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Perspectives on signs and symptoms indicative of temporomandibular disorders among adults
Umeå University, Faculty of Medicine, Department of Odontology. Umeå University.ORCID iD: 0000-0002-2183-7497
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 [en]
epidemiology, temporomandibular disorders, headache, gender, treatment need, clinical decision-making, widespread pain
National Category
Dentistry
Identifiers
URN: urn:nbn:se:umu:diva-183170ISBN: 978-91-7855-555-0 (electronic)ISBN: 978-91-7855-554-3 (print)OAI: oai:DiVA.org:umu-183170DiVA, id: diva2:1555403
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
List of papers
1. Prevalence of signs and symptoms indicative of temporomandibular disorders and headaches in 35-, 50-, 65- and 75-year-olds living in Västerbotten, Sweden
Open this publication in new window or tab >>Prevalence of signs and symptoms indicative of temporomandibular disorders and headaches in 35-, 50-, 65- and 75-year-olds living in Västerbotten, Sweden
2014 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 6, p. 458-465Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Informa Healthcare, 2014
Keywords
craniomandibular disorders, epidemiology, gender, headache, pain
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-85835 (URN)10.3109/00016357.2013.860620 (DOI)000340259700009 ()24417523 (PubMedID)2-s2.0-84904689003 (Scopus ID)
Available from: 2014-02-11 Created: 2014-02-11 Last updated: 2023-03-23Bibliographically approved
2. Associations between craniomandibular disorders, sociodemographic factors and self-perceived general and oral health in an adult population
Open this publication in new window or tab >>Associations between craniomandibular disorders, sociodemographic factors and self-perceived general and oral health in an adult population
2014 (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. 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.

Place, publisher, year, edition, pages
Informa Healthcare, 2014
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-94533 (URN)10.3109/00016357.2014.949843 (DOI)000344330400070 ()25220523 (PubMedID)2-s2.0-84951780871 (Scopus ID)
Available from: 2014-10-13 Created: 2014-10-13 Last updated: 2023-03-24Bibliographically approved
3. Factors associated with clinical decision-making in relation to treatment need for temporomandibular disorders
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
4. Association between signs of hyperalgesia and reported frequent pain in jaw-face and head
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
5. The association between myofascial orofacial pain with and without referral and widespread pain
Open this publication in new window or tab >>The association between myofascial orofacial pain with and without referral and widespread pain
Show others...
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

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