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  • 1.
    Böthun, Alicia
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Lampa, Ewa
    Umeå University, Faculty of Medicine, Department of Odontology.
    Österlund, Catharina
    Umeå University, Faculty of Medicine, Department of Odontology.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Hellström, Fredrik
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Occupational Health Science and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Whiplash trauma did not predict jaw pain after 2 years: an explorative study2024In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 28, article id 165Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore predictive factors for the development and maintenance of jaw pain over a 2-year period.

    Methods: One hundred nineteen cases (73 women) and 104 controls (59 women), mean age 34.9 years (SD 13.9), attended baseline and 2-year follow-up examinations. The whiplash cases visited the emergency department at Umeå University Hospital, Sweden, with neck pain within 72 h following a car accident, and baseline questionnaires were answered within a month after trauma. Controls were recruited via advertising. Inclusion criteria were age 18–70 years, living in Umeå municipality and Swedish speaking. The exclusion criterion was neck fracture for cases and a previous neck trauma for controls. Validated questionnaires recommended in the standardized Research Diagnostic Criteria for temporomandibular disorders were used. Jaw pain was assessed by two validated screening questions answered with “yes” or “no.” A logistic regression analysis was used to predict the outcome variable jaw pain (yes/no) after 2 years.

    Results: Whiplash trauma did not increase the odds of development of jaw pain over a 2-year period (OR 1.97, 95% CI 0.53–7.38). However, non-specific physical symptoms (OR 8.56, 95% CI 1.08–67.67) and female gender (OR 4.89, 95% CI 1.09–22.02) did increase the odds for jaw pain after 2 years.

    Conclusion: The development and maintenance of jaw pain after whiplash trauma are primarily not related to the trauma itself, but more associated with physical symptoms.

    Clinical relevance: The development of jaw pain in connection with a whiplash trauma needs to be seen in a biopsychosocial perspective, and early assessment is recommended.

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  • 2.
    De la Torre Canales, Giancarlo
    et al.
    Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & amp; Science, Caparica, Almada, Portugal; Department of Dentistry, Ingá University Center, Uningá, Paraná, Brazil.
    Câmara-Souza, Mariana Barbosa
    Department of Dentistry, Ingá University Center, Uningá, Paraná, Brazil.
    Ernberg, Malin
    Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Al-Moraissi, Essam Ahmed
    Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
    Grigoriadis, Anastasios
    Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Poluha, Rodrigo Lorenzi
    Department of Dentistry, State University of Maringa, Paraná, Brazil.
    Christidis, Maria
    The Institute of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Jasim, Hajer
    Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; Public Dental Services, Department of Orofacial Pain and Jaw Function, Folktandvården Stockholms län AB, Eastmaninstitutet, Stockholm, Sweden.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Christidis, Nikolaos
    Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Botulinum toxin-a for the treatment of myogenous temporomandibular disorders: an umbrella review of systematic reviews2024In: Drugs, ISSN 0012-6667, E-ISSN 1179-1950Article, review/survey (Refereed)
    Abstract [en]

    Objective: Temporomandibular disorders (TMDs) encompass several conditions that cause pain and impair function of the masticatory muscles (M-TMDs) and temporomandibular joints. There is a large interest among clinicians and researchers in the use of botulinum toxin-A (BoNT-A) as a treatment for M-TMD. However, due to the lack of consistent evidence regarding the efficacy as well as adverse events of BoNT-A, clinical decision making is challenging. Therefore, this umbrella review aimed to systematically assess systematic reviews (SRs) evaluating BoNT-A treatment effects on pain intensity, mandibular movements, and adverse events in patients with M-TMDs.

    Method: An electronic search was undertaken in the databases MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Epistemonikos, ClinicalTrials.gov, and ICTRP to identify SRs investigating BoNT-A effects on M-TMDs, published from the inception of each database until 6 December 2023. The quality of evidence was rated according to the critical appraisal checklist developed by the umbrella review methodology working group. Only high-quality SRs were included.

    Results: In total, 18 SRs were included. BoNT-A was shown to be more effective than placebo to reduce pain intensity, but not compared to standard treatments. Additionally, BoNT-A was not superior to placebo or standard treatments regarding improvement of mandibular movements. BoNT-A was considered to have a higher risk for adverse events on muscle and bony tissue compared with other treatments.

    Conclusion: The synthesis in this umbrella review provides the highest level of evidence present. Taken together, there are indications of effectiveness of BoNT-A for treatment of M-TMDs, supported by moderate evidence. However, considering the risk of causing serious adverse events, treatment with BoNT-A is recommended to be the last treatment alternative.

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  • 3.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Näsström, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Patients' perceived treatment need owing to temporomandibular disorders and perceptions of related treatment in dentistry: a mixed method study2019In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 46, no 9, p. 792-799Article in journal (Refereed)
    Abstract [en]

    Background: To easily identify patients who could benefit from a temporomandibular disorder (TMD) examination, three screening questions (3Q/TMD) have been introduced in large parts of Sweden. The questions are related to a TMD diagnosis. However, how the questions relate to a treatment need is unknown.

    Objectives: The first aim of the study was to identify predicting factors for perceived treatment need among adult individuals who screened positive to the 3Q/TMD. The second aim was to explore individuals' thoughts and experiences related to treatment of their TMD complaint.

    Methods: This mixed‐method study with a case‐control design was conducted in Västerbotten, Sweden, during 2014. Individuals who screened positive to at least one of the 3Q/TMD questions were allocated 3Q‐positives, whereas those with negative answers to all questions were allocated 3Q‐negatives. In total, 300 individuals (140 randomly selected 3Q‐positives, and 160 age‐ and gender‐matched 3Q‐negatives) were included. All individuals answered questions related to treatment need. The answers were analysed in a qualitative approach with qualitative content analysis.

    Results: In total, 81% of 3Q‐positives expressed a treatment need related to their TMD symptoms. The perceived treatment need was predicted by frequent pain (Q1) and frequent functional disturbances (Q3). Among the 3Q‐positives, 54% reported mistrust in dentists' ability to treat TMD symptoms. The informants expressed a need for information about their symptoms and possible treatment options.

    Conclusion: Affirmative answers to 3Q/TMD were associated with TMD treatment need. Dentists should give advice to patients with TMD symptoms and address their concerns.

  • 4.
    Holmström, Anna-Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Vallin, Simon
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Effect on orofacial pain in patients with chronic pain participating in a multimodal rehabilitation programme: a pilot study2023In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 23, no 4, p. 656-661Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Orofacial pain in patients taking part in a multimodal rehabilitation programme (MMRP) due to chronic bodily pain is common but it is not known whether such a rehabilitation programme can also have an effect on the presence of orofacial pain. The first aim of this study was to evaluate the effect of an MMRP on orofacial pain frequency. The second aim was to evaluate differences in the effect on quality of life and on psychosocial factors related to chronic pain.

    METHODS: MMRP was evaluated through validated questionnaires from the Swedish Quality Registry for Pain Rehabilitation (SQRP). Fifty-nine patients participating in MMRP filled out the two screening questions for orofacial pain in addition to the SQRP questionnaires before and after participation in MMRP during the period August 2016 to March 2018.

    RESULTS: Pain intensity decreased significantly after the MMRP (p=0.005). Fifty patients (69.4 %) reported orofacial pain before MMRP and no significant decrease after the programme (p=0.228). Among individuals with orofacial pain, the self-reported level of depression decreased after participation in the programme (p=0.004).

    CONCLUSIONS: Even though orofacial pain is common among patients with chronic bodily pain, participation in a multimodal pain programme was not enough to reduce frequent orofacial pain. This finding implies that specific orofacial pain management including information about jaw physiology could be a justified component of patient assessment prior to a multimodal rehabilitation programme for chronic bodily pain.

  • 5.
    Häggman-Henrikson, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Liv, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Ilgunas, Aurelija
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Visscher, Corine M.
    Lobbezoo, Frank
    Durham, Justin
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Increasing gender differences in the prevalence and chronification of orofacial pain in the population2020In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 161, no 8, p. 1768-1775Article in journal (Refereed)
    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.

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  • 6.
    Häggman-Henrikson, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden.
    Visscher, Corine M.
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, Amsterdam, Netherlands.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ljótsson, Brjánn
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Peck, Christopher C.
    The University of Sydney Westmead Initiative, The University of Sydney, Sydney, Australia.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Even mild catastrophic thinking is related to pain intensity in individuals with painful temporomandibular disorders2021In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 48, no 11, p. 1193-1200Article in journal (Refereed)
    Abstract [en]

    Aims: Temporomandibular disorders (TMD) are often associated with psychological comorbidities. One such comorbidity is pain catastrophising, that is, exaggeration of negative consequences of a painful event. The aim was to investigate catastrophising in individuals with painful TMD compared to controls and the association between catastrophising and pain intensity, number of pain sites and functional limitations.

    Methods: A community-based sample of 110 individuals (83 women; 20–69 yrs) with painful TMDs (myalgia/arthralgia as per Diagnostic Criteria for TMD) and 190 age- and gender-matched controls (119 women; 20–69 yrs) from the Public Dental services in Västerbotten, Sweden, participated. Associations between catastrophising and functional jaw limitations, respectively, and painful TMD were evaluated with ordinal regression adjusted for the effect of gender and age. Associations (Spearman's correlation) of the Pain catastrophising Scale (PCS) with Jaw Functional Limitation Scale (JFLS-20), pain site number (whole-body pain map), and characteristic pain intensity (CPI) and intergroup comparisons (Mann-Whitney U test) of these variables were also calculated.

    Results: Levels of catastrophising were associated with TMD pain (OR 1.6, 95%CI 1.1–2.6). Among individuals with painful TMD, catastrophising was correlated to pain intensity (r=0.458, p<0.01) and functional limitations (r=0.294–0.321, p≤0.002), but not to number of pain sites.

    Conclusion: Compared to controls, community-based individuals with painful TMD demonstrated higher levels of pain catastrophising, and this catastrophising was associated with increased pain intensity and jaw dysfunction. The relatively low scores of pain catastrophising suggest that even mild catastrophic thinking is associated with pain perception and jaw function, and should be considered in patient management.

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  • 7.
    Ilgunas, Aurelia
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Häggman-Henrikson, Birgitta
    Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Lobbezoo, Frank
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Visscher, Corine M.
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Durham, Justin
    School of Dental Sciences, Newcastle University, Newcastle, UK; Newcastle Hospitals’ NHS Foundation Trust, Newcastle, UK.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Patients' experiences of temporomandibular disorders and related treatment2023In: BMC Oral Health, E-ISSN 1472-6831, Vol. 23, no 1, article id 653Article in journal (Refereed)
    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.

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  • 8.
    Ilgunas, Aurelia
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Visscher, C.M.
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Lobbezoo, F.
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Durham, J.
    School of Dental Sciences, Newcastle University, Newcastle, UK;Newcastle Hospitals’ NHS Foundation Trust, Newcastle, UK.
    Liv, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    The longitudinal relationship between jaw catching/locking and pain2023In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 102, no 4, p. 383-390Article in journal (Refereed)
    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.

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  • 9.
    Ilgunas, Aurelija
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Häggman-Henrikson, Birgitta
    Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Karlsson Wirebring, Linnea
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lobbezoo, Frank
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.
    Visscher, Corine M.
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.
    Durham, Justin
    School of Dental Sciences, Newcastle University, Newcastle, UK and Newcastle Hospitals’ NHS Foundation Trust, Newcastle, UK.
    Conceptualizing the clinical decision-making process in managing temporomandibular disorders: a qualitative study2021In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 129, no 5, article id e12811Article in journal (Refereed)
    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.

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  • 10.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry. Odontology, Umeå University.
    Effektiv screeningmetod för vanliga symtom i ansikte och käkar2018In: Best Practice NordicArticle in journal (Other (popular science, discussion, etc.))
  • 11.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Recognition of Temporomandibular Disorders: validity and outcome of three screening questions (3Q/TMD)2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Pain and dysfunction in the temporomandibular region (Temporomandibular Disorders, TMD) are common conditions in the general population with an estimated treatment need of 5-15% in the general population. However, in Sweden, traceable performed treatments are significantly lower. The reasons for this indicated under-treatment are not known. To easily detect patients with a potential TMD related condition, three screening questions, 3Q/TMD, have been introduced. The aim with this project was to evaluate the validity and outcome of the 3Q/TMD with the objective to recognize individuals with TMD and potential treatment need in the Public Dental Health service (PDHS).

    Methods

    The thesis is based on four study samples; three from the PDHS in the county of Västerbotten, Sweden and one sample from the specialized orofacial pain clinic at the Academic Centre for Dentistry, ACTA, Amsterdam, the Netherlands. The bases for all studies are individuals’ answers to the 3Q/TMD and quantitative approaches were used in the analyses. The prevalence of affirmative answers was evaluated in a large cross-sectional study over the lifespan. The validity of the 3Q/TMD in relation to the Diagnostic Criteria for TMD (DC/TMD) as reference standard was established in two case-control studies. The outcome of the 3Q/TMD on TMD treatment within general practice was evaluated in a cohort study.

    Results

    Affirmative answers to the 3Q/TMD increased during adolescence. Women answered affirmatively to the 3Q/TMD significantly more often compared to men for all age groups expect for the first and last parts of a one hundred-year lifespan. The highest prevalence was reported by women during their fertile period in life. In a general population sample, 74% of individuals with an affirmative answer qualified for a DC/TMD pain or dysfunctional diagnosis, as compared to 64% in a specialist patient sample. In the general population sample, for the individual 3Q/TMD questions, as well as combinations of questions, the negative predictive values were high (0.92-0.99). For the specialist sample, when at least one question was answered affirmatively the negative predictive value was high (0.90). The positive predictive value was high (0.89) when all three questions were positive. There was significantly more treatment performed or recommended for 3Q-positives (21.5%) compared to 3Q-negatives (2.2%) (P<0.001). The odds ratio for TMD-related treatment for 3Q-positives versus 3Q-negatives was 12.1 (95% CI: 6.3-23.4).

    Conclusion

    The 3Q/TMD is a convenient and valid tool to recognize individuals who would benefit from a further TMD examination within an adult, general population. Within specialized orofacial pain clinics, the questions are useful as guidance for further diagnostics. Although the 3Q/TMD was a factor related to TMD treatment, the majority of individuals with self-reported symptoms of TMD still did not receive traceable assessment or treatment. Factors associated with dentists’ clinical decision-making in relation to TMD warrants further research. The utilization of the 3Q/TMD as a part of a decision tree for the clinician can improve the health care for patients with TMD and is therefore recommended within dentistry.

     

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  • 12.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Begic, Arnela
    Umeå University, Faculty of Medicine, Department of Odontology.
    Landgren, Henrik
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lundén, Victor
    Umeå University, Faculty of Medicine, Department of Odontology.
    Svensson, P.
    Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden; Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
    Österlund, Catharina
    Umeå University, Faculty of Medicine, Department of Odontology.
    The impact of gender of the examiner on orofacial pain perception and pain reporting among healthy volunteers2022In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 26, p. 3033-3040Article in journal (Refereed)
    Abstract [en]

    Objectives: Pain on palpation of jaw muscles is a commonly used diagnostic criterion when examining patients with orofacial pain. It is not known, however, if pain reports are affected by the gender of the examiner. Our aim was to investigate if pressure pain threshold (PPT), pressure pain tolerance (PTol), and pain intensity assessed over the masseter muscles in healthy individuals are affected by the gender of the examiner.

    Materials and methods: Healthy, pain-free individuals were recruited on a voluntary basis. PPT and PTol were assessed using pressure algometry. At the PTol level, participants also rated pain intensity on a 0–10 numeric rating scale. Assessments of PPT and PTol were conducted with six repeated measurements performed twice, separately by one female and one male examiner, on each participant.

    Results: In total, 84 participants (43 women; median age 24, IQR 6) were included. With a female examiner, women reported higher pain intensity than men (Mann Whitney U, p = 0.005). In the multivariable analysis, significantly higher PTol was predicted by male examiner. Also, a higher ratio between PTol and reported pain intensity was predicted by male examiner.

    Conclusions: The gender of the examiner influences pain reporting and perception in an experimental setting. This effect on pain perception related to gender of the examiner is probably related to normative gender behaviors rather than to biological alterations within the examined individual.

    Clinical relevance: In clinical and experimental settings, gender of the examiner may affect not only pain perception but also pain reporting, with potential implications for diagnostics in patients with pain.

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  • 13.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology.
    Visscher, C. M.
    Lobbezoo, F.
    Marklund, Susanna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Temporomandibular pain and jaw dysfunction at different ages covering the lifespan - A population based study2016In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 20, no 4, p. 532-540Article in journal (Refereed)
    Abstract [en]

    Background

    Temporomandibular pain and jaw dysfunction can have a negative effect on daily life, but these conditions are not well recognized in the health care systems. The general aim was to examine the cross-sectional prevalence of frequent temporomandibular pain and jaw dysfunction in men and women across the lifespan.

    Methods

    The analysis was based on data from 137,718 individuals (mean age 35years, SD 22.7) who answered three questions (3Q/TMD) included in the digital health declaration in the Public Dental Health care in the county of Vasterbotten, Sweden; Q1: Do you have pain in your temple, face, jaw or jaw joint once a week or more?'; Q2: Does it hurt once a week or more when you open your mouth or chew?'; and Q3: Does your jaw lock or become stuck once a week or more?'

    Results

    The prevalence of frequent temporomandibular pain (Q1) was 5.2% among women and 1.8% among men (p<0.0001). The prevalence of frequent pain on jaw movement (Q2) was 2.5% among women and 0.9% among men (p<0.0001). The prevalence of frequent locking of the jaw (Q3) was 2.7% among women and 1.2% among men (p<0.0001).

    Conclusions

    The study shows that the cross-sectional prevalence of temporomandibular pain and jaw dysfunction varies during the lifespan. For men and women, respectively, symptoms increase during adolescence, peak in middle age and then gradually diminish. The prevalence of these symptoms is significantly higher among women except from the first and last decades of a 100-year lifespan.

  • 14.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ilgunas, Aurelia
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Elias, B.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Roudini, O. A.L.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Visscher, C.M.
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
    Lobbezoo, F.
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Liv, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Associations between screening for functional jaw disturbances and patient reported outcomes on jaw limitations and oral behaviors2023In: Journal of Evidence-Based Dental Practice, ISSN 1532-3382, E-ISSN 1532-3390, Vol. 23, no 3, article id 101888Article in journal (Refereed)
    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.

  • 15.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Karlsson Wirebring, Linnea
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jawfunction, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Decision-making in dentistry related to temporomandibular disorders: a 5-yr follow-up study2018In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 126, no 6, p. 493-499Article in journal (Refereed)
    Abstract [en]

    Temporomandibular disorders (TMDs) are common, but many patients with such disorders go undetected and under-treated. Our aim was to evaluate the outcome of using a screening tool (5 yr after it was first implemented), on the clinical decision-making for patients with TMDs. Adults who attended for a dental check-up at the Public Dental Health Services in Västerbotten, Sweden, answered three screening questions (3Q/TMD) on frequent jaw pain, pain on jaw function, and catching/locking of the jaw. The dental records of a random sample of 200 individuals with at least one positive response to 3Q/TMD (3Q screen-positive patients) and 200 individuals with all negative responses (3Q screen-negative patients) were reviewed for TMD-related treatment decisions. A clinical decision related to TMD was absent in 45.5% of 3Q screen-positive patients. Treatment of TMDs was associated with a positive response to the screening question on jaw pain (OR = 6.7, 95% CI: 3.2-14.0) and was more frequent among 3Q screen-positive patients (24%) than among 3Q screen-negative patients (2%; OR = 15.5, 95% CI: 5.5-43.9), just as a female examiner was associated with more frequent treatment of TMDs (OR = 3.1, 95% CI: 1.2-8.4). The results indicate under-treatment of TMD within general dental practice and that male clinicians are less likely to initiate TMD treatment.

  • 16.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Marklund, Susanna
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Visscher, Corine
    Academic Centre for Dentistry Amsterdam (ACTA).
    Lobbezoo, Frank
    Academic Centre for Dentistry Amsterdam (ACTA).
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Malmö Högskola.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Outcome of three screening questions for temporomandibular disorders (3Q/TMD) on clinical decision-making2017In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 44, no 8, p. 573-579Article in journal (Refereed)
    Abstract [en]

    Patients with temporomandibular disorders (TMD) seem to go undetected and not adequately managed within dentistry. To identify these patients, three screening questions (3Q/TMD) have been introduced within dentistry in parts of Sweden. It is not known whether 3Q/TMD affects the clinical decision-making for these patients. The aim of this study was to evaluate the outcome of 3Q/TMD on the clinical decision-making and to analyse whether gender, age and the fee system the individual was assigned to were related to prescribed TMD treatment. This cohort study was carried out within the Public Dental Health service in Vasterbotten, Sweden. As part of the routine dental check-up, a health declaration including 3Q/TMD was completed. The study population was randomly selected based on their 3Q/TMD answers. In total, 300 individuals with an affirmative answer to any of the 3Q/TMD, and 500 individuals with all negative answers were selected. The 3Q/TMD includes questions on weekly jaw-face-temple pain (Q1), pain on function (Q2) and catching/locking of the jaw (Q3). The 3Q/TMD was analysed in relation to prescribed treatment assessed from dental records. There was significantly more treatment performed or recommended for 3Q-positives (215%), compared to 3Q-negatives (22%) (P < 0001). The odds ratio for TMD-related treatment for 3Q-positives versus 3Q-negatives was 121 (95% CI: 63-234). Although affirmative answers to the 3Q/TMD was related to TMD treatment, the majority of individuals with a screen positive still did not, according to dental records, receive assessment or treatment. Further studies are needed to better understand the clinical decision-making process for patients with TMD.

  • 17.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Parvaneh, Hasti
    Academic Centre for Dentistry Amsterdam (ACTA).
    Lobbezoo, Frank
    Academic Centre for Dentistry Amsterdam (ACTA).
    Häggman-Henrikson, Birgitta
    Malmö Högskola.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Visscher, Corine
    Academic Centre for Dentistry Amsterdam (ACTA).
    Validity of three screening questions in relation to the DC/TMD in a specialized orofacial pain clinicManuscript (preprint) (Other academic)
    Abstract [en]

    Aims: To determine the validity of three screening questions (3Q/TMD) in relation to the

    Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), in a specialized orofacial pain

    clinic.

    Methods: Consecutive patients, >18 years, referred with a TMD complaint to the Orofacial pain

    clinic, Academic Centre for Dentistry Amsterdam, ACTA, the Netherlands, were included in the

    study. The study sample, (n=449) with mean age 44 years (72% females) answered the

    3Q/TMD and the DC/TMD questionnaire before a clinical DC/TMD examination. The 3Q/TMD

    constitutes of two questions on weekly pain from the jaw, face, and temple region, in rest (Q1)

    and on function (Q2), and one function-related question on weekly catching and/or locking of the

    jaw (Q3). Q1 and Q2 were evaluated in relation to a DC/TMD pain diagnosis and Q3 in relation

    to a subgroup of DC/TMD intra-articular diagnosis, referred to as the reference standard.

    Results: In total, 44% of patients received a pain-related DC/TMD diagnosis and 33% an

    intraarticular reference DC/TMD diagnosis. Sensitivity for the two pain screening questions was

    high (0.83-0.94), whereas specificity was low (0.41-0.55). For the function-related question,

    sensitivity was low (0.48), whereas specificity was high (0.96).

    Conclusions: In most TMD-pain patients, the two pain screening questions are positive. The

    high negative predictive values of the two questions on pain (Q1 and Q2) indicate that in

    patients with negative responses, the presence of pain-related TMD is quite unlikely. For the

    functional screening question (Q3), a positive response is indicative for a subgroup of intra-

    articular DC/TMD diagnoses.

  • 18.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Parvaneh, Hasti
    Lobbezoo, Frank
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Visscher, Corine Mirjam
    Diagnostic accuracy of three screening questions (3Q/TMD) in relation to the DC/TMD in a specialized orofacial pain clinic2018In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, no 6, p. 380-386Article in journal (Refereed)
    Abstract [en]

    Objective: To determine the diagnostic accuracy of three screening questions (3Q/TMD) in relation to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), in a specialized clinic.

    Material and methods: Consecutive patients, >18 years, referred with a possible TMD complaint to the Orofacial Pain and Dysfunction clinic, Academic Centre for Dentistry Amsterdam, the Netherlands, were included in the study. All patients (n = 449; mean age 44 years; 72% females), answered the 3Q/TMD and the DC/TMD questionnaire before a DC/TMD examination. The 3Q/TMD constitutes of two questions on weekly pain from the jaw, face and temple region (Q1), and on function (Q2), and one function-related question on weekly catching and/or locking of the jaw (Q3). Q1 and Q2 were evaluated in relation to a DC/TMD pain diagnosis and Q3 in relation to a subgroup of DC/TMD intra-articular diagnosis, referred to as the reference standard.

    Results: In total, 44% of patients received a pain-related DC/TMD diagnosis and 33% an intra-articular reference DC/TMD diagnosis. Sensitivity for the two pain screening questions was high (0.83–0.94), whereas specificity was low (0.41–0.55). For the function-related question, sensitivity was low (0.48), whereas specificity was high (0.96).

    Conclusions: In a specialized pain clinic, the two pain questions (Q1, Q2) are positive in most patients with pain-related TMD. Therefore, in case of a positive response, further diagnostic procedures for TMD pain are warranted. For the functional screening question (Q3), a positive response is indicative for an intra-articular DC/TMD diagnosis, while in case of a negative outcome, an intra-articular TMD might still be present.

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  • 19.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Visscher, C M
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Lobbezoo, F
    Marklund, Susanna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Validity of three screening questions (3Q/TMD) in relation to the DC/TMD2016In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 43, no 10, p. 729-736Article in journal (Refereed)
    Abstract [en]

    Temporomandibular disorders (TMD) are common but seem to be largely undetected within general dental care. To improve dentists' awareness of these symptoms, three screening questions (3Q/TMD) have been introduced. Our aim was to validate 3Q/TMD in relation to the diagnostic criteria for TMD (DC/TMD), while taking into account the severity level of the symptoms. The study population consisted of 7831 individuals 20-69 years old, who had their routine dental check-up at the Public Dental Health Service in Västerbotten, Sweden. All patients answered a health declaration, including the 3Q/TMD regarding frequent temporomandibular pain, pain on movement and catching/locking of the jaw. All 3Q-positives (at least one affirmative) were invited for examination in randomised order. For each 3Q-positive, a matched 3Q-negative was invited. In total, 152 3Q-positives and 148 3Q-negatives participated. At examination, participants answered 3Q/TMD a second time, before they were examined and diagnosed according to DC/TMD. To determine symptom's severity, the Graded Chronic Pain Scale and Jaw Functional Limitation Scale-20 (JFLS-20) were used. In total, 74% of 3Q-positives and 16% of 3Q-negatives met the criteria for DC/TMD pain or dysfunction (disc displacements with reduction and degenerative joint disorder were excluded). Fifty-five per cent of 3Q-positives had a TMD diagnosis and CPI score ≥3 or a JFLS-20 score ≥5, compared to 4% of 3Q-negatives. The results show that the 3Q/TMD is an applicable, cost-effective and valid tool for screening a general adult population to recognise patients in need of further TMD examination and management.

  • 20.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Visscher, Corine M.
    Alstergren, Per
    Lobbezoo, Frank
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    The outcome of a temporomandibular joint compression test for the diagnosis of arthralgia is confounded by concurrent myalgia2020In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 24, p. 97-102Article in journal (Refereed)
    Abstract [en]

    Objective: Pain in the orofacial region may originate from different structures, and one challenge for the clinician is to determine the primary origin of pain reported by the patient. In clinical practice, it is important to discriminate between a temporomandibular joint (TMJ) pain disorder and jaw muscle pain; therefore, tests that are proposed for such purposes warrant evaluation. The aim of the present study was to evaluate the outcome of a TMJ compression test in relation to a Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) arthralgia diagnosis.

    Methods: A study population (n = 300), randomly selected from the adult population in Västerbotten, Sweden, was examined according to the DC/TMD criteria and with a TMJ compression test. This test is comprised of forceful unilateral biting for 20 s on a wooden spatula in the first molar region. Familiar pain on the contralateral side to the clenching side was considered a positive test outcome.

    Results: Positive contralateral outcome of the TMJ compression test was associated with an arthralgia diagnosis (B = 1.737; OR 5.7, 95% CI 3.3–9.9). This association was confounded by concurrent myalgia (B = 1.737 → B = 0.996, 42.7%).

    Conclusion: In a general population, a negative TMJ compression test was strongly associated with the absence of a contralateral TMJ arthralgia diagnosis according to DC/TMD. The association between a positive TMJ compression test and a DC/TMD arthralgia diagnosis was confounded by the presence of myalgia.

    Clinical relevance: Concurrent myalgia renders the usefulness of the TMJ compression test for predicting an arthralgia diagnosis questionable.

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  • 21.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Visscher, Corine M.
    Lobbezo, Frank
    Yekkalam, Negin
    Umeå University, Faculty of Medicine, Department of Odontology.
    Vallin, Simon
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    The association between myofascial orofacial pain with and without referral and widespread pain2022In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 80, no 7, p. 481-486Article in journal (Refereed)
    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.

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  • 22.
    Lövgren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Österlund, Catharina
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ilgunas, Aurelija
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lampa, Ewa
    Umeå University, Faculty of Medicine, Department of Odontology.
    Hellström, Fredrik
    A high prevalence of TMD is related to somatic awareness and pain intensity among healthy dental students2018In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, no 6, p. 387-393Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Dental students have been identified as a group with high risks of developing both temporomandibular disorders (TMD) and psychosocial conditions. Our primary aim was to evaluate the cross-sectional prevalence of TMD diagnoses, as defined in the Diagnostic Criteria (DC)/TMD, among dental students. The secondary aim was to evaluate the prevalence and association of behavioural and psychosocial factors in relation to DC/TMD diagnoses.

    MATERIALS AND METHODS: The study was conducted among undergraduate dental students during the second semester of their third year at the Department of Odontology, Medical Faculty, Umeå University, Sweden. Three consecutive cohorts were recruited during August in 2013, 2014, 2015. In total, 54 students were included and examined according the DC/TMD procedure.

    RESULTS AND CONCLUSIONS: The prevalence of any DC/TMD diagnosis was 30%. The most prevalent TMD diagnosis was myalgia. Individuals with a TMD-pain diagnosis (i.e. myalgia or arthralgia) reported significantly higher pain intensity levels according to the Graded Chronic Pain Scale (GCPS) as compared to individuals without TMD-pain (Fisher's exact test p < .001, two-sided). In addition, individuals with any TMD scored significantly higher jaw functional limitations according to the Jaw Functional Limitation Scale 20 (JFLS-20, p < .001) and oral parafunctions according to the Oral Behavior Checklist (OBC, p = .005) as compared to individuals without TMD. The psychosocial factors evaluated did not differ between individual with or without a TMD diagnosis. The majority of the dental students reported symptoms that are already identified as risk factors for developing TMD and pain conditions. However, longitudinal data are needed to evaluate how this evolves over time.

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  • 23.
    Molin, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Vestberg, Maria
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ringnér, Anders
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Paediatrics, Umeå University Hospital, Umeå, Sweden.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Health Sciences, University West, Trollhättan, Sweden.
    Lindgren, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rather a competent practitioner than a compassionate healer: patients’ satisfaction with interactions in psychiatric inpatient care2021In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 42, no 6, p. 549-554Article in journal (Refereed)
    Abstract [en]

    Interactions with staff are important aspects in patients’ experiences of psychiatric inpatient care (PIC). This study aimed to evaluate patients’ satisfaction with their interactions with PIC staff and whether sociodemographic factors, depression and anxiety symptoms were associated with their perceptions of these interactions. In this cross-sectional study, we collected data from 84 patients receiving inpatient care in three psychiatric settings in Sweden. The patients’ perceptions of interactions with staff and self-reported degrees of depression and anxiety were evaluated through questionnaires. Overall, patients were satisfied with the patient–staff interaction. However, significantly higher scores were related to staffs’ practical competence than to their compassion. Older patients reported significantly more satisfaction than younger patients with their most recent meeting with staff. Tailored nursing interventions may improve staff’s compassionate capacity. Further research in larger samples is ne

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  • 24.
    Näsström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Fallgren, Jakob
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    The implementation of a decision-tree did not increase decision-making in patients with temporomandibular disorders in the public dental health service2019In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, no 5, p. 394-399Article in journal (Refereed)
    Abstract [en]

    Objective: Many patients with temporomandibular disorders (TMD) seem to go undetected within primary dental health care. Primarily we evaluated if the implemented intervention increased the clinical decision-making for TMD patients; secondarily we evaluated if other factors could be identified that predicted performed or recommended TMD treatment.

    Material and Methods: This case–control study was carried out within the Public Dental Health service in Västerbotten County, Sweden. An intervention based on a decision-tree with three screening questions for TMD (3Q/TMD) was implemented during 2015 in four clinics and compared with the remaining county. A total of 400 individuals were selected—200 3Q-positives and 200 3Q-negatives. The 3Q/TMD consists of Q1—frequent jaw pain, Q2—frequent pain on function, and Q3—frequent catching and/or locking of jaw. The 3Q/TMD answers were analyzed in relation to TMD treatment and any TMD related decision that was collected from the digital dental records.

    Results: The intervention did not increase the frequencies of traceable clinical decisions among patients with TMD.

    Conclusions: Despite the implemented intervention aimed, the indicated undertreatment of patients with TMD remains. Future studies are still needed to gain a deeper understanding of the clinical decision-making process for TMD patients in general practice dentistry.

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  • 25. Sharma, Sonia
    et al.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Åkerman, Sigvard
    Nilsson, Peter M.
    Axtelius, Björn
    List, Thomas
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Prevalence of facial pain and headache in Sweden2021In: The Journal of Oral & Facial Pain and Headache, ISSN 2333-0384 , E-ISSN 2333-0376 , Vol. 35, no 2, p. 139-149Article in journal (Refereed)
    Abstract [en]

    AIMS: To compare the prevalence of facial pain and headache across various regions in Sweden.

    METHODS: This study involved a comparison of cross-sectional questionnaire studies over a period of 10 years including 128,193 individuals and assessed facial pain, pain on function, and headache. Participants included (1) all Public Dental Service patients aged 16 to 90 years in Västerbotten (n = 57,283) and Gävleborg (n = 60,900); and (2) random samples of residents in Kalmar (n = 3,560) and Skåne (n = 6,450). Facial pain and pain on function were assessed for all participants, and headache was also assessed for participants in Kalmar and Skåne. Descriptive statistics were used to estimate unadjusted prevalence estimates and demographic characteristics. Prevalence estimates were adjusted for age and sex using weighted distributions from the 2015 data in the Swedish population registry before comparisons across the regions.

    RESULTS: Overall, the prevalence of facial pain and headache were significantly higher in female than in male participants (P < .01). The standardized prevalence of facial pain was 4.9% in Västerbotten, 1.4% in Gävleborg, 4.6% in Kalmar, and 7.6% in Skåne. For headache, the standardized prevalence was 18.9% in Kalmar and 21.3% in Skåne. In Skåne, individuals with facial pain had a 15-fold higher odds of headache than those without.

    CONCLUSION: In the present Swedish epidemiologic study, the prevalence of facial pain ranged from 1.4% in Gävleborg to 7.6% in Skåne. Besides different sampling frames and other population characteristics, the presence of a high number of immigrants in Skåne may account for some differences in pain prevalence across the Swedish regions.

  • 26.
    Stålnacke, Clara
    et al.
    Orthodontic Clinic, Region Gävleborg, Gävle, Sweden; Department of Orthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden; Department of Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden.
    Ganzer, Niels
    Orthodontic Clinic, Region Gävleborg, Gävle, Sweden; Department of Orthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden; Department of Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden.
    Liv, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry. Neuroscience Center, Multidisciplinary Pain Center, Rigshospitalet, Copenhagen, Denmark.
    Prevalence of temporomandibular disorder in adult patients with chronic pain2021In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 21, no 1, p. 41-47Article in journal (Refereed)
    Abstract [en]

    Objectives: Chronic pain patients often suffer in multiple locations. In health care, examinations of bodily pain usually do not include questions about temporomandibular disorders (TMD); hence TMD symptoms and potential comorbidities are not regularly assessed. Therefore, the primary aim was to evaluate the prevalence of TMD in patients referred to a pain rehabilitation clinic, and the secondary aim was to evaluate possible factors associated with TMD symptoms.

    Methods: Consecutive chronic pain patients referred to the Pain Rehabilitation Clinic at the Umea University Hospital in Sweden were included. TMD symptoms were assessed using three valid screening questions - 3Q/TMD. Pain sites, emotional distress, kinesiophobia, and demographics were obtained from the Swedish Quality Registry for Pain Rehabilitation.

    Results: In total, 188 (144 women) chronic pain patients (mean age 41.8 years) were included. Of these, 123 (96 women) answered affirmatively to at least one of the 3Q/TMD. The relative risk of TMD symptoms among the patients with chronic pain, in comparison to the general population, was 7.1 (95% CI 5.9-8.4). Age was the only independent variable associated with TMD among the patients (p = 0.018).

    Conclusions: The prevalence of TMD symptoms was higher in a chronic pain population compared to the general population. The 3Q/TMD questionnaire could be a suitable screening tool at pain rehabilitation clinics to identify patients for further examination of involvement of pain in the trigeminal region. Our results reinforce the clinical importance of paying attention to concurrent widespread pain and local TMD symptoms.

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