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Yekkalam, N., Novo, M., Tyrberg, M. J. & Sipilä, K. (2024). Risk factors associated with symptoms of temporomandibular disorders among women with hypermobile Ehlers–Danlos syndrome: Questionnaire‐based study in Finland and Sweden. Journal of Oral Rehabilitation
Open this publication in new window or tab >>Risk factors associated with symptoms of temporomandibular disorders among women with hypermobile Ehlers–Danlos syndrome: Questionnaire‐based study in Finland and Sweden
2024 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Generalized joint hypermobility as a characteristic feature of Ehlers–Danlos syndromes (EDS) is among the factors contributing to temporomandibular disorders (TMD).

Objective: To evaluate the prevalence of TMD symptoms and their risk factors among women born in Sweden or Finland who were 27- to 78-year-olds with diagnosed hypermobile EDS (hEDS).

Methods: A cohort of women with confirmed hEDS (n = 185) was constructed from the members of the National EDS Associations in both countries. Based on questionnaire data, frequency of independent variables in terms of socio-demographic, general health and oral health-related factors, comorbid symptoms and psychological distress for self-reported TMD symptoms as the dependent variables, were calculated first. Prevalence ratios (PR) and their 95% confidence interval (95% CI) were estimated for the association between independent and dependent variables.

Results: Nearly all participants reported TMD symptoms (98%) with TMD pain (95%), TMJ clicking (90%) and jaw fatigue (80%) as the most common symptoms and TMJ crepitation (63%) and luxation (44%) as the least common symptoms. Risk factors for TMD among 27- to 50-year-olds participants were Finland as a country of birth, living alone and self-reported worst pain in the body (not the joints). The respective risk factors among the 51- to 78-year-olds were Finland as a country of birth, family history of EDS, tinnitus and regularly taking contraceptives.

Conclusions: Among adult women with confirmed hEDS, socio-demographic and health-related factors and comorbid symptoms were significantly associated with TMD but with differences regarding age group. Therefore, management of TMD requires a multidisciplinary approach among the affected.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
Ehlers–Danlos syndromes, epidemiology, gender, generalized joint hypermobility, hypermobility spectrum disorder, temporomandibular disorders
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-223920 (URN)10.1111/joor.13706 (DOI)2-s2.0-85191239306 (Scopus ID)
Available from: 2024-05-01 Created: 2024-05-01 Last updated: 2024-05-02
Oelerich, O., Daume, L., Yekkalam, N., Hanisch, M. & Menne, M. C. (2024). Temporomandibular disorders among Ehlers-Danlos syndromes: a narrative review. Journal of international medical research, 52(4)
Open this publication in new window or tab >>Temporomandibular disorders among Ehlers-Danlos syndromes: a narrative review
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2024 (English)In: Journal of international medical research, ISSN 0300-0605, E-ISSN 1473-2300, Vol. 52, no 4Article in journal (Refereed) Published
Abstract [en]

This narrative review aims to demonstrate and summarize the complex relationship between Ehlers-Danlos syndromes (EDS) and temporomandibular disorders (TMD) by reviewing the results of observational studies and case reports. EDS are a set of hereditary connective tissue disorders, where generalized joint hypermobility (GJH), especially in the hypermobile subtype (hEDS), is a key symptom. Mutations have been identified in genes that impact the production or assembly of collagen for all subtypes except hEDS. While the correlation between GJH and TMD has been analysed in various studies, fewer studies have examined TMD in patients with EDS, with most showing an increased prevalence of TMD. In case–control studies, an elevated prevalence of myalgia, arthralgia and disc-related disorders was found in individuals with EDS. Various therapeutic interventions have been reported within the literature in the form of case reports and observational studies, but there are no long-term clinical trials with results on the efficacy of different therapeutic approaches to date. This review demonstrates the high prevalence of different TMDs in different subtypes of EDS, but also shows that little is known about the success of treatment thus far. Further clinical research is necessary to provide adequate guidance on targeted treatment.

Place, publisher, year, edition, pages
Sage Publications, 2024
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-223278 (URN)10.1177/03000605241242582 (DOI)2-s2.0-85190489518 (Scopus ID)
Funder
German Research Foundation (DFG), 493624047German Research Foundation (DFG), 493624047
Available from: 2024-04-12 Created: 2024-04-12 Last updated: 2024-04-24Bibliographically approved
Wänman, A., Marklund, S. & Yekkalam, N. (2024). Treatment outcome in patients with myofascial orofacial pain: a randomized clinical trial. Journal of Oral Health and Craniofacial Science, 9(1), 001-008
Open this publication in new window or tab >>Treatment outcome in patients with myofascial orofacial pain: a randomized clinical trial
2024 (English)In: Journal of Oral Health and Craniofacial Science, E-ISSN 2573-6191, Vol. 9, no 1, p. 001-008Article in journal (Refereed) Published
Abstract [en]

Background: Temporomandibular Disorder (TMD) pain attributed to myalgia is a common condition and patients should get advice on the best treatment option. 

Objectives: The aim was to evaluate the effect of two different exercise programs, or bite splint therapy, respectively, in patients with chronic frequent primary myofascial orofacial pain. 

Methods: The study was a randomized clinical trial including patients fulϐilling criteria of chronic frequent primary myofascial orofacial pain with a reported pain intensity of ≥ 4 on a numerical rating scale (0-10). Ninety subjects were randomized to either bite splint, home exercises, or a supervised exercise program. Two examiners blinded to the treatment modality examined the same subject at baseline and a 3-month follow-up. Non-parametric statistical methods were applied for the outcome of treatment in intended-to-treat analyses. A P-value <0.05 was considered statistically signiϐicant. 

Results: The pain severity index was signiϐicantly reduced (p < 0.001) in all treatment groups. Jaw opening capacity improved signiϐicantly (p < 0.05) for those randomized to bite splint and for those in the home exercise program. About 70% of the participants reported improvement in their TMD pain severity with no signiϐicant difference between treatments. Both exercise groups improved in jaw function at the 3-month follow-up compared to baseline. Those who had a bite splint reported significantly more improvement in their headaches compared to those in the exercise programs.

Conclusion: Jaw exercise programs and bite splint treatments had similar positive effects on TMD pain severity attributed to myalgia after 3 months.

Place, publisher, year, edition, pages
Heighten Science Publications Corporation, 2024
Keywords
Oral appliance; Exercise; Myalgia; Physiotherapy; Temporomandibular disorders
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-220831 (URN)10.29328/journal.johcs.1001046 (DOI)
Available from: 2024-02-13 Created: 2024-02-13 Last updated: 2024-02-13Bibliographically approved
Yekkalam, N., Novo, M. & Wänman, A. (2024). Treatments related to temporomandibular disorders among patients with prevalent types of Ehlers-Danlos syndrome in Sweden. Cranio
Open this publication in new window or tab >>Treatments related to temporomandibular disorders among patients with prevalent types of Ehlers-Danlos syndrome in Sweden
2024 (English)In: Cranio, ISSN 0886-9634, E-ISSN 2151-0903Article in journal (Refereed) Epub ahead of print
Abstract [en]

The aim of this study was to assess the received TMD treatment modalities and the perceived outcome among the frequent types of EDS. A digital questionnaire was sent to the member of the National Swedish EDS Association during January-March 2022. The subsamples of hypermobile and classical EDS were constructed. Almost 90% reported TMD symptoms. Bite splint therapy, counselling, jaw training and occlusal adjustment were reported as the most common treatments with no statistically significant difference in terms of good effect between the two subsamples. Hypermobile and classical EDS might consider as an entity with regards to TMD.

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
Temporomandibular disorders, Ehlers-Danlos syndrome, hypermobility, splint therapy, jaw exercises, occlusal adjustment, counselling
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-221701 (URN)10.1080/08869634.2024.2319565 (DOI)2-s2.0-85186567425 (Scopus ID)
Available from: 2024-03-01 Created: 2024-03-01 Last updated: 2024-04-16
Yekkalam, N., Storm Mienna, C., Stoor, J. P. & San Sebastian, M. (2023). Social determinants of self-reported oral health among Sámi in Sweden. Community Dentistry and Oral Epidemiology, 51(6), 1258-1265
Open this publication in new window or tab >>Social determinants of self-reported oral health among Sámi in Sweden
2023 (English)In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 51, no 6, p. 1258-1265Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate the prevalence of poor self-reported oral health and to identify socio-demographic, socio-economic and cultural-related risk factors associated with poor oral health among Sámi in Sweden.

Methods: A Sámi sample frame was constructed drawing from three pre-existing registers. All identified persons aged 18–84 were invited to participate in the study during February–May 2021. Among the 9249 invitations, 3779 answered the survey. The frequencies of the independent variables in terms of socio-economic, socio-demographic and cultural-related factors as well as the outcome, self-reported oral health, were calculated first. Prevalence ratios (PRs) and their 95% confidence interval (95% CI) were estimated to assess the relationship between the independent variables and the outcome.

Results: Overall, 32.5% of the participants reported a poor oral health with a higher prevalence among men compared to women. Among the socio-demographic factors, being old (PR: 1.99; 95% CI: 1.59–2.51), unmarried (PR: 1.17; 95% CI: 1.03–1.33) and divorced or widow-er (PR: 1.27; 95% CI: 1.09–1.46) were statistically associated to poor self-reported oral health. Among the socio-economic factors, a low education level (PR: 1.56; 95% CI: 1.29–1.89), belonging to the poorest quintile (PR: 1.63; 95% CI: 1.35–1.96), and experiencing difficulties to make ends meet several times during the last 12 months (PR: 1.74; 95% CI: 1.51–1.99) were statistically significant related to poor oral health.

Conclusions: The self-reported oral health among Sámi in Sweden appears to be worse than that of the general Swedish population. Several socio-economic and socio-demographic factors were found to be strongly associated with poor self-reported oral health. Targeted interventions addressing these social determinants are needed to reduce inequalities in oral health among the Sámi population.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
indigenous, oral health, risk factors, social, Sámi, Sápmi
National Category
Dentistry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-212500 (URN)10.1111/cdoe.12894 (DOI)001032472000001 ()37489613 (PubMedID)2-s2.0-85165576994 (Scopus ID)
Funder
Public Health Agency of Sweden
Available from: 2023-08-01 Created: 2023-08-01 Last updated: 2024-01-08Bibliographically approved
Lövgren, A., Visscher, C. M., Lobbezo, F., Yekkalam, N., Vallin, S., Wänman, A. & Häggman-Henrikson, B. (2022). The association between myofascial orofacial pain with and without referral and widespread pain. Acta Odontologica Scandinavica, 80(7), 481-486
Open this publication in new window or tab >>The association between myofascial orofacial pain with and without referral and widespread pain
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2022 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 80, no 7, p. 481-486Article in journal (Refereed) Published
Abstract [en]

Objectives: Pain referral on palpation has been suggested to be a clinical sign of central sensitization potentially associated with widespread pain conditions. Our aim was to evaluate if myofascial pain with referral is a better predictor for widespread pain when compared to no pain or local myofascial pain.

Materials and methods: Individuals at the Public Dental services in Västerbotten, Sweden, were randomly invited based on their answers to three screening questions for temporomandibular disorders (TMD). In total, 300 individuals (202 women, 20–69 yrs) were recruited, and examined according to the Diagnostic Criteria for TMD (DC/TMD) after completion of a body pain drawing. Widespread pain was considered present when seven or more pain sites were reported on the widespread pain index. A binary logistic regression model, adjusted for the effect of age and gender were used to evaluate the association between myofascial orofacial pain and widespread pain.

Results: Widespread pain was reported by 31.3% of the study sample. There was a 57.3% overlap with myofascial pain. Widespread pain was associated to myofascial orofacial pain with and myofascial orofacial pain (OR 4.83 95% CI 2.62–9.05 and OR 11.62 95% CI 5.18–27.88, respectively).

Conclusion: These findings reinforce the existing knowledge on the overlap between painful TMD and other chronic pain conditions.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
General practice dentistry, temporomandibular disorders, myofascial pain, widespread pain
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-183181 (URN)10.1080/00016357.2022.2036363 (DOI)000819751800001 ()35776512 (PubMedID)2-s2.0-85133290624 (Scopus ID)
Funder
Umeå UniversityRegion Västerbotten
Note

Originally included in thesis in manuscript form.

Available from: 2021-05-18 Created: 2021-05-18 Last updated: 2022-12-13Bibliographically approved
Yekkalam, N. (2021). Perspectives on signs and symptoms indicative of temporomandibular disorders among adults. (Doctoral dissertation). Umeå: Umeå Universitet
Open this publication in new window or tab >>Perspectives on signs and symptoms indicative of temporomandibular disorders among adults
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The aim of this thesis was to delve deeper into the different aspects of temporomandibular disorders (TMD) as a public health problem among adults. The studies evaluated signs and symptoms indicative of TMD in terms of prevalence, associated factors, treatment need estimate, possible factors underpinning treatment need owing to TMD, as well as possible influences of pain conditions on TMD symptoms and diagnosis in adult populations.

Study populations and Methods: The thesis is comprised of five papers. The first four papers (I-IV) included individuals 35, 50, 65 and, 75 years old living in Västerbotten County, Sweden. The study sample was stratified based on the area of residence – coast (mainly urban area) and inland (mainly rural area). Scrutiny constituted a questionnaire and a clinical examination. Of 1200 individuals contacted (300 in each age group), 987 (82%) returned a filled-out questionnaire and 779 (65%) participated in the clinical examination. Distribution of signs and symptoms indicative of TMD in the different age groups, associations between different factors and TMD signs, symptoms and treatment need owing to TMD, as well as association between different patterns of pain to palpation and pain in the jaw-face-head region were analyzed. Paper V assessed the association between widespread pain and TMD pain in 300 individuals of which 110 diagnosed as TMD pain according to DC/TMD (arthralgia, myalgia and myofascial pain with referral). Logistic regression analysis was applied in the papers II-V and the results were presented as odds ratios (OR) with 95% confidence interval (95% CI).

Results: The prevalence of symptoms indicative of TMD and frequent headaches was high in the adult population. The age and gender patterns were, for the most part, similar for the frequent symptoms in terms of prevalence. In general, lower prevalence of frequent headaches and symptoms indicative of TMD were observed among the elderly compared to the younger age groups. Clinical signs indicative of TMD were more commonly registered among women. In the analysis of putative factors related to presence of signs and symptoms, self- perceived impaired general health status was the most consistent finding in the different age groups. The estimated treatment need owing to TMD was 15% for the total sample. The presence of TMD signs, symptoms, smoking, living on the coast, and being a woman emerged as important factors in the clinical decision- making process of treatment need due to TMD. A significant dose-response like pattern was observed between frequent pain in the jaw-face-head region and the patterns of pain elicited to palpation. Individuals with widespread pain compared to those without widespread pain significantly more often had a TMD diagnosis of myofascial pain with referral and myalgia according to the DC/TMD.

Conclusions: The age and gender differences on signs and symptoms indicative of TMD among adults are likely related to factors included in the biopsychosocial model. The associations between comorbidities and TMD may influence demand for treatment among the affected. Thus, TMD treatment should be included in the medical health care payment systems. A significant proportion of the adult population has a need of treatment related to TMD. Generalized hyperalgesia and widespread pain conditions are related to pain in the jaw-face-head region and should be acknowledged in clinical evaluations, diagnostic decisions, treatment planning as well as in research settings.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2021. p. 80
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 145
Keywords
epidemiology, temporomandibular disorders, headache, gender, treatment need, clinical decision-making, widespread pain
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-183170 (URN)978-91-7855-555-0 (ISBN)978-91-7855-554-3 (ISBN)
Public defence
2021-06-15, Sal B, byggnad 1D, våning 9, Umeå, 09:00 (English)
Opponent
Supervisors
Note

Uppgift om ISBN för tryckt format saknas i publikationen.

Available from: 2021-05-25 Created: 2021-05-18 Last updated: 2021-06-17Bibliographically approved
Yekkalam, N. & Wänman, A. (2020). Association between signs of hyperalgesia and reported frequent pain in jaw-face and head. Acta Odontologica Scandinavica, 72(8), 1054-1065
Open this publication in new window or tab >>Association between signs of hyperalgesia and reported frequent pain in jaw-face and head
2020 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 8, p. 1054-1065Article in journal (Refereed) Published
Abstract [en]

Objective: To analyze the relationship between different sites of elicited pain to muscle palpation (PtP), and reported frequent pain in jaw-face and head.

Materials and methods: The analysis was based on an epidemiological sample of 1200 randomly selected individuals, of which 779 (65%) both completed a questionnaire and participated in a clinical examination. The questionnaire addressed the presence of pain in the jaw-face region and headache, respectively. Part of the clinical examination entailed palpation of the jaw, neck, shoulder, arm, thumb and calf muscles. Logistic regression was applied with pain and headache as dependent variables. A p-value < .05 determined statistical significance.

Results: Five percent of participants reported frequent pain in jaw-face, and 17% reported frequent headaches. In the regression analysis, frequent headaches were significantly associated with jaw muscle PtP (OR 2.1, CI 1.4–3.4), regional PtP (OR 4.5, CI 2.6–7.6), and generalized PtP (OR 6.1, CI 2.2–17.0). Jaw-face pain was significantly associated with regional PtP (OR 5.3, CI 2.2–13.0) and generalized PtP (OR 30.1, CI 9.3–97.0). The relationship between pain prevalence and PtP showed a dose-response pattern.

Conclusions: The study indicates that frequent jaw-face pain and headache are primarily associated with signs of regional and widespread hyperalgesia, which may be linked to the central sensitization mechanism. Signs of widespread hyperalgesia should be accounted for in the diagnostic algorithms when examining patients with pain in the jaw, face, and head regions.

Place, publisher, year, edition, pages
Taylor & Francis, 2020
Keywords
Epidemiology, myofascial pain, temporomandibular disorders, headaches, diagnosis
National Category
Dentistry
Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-175407 (URN)10.1080/00016357.2020.1814963 (DOI)000568933300001 ()32924721 (PubMedID)2-s2.0-85090977631 (Scopus ID)
Funder
Västerbotten County Council
Available from: 2020-09-28 Created: 2020-09-28 Last updated: 2023-03-23Bibliographically approved
Yekkalam, N., Coello, E., Mikaela, E., Hajer, J., Nikolaos, C. & Ernberg, M. (2019). Could Reported Sex Differences in Hypertonic Saline-induced Muscle Pain be a dose Issue?. Dental Oral Biology and Cranofacial Research, 2(5), 3-8
Open this publication in new window or tab >>Could Reported Sex Differences in Hypertonic Saline-induced Muscle Pain be a dose Issue?
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2019 (English)In: Dental Oral Biology and Cranofacial Research, ISSN 2613-4950, Vol. 2, no 5, p. 3-8Article in journal (Refereed) Published
Abstract [en]

Higher levels of experimental muscle pain induced by injection of the same volume of noxious substances have been reported by women compared to men. This could hypothetically be related to the difference in muscle volume between men and women. The aim of this study was to investigate if the sex differences reported by intramuscular injection of hypertonic saline would disappear if a larger dose is given to men than women under similar conditions.

Methods: Fifty-six healthy volunteers (25 men and 31 women) received hypertonic saline injection into the masseter muscle, 0.5 mL for men and 0.3 mL for women, to evoke pain. Pain intensity was assessed with 0-100 mm visual analogue scale (VAS) every 15 seconds until pain subsided or maximum 300s. VAS was also used to assess perceived unpleasantness and anxiety. Pain drawings were used to assess maximal pain distribution, and the McGill pain questionnaire to assess pain quality.

Results: There was no sex difference in maximum pain intensity, unpleasantness, anxiety or pain drawing area, but the evoked pain had larger total pain area (p=0.005), and longer duration (p<0.001) in the men than women. The sexes also used some different pain descriptors.

Conclusions: This study shows that the previously reported higher pain levels in women were abolished when a lower dose of hypertonic saline was injected into the masseter muscle of the women than men. This might indicate that the sex differences reported to hypertonic-induced muscle pain may be a dose issue. Further studies are required to validate these results

Keywords
experimental pain, hypertonic saline solution, intramuscular injections, masseter, sex difference, temporomandibular joint disorder
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-167330 (URN)10.31487/j.DOBCR.2019.05.02 (DOI)
Available from: 2020-01-16 Created: 2020-01-16 Last updated: 2020-01-17Bibliographically approved
Yekkalam, N. & Wänman, A. (2016). Factors associated with clinical decision-making in relation to treatment need for temporomandibular disorders. Acta Odontologica Scandinavica, 74(2), 134-141
Open this publication in new window or tab >>Factors associated with clinical decision-making in relation to treatment need for temporomandibular disorders
2016 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, no 2, p. 134-141Article in journal (Refereed) Published
Abstract [en]

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

Keywords
Clinical decision-making, craniomandibular disorder, gender, orofacial pain, treatment need
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-114001 (URN)10.3109/00016357.2015.1063159 (DOI)000366811600009 ()26139326 (PubMedID)2-s2.0-84951849523 (Scopus ID)
Available from: 2016-01-25 Created: 2016-01-11 Last updated: 2023-03-24Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2183-7497

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