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Temporomandibular disorders among Sami women: perspectives based on an epidemiological survey with mixed methods
Umeå University, Faculty of Medicine, Department of Odontology. (Arcum)
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction The aim of the research project was to examine prevalence, co-morbidity, and impact on daily life of pain and dysfunction in the jaw-face, head, and neck-shoulder regions among adult Sami women in northern Sweden. The aim of the qualitative part of the study was to explore, thoughts, experiences, and beliefs regarding temporomandibular disorders (TMD) among Sami women with and without TMD, to gain insights into their health care experiences.

Methods The research project used a mixed methods approach including questionnaire analysis, a case-control study, and thematic interviews. The study population (Papers I and III) included 487 women living in the Arctic region of northern Sweden and enrolled in the register of the Swedish Sami Parliament or registered as reindeer owners or reindeer herders in the Swedish Board of Agriculture. Two years after the questionnaire study, 22 women (cases) with longstanding, intense, and frequent symptoms indicative of TMD, together with 46 age-matched women (controls) without any symptoms in the jaw–face region, underwent a clinical examination of the function of the temporomandibular joint, jaw- and neck muscles, mandibular mobility, and dental occlusion. The examiner was blind to the women’s affiliation (Paper II). Thematic interviews with a strategic subsample of 17 Sami women (Paper IV) were thereafter conducted and analyzed with a grounded theory approach.

Results The prevalence of frequent symptoms indicative of TMD was 17%, of headaches 19%, and of neck-shoulder pain (NSP) 30%. Seventeen percent reported that their TMD affected daily life. Duration of jaw pain, troublesome impaired jaw opening, and neck pain, together with a low education level, affected the statement of whether TMD influenced daily life or not. Factors related to pain had the greatest influence when these Sami women rated the related impairment. There was a statistically significant relationship between TMD, frequent headaches, and frequent NSP (P <0.0001). Longstanding, intense, and frequent symptoms indicative of TMD remained essentially unchanged over the two-year follow-up period. Cases reported impaired general health and awareness of clenching teeth significantly more frequently than did controls. Variations in dental occlusion did not distinguish cases from controls. In the qualitative part of the project the core category, “Grin(d) and bear it,” summarizes the participants’ various ways and stages of processing and handling the interacting categories: (1) triggers, (2) strains, (3) distrust, and (4) reconciliation with pain and/or difficulties in life. Perpetuating factors were described as mental-physical strain and stress, and also a tooth clenching behavior. Women without TMD expressed factors that helped them to handle strains, reconcile, and stay healthy. They relied on helpful social support.

Conclusion Disabling TMD, headaches, and NSP are common in Sami women. Women with TMD commonly expressed that tooth clenching was a familiar habit related to strains in life; they described an impaired general state of health and distrust in the care providers’ competence and ability to manage their problems. Women without TMD expressed confidence in their self-efficacy and were generally less concerned with strains in their lives. Rehabilitation strategies aiming at empowerment and improved self-efficacy may be a successful approach in women with disabling TMD.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2014. , 83 p.
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 133
Keyword [en]
epidemiology, gender, headache, indigenous, pain, qualitative, quality of life, temporomandibular
National Category
Dentistry
Research subject
Odontology
Identifiers
URN: urn:nbn:se:umu:diva-92696ISBN: 978-91-7601-121-8 (print)OAI: oai:DiVA.org:umu-92696DiVA: diva2:745766
Public defence
2014-10-03, Sal B, byggnad 1D, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2014-09-12 Created: 2014-09-01 Last updated: 2016-08-18Bibliographically approved
List of papers
1. "Grin(d) and bear it": narratives from Sami women with and without temporomandibular disorders. A qualitative study.
Open this publication in new window or tab >>"Grin(d) and bear it": narratives from Sami women with and without temporomandibular disorders. A qualitative study.
2014 (English)In: Journal of oral & facial pain and headache, ISSN 2333-0384, Vol. 28, no 3, 243-251 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: To explore thoughts, experiences, and beliefs regarding temporomandibular disorders (TMD) among Sami women with and without TMD in order to gain insights into their health care experiences and to generate a hypothesis regarding factors associated with long-standing TMD.

METHODS: Qualitative thematic interviews were conducted with a strategic sample of 17 Sami women, of whom 10 had a TMD diagnosis according to the Research Diagnostic Criteria for TMD and 7 age-matched women who had no signs or symptoms of TMD. Their ages were between 23 and 58 years. The thematic interviews were audiotaped, transcribed verbatim, and analyzed based on Grounded Theory, a qualitative methodology aiming to generate hypotheses grounded in the gathered data.

RESULTS: The core category that evolved was "Grin(d) and bear it," which summarizes the Sami participants' various ways and stages of processing and handling the interacting categories (triggers, strains, distrust, and reconciliation with pain and/or difficulties in life). They described divergent as well as similar understandings of triggering factors. Maintaining factors were described as mental-physical strain and stress, and also a jaw-clenching behavior. Women without TMD contributed with factors that helped them to handle strains, reconcile, and stay healthy. They relied on strong social support.

CONCLUSION: Based on the analysis, the following hypothesis was generated: Women with TMD, associated headaches, and neck-shoulder pain may benefit from efforts aimed at empowering them to use their own abilities to reduce stress behavior, strain, and disuse of the jaw. Rehabilitation strategies in groups might increase their sense of coherence and increase social support, which seems to be more limited than in women with no symptoms of TMD.

Place, publisher, year, edition, pages
Quintessence publishing, 2014
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-91788 (URN)000340227800006 ()25068218 (PubMedID)
Available from: 2014-08-15 Created: 2014-08-15 Last updated: 2016-05-24Bibliographically approved
2. Self-reported impact on daily life activities related to temporomandibular disorders, headaches, and neck-shoulder pain among women in a Sami population living in Northern Sweden
Open this publication in new window or tab >>Self-reported impact on daily life activities related to temporomandibular disorders, headaches, and neck-shoulder pain among women in a Sami population living in Northern Sweden
2012 (English)In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 26, no 3, 215-224 p.Article in journal (Refereed) Published
Abstract [en]

Aims: To analyze the influence of frequency, intensity, and duration of temporomandibular disorders (TMD), headaches, and neck-shoulder pain (NSP) on Sami women's daily life. A further aim was to analyze the relationship between these symptoms and age.

Methods: All 751 Sami women 21 to 70 years old registered in either the Swedish Sami Parliament's electoral register or registered as reindeer owners or herders and living north of the Arctic Circle in Sweden were sent a questionnaire regarding TMD symptoms, NSP, and headaches. In total, 487 women (65%) participated. The questionnaire focused on symptom frequency, duration, and intensity and whether these symptoms influenced activities of daily life. The symptom's interference with daily life activities was measured, respectively, with a numerical rating scale (NRS). The statistical analyses included multiple logistic regression analysis and Chi-square test. A P value < .05 was considered statistically significant.

Results: Seventeen percent of the women reported that symptoms in the jaw-face region to some degree disturbed their daily life, and for 6%, the interference was significant (>= 5 on NRS). Duration of jaw pain, troublesome impaired jaw opening, and neck pain, together with a low education level, affected reports of whether symptoms of TMD influenced daily life. Almost half of the study population reported that headaches had a negative impact on their life. A similar pattern was reported for NSP. The prevalence of frequent and troublesome symptoms of TMD and headaches, but not NSP, showed a declining trend with age.

Conclusion: TMD symptoms, headaches, and NSP negatively influence many Sami women's daily life. Factors related to pain had the greatest influence when these Sami women rated the related impairment.

Place, publisher, year, edition, pages
Hanover Park, IL: Quintessence Publishing, 2012
Keyword
headache, oral health, pain, quality of life, temporomandibular disorders
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-58163 (URN)000306938800008 ()
Available from: 2012-08-28 Created: 2012-08-27 Last updated: 2017-12-07Bibliographically approved
3. A two-year follow-up study of temporomandibular disorders in a female Sami population: validation of cases and controls as predicted by questionnaire
Open this publication in new window or tab >>A two-year follow-up study of temporomandibular disorders in a female Sami population: validation of cases and controls as predicted by questionnaire
2007 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 65, no 6, 341-347 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The first aim of this study was to validate persistent, severe symptoms of temporomandibular disorders (TMD) among Sami females, as predicted by questionnaire. The second aim was to establish diagnoses according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis 1 among predicted cases and controls. The third aim was to compare subjects with severe TMD to controls in regard to dental occlusion, general health, and parafunctions.

MATERIAL AND METHODS: The subjects, Sami females living in the Arctic region of northern Sweden, all with long-standing (>or=1 year), intense (>or=5 on NS), and frequent (>or=once a week) symptoms of pain and dysfunction in the jaw-face region, were invited for clinical examination; 22 (63%) agreed to participate. Forty-six subjects with no symptoms in the jaw-face region were matched to these cases in accordance with five age groups. The examiner was blind to subject affiliation.

RESULTS: The positive predictive value of presenting with signs and symptoms of TMD at follow-up was 0.82; the negative value was 0.87. Cases reported impaired general health and awareness of parafunctions significantly more frequently than did controls. Registered dental occlusion factors did not distinguish cases from controls.

CONCLUSIONS: Long-standing, intense, and frequent TMD symptoms remained essentially unchanged over the 2-year follow-up of females in a Sami population. Presence of severe TMD was related to impaired general health and awareness of oral parafunctions.

Place, publisher, year, edition, pages
Informa Healthcare, 2007
Keyword
Females, pain, prospective, Sami, temporomandibular
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-20919 (URN)10.1080/00016350701742356 (DOI)000251547900006 ()18071955 (PubMedID)
Available from: 2009-03-30 Created: 2009-03-30 Last updated: 2017-12-13Bibliographically approved
4. Temporomandiular disorders, headaches, and cervical pain among females in a Sami population
Open this publication in new window or tab >>Temporomandiular disorders, headaches, and cervical pain among females in a Sami population
2006 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 64, no 5, 319-325 p.Article in journal (Refereed) Published
Abstract [en]

Objective. The aim of this study was to examine the prevalence and co-morbidity of long-standing, intense, and frequent symptoms of pain and dysfunction in the jaw-face, head, and cervical region among adult females drawn from the Sami population in northern Sweden.

Methods. A total of 487 females, taken from the register of the Swedish Sami Parliament or registered as reindeer owners or reindeer herders in the Swedish Board of Agriculture and living in the Arctic region of northern Sweden, participated in a questionnaire study.

Results. The prevalence of pain and/or dysfunction in the jaw-face region was 32%, of headaches 61%, and of pain in the cervical region 56%. When the criterion of frequent symptoms (once a week or more often) was used, prevalence dropped to 17%, 19%, and 30%, respectively, and when that of intense symptoms, defined as 5 or more on an 11-point numerical rating scale, was added, prevalence dropped further to 8%, 11%, and 20%, respectively. The majority reported long-standing symptoms (67-98% depending on symptom). A high statistically significant relationship was found between frequent symptoms of pain and/or dysfunction in the jaw-face, frequent headaches, and frequent cervical pain (p <0.0001).

Conclusions. Symptoms in the jaw-face, headaches, and cervical pain were frequently reported among a sample of Sami females living in the Swedish Arctic region. The prevalence of symptoms was strongly dependent on criteria of frequency and intensity.

Place, publisher, year, edition, pages
Informa Healthcare, 2006
Keyword
Cross-sectional, epidemiology, gender, masticatory, native
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-13578 (URN)10.1080/00016350600801915 (DOI)000240200900011 ()16945899 (PubMedID)
Available from: 2008-01-18 Created: 2008-01-18 Last updated: 2014-09-12Bibliographically approved

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