Maria Nilner

Symptoms and Signs of Temporomandibular Disorders in Girls with Normal Occlusion and Class II Malocclusion

Mandibular function, headaches, and symptoms and signs of temporomandibular disorders (TMD) were studied in one group of girls with a well-defined normal occlusion (n = 60) and another group with class II malocclusion (n = 123). Frequent headaches and temporomandibular joint clicking, muscle tenderness to palpation, pain on mandibular movement, awareness of tooth clenching, and grinding were commoner in the class II malocclusion group. Awareness of tooth clenching had the largest influence on the odds for symptoms and signs of temporomandibular disorders (TMD) in a logistic regression analysis. Occlusal variables that increased the odds for symptoms and signs of TMD were large overjet, frontal open bite, few occlusal contacts, lateral sliding retruded-intercuspal contact position, crowding, and non-working side interferences. We concluded that normal occlusions have lower odds for symptoms and signs of TMD, whereas some occlusal characteristics, more frequently found in the class II malocclusion group, increased the odds for symptoms and signs of TMD.

Relationship between clinical and radiologic findings of the temporomandibular joint in rheumatoid arthritis.

The relationship between clinical findings in the craniomandibular system and radiologic findings in the temporomandibular joint was investigated in 101 adults with rheumatoid arthritis. Radiologic changes were correlated with duration and severity of temporomandibular joint symptoms and general joint disease. The radiologic changes were also associated with loss of occlusal support, anterior open bite, and occlusal interferences. Most joints with crepitus exhibited radiologic erosion. Joints with mutilating changes were silent.

Treatment outcome of appliance therapy in temporomandibular disorder patients with myofascial pain after 6 and 12 months

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) patients 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 in improvement of overall subjective symptoms in an intent‐to‐treat analysis between groups T and C was found at the follow‐ups. In a survival analysis of treatment compliance, a significant difference was found between groups T and C. At the 6‐ and 12‐month follow‐ups, a significant reduction in myofascial pain, as measured on a visual analog 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 use of the stabilization appliance in the treatment of TMD patients with myofascial pain.

Short-term effect of occlusal adjustment on craniomandibular disorders including headaches

The aim of this study was to assess the short-term effect of occlusal adjustment on craniomandibular disorders. Fifty patients were randomly selected and divided into a treatment (T) and a control (C) group. The initial clinical examination and the follow-up were made by one observer and the occlusal adjustment by another. There were no significant differences between groups with regard to frequency of headaches, facial pain, pain on mandibular function, or duration of headaches and facial pain. Fifty-two percent of the patients in the treatment group and 20% of the patients in the control group reported reduced subjective symptoms overall at follow-up examination. The improvement was statistically significant within the T group and significantly greater than in the C group. There was no significant change within or between groups with regard to frequency of headaches, facial pain, or pain on mandibular movements. There was an almost significant difference between groups after treatment with regard to changes in the number of tender muscles. The results of this study indicate that occlusal adjustment provides a general subjective improvement of craniomandibular disorders.

TMD before and after correction of dentofacial deformities by orthodontic and orthognathic treatment

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.

A 40 years follow-up of dental arch dimensions and incisor irregularity in adults

Dentoalveolar changes in adulthood have not been extensively documented. Such changes may have important implications for the long-term stability of orthodontic treatment. To analyse occlusal and dentoalveolar changes in adults from the age of 20 years to the age of 60 years. The material comprised 18 Swedish dentists, 16 men and 2 women, with no missing teeth and no prosthodontic or orthodontic treatment. Measurements were recorded on study casts made between 1949 and 1989 at the Department of Stomatognathic Physiology at the Faculty of Odontology in Malmö, thus documenting changes over an average period of 38.4 years. Malocclusion traits, overbite, overjet, dental arch length and width, and Littles irregularity index were registered. There was a significant increase in Littles irregularity index in the mandible (1.0 mm, P < 0.01) and a decrease in arch length in both jaws (0.5-0.9 mm, P < 0.05). The maxillary and mandibular intercanine widths decreased by 0.8 and 1.0 mm, respectively (P < 0.001). The malocclusion traits, overbite, and overjet remained unchanged during the observation period. The results confirm that dentoalveolar changes occur as a continuous process throughout adult life. The findings of potential clinical importance are decreases in arch length and depth, resulting in a decrease in intercanine width and an increase in anterior crowding. In clinical orthodontic practice, these findings have important implications for treatment planning and long-term stability after orthodontic treatment.

TMD in consecutive patients referred for orthognathic surgery

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.

Does splint therapy work for temporomandibular pain

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.Conclusions 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.

Office and ambulatory blood pressure in patients with craniomandibular disorders

To assess the physiologic response to daily life stress in patients with craniomandibular disorders (CMD), office and ambulatory blood pressure and heart rate were studied in 25 female patients and 25 controls. Significant differences (p < 0.05) were found between the groups for heart rate before the clinical examination and that in the patient group when compared before and after the clinical examination. Higher values were found for mean daytime systolic and diastolic blood pressure in the control group compared with the patient group (p < 0.05). The mean number of systolic blood pressure > or = 140 mmHg during 24 h and daytime was significantly higher (p < 0.05) in the control group than in the patient group. In this study the CMD patients with muscular diagnosis were not more stressed than healthy subjects in the daily activities as evaluated by ambulatory blood pressure measurements.

Achieved competences in temporomandibular disorders/orofacial pain: a comparison between two dental schools in Europe

AIMS The aim was to study achieved competences in temporomandibular disorders (TMD)/orofacial pain (OP) at two universities by comparing students 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.