Päivi M. Niemi

Effect of artificial occlusal interferences depends on previous experience of temporomandibular disorders

Studies on artificial interferences in subjects with no temporomandibular (TMD) history have shown adaptation to the interference within a fairly short period of time. The role of occlusal factors in the etiology of TMD has therefore been questioned. The results might have been different, however, if subjects with a prior TMD history had been included in the study groups. To test this assumption in a randomized double-blind clinical set-up, we included healthy women without (n = 26) as well as with (n = 21) an earlier TMD history. Both groups were randomly divided into true and placebo interference groups. Artificial interferences were introduced in the true interference groups and simulated in the placebo groups. The subjects were followed for 2 weeks, after which the interferences were removed. The subjects without a TMD history showed fairly good adaptation to the interferences, but the subjects with a TMD history and true interferences showed a significant increase in clinical signs compared to the other groups. We suggest that the etiological role of occlusal interferences in TMD may not have been correctly addressed in previous studies with artificial interferences and allow no conclusions as regards TMD etiology.

Subjective reactions to intervention with artificial interferences in subjects with and without a history of temporomandibular disorders.

In a previous double-blind randomized controlled study, subjects with a history of temporomandibular disorder (TMD) reacted to artificial interference with more signs of TMD than did subjects with no TMD history. In the present study, we analysed the subjective reactions of these individuals on several symptom scales. Every day during the 2-week follow-up period, the subjects rated the intensity of their symptoms on 9 VAS scales (occlusal discomfort, chewing difficulties, tender teeth, fatigue in the jaws, headache, facial pain, opening difficulty, bruxism, ear symptoms). Subjects with a history of TMD and true interferences reported stronger symptoms than subjects with no TMD history and placebo interferences. The most prominent symptoms were occlusal discomfort and chewing difficulties. The difference in outcome between the groups with and without a TMD history suggests that there are individual differences in vulnerability to occlusal interferences. It is likely that the etiological role of occlusal interferences in TMD has not been correctly addressed in previous studies on artificial interferences.

Psychological factors and responses to artificial interferences in subjects with and without a history of temporomandibular disorders

Objective. It has often been suggested that psychological factors play a role in temporomandibular disorders (TMD). However, reports on psychological factors in TMD patients and controls have been equivocal. In a previous double-blind randomized controlled study, subjects with a TMD history showed more clinical signs and subjective symptoms and adapted less well to the artificial interferences than subjects without an earlier TMD history. In the present study, we analyzed the associations of psychological factors with symptom responses and adaptation to interferences. Material and Methods. Before the intervention, the subjects filled in questionnaires dealing with personality traits, level of psychological and somatic stress symptoms, coping strategies, and health beliefs. Every day during the 2-week follow-up period, the subjects rated the intensity of their symptoms on 9 modified visual analog scales (VAS). Results. Health hardiness, positive socialization history and inhibition of aggression were associated with weaker symptom responses and better adaptation to true artificial interferences. Some personality characteristics in subjects with an earlier TMD history tended to associate with higher symptom reporting despite the type of intervention. Conclusions. Psychological factors appeared significant for the symptom responses to artificial interferences, and they seem to play a different role in responses in subjects with an earlier TMD history compared to those without.

Volumes of the caudate nuclei in women with somatization disorder and healthy women

Very little is known about the pathophysiology of somatization disorder. This study was designed to analyze the volumes of some brain structures possibly involved in somatization based on the observation of glucose metabolism of the brain in these patients. We studied 10 female patients with a diagnosis of somatization disorder or undifferentiated somatoform disorder with no comorbid current DSM-IV Axis I disorder and compared them to 16 healthy female volunteers using brain MRI (1.5 T instrument). The patients had bilateral enlargement of caudate nuclei volumes compared with healthy volunteers. These volume differences in the caudate nuclei could be associated with the pathophysiology of somatization.

Cognitive functioning in severe somatization – a pilot study

Objective:  Somatizing patients often report cognitive complaints but neuropsychological research on somatization is scarce. We investigated somatizing patients for functioning in different cognitive domains.

Severe somatization in women is associated with altered cerebral glucose metabolism.

BACKGROUND Somatization is a clinical phenomenon characterized by multiple, medically unexplained somatic symptoms. The pathophysiology remains unknown. We aimed to test the hypothesis of a central nervous system dysfunction in the pathophysiology of this disorder. METHOD We studied 10 female patients diagnosed as having somatization disorder or undifferentiated somatoform disorder with no current Axis I disorders according to DSM-IV. They were compared with 17 healthy female volunteers using brain [18F]-fluorodeoxyglucose-PET with MRI reference. RESULTS The patients had lower cerebral metabolism rates of glucose (P<0.05) in both caudate nuclei, left putamen and right precentral gyrus compared with healthy volunteers. CONCLUSIONS This is the first study to demonstrate changes in brain metabolism in somatizing women. The regional cerebral hypometabolism is probably associated with the pathophysiology of somatization.

Fluctuation of treatment need for temporomandibular disorders and age, gender, stress, and diagnostic subgroup

Associations between fluctuation of treatment need for temporomandibular disorders (TMD) and age, gender, stress, and diagnostic subgrouping were analyzed in a 2-year follow-up of 391 subjects. All the studied factors were significantly associated with the treatment need for TMD at all examinations. The diagnostic subgroup (TMD arthro, TMD myo, TMD comb, or non-classified) at base line was significantly associated with the fluctuation of the treatment need for TMD also during the follow-up, but age, gender, and stress score were not. In the subgroup needing active treatment for TMD at least once during the follow-up (n = 65), the stress score did not show statistically significant covariation with the treatment need. The diagnostic subgrouping of these 65 subjects at the second and third examination at 12-month intervals did not show any association with the subgrouping at base line or with any studied variable. Detailed descriptive diagnostics may serve well in treatment planning but do not necessarily help us in understanding the nature of TMD.

Brain glucose metabolism and temperament in relation to severe somatization

Abstract  Little is known about the pathophysiology of somatization. The authors’ aim was to explore associated factors with somatoform disorders. The authors studied 10 female patients with a diagnosis of somatization disorder or undifferentiated somatoform disorder with no comorbid current Diagnostic and Statistical Manual of Mental Disorders (4th edn) Axis I disorder and 12 healthy female volunteers. The predicting variables were temperament factors of the 240‐item Temperament and Character Inventory instrument and regional brain glucose metabolism. Low novelty‐seeking and high harm avoidance temperament traits and low caudate and low putamen glucose metabolism were statistically significantly associated with severe somatization (P < 0.05). In the present study, severe somatization associates with both altered brain glucose metabolism and temperament factors. No other studies on association of somatization with brain glucose metabolism and temperament have been published. The results are still considered exploratory due to the small number of subjects.

Adolescent loneliness and social anxiety as predictors of bullying victimisation

Abstract This study examined the relationships between social loneliness, emotional loneliness, social anxiety and peer victimisation among 390 seventh- through ninth-grade secondary students. Data were collected in the fall and spring of the school year. Path analyses revealed that feelings of loneliness (both social and emotional) increased adolescents’ peer victimisation experiences, however social loneliness was associated with higher levels of peer victimisation than emotional loneliness in seventh and eighth grade. Early experiences of social anxiety significantly predicted bullying victimisation. Implications for research and intervention programmes are discussed.