Umeå universitets logga

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

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

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

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

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

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

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

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

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.

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.

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.