Sigvard Åkerman

Tomography as an aid to detect macroscopic changes of the temporomandibular joint An autopsy study of the aged

The aim of this study was to evaluate the possibility of detecting macroscopic changes of the temporomandibular joint with the aid of tomographic examination. Forty-four autopsy specimens were examined with corrected sagittal and frontal tomography. The tomograms were evaluated without comparative assessment of the macroscopic appearance. The diagnostic sensitivity, specificity, and predictive values were calculated. Diagnostic accuracy depends on the severity, extent, and localization of the macroscopic changes. All joints with severe and extensive macroscopic changes were identified on tomograms; two thirds of the joints with moderate changes were correctly diagnosed. Macroscopic changes of the condyle were more frequently detected than those of the temporal component. The specificity for single areas of the joints was higher than the sensitivity--that is, normal areas were more easily assessed than areas with changes.

Bilateral degenerative changes and deviation in form of temporomandibular joints An autopsy study of elderly individuals

The right and left temporomandibular joints were removed as blocks from the skulls of 22 individuals in the 60-89-year-old age group at autopsy. The skulls were examined to determine the number and position of teeth and dentures. The articular surfaces of the joints were examined macroscopically for topographical distribution and degree of degenerative changes and topographical distribution of deviation in form. Indices of degenerative changes and of deviation in form were proposed. Correlations were found between the right and left joints with respect to both indices for degenerative changes and deviation in form. The indices were also correlated with each other within the same joint. A sex difference was found for degenerative changes and deviation in form, with the most advanced changes in the joints of women. It was concluded that degenerative changes and deviation in form in this age group were correlated between right and left joints and within the same joint.

Macroscopic and microscopic appearance of radiologic findings in temporomandibular joints from elderly individuals: An autopsy study

Abstract The macroscopic and microscopic appearance of radiologic findings in 40 temporomandibular joints (TMJ) taken at autopsy from 20 elderly individuals was investigated. The radiologic signs of erosion and sclerosis were strongly associated with macroscopic articular surface destruction only on the condyle while the soft tissue lining was most often intact in areas with a sclerosis of the temporal component. Radiologic concavity, osteophyte, and flattening presented none or mild macroscopic changes. The microscopic appearance of erosion and cyst formation was characterized by the presence of a cell-rich fibrous and wellvascularized connective tissue. In 4 joints with fibrous ankylosis, an articular soft tissue lining was completely lacking. In areas with radiologic sclerosis, thickening of the cortical and subcortical bone was observed. Both erosions and sclerosis were found in most joints with anterior disc position or disc perforation. It was concluded that radiologic signs of erosion and sclerosis in the condyle are more reliable signs of joint disease than such changes in the temporal component.

Macroscopic and microscopic findings of areas with radiologic erosions in human temporomandibular joints

The aim was to describe the macroscopic and microscopic findings of areas with radiologic erosions in the human temporomandibular joint. An autopsy material of 40 human joints, removed as blocks, was examined with tomography, and an erosion was found in 37 areas. A macroscopic and a microscopic examination focused on the presence of the calcified cartilage zone (CCZ) was performed in these areas. In the condyle 13 of 14 areas with a radiologic erosion showed denudation of bone macroscopically. Microscopically, these areas were covered by a thin fibrocellular tissue, and the CCZ was absent. In the temporal component, only 1 of the 23 areas showed bone exposure macroscopically. Microscopically, the soft tissue in these areas varied in thickness. The CCZ was missing in 13 of the 23 areas, even in some areas that appeared normal macroscopically and were microscopically covered by intact soft tissue. Thus, in areas with a radiologic erosion the macroscopic and microscopic appearance differed between the condyle and the temporal component. The nature of the findings is discussed.

Intra-articular and skin surface temperature of the temporomandibular joint in patients with rheumatoid arthritis

Intra-articular and skin surface temperatures of the temporomandibular joint (TMJ) were investigated in 34 patients with rheumatoid arthritis (RA). History was taken, and a clinical examination of the stomatognathic system was performed. The intra-articular temperature measurement was made with a thermocouple inserted through a needle, and the skin surface measurement was made with a thermocouple lateral to the condylar pole. The intra-articular temperature was lower for 37% and higher for 30% of the patients, whereas skin surface temperature was lower for 18% and higher for 6%, compared with normal individuals. Intra-articular and skin surface temperatures were positively correlated, and the average difference between skin surface and intra-articular temperatures was 1.6 degrees C. The intra-articular temperature was most strongly and positively correlated to the number of joint regions affected by RA and negatively correlated to the number of tender masticatory muscles, whereas skin surface temperature was most strongly and positively correlated to room temperature and negatively correlated to the number of tender masticatory muscles. These results indicate that pain and tenderness of masticatory muscles in RA are associated with hypothermia of the TMJ.

Clinical and radiological findings in temporomandibular joints with disc perforation

Sixteen temporomandibular joints from 15 patients, reported to have disc perforation at arthrography, were studied. Pain from the TMJ region was reported by 11 patients. Clicking was found in 6 joints and crepitation in 6 joints. Nine patients displayed a deviation of the mandible at maximum mouth opening towards the affected side. The muscles of the affected side were tender on palpation more frequently than those on the contralateral side. The disc perforation was located in the posterior attachment in most joints. An anterior disc displacement was found in all joints except one, which exhibited a normal disc position. In 4 joints with an anterior disc displacement with reduction, the configuration of the discs varied, whereas in all 11 joints with an anterior disc displacement without reduction the disc was biconvex. In most joints, the condyle was located in a central position in the fossa in the intercuspal position and 13 joints were tomographically diagnosed as being osteoarthrotic. It is concluded that most joints with disc perforations are osteoarthrotic and the most severe clinical and radiological findings are associated with an anterior disc displacement without reduction.

Calcified cartilage zone and its dimensional relationship to the articular cartilage in the human temporomandibular joint of elderly individuals

The aim was to describe the appearance of the calcified cartilage zone (CCZ) and to determine its dimensional relationship to the articular cartilage thickness in the normal human temporomandibular joint. An autopsy material comprising 21 joints from 12 elderly individuals was examined microscopically. The appearance of the CCZ was examined, and the thickness of the CCZ and of the total articular cartilage was measured in 18 different positions in each joint. The CCZ was outlined by a flat or gently undulating tidemark and an irregular osteochondral junction. The cellularity of the CCZ varied extensively. The cells were numerous in the CCZ when the overlying articular cartilage displayed high cellularity. Statistical analysis of the measurements demonstrated a relationship (p < 0.001) between the thickness of the CCZ and of the articular cartilage. Our findings, both qualitative and quantitative, indicate a close relationship between the physiology of the CCZ and of the overlying articular cartilage.

Effect of dental amalgam restorations on the mercury content of nerve tissues

In an autopsy study in two men and an experimental study performed on three female beagles the mercury burden of nerve tissues was determined. Nerve tissues from the head and face region and from three peripheral nerves were analyzed for mercury content with the aid of atomic absorption spectroscopy. In the dogs dental amalgam restorations were placed so as to investigate the possible influence from the amalgam on the mercury content of the tissues under study. The mercury content in man and dogs differed widely from one nerve to another, with no apparent relation to the number, type, or location of tooth restorations.

Some anatomical factors of the upper compartment of the temporomandibular joint related to the disc position

Temporomandibular joint (TMJ) arthrograms of 20 joints with superior disc position (SDP), 20 joints with anterior disc displacement with reduction (ADDWR), and 20 joints with anterior disc displacement without reduction (ADDWOR) were compared. The distance from the insertion of the posterior disc attachment of the upper joint compartment to the top of the mandibular fossa in joints with ADDWR was significantly longer than in joints with SDP and ADDWOR (p = 0.003). The distance from the top of the mandibular fossa to the top of the articular eminence in joints with ADDWR was significantly shorter than in joints with ADDWOR (p = 0.006). The entire distance of the upper joint compartment in joints with ADDWR was significantly longer than in joints with SDP and ADDWOR (p = 0.02).

Dental politics and subsidy systems for adults in Sweden from 1974 until 2016

Aims:The dental health sector, as part of the Swedish welfare system, originated in 1974. Since then, the dental insurance has undergone three major changes. The aim of this archive study was to study where in the legislative process the dental politics concerning national dental insurance and subsidies were formed.Materials and Methods:The material, such as Commission of inquiry proposals and Government Bills from four major dental reforms, was collected from the library at the Sveriges Riksdag (Swedish Parliament) and was analysed and structured using a modified version of the Health Field Model.Results:The views on the fundamental ideas, such as the connection between general and dental health, preventive dentistry, rehabilitation of the mouth and promotion of dental health, were the same over the years. The views on dentistry as a market, when it comes to freedom of prices, have undergone a major change since 1974, but the view on the welfare state remains the same.Conclusions:The Swedish dental subsidy systems and how dentistry has been treated politically are the results of a chain of events ranging from care for the populations dental health, political doctrines, ‘zeitgeist‚, dental policy, to state finances.