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Isberg, Annika
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Publications (10 of 30) Show all publications
Kreiner, M., Okeson, J., Tanco, V., Waldenström, A. & Isberg, A. (2020). Orofacial Pain and Toothache as the Sole Symptom of an Acute Myocardial Infarction Entails a Major Risk of Misdiagnosis and Death. Journal of Oral & Facial Pain and Headache, 34(1), 53-60
Open this publication in new window or tab >>Orofacial Pain and Toothache as the Sole Symptom of an Acute Myocardial Infarction Entails a Major Risk of Misdiagnosis and Death
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2020 (English)In: Journal of Oral & Facial Pain and Headache, ISSN 2333-0384, Vol. 34, no 1, p. 53-60Article in journal (Refereed) Published
Abstract [en]

Aims: To provide an update of knowledge regarding the clinical presentation and neurophysiologic aspects of orofacial pain of cardiac origin in the form of a literature review. Methods: The peer-reviewed databases Scopus/Embase, NCBI (PubMed), and Science Direct were searched up to December 2018. Results: Patients with myocardial infarction presenting without chest pain run a higher risk of death due to missed diagnosis and subsequently a significantly greater delay between the onset of symptoms and arrival at the hospital. During myocardial ischemia, orofacial pain is reported by 4 in 10 patients and described as oppressive and/or burning. Up to 4% of myocardial infarction patients experience pain solely in the orofacial structures, women more often than men. Orofacial pain during myocardial ischemia is associated with ischemia within the inferior wall of the heart, suggesting the involvement of the vagal system. Conclusion: The clinician’s awareness of the full spectrum of clinical characteristics of a myocardial infarction constitutes a key factor in accurate diagnosis. Health care professionals and the general public should be aware of the possibility of myocardial infarction presenting with orofacial pain, toothache, or ear/temporomandibular joint pain as the only symptom.

Place, publisher, year, edition, pages
QUINTESSENCE PUBLISHING, 2020
Keywords
cardiac ischemia, cardiac pain, myocardial infarction, orofacial pain, toothache
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-167610 (URN)10.11607/ofph.2480 (DOI)000507518000006 ()31465031 (PubMedID)2-s2.0-85077943360 (Scopus ID)
Available from: 2020-02-07 Created: 2020-02-07 Last updated: 2021-05-11Bibliographically approved
Kreiner, M., lvarez, R., Michelis, V., Waldenström, A. & Isberg, A. (2016). Craniofacial pain can be the sole prodromal symptom of an acute myocardial infarction: an interdisciplinary study. Acta odontológica latinoamericana : AOL, 29(1), 23-28
Open this publication in new window or tab >>Craniofacial pain can be the sole prodromal symptom of an acute myocardial infarction: an interdisciplinary study
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2016 (English)In: Acta odontológica latinoamericana : AOL, ISSN 0326-4815, Vol. 29, no 1, p. 23-28Article in journal (Refereed) Published
Abstract [en]

We recently found craniofacial pain to be the sole symptom of an acute myocardial infarction (AMI) in 4% of patients. We hypothesized that this scenario is also true for symptoms of prodromal (pre-infarction) angina. We studied 326 consecutive patients who experienced myocardial ischemia. Intra-individual variability analyses with respect to ECG findings and pain characteristics were performed for those 150 patients who experienced at least one recurrent ischemic episode. AMI patients (n=113) were categorized into two subgroups: "abrupt onset" (n=81) and "prodromal angina" (n=32). Age, gender and risk factor comparisons were performed between groups. Craniofacial pain constituted the sole prodromal symptom of an AMI in 5% of patients. In those who experienced two ischemic episodes, women were more likely than men to experience craniofacial pain in both episodes (p<0.01). There was no statistically significant difference between episodes regarding either ECG findings or the use of the two typical pain quality descriptors "pressure" and "burning". This study is to our knowledge the first to report that craniofacial pain can be the only symptom of a pre-infarction angina. Craniofacial pain constitutes the sole prodromal AMI symptom in one out of 20 AMI patients. Recognition of this atypical symptom presentation is low because research on prodromal AMI symptoms has to date studied only patients with chest pain. To avoid a potentially fatal misdiagnosis, awareness of this clinical presentation needs to be brought to the attention of clinicians, researchers and the general public.

Keywords
facial pain, Myocardial infarction, myocardial ischemia
National Category
Health Sciences Dentistry
Identifiers
urn:nbn:se:umu:diva-43288 (URN)2-s2.0-85029549864 (Scopus ID)
Note

Originally included in thesis in manuscript form. 

Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2023-03-24Bibliographically approved
Salé, H., Bryndahl, F. & Isberg, A. (2014). A 15-year follow-up of temporomandibular joint symptoms and magnetic resonance imaging findings in whiplash patients: a prospective, controlled study. Oral surgery, oral medicine, oral pathology and oral radiology, 117(4), 522-532
Open this publication in new window or tab >>A 15-year follow-up of temporomandibular joint symptoms and magnetic resonance imaging findings in whiplash patients: a prospective, controlled study
2014 (English)In: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, Vol. 117, no 4, p. 522-532Article in journal (Other academic) Published
Keywords
Whiplash trauma, Temporomandibular joint, Magnetic resonance imaging, follow-up, controlled, prospective
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-48154 (URN)10.1016/j.oooo.2014.01.020 (DOI)000333410000023 ()2-s2.0-84896352344 (Scopus ID)
Note

Originally published in thesis in manuscript form.

Available from: 2011-10-10 Created: 2011-10-10 Last updated: 2023-03-23Bibliographically approved
Kreiner, M., Alvarez, R., Waldenström, A., Michelis, V., Muñiz, R. & Isberg, A. (2014). Craniofacial pain of cardiac origin is associated with inferior wall ischemia. Journal of oral & facial pain and headache, 28(4), 317-321
Open this publication in new window or tab >>Craniofacial pain of cardiac origin is associated with inferior wall ischemia
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2014 (English)In: Journal of oral & facial pain and headache, ISSN 2333-0384, Vol. 28, no 4, p. 317-321Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
Quintessence Publishing, 2014
Keywords
acute myocardial infarction, cardiac ischemia, chest pain, cranio facial pain, dental pain
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-97266 (URN)000344838900004 ()
Available from: 2014-12-12 Created: 2014-12-12 Last updated: 2018-06-07Bibliographically approved
Salé, H., Bryndahl, F. & Isberg, A. (2013). 15-year natural course of temporomandibular joints in asymptomatic and symptomatic non-patient volunteers: a prospective clinical and MR imaging study. Radiology, 267(1), 183-194
Open this publication in new window or tab >>15-year natural course of temporomandibular joints in asymptomatic and symptomatic non-patient volunteers: a prospective clinical and MR imaging study
2013 (English)In: Radiology, ISSN 0033-8419, E-ISSN 1527-1315, Vol. 267, no 1, p. 183-194Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
Radiological Society of North America, 2013
Keywords
Temporomandibular joint, Magnetic resonance imaging, natural course, volunteers
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-48153 (URN)10.1148/radiol.12112243 (DOI)2-s2.0-84875419412 (Scopus ID)
Note

Originally pulished in thesis in manuscript form.

Available from: 2011-10-10 Created: 2011-10-10 Last updated: 2023-03-23Bibliographically approved
Bryndahl, F., Warfvinge, G., Eriksson, L. & Isberg, A. (2011). Cartilage changes link retrognathic mandibular growth to TMJ disc displacement in a rabbit model. International Journal of Oral and Maxillofacial Surgery, 40(6), 621-627
Open this publication in new window or tab >>Cartilage changes link retrognathic mandibular growth to TMJ disc displacement in a rabbit model
2011 (English)In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 40, no 6, p. 621-627Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
Elsevier, 2011
Keywords
adaptive modelling, adolescence, biomechanical function, mandibular retrognathia, temporomandibular joint
National Category
Radiology, Nuclear Medicine and Medical Imaging
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-45669 (URN)10.1016/j.ijom.2011.01.004 (DOI)21334177 (PubMedID)2-s2.0-79956286781 (Scopus ID)
Available from: 2011-08-09 Created: 2011-08-09 Last updated: 2023-03-24Bibliographically approved
Isberg, A. & Salé, H. (2011). Recalling pain: author's response [Letter to the editor]. The Journal of the American Dental Association (1939), 142(1), 24-24
Open this publication in new window or tab >>Recalling pain: author's response
2011 (English)In: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 142, no 1, p. 24-24Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
American Dental Association, 2011
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-104559 (URN)10.14219/jada.archive.2011.0018 (DOI)000286867300018 ()2-s2.0-79851499529 (Scopus ID)
Available from: 2015-06-15 Created: 2015-06-11 Last updated: 2023-03-24Bibliographically approved
Salé, H., Hedman, L. & Isberg, A. (2010). Accuracy of patients' recall of temporomandibular joint pain and dysfunction after experiencing whiplash trauma: a prospective study. The Journal of the American Dental Association (1939), 141(7), 879-886
Open this publication in new window or tab >>Accuracy of patients' recall of temporomandibular joint pain and dysfunction after experiencing whiplash trauma: a prospective study
2010 (English)In: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 141, no 7, p. 879-886Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Researchers have conducted studies regarding whiplash-induced temporomandibular joint (TMJ) pain and dysfunction mainly under the presumption that patients' memory of symptoms remains accurate across time. In this prospective study, the authors aimed to determine the frequency of patients' inaccurate retrospective reports of TMJ pain and dysfunction after whiplash trauma.

METHODS: The authors assessed TMJ pain and dysfunction in 60 patients consecutively seen in a hospital emergency department directly after the patients experienced whiplash trauma in rear-end automobile accidents. They followed up with 59 patients one year later. The participants completed a self-administered questionnaire followed by a comprehensive interview during both examinations. The study group consisted of the 40 patients who reported previous or current TMJ pain, dysfunction or both at either examination or at both examinations.

RESULTS: The agreement between each patient's inceptive and retrospective reports of TMJ pain and dysfunction yielded a kappa value of 0.41 (95 percent confidence interval [CI] 0.18-0.64). Sixteen patients (40 percent, 95 percent CI 25-57 percent) had inaccurate recall. Recollection errors were addition, omission, and forward and backward telescoping. Seven patients incorrectly referred symptom onset to the accident.

CONCLUSIONS: The high frequency of inaccurate recall of TMJ pain and dysfunction one year after whiplash trauma implies that clinicians and researchers should interpret with caution the results of previous studies that relied on retrospective data regarding whiplash-induced TMJ pain and dysfunction.

CLINICAL IMPLICATIONS: To achieve valid long-term evaluations in clinical research, the patient's TMJ status should be established at the time of an accident.

Place, publisher, year, edition, pages
American dental association, 2010
Keywords
temporomandibular joint, memory, whiplash injuries, prospective studies
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-35193 (URN)10.14219/jada.archive.2010.0287 (DOI)000279842600019 ()20592409 (PubMedID)2-s2.0-77954920230 (Scopus ID)
Available from: 2010-08-09 Created: 2010-08-09 Last updated: 2023-03-24Bibliographically approved
Kreiner, M., Falace, D., Michelis, V., Okeson, J. & Isberg, A. (2010). Quality difference in craniofacial pain of cardiac vs. dental origin. Journal of Dental Research, 89(9), 965-969
Open this publication in new window or tab >>Quality difference in craniofacial pain of cardiac vs. dental origin
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2010 (English)In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 89, no 9, p. 965-969Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
Sage, 2010
Keywords
acute myocardial infarction, cardiac ischemia, craniofacial pain, dental pain and referred pain
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-35486 (URN)10.1177/0022034510370820 (DOI)000281081500014 ()20448243 (PubMedID)2-s2.0-77956054905 (Scopus ID)
Available from: 2010-08-20 Created: 2010-08-20 Last updated: 2023-03-24Bibliographically approved
Isberg, A. (2009). The life-threatening TMD. Cranio, 27(1), 1-2
Open this publication in new window or tab >>The life-threatening TMD
2009 (English)In: Cranio, ISSN 0886-9634, E-ISSN 2151-0903, Vol. 27, no 1, p. 1-2Article in journal (Refereed) Published
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-30056 (URN)19241790 (PubMedID)
Available from: 2009-12-02 Created: 2009-12-02 Last updated: 2018-06-08Bibliographically approved
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