoms of TMD and were subsequently clinically examined. Helkimos clinical dysfunction index and BMI were calculated. The mean MBF value in the molar region was significantly higher in males (878 N, SD 194) than in females (690 N, SD 175) (p<0.001). The incisal forces were 283 N (SD 95) and 226 N (SD 86) (p<0.001), respectively. According to multiple linear regression, TMJ discomfort was significantly negatively associated with MBF in the molar region (p<0.05) and overjet was significantly negatively associated with maximal incisal bite force (p<0.05). No significant associations between MBFs and body mass were found. The results demonstrate that in a population-based cohort of young adults signs, and symptoms of TMD and studied occlusal factors, unlike body mass, associate independently with MBF.

Perceived orofacial pain and its associations with reported bruxism and insomnia symptoms in media personnel with or without irregular shift work.

A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (n=750) and to an equal number of randomly selected controls in the same company with regular 8-hour daytime work. The aims were to investigate the prevalence and severity of perceived orofacial pain (Research Diagnostic Criteria for Temporomandibular Disorders Axis II) and to analyze whether current orofacial pain was associated with reported bruxism and insomnia symptoms (Diagnostic and Statistical Manual of Mental Disorders–IV and the International Classification of Sleep Disorders Revised). The response rate in the irregular shift-work group was 82.3% (56.6% men) and in the regular daytime-work group 34.3% (46.7% men). Current orofacial pain was found overall in 19.6%, of which 88.3% had experienced the pain over 6 months. All claimed that their pain fluctuated. No subjects with chronic orofacial pain reported disabling pain, and grades III and IV were not found. Insomnia symptoms and frequent bruxism were significantly more prevalent in chronic pain grade II than in lower grades. According to logistic regression, current orofacial pain was significantly positively associated with frequent bruxism (p<0.001), female gender (p<0.001), and disrupted sleep (p<0.01), and significantly negatively associated with age over 45 years (p<0.01). Our results revealed a clear-cut association between perceived orofacial pain and reported bruxism. The association held with both chronic orofacial pain intensity and current pain. Based on the multivariate analyses, it can be concluded that disrupted sleep and bruxism may be concomitantly involved in the development of orofacial pain.

Diagnostic accuracy of portable instrumental devices to measure sleep bruxism: a systematic literature review of polysomnographic studies

This study systematically reviews the sleep bruxism (SB) literature published in the MEDLINE and Scopus databases to answer the following question: What is the validity of the different portable instrumental devices that have been proposed to measure SB if compared with polysomnographic (PSG) recordings assumed as the gold standard? Four clinical studies on humans, assessing the diagnostic accuracy of portable instrumental approaches (i.e. Bitestrip, electromyography (EMG)-telemetry recordings and Bruxoff) with respect to PSG, were included in the review. Methodological shortcomings were identified by QUADAS-2 quality assessment. Findings showed contrasting results and supported only in part the validity of the described diagnostic devices with respect to PSG. The positive predictive value (PPV) of the Bitestrip device was 59-100%, with a sensitivity of 71-84·2%, whilst EMG-telemetry recordings had an unacceptable rate of false-positive findings (76·9%), counterbalanced by an almost perfect sensitivity (98·8%). The Bruxoff device had the highest accuracy values, showing an excellent agreement with PSG for both manual (area under ROC = 0·98) and automatic scoring (0·96) options as well as for the simultaneous recording of events with respect to PSG (0·89-0·91). It can be concluded that the available information on the validity of portable instrumental diagnostic approaches with respect to PSG recordings is still scarce and not solid enough to support any non-PSG techniques employ as a stand-alone diagnostic method in the research setting, with the possible exception of the Bruxoff device that needs to be further confirmed with future investigations.

Associations of reported bruxism with insomnia and insufficient sleep symptoms among media personnel with or without irregular shift work.

BackgroundThe aims were to investigate the prevalence of perceived sleep quality and insufficient sleep complaints, and to analyze whether self-reported bruxism was associated with perceptions of sleep, and awake consequences of disturbed sleep, while controlling confounding factors relative to poor sleep.MethodsA standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (n = 750) and to an equal number of randomly selected controls in the same company with regular eight-hour daytime work.ResultsThe response rate in the irregular shift work group was 82.3% (56.6% men) and in the regular daytime work group 34.3% (46.7% men). Self-reported bruxism occurred frequently (often or continually) in 10.6% of all subjects. Altogether 16.8% reported difficulties initiating sleep (DIS), 43.6% disrupted sleep (DS), and 10.3% early morning awakenings (EMA). The corresponding figures for non-restorative sleep (NRS), tiredness, and sleep deprivation (SLD) were 36.2%, 26.1%, and 23.7%, respectively. According to logistic regression, female gender was a significant independent factor for all insomnia symptoms, and older age for DS and EMA. Frequent bruxism was significantly associated with DIS (p = 0.019) and DS (p = 0.021). Dissatisfaction with current work shift schedule and frequent bruxism were both significant independent factors for all variables describing insufficient sleep consequences.ConclusionSelf-reported bruxism may indicate sleep problems and their adherent awake consequences in non-patient populations.

Self-reported bruxism mirrors anxiety and stress in adults.

Objectives: The aims were to analyze whether the levels of self-reported bruxism and anxiety associate among otherwise healthy subjects, and to investigate the independent effects of anxiety and stress experience on the probability of self-reported bruxism. Study Design: As part of a study on irregular shift work, a questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (number of subjects: n=750) and to an equal number of randomly selected employees in the same company with regular eight-hour daytime work. Results: The response rates were 82.3% (56.6 % men) and 34.3 % (46.7 % men), respectively. Among the 874 respondents, those aware of more frequent bruxism reported significantly more severe anxiety (p<0.001). Adjusted by age and gender, frequent bruxers were more than two times more likely to report severe stress (odds ratio 2.5; 95% confidence interval 1.5-4.2) and anxiety (odds ratio 2.2; 95% confidence interval 1.3-3.6) than non-or-mild bruxers. Conclusions: Present findings suggest that self-reported bruxism and psychological states such as anxiety or stress may be related in working age subjects. Key words:Bruxism, self-report, anxiety, stress, adult.

Reported bruxism and stress experience in media personnel with or without irregular shift work.

A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (n = 750) and to an equal number of randomly selected controls with regular 8‐hour daytime work. The aim was to analyze whether irregular shift work, workload in terms of weekly working hours, dissatisfaction with current workshift schedule, health‐care use, age and gender were associated with self‐reported bruxism and experienced stress. The response rates were 58.3% (n = 874, 53.7% men) overall, 82.3% (n = 617, 56.6% men) for irregular shift workers and 34.3% (n = 257, 46.7% men) for the regular daytime work group. Those with irregular shifts were more often dissatisfied with their current workshift schedule than those in daytime work (25.1% versus 5.1%, P < 0.01). Irregular shift work was significantly associated with more frequent stress (P < 0.001), but not with self‐reported bruxism. Workers dissatisfied with their current schedule reported both bruxism (P < 0.01) and stress (P < 0.001) more often than those who felt satisfied. In multivariate analyses, frequent bruxism was significantly associated with dissatisfaction with current workshift schedule (P < 0.05), number of dental visits (P < 0.05), and visits to a physician (P < 0.01), and negatively associated with age (P < 0.05), while severe stress was significantly positively associated with number of visits to a physician (P < 0.001). It was concluded that dissatisfaction with ones workshift schedule and not merely irregular shift work may aggravate stress and bruxism.

Reported bruxism and restless legs syndrome in media personnel with or without irregular shift work.

A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (n=750) and to an equal number of randomly selected controls in the same company with regular 8-h daytime work. The questionnaire covered demographic items, employment details, general health experience, physical status, psychosocial status, stress, work satisfaction and performance, tobacco use, bruxism, and restless legs symptoms (RLS). The aim was to investigate among a multiprofessional media personnel the associations between reported bruxism and RLS, while simultaneously controlling the effects of gender, age, tobacco use, shift work, and dissatisfaction with current workshift schedule. The overall response rate was 58.3% (53.7% men). The response rate in the irregular shift work group was 82.3% (56.6% men) and in the regular daytime work group 34.3% (46.7% men). In the bivariate analyses, RLS was more prevalent in workers at either end of the studied age range (p<0.05). Self-reported frequent bruxism was significantly associated with younger age (p<0.05). Females reported RLS (11.4%) slightly more often than males (7.7%) (NS). In logistic regression, frequent bruxism (p<0.05) and older age (p<0.05) were significantly positively associated with RLS. Dissatisfaction with ones current workshift schedule (p<0.05) and RLS (p<0.05) were significantly positively associated with frequent bruxism, while age (p<0.05) was significantly negatively associated. In conclusion, perceived bruxism may be a sign of a stressful situation or dissatisfaction, while RLS as a more stable trait may in itself negatively affect sleep quality and further enhance the problem.