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  • 1.
    Engström, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Odontology, Clinical Oral Physiology.
    Johansson, Anders
    Keshishian, Patrik
    Forsberg, Mona
    Juvenile Arthritis and Development of Symptoms of Temporomandibular Disorders: A 15-year Prospective Cohort Study2007In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 21, no 2, p. 120-126Article in journal (Refereed)
    Abstract [en]

    To compare the development of symptoms of temporomandibular disorders (TMD) in a sample of patients with juvenile arthritis (JA) and a matched control sample.

    Methods: In 1986, 40 patients with JA (28 girls and 12 boys; mean age ± SD, 18 ± 4.5 years) and an ag- and sex-matched control sample were examined for signs and symptoms of TMD. Fifteen years later in 2001, a questionnaire concerning symptoms of TMD was sent to these subjects. Twenty-eight individuals (68%) in the JA sample (20 women and 8 men; mean age ± SD, 35 ± 5.2 years) and 26 controls (19 women and 7 men; 34 ± 4.0 years) were available for the follow-up.

    Results: The overall prevalence of symptoms of TMD increasead between the 2 examinations in both groups. The prevalence of reported TMD symptoms, such as jaw pain, fatigue in the jaws, and difficulty opening the jaws wide, as well as awareness of tooth clenching, headaches, neck and shoulder pains, was significantly greater among the JA sample than among the controls at the follow-up.

    Conclusion: The study indicates that prevalence of pain and dysfunction in the craniofacial or cervical regions of JA patients is increased more than 20 years after the onset of JA compared to healthy individuals.

  • 2.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Näsström, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Patients' perceived treatment need owing to temporomandibular disorders and perceptions of related treatment in dentistry: a mixed method study2019In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 46, no 9, p. 792-799Article in journal (Refereed)
    Abstract [en]

    Background: To easily identify patients who could benefit from a temporomandibular disorder (TMD) examination, three screening questions (3Q/TMD) have been introduced in large parts of Sweden. The questions are related to a TMD diagnosis. However, how the questions relate to a treatment need is unknown.

    Objectives: The first aim of the study was to identify predicting factors for perceived treatment need among adult individuals who screened positive to the 3Q/TMD. The second aim was to explore individuals' thoughts and experiences related to treatment of their TMD complaint.

    Methods: This mixed‐method study with a case‐control design was conducted in Västerbotten, Sweden, during 2014. Individuals who screened positive to at least one of the 3Q/TMD questions were allocated 3Q‐positives, whereas those with negative answers to all questions were allocated 3Q‐negatives. In total, 300 individuals (140 randomly selected 3Q‐positives, and 160 age‐ and gender‐matched 3Q‐negatives) were included. All individuals answered questions related to treatment need. The answers were analysed in a qualitative approach with qualitative content analysis.

    Results: In total, 81% of 3Q‐positives expressed a treatment need related to their TMD symptoms. The perceived treatment need was predicted by frequent pain (Q1) and frequent functional disturbances (Q3). Among the 3Q‐positives, 54% reported mistrust in dentists' ability to treat TMD symptoms. The informants expressed a need for information about their symptoms and possible treatment options.

    Conclusion: Affirmative answers to 3Q/TMD were associated with TMD treatment need. Dentists should give advice to patients with TMD symptoms and address their concerns.

  • 3. Forsberg, Hans
    et al.
    Sjödin, Lars
    Lundgren, Per
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Oral health in the adult population of Västerbotten, Sweden - a comparison between an epidemiological survery and data obtained from digital dental records2008In: Swedish Dental Journal: Oral health in the adult population of Västerbotten, Sweden - a comparison between an epidemiological survey and data obtained from digital records., Vol. 32, p. 17-25Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to analyse the possibilities and limitations of using data drawn from electronic dental patient records (EDPRs) in monitoring dental health among adults in a northern Swedish county. Material and Methods: The study population comprised all 35-, 50-, 65- and 75-year-old patients who were examined and, where required, received treatment at the Public Dental Service (PDS) in Västerbotten, Sweden, in 2003 and in 2004. In total 2,497 patients in 2003, and 2,546 patients in 2004 met the inclusion criteria. As controls, 779 subjects randomly drawn from the adult population in the same age groups and from the same county were used. They participated in an oral health survey and were examined clinically between October 2002 and March 2003. Results: When oral health was estimated based on EDPRs the prevalence of edentulous subject was significantly underestimated, while the mean numbers of teeth and the mean values of sound teeth were significantly overestimated. No statistically significant difference was found in prevalence of primary decayed tooth surfaces (DS). The prevalence of filled teeth (FT) was fairly similar between the study samples. Registrations of periodontal status were mainly missing in the EDPRs. Since registrations related to temporomandibular disorders are not included in the T4 system its prevalence could no be assessed and accordingly not compared with the epidemiological sample. Conclusion: The study shows that clinical registration based on EDPRs is at present not accurate enough to be used as indicators of oral health status among adults in a community.The objective of this study was to analyse the possibilities and limitations of using data drawn from electronic dental patient records (EDPRs) in monitoring dental health among adults in a northern Swedish county. Material and Methods: The study population comprised all 35-, 50-, 65- and 75-year-old patients who were examined and, where required, received treatment at the Public Dental Service (PDS) in Västerbotten, Sweden, in 2003 and in 2004. In total 2,497 patients in 2003, and 2,546 patients in 2004 met the inclusion criteria. As controls, 779 subjects randomly drawn from the adult population in the same age groups and from the same county were used. They participated in an oral health survey and were examined clinically between October 2002 and March 2003. Results: When oral health was estimated based on EDPRs the prevalence of edentulous subject was significantly underestimated, while the mean numbers of teeth and the mean values of sound teeth were significantly overestimated. No statistically significant difference was found in prevalence of primary decayed tooth surfaces (DS). The prevalence of filled teeth (FT) was fairly similar between the study samples. Registrations of periodontal status were mainly missing in the EDPRs. Since registrations related to temporomandibular disorders are not included in the T4 system its prevalence could no be assessed and accordingly not compared with the epidemiological sample. Conclusion: The study shows that clinical registration based on EDPRs is at present not accurate enough to be used as indicators of oral health status among adults in a community.

  • 4.
    Häggman-Henrikson, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden.
    Lampa, Ewa
    Umeå University, Faculty of Medicine, Department of Odontology.
    Marklund, Susanna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Pain and Disability in the Jaw and Neck Region following Whiplash Trauma2016In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 95, no 10, p. 1155-1160Article in journal (Refereed)
    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.

  • 5.
    Häggman-Henrikson, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial pain and Jaw function, Malmö University, Malmö, Sweden.
    Wiesinger, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Research and Development, Västernorrland County Council, Umeå University, Umeå, Sweden.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    The effect of supervised exercise on localized TMD pain and TMD pain associated with generalized pain2018In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, no 1, p. 6-12Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the effect of a supervised exercise program in patients with localized/regional temporomandibular disorder (TMD) pain and with TMD associated with generalized pain.

    Material and methods: Consecutively referred patients with localized/regional TMD pain (n = 56; 46 women and 10 men, mean age 44 years) and TMD associated with generalized pain (n = 21; 21 women, mean age 41 years) participated. Patients underwent a 10-session structured supervised exercise program over 10-20 weeks that included relaxation, and coordination and resistance training of the jaw and neck/shoulders. The outcomes were jaw pain intensity on the Numerical Rating Scale, endurance time for jaw opening and protrusion against resistance and chewing, and effect of pain on daily activities.

    Results: After the exercise program, a reduction in jaw pain was reported by the local (p = .001) and general (p = .011) pain groups. There were no significant differences in jaw pain intensity between the groups, before (p = .062) or after treatment (p =.121). Endurance time increased for both groups for jaw opening/protrusion (both p <. 001) and chewing (both p = .002). The effect of jaw pain on daily activities decreased after exercise compared to baseline for both the local (p < .001) and general (p = .008) pain groups.

    Conclusions: Supervised exercise can reduce TMD pain and increase capacity in patients with TMD. The results suggest that activation of the jaw motor system with exercise has a positive effect in patients with localized/regional TMD pain and TMD associated with generalized pain.

  • 6.
    Lampa, Ewa
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    List, Thomas
    Häggman-Henrikson, Birgitta
    Relationship Between Psychosocial Factors and Pain in the Jaw and Neck Regions Shortly After Whiplash Trauma2019In: Journal of Oral & Facial Pain and Headache, ISSN 2333-0384, Vol. 33, no 2, p. 213-219Article in journal (Refereed)
    Abstract [en]

    Aims: To assess jaw pain shortly after whiplash trauma in relation to neck pain, physical symptoms, depression, and jaw pain-related disability.

    Methods: A total of 181 cases (106 women and 75 men, mean ages 33.7 and 36.8 years, respectively) were examined within 1 month after a whiplash trauma and compared to 117 controls (68 women and 49 men, 34.2 and 30.9 years, respectively). Participants rated current jaw and neck pain intensity on a numeric rating scale and rated nonspecific physical symptoms and depression symptoms on subscales of the Symptom Checklist-90-Revised. The nonspecific physical symptoms were further analyzed with and without pain items. Disability related to jaw pain and neck pain was also assessed. Differences between groups were calculated using Mann-Whitney U test, and correlations were measured using Spearman correlation.

    Results: Compared to controls, cases reported higher current jaw and neck pain intensity (P < .0001), together with higher scores for physical nonpain and pain symptoms, depression, and jaw pain-related disability (P < .0001 for all). For cases, there were moderate correlations between nonspecific physical symptoms and jaw pain and neck pain, as well as between jaw pain-related disability and jaw pain and neck pain (r = 0.43 to 0.77, P < .0001 for all). Low correlations were observed between depression and jaw pain and neck pain (r = 0.34 to 0.39, both P < .0001).

    Conclusion: Shortly after a whiplash trauma, pain in the jaw and neck regions is associated with the severity of psychosocial factors. Thus, psychosocial factors may play a role in the development of pain in the jaw region after whiplash trauma.

  • 7.
    Lampa, Ewa
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Nordh, Erik
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial pain and Jaw function, Malmö University, Malmö, Sweden.
    Effects on jaw function shortly after whiplash trauma2017In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 44, no 12, p. 941-947Article in journal (Refereed)
    Abstract [en]

    Normal jaw function involves muscles and joints of both jaw and neck. A whiplash trauma may disturb the integrated jaw-neck sensory-motor function and thereby impair chewing ability; however, it is not known if such impairment is present shortly after a neck trauma or develops over time. The aim was to evaluate jaw function after a recent whiplash trauma. Eighty cases (47 women) were examined within 1 month after a whiplash trauma and compared to 80 controls (47 women) without neck trauma. Participants completed the Jaw disability checklist (JDC) and Neck Disability Index (NDI) questionnaires and performed a 5-minute chewing test. Elicited fatigue and pain during chewing were noted, and group differences were evaluated with Fisher's exact test and Mann-Whitney U-test. Compared to controls, cases had higher JDC (P<.0001) and NDI scores (15% vs 2%, P<.0001), and reported more fatigue (53% vs 31%, P=.006) and pain (30% vs 10%, P=.003) during the chewing test. Cases also had a shorter onset time for fatigue and pain (both P=.001) Furthermore, cases reporting symptoms during chewing had higher JDC and NDI scores compared to cases not reporting symptoms (both P=.01). Symptoms mainly occurred in the trigeminal area for both groups, but also in spinal areas more often for cases than for controls. Taken together, the results indicate that jaw-neck sensory-motor function is impaired already within 1month after a whiplash trauma. The association between neck disability and jaw impairment underlines the close functional relationship between the regions, and stresses the importance of multidisciplinary assessment.

  • 8.
    Lampa, Ewa
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Nordh, Erik
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Häggman-Henrikson, Birgitta
    The Course of Orofacial Pain and Jaw Disability after Whiplash Trauma: A 2-year Prospective StudyManuscript (preprint) (Other academic)
  • 9.
    Lampa, Ewa
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Nordh, Erik
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Stålnacke, Britt-Marie
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology.
    The Course of Orofacial Pain and Jaw Disability after Whiplash Trauma: A 2-year Prospective Study.2019In: Spine, ISSN 0362-2436, E-ISSN 1528-1159Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Prospective cohort study OBJECTIVE.: To evaluate the course of orofacial pain and jaw disability in relation to neck pain, neck disability and psychosocial factors at the acute stage and the chronic stage after whiplash trauma.Summary of Background Data Many individuals report chronic pain in the orofacial region after whiplash trauma. The possible association between whiplash trauma and orofacial pain is debated. Prospective studies are therefore needed to evaluate the development of orofacial pain after whiplash trauma.

    METHODS: Within one month following a whiplash trauma, 176 cases were examined and compared to 116 controls with questionnaires concerning neck and jaw pain and related disability, non-specific physical symptoms and depression. At the 2-year follow-up, 119 cases (68%) and 104 controls (90%) were re-examined.

    RESULTS: Compared to controls, cases reported more jaw and neck pain, both at baseline and follow-up. A majority (68%) of cases with pain in the jaw region in the acute stage also reported jaw pain at the follow-up. The intensity of jaw and neck pain was correlated both at baseline and follow-up. Both neck pain and jaw pain was correlated to non-specific physical symptoms and to depression.

    CONCLUSION: Orofacial pain and jaw disability related to neck pain is often present already at the acute stage after whiplash trauma and persist into the chronic stage for most individuals. Assessment following whiplash trauma should therefore include both the neck and the orofacial regions. More studies are needed to further evaluate risk factors for development of orofacial pain after whiplash trauma.

    LEVEL OF EVIDENCE: 3.

  • 10.
    Lindfors, Erik
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Arima, Taro
    Baad-Hansen, Lene
    Bakke, Merete
    De Laat, Antoon
    Giannakopoulos, Nikolaos Nikitas
    Glaros, Alan
    Guimarães, Antonio Sergio
    Johansson, Anders
    Le Bell, Yrsa
    Lobbezoo, Frank
    Michelotti, Ambra
    Müller, Frauke
    Ohrbach, Richard
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Magnusson, Tomas
    Ernberg, Malin
    Jaw Exercises in the Treatment of Temporomandibular Disorders: An International Modified Delphi Study2019In: Journal of oral & facial pain and headache, ISSN 2333-0376Article in journal (Refereed)
    Abstract [en]

    AIMS: To investigate whether an international consensus exists among TMD experts regarding indications, performance, follow-up, and effectiveness of jaw exercises.

    METHODS: A questionnaire with 31 statements regarding jaw exercises was constructed. Fourteen international experts with some geographic dispersion were asked to participate in this Delphi study, and all accepted. The experts were asked to respond to the statements according to a 5-item verbal Likert scale that ranged from "strongly agree" to "strongly disagree." The experts could also leave free-text comments, which was encouraged. After the first round, the experts received a compilation of the other experts' earlier responses. Some statements were then rephrased and divided to clarify the essence of the statement. Subsequently, the experts were then asked to answer the questionnaire (32 statements) again for the second round. Consensus was set to 80% agreement or disagreement.

    RESULTS: There is consensus among TMD experts that jaw exercises are effective and can be recommended to patients with myalgia in the jaw muscles, restricted mouth opening capacity due to hyperactivity in the jaw closing muscles, and disc displacement without reduction. The patients should always be instructed in an individualized jaw exercise program and also receive both verbal advice and written information about the treatment modality.

    CONCLUSION: This Delphi study showed that there is an international consensus among TMD experts that jaw exercises are an effective treatment and can be recommended to patients with TMD pain and disturbed jaw function.

  • 11.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology.
    Visscher, C. M.
    Lobbezoo, F.
    Marklund, Susanna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Temporomandibular pain and jaw dysfunction at different ages covering the lifespan - A population based study2016In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 20, no 4, p. 532-540Article in journal (Refereed)
    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.

  • 12.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Karlsson Wirebring, Linnea
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jawfunction, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Decision-making in dentistry related to temporomandibular disorders: a 5-yr follow-up study2018In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 126, no 6, p. 493-499Article in journal (Refereed)
    Abstract [en]

    Temporomandibular disorders (TMDs) are common, but many patients with such disorders go undetected and under-treated. Our aim was to evaluate the outcome of using a screening tool (5 yr after it was first implemented), on the clinical decision-making for patients with TMDs. Adults who attended for a dental check-up at the Public Dental Health Services in Västerbotten, Sweden, answered three screening questions (3Q/TMD) on frequent jaw pain, pain on jaw function, and catching/locking of the jaw. The dental records of a random sample of 200 individuals with at least one positive response to 3Q/TMD (3Q screen-positive patients) and 200 individuals with all negative responses (3Q screen-negative patients) were reviewed for TMD-related treatment decisions. A clinical decision related to TMD was absent in 45.5% of 3Q screen-positive patients. Treatment of TMDs was associated with a positive response to the screening question on jaw pain (OR = 6.7, 95% CI: 3.2-14.0) and was more frequent among 3Q screen-positive patients (24%) than among 3Q screen-negative patients (2%; OR = 15.5, 95% CI: 5.5-43.9), just as a female examiner was associated with more frequent treatment of TMDs (OR = 3.1, 95% CI: 1.2-8.4). The results indicate under-treatment of TMD within general dental practice and that male clinicians are less likely to initiate TMD treatment.

  • 13.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Marklund, Susanna
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Visscher, Corine
    Academic Centre for Dentistry Amsterdam (ACTA).
    Lobbezoo, Frank
    Academic Centre for Dentistry Amsterdam (ACTA).
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Malmö Högskola.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Outcome of three screening questions for temporomandibular disorders (3Q/TMD) on clinical decision-making2017In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 44, no 8, p. 573-579Article in journal (Refereed)
    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.

  • 14.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Parvaneh, Hasti
    Lobbezoo, Frank
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Visscher, Corine Mirjam
    Diagnostic accuracy of three screening questions (3Q/TMD) in relation to the DC/TMD in a specialized orofacial pain clinic2018In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, no 6, p. 380-386Article in journal (Refereed)
    Abstract [en]

    Objective: To determine the diagnostic accuracy of three screening questions (3Q/TMD) in relation to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), in a specialized clinic.

    Material and methods: Consecutive patients, >18 years, referred with a possible TMD complaint to the Orofacial Pain and Dysfunction clinic, Academic Centre for Dentistry Amsterdam, the Netherlands, were included in the study. All patients (n = 449; mean age 44 years; 72% females), answered the 3Q/TMD and the DC/TMD questionnaire before a DC/TMD examination. The 3Q/TMD constitutes of two questions on weekly pain from the jaw, face and temple region (Q1), and on function (Q2), and one function-related question on weekly catching and/or locking of the jaw (Q3). Q1 and Q2 were evaluated in relation to a DC/TMD pain diagnosis and Q3 in relation to a subgroup of DC/TMD intra-articular diagnosis, referred to as the reference standard.

    Results: In total, 44% of patients received a pain-related DC/TMD diagnosis and 33% an intra-articular reference DC/TMD diagnosis. Sensitivity for the two pain screening questions was high (0.83–0.94), whereas specificity was low (0.41–0.55). For the function-related question, sensitivity was low (0.48), whereas specificity was high (0.96).

    Conclusions: In a specialized pain clinic, the two pain questions (Q1, Q2) are positive in most patients with pain-related TMD. Therefore, in case of a positive response, further diagnostic procedures for TMD pain are warranted. For the functional screening question (Q3), a positive response is indicative for an intra-articular DC/TMD diagnosis, while in case of a negative outcome, an intra-articular TMD might still be present.

  • 15.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Visscher, C M
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Lobbezoo, F
    Marklund, Susanna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Validity of three screening questions (3Q/TMD) in relation to the DC/TMD2016In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 43, no 10, p. 729-736Article in journal (Refereed)
    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.

  • 16.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Visscher, Corine M
    Alstergren, Per
    Lobbezoo, Frank
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    The outcome of a temporomandibular joint compression test for the diagnosis of arthralgia is confounded by concurrent myalgia2019In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771Article in journal (Refereed)
    Abstract [en]

    Objective: Pain in the orofacial region may originate from different structures, and one challenge for the clinician is to determine the primary origin of pain reported by the patient. In clinical practice, it is important to discriminate between a temporomandibular joint (TMJ) pain disorder and jaw muscle pain; therefore, tests that are proposed for such purposes warrant evaluation. The aim of the present study was to evaluate the outcome of a TMJ compression test in relation to a Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) arthralgia diagnosis.

    Methods: A study population (n = 300), randomly selected from the adult population in Västerbotten, Sweden, was examined according to the DC/TMD criteria and with a TMJ compression test. This test is comprised of forceful unilateral biting for 20 s on a wooden spatula in the first molar region. Familiar pain on the contralateral side to the clenching side was considered a positive test outcome.

    Results: Positive contralateral outcome of the TMJ compression test was associated with an arthralgia diagnosis (B = 1.737; OR 5.7, 95% CI 3.3–9.9). This association was confounded by concurrent myalgia (B = 1.737 → B = 0.996, 42.7%).

    Conclusion: In a general population, a negative TMJ compression test was strongly associated with the absence of a contralateral TMJ arthralgia diagnosis according to DC/TMD. The association between a positive TMJ compression test and a DC/TMD arthralgia diagnosis was confounded by the presence of myalgia.

    Clinical relevance: Concurrent myalgia renders the usefulness of the TMJ compression test for predicting an arthralgia diagnosis questionable.

  • 17.
    Marklund, Susanna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial pain and Jaw function, Malmö University, Malmö, Sweden.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Risk factors associated with incidence and persistence of frequent headaches2014In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 8, p. 788-794Article in journal (Refereed)
    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.

  • 18.
    Marklund, Susanna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Wiesinger, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Reciprocal influence on the incidence of symptoms in trigeminally and spinally innervated areas2010In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 14, no 4, p. 366-371Article in journal (Refereed)
    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.

  • 19.
    Marklund, Susanna
    et al.
    Umeå University, Faculty of Medicine, Odontology, Clinical Oral Physiology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Odontology, Clinical Oral Physiology.
    Incidence and prevalence of myofascial pain in the jaw-face region: a one-year prospective study on dental students2008In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 66, no 2, p. 113-121Article in journal (Refereed)
    Abstract [en]

    Objective. The aims of this study were to examine the 1-year period prevalence, incidence, and course of myofascial pain in the jaw-face region, and to analyze whether female gender, dental occlusion, and oral parafunctions have any influence on these signs and symptoms. Material aad methods. The study population comprised 308 dental students examined at the start of their dentistry course and re-examined after 1 year. Case histories were collected using a questionnaire. The clinical examination included palpation sites of muscles, a submaximal clenching test, measurements of maximal mandibular mobility, and classification of morphological and functional dental occlusion. Results. The 1-year period prevalence of frequent myofascial symptoms was 19%. The incidence of myofascial pain, according to the Research Diagnostic Criteria for TemporoMandibular Disorders (RDC/TMD), was 4%. The female students presented an almost 4-fold incidence rate of myofascial symptoms compared to the male students. Non-symptomatic subjects were found among those without awareness of bruxism and with simultanious bilateral contact in the retruded contact position (RCP), and among those with a stable intercuspal position (ICP). Variations in morphological occlusion did not show any relation to myofascial symptoms, nor did contact patterns in eccentric positions. Conclusions. Female dental students were more prone to developing frequent myofascial pain and to perceiving local muscle soreness than were male students during a 1-year period. Both self-reported bruxism and registered mandibular instability in ICP showed association with the 1-year period prevalence of myofascial signs and symptoms in the jaw-face region.

  • 20.
    Marklund, Susanna
    et al.
    Umeå University, Faculty of Medicine, Odontology, Clinical Oral Physiology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Odontology, Clinical Oral Physiology.
    Incidence and prevalence of temporomandibular joint pain and dysfunction: a one-year prospective study of university students2007In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 65, no 2, p. 119-127Article in journal (Refereed)
    Abstract [en]

    Objective. The aims of this study were to investigate the incidence and recovery of temporomandibular joint (TMJ) pain and dysfunction during a 1-year period, and to examine factors associated with TMJ signs and symptoms.

    Material and Methods. The study population comprised 371 dental students examined at the start of education, out of which 308 were re-examined after 1 year. Case histories were collected with the aid of a questionnaire.

    The cinical examination involved TMJ mobility, TMJ pain, TMJ sounds, morhological and functional dental occlusion.

    Results. The 1-year incidence of TMJ signs and/or symptoms was 12%, with no statistically significant difference between men and women. Reported TMJ sounds (10%) and clinically registered TMJ pain (8%) reached the highest incidence rates. Approximately a quarter of those who had TMJ signs and/or symptoms at baseline had recovered at follow-up. Subjects with a non-symptomatic TMJ were significantly more often found among men and among those with bilateral contacts in centric relation, a normal transverse inter-maxillary relationship, and a stabile manadibular position in centric occlusion.

    Conclusion. The 1-year incidence of TMJ pain and/or dysfunction was high among 1st-year univerisity students. The persistence of signs and symptoms during the observation period was related to gender, while incidence and disappearance of symptoms were not. Dental occlusion was not rejected as a possible concurrent factor in relation to TMJ pain and/or dysfunction among university students.

  • 21.
    Marklund, Susanna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Risk factors associated with incidence and persistence of signs and symptoms of temporomandibular disorders2010In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 68, no 5, p. 289-299Article in journal (Refereed)
    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.

  • 22.
    Näsström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Fallgren, Jakob
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    The implementation of a decision-tree did not increase decision-making in patients with temporomandibular disorders in the public dental health service2019In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, no 5, p. 394-399Article in journal (Refereed)
    Abstract [en]

    Objective: Many patients with temporomandibular disorders (TMD) seem to go undetected within primary dental health care. Primarily we evaluated if the implemented intervention increased the clinical decision-making for TMD patients; secondarily we evaluated if other factors could be identified that predicted performed or recommended TMD treatment.

    Material and Methods: This case–control study was carried out within the Public Dental Health service in Västerbotten County, Sweden. An intervention based on a decision-tree with three screening questions for TMD (3Q/TMD) was implemented during 2015 in four clinics and compared with the remaining county. A total of 400 individuals were selected—200 3Q-positives and 200 3Q-negatives. The 3Q/TMD consists of Q1—frequent jaw pain, Q2—frequent pain on function, and Q3—frequent catching and/or locking of jaw. The 3Q/TMD answers were analyzed in relation to TMD treatment and any TMD related decision that was collected from the digital dental records.

    Results: The intervention did not increase the frequencies of traceable clinical decisions among patients with TMD.

    Conclusions: Despite the implemented intervention aimed, the indicated undertreatment of patients with TMD remains. Future studies are still needed to gain a deeper understanding of the clinical decision-making process for TMD patients in general practice dentistry.

  • 23. Pihlgren, Karin
    et al.
    Forsberg, Hans
    Sjödin, Lars
    Lundgren, Per
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Changes in tooth mortality between 1990 and 2002 among adults in Västerbotten County, Sweden: influence of socioeconomic factors, general health, smoking, and dental care habits on tooth mortality2011In: Swedish Dental Journal, ISSN 0347-9994, Vol. 35, no 2, p. 77-88Article in journal (Refereed)
    Abstract [en]

    The objectives of the study were to analyse changes in tooth mortality among adults in Västerbotten County, Sweden, between 1990 and 2002 and determine whether socioeconomic factors, general health, smoking, and dental care habits influenced tooth mortality. The study was based on samples drawn from the adult population in Västerbotten County in 1990 and 2002. The studied age groups were 35-, 50-, and 65-year-olds. In 2002 75-year-olds were included. The surveys comprised a clinical examination and a questionnaire.The latter focused on oro-facial symptoms, socioeconomic factors, general health, smoking, and dental care habits. Complete data were obtained from 715 individuals in 1990 and from 768 individuals in 2002.Variables used to depict tooth mortality were edentulousness, occlusal supporting zones (Eichner index), and number of teeth. The prevalence of edentulousness in Västerbotten County decreased from 12.7% in 1990 to 3.7% in 2002 (P < 0.001). The mean number of teeth increased in all age groups between 1990 and 2002, and so did the number of individuals with tooth contact in all occlusal supporting zones and no gaps between teeth. Low educational level, weak economic status, smoking, and irregular visits to the dental clinic were all significantly related to increased tooth mortality. Between 1990 and 2002 tooth mortality decreased significantly in the adult population of Västerbotten County, Sweden. Cross-sectional analysis identified socioeconomic factors, smoking, and irregular use of dental care services as being related to tooth mortality in both 1990 and 2002.

  • 24.
    Storm Mienna, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Glas, Linnéa
    Umeå University, Faculty of Medicine, Department of Odontology.
    Magnusson, My
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ilgunas, Aurelija
    Umeå University, Faculty of Medicine, Department of Odontology.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial pain and Jaw function, Malmö Universiy, Malmö, Sweden.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Patients' experiences of supervised jaw-neck exercise among patients with localized TMD pain or TMD pain associated with generalized pain2019In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate temporomandibular disorder (TMD) patients’ experiences of a supervised jaw-neck exercise programme.

    Materials and methods: The study used a mixed method design. All patients were diagnosed with myalgia according to the Research Diagnostic Criteria for TMD and divided into local myalgia (n = 50; 38 women, mean age 43 yrs, SD 14), and myalgia with generalized pain (n = 28; 27 women, mean age 43 yrs, SD 13). Patients participated in a ten-session supervised exercise programme that included relaxation, coordination and resistance training of the jaw, neck and shoulders. After the 10 sessions an evaluation form was filled out including both open- and closed-ended questions. The quantitative analysis was based on closed-ended questions concerned experience, adaptation and side-effects from the exercise programme. The qualitative analysis was employing inductive content analysis of open-ended questions.

    Results: Patients reported similar positive overall experiences of exercise regardless of diagnosis, although more individuals in the general pain group experienced pain during training (57%) compared to the local pain group (26%; p = .015). Patients in both groups shared similar experiences and acknowledged the possibility to participate in an individualized and demanding exercise programme. They expressed feelings of being noticed, taken seriously and respectful care management to be key factors for successful treatment outcome. The exercise programme was acknowledged as a valuable part of treatment.

    Conclusion: The hypothesis generated was that individualized and gradually demanding exercise in the rehabilitation process of TMD stimulates self-efficacy and confidence in chronic TMD patients regardless of whether the pain was localized or combined with wide-spread pain.

  • 25.
    Storm Mienna, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Johansson, Eva E
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    "Grin(d) and bear it": narratives from Sami women with and without temporomandibular disorders. A qualitative study.2014In: Journal of oral & facial pain and headache, ISSN 2333-0384, Vol. 28, no 3, p. 243-251Article in journal (Refereed)
    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.

  • 26.
    Storm Mienna, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    A two-year follow-up study of temporomandibular disorders in a female Sami population: validation of cases and controls as predicted by questionnaire2007In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 65, no 6, p. 341-347Article in journal (Refereed)
    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.

  • 27.
    Storm Mienna, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    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 Sweden2012In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 26, no 3, p. 215-224Article in journal (Refereed)
    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.

  • 28.
    Storm Mienna, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Temporomandiular disorders, headaches, and cervical pain among females in a Sami population2006In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 64, no 5, p. 319-325Article in journal (Refereed)
    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.

  • 29.
    Wiesinger, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology.
    Hellström, F
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Experimental masseter muscle pain alters jaw-neck motor strategy2013In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 17, no 7, p. 995-1004Article in journal (Refereed)
    Abstract [en]

    Background: A functional integration between the jaw and neck regions has been demonstrated during normal jaw function. The effect of masseter muscle pain on this integrated motor behaviour in man is unknown. The aim of this study was to investigate the effect of induced masseter muscle pain on jaw-neck movements during a continuous jaw opening-closing task.

    Methods: Sixteen healthy men performed continuous jaw opening-closing movements to a target position, defined as 75% of the maximum jaw opening. Each subject performed two trials without pain (controls) and two trials with masseter muscle pain, induced with hypertonic saline as a single injection. Simultaneous movements of the mandible and the head were registered with a wireless optoelectronic three-dimensional recording system. Differences in movement amplitudes between trials were analysed with Friedman's test and corrected Wilcoxon matched pairs test.

    Results: The head movement amplitudes were significantly larger during masseter muscle pain trials compared with control. Jaw movement amplitudes did not differ significantly between any of the trials after corrected Wilcoxon tests. The ratio between head and jaw movement amplitudes was significantly larger during the first pain trial compared with control.

    Conclusions: Experimental masseter muscle pain in humans affected integrated jaw-neck movements by increasing the neck component during continuous jaw opening-closing tasks. The findings indicate that pain can alter the strategy for jaw-neck motor control, which further underlines the functional integration between the jaw and neck regions. This altered strategy may have consequences for development of musculoskeletal pain in the jaw and neck regions.

  • 30.
    Wiesinger, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden.
    Hellström, Fredrik
    Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Umeå, Sweden.
    Englund, Erling
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Does induced masseter muscle pain affect integrated jaw-neck movements similarly in men and women?2016In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 124, no 6, p. 546-553Article in journal (Refereed)
    Abstract [en]

    Normal jaw opening-closing involves simultaneous jaw and head-neck movements. We previously showed that, in men, integrated jaw-neck movements during jaw function are altered by induced masseter muscle pain. The aim of this study was to investigate possible sex-related differences in integrated jaw-neck movements following experimental masseter muscle pain. We evaluated head-neck and jaw movements in 22 healthy women and 16 healthy men in a jaw opening-closing task. The participants performed one control trial and one trial with masseter muscle pain induced by injection of hypertonic saline. Jaw and head movements were registered using a three-dimensional optoelectronic recording system. There were no significant sex-related differences in jaw and head movement amplitudes. Head movement amplitudes were significantly greater in the pain trials for both men and women. The proportional involvement of the neck motor system during jaw movements increased in pain trials for 13 of 16 men and for 18 of 22 women. Thus, acute pain may alter integrated jaw-neck movements, although, given the similarities between men and women, this interaction between acute pain and motor behaviour does not explain sex differences in musculoskeletal pain in the jaw and neck regions.

  • 31.
    Wiesinger, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology. Wänman.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Hellström, F
    Jaw-opening accuracy is not affected by masseter muscle vibration in healthy men2014In: Experimental Brain Research, ISSN 0014-4819, E-ISSN 1432-1106, Vol. 232, no 11, p. 3501-3508Article in journal (Refereed)
    Abstract [en]

    There is a functional integration between the jaw and neck regions with head extension-flexion movements during jaw-opening/closing tasks. We recently reported that trigeminal nociceptive input by injection of hypertonic saline into the masseter muscle altered this integrated jaw-neck function during jaw-opening/closing tasks. Thus, in jaw-opening to a predefined position, the head-neck component increased during pain. Previous studies have indicated that muscle spindle stimulation by vibration of the masseter muscle may influence jaw movement amplitudes, but the possible effect on the integrated jaw-neck function is unknown. The aim of this study was to investigate the effect of masseter muscle vibration on jaw-head movements during a continuous jaw-opening/closing task to a target position. Sixteen healthy men performed two trials without vibration (Control) and two trials with bilateral masseter muscle vibration (Vibration). Movements of the mandible and the head were registered with a wireless three-dimensional optoelectronic recording system. Differences in jaw-opening and head movement amplitudes between Control and Vibration, as well as achievement of the predefined jaw-opening target position, were analysed with Wilcoxon's matched pairs test. No significant group effects from vibration were found for jaw or head movement amplitudes, or in the achievement of the target jaw-opening position. A covariation between the jaw and head movement amplitudes was observed. The results imply a high stability for the jaw motor system in a target jaw-opening task and that this task was achieved with the head-neck and jaw working as an integrated system.

  • 32.
    Wiesinger, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Odontology, Clinical Oral Physiology.
    Malker, Hans
    Englund, Erling
    Wänman, Anders
    Umeå University, Faculty of Medicine, Odontology, Clinical Oral Physiology.
    Back pain in relation to musculoskeletal disorders in the jaw-face: a matched case-control study2007In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 131, no 3, p. 311-319Article in journal (Refereed)
    Abstract [en]

    Back pain and temporomandibular disorders are both common conditions in the population with influence on the human motor system, but a possible co-morbidity between these conditions has not been fully investigated. The aim of this study was to test the hypothesis of an association between long-term back pain and pain and/or dysfunction in the jaw-face region. Back pain was defined as pain in the neck, shoulders and/or low back. The study-population comprised 96 cases with long-term back pain and 192 controls without back pain. We used a screening procedure, a questionnaire and a clinical examination of the jaw function. The questionnaire focused on location, frequency, duration, intensity and impact on daily life of symptoms in the jaw-face and back regions. The analysis was conducted on 16 strata, matched by age and sex for case vs. control, using Mantel-Haenszel estimates of matched odds ratio (OR) and 95% confidence interval (CI) as well as the corrected Mantel-Haenszel chi(2) test. The overall prevalence of frequent symptoms in the jaw-face region, as reported in the questionnaire, was 47% among cases and 12% among controls. The difference was statistically significant (P<0.0001) with a sevenfold odds ratio (CI: 3.9-13.7). Moderate to severe signs from the jaw region were clinically registered among 49% of the cases and 17% of the controls (P<0.0001, OR: 5.2, CI: 2.9-9.2). The results showed statistically significant associations between long-term back pain and musculoskeletal disorders in the jaw-face and indicate co-morbidity between these two conditions.

  • 33.
    Wiesinger, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Odontology, Clinical Oral Physiology.
    Malker, Hans
    Englund, Erling
    Wänman, Anders
    Umeå University, Faculty of Medicine, Odontology, Clinical Oral Physiology.
    Does a dose-response relation exist between spinal pain and temporomandibular disorders?2009In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 10, p. 28-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to test whether a reciprocal dose-response relation exists between frequency/severity of spinal pain and temporomandibular disorders (TMD). METHODS: A total of 616 subjects with varying severity of spinal pain or no spinal pain completed a questionnaire focusing on symptoms in the jaw, head and spinal region. A subset of the population (n = 266) were sampled regardless of presence or absence of spinal pain. We used two different designs, one with frequency/severity of spinal pain, and the other, with frequency/severity of TMD symptoms as independent variable. All 616 participants were allocated to four groups, one control group without spinal pain and three spinal pain groups. The subjects in the subset were allocated to one control group without TMD symptoms and three TMD groups. Odds ratios (ORs) were calculated for presence of frequent TMD symptoms in the separate spinal pain groups as well as for frequent spinal pain in the separate TMD groups. RESULTS: The analysis showed increasing ORs for TMD with increasing frequency/severity of spinal pain. We also found increasing ORs for spinal pain with increasing frequency/severity of TMD symptoms. CONCLUSION: This study shows a reciprocal dose-response-like relationship between spinal pain and TMD. The results indicate that these two conditions may share common risk factors or that they may influence each other. Studies on the temporal sequence between spinal pain and TMD are warranted.

  • 34.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Endurance to physical strain in patients with temporomandibular disorders: a case-control study2012In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, ISSN 1502-3850, Vol. 70, no 6, p. 455-462Article in journal (Refereed)
    Abstract [en]

    Abstract Objective. The hypothesis tested was whether patients with temporomandibular disorders (TMD) have an impaired endurance to motor tasks, under physical strain. Material and methods. The study population included 81 cases with TMD and 75 controls. After giving their informed consent, the participants filled out a questionnaire and performed five endurance trials. Each trial was measured in seconds from start to termination. The tests included: (a) holding the arm in a straight out position with a 2 kg weight in the hand, (b) lifting and lowering the arm with a 2 kg weight in the hand, (c) opening and closing the mandible repeatedly against a resistance of 1.6 kg during the jaw-opening phase, (d) protruding and retracting the mandible repeatedly against a resistance of 1.6 kg during the protruding phase and (e) unilateral chewing of three pieces of chewing gum. Analysis of differences between cases and controls for endurance were evaluated with Mann-Whitney U-test. A p-value < 0.05 was considered statistically significant. Results. The cases had statistically significantly (p < 0.0001) lower endurance time than controls for all tests. Conclusions. Patients with TMD compared to those without signs and symptoms of TMD have an impaired capacity to endure motor tasks that involve physical demand of the jaw muscles and shoulder girdle muscles.

  • 35.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Odontology, Clinical Oral Physiology.
    Temporomandibular disorders among smokers and nonsmokers: a longitudinal cohort study2005In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 19, no 3, p. 209-217Article in journal (Refereed)
    Abstract [en]

    Aims: To evaluate whether smoking influences the presence and/or development of signs and symptoms of temporomandibular disorders(TMD) among adults.

    Methods: A random sample of subjects 35, 50 and 65 years of age was drawn from the general population and examined with the aid of a questionnaire and a clinical examination. Within the sample,. smokers were identified based on reported current smoking and nonsmokers were matched to the smokers based on age, gender, educational level, area of residence, and number of teeth. In total, 268 subjects were matched (134 pairs). Six years after the baseline examination, 122 matched pairs were re-examined.

    Results: Mild symptoms of TMD were reported by approximately 30% of the sample both at baseline and at the folllow-up examaination 6 years later. Pain in the jaws and/or more severe symptoms of TMD were reported by approximately 15% on both occasions. No significant differences between smokers and nonsmokers were found regarding symptoms of TMD. In both examinations, mild signs (dysfuntion index I) were found in approcimately 40% of the sample and moderate to severe signs (dysfunction index II to III) in approximately 20%; no statistically significant differences were found between smokers and nonsmokers. No significant differences were found between smokers and nonsmokers regarding the course of symptoms or signs of TMD during the study period.

    Conclusion: Smoking is not a factor related to the presence or development of signs and symptoms of TMD.

  • 36.
    Wänman, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Marklund, Susanna
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Clinical Oral Physiology, Västerbotten County Council, Umeå, Sweden.
    Treatment outcome of supervised exercise, home exercise and bite splint therapy, respectively, in patients with symptomatic disc displacement with reduction: A randomised clinical trial2019In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842Article in journal (Refereed)
    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.

  • 37.
    Yekkalam, Negin
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Associations between craniomandibular disorders, sociodemographic factors and self-perceived general and oral health in an adult population2014In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 8, p. 1054-1065Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of this study was to analyze the relationships between pain in the craniomandibular region and jaw dysfunction, respectively, to sociodemographic factors and self-perceived general and oral health in a middle-aged and elderly population in Västerbotten County, Sweden.

    Materials and methods. Six hundred individuals, 35-, 50-, 65- and 75 years old, from inland and 600 individuals from coastal areas were randomly selected in 2002. Of these, 987 individuals completed a questionnaire and 779 participated in a clinical examination. Thirty-five- and 50-year-olds together constituted a middle-aged group and the rest an elderly group.

    Results. Among the middle-aged, craniomandibular pain was associated with impaired general health status, signs of temporomandibular disorder (TMD) pain were associated with female gender and living alone, jaw dysfunction symptoms were associated with university degree and chewing with caution; and signs of TMD dysfunction were associated with female gender and living in the more densely populated coastal region. Among the elderly, craniomandibular pain was more common among those living in the inland region, craniomandibular pain and signs of TMD pain were associated with impaired general health status, jaw dysfunction symptoms were associated with higher education level and self-perceived impaired general health and oral health; and signs of TMD dysfunction were associated with female gender and living in the coastal region. Dental status was not associated with craniomandibular pain.

    Conclusions. Socioeconomic factors and impaired general state of health were related to signs and symptoms indicative of CMD. These factors may influence demand for treatment among the affected.

  • 38.
    Yekkalam, Negin
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Factors associated with clinical decision-making in relation to treatment need for temporomandibular disorders2016In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, no 2, p. 134-141Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of this study was to analyze dentist's clinical decision-making related to treatment need for temporomandibular disorders (TMD) in an adult population. Materials and methods. The study population comprised 779 randomly selected 35, 50, 65 and 75 year old individuals living in the county of Vasterbotten, Sweden. The participants filled out a questionnaire and were examined clinically according to a structured protocol. The four examiners (two men, two women) were experienced dentists and were calibrated before the start of the study. After examination they individually assessed the need of treatment owing to TMD. Results. In total, 15% of the study population was considered to have a treatment need owing to TMD. The highest estimate was noted for 35 and 50 years old women and the lowest for 65 and 75 years old men. Overall, 21% of the women and 8% of the men were considered to have a treatment need owing to TMD, with statistically significant differences between men and women for the 35 and 50 years old groups. Inter-individual variations in dentists' decisions were observed. In a multivariate analysis, female gender, signs and symptoms of TMD pain, signs and symptoms of TMD dysfunction and smoking were associated with estimated treatment need. Conclusions. The prevalence of estimated treatment need owing to TMD was fairly high, but the dentists' clinical decision-making process showed large inter-individual variability. The observation calls for further research on the factors affecting the decision-making process in care providers.

  • 39.
    Yekkalam, Negin
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Prevalence of signs and symptoms indicative of temporomandibular disorders and headaches in 35-, 50-, 65- and 75-year-olds living in Västerbotten, Sweden2014In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 6, p. 458-465Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of this study was to analyze and compare prevalence of signs and frequently occurring symptoms indicative of temporomandibular disorder (TMD) and headaches in 35-, 50-, 65- and 75-year-old men and women in Västerbotten County, Sweden.

    Materials and methods. From a total target population of 11 324 subjects living in Västerbotten County in the year 2002, 300 individuals in each age group were randomly selected. Of these, 998 (82% response rate) answered and returned a postal questionnaire and 779 (65% response rate) individuals accepted a clinical examination.

    Results. The prevalence of frequent TMD symptoms peaked among 50-year-old women and then declined. Women at this age reported significantly higher prevalence compared to men for all TMD symptoms except temporomandibular joint locking. In the 65- and 75-year-olds, the prevalence was practically equal between men and women as well as between these ages. Frequent headaches showed the highest prevalence among 35- and 50-year-old women, with a statistically significant difference between men and women of 50 years of age (p < 0.05). Fifty-year-old women had statistically significantly higher prevalence of muscle pain to palpation (p < 0.001), temporomandibular joint sounds (p < 0.01) and impaired maximal jaw opening capacity (p < 0.01), compared to 50-year-old men.

    Conclusions. The different symptoms indicative of TMD and headaches showed a similar pattern, with higher prevalence among the 35- and 50-year-old, as compared to the 65- and 75-year-old, participants. The pattern may be related to biological, psychosocial or generation-related factors.

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