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Increasing gender differences in the prevalence and chronification of orofacial pain in the population
Umeå universitet, Medicinska fakulteten, Institutionen för odontologi. Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
Umeå universitet, Medicinska fakulteten, Institutionen för odontologi. Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden.
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2020 (Engelska)Ingår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 161, nr 8, s. 1768-1775Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Although a fluctuating pattern of orofacial pain across the life span has been proposed, data on its natural course is lacking. The longitudinal course of orofacial pain in the general population was evaluated using data from routine dental check-ups at all Public Dental Health services in Västerbotten, Sweden. In a large population sample, two screening questions were used to identify individuals with pain once a week or more in the orofacial area. Incidence and longitudinal course of orofacial pain were evaluated using annual data for 2010-2017. To evaluate predictors for orofacial pain remaining over time, individuals who reported pain on at least two consecutive dental check-ups were considered persistent. A generalized estimating equation model was used to analyze the prevalence, accounting for repeated observations on the same individuals. In total, 180,308 individuals (equal gender distribution) were examined in 525,707 dental check-ups. More women than men reported orofacial pain (OR 2.58, 95% CI 2.48-2.68), and there was a significant increase in the prevalence of reported pain from 2010 to 2017 in both women and men. Longitudinal data for 135,800 individuals were available for incidence analysis. Women were at higher risk of both developing orofacial pain (IRR 2.37; 95% CI 2.25-2.50) and reporting pain in consecutive check-ups (IRR 2.56, 95% CI 2.29-2.87). In the northern Swedish population studied, the prevalence of orofacial pain increases over time and more so in women, thus indicating increasing differences in gender for orofacial pain.

Ort, förlag, år, upplaga, sidor
Lippincott Williams & Wilkins, 2020. Vol. 161, nr 8, s. 1768-1775
Nyckelord [en]
Chronic pain, Facial pain, Gender, Orofacial pain, Temporomandibular disorders, Incidence, Prevalence
Nationell ämneskategori
Odontologi
Identifikatorer
URN: urn:nbn:se:umu:diva-169218DOI: 10.1097/j.pain.0000000000001872ISI: 000559753000011PubMedID: 32701837Scopus ID: 2-s2.0-85088530490OAI: oai:DiVA.org:umu-169218DiVA, id: diva2:1416919
Tillgänglig från: 2020-03-25 Skapad: 2020-03-25 Senast uppdaterad: 2023-03-23Bibliografiskt granskad
Ingår i avhandling
1. Exploring temporomandibular disorders: longitudinal and qualitative perspectives
Öppna denna publikation i ny flik eller fönster >>Exploring temporomandibular disorders: longitudinal and qualitative perspectives
2023 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[sv]
Smärta och funktionsstörning i käksystemet : longitudinellt och kvalitativt perspektiv
Abstract [en]

Background: Ideally, all clinical decision-making should enable care provision on the best available scientific evidence, clinical experience, and evaluated risks and benefits. Even though there are validated and evaluated decision tools for identification, diagnostics and treatment of temporomandibular disorders (TMD), patients with TMD still seem to go undetected, undiagnosed and undertreated in dentistry. Reasons for this discrepancy are unclear, but this clearly is a disadvantage for patients with TMD. Therefore, this project aimed to explore TMD in relation to the longitudinal course of the symptoms, dentists’ decision-making, and patients’ experiences.

Methods: The project was conducted at the Public Dental Health Services in the Region of Västerbotten, Northern Sweden. Data in the longitudinal studies were based on the screening instrument for TMD, the 3Q/TMD, and included self-reported orofacial pain and jaw dysfunction, specifically jaw catching/locking, from 2010 to 2017 (n=180,308; age 5-104). Descriptive statistics, generalized estimating equation models, and Poisson regression were used for analyses. Data included in the qualitative studies were the transcribed individual interviews with dentists (n=22, age 25-64) and patients (n=16, age 20-65). Analyses were based on the Grounded Theory and the Qualitative Context Analysis.

Results: The prevalence of orofacial pain increased over time (p<.01), but the prevalence of jaw catching/locking remained similar. The incidence, prevalence, and persistence of orofacial pain and jaw catching/locking were significantly higher in women than in men (p<.01). Women were at a higher risk for reporting both the first onset and the persistent orofacial pain (IRR 2.37; 95% CI, 2.25-2.50 and IRR 2.56; 95% CI, 2.28-2.87, respectively), and jaw catching/locking (IRR 2.29; 95% CI, 2.11-2.49 and IRR 2.32; 95% CI, 2.04-2.63, respectively) when compared to men. The onset of pain or jaw catching/locking was mostly independent and exclusive, i.e. without the other symptom (84.1%), and was higher for orofacial pain (64.9%) than for jaw catching/locking (19.2%). The decision-making process in the management of TMD was illustrated as an interplay between internal and external elements, where the dentists wished to apply professional knowledge but identified organizational obstacles and lack of self-confidence in their clinical decision-making for TMD. The patients expressed worry and social discomfort as a consequence of TMD. However, they strived to deal with the symptoms on their own as long as possible before seeking help. The challenges to access dental care and to receive suitable management were acknowledged. The right care at the right time was identified more like a wish than a current state of perceived TMD management.

Conclusions: The observed longitudinal patterns of orofacial pain and jaw dysfunction indicate increasing prevalence of orofacial pain together with substantial gender differences in TMD. The finding of independent onset of jawcatching/locking and orofacial pain reinforces that these two differ in the pathophysiology. The challenges in decision-making for patients with TMD and perceived suboptimal management of TMD symptoms are partly related to the structural organization of the Public Dental Health Services. Thus, careful review of the current organization is warranted since the treatment-need related to orofacial pain will probably increase.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2023. s. 74
Serie
Umeå University odontological dissertations, ISSN 0345-7532 ; 148
Nyckelord
cohort studies, decision-making, dental health services, dentistry, epidemiology, evidence-based dentistry, facial pain, population health, qualitative studies, temporomandibular joint disorders, women
Nationell ämneskategori
Odontologi
Forskningsämne
odontologi
Identifikatorer
urn:nbn:se:umu:diva-202148 (URN)978-91-7855-950-3 (ISBN)978-91-7855-951-0 (ISBN)
Disputation
2023-02-03, Sal B, byggnad 1D, Norrlands universitetssjukhus, Umeå, 13:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2023-01-13 Skapad: 2023-01-09 Senast uppdaterad: 2023-01-10Bibliografiskt granskad

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