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Publications (10 of 16) Show all publications
Wänman, A. & Marklund, S. (2019). Treatment outcome of supervised exercise, home exercise and bite splint therapy, respectively, in patients with symptomatic disc displacement with reduction: A randomised clinical trial. Journal of Oral Rehabilitation
Open this publication in new window or tab >>Treatment outcome of supervised exercise, home exercise and bite splint therapy, respectively, in patients with symptomatic disc displacement with reduction: A randomised clinical trial
2019 (English)In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842Article in journal (Refereed) Epub ahead of print
Abstract [en]

The best treatment strategy for disturbing temporomandibular clicking sounds is not known. The aim was to evaluate the effect of exercise and bite splint therapy, respectively, in patients with symptomatic disc displacement with reduction. The study was a randomised clinical trial of subjects with temporomandibular joint (TMJ) clicking sounds with a reported severity/intensity of >= 4 on a numerical rating scale (0-10) and signs fulfilling the Research Diagnostic Criteria (RDC/TMD) for disc displacement with reduction. Thirty subjects each were randomised to bite splint, home exercise, or supervised exercise programme at the clinic. Two examiners (authors), blinded to the treatment modality, examined the same subject at baseline and at a 3-month follow-up. Non-parametric statistical methods were applied for analyses. A P-value <.05 was considered statistically significant. The dropout rate was highest in the home exercise group. About 50% of the participants reported improvement of their TMJ sounds with no significant difference between treatments. In the supervised exercise and the bite splint groups, approximately 2/3 of the patients reported 30% or more improvement of their TMJ sounds and half reported 50% improvement or more. The supervised exercise group also showed reductions in TMD pain, neck disability, mood disturbances and somatisation. Jaw exercise programmes and bite splint treatments had positive effects on TMJ clicking. The supervised exercise programme had an additional effect on the subject's well-being and thus may help to encourage patient's empowerment and coping strategies.

Keywords
home care, motor activity, oral appliance, temporomandibular disorders, temporomandibular joint dysfunction
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-164950 (URN)10.1111/joor.12888 (DOI)000488282900001 ()31520538 (PubMedID)
Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-14
Marklund, S., Storm Mienna, C., Wahlström, J., Englund, E. & Wiesinger, B. (2019). Work ability and productivity among dentists: associations with musculoskeletal pain, stress, and sleep. International Archives of Occupational and Environmental Health
Open this publication in new window or tab >>Work ability and productivity among dentists: associations with musculoskeletal pain, stress, and sleep
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2019 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose: Work ability can be measured by the work ability index (WAI), and work-related questions measuring productivity loss in terms of quality and quantity of work. Dentists have high occupational risk of musculoskeletal pain and the exposure of ergonomic strain is already high during dental education. The aim was to evaluate work ability and productivity among dentists, and to identify gender differences and associations with sleep, stress, and reported frequent pain.

Methods: The study population comprised 187 dentists (123 women and 64 men) who had been working as dentists between 5 and 12 years. Participants completed a questionnaire regarding sleep, stress, presence of pain at different sites, work ability assessed by WAI, and productivity in terms of quality and quantity of work.

Results: Poor sleep quality and high level of stress were reported by 31% and 48.1% of participants, respectively, with no gender differences and no association with age. The prevalence of frequent pain ranged 6.4–46.5% with shoulders being the most prevalent site. Thirty-three percent reported reduced work ability. Poor sleep, high amount of stress, and multi-site pain were associated with decreased work ability.

Conclusions: A high prevalence of pain was shown among dentists. Decreased work ability in terms of productivity loss was associated with poor sleep quality, high amount of stress, and multi-site pain. Preventive actions at the workplace should promote good musculoskeletal health, and measures taken, both individual and organizational, to minimize the risk of high, persistent stress and work-related pain.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Dentist, Pain, Productivity, Sleep, Stress, Work ability
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-164959 (URN)10.1007/s00420-019-01478-5 (DOI)000492568400001 ()31654126 (PubMedID)
Funder
Västerbotten County Council
Available from: 2019-11-06 Created: 2019-11-06 Last updated: 2019-11-19
Lövgren, A., Marklund, S., Visscher, C., Lobbezoo, F., Häggman-Henrikson, B. & Wänman, A. (2017). Outcome of three screening questions for temporomandibular disorders (3Q/TMD) on clinical decision-making. Journal of Oral Rehabilitation, 44(8), 573-579
Open this publication in new window or tab >>Outcome of three screening questions for temporomandibular disorders (3Q/TMD) on clinical decision-making
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2017 (English)In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 44, no 8, p. 573-579Article in journal (Refereed) Published
Abstract [en]

Patients with temporomandibular disorders (TMD) seem to go undetected and not adequately managed within dentistry. To identify these patients, three screening questions (3Q/TMD) have been introduced within dentistry in parts of Sweden. It is not known whether 3Q/TMD affects the clinical decision-making for these patients. The aim of this study was to evaluate the outcome of 3Q/TMD on the clinical decision-making and to analyse whether gender, age and the fee system the individual was assigned to were related to prescribed TMD treatment. This cohort study was carried out within the Public Dental Health service in Vasterbotten, Sweden. As part of the routine dental check-up, a health declaration including 3Q/TMD was completed. The study population was randomly selected based on their 3Q/TMD answers. In total, 300 individuals with an affirmative answer to any of the 3Q/TMD, and 500 individuals with all negative answers were selected. The 3Q/TMD includes questions on weekly jaw-face-temple pain (Q1), pain on function (Q2) and catching/locking of the jaw (Q3). The 3Q/TMD was analysed in relation to prescribed treatment assessed from dental records. There was significantly more treatment performed or recommended for 3Q-positives (215%), compared to 3Q-negatives (22%) (P < 0001). The odds ratio for TMD-related treatment for 3Q-positives versus 3Q-negatives was 121 (95% CI: 63-234). Although affirmative answers to the 3Q/TMD was related to TMD treatment, the majority of individuals with a screen positive still did not, according to dental records, receive assessment or treatment. Further studies are needed to better understand the clinical decision-making process for patients with TMD.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Temporomandibular Joint Disorders, Facial Pain, Public health dentistry, Decision-making, Clinical Decision Support systems, Health services research
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-133996 (URN)10.1111/joor.12518 (DOI)000405237900001 ()28452123 (PubMedID)
Note

Originally published in manuscript form with title: Outcome of three screening questions for temporomandibular disorders (3Q/TMD) on clinical decision-making : Clinical decision making for TMD

Available from: 2017-04-25 Created: 2017-04-25 Last updated: 2018-06-09Bibliographically approved
Häggman-Henrikson, B., Lampa, E., Marklund, S. & Wänman, A. (2016). Pain and Disability in the Jaw and Neck Region following Whiplash Trauma. Journal of Dental Research, 95(10), 1155-1160
Open this publication in new window or tab >>Pain and Disability in the Jaw and Neck Region following Whiplash Trauma
2016 (English)In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 95, no 10, p. 1155-1160Article in journal (Refereed) Published
Abstract [en]

The relationship between whiplash trauma and chronic orofacial pain is unclear, especially with regard to the time elapsed from trauma to development of orofacial pain. The aim was to analyze prevalence of jaw pain and disability, as well as the relationship between pain and disability in the jaw and neck regions in the early nonchronic stage after whiplash trauma. In this case-control study, 70 individuals (40 women, 30 men, mean age 35.5 y) who visited an emergency department with neck pain following a car accident were examined within 3 wk of trauma (group 1) and compared with 70 individuals (42 women, 28 men, mean age 33.8 y), who declined to attend a clinical examination but agreed to fill in questionnaires (group 2). The 2 case groups were compared with a matched control group of 70 individuals (42 women, 28 men, mean age 37.6 y) without a history of neck trauma. All participants completed questionnaires regarding jaw pain and dysfunction, rating pain intensity in jaw and neck regions on the Numerical Rating Scale, the Neck Disability Index, and Jaw Disability Checklist. Compared with controls, individuals with a recent whiplash trauma reported more jaw pain and dysfunction. Furthermore, there was a moderate positive correlation between jaw and neck pain ratings for group 1 (r = 0.61, P < 0.0001) and group 2 (r = 0.59, P < 0.0001). In the logistic regression analysis, cases showed higher odds ratios (range, 6.1 to 40.8) for jaw and neck pain and disability compared with controls. Taken together, the results show that individuals with a recent whiplash trauma report more jaw pain and disability compared with controls without a history of neck trauma. Furthermore, the correlation between jaw and neck pain intensity implies that intensity of neck pain in the acute stage after whiplash trauma might be a possible risk factor also for development of chronic orofacial pain.

Keywords
myofascial pain, neurophysiology, neuroscience/neurobiology, orofacial pain/TMD, risk factor(s), mporomandibular disorders/TMD
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-126320 (URN)10.1177/0022034516653598 (DOI)000382310400011 ()27307051 (PubMedID)
Available from: 2016-11-02 Created: 2016-10-03 Last updated: 2018-11-08Bibliographically approved
Lövgren, A., Häggman-Henrikson, B., Visscher, C. M., Lobbezoo, F., Marklund, S. & Wänman, A. (2016). Temporomandibular pain and jaw dysfunction at different ages covering the lifespan - A population based study. European Journal of Pain, 20(4), 532-540
Open this publication in new window or tab >>Temporomandibular pain and jaw dysfunction at different ages covering the lifespan - A population based study
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2016 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 20, no 4, p. 532-540Article in journal (Refereed) Published
Abstract [en]

Background

Temporomandibular pain and jaw dysfunction can have a negative effect on daily life, but these conditions are not well recognized in the health care systems. The general aim was to examine the cross-sectional prevalence of frequent temporomandibular pain and jaw dysfunction in men and women across the lifespan.

Methods

The analysis was based on data from 137,718 individuals (mean age 35years, SD 22.7) who answered three questions (3Q/TMD) included in the digital health declaration in the Public Dental Health care in the county of Vasterbotten, Sweden; Q1: Do you have pain in your temple, face, jaw or jaw joint once a week or more?'; Q2: Does it hurt once a week or more when you open your mouth or chew?'; and Q3: Does your jaw lock or become stuck once a week or more?'

Results

The prevalence of frequent temporomandibular pain (Q1) was 5.2% among women and 1.8% among men (p<0.0001). The prevalence of frequent pain on jaw movement (Q2) was 2.5% among women and 0.9% among men (p<0.0001). The prevalence of frequent locking of the jaw (Q3) was 2.7% among women and 1.2% among men (p<0.0001).

Conclusions

The study shows that the cross-sectional prevalence of temporomandibular pain and jaw dysfunction varies during the lifespan. For men and women, respectively, symptoms increase during adolescence, peak in middle age and then gradually diminish. The prevalence of these symptoms is significantly higher among women except from the first and last decades of a 100-year lifespan.

National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-119269 (URN)10.1002/ejp.755 (DOI)000372516800005 ()26311138 (PubMedID)
Available from: 2016-06-02 Created: 2016-04-15 Last updated: 2018-06-07Bibliographically approved
Lövgren, A., Visscher, C. M., Häggman-Henrikson, B., Lobbezoo, F., Marklund, S. & Wänman, A. (2016). Validity of three screening questions (3Q/TMD) in relation to the DC/TMD. Journal of Oral Rehabilitation, 43(10), 729-736
Open this publication in new window or tab >>Validity of three screening questions (3Q/TMD) in relation to the DC/TMD
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2016 (English)In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 43, no 10, p. 729-736Article in journal (Refereed) Published
Abstract [en]

Temporomandibular disorders (TMD) are common but seem to be largely undetected within general dental care. To improve dentists' awareness of these symptoms, three screening questions (3Q/TMD) have been introduced. Our aim was to validate 3Q/TMD in relation to the diagnostic criteria for TMD (DC/TMD), while taking into account the severity level of the symptoms. The study population consisted of 7831 individuals 20-69 years old, who had their routine dental check-up at the Public Dental Health Service in Västerbotten, Sweden. All patients answered a health declaration, including the 3Q/TMD regarding frequent temporomandibular pain, pain on movement and catching/locking of the jaw. All 3Q-positives (at least one affirmative) were invited for examination in randomised order. For each 3Q-positive, a matched 3Q-negative was invited. In total, 152 3Q-positives and 148 3Q-negatives participated. At examination, participants answered 3Q/TMD a second time, before they were examined and diagnosed according to DC/TMD. To determine symptom's severity, the Graded Chronic Pain Scale and Jaw Functional Limitation Scale-20 (JFLS-20) were used. In total, 74% of 3Q-positives and 16% of 3Q-negatives met the criteria for DC/TMD pain or dysfunction (disc displacements with reduction and degenerative joint disorder were excluded). Fifty-five per cent of 3Q-positives had a TMD diagnosis and CPI score ≥3 or a JFLS-20 score ≥5, compared to 4% of 3Q-negatives. The results show that the 3Q/TMD is an applicable, cost-effective and valid tool for screening a general adult population to recognise patients in need of further TMD examination and management.

National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-127275 (URN)10.1111/joor.12428 (DOI)000383570000001 ()27573533 (PubMedID)
Available from: 2016-11-04 Created: 2016-11-04 Last updated: 2018-06-09Bibliographically approved
Marklund, S., Häggman-Henrikson, B. & Wänman, A. (2014). Risk factors associated with incidence and persistence of frequent headaches. Acta Odontologica Scandinavica, 72(8), 788-794
Open this publication in new window or tab >>Risk factors associated with incidence and persistence of frequent headaches
2014 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 8, p. 788-794Article in journal (Refereed) Published
Abstract [en]

Abstract Objective. Headaches represent a significant public health problem, but the knowledge of factors specifically related to incidence and persistence of headaches is still limited. The aim of this study was to evaluate whether gender, self-reported bruxism and variations in the dental occlusion contribute to onset and persistence of frequent headaches. Materials and methods. The study population comprised 280 dental students, examined annually in a 2-year prospective study with a questionnaire and a clinical examination of the jaw function. In the analysis subjects were dichotomized into cases with frequent (once a week or more) or without frequent headaches (controls). The 2-year cumulative incidence was based on subjects without frequent headaches at baseline. Cases with 2-year persistent headaches reported such symptoms at all three examinations. Self-reported bruxism and factors in the dental occlusion at baseline were used as independent variables in logistic regression analyses. Results. The 2-year cumulative incidence of frequent headaches was 21%. Female gender (OR = 2.6; CI = 1.3-5.4), self-reported bruxism (OR = 2.3; CI = 1.2-4.4) and mandibular instability in intercuspal position (OR = 3.2; CI = 1.4-7.5) were associated with incidence of frequent headaches. Persistent headaches during the observation period were present in 12 individuals (4%) and significantly related to mandibular instability in intercuspal position (OR = 6.1; CI = 1.6-22.6). Conclusions. The results indicate that female gender, self-reported bruxism and mandibular instability in intercuspal position are of importance in the development of frequent headaches. In management of these patients a multidisciplinary approach including dentists may be important and, thus, advocated.

Place, publisher, year, edition, pages
Informa Healthcare, 2014
National Category
Dentistry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-94535 (URN)10.3109/00016357.2014.906652 (DOI)000344330400032 ()24702010 (PubMedID)
Available from: 2014-10-13 Created: 2014-10-13 Last updated: 2018-06-07Bibliographically approved
Marklund, S., Wiesinger, B. & Wänman, A. (2010). Reciprocal influence on the incidence of symptoms in trigeminally and spinally innervated areas. European Journal of Pain, 14(4), 366-371
Open this publication in new window or tab >>Reciprocal influence on the incidence of symptoms in trigeminally and spinally innervated areas
2010 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 14, no 4, p. 366-371Article in journal (Refereed) Published
Abstract [en]

Temporomandibular disorders (TMD), headaches, and spinal pain show co-morbidity and may therefore influence each other. The hypothesis tested is that the presence of any of these conditions will increase the risk of onset of new symptoms within a 2-year period. The study population comprised 280 dental students, who were examined three times at 12-month intervals. The incidence was calculated for a 2-year period, based on subjects without the defined symptom at baseline. Each participant was classified into five different case-control groups, representing incidence cases or no incidence (controls) of: (1) nonpain TMD symptoms; (2) jaw pain; (3) headaches; (4) spinal pain; and (5) TMD pain. Presence of headaches and of spinal pain and signs and symptoms of TMD at baseline were used as independent variables in logistic regression analyses, controlling for age and sex. Incidence cases with TMD pain reported spinal pain at baseline significantly more often than the controls, and were mostly women. Incidence cases with headaches and incidence cases with jaw pain significantly more often had signs of TMD and reported spinal pain at baseline, compared to controls. Incidence cases with nonpain TMD symptoms or spinal pain significantly more often presented with signs of TMD at baseline. Our findings show that pain and dysfunction in trigeminally innervated areas and pain in spinally innervated areas mutually predict the onset of new symptoms in dental students, indicating common pathophysiological mechanisms and individual vulnerability. This may be of importance in risk assessment and treatment planning of individuals with musculoskeletal pain.

Place, publisher, year, edition, pages
John Wiley & Sons, 2010
Keywords
Incidence, Temporomandibular disorders, Headaches, Spinal pain, Reciprocal influence, Prospective cohort
National Category
Dentistry
Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-25688 (URN)10.1016/j.ejpain.2009.06.004 (DOI)000277881000006 ()
Available from: 2009-09-07 Created: 2009-08-28 Last updated: 2018-06-08Bibliographically approved
Marklund, S. & Wänman, A. (2010). Risk factors associated with incidence and persistence of signs and symptoms of temporomandibular disorders. Acta Odontologica Scandinavica, 68(5), 289-299
Open this publication in new window or tab >>Risk factors associated with incidence and persistence of signs and symptoms of temporomandibular disorders
2010 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 68, no 5, p. 289-299Article in journal (Refereed) Published
Abstract [en]

This 2-year prospective observational study indicated that self-reported bruxism and variations in dental occlusion were linked to the incidence and persistence of TMJ signs and symptoms to a higher extent than to myofascial pain.

Keywords
Dental occlusion, musculoskeletal disorders, myofascial pain, risk, temporomandibular joint
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-39527 (URN)10.3109/00016357.2010.494621 (DOI)000281512900006 ()20528485 (PubMedID)
Available from: 2011-01-31 Created: 2011-01-31 Last updated: 2018-06-08Bibliographically approved
Marklund, S. (2009). Temporomandibular disorders: incidence, course, and risk factors. (Doctoral dissertation). Umeå
Open this publication in new window or tab >>Temporomandibular disorders: incidence, course, and risk factors
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Käkfunktionsstörning : förlopp och riskfaktorer
Abstract [en]

Temporomandibular disorders (TMD) embrace pain and dysfunction in the temporomandibular joint (TMJ) and jaw muscles. TMD is a prevalent condition in the population and constitutes a significant health problem. Knowledge of factors influencing the onset and course of TMD is important in preventive care and development of treatment strategies as well as in clinical decision making. The aim of this thesis was to gain knowledge of whether variations in dental occlusion, bruxism, spinal pain and gender predicted the development and course of TMD.

The study population comprised 371 undergraduate dental students. A questionnaire was used to obtain case histories. Clinical examination included the function of the TMJ, jaw muscles, maximal jaw mobility, the morphological occlusion, and contact patterns in centric and eccentric positions. The examinations were performed at start, and after 12 and 24 months. In total, 280 subjects were examined at all three occasions.

The incidence of TMJ pain and dysfunction was high among both males and females. The course composed onset, recovery and maintenance resulting in a fluctuating pattern. Females were more likely to have persistent TMJ pain and dysfunction than males. The incidence and persistence of jaw muscle signs and symptoms was high and significantly more common in females. A similar fluctuating pattern as for TMJ pain and dysfunction was found. Crossbite predicted onset and persistence of TMJ pain and dysfunction; mandibular instability in centric positions predicted persistent TMJ pain and dysfunction, as well as persistent jaw muscle signs or symptoms. Reported bruxism increased the risk for TMJ pain and dysfunction but did not significantly affect the course of jaw muscle signs and symptoms. Spinal pain at baseline predicted the onset of jaw pain, headaches, and TMD pain. Signs of TMD at baseline predicted the onset of non-pain symptoms of TMD, jaw pain, headaches, and spinal pain.

In conclusion, the results in this thesis show high incidence rates for TMD, headaches, and spinal pain among dental students. Crossbite, mandibular instability, reported bruxism, as well as female gender were identified as contributing risk factors. Spinal pain and TMD mutually predicted each other, indicating common pathophysiological mechanisms and individual vulnerability. The findings support a multidisciplinary approach, and it is recommended that the status and function of the jaw system be considered in patients with spinal pain.

Place, publisher, year, edition, pages
Umeå: , 2009. p. 68
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 108
Keywords
bruxism, dental occlusion, gender, headaches, longitudinal, myofascial pain, orofacial pain, prospective cohort, risk factors, spinal pain, temporomandibular joint
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-25689 (URN)978-91-7264-832-6 (ISBN)
Distributor:
Klinisk oral fysiologi, 901 87, Umeå
Public defence
2009-09-25, Sal B, By 1D, 9tr, Tandläkarhögskolan, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-09-07 Created: 2009-08-28 Last updated: 2018-06-08Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4443-6960

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