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  • 1.
    Bodin, Ingrid
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Impairment of intra-oral sensation, discrimination ability, and swallowing function following radiotherapy and surgery for oral and pharyngeal cancer2004Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Oral and pharyngeal cancer is commonly treated with a combination of radiotherapy and surgery. It is a clinical knowledge that patients often experience severe swallowing disorders following treatment. Since surgical sequelae are instantaneous and obvious, little attention has been paid to other concurrent effects of the treatment. To shed light on this subject, the aim of this thesis was twofold (i) to make a retrospective inventory of the sequelae following treatment and (ii) to perform a prospective, inceptive examination at diagnosis, and to follow-up after radiotherapy, six months and 12 months after surgery.

    The files of ninety-nine patients revealed that following treatment one-third had to use gastric fistulas and more than nine of ten patients had restricted swallowing capacity. Every second patient could only swallow puréed or liquid food.

    Adequate intra-oral sensation and discrimination ability is essential for bolus preparation and bolus control, for appropriate elicitation of the swallowing reflex and, hence, for the oral phase of swallowing. At the inceptive examination, the prospective part of the study demonstrated intra-oral discrimination ability in patients was equal to that in healthy controls but was impaired six months after treatment and there was no significant improvement after 12 months. It had been expected that the patient’s healthy, non-tumor side would compensate but it did not. An explanation was found when it was revealed that radiotherapy induced a delayed decline in intra-oral sensation. Sensory decline was not demonstrated within a month after radiotherapy but was manifest six months later. Since the radiotherapy field includes the neck, because of the risk for metastasis, it is highly plausible that pharyngeal sensation declines in a manner corresponding to that found intra-orally when the healthy side is irradiated. In accord with this presumption, pharyngeal swallowing function deteriorated in patents with oral tumors. Cineradiographic evaluation of oral and pharyngeal swallowing function disclosed a significant association between the degree of swallowing dysfunction and the degree of sensory decline and with the degree of impairment of shape recognition.

    Conclusions: Delayed intra-oral sensory decline, found to be induced by radiotherapy, can be expected to appear in the entire radiation field, including the oral cavity and the pharynx, with adverse effect on swallowing. Testing intra-oral sensation close to the last radiotherapy session is not advisable, because sensory decline does not develop immediately after radiotherapy but manifests after six months. Spontaneous sensory rehabilitation cannot be expected after six months. The significant association between degree of swallowing dysfunction and degree of intra-oral sensory decline and impaired discrimination ability must be considered in the quest for functional rehabilitation of patients treated for oral or pharyngeal cancer.

  • 2.
    Bodin, Ingrid
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Levring Jäghagen, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Isberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Intraoral sensation before and after radiotherapy and surgery for oral and pharyngeal cancer.2004Inngår i: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 26, nr 11, 923-929 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Patients with unilateral oral or pharyngeal cancer often receive bilateral radiotherapy because of the potential for metastases. Because postoperative sequelae are evident on the tumor side, to date little attention has been paid to sensory alterations after radiotherapy on the healthy, nontumor side. The objective of this study was to investigate possible sensory alterations. METHODS: Intraoral sensation was tested bilaterally at standardized sites in 27 patients and 20 controls. Preoperative radiotherapy was bilateral in 19 patients and unilateral in eight patients. Patients were tested before treatment, after radiotherapy, and after surgery at 6 months and 1 year. Comparisons were performed interindividually and intraindividually and between groups. RESULTS: A delayed deterioration of sensation was revealed on the nontumor side 6 months after radiotherapy. There was no recovery 1 year after treatment. CONCLUSIONS: Intraoral sensation cannot be evaluated directly after radiotherapy. It is plausible that sensory deterioration after radiotherapy has an impact on functional rehabilitation after tumor treatment.

  • 3.
    Bodin, Ingrid
    et al.
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Lind, Magnus
    Arnander, Claes
    Free radial forearm flap reconstruction in surgery of the oral cavity and pharynx: surgical complications, impairment of speech and swallowing.1994Inngår i: Clinical Otolaryngology, ISSN 1749-4478, Vol. 19, nr 1, 28-34 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The first 100 consecutive free radial forearm flaps used in reconstruction for oral and pharyngeal cancer were investigated. Seven re-operations took place due to circulatory impairment of the flap. Two flaps underwent partial, and four total necrosis, one of those patients died of massive haemorrhage. Post-operative infection was significantly correlated to increased time between the last radiotherapy session and surgery. All but eight patients had post-operative impairment of swallowing and all but five patients had impairment of speech articulation or hypernasality. Post-operative time spent in hospital was a range of 12-122 days (mean 37 days). The 2-year survival rate was 70% and the 5-year survival rate was 45%.

  • 4.
    Bodin, Ingrid
    et al.
    Umeå universitet, Medicinsk fakultet, Odontologi.
    Lind, Magnus
    Henningsson, Gunilla
    Isberg, Annika
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Deterioration of intraoral hole size identification after treatment of oral and pharyngeal cancer.1999Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, Vol. 119, nr 5, 609-616 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Thirty-one patients with a diagnosed malignant tumour of the oral cavity or pharynx were tested in hole size identification on four test occasions: before all treatment, after radiotherapy and 6 months and 1 year after surgical treatment. They were compared within groups as well as with a group of healthy reference individuals of the same age who underwent the same test procedure at a 2 months' interval. The oral group did not decline in hole size identification after radiotherapy, but did after surgery. The deterioration was persistent 1 year after surgery. The pharyngeal group did not change performance in hole size identification after radiotherapy, nor after surgery. It is obvious that surgery of the oral structures causes the deterioration. No correlation with damage to the lingual nerve could be registered. The oral cavity reacts as one unit, despite sensory input from two sides. The non-operated side does not compensate for the operated side. It is plausible that decreased oral sensory acuity, in recognizing hole size of the bolus, contributes to postoperative swallowing problems.

  • 5.
    Bodin, Ingrid
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Lind, Magnus
    Henningsson, Gunilla
    Isberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Deterioration of intraoral recognition of shapes after treatment of oral and pharyngeal cancer.2000Inngår i: Otolaryngology and head and neck surgery, ISSN 0194-5998, E-ISSN 1097-6817, Vol. 122, nr 4, 584-589 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Thirty patients with diagnosed malignant tumors of the oral cavity or pharynx were tested in regards to intraoral shape recognition at 4 test occasions: before all treatment, after radiotherapy, 6 months after surgery, and 1 year after surgery. They were compared within groups as well as with a group of healthy reference individuals of the same age who underwent the same test procedure at a 2-month interval. The tumor itself did not influence the capability of shape recognition. The reference individuals demonstrated significantly better results on the second test occasion, which is known as a learning effect. Learning improvement was not seen in the patients whose second test occasions were after radiotherapy, implying an impediment amounting to the magnitude of the learning effect. At 6 months after surgery the patients' capabilities of shape recognition had deteriorated significantly with no difference between the oral cancer group and the pharyngeal cancer group. No spontaneous rehabilitation had taken place 1 year after surgery. The presence or absence of surgical lingual nerve damage did not influence the results. The nonoperated side does not compensate for the operated one. It is plausible that decreased oral sensory acuity in recognizing the shape of the bolus contributes to postoperative swallowing problems.

  • 6.
    Bryndahl, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Temporomandibular joint disk displacement and subsequent adverse mandibular growth: a radiographic, histologic and biomolecular experimental study2008Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The mandibular condyles represent important growth sites within the facial skeleton. Condylar growth is not a pacemaker of mandibular development, but it provides regional adaptive growth that is of considerable clinical significance, as the condyle’s upward and backward growth movement regulates the anteriorly and inferiorly directed displacement of the mandible as a whole.

    Orthopedic problems of the temporomandibular joint (TMJ), such as displacement of the TMJ disk, are common in the adolescent population. Clinical studies of mandibular asymmetry and mandibular retrognathia in adults as well as in children and adolescents, have reported an association with coexisting non-reducing displacement of the TMJ disk without identifying the cause and effect. Through experimental studies causality has been established, and unilateral affliction during growth has been shown to retard ipsilateral mandibular development with facial asymmetry as the sequel. It was hypothesized that bilateral non-reducing TMJ disk displacement during growth would impair mandibular development bilaterally, resulting in mandibular retrognathia. TMJ disk displacement has repeatedly been demonstrated to induce histological reactions of the condylar cartilage. An additional assumption was therefore that a non-deranged TMJ disk function is crucial for the maintenance of the growing condyle’s biophysical environment, and that a connection ought to exist between the amount of condylar cartilage changes caused by TMJ disk displacement and the amount of subsequent adverse mandibular growth. It was also hypothesized that non-reducing displacement of the TMJ disk in growing individuals would result in qualitative and quantitative changes of the condylar subchondral bone.

    An improved experimental cephalometric method was developed in order to optimize the reliability of longitudinal radiographic evaluation of fast growing small animals. Bilateral non-reducing TMJ disk displacement was surgically created in ten growing New Zealand White rabbits, with ten additional rabbits serving as a sham operated control group. The amount and direction of craniofacial growth was followed over time in serial cephalograms, aided by tantalum implants in the jaws. The study period was chosen to correspond to childhood and adolescence in man. The assessed growth of each side of the mandible was correlated to the histological feature of ipsilateral condylar cartilage at the end of the growth period. The amount and composition of subchondral bone from three regions of interest in the condyle, and the expression of local growth factors in the adjacent condylar cartilage was evaluated.

    The results verified that bilateral non-reducing TMJ disk displacement retarded mandibular growth bilaterally; the extent corresponding to mandibular retrognathia in man. Displacement of the TMJ disk during the growth period induced condylar cartilage adaptive reactions that were associated with both an adverse amount and direction of mandibular growth, manifesting in a retrognathic mandibular growth pattern. Growth impairment fluctuated over time, with the most striking retardation occurring during periods of increased general growth, implying a local growth reduction explicitly counteracting general hormonal growth acceleration. A significant decrease of the total amount of subchondral bone, in spite of a general increase of new bone formation in the experimental condyles, pointed to a reparative compensation for an extensive resorption of subchondral bone due to displacement of the TMJ disk, but not to the extent that normal growth would be maintained. These results constitute an explanation for the adverse mandibular development following non-reducing TMJ disk displacement in growing individuals.

    This project has shown that non-reducing displacement of the TMJ disk during growth has significant consequences on facial development. The findings strongly advocate early and accurate diagnosis and treatment of TMJ disk displacement in the adolescent population, thereby presumably reducing the need for future orthodontic and surgical craniofacial corrective therapy. The results furthermore enhance the need for full appraisal of TMJ disk function in the adolescent population during orthodontic functional therapy, as the condylar cartilage and subchondral bone reactions to a concomitantly displaced non-reducing TMJ disk must be expected to interfere with the intended growth stimulating treatment. The findings of intact articular layers in spite of gross histological and morphological soft and hard tissue changes as a sequel to TMJ disk displacement in growing individuals, implicate a clinical risk of false positive radiographic diagnosis of degenerative changes of the TMJ in children and adolescents.

  • 7.
    Bryndahl, Fredrik
    et al.
    Umeå universitet, Medicinsk fakultet, Odontologi. Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Eriksson, Lars
    Malmö högskola.
    Legrell, Per Erik
    Umeå universitet, Medicinsk fakultet, Odontologi. Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Isberg, Annika
    Umeå universitet, Medicinsk fakultet, Odontologi. Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Bilateral TMJ disk displacement induces mandibular retrognathia2006Inngår i: Journal of dental research, ISSN 0022-0345, Vol. 85, nr 12, 1118-1123 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 8.
    Bryndahl, Fredrik
    et al.
    Umeå universitet, Medicinsk fakultet, Odontologi. Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Legrell, Per Erik
    Umeå universitet, Medicinsk fakultet, Odontologi. Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Eriksson, Lars
    Malmö Högskola.
    Isberg, Annika
    Umeå universitet, Medicinsk fakultet, Odontologi. Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Titanium screw implants in optimization of radiographic evaluation of facial growth in longitudinal Animal studies2004Inngår i: The angle orthodontist, ISSN 0003-3219, Vol. 74, nr 5, 610-617 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 9.
    Bryndahl, Fredrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Warfvinge, G
    Eriksson, L
    Isberg, A
    Cartilage changes link retrognathic mandibular growth to TMJ disc displacement in a rabbit model2011Inngår i: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 40, nr 6, 621-627 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Recent experimental research demonstrated that non-reducing temporomandibular joint (TMJ) disc displacement in growing rabbits impaired mandibular growth. TMJ disc displacement is also shown to induce histological changes of the condylar cartilage. The authors hypothesized that the severity of these changes would correlate to the magnitude of mandibular growth. Bilateral non-reducing TMJ disc displacement was surgically created in 10 growing New Zealand White rabbits. Ten additional rabbits constituted a sham operated control group. Aided by tantalum implants, growth was cephalometrically determined for each mandibular side during a period equivalent to childhood and adolescence in man. At the end of the growth period, histologically classified cartilage features were correlated with the assessed ipsilateral mandibular growth. Non-reducing displacement of the TMJ disc during the growth period induced histological reactions of the condylar cartilage in the rabbit model. The severity of cartilage changes was inversely correlated to the magnitude and the direction of mandibular growth, which resulted in a retrognathic growth pattern.

  • 10.
    Bryndahl, Fredrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Warfvinge, Gunnar
    Malmö högskola.
    Eriksson, Lars
    Malmö högskola.
    Isberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Cartilage changes link retrognathic growth to TMJ disk displacementManuskript (preprint) (Annet vitenskapelig)
  • 11.
    Bryndahl, Fredrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Warfvinge, Gunnar
    Rabie, A Bakr M
    Isberg, Annika
    Subchondral bone loss explains retrognathic mandibular growth at TMJ disk displacementManuskript (Annet (populærvitenskap, debatt, mm))
  • 12. Carlsson, G
    et al.
    Wahlin, Ylva-Britt
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Johansson, Anders
    Umeå universitet, Medicinsk fakultet, Odontologi, Parodontologi.
    Olsson, A
    Eriksson, T
    Claesson, Rolf
    Umeå universitet, Medicinsk fakultet, Odontologi.
    Hänström, Lennart
    Umeå universitet, Medicinsk fakultet, Odontologi.
    Henter, JI
    Periodontal disease in patients from the original Kostmann family with severe congenital neutropenia2006Inngår i: Journal of Periodontology, ISSN 0022-3492, Vol. 77, nr 4, 744-751 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Patients with Kostmann syndrome (severe congenital neutropenia [SCN]) typically normalize their absolute neutrophil count (ANC) upon granulocyte colony-stimulating factor (G-CSF) therapy. However, although they no longer experience life-threatening bacterial infections, they frequently still have recurrent gingivitis and even severe periodontitis, often starting in early childhood. METHODS: We studied the periodontal disease in the four surviving patients belonging to the family originally described by Kostmann. Their odontological records, x-rays, color photos, bacterial cultures, serum antibodies to oral bacteria, and histopathological examinations were reviewed. The data were also correlated to previous investigations on their antibacterial peptides and molecular biology. RESULTS: Three patients had periodontal disease, despite normal ANC and professional dental care, and had neutrophils deficient in antibacterial peptides. One of these patients also had a heterozygous mutation in the neutrophil elastase gene, had severe periodontal disease and overgrowth of the periodontal pathogen Actinobacillus actinomycetemcomitans in the dental flora, and 15 permanent teeth had been extracted by the age of 27. One bone marrow-transplanted patient had no periodontal disease. CONCLUSIONS: Normalized ANC levels are not sufficient to maintain normal oral health in SCN patients, and because neutrophils are important for first-line defense and innate immunity, the deficiency of the antibacterial peptide LL-37 probably explains their chronic periodontal disease. Professional dental care is still important for SCN patients, despite treatment with G-CSF and normal ANC levels. Whether antibacterial peptides play a role in the pathogenesis of periodontitis in other patients remains to be elucidated.

  • 13.
    Ebrahimi, Majid
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Boldrup, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Coates, Philip J
    Wahlin, Ylva-Britt
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Bourdon, Jean-Christophe
    Nylander, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Expression of novel p53 isoforms in oral lichen planus.2007Inngår i: Oral Oncology, ISSN 1368-8375, Vol. 44, nr 2, 156-161 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Oral lichen planus (OLP) is a chronic inflammatory disease of unknown origin, showing little spontaneous regression. WHO classifies OLP as a premalignant condition, however, the underlying mechanisms initiating development of cancer in OLP lesions are not understood. The p53 tumour suppressor plays an important role in many tumours, and an increased expression of p53 protein has been seen in OLP lesions. Recently it was shown that the human TP53 gene encodes at least nine different isoforms. Another member of the p53 family, p63, comprises six different isoforms and plays a crucial role in the formation of oral mucosa, salivary glands, teeth and skin. It has also been suggested that p63 is involved in development of squamous cell carcinoma of the head and neck (SCCHN). In contrast to p53, a decreased expression of p63 protein has been seen in OLP lesions. In this study, we mapped the expression of five novel p53 isoforms at RNA and protein levels in OLP and matched normal controls. In the same samples we also measured levels of p63 isoforms using quantitative RT-PCR. Results showed p53 to be expressed in all OLP lesions and normal tissues. The p53beta and Delta133p53 isoforms were expressed in the majority of samples whereas the remaining three novel isoforms analysed were expressed in only a few samples. Levels of p63 isoforms were lower in OLP lesions compared with normal tissue, however, changes were not statistically significant.

  • 14.
    Ebrahimi, Majid
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Wahlin, Ylva-Britt
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Coates, Philip J
    Sjöström, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Nylander, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Decreased expression of p63 in oral lichen planus and graft-vs.-host disease associated with oral inflammation.2006Inngår i: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 35, nr 1, 46-50 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Oral lichen planus (OLP) and graft-vs.-host disease (GVHD) are conditions with increased risk of malignant transformation to squamous cell carcinoma of the head and neck (SCCHN). The p63 gene encodes six different proteins and is expressed at high levels in SCCHN. METHODS: Biopsies from patients diagnosed with OLP and GVHD were analysed for p63 protein expression using antibodies distinguishing between the major isoforms expressed in normal epithelia, in parallel with biopsies from normal buccal mucosa and SCCHN. RESULTS: In OLP and GVHD a decreased expression of all p63 isoforms was seen, while expression of p53 protein was upregulated, compared with normal mucosa. In SCCHN, p63 was abundantly expressed and some tumours showed strong p53 staining, suggestive of p53 mutation. CONCLUSIONS: Decreased p63 and increased p53 expression in OLP and GVHD indicates a coordinated action of these two related proteins to protect the oral mucosae from the damaging effects of underlying inflammation. In SCCHN disruption of the TP53 gene and overrepresentation of certain p63 isoforms

  • 15.
    Ebrahimi, Majid
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi. Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Wahlin, Ylva-Britt
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Coates, Philip J
    Wiik, Allan
    Roos, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Nylander, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Detection of antibodies against p63 and p73 isoforms in sera from patients diagnosed with oral lichen planus.2007Inngår i: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 36, nr 2, 93-98 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Oral lichen planus (OLP) is a chronic inflammatory disease of oral mucosa. Despite numerous publications and intense research, the etiology of OLP is still unknown, however, autoimmunity as a possible causative factor has been discussed. Methods: In the present study sera from 20 patients clinically and histologically diagnosed with OLP were analyzed for antibodies directed toward p53, p63, and p73 using Western blot. Results: Sera from two patients reacted with all six p63 isoforms, and one also with p73. The strongest reaction was noted against the TAp63beta protein, which is the most potent transactivator of all p63 proteins and is implicated in the differentiation of stratified epithelia. Conclusions: This is the first demonstration of antibodies directed against all p63 and some p73 isoforms in sera from patients diagnosed with OLP.

  • 16.
    Flygare, Lennart
    et al.
    Sundebyns sjukhus, Luleå.
    Legrell, Per Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Kontrastmedel inom odontologisk radiologi2009Inngår i: Tandläkartidningen, ISSN 0039-6982, Vol. 101, nr 2, 68-73 s.Artikkel i tidsskrift (Annet vitenskapelig)
  • 17.
    Fridell, Sara
    et al.
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Ahlqvist, Jan
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    The use of dental radiographs for identification of children with unrestored dentitions.2006Inngår i: The Journal of Forensic Odonto-Stomatology, Vol. 24, nr 2, 42-46 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The success of dental identification is often dependent on the extent of previous dental care and the location of detailed dental records. However, several factors limit available comparable data among children. There are often no clinical indications for dental radiography before the age of five and many children and adolescents have no restorative care. This reduces the amount of individualizing information suitable for comparative identification. The aim of this study was to investigate matching of dental x-rays from children without fillings at different ages, and to see if radiographic expertise facilitated radiographic comparison. Five general dental practitioners (GDP) and five oral and maxillofacial radiologists (OMR) attempted to match bitewing examinations from 30 children. The results showed that dentists are likely to match bitewing radiographs in these conditions. This likelihood is further enhanced when oral and maxillofacial radiologists compare images. This suggests that manual comparison of bitewings from children allow sufficient concordant visible points for identification to occur.

  • 18.
    Häll, Lars O
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Pedagogiska institutionen.
    Söderström, Tor
    Umeå universitet, Samhällsvetenskapliga fakulteten, Pedagogiska institutionen.
    Ahlqvist, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Nilsson, Tore
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Collaborative learning with screen-based simulation in health care education: an empirical study of collaborative patterns and proficiency development2011Inngår i: Journal of Computer Assisted Learning, ISSN 0266-4909, E-ISSN 1365-2729, Vol. 27, nr 5, 448-461 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This article is about collaborative learning with educational computer-assisted simulation(ECAS) in health care education. Previous research on training with a radiological virtual reality simulator has indicated positive effects on learning when compared to a more conventional alternative. Drawing upon the field of Computer-Supported Collaborative Learning, we investigate collaborative patterns, their causes, and their implications for learning. We investigate why the extent of application of subject-specific terminology differs between simulation training and more conventional training. We also investigate how the student-simulator interaction affordances produce collaborative patterns and impact learning. Proficiency tests before and after training, observations during training, and interviews after training constitute the empirical foundation. Thirty-six dentistry students volunteered for participation. The results showed that not only the task but also the medium of feedback impacts the application of subject-specific terminology. However, no relation to proficiency development was revealed.We identified turn-taking as well as dominance patterns of student-simulator interaction but again found no relation to proficiency development. Further research may give us deeper insights into if and how these collaborative patterns, in other respects, impact collaborative learning with ECAS in health care education.

  • 19.
    Isberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    The life-threatening TMD2009Inngår i: Cranio, ISSN 0886-9634, Vol. 27, nr 1, 1-2 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 20.
    Isberg, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Kreiner, Marcelo
    Craniofacial pain: authors' response2007Inngår i: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 138, nr 4, 440-441 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 21.
    Isberg, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Salé, Hanna
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Recalling pain: author's response2011Inngår i: The Journal of the American Dental Association (1939), ISSN 0002-8177, Vol. 142, nr 1, 24-24 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 22.
    Isberg, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Salé, Hanna
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    TMJ and whiplash: reply2007Inngår i: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 138, nr 11, 1422-1422 s.Artikkel i tidsskrift (Annet vitenskapelig)
  • 23.
    Johansson, Elias P
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Ahlqvist, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Garoff, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Karp, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi.
    Levring Jäghagen, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Ultrasound screening for asymptomatic carotid stenosis in subjects with calcifications in the area of the carotid arteries on panoramic radiographs: a cross-sectional study2011Inngår i: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 11, nr 44, 1-9 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Directed ultrasonic screening for carotid stenosis is cost-effective in populations with > 5% prevalence of the diagnosis. Occasionally, calcifications in the area of the carotid arteries are incidentally detected on odontological panoramic radiographs. We aimed to determine if directed screening for carotid stenosis with ultrasound is indicated in individuals with such calcifications. Methods: This was a cross-sectional study. Carotid ultrasound examinations were performed on consecutive persons, with findings of calcifications in the area of the carotid arteries on panoramic radiography that were otherwise eligible for asymptomatic carotid endarterectomy. Results: Calcification in the area of the carotid arteries was seen in 176 of 1182 persons undergoing panoramic radiography. Of these, 117 fulfilled the inclusion criterion and were examined with carotid ultrasound. Eight persons (6.8%; 95% CI 2.2-11.5%) had a carotid stenosis - not significant over the 5% pre-specified threshold (p = 0.232, Binomial test). However, there was a significant sex difference (p = 0.008), as all stenoses were found in men. Among men, 12.5% (95% CI 4.2-20.8%) had carotid stenosis - significantly over the 5% pre-specified threshold (p = 0.014, Binomial test). Conclusions: The incidental finding of calcification in the area of the carotid arteries on panoramic radiographs should be followed up with carotid screening in men that are otherwise eligible for asymptomatic carotid endarterectomy.

  • 24.
    Jungner, Måns
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Käkkirurgi. Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Legrell, Per Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Lundgren, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Käkkirurgi.
    Follow-up study of implants with turned or oxidized surfaces placed after sinus augmentation2014Inngår i: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, Vol. 29, nr 6, 1380-1387 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To compare long-term survival and clinical outcomes of endosseous implants with different surface characteristics in patients with sinus elevation procedures, autologous bone grafting, and delayed implant placement. Materials and Methods: Implant survival, peri-implant soft tissue conditions, marginal bone level, intrasinus apical bone level, and sinus health were studied in patients subjected to autologous bone graft and delayed placement of implants with turned or oxidized surfaces. After a minimum of 5 years of functional loading, all patients were clinically examined regarding gingival pocket depth (PD) and bleeding on probing (BoP). The marginal bone level (MBL) was measured in intraoral radiographs. Cone beam computed tomography was used to evaluate the apical bone level (ABL) of the implants and intrasinus conditions. Results: Twenty-eight patients received sinus elevation and a total of 92 dental implants. Thirteen patients received 47 implants with a turned surface, and 15 patients received 45 implants with an oxidized surface. Mean follow-up was 10 years (range, 5 to 19 years). No significant difference was found between the two implant surfaces in terms of PD, BoP, MBL, or ABL. Four patients (14%) exhibited radiographic signs of sinus pathology, with opacification, polyplike structures, and thickening of the sinus membrane. Radiographic signs of sinus pathology were not correlated to implant survival or to the investigated parameters. Conclusion: Grafting of the maxillary sinus floor with intraorally harvested bone and delayed placement of either turned or oxidized implants results in equally high long-term survival rates, stable marginal and apical bone levels, and good peri-implant soft tissue health.

  • 25.
    Jäghagen, Eva Levring
    et al.
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Berggren, Diana
    Umeå universitet, Medicinsk fakultet, Klinisk vetenskap, Öron- näs- och halssjukdomar.
    Dahlqvist, Ake
    Umeå universitet, Medicinsk fakultet, Klinisk vetenskap, Öron- näs- och halssjukdomar.
    Isberg, Annika
    Prediction and risk of dysphagia after uvulopalatopharyngoplasty and uvulopalatoplasty.2004Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, Vol. 124, nr 10, 1197-1203 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To test the hypothesis that preoperative asymptomatic pharyngeal swallowing dysfunction predisposes for the development of symptoms of dysphagia after uvulopalatopharyngoplasty (UPPP) and uvulopalatoplasty (UPP). MATERIAL AND METHODS: A total of 42 patients who snored were scheduled to undergo UPPP (n = 20) or UPP (n = 22). UPP was performed using either a CO2 laser or a conventional steel scalpel. Preoperatively and 1 year postoperatively all patients were examined videoradiographically to assess pharyngeal swallowing function. They also completed a questionnaire pre- and postoperatively concerning their snoring problems and swallowing function as well as the outcome of surgery. RESULTS: Preoperatively, 7 (17%) patients reported dysphagia. Pharyngeal swallowing dysfunction was demonstrated in 6/7 patients with preoperative dysphagia while pharyngeal swallowing dysfunction was evident preoperatively in 18/35 non-dysphagic patients. Of the 35 patients without preoperative dysphagia, 10 (29%/) developed dysphagia after surgery. There was no significant risk of development of postoperative dysphagia for patients with compared to patients without preoperative pharyngeal swallowing dysfunction. Only one of the seven patients with preoperative dysphagia experienced worsening of the problem. A total of 93% of the patients reported a decrease in snoring and 95% reported a decrease in daytime sleepiness. CONCLUSIONS: Preoperative pharyngeal swallowing dysfunction was not proven to predict the development of dysphagia after UPPP or UPP. The surgical method did not influence the frequency of postoperatively acquired dysphagia. The results do not indicate that patients with preoperative dysphagia should be excluded from treatment with UPPP or UPP.

  • 26.
    Kreiner, Marcelo
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Craniofacial pain of cardiac origin: an interdisciplinary study2011Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Referred pain is frequently associated with misdiagnosis and unnecessary therapy directed to the pain location instead of its origin. When craniofacial pain is the sole symptom of myocardial ischemia, failure to recognize its cardiac source can endanger the patient. In particular, patients with acute myocardial infarction (AMI) who do not experience chest pain run a very high risk of misdiagnosis and death. Pain that is limited to the craniofacial region during myocardial ischemia has so far been described only in case reports and its overall prevalence is unknown. Experimental research in animals suggests a vagal involvement in the pathological mechanisms of cardiac pain referred to the face.

    The aim of this study was to gain knowledge about the prevalence, clinical characteristics and possible mechanisms of craniofacial pain of cardiac origin, in order to improve the clinician’s ability to make a correct diagnosis. It was hypothesized that the quality of craniofacial pain from cardiac versus dental origin would differ, implying a high diagnostic validity. It was also hypothesized that craniofacial pain can be the sole symptom of a prodromal (pre-infarction) angina episode and that this pain location would be especially associated with cardiac ischemia in the areas more densely innervated by vagal afferent fibres.

    The study group was comprised of consecutive patients who experienced craniofacial pain of a verified cardiac (n=326) or dental (n=359) origin. Demographic details on age, gender and pain characteristics (location, quality and intensity) were assessed in both groups. Cardiovascular risk factors, cardiac diagnosis and ECG signs of ischemia were also assessed in the cardiac pain group. Ethics approval and informed consent for each patient was obtained.

    Craniofacial pain was found to be the sole symptom of myocardial ischemia in 6% of patients and was the sole symptom of an AMI in 4% of patients; this craniofacial pain was more prevalent in women (p=0.031). In those patients without chest pain, it was the most frequent pain location and was the only symptom of prodromal angina in 5% of AMI patients. The craniofacial pain included the throat, the jaws, the temporomandibular joints/ears and the teeth, mainly bilaterally. The pain quality descriptors “pressure” and “burning” were statistically associated with pain of cardiac origin, while “throbbing” and “aching” were associated with an odontogenic cause (p<0.001). In myocardial ischemia patients, the occurrence of craniofacial pain was associated with an inferior localization of ischemia in the heart (p<0.001).

    In conclusion, this study showed that pain in the craniofacial region could be the sole symptom of cardiac ischemia and AMI, particularly in women. Craniofacial pain of cardiac origin was commonly bilateral, with the quality pain descriptors “pressure” and “burning”, and pain provocation with physical activity and pain relief at rest. The association between the presence of craniofacial pain and inferior wall ischemia suggests a vagal involvement in the mechanisms of cardiac pain referred to the craniofacial region. Since the possibility of misdiagnosis and death in this group of patients is high, awareness of this clinical presentation needs to be brought to the attention of researchers, clinicians and the general public.

  • 27.
    Kreiner, Marcelo
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Alvarez, Ramón
    Waldenström, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Michelis, Virginia
    Muñiz, Rosana
    Isberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Craniofacial pain of cardiac origin is associated with inferior wall ischemia2014Inngår i: Journal of oral & facial pain and headache, ISSN 2333-0384, Vol. 28, nr 4, 317-321 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: To investigate possible associations between the presence of craniofacial pain of cardiac origin and the location of cardiac ischemia and conventional risk factors. Methods: A total of 326 consecutive patients with confirmed myocardial ischemia (192 males, 134 females, mean age 64 years) were studied. Demographic details, health history, risk factors, prodromal symptoms, electrocardiogram (ECG) findings, and pain characteristics during the ischemic episode were assessed. The location of the ischemia according to the ECG findings was categorized as anterior, inferior, or lateral. Univariate chi-square analyses and a multivariate logistic regression model were used for data analysis. Two age subgroups (< 65 and > 65) were established when controlling for covariates. Results: Craniofacial pain of cardiac origin was significantly associated with an inferior localization of cardiac ischemia (P < .001) and was more frequently reported in diabetic patients (P = .014). Thirty-eight patients (12%) did not experience chest pain during the myocardial ischemia. Nine patients (3%) experienced a prodromal angina episode without chest pain. Conclusion: The occurrence of craniofacial pain during myocardial ischemia, with or without an acute myocardial infarction, was associated with ischemia within the inferior wall. This result suggests the involvement of the vagal afferent system in the mechanisms of craniofacial pain of cardiac origin.

  • 28.
    Kreiner, Marcelo
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Falace, D
    Michelis, V
    Okeson, JP
    Isberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Quality difference in craniofacial pain of cardiac vs. dental origin2010Inngår i: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 89, nr 9, 965-969 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Craniofacial pain, whether odontogenic or caused by cardiac ischemia, is commonly referred to the same locations, posing a diagnostic challenge. We hypothesized that the validity of pain characteristics would be high in assessment of differential diagnosis. Pain quality, intensity, and gender characteristics were assessed for referred craniofacial pain from dental (n = 359) vs. cardiac (n = 115) origin. The pain descriptors "pressure" and "burning" were statistically associated with pain from cardiac origin, while "throbbing" and "aching" indicated an odontogenic cause. No gender differences were found. These data should now be added to those craniofacial pain characteristics already known to point to acute cardiac disease rather than dental pathology, i.e., pain provocation/aggravation by physical activity, pain relief at rest, and bilateralism. To initiate prompt and appropriate treatment, dental and medical clinicians as well as the public should be alert to those clinical characteristics of craniofacial pain of cardiac origin.

  • 29.
    Kreiner, Marcelo
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Okeson, Jeffrey P
    Michelis, Virginia
    Lujambio, Mariela
    Isberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Craniofacial pain as the sole symptom of cardiac ischemia: a prospective multicenter study2007Inngår i: The Journal of the American Dental Association (1939), ISSN 0002-8177, Vol. 138, nr 1, 74-79 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Craniofacial pain can be the only symptom of cardiac ischemia. Failure to recognize its cardiac source can put the patient's life at risk. The authors conducted a study to reveal the prevalence of, the distribution of and sex differences regarding craniofacial pain of cardiac origin.

    METHODS: The authors prospectively selected consecutive patients (N = 186) who had had a verified cardiac ischemic episode. They studied the location and distribution of craniofacial and intraoral pain in detail.

    RESULTS: Craniofacial pain was the only complaint during the ischemic episode in 11 patients (6 percent), three of them who had acute myocardial infarction (AMI). Another 60 patients (32 percent) reported craniofacial pain concomitant with pain in other regions. The most common craniofacial pain locations were the throat, left mandible, right mandible, left temporomandibular joint/ear region and teeth. Craniofacial pain was pre-ponderantly manifested in female subjects (P = .031) and was the dominating symptom in both sexes in the absence of chest pain.

    CONCLUSIONS: Craniofacial pain commonly is induced by cardiac ischemia. This must be considered in differential diagnosis of toothache and orofacial pain.

    CLINICAL IMPLICATIONS: Because patients who have AMI without chest pain run a higher risk of experiencing a missed diagnosis and death, the dentist's awareness of this symptomatology can be crucial for early diagnosis and timely treatment.

  • 30.
    Legrell, P E
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Nyquist, H
    Umeå universitet, Samhällsvetenskapliga fakulteten, Statistiska institutionen.
    Isberg, A
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Validity of identification of gonion and antegonion in frontal cephalograms2000Inngår i: Angle orthodontist, ISSN 0003-3219, E-ISSN 1945-7103, Vol. 70, nr 2, 157-64 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study was designed to develop a method of transferring gonion from lateral to frontal cephalograms, and to use this method as gold standard when evaluating observer performance in identifying gonion in frontal cephalograms. Observer ability to identify antegonion was also evaluated. There was a range of 28 mm in the observers' identification of gonion and a statistically significant deviation from gold standard. The factors "observer" and "cephalogram," regarded as random effects in an ANOVA analysis, and their interaction, each influenced the result, P < .001. The deviation from the mean of all observations for antegonion ranged 8 mm with "cephalogram" having a statistically significant influence. The results suggest that neither gonion nor antegonion can be routinely used as valid landmarks in frontal cephalograms. Gonion can, however, be used if first identified in a lateral cephalogram and transferred to a paired frontal cephalogram aided by radiographic indicators combined with a bilateral scrutiny of projection geometry in different planes through gonion and indicator.

  • 31.
    Levring Jäghagen, Eva
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Nielun toiminnan häiriöt vaarantavat terveyden ja heikentävät elämänlaatua, Videofluorografia avuksi2009Inngår i: Suomen Hammasläökärilehti, ISSN 0355-5094, Vol. 16, nr 3, 58-69 s.Artikkel i tidsskrift (Annet vitenskapelig)
  • 32.
    Levring Jäghagen, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Svalgfunktionen: videoradiografisk undersökning under sväljning och tal2009Inngår i: Tandläkartidningen, ISSN 0039-6982, Vol. 101, nr 1, 68-78 s.Artikkel i tidsskrift (Annet vitenskapelig)
  • 33.
    Levring Jäghagen, Eva
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Videografisk undersökning av svalgfunktion under tal och sväljning2009Inngår i: Tandlægebladet, ISSN 0039-9353, Vol. 113, nr 2, 92-105 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Att ha ett svårförståeligt tal är ett socialt handikapp som kan misstolkas som att individen har en intellektuell funktionsnedsättning. Sväljningssvårigheter som aspiration med hosta och risk för kvävning, kan i värsta fall vara livshotande men också socialt och fysiskt handikappande eftersom måltiden är viktig såväl i det sociala umgänget som för nutrition.

    Svalget (farynx) utgör förbindelsen mellan näsa och mun till struphuvudet (larynx) och matstrupen (esofagus). Farynx är därmed delaktig i de livsuppehållande funktionerna andning och sväljning samt under tal, hostning, kräkning och kväljning. Farynxdysfunktion kan ge  avvikande tal, sväljningssvårigheter, snarkning, sömnapné och kan i värsta fall leda till kvävning.

    Videoradiografisk undersökning är en viktig del vid bedömning av avvikelser i farynx funktion under tal och sväljning samt som underlag för val av behandlingsstrategi. Bariumsulfatbaserad kontrastmedel används vid undersökningarna för att visualisera mjukvävnaderna i farynx under tal samt som bolus vid bedömning av tugg- och sväljningsfunktion.

  • 34.
    Levring Jäghagen, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Videoradiografisk undersökning av svalgfunktion under tal och sväljning2009Inngår i: Den norske tannlegeforenings tidende, ISSN 0029-2303, Vol. 119, nr 1, 38-47 s.Artikkel i tidsskrift (Annet vitenskapelig)
  • 35.
    Levring Jäghagen, Eva
    et al.
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Bodin, Ingrid
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Isberg, Annika
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Pharyngeal swallowing dysfunction following treatment for oral and pharyngeal cancer: Association with diminished intraoral sensation and discrimination ability2008Inngår i: Head and Neck, ISSN 1043-3074, Vol. 30, nr 10, 1344-1351 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background.

    Swallowing disorders following treatment for oral and pharyngeal cancer are mainly considered a surgical sequel. The recent finding that radiotherapy-induced decline in intraoral sensory abilities established an incentive to elucidate any association between the degree of sensory decline and the degree of swallowing dysfunction.

    Methods.

    Oral and pharyngeal swallowing was cineradiographically examined in 15 patients with oral or pharyngeal cancer before and after treatment. The patients were also tested for intraoral sensation, shape recognition, and hole size identification.

    Results.

    Swallowing function deteriorated in 67% of the patients 6 months posttreatment, with no significant improvement after 12 months. The degree of swallowing dysfunction was statistically significantly associated with the degree of diminished intraoral sensation and shape recognition.

    Conclusion.

    In the quest for rehabilitation after treatment for oral and pharyngeal cancer, the impact of impaired intraoral sensation and discrimination ability on swallowing function should be taken into consideration

  • 36.
    Levring Jäghagen, Eva
    et al.
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Franklin, KA
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin.
    Isberg, A
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Snoring, sleep apnoea and swallowing dysfunction: a videoradiographic study2003Inngår i: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, Vol. 32, nr 5, 311-316 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Snoring is associated with subclinical pharyngeal swallowing dysfunction, probably owing to vibration trauma to the pharyngeal tissues caused by snoring. Negative intrathoracic pressure during apnoea causes stretching of the velum and pharynx. The aim of this study was to investigate whether patients with severe sleep apnoea have an increased frequency of videoradiographically diagnosed subclinical pharyngeal swallowing dysfunction compared with snoring patients with or without mild sleep apnoea as well as with non-snoring controls. METHODS: Eighty consecutive patients referred for sleep apnoea recordings because of snoring were examined. Fourteen of these patients were excluded because they suffered from dysphagia. Fifteen non-snoring, non-dysphagic volunteers served as controls. Videoradiography was performed to examine the oral and pharyngeal swallowing function in patients and controls. Overnight sleep apnoea recordings were used to evaluate the apnoea-hypopnoea index (AHI). RESULTS: Pharyngeal swallowing dysfunction was observed in 34/66 (52%) of the snoring patients and in 1/15 (7%) of the non-snoring controls. Pharyngeal swallowing dysfunction was observed in 50% of patients with an AHI of >or=30, in 61% of patients with an AHI of 5-29 and in 43% of patients with an AHI of <5. There was no significant difference in the frequency of pharyngeal swallowing dysfunction between snoring patients with different AHIs. CONCLUSION: Snoring patients run an increased risk of developing subclinical pharyngeal swallowing dysfunction independent of concomitant sleep apnoea.

  • 37. Lindgren, Christer
    et al.
    Mordenfeld, Arne
    Hallman, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    A Prospective 1-Year Clinical and Radiographic Study of Implants Placed after Maxillary Sinus Floor Augmentation with Synthetic Biphasic Calcium Phosphate or Deproteinized Bovine Bone2012Inngår i: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, Vol. 14, nr 1, 41-50 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The technique of using bone grafts or different biomaterials for augmentation of the maxillary sinus prior to implant placement is well accepted by clinicians. However, clinical documentation of some bone substitutes is still lacking.

    Purpose: This prospective study was designed to evaluate the success rate of implants placed after maxillary sinus augmentation with a novel synthetic biphasic calcium phosphate (BCP) or deproteinized bovine bone (DBB), the latter acting as control.

    Material and Methods: Nine edentulous patients and two partially edentulous patients with a mean age of 67 years with a bilateral need for sinus augmentation, < 5 mm residual bone in the floor of the sinus and a crestal width 34 mm, were included in the study. After bilateral elevation of the Schneiderian membrane, all patients were randomized for augmentation with synthetic BCP in one side and DBB in the contralateral side. After 8 months of graft healing, 62 implants with an SLActive surface were placed. Implant survival, graft resorption, plaque index, bleeding on probing, sulcus bleeding index, probing pocket depth, and implant success rate were evaluated after 1 year of functional loading.

    Results: After a mean of 118 days, all patients received their fixed prosthetic constructions. One implant was lost in each biomaterial, giving an overall survival rate of 96.8%. Success rates for implants placed in BCP and DBB were 91.7 and 95.7%, respectively. No significant difference in marginal bone loss was found around implants placed in BCP, DBB, or residual bone, respectively. The mean graft resorption was 0.43 mm (BCP) and 0.29 mm (DBB).

    Conclusion: In this limited study, implant success rate was not dependent on the biomaterial used for maxillary sinus augmentation. Similar results were found after 1 year of functional loading for implants placed after sinus augmentation using BCP or DBB.

  • 38.
    Marklund, Marie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Ortodonti.
    Legrell, Per Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    An orthodontic oral appliance2010Inngår i: Angle orthodontist, ISSN 0003-3219, Vol. 80, nr 6, 1116-1121 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: This pilot study was performed to test the hypothesis that an orthodontic oral appliance (OA) that is designed to work against the backwardly directed forces on the upper incisors may counteract the reduction in overjet from these devices.

    MATERIALS AND METHODS: Thirty patients with normal bites, good oral health, and milder sleep apnea were randomized to treatment with either OAs or orthodontic OAs. Bite changes were evaluated on plaster casts and radiographs and by questionnaires after a mean of 2.4 years in 19 frequent users.

    RESULTS: Four of nine patients in the orthodontic OA group increased their overjet by > or =0.4 mm, while none of the 10 patients in the OA group experienced that effect.

    CONCLUSION: Only the orthodontic OA increases the overjet; this design may therefore be beneficial to patients at risk of negative effects on their bite during OA treatment.

  • 39.
    Moberg Wing, Anncatherine
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning. Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk kemi och biofysik. Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Absorption and accumulation of cadmium from cereal grains1993Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Cadmium (Cd) is a potentially toxic trace element. Cereal grains contribute one-third to one-half of the Cd exposure via the diet. Among cereal grains, wheat generally contains the highest Cd concentration and the bran and germ fractions contain more Cd than the endosperm. An increase in the consumption of unrefined grains may cause an increase in the body burden of Cd if an increase in the exposure to Cd via the diet leads directly to increased Cd absorption and accumulation. However, there is evidence that certain factors may reduce the availability of Cd for absorption from the diet.

    The purposes of these studies were to refine an atomic absorption spectrometric method for measuring the accumulation of Cd from diets with low, naturally occuring concentrations of Cd, to evaluate the extent to which Cd is accumulated from different milling fractions of wheat and from different cereal grains, and to determine to what extent the presence of certain minerals and mineral-binding factors in the diet and the iron (Fe) status of the individual affect Cd accumulation from cereal grain diets.

    The results of the method studies showed that the amount of Cd in the liver and kidneys of rats after six weeks on different diets and the retention of 109Cd in these organs three weeks after the ingestion of 109Cd-labelled test meals of the diets were in agreement on the fractional and total accumulation of Cd from the diets.

    To a first approximation, the accumulation of Cd in the liver and kidneys in rats appears to be the product of the separate effects of the concentration of Cd in the diet which is available for absorption and the Fe status of the rats.

    The Cd concentration in grains varied by a factor of five between whole wheat and rye and the amounts of Cd accumulated in rats from diets with whole grains were nearly proportional to the Cd concentrations in the grains.

    The fractional accumulation of Cd was lower in rats given diets with whole grains or wheat fractions high in fiber and phytic acid than in rats fed endosperm wheat diets. This lower fractional Cd accumulation did not compensate for the high Cd concentrations in whole wheat and wheat bran.

    The fractional accumulation of Cd in the liver of rats is inversely related to their Fe status. The fractional Cd accumulation in the liver of rats with low Fe status was as much as ten times that in rats with high Fe status. The Cd accumulation in the kidneys appears to be even more sensitive to Fe status.

    The accumulation of Cd in human placenta supports these conclusions. Women who eat diets with less cereal grain fiber and who also maintain their Fe stores during pregnancy generally accumulate less Cd in the placenta than those who eat more grain fiber and/or have lower Fe status.

    On the basis of these results, it is recommended that as much as possible of the dietary fiber from cereal grains should derive from grains with low Cd concentrations. It is also imperative that the diet provide sufficient Fe and other nutrients to promote Fe status and thereby limit Cd accumulation.

  • 40.
    Nilsson, Tore A
    et al.
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Hedman, Leif
    Umeå universitet, Samhällsvetenskaplig fakultet, Psykologi.
    Ahlqvist, Jan B
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    A Randomized Trial of Simulation-Based Versus Conventional Training of Dental Student Skill at Interpreting Spatial Information in Radiographs.2007Inngår i: The Journal of the Society for Simulation in Healthcare.: Simulation in Healthcare:, ISSN 1559-2332, Vol. 2, nr 3, 164-169 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Abstract Introduction: A radiology simulator has been developed. We tested the simulator with students in an oral radiology program for training interpretation of spatial relations in radiographs utilizing parallax. The aim of the study was to compare learning outcome regarding interpretative skill after training in the simulator vs. after conventional training.

    Methods: Fifty-seven dental students voluntarily participated in a randomized experimental study. The participants' proficiency in interpretation of spatial information in radiographs and their visual-spatial ability was assessed. Proficiency was assessed by a test instrument designed by the authors and visual-spatial ability with the Mental Rotations Test, version A (MRT-A). Randomization to training group was based on pre-training proficiency test results. The experimental group trained in the simulator and the control group received conventional training. Training lasted for 90 minutes for both groups. Immediately after training a second proficiency test was performed.

    Results: The proficiency test results were significantly higher after training for the experimental group (P <= 0.01), but not for the control group. Univariate variance analysis of difference in proficiency test score revealed a significant interaction effect (P = 0.03) between training group and MRT-A category; in the experimental group there was a stronger training effect among students with low level of MRT-A.

    Conclusions: Training in the simulator improved skill in interpreting spatial information in radiographs when evaluated immediately after training. For individuals with low visual-spatial ability simulator based training seems to be more beneficial than conventional training.

  • 41.
    Nilsson, Tore A.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi. Univ Hosp, Oral & Maxillofacial Radiol Clin, SE-90185 Umea, Sweden.
    Hedman, Leif R
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Ahlqvist, Jan B
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Dental student skill retention eight months after simulator-supported training in oral radiology2011Inngår i: Journal of dental education, ISSN 1930-7837, Vol. 75, nr 5, 679-684 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this project was to investigate the long-term effects on skill to interpret spatial information in radiographs after conventional and simulator-supported training. The study was a follow-up of a previously reported randomized experimental study. The original study population was comprised of fifty-seven dental students. Forty-five individuals agreed to participate in a follow-up study eight months after completion of the original study. During the time interval between completion of the previous study and the follow-up study, the participants underwent an examination in oral radiology and had theoretical and clinical training in other topics than oral radiology. Skill at interpreting spatial information in radiographs was assessed with a previously used test instrument. The test instrument was identical with the instrument used for baseline assessment in the original study. The results showed that the skill to interpret spatial relations in radiographs eight months after completion of simulator-supported training was significantly better (p=0.01) than before training. The conventional training showed almost the same pattern, but the difference was smaller and not statistically significant (p=0.11). It is concluded that simulator-supported training is a valuable adjunct to conventional educational methods in oral radiology.

  • 42.
    Nilsson, Tore
    et al.
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Ahlqvist, Jan
    Johansson, Magnus
    Isberg, Annika
    Virtual reality for simulation of radiographic projections: validation of projection geometry2004Inngår i: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, Vol. 33, nr 1, 44-50 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To develop a software for virtual reality (VR) simulation of X-ray images based on perspective projections through a patient model derived from data from a CT examination and to evaluate the accuracy in the projection geometry obtained by the software.

    Methods: A VR software was developed on a personal computer, with models of a patient, an X-ray machine and a detector. The model of the patient was derived from data from a CT examination of a dry skull. Simulated radiographic images of the patient model could be rendered as perspective projections based on the relative positions between the models. The projection geometry of the software was validated by developing an artificial CT data set containing high attenuation points as objects to be imaged. The accuracy in projection geometry was evaluated in a systematic way. The distances between two dots, representing the projected test points in the simulated radiographic images, were measured. They were compared with theoretical calculations of the corresponding distances using traditional mathematical tools.

    Results: The difference between the simulated and calculated projected distances never exceeded 0.5 mm. The error in simulated projected distances was in most cases within 1%. No systematic errors were revealed.

    Conclusion: The software, developed for personal computers, can produce simulated X-ray images with high geometric accuracy based on perspective projections through a CT data set. The software can be used for simulation of radiographic examinations.

  • 43.
    Nilsson, Tore
    et al.
    Umeå universitet, Medicinsk fakultet, Odontologi.
    Hedman, Leif
    Umeå universitet, Samhällsvetenskaplig fakultet, Psykologi.
    Ahlqvist, Jan
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi. Oral diagnostisk radiologi.
    Visual-spatial ability and interpretation of three-dimensional information in radiographs2007Inngår i: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, Vol. 36, 86-91 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To investigate whether skill in the interpretation of three-dimensional (3D) information in radiographs utilizing the parallax phenomenon is associated with visual-spatial ability and whether development of this skill is related to visual-spatial ability.

    Methods: Eighty-six individuals with a median age of 25 years participated in the study. It was organized into three parts: (1) assessment before training, (2) training in object depth localization utilizing parallax and (3) assessment after training. Before training, visual-spatial ability was assessed with a mental rotation test, MRT-A; skill in interpreting 3D information was assessed with two specifically designed proficiency tests: a radiography test, which assessed the ability to interpret 3D information in radiographs utilizing motion parallax and a principle test which assessed understanding of the principles of motion parallax. After training, skill in interpreting 3D information was reassessed. Improvement was defined as the difference between test scores after training and before training. Multiple linear regression was used to analyse the effect of student and training characteristics on proficiency test results and improvement.

    Results: Radiography test results after training and improvement of radiography test results were significantly associated with MRT-A scores (P<0.001 and P=0.020, respectively). Principle test results were high before training and did not improve after training. The test results were associated with MRT-A both before (P=0.009) and after training (P=0.003).

    Conclusions: Understanding of the parallax phenomenon is associated with visual-spatial ability. Development of the skill to interpret 3D information in radiographs utilizing parallax is facilitated for individuals with high visual-spatial ability.

  • 44.
    Nylander, Elisabet
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Dermatologi och venereologi.
    Wahlin, Ylva-Britt
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Lundskog, B
    Umeå universitet, Medicinsk fakultet, Medicinsk biovetenskap, Patologi.
    Wahlin, Anders
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Medicin.
    Genital graft-versus-host disease in a male following allogeneic stem cell transplantation2007Inngår i: Acta Dermato-Venereologica, ISSN 0001-5555, Vol. 87, nr 4, 367-368 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 45.
    Nylander Lundqvist, Elisabet
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Dermatologi och venereologi.
    Wahlin, Ylva-Britt
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Bergdahl, M
    Umeå universitet, Medicinsk fakultet, Odontologi.
    Bergdahl, Jan
    Umeå universitet, Samhällsvetenskaplig fakultet, Psykologi.
    Psychological health in patients with genital and oral erosive lichen planus2006Inngår i: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, Vol. 20, nr 6, 661-666 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Erosive lichen planus is a severe, recurrent and recalcitrant disease that affects several mucosal areas, mostly the genital area and the mouth, but also, for example, the oesophagus and perianal area. The disease causes serious symptoms, because of the raw, de-epithelialized mucosa and healing with scars/adhesions, which affect the patient's life in many ways. It causes, for example, difficulties in eating, drinking and going to the bathroom. Treatment is complicated and, so far, few therapeutic drugs other than steroids have been reported. OBJECTIVES: As the disease has severe implications on the patient's life it is important to investigate the psychological health of the patients, as well as the influence of stress on their health and wellbeing, in order to improve treatment. STUDY DESIGN, SUBJECTS AND METHODS: Forty-nine consecutive patients with erosive lichen planus were included during a 1-year period. The study was carried out as 'state-of-the-last-month', and stress, state anxiety, depression and 'erosive lichen planus factors', i.e. symptoms affecting daily life, were assessed. RESULTS: Eighty-seven per cent of the patients had symptoms, severely affecting daily life. Unexpectedly, oral symptoms seemed to be the most prominent. Our results showed that depression, anxiety and stress were more common in patients with erosive lichen planus than in a control group. DISCUSSION AND CONCLUSIONS: Erosive lichen planus is a severe disease with symptoms and complications affecting the patient's life. Our results indicate that their psychological health is also affected and emphasize the need for close collaboration between physicians, dentists with special knowledge in oral medicine and counsellors/psychologists to optimize handling of these patients.

  • 46.
    Nyström, Elisabeth
    et al.
    Umeå universitet, Medicinsk fakultet, Odontologi. Umeå universitet, Medicinsk fakultet, Odontologi, Käkkirurgi.
    Ahlqvist, Jan
    Umeå universitet, Medicinsk fakultet, Odontologi. Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Gunne, Johan
    Umeå universitet, Medicinsk fakultet, Odontologi.
    Kahnberg, KE
    10-year follow-up of onlay bone grafts and implants in severely resorbed maxillae.2004Inngår i: International Journal of Oral and Maxillofacial Surgery, Vol. 33, nr 3, 258-62 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Thirty patients with extremely resorbed maxillae had reconstructive bone grafts from the ala iliaca and endosseous implants in a one-stage procedure. The first ten patients constituted a development group and the following 20 patients a routine group. The marginal bone level and implants success rate was evaluated in a prospective long-term follow-up for a minimum of 10 years (10-13 years). Clinical and radiographic examinations were performed at 6 months and then annually up to 5 years. The final examinations were performed at the 10-year follow-up. The bridges were removed at every clinical examination. Marginal bone loss was seen up to the 3-year examination, where it averaged 4.6 mm in the routine group. Between the 3- and 10-year follow-up no significant change was registered. The initial bone loss was probably due to the design of the 3.6 mm conical unthreaded marginal part of the implant. The implant success rate was 83.1% in the routine group. Failures mostly occurred during the first 2 years (14 out of 20). A substantial amount of bone can be gained in patients with extremely resorbed maxillae, when treated with bone graft according to the procedure described in this study.

  • 47.
    Nyström, Elisabeth
    et al.
    Umeå universitet, Medicinsk fakultet, Odontologi, Käkkirurgi.
    Ahlqvist, Jan
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Legrell, Per Erik
    Umeå universitet, Medicinsk fakultet, Odontologi, Oral diagnostisk radiologi.
    Kahnberg, K E
    Bone graft remodelling and implant success rate in the treatment of the severely resorbed maxilla: a 5-year longitudinal study.2002Inngår i: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, Vol. 31, nr 2, 158-164 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A total of 30 patients, 10 in a developmental group and 20 in a routine group, with extremely resorbed maxillae were treated with bone grafting from the hip and implant placement in a one-stage procedure. All patients were followed for a minimum of 5 years and were examined regarding the long-term success rate of the implants and marginal bone level. The implant success rate was 74.6% for the whole patient group and 85.8% for the routine group, after 5 years. The marginal bone along the implant surface decreased continuously, up to 3 years and thereafter the bone level stabilized. In the routine group, changes in bone graft dimensions over time were also evaluated by computerized tomography. The mean height of the bone graft postoperatively at all implant sites was 8.3 mm. The total mean bone height, including bone graft and residual alveolar crest, was 12.4 mm. After 5 years the total bone height had decreased to a mean of 10 mm. The mean width of the bone graft was 12 mm postoperatively and 8.7 mm at the 5-year examination. A substantial amount of bone can be gained in patients with extremely resorbed maxillae, when treated with bone graft according to the procedure described in this study.

  • 48.
    Salé, Hanna
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Temporomandibular joint sequelae after whiplash trauma.: Long-term, prospective, controlled study2011Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Whiplash-related injuries and manifestations, typically neck pain, following car collisions are known to potentially disable individuals with a high and increasing cost to society. There is limited knowledge regarding the temporomandibular joint (TMJ) sequelae following whiplash trauma. Previous studies are typically based on retrospective data and few follow-ups are prospective and controlled in design. Furthermore, previous follow-ups have not included magnetic resonance (MR) imaging, which is a prerequisite for verification of TMJ status.

    The aims of this prospective long-term study were (i) to determine frequency of inaccurate recall of TMJ symptoms in patients with a history of whiplash trauma, and (ii) to evaluate incidence, prevalence and progression of TMJ pathology, verified with MR imaging, and TMJ symptoms in patients after whiplash trauma, compared with the natural course in matched volunteers.

    We studied 60 consecutive patients who had neck symptoms following a rear-end car collision and were seen at a hospital emergency department. Bilateral TMJ MR imaging and clinical examination were performed at inception and at follow-up on average 15 years later. A self-administered questionnaire regarding TMJ symptoms (pain, dysfunction, or both) and a subsequent interview were performed at inception, at the one-year, and 15-year follow-up. Fifty-seven patients (95%) participated in all three examinations (85% for MR imaging examinations). Concurrently, 53 volunteers matched by age and sex followed the same protocol. Fifty volunteers (94%) participated in all three examinations (89% for MR imaging examinations). Ethics approval of the study protocol and informed consent from all participants was obtained.

    The calculated agreement between each patient’s inceptive and retrospective reports on TMJ symptoms yielded a kappa value of 0.41 (95% CI 0.18-0.64). Sixteen patients (40%) had inaccurate recall one year after whiplash trauma. There was no statistically significant difference in TMJ symptoms reported by the patients to be present before whiplash trauma compared with matched volunteers at inception. Prevalence of TMJ symptoms increased significantly with whiplash trauma and the increase remained stable throughout the 15-year study period, which contrasted to the natural course in volunteers. After one year the difference in prevalence between patients and volunteers was 54% versus 21% (p=0.0003) and after 15 years 49% versus 18% (p=0.0017). There was no statistically significant difference between patients and volunteers in prevalence of TMJ disc displacement either at inception (63% versus 53%) or at 15-year follow-up (63% versus 55%). TMJ disc displacement was significantly more prevalent in symptomatic volunteers compared with asymptomatic volunteers (89% versus 31%, p=0.0002). Incidence or progression of MR imaging verified TMJ pathology did not differ between patients and volunteers.

    This prospective 15-year follow-up concludes

    - that future studies on TMJ sequelae following whiplash trauma should be prospective in study design with examinations conducted in close proximity to whiplash trauma. This allows for reliable baseline status and potential bias of inaccurate recall of symptoms is minimized.

    - that future controlled studies on TMJ pathology in patients should include control groups of not only asymptomatic but also symptomatic volunteers in order to avoid potentially biased conclusions.

    - that one of three patients exposed to whiplash trauma can be expected to develop TMJ symptoms beyond that which corresponds to the natural course in volunteers. This finding and previously reported impairment of jaw function in patients with symptoms after whiplash trauma points to the need for including TMJs and related muscles in routine medical examinations of patients with symptoms following whiplash trauma.

    - that adult individuals presenting with no or mild TMJ symptoms seldom show development or aggravation of TMJ pathology and there is no or little indication for TMJ treatment of these adult individuals. This is in contrast to the higher progression of TMJ pathology previously reported for adult patients with TMJ symptoms, which requires treatment.

  • 49.
    Salé, Hanna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Bryndahl, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Isberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    15-year natural course of temporomandibular joints in asymptomatic and symptomatic non-patient volunteers: a prospective clinical and MR imaging study2013Inngår i: Radiology, ISSN 0033-8419, E-ISSN 1527-1315, Vol. 267, nr 1, 183-194 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To determine the incidence, prevalence, and progression of temporomandibular joint (TMJ) magnetic resonance (MR) imaging findings and symptoms during 15 years in adult asymptomatic and symptomatic volunteers (nonpatients).

    Materials and Methods: A regional committee for medical research ethics approved the study, and informed volunteer consent was obtained. Fifty-three volunteers were examined at study inception. For clinical assessment, a self-administered questionnaire was given, followed by an interview with each volunteer at study inception, at 1 year later, and at 15 years later. Bilateral TMJ MR imaging and clinical examination were performed at inception and at 15-year follow-up. The MR images were assessed for disk position, bone status, and joint fluid. All 53 volunteers participated at 1-year follow-up, and 50 of 53 volunteers participated at 15-year follow-up; of these 50 volunteers, 47 underwent MR imaging. The Fisher exact test was used to determine differences between groups, and the Wilcoxon signed-rank test was used to determine differences in prevalence of TMJ symptoms among the three examination times.

    Results: At study inception, TMJ disk displacement was observed in 31% of asymptomatic volunteers (nine of 29) compared with 89% of symptomatic volunteers (16 of 18, P < .001). Inceptive TMJ status was maintained after 15 years in 91% (43 of 47). Unilateral progression was observed in four volunteers (9%); one was symptomatic and three were asymptomatic. Progression involved development of new disk displacement (n = 1), development of new bone changes (n = 2), and aggravation from reducing to non-reducing disk displacement (n = 1). Prevalence of TMJ symptoms did not change significantly between examination times (P = .77). TMJ clicking was the most common clinical symptom.

    Conclusion: Volunteers with mild symptoms had a prevalence of disk displacement of the same magnitude as that reported in patients, although most volunteers, symptomatic as well as asymptomatic, maintained their TMJ status during 15 years.

  • 50.
    Salé, Hanna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi. Malmö Univ, Fac Odontol, Dept Oral & Maxillofacial Radiol, SE-20506 Malmö, Sweden.
    Bryndahl, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Isberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    A 15-year follow-up of temporomandibular joint symptoms and magnetic resonance imaging findings in whiplash patients: a prospective, controlled study2014Inngår i: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, Vol. 117, nr 4, 522-532 s.Artikkel i tidsskrift (Annet vitenskapelig)
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