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Lövgren, A., Ilgunas, A., Häggman-Henrikson, B., Elias, B., Roudini, O. A., Visscher, C., . . . Liv, P. (2023). Associations between screening for functional jaw disturbances and patient reported outcomes on jaw limitations and oral behaviors. Journal of Evidence-Based Dental Practice, 23(3), Article ID 101888.
Open this publication in new window or tab >>Associations between screening for functional jaw disturbances and patient reported outcomes on jaw limitations and oral behaviors
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2023 (English)In: Journal of Evidence-Based Dental Practice, ISSN 1532-3382, E-ISSN 1532-3390, Vol. 23, no 3, article id 101888Article in journal (Refereed) Published
Abstract [en]

Objectives: Temporomandibular disorders (TMDs) is a collective term for pain and functional disturbances related to the jaw muscles and the temporomandibular joint. In contrast to screening for orofacial pain, knowledge is limited on the association between patient-reported outcomes and screening for joint-related functional jaw disturbances. Therefore, our aim was to evaluate the association between a screening question for functional jaw disturbances, and disease-specific outcome measures for functional jaw limitations and oral behaviors.

Methods: This study included 299 individuals (201 women; 20-69 years, median 37.0) in a general population sample from Västerbotten, Northern Sweden in 2014. A single screening question for functional jaw disturbances “Does your jaw lock or become stuck once a week or more?” was used to categorize individuals as cases or controls. Patient-reported outcomes on functional jaw disturbances were assessed with the 20-item jaw functional limitation scale (JFLS-20) and oral behaviors with the 21-item Oral Behaviors Checklist (OBC-21).

Results: The strongest predictive probability to have a positive screening outcome was functional jaw limitations related to mobility (AUCboot=0.78, 95 CI:0.71-0.86, P <.001), followed by limitations related to communication (AUCboot = 0.74, 95 CI:0.63-0.80, P <.001) and mastication (AUCboot = 0.73, 95 CI:0.66-0.81, P <.001). The frequency of oral behaviors was not significantly associated with a positive screening outcome (AUCboot = 0.65, 95 CI:0.55-0.72, P =.223).

Conclusions: Self-reported functional limitations, but not oral behaviors, are strongly associated with a single screening question for frequent functional jaw disturbances. This finding provides support for incorporating a question on jaw catching/locking once a week or more in screening instruments for TMDs.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Clinical decision-making, Dental, General practice, Screening, Temporomandibular joint disorders
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-212835 (URN)10.1016/j.jebdp.2023.101888 (DOI)2-s2.0-85166922410 (Scopus ID)
Available from: 2023-08-15 Created: 2023-08-15 Last updated: 2023-09-28Bibliographically approved
Ilgunas, A. (2023). Exploring temporomandibular disorders: longitudinal and qualitative perspectives. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Exploring temporomandibular disorders: longitudinal and qualitative perspectives
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Smärta och funktionsstörning i käksystemet : longitudinellt och kvalitativt perspektiv
Abstract [en]

Background: Ideally, all clinical decision-making should enable care provision on the best available scientific evidence, clinical experience, and evaluated risks and benefits. Even though there are validated and evaluated decision tools for identification, diagnostics and treatment of temporomandibular disorders (TMD), patients with TMD still seem to go undetected, undiagnosed and undertreated in dentistry. Reasons for this discrepancy are unclear, but this clearly is a disadvantage for patients with TMD. Therefore, this project aimed to explore TMD in relation to the longitudinal course of the symptoms, dentists’ decision-making, and patients’ experiences.

Methods: The project was conducted at the Public Dental Health Services in the Region of Västerbotten, Northern Sweden. Data in the longitudinal studies were based on the screening instrument for TMD, the 3Q/TMD, and included self-reported orofacial pain and jaw dysfunction, specifically jaw catching/locking, from 2010 to 2017 (n=180,308; age 5-104). Descriptive statistics, generalized estimating equation models, and Poisson regression were used for analyses. Data included in the qualitative studies were the transcribed individual interviews with dentists (n=22, age 25-64) and patients (n=16, age 20-65). Analyses were based on the Grounded Theory and the Qualitative Context Analysis.

Results: The prevalence of orofacial pain increased over time (p<.01), but the prevalence of jaw catching/locking remained similar. The incidence, prevalence, and persistence of orofacial pain and jaw catching/locking were significantly higher in women than in men (p<.01). Women were at a higher risk for reporting both the first onset and the persistent orofacial pain (IRR 2.37; 95% CI, 2.25-2.50 and IRR 2.56; 95% CI, 2.28-2.87, respectively), and jaw catching/locking (IRR 2.29; 95% CI, 2.11-2.49 and IRR 2.32; 95% CI, 2.04-2.63, respectively) when compared to men. The onset of pain or jaw catching/locking was mostly independent and exclusive, i.e. without the other symptom (84.1%), and was higher for orofacial pain (64.9%) than for jaw catching/locking (19.2%). The decision-making process in the management of TMD was illustrated as an interplay between internal and external elements, where the dentists wished to apply professional knowledge but identified organizational obstacles and lack of self-confidence in their clinical decision-making for TMD. The patients expressed worry and social discomfort as a consequence of TMD. However, they strived to deal with the symptoms on their own as long as possible before seeking help. The challenges to access dental care and to receive suitable management were acknowledged. The right care at the right time was identified more like a wish than a current state of perceived TMD management.

Conclusions: The observed longitudinal patterns of orofacial pain and jaw dysfunction indicate increasing prevalence of orofacial pain together with substantial gender differences in TMD. The finding of independent onset of jawcatching/locking and orofacial pain reinforces that these two differ in the pathophysiology. The challenges in decision-making for patients with TMD and perceived suboptimal management of TMD symptoms are partly related to the structural organization of the Public Dental Health Services. Thus, careful review of the current organization is warranted since the treatment-need related to orofacial pain will probably increase.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2023. p. 74
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 148
Keywords
cohort studies, decision-making, dental health services, dentistry, epidemiology, evidence-based dentistry, facial pain, population health, qualitative studies, temporomandibular joint disorders, women
National Category
Dentistry
Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-202148 (URN)978-91-7855-950-3 (ISBN)978-91-7855-951-0 (ISBN)
Public defence
2023-02-03, Sal B, byggnad 1D, Norrlands universitetssjukhus, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2023-01-13 Created: 2023-01-09 Last updated: 2023-01-10Bibliographically approved
Ilgunas, A., Fjellman-Wiklund, A., Häggman-Henrikson, B., Lobbezoo, F., Visscher, C. M., Durham, J. & Lövgren, A. (2023). Patients' experiences of temporomandibular disorders and related treatment. BMC Oral Health, 23(1), Article ID 653.
Open this publication in new window or tab >>Patients' experiences of temporomandibular disorders and related treatment
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2023 (English)In: BMC Oral Health, E-ISSN 1472-6831, Vol. 23, no 1, article id 653Article in journal (Refereed) Published
Abstract [en]

Background: Temporomandibular disorders (TMD) are common and therefore managed by dentists on a daily basis. However, patients with TMD consistently go undetected and therefore untreated in dentistry. The reasons for these shortcomings have not been fully explored, specifically with regard to patients’ perspectives. Therefore, this study aimed to explore patients’ experiences of TMD and related treatment, with special focus on the experiences of having TMD, factors related to seeking care, and perspectives on received treatment.

Methods: Purposive sampling was used to recruit adult patients at the Public Dental Health services (PDHS) in the Region of Västerbotten, Sweden, during 2019. Individual semi-structured interviews were conducted and analysed using Qualitative Content Analysis. Sixteen patients were interviewed (ten women and six men, 20–65 years). The interviews probed the patients’ perspectives of having TMD, seeking care, and receiving treatment. All participants were also examined according to the Diagnostic Criteria for TMD (DC/TMD) and qualified for at least one DC/TMD diagnosis.

Results: The data analysis led to the main theme Seeking care when the situation becomes untenable, but dental care fails to meet all needs. The patients expressed worry and social discomfort because of the symptoms but still strived to have an as normal daily life as possible. However, severe symptoms and associated consequences compelled them to seek professional help. Experiences of distrust together with challenges to access the PDHS were identified and related to the patients’ unfulfilled expectations.

Conclusions: Patients’ reported experiences indicate that receiving timely and appropriate care is more of an unfulfilled expectation than the current state of management of patients with TMD in dentistry.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
General practice, Dental, Temporomandibular joint disorders, Qualitative research
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-202143 (URN)10.1186/s12903-023-03230-5 (DOI)37684660 (PubMedID)2-s2.0-85170284061 (Scopus ID)
Funder
Umeå UniversityRegion Västerbotten
Note

Originally included in thesis in manuscript form.

Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2024-07-04Bibliographically approved
Ilgunas, A., Häggman-Henrikson, B., Visscher, C., Lobbezoo, F., Durham, J., Liv, P. & Lövgren, A. (2023). The longitudinal relationship between jaw catching/locking and pain. Journal of Dental Research, 102(4), 383-390
Open this publication in new window or tab >>The longitudinal relationship between jaw catching/locking and pain
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2023 (English)In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 102, no 4, p. 383-390Article in journal (Refereed) Published
Abstract [en]

Orofacial pain and joint-related dysfunction can negatively affect daily jaw function. A common cause for limitations in jaw movements is joint-related dysfunction such as various forms of catching and locking. However, knowledge is limited regarding the development and natural course of joint-related jaw dysfunction and its relationship to the onset and course of orofacial pain. Therefore, the aim was to evaluate the incidence, prevalence, and gender differences in jaw catching/locking over time and in relation to orofacial pain in the general population. Data from 3 validated screening questions on orofacial pain and jaw catching/locking were collected from all routine dental checkups in the Public Dental Health Services in Västerbotten, Sweden, from 2010 to 2017. Logistic generalized estimating equation was used to account for repeated observations and Poisson regression for incidence analysis. In total, 180,308 individuals (aged 5–104 y) were screened in 525,707 dental checkups. In 2010, based on 37,647 individuals, the prevalence of self-reported catching/locking was higher in women than in men (3.2% vs. 1.5%; odds ratio, 2.11; 95% confidence interval [CI], 1.83–2.43), and this relationship and magnitude remained similar throughout the study period. The annual incidence rate was 1.1% in women and 0.5% in men. Women were at a higher risk than men for reporting both first onset (incidence rate ratio [IRR], 2.29; 95% CI, 2.11–2.49) and persistent (IRR, 2.31; 95% CI, 2.04–2.63) catching/locking. For the onset subcohort (n = 135,801), an independent onset of orofacial pain or jaw catching/locking exclusively was reported by 84.1%, whereas a concurrent onset was reported by 13.4%. Our findings of higher incidence, prevalence, and persistence in women than in men indicate that the gender differences seen for orofacial pain are evident also for jaw catching/locking. The findings also suggest independent onset of self-reported catching/locking and orofacial pain, which reinforces the pathophysiological differences between these conditions.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
cohort studies, dentistry, epidemiology, facial pain, population health, temporomandibular joint disorders
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-202140 (URN)10.1177/00220345221138532 (DOI)000893183300001 ()36940290 (PubMedID)2-s2.0-85143637716 (Scopus ID)
Funder
Swedish Dental AssociationUmeå UniversityRegion Västerbotten
Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2023-07-14Bibliographically approved
Ilgunas, A., Lövgren, A., Fjellman-Wiklund, A., Häggman-Henrikson, B., Karlsson Wirebring, L., Lobbezoo, F., . . . Durham, J. (2021). Conceptualizing the clinical decision-making process in managing temporomandibular disorders: a qualitative study. European Journal of Oral Sciences, 129(5), Article ID e12811.
Open this publication in new window or tab >>Conceptualizing the clinical decision-making process in managing temporomandibular disorders: a qualitative study
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2021 (English)In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 129, no 5, article id e12811Article in journal (Refereed) Published
Abstract [en]

Management of patients with temporomandibular disorders (TMD) appears to be more challenging than for other dental conditions. This study aimed to explore the decision-making process in TMD management, and thereby to conceptualize the decision-making process in dentistry. Individual semi-structured interviews were conducted during 2018 and 2019 with a purposive sample of 22 general dental practitioners from the Public Dental Healthcare Services and private practices in the Region of Västerbotten, Northern Sweden. The interviews were analysed using the Grounded Theory approach of Charmaz. Data analysis resulted in the core category 'Combining own competence and others' expectations in the desire to do the right thing'. The dentists showed interest in and a desire to apply professional knowledge, but also reflected on challenges and complexity in the decision-making process forTMD. The challenges were primarily related to organisational factors and lack of self-confidence. This identifies a need for re-organisation of daily clinical management in dentistry, and a need for more postgraduate training to improve self-confidence. The complexity of the decision-making process for TMD makes the study findings applicable in other dental situations.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
decision-making, dental health services, evidence-based dentistry, qualitative research, temporomandibular joint disorders
National Category
Dentistry Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-184795 (URN)10.1111/eos.12811 (DOI)000662824700001 ()34145628 (PubMedID)2-s2.0-85107969782 (Scopus ID)
Projects
ujl
Available from: 2021-06-18 Created: 2021-06-18 Last updated: 2023-12-14Bibliographically approved
Häggman-Henrikson, B., Liv, P., Ilgunas, A., Visscher, C. M., Lobbezoo, F., Durham, J. & Lövgren, A. (2020). Increasing gender differences in the prevalence and chronification of orofacial pain in the population. Pain, 161(8), 1768-1775
Open this publication in new window or tab >>Increasing gender differences in the prevalence and chronification of orofacial pain in the population
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2020 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 161, no 8, p. 1768-1775Article in journal (Refereed) Published
Abstract [en]

Although a fluctuating pattern of orofacial pain across the life span has been proposed, data on its natural course is lacking. The longitudinal course of orofacial pain in the general population was evaluated using data from routine dental check-ups at all Public Dental Health services in Västerbotten, Sweden. In a large population sample, two screening questions were used to identify individuals with pain once a week or more in the orofacial area. Incidence and longitudinal course of orofacial pain were evaluated using annual data for 2010-2017. To evaluate predictors for orofacial pain remaining over time, individuals who reported pain on at least two consecutive dental check-ups were considered persistent. A generalized estimating equation model was used to analyze the prevalence, accounting for repeated observations on the same individuals. In total, 180,308 individuals (equal gender distribution) were examined in 525,707 dental check-ups. More women than men reported orofacial pain (OR 2.58, 95% CI 2.48-2.68), and there was a significant increase in the prevalence of reported pain from 2010 to 2017 in both women and men. Longitudinal data for 135,800 individuals were available for incidence analysis. Women were at higher risk of both developing orofacial pain (IRR 2.37; 95% CI 2.25-2.50) and reporting pain in consecutive check-ups (IRR 2.56, 95% CI 2.29-2.87). In the northern Swedish population studied, the prevalence of orofacial pain increases over time and more so in women, thus indicating increasing differences in gender for orofacial pain.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2020
Keywords
Chronic pain, Facial pain, Gender, Orofacial pain, Temporomandibular disorders, Incidence, Prevalence
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-169218 (URN)10.1097/j.pain.0000000000001872 (DOI)000559753000011 ()32701837 (PubMedID)2-s2.0-85088530490 (Scopus ID)
Available from: 2020-03-25 Created: 2020-03-25 Last updated: 2023-03-23Bibliographically approved
Larsson, J., Westergren, H., Häggman-Henrikson, B., Ilgunas, A., Wänman, A. & Malmström, E.-M. (2020). The feasibility of gym-based exercise therapy for patients with persistent neck pain. Scandinavian Journal of Pain, 20(2), 261-272
Open this publication in new window or tab >>The feasibility of gym-based exercise therapy for patients with persistent neck pain
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2020 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 20, no 2, p. 261-272Article in journal (Refereed) Published
Abstract [en]

Background and aims: Persistent neck pain is common and can be detrimental to the health of those who are affected. This is particularly common after neck trauma, where it poses a challenge to health care providers. In this paper, we present the design and results of a study aimed primarily at assessing the feasibility of a supervised exercise intervention for patients with persistent neck pain after trauma. As a secondary aim, we analyzed the results of the intervention.

Methods: We designed and conducted a feasibility study using a mixed methods design. Ten patients with persistent neck pain (nine with a history of neck trauma and one with sudden onset of neck pain) were recruited from a specialized pain rehabilitation center and underwent a gym-based individual exercise therapy intervention, supervised by a physical therapist. We assessed the feasibility of the exercise therapy intervention based on the experiences of the patients and physical therapists. We analyzed both quantitative and qualitative results using descriptive statistics, content analysis, and questionnaires.

Results: The study found the exercise therapy to be a feasible alternative for patients with persistent neck pain. Most of the practical aspects of the intervention and study were executed as planned, and the study was well received by the patients, who found it a valuable part of their rehabilitation. In the quantitative analysis, improvements were observed on the Neck Disability Index, numerical rating scale for pain, EuroQol 5D, and physical activity, with scores on the Neck Disability Index showing a statistically significant improvement. Scores on the Disability Rating Index showed a non-significant deterioration. The qualitative analysis uncovered one overarching theme and four themes for the patients and three themes for the physical therapist.

Conclusions: The exercise therapy intervention seems to be feasible with favorable outcomes for the patients. The quantitative and qualitative analyses demonstrated exercise therapy to be beneficial from several different perspectives. However, although structured, the training needs customization and individual adaption from a clinical reasoning perspective in order to meet each patient’s individual needs.

Implications: This study shows that supervised gym-based exercise therapy is feasible for patients with severe, persistent neck pain. It facilitates and motivates the execution of a larger, controlled trial, which might then lead to a new and potentially effective addition to the toolbox of all health care providers treating patients with persistent neck pain.

Place, publisher, year, edition, pages
Walter de Gruyter, 2020
Keywords
neck pain, chronic pain, rehabilitation, exercise therapy, physical therapy modalities, feasibility studies
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-171333 (URN)10.1515/sjpain-2019-0085 (DOI)000530050100005 ()31811812 (PubMedID)2-s2.0-85084102359 (Scopus ID)
Available from: 2020-06-12 Created: 2020-06-12 Last updated: 2023-03-23Bibliographically approved
Storm Mienna, C., Glas, L., Magnusson, M., Ilgunas, A., Häggman-Henrikson, B. & Wänman, A. (2019). Patients' experiences of supervised jaw-neck exercise among patients with localized TMD pain or TMD pain associated with generalized pain. Acta Odontologica Scandinavica, 77(7), 495-501
Open this publication in new window or tab >>Patients' experiences of supervised jaw-neck exercise among patients with localized TMD pain or TMD pain associated with generalized pain
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2019 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, no 7, p. 495-501Article in journal (Refereed) Published
Abstract [en]

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

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

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

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

Place, publisher, year, edition, pages
Abingdon: Taylor & Francis, 2019
Keywords
Exercise therapy, orofacial pain, pain, qualitative, temporomandibular disorders
National Category
Dentistry
Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-157932 (URN)10.1080/00016357.2019.1598573 (DOI)000465814900001 ()30957601 (PubMedID)2-s2.0-85063993451 (Scopus ID)
Available from: 2019-04-08 Created: 2019-04-08 Last updated: 2024-07-02Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1053-7170

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