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On temporomandibular disorders: Time trends, associated factors, treatment need and treatment outcome
Jönköping University, School of Health and Welfare, HHJ. Oral health.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

During the last few decades, and especially during the 1990s, an increase in musculoskeletal pain conditions and stress-related ill-health has been observed in Sweden. At the same time, an improvement in the oral health of the population has been noted. The overall aim of this thesis was to acquire knowledge relating to possible time trends for the presence of temporomandibular disorders (TMD) in the population. A further objective was to study factors that possibly influence the presence of these disorders and the outcome of their treatment.

Studies I–III are based on a series of repeated cross-sectional population-based investigations. Three independent samples of 130 individuals in the age groups of 3, 5, 10, 15, 20, 30, 40, 50, 60 and 70 years were randomly selected from the inhabitants of the city of Jonkoping, Sweden in 1983, 1993 and 2003. The total participation rate was 21%, 22% and 29% respectively. The participants were examined using a questionnaire, interview and a clinical examination of the stomatognathic system regarding the presence of symptoms and signs indicative of TMD. Study IV is a retrospective survey of a clinical sample of patients referred to and treated at the Department of Stomatognathic Physiology, The Institute for Postgraduate Dental Education, Jonkoping, in 1995–2002. The overall frequencies of symptoms and the rates for some clinical signs and consequently of an estimated treatment need in adults increased during the study period. In 2003, the prevalence of frequent headache in 20-year-olds, mainly females, had markedly increased. The reports of bruxism among adults increased from 1983 to 2003. Awareness of bruxism and self-perceived health impairment were associated with TMD symptoms and signs. A favourable treatment outcome was observed for the majority of patients with common TMD sub-diagnoses and no strong predictors of treatment outcome were found.

In conclusion, the results suggest some time trends towards an increased prevalence in the overall symptoms and some signs indicative of TMD in the Swedish adult population during the time period 1983–2003. A profound understanding of the social determinants of health is recommended when planning public health resources.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences , 2012. , 120 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 38
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-19842ISBN: 978-91-85835-37-9 (print)OAI: oai:DiVA.org:hj-19842DiVA: diva2:570193
Public defence
2012-12-14, Forum Humanum, HHJ (School of Health Sciences), 13:00
Opponent
Supervisors
Available from: 2012-11-26 Created: 2012-11-16 Last updated: 2015-08-26Bibliographically approved
List of papers
1. Prevalence of symptoms and signs indicative of temporomandibular disorders in children and adolescents: A cross-sectional epidemiological investigation covering two decades
Open this publication in new window or tab >>Prevalence of symptoms and signs indicative of temporomandibular disorders in children and adolescents: A cross-sectional epidemiological investigation covering two decades
2009 (English)In: European Archives of Paediatric Dentistry, ISSN 1818-6300, Vol. 10, no Suppl. 1, 16-25 p.Article in journal (Refereed) Published
Abstract [en]

AIM: These were to 1) estimate the prevalence of subjective symptoms and clinical signs of temporomandibular disorders (TMD) in children and adolescents in the city of Jönköping, Sweden, 2) follow possible variations in TMD signs and symptoms over a 20-year period, and 3) study possible associations between TMD symptoms and signs and factors of interest. DESIGN: About 100 individuals in the age groups of 3, 5, 10 and 15 years participated in crosssectional stratified epidemiological investigations in 1983, 1993 and 2003. METHODS: All participants were asked to fill in a questionnaire including questions on general and oral health, dental care habits and some sociodemographic issues. More specific questions recorded the presence or absence of subjective symptoms: tiredness in the jaws on awakening or during chewing; clicking sounds or crepitations from the temporomandibular joints (TMJs); locking/ catching of the mandible; luxation of the mandible; reduced jaw movement capacity; pain during jaw movements; other pain conditions in the jaws or in the TMJ regions. Subjects were examined clinically at each time period for; jaw mobility (maximum jaw opening including vertical overbite, maximum laterotrusion to the right and to the left, maximum protrusion); TMJ function (normal function, deflection on jaw opening of > 2 mm, TMJ clicking or crepitations, TMJ locking, TMJ luxation); pain on jaw movement (no pain on movements, pain on one movement, pain on more than one movement); muscle pain (no muscle pain, pain on palpation in 1-3 sites, pain on palpation in > 3 sites); TMJ pain (no joint pain, pain on lateral palpation of one or both joints, pain on posterior palpation of one or both joints). No functional examination of the masticatory system was performed in children aged 3 and 5 years. RESULTS: TMD-related symptoms were very rare in 3- and 5-year-olds. In the age groups of 10- and 15-yearolds, 5-9% of the participants reported more severe symptoms, up to 50% showed one or more TMD signs, while it was estimated that 1-2% were in need of TMD treatment. Several symptoms and signs increased with age. No gender differences, with the exception of recurrent headache, were noted. Oral parafunctions were reported by 11-47%. Apart from a few variables, no statistically significant changes in the prevalence of TMD symptoms and signs were observed over the 20-year period. Clenching/grinding of teeth and general health factors were found to be associated with TMD symptoms and signs. CONCLUSIONS: The prevalence of more severe TMD symptoms and signs in children and adolescents was generally low in all three examinations and did not change significantly during the 20-year period. Increasing age, general health factors and oral parafunctions were associated with TMD symptoms and signs in 10- and 15-year-olds.

Keyword
TMD, treatment need, cross-sectional, parafunctions, headache
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-11294 (URN)19863894 (PubMedID)
Available from: 2010-01-13 Created: 2010-01-13 Last updated: 2012-11-26Bibliographically approved
2. Prevalence of symptoms indicative of temporomandibular disorders in adults: cross-sectional epidemiological investigations covering two decades
Open this publication in new window or tab >>Prevalence of symptoms indicative of temporomandibular disorders in adults: cross-sectional epidemiological investigations covering two decades
2012 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 70, no 3, 213-223 p.Article in journal (Refereed) Published
Abstract [en]

Objectives. The aims were (1) to study possible secular trends in the prevalence of temporomandibular disorder (TMD) symptoms in adults and (2) to analyse possible associations between TMD symptoms and background factors. Materials and methods. The investigation has a repeated cross-sectional design. Three independent, randomly selected samples of 100 individuals in the age groups of 20, 30, 40, 50, 60 and 70 years, a total of 1704 subjects, participated in the Jönköping studies in 1983, 1993 and 2003. All the subjects were evaluated using a questionnaire and a structured interview relating to the presence of TMD symptoms. Associations between symptoms and the Anamnestic Dysfunction Index (Ai) as dependent variables and each of the independent variables, age group, gender, reported bruxism, trauma (1983), self-perceived health impairment and the year of investigation were analysed in binary logistic regression models. Results. The prevalence of the separate symptoms, apart from for TMJ clicking, did not vary to any statistically significant degree between the different examination years. However, the prevalence of recurrent headache in 20-year-old subjects rose remarkably in 2003 and an increase in the Ai I and Ai II for the whole population was observed during the 20-year period. Reported bruxism, which increased during the study period, and self-perceived health impairment were associated with most of the TMD symptoms and the Ai. Conclusions. An increase in the prevalence of TMD symptoms expressed as Anamnestic Dysfunction Index I and II has been noted over a 20-year period.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-16986 (URN)10.3109/00016357.2011.634832 (DOI)22126531 (PubMedID)
Available from: 2012-01-02 Created: 2012-01-02 Last updated: 2017-12-08Bibliographically approved
3. Clinical signs indicative of temporomandibular disorders in adults: time trends and associated factors
Open this publication in new window or tab >>Clinical signs indicative of temporomandibular disorders in adults: time trends and associated factors
2013 (English)In: Swedish Dental Journal, ISSN 0347-9994, Vol. 37, no 1, 1-11 p.Article in journal (Refereed) Published
Abstract [en]

The study aimed to examine possible time trends in the prevalence of clinical signs indicative of temporomandibular disorder (TMD) in an adult population, to analyse possible associations between TMD signs and associated factors and to estimate the need for TMD treatment. Three independent, stratified and randomly selected samples of around 100 individuals in the age groups of 20, 30, 40, 50, 60 and 70 years participated in the Jönköping studies in 1983,1993 and 2003. The study material consisted of 1,693 subjects who, after answering a questionnaire and being interviewed about the presence of TMD symptoms, were clinically examined in terms of the presence of TMD signs according to the Clinical Dysfunction Index (Di) by Helkimo. Associations between clinical signs and the Di as dependent variables and each of the independent variables of age group, gender, reported bruxism, trauma, self-perceived healthiness and the year of investigation were analysed in binary logistic regression models. Estimates of the need for TMD treatment were based on the presence of a combination of severe symptoms and clinical signs. The prevalence of severely impaired jaw movement capacity, relating to horizontal movements, had increased in 2003. The prevalence of muscle pain and temporomandibular joint pain upon posterior palpation was found to vary statistically significantly between 1993 and 2003. Gender differences were noted in these changes overtime. Female gender, advancing age, awareness of bruxism, self-perceived health impairment and the wearing of complete dentures were associated with TMD signs and a higher degree of clinical dysfunction. The estimated need for TMD treatment increased from 5% in 1983 to 8% in 2003 and was higher in women than in men. In conclusion, the results indicate that the prevalence of some TMD signs and of estimated treatment need increased during the period 1983-2003.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-20955 (URN)23721032 (PubMedID)
Available from: 2013-04-18 Created: 2013-04-18 Last updated: 2017-12-06Bibliographically approved
4. Patients referred to a specialist clinic because of suspected temporomandibular disorders: a survey of 3194 patients in respect of diagnoses, treatments, and treatment outcome.
Open this publication in new window or tab >>Patients referred to a specialist clinic because of suspected temporomandibular disorders: a survey of 3194 patients in respect of diagnoses, treatments, and treatment outcome.
2004 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 62, no 4, 183-192 p.Article in journal (Refereed) Published
Abstract [en]

The aims were to study the patient population at a temporomandibular disorders (TMD) specialist clinic over time, and to try to find variables of importance for treatment outcome. The material consisted of 3194 consecutive patients who were referred to the clinic and underwent a clinical examination during the period 1995-2002. A number of patient and treatment-related variables that had been collected in an electronic database were analyzed retrospectively. The age and sex distribution of the present patient material was in line with several previous investigations of TMD patients. The mean age of both men and women was 42 years, and there was a large preponderance of women. A vast majority of the patients responded positively, and in few visits, on traditional conservative treatment methods. In line with previous studies, no strong predictors for treatment outcome were found. However, the diagnoses of disk displacement without reduction, arthritis in TMJs, and myalgia in masticatory muscles were predictors for a significant improvement, while the diagnosis orofacial pain of unspecified origin predicted a poorer prognosis.

Keyword
Adolescent, Adult, Aged, Aged; 80 and over, Chi-Square Distribution, Child, Dislocations/diagnosis/therapy, Facial Pain/etiology/therapy, Female, Humans, Logistic Models, Male, Middle Aged, Occlusal Splints, Physical Therapy Modalities, Prognosis, Questionnaires, Retrospective Studies, Temporomandibular Joint Disorders/*diagnosis/*therapy, Treatment Outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-4615 (URN)10.1080/00016350410001595 (DOI)15513414 (PubMedID)
Available from: 2007-11-20 Created: 2007-11-20 Last updated: 2017-12-12Bibliographically approved

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