Thomas List

Skåne University Hospital, Malmö, Skåne, Sweden

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Publications (110)197.85 Total impact

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    ABSTRACT: The purpose of this study was to examine magnetic resonance imaging findings in patients with painful disc displacement without reduction of the temporomandibular joint to determine whether the findings were able to predict treatment outcome of lavage and a control group treated with local anaesthesia without lavage in a short-term: 3-month perspective. Bilateral magnetic resonance images were taken of 37 patients with the clinical diagnosis of painful disc displacement without reduction. Twenty-three patients received unilateral extra-articular local anaesthetics and 14 unilateral lavage and extra-articular local anaesthetics. The primary treatment outcome defining success was reduction in pain intensity of at least 30% during jaw movement at the 3-month follow-up. Bilateral disc displacement was found in 30 patients. In 31 patients the disc on the treated side was deformed, and bilaterally in 19 patients. Osteoarthritis was observed in 28 patients, and 13 patients had bilateral changes. Thirty patients responded to treatment and 7 did not, with no difference between the two treated groups. In neither the treated nor the contralateral temporomandibular joint did treatment outcome depend on disc diagnosis, disc shape, joint effusion, or osseous diagnoses. Magnetic resonance imaging findings of disc position, disc shape, joint effusion or osseous diagnosis on the treated or contralateral side did not give information of treatment outcome. Magnetic resonance imaging findings could not predict treatment outcome in patients treated with either local anaesthetics or local anaesthetics and lavage.
    02/2015; 6(1). DOI:10.5037/jomr.2015.6105
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    ABSTRACT: We aimed to evaluate the effect of painful tooth stimulation on gingival somatosensory sensitivity of healthy volunteers in a randomized, controlled design. Thirteen healthy volunteers (six women, seven men; 28.4 ± 5.0 years) were included for two experimental sessions of electrical tooth stimulation: painful tooth stimulation and tooth stimulation below the sensory threshold (control). Eight of the human subjects participated in a third session without tooth stimulation. In all sessions, the somatosensory sensitivity of the gingiva adjacent to the stimulated tooth was evaluated with a standardized battery of quantitative sensory tests (QST) before, immediately after and 30 min after tooth stimulation. Painful tooth stimulation evoked significant decreases in warmth and heat pain thresholds (P P = 0.024) and increases in mechanical detection thresholds (decreased sensitivity) (P P P > 0.086). No QST changes were detected in the session without tooth stimulation (P > 0.060). In conclusion, modest increased gingival sensitivity to warmth, painful heat and pressure stimuli as well as desensitization to non-painful mechanical stimulation were demonstrated after tooth stimulation. This suggests involvement of competing heterotopic facilitatory and inhibitory mechanisms. Furthermore, stimulation below the sensory threshold induced similar thermal sensitization suggesting the possibility of activation of axon-reflex-like mechanisms even at intensities below the perception threshold. These findings may have implications for interpretation of somatosensory results in patients with chronic intraoral pain.
    Experimental Brain Research 01/2015; DOI:10.1007/s00221-014-4186-4 · 2.17 Impact Factor
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    ABSTRACT: To determine the impact of oral diseases on everyday life, measures of oral quality of life are needed. In complementing traditional disease-based measures, they assess the need for oral care to evaluate oral health care programs and management of treatment. To assess the reliability and validity of the Oral Impact of Daily Performance (OIDP) and the short-form Oral Health Impact Profile (OHIP-14) among high school students in Xi'an, the capital of Shanxi province, China. Cross-sectional one-stage stratified random cluster sample using high schools as the primary sampling unit. Students completed self-administered questionnaires at school. The survey included the OHIP-14 and OIDP inventories, translated and culturally adapted for China, and global oral health and socio-behavioral measures. A total of 5,608 students participated in the study, with a 93% response rate (mean age 17.2, SD 0.8, 52% females, 45.3% urban residents).The proportion experiencing at least one impact (at any frequency) during the previous six months was 62.9% for the OHIP-14 and 45.8% for the OIDP. Cronbach's alpha measured internal consistency at 0.85 for OHIP-14 and 0.75 for OIDP while Cohen's kappa varied between 0.27 and 0.58 for OHIP-14 items and between 0.23 and 0.65 for OIDP items. Kappa scores for the OHIP-14 and OIDP additive scores were 0.52 and 0.66, respectively. Both measures varied systematically and in the expected direction, with global oral health measures showing criterion validity. The correlation between OIDP and OHIP-14 was rs +0.65. That both measures varied systematically with socio-behavioral factors indicates construct validity. Both the OIDP and OHIP-14 inventories had reasonable reliability and construct validity in relation to subjective global oral health indicators among adolescents attending high schools in China and thus appear to be useful oral health -related quality of life measures in this context. Overall, the OHIP-14 and OIDP performed equally well, although OHIP-14 had superior content validity due to its sensitivity towards less severe impacts.
    BMC Oral Health 12/2014; 14(1):158. DOI:10.1186/1472-6831-14-158 · 1.15 Impact Factor
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    ABSTRACT: Background Chronic myalgia is associated with higher muscle levels of certain algesic biomarkers. The aim of this study was to investigate if hypertonic saline-induced jaw myalgia also leads to release of such biomarkers and if there were any sex differences in this respect. Methods Healthy participants, 15 men and 15 aged-matched women (25.7 +/- 4.3 years) participated. Intramuscular microdialysis into masseter muscles was performed to sample serotonin (5-HT), glutamate, lactate, pyruvate, glucose and glycerol. After 2 hours 0.2 mL hypertonic saline (58.5 mg/mL) was injected into the masseter on one side and 0.2 mL isotonic saline (9 mg/mL) into the contralateral masseter close to the microdialysis catheter. Microdialysis continued for 1 hour after the injections. Pressure pain thresholds (PPT) and pain were assessed before and after injections. Results The median (IQR) peak pain intensity (0-100 visual analogue scale) after hypertonic saline was 52.5 (38.0) and after isotonic saline 7.5 (24.0) (p < 0.05). 5-HT, glutamate and glycerol increased after hypertonic saline injection (p < 0.05). Lactate, pyruvate and glucose showed no change. PPT after microdialysis was reduced on both sides (p < 0.05) but without side differences. Pain after hypertonic saline injection correlated positively to 5-HT (p < 0.05) and negatively to glycerol (p < 0.05). Conclusions 5-HT, glutamate and glycerol increased after a painful hypertonic saline injection into the masseter muscle, but without sex differences. Since increased levels of 5-HT and glutamate have been reported in chronic myalgia, this strengthens the validity of the pain model. Glycerol warrants further investigations.
    The Journal of Headache and Pain 12/2014; 15(89). · 3.28 Impact Factor
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    ABSTRACT: Chronic myalgia is associated with higher muscle levels of certain algesic biomarkers. The aim of this study was to investigate if hypertonic saline-induced jaw myalgia also leads to release of such biomarkers and if there were any sex differences in this respect. Healthy participants, 15 men and 15 aged-matched women (25.7 +/- 4.3 years) participated. Intramuscular microdialysis into masseter muscles was performed to sample serotonin (5-HT), glutamate, lactate, pyruvate, glucose and glycerol. After 2 hours 0.2 mL hypertonic saline (58.5 mg/mL) was injected into the masseter on one side and 0.2 mL isotonic saline (9 mg/mL) into the contralateral masseter close to the microdialysis catheter. Microdialysis continued for 1 hour after the injections. Pressure pain thresholds (PPT) and pain were assessed before and after injections. The median (IQR) peak pain intensity (0-100 visual analogue scale) after hypertonic saline was 52.5 (38.0) and after isotonic saline 7.5 (24.0) (p < 0.05). 5-HT, glutamate and glycerol increased after hypertonic saline injection (p < 0.05). Lactate, pyruvate and glucose showed no change. PPT after microdialysis was reduced on both sides (p < 0.05) but without side differences. Pain after hypertonic saline injection correlated positively to 5-HT (p < 0.05) and negatively to glycerol (p < 0.05). 5-HT, glutamate and glycerol increased after a painful hypertonic saline injection into the masseter muscle, but without sex differences. Since increased levels of 5-HT and glutamate have been reported in chronic myalgia, this strengthens the validity of the pain model. Glycerol warrants further investigations.
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    ABSTRACT: Chronic oro-facial pain conditions such as persistent idiopathic facial pain (PIFP), atypical odontalgia (AO) and burning mouth syndrome (BMS), usually grouped together under the concept of idiopathic oro-facial pain, remain a diagnostic and therapeutic challenge. Lack of understanding of the underlying pathophysiological mechanisms of these pain conditions is one of the important reasons behind the problems in diagnostic and management. During the last two decades, neurophysiological, psychophysical, brain imaging and neuropathological methods have been systematically applied to study the trigeminal system in idiopathic oro-facial pain. The findings in these studies have provided evidence for neuropathic involvement in the pathophysiology of PIFP, AO and BMS. The present qualitative review is a joint effort of a group of oro-facial pain specialists and researchers to appraise the literature on idiopathic oro-facial pain with special focus on the currently available studies on their pathophysiological mechanisms. The implications of the findings of these studies for the clinical diagnosis and treatment of idiopathic oro-facial pain conditions are discussed. © 2014 John Wiley & Sons Ltd.
    Journal of Oral Rehabilitation 12/2014; 42(4). DOI:10.1111/joor.12256 · 1.93 Impact Factor
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    ABSTRACT: Abstract This double-blind, placebo-controlled, randomized cross-over clinical experimental study tested the reliability, validity, and sensitivity to change of punctuate pain thresholds and self-reported pain on needle penetration. Female subjects without orofacial pain were tested in 2 sessions at 1- to 2-week intervals. The test site was the mucobuccal fold adjacent to the first upper right premolar. Active lidocaine hydrochloride 2% (Dynexan) or placebo gel was applied for 5 minutes, and sensory testing was performed before and after application. The standardized quantitative sensory test protocol included mechanical pain threshold (MPT), pressure pain threshold (PPT), mechanical pain sensitivity (MPS), and needle penetration sensitivity (NPS) assessments. Twenty-nine subjects, mean (SD) age 29.0 (10.2) years, completed the study. Test-retest reliability intraclass correlation coefficient at 10-minute intervals between examinations was MPT 0.69, PPT 0.79, MPS 0.72, and NPS 0.86. A high correlation was found between NPS and MPS (r = 0.84; P < .001), whereas NPS and PPT were not significantly correlated. The study found good to excellent test-retest reliability for all measures. None of the sensory measures detected changes in sensitivity following lidocaine 2% or placebo gel. Electronic von Frey assessments of MPT/MPS on oral mucosa have good validity.
    Anesthesia Progress 12/2014; 61(4):135-144. DOI:10.2344/0003-3006-61.4.135
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    ABSTRACT: The reliability of comprehensive intra-oral quantitative sensory testing (QST) protocol has not been examined systematically in patients with chronic oro-facial pain. The aim of the present multicentre study was to examine test–retest and interexaminer reliability of intra-oral QST measures in terms of absolute values and z-scores as well as within-session coefficients of variation (CV) values in patients with atypical odontalgia (AO) and healthy pain-free controls. Forty-five patients with AO and 68 healthy controls were subjected to bilateral intra-oral gingival QST and unilateral extratrigeminal QST (thenar) on three occasions (twice on 1 day by two different examiners and once approximately 1 week later by one of the examiners). Intra-class correlation coefficients and kappa values for interexaminer and test–retest reliability were computed. Most of the standardised intra-oral QST measures showed fair to excellent interexaminer (9–12 of 13 measures) and test–retest (7–11 of 13 measures) reliability. Furthermore, no robust differences in reliability measures or within-session variability (CV) were detected between patients with AO and the healthy reference group. These reliability results in chronic orofacial pain patients support earlier suggestions based on data from healthy subjects that intra-oral QST is sufficiently reliable for use as a part of a comprehensive evaluation of patients with somatosensory disturbances or neuropathic pain in the trigeminal region.
    Journal of Oral Rehabilitation 10/2014; 42(2). DOI:10.1111/joor.12245 · 1.93 Impact Factor
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    ABSTRACT: AimsThe aim was to study achieved competences in temporomandibular disorders (TMD)/orofacial pain (OP) at two universities by comparing student's knowledge and understanding, satisfaction with their education and confidence in their clinical competences of TMD/OP.Methods The study was conducted in collaboration between Malmö University, Sweden—which uses problem-based learning—and the University of Naples Federico II, Italy—which uses traditional educational methods. Final-semester dental students responded to a self-report questionnaire regarding their knowledge and understanding, interpretation of cases histories, clinical experience, satisfaction and confidence in clinical examination, management and treatment evaluation.ResultsNo significant difference was found between the students regarding knowledge and understanding. Eighty-seven per cent of the Malmö students and 96% of the Naples students met the criterion on achieved competence. Malmö students had a higher per cent of correct diagnoses than Naples students in the interpretation of case histories. Overall, Malmö students reported most clinical experience and higher confidence than Naple students.Conclusions The main findings were that students from Malmö and Naples were, similar in knowledge and understanding of TMD/OP and in satisfaction with their clinical competences. However, Malmö students perceived more confidence in clinical management of patients with TMD/OP. This may reflect that, besides the theoretical part of the programme, a sufficient level of clinical exposure to patients with TMD/OP is essential to gain competences in TMD/OP.
    European Journal Of Dental Education 08/2014; DOI:10.1111/eje.12117 · 1.45 Impact Factor
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    ABSTRACT: Noxious tooth pulp stimulation elicits changes in central neurons in the trigeminal brainstem complex in animals. Also, painful electrical tooth stimulation (TS) in humans has been shown to evoke changes in gingival blood flow suggesting an axon-reflex mediated neurogenic inflammation. No human studies have so far investigated the effect of experimental tooth pain on the somatosensory sensitivity of the gingiva adjacent to the stimulated tooth. Objective: The aim of this study was to evaluate the possible effect of painful electrical tooth stimulation on gingival somatosensory sensitivity in a randomized cross-over design. Method: Thirteen healthy volunteers (6 women, 7 men; 28.4 ± 5.0 years) participated in two experimental sessions (Pain vs. Control) in randomized order. Thirteen standardized quantitative sensory testing (QST) measures were obtained on the buccal attached gingiva of an upper central incisor before, immediately after and 30 min after 3 x 2 min of moderately painful (50 on a 0-100 numerical rating scale) electrical TS (5 Hz, 10 ms pulses). TS below the individual sensory threshold served as the non-painful control. Result: Painful TS evoked significant decreases in warmth and heat pain thresholds (increased sensitivity) (P < 0.001) and increases in mechanical detection thresholds as well as pressure pain thresholds (decreased sensitivity)(P < 0.050). Similar thermal threshold changes (P < 0.019) but no changes in mechanical sensitivity (P > 0.086) were found in the control session. No significant somatosensory changes were found in either session regarding cold detection and cold pain thresholds, thermal sensory limen, mechanical pain threshold, mechanical pain sensitivity, wind-up, or vibration detection (P > 0.061). Conclusion: Subtle differential effects on in gingival thermal and mechanical somatosensory sensitivity were detected up to 30 min after short-term painful TS, indicating involvement of competing facilitatory and inhibitory mechanisms. Only effects on mechanical sensitivity were specific to painful TS.
    IADR General Session and Exhibition 2014; 06/2014
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    ABSTRACT: Objective: Results from several studies indicate that serotonin (5-HT) may have a role in the pathogenesis of chronic muscle pain. The aim of this study was to investigate if the 5-HT3 receptor antagonist granisetron reduces experimental myalgia induced by hypertonic saline. Method: Sixty healthy subjects (30 women and 30 men) participated in the study. Blood or saliva was sampled for later genetic analyses to investigate if polymorphisms of the HTR3A and HTR3B genes, coding for the 5-HT3A and 5-HT3B receptors respectively, contribute to pain perception and the efficacy of granisetron. A bilateral injection of hypertonic saline (5.5%, 0.2 mL) was administered into the masseter muscle as an internal control (injection 1). Thirty minutes later 0.5 mL granisetron (1 mg/mL) was injected into the masseter muscle on one side and 0.5 mL isotonic saline (9 mg/mL) on the contralateral side in a randomized, double-blind order. This followed by another bilateral hypertonic saline injection (injection 2) after 2 min. Pain induced by each saline injection was assessed on a visual analogue scale (VAS) immediately after the injections and then every 15 sec until pain subsided. Result: The first injection of hypertonic saline induced pain of similar intensity on both sides (median 37.9) that lasted for less than 5 min. However, the second injection of hypertonic saline induced pain of significantly less intensity (P < 0.001) and shorter duration (P < 0.05) on the side pretreated with granisetron compared with the control side. The genetic analyses are ongoing. Conclusion: This study showed that blocking of the 5-HT3 receptor with granisetron decreased experimental pain induced by intramuscular injection of hypertonic saline in healthy subjects and thus that granisetron may serve as a potential analgesic drug for myalgic conditions. Further studies are needed to explore the effect of granisetron in chronic myalgia.
    IADR General Session and Exhibition 2014; 06/2014
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    ABSTRACT: Objective: Dopaminergic pathways could be involved in the pathophysiology of myofascial TMD. Therefore, the aim of this study was to investigate the levels of dopamine as well a serotonin (5-HT) in plasma between patients with myofascial temporomandibular disorders (M-TMD) and healthy subjects. Method: Fifteen M-TMD patients (mean age: 31.8 ± 13.4 yrs) and 15 age and sex-matched healthy subjects (mean age: 31.6 ± 12.4 yrs) were included in this study. The Diagnosis M-TMD was established according to the research Diagnostic Criteria for TMD. A venous blood sample was collected and present pain intensity (0-10 numeric rating scale) and the pressure pain threshold (PPT, kPa) over the masseter muscles were assessed. Independent samples t-test and Pearson’s correlation test was used for statistical analyses. Result: The plasma level of dopamine differed significantly between M-TMD patients (4.98 ± 2.55 nM) and healthy controls (2.73 ± 1.24 nM; P < 0.01). A significant difference for plasma 5-HT was not observed between groups (P = 0.75). The M-TMD patients had significantly higher present pain intensity (P < 0.001), and lower PPT (P < 0.01) compared to the healthy controls. Importantly, the level of dopamine correlated significantly with pain intensity (r = 0.518, n = 28, P < 0.01), but not with PPT (r = -0.133, n = 28, P = 0.498). Conclusion: The M-TMD patients had significantly higher levels of dopamine, present pain intensity and lower PPT, but a significant difference for 5-HT was not observed. Dopamine had a significant positive correlation with pain intensity. This and previous studies suggest that dopaminergic pathways could play a role in the pathophysiology of M-TMD but more research is required.
    IADR General Session and Exhibition 2014; 06/2014
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    ABSTRACT: To examine (1) the occurrence of magnetic resonance imaging (MRI) signal changes in the painful regions of patients with atypical odontalgia (AO) and (2) the correlation of such findings to periapical bone defects detected with a comprehensive radiographic examination including cone beam computed tomography (CBCT).
    06/2014; 28(3):233-42. DOI:10.11607/ofph.1230
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    ABSTRACT: Aims: To investigate the association between experimental tooth clenching and the release of β-endorphin in patients with myofascial temporomandibular disorders (M-TMD) and healthy subjects. Methods: Fifteen M-TMD patients and 15 healthy subjects were included and assigned an experimental tooth-clenching task. Venous blood was collected and pain intensity was noted on a visual analog scale. The masseter pressure pain threshold (PPT) was assessed 2 hours before the clenching task and immediately after. A mixed-model analysis of variance was used for statistical analyses. Results: Significant main effects for time and group were observed for pain intensity and PPT, with significantly lower mean values of pain intensity (P < .001) and PPT (P < .01) after the clenching task compared with baseline. M-TMD patients had significantly higher pain intensity (P < .001) and significantly lower PPT (P < .05) than healthy subjects. No significant time or group effects were observed for the level of β-endorphin. Neither pain intensity nor PPT correlated significantly with β-endorphin levels. Conclusion: This experimental tooth-clenching task was not associated with significant alterations in β-endorphin levels over time, but with mechanical hyperalgesia and low to moderate levels of pain in healthy subjects and M-TMD patients, respectively. More research is required to understand the role of the β-endorphinergic system in the etiology of M-TMD.
    03/2014; 28(2):159-64. DOI:10.11607/ofph.1210
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    ABSTRACT: We reported the development and psychometric evaluation of a Swedish 14-item and a five-item short form of the Oral Health Impact Profile. The 14-item version was derived from the English-language short form developed by Slade in1997. The five-item version was derived from the German-language short form developed by John et al. in 2006. Validity, reliability and normative values for the two short form summary scores were determined in a random sample of the adult Swedish population (response rate: 46%, N = 1366 subjects). Subjects with sufficient OHRQoL information to calculate a summary score (N = 1309) were on average 50·1 ± 17·4 years old, and 54% were women. Short form summary scores correlated highly with the 49-item OHIP-S (r ≥ 0·97 for OHIP-S14, r ≥ 0·92 for OHIP-S5) and with self-report of oral health (r ≥ 0·41). Reliability, measured with Cronbach's alpha (0·91 for OHIP-S14, 0·77 for OHIP-S5), was sufficient. In the general population, 50% of the subjects had ≥2 OHIP-S14 score points and 10% had ≥11 points, respectively. Among subjects with their own teeth only and/or fixed dental prostheses and with partial removable dental prostheses, 50% of the population had ≥2 OHIP-S14 score points, and 10% had ≥11 points. For subjects with complete dentures, the corresponding figures were 3 and 24 points. OHIP-S5 medians for subjects in the three population groups were 1, 1 and 2 points. Swedish 14-item and 5-item short forms of the OHIP have sufficient psychometric properties and provide a detailed overview about impaired OHRQoL in Sweden. The norms will serve as reference values for future studies.
    Journal of Oral Rehabilitation 01/2014; DOI:10.1111/joor.12137 · 1.93 Impact Factor
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    ABSTRACT: In electromyographic (EMG) and functional magnetic resonance imaging (fMRI) studies, muscle and brain activity was compared during low levels of tooth clenching using a novel biting device to control bite force. A total of 21 healthy subjects performed motor tasks, comprising tooth clenching at 5, 10 and 20 N. During all measurements, subjects kept the novel bite device between the anterior teeth during tooth clenching. The EMG study (n = 15) characterised jaw muscle activity for the three motor tasks and demonstrated significant differences in root mean square (RMS) EMG amplitude between 5-, 10- and 20-N tooth clenching (F = 46·21, P < 0·001). There were no differences in variability of muscle activity between the three tooth-clenching levels. In an fMRI pilot study (n = 6), statistical comparisons were used to identify brain regions with significant activation in the subtraction of baseline from 5- or 20-N tooth-clenching activity. 5- and 20-N tooth clenching significantly and bilaterally activated the sensorimotor cortex, supplementary motor area, cerebellum and basal ganglia (P < 0·05, corrected for multiple comparisons). However, activation of each brain region did not differ significantly between two tooth-clenching tasks. Based on these preliminary findings, we propose that the novel biting device may be useful in further fMRI studies on controlled jaw muscle activation patterns in different craniofacial pain conditions. In addition, our fMRI result suggests that there are no significant differences in brain activity within low levels of tooth clenching with controlled force.
    Journal of Oral Rehabilitation 01/2014; 41(2). DOI:10.1111/joor.12128 · 1.93 Impact Factor
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    ABSTRACT: The purpose of this systematic review was to describe the prevalence of whiplash trauma in patients with temporomandibular disorders (TMDs) and to describe clinical signs and symptoms in comorbid TMD/whiplash compared with TMD localised to the facial region. A systematic literature search of the PubMed, Cochrane Library and Bandolier databases was carried out for articles published from 1 January 1966 to 31 December 2012. The systematic search identified 129 articles. After the initial screening of abstracts, 32 articles were reviewed in full text applying inclusion and exclusion criteria. Six studies on the prevalence of neck trauma in patients with TMD met the inclusion criteria and were included in the review. Two of the authors evaluated the methodological quality of the included studies. The reported prevalence of whiplash trauma ranged from 8·4% to 70% (median 35%) in TMD populations, compared with 1·7-13% in the non-TMD control groups. Compared with patients with TMD localised to the facial region, TMD patients with a history of whiplash trauma reported more TMD symptoms, such as limited jaw opening and more TMD pain, and also more headaches and stress symptoms. In conclusion, the prevalence of whiplash trauma is higher in patients with TMD compared with non-TMD controls. Furthermore, patients with comorbid TMD/whiplash present with more jaw pain and more severe jaw dysfunction compared with TMD patients without a history of head-neck trauma. These results suggest that whiplash trauma might be an initiating and/or aggravating factor as well as a comorbid condition for TMD.
    Journal of Oral Rehabilitation 01/2014; 41(1):59-68. DOI:10.1111/joor.12123 · 1.93 Impact Factor
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    ABSTRACT: There is a need to expand the current temporomandibular disorders' (TMDs) classification to include less common but clinically important disorders. The immediate aim was to develop a consensus-based classification system and associated diagnostic criteria that have clinical and research utility for less common TMDs. The long-term aim was to establish a foundation, vis-à-vis this classification system, that will stimulate data collection, validity testing and further criteria refinement. A working group [members of the International RDC/TMD Consortium Network of the International Association for Dental Research (IADR), members of the Orofacial Pain Special Interest Group (SIG) of the International Association for the Study of Pain (IASP), and members from other professional societies] reviewed disorders for inclusion based on clinical significance, the availability of plausible diagnostic criteria and the ability to operationalise and study the criteria. The disorders were derived from the literature when possible and based on expert opinion as necessary. The expanded TMDs taxonomy was presented for feedback at international meetings. Of 56 disorders considered, 37 were included in the expanded taxonomy and were placed into the following four categories: temporomandibular joint disorders, masticatory muscle disorders, headache disorders and disorders affecting associated structures. Those excluded were extremely uncommon, lacking operationalised diagnostic criteria, not clearly related to TMDs, or not sufficiently distinct from disorders already included within the taxonomy. The expanded TMDs taxonomy offers an integrated approach to clinical diagnosis and provides a framework for further research to operationalise and test the proposed taxonomy and diagnostic criteria.
    Journal of Oral Rehabilitation 01/2014; 41(1):2-23. DOI:10.1111/joor.12132 · 1.93 Impact Factor
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    ABSTRACT: Aims: The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments. Methods: Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project-the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings. Results: The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive selfreport instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions. Conclusion: The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations.
    01/2014; 28(1):6-27. DOI:10.11607/jop.1151
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    ABSTRACT: This study reports the findings and challenges of the assessment of oro-facial aesthetics in the Swedish general population and the development of normative values for the self-reporting Orofacial Esthetic Scale (OES). In a Swedish national sample of 1406 adult subjects (response rate: 47%), OES decile norms were established. The influence of sociodemographics (gender, age, and education), oral health status and general health status on OES scores was analysed. Mean ± standard deviation of OES scores was 50·3 ± 15·6 units (0, worst score; 70, best score); <1% of the subjects had the minimum score of 0, and 11% had the maximum score of 70 OES units. Orofacial Esthetic Scale score differences were (i) substantial (>5 OES units) for subjects with excellent/very good versus good to poor oral or general health status; ii) small (2 units), but statistically significant for gender (P = 0·01) and two age groups (P = 0·02), and (iii) absent for subjects with college versus no college education (P = 0·31) or with and without dentures (P = 0·90). To estimate normative values for a self-reporting health status, instrument is considered an important step in standardisation, and the developed norms provide a frame of reference in the general population to interpret the Orofacial Esthetic Scale scores.
    Journal of Oral Rehabilitation 12/2013; 41(2). DOI:10.1111/joor.12121 · 1.93 Impact Factor

Publication Stats

2k Citations
197.85 Total Impact Points

Institutions

  • 2014
    • Skåne University Hospital
      Malmö, Skåne, Sweden
    • University of Sydney
      • Jaw Function and Orofacial Pain Research Unit
      Sydney, New South Wales, Australia
  • 2011–2014
    • Aarhus University
      • • Department of Dentistry
      • • Department of Radiology
      Aarhus, Central Jutland, Denmark
    • Karolinska Institutet
      • Institutionen för odontologi
      Solna, Stockholm, Sweden
  • 2003–2014
    • Malmö University
      • Faculty of Odontology (OD)
      Malmö, Skåne, Sweden
  • 2013
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
  • 2010–2013
    • Mid Sweden University
      Härnösand, Västernorrland, Sweden
  • 2012
    • Akademiska Sjukhuset
      Uppsala, Uppsala, Sweden
  • 1998–2010
    • University Hospital Linköping
      • Department of Rheumatology
      Linköping, Östergötland, Sweden
  • 2008
    • University at Buffalo, The State University of New York
      • Department of Oral Diagnostic Sciences
      Buffalo, NY, United States
  • 2005
    • Folktandvården Stockholm AB
      Tukholma, Stockholm, Sweden