Interprofessional cooperation with a dermatovenerologist - specifics of hidradenitis suppurativa management in gynaecological practice.

Hidradenitis suppurativa is a chronic immune-mediated inflammatory disease that is manifested by formation of painful nodules, abscesses and suppurating fistulas, primarily in the intertriginous spaces. This painful, often under-diagnosed disease affects much more women. They are also exposed to certain specific challenges in the management of this disease, especially during menstruation or pregnancy. The treatment requires the interdisciplinary cooperation of a dermatologist, gynaecologist, obstetrician and last but not least an algesiologist and psychotherapist. Above all, early and correct diagnosis, initiation of therapy in the early stages of the disease, is a key, which also plays a fundamental role in controlling inflammatory activity, preventing complications and further prognosis.

Body movement during sleep in subjects with long-standing bruxing behavior.

PURPOSE: This study aimed to determine whether patients with long-standing nocturnal bruxing behavior present different body movement activity during sleep compared with healthy subjects. MATERIALS AND METHODS: Eleven bruxers and 8 nonbruxers were studied in the sleep laboratory, and motor activity was detected with sensor pads placed under the mattress. Movements simultaneously recorded on videotapes were classified according to their duration and grouped in different types according to their characteristics. RESULTS: Subjects with bruxism had significantly more movements during sleep compared with controls; the difference was especially obvious for movements of short duration (< 5 seconds). The differences became significant from the fourth hour of sleep. These short movements were twitches, jerks, or any sudden, brusque movements of the extremities, but without the periodicity encountered in, for example, periodic limb movements during sleep. No significant relationship was found between the occurrence of masseter activity and movements. CONCLUSION: The findings suggest that subjects with nocturnal bruxism have movement disorders that are expressed not only as grinding or clenching of the teeth, but also as an increase of short-duration body movements during sleep. This reinforces the hypothesis of a central etiology common to both bruxism and short movements during sleep.

Reported symptoms and clinical findings in a group of subjects with longstanding bruxing behaviour.

Signs and symptoms of craniomandibular dysfunction (CMD) and social medical history were reported in 29 subjects, aged 23-68 years, with longstanding (5 years or more) bruxing behaviour. The subjects were selected from answers to an advertisement in the local newspaper. The subjects presented many symptoms of a general character including somatic and psycho-social problems, sleep disorders (72%), and pain (86%). More than half of the subjects (55%) had symptoms every day. Frequent aches in the neck, back, throat or shoulders were reported by 69% and frequent headache by 48% of the subjects. The most common symptoms of CMD were pain in the face or jaws (48%), stiffness in the jaws in the morning (44%), temporomandibular joint (TMJ) sounds (34%) and fatigue in the jaws during chewing (38%) and the most common clinical signs were more than three muscles tender on palpation (76%), TMJ-sounds (55%) and tenderness of TMJ on lateral palpation (66%). There was a statistically significant correlation between frequent tooth clenching and headache, pain in the neck, back, throat or shoulders, sleep disorders and high scores of the clinical dysfunction index (Di). The frequent clenchers had higher score values than the 'non-clenchers' for pain in the face and the jaws; headache; pain in the neck, back, throat or shoulders and the clinical dysfunction index (Di). These findings indicate a causal relationship between frequent tooth clenching and signs and symptoms of CMD, including headache and pain in the neck, back, throat or shoulders and high pathogenicity for frequent clenching. However, the material in this study is small and some precaution must be taken prior to generalized conclusions. More studies are required, especially sleep laboratory investigations, which could perhaps give answers to some of the numerous questions in this unexplored field of odontology.

Personality traits in a group of subjects with long-standing bruxing behaviour.

The personality pattern of 29 subjects, 10 men and 19 women, with a mean age of 37.7 years (range 23-68) was studied by means of a personality inventory (KSP) and compared with the personality traits of a 'normal population'. The bruxers had significantly higher scores in the somatic anxiety and muscular tension scales and lower scores in the socialization scale; that is, the bruxers were more anxiety-prone, had higher vulnerability for psychosomatic disorders and were less socialized. The frequent clenchers (once to twice a week) comprised a special subgroup within the material with higher values in the somatic anxiety, psychic anxiety and muscular tension scales. A strong correlation was found between high values in the muscular tension scale and headache; aching neck, back, throat or shoulders; tooth clenching; number of muscles tender at palpation and the clinical dysfunction index (Di). The results of this study indicate a possible aetiological relationship between personality, tooth clenching and craniomandibular dysfunction (CMD). However, the material was small and some precaution must be taken prior to generalization of the results. Studies on larger material are needed and especially more studies in sleep laboratories.

Descriptive physiological data on a sleep bruxism population.

We studied 24 bruxers (23-67 years old). They often complained of orofacial and bodily pain and presented autonomic symptoms (sweating 23%, palpitations at night 62%, decreased libido 50%); 19% had increased blood pressure requiring treatment, and 65% reported frequent headaches in the morning. Deep sleep and rapid eye movement (REM) were delayed. An average of 167 orofacial episodes developed during the night. The mean number of masseter bursts strictly defined as bruxism was 79, the mean delay for the first occurrence after sleep onset 18 minutes. The majority of bruxism occurred in stage 2 sleep and REM sleep. The mean number of shifts of sleep stages was 70, one-third occurring within the first minute following a bruxing episode, and 15% of bruxing episodes developed after a shift in sleep stage. Electroencephalogram showed alpha-delta pattern in 15% of the subjects. Short-lasting alpha activity was often encountered during the 10 seconds preceding the development of a bruxing episode. Tachycardia developed at its onset, persisting for 10 seconds. We suggest that, as a minor alarm response to endogenous/exogenous stimuli, arousal develops and is often followed by motor activation, such as a burst of bruxing, with, as in any situation when motor activity suddenly increases, a secondary increase of heart activity.

Ten-year follow-up study of personality traits in adults with intact and restored dentitions.

The personality traits of 69 of a sample of 70 adolescents aged 25-26 years were re-examined after 10 years by means of a personality inventory (KSP). A total of 11 subjects had intact dentitions (group I), while 18 subjects had had some fillings in their teeth since the first examination (group FI), and 40 subjects had restored dentitions from the starting-point (group F). The subjects with fillings 10 years ago had significantly higher scores in two of the anxiety variables--somatic anxiety and muscular tension--and in the hostility variable, suspicion, than did those without the fillings. Together with the finding of a significant correlation between high scores for the clinical dysfunction index (DiII and DiIII) and the muscular tension scale, the results of this study support the hypothesis of a possible correlation between dental filling therapy, craniomandibular disorders (CMD) and personality. Frequent tooth clenching (once to twice a week or more) was significantly more common among the subjects with fillings 10 years ago. The clenchers scored highest in the somatic anxiety, muscular tension and suspicion scales and constituted a well-defined subgroup within the subjects of this study. There was a highly significant increase of muscular tension among the clenchers during the 10-year examination period compared to the non-clenchers. However, the results of this study are not clear-cut. There was no statistically significant difference in personality between subjects with fillings after 10 years (group F + Fi) and the group of subjects with intact teeth (group I). Hypothetically, this may indicate that the differences found in this study could be due to how long the fillings had been in the mouth and at which age they were inserted. In order to test the hypothesis further and to establish the possible mechanisms behind this finding, more studies are necessary and especially more longitudinal comparative studies between subjects with intact and restored dentitions.

Ten-year follow-up study of signs and symptoms of craniomandibular disorders in adults with intact and restored dentitions.

Signs and symptoms of craniomandibular dysfunction (CMD) and oral parafunctions were re-examined in subjects, 25-26 years of age, 10 years after the first examination. Forty subjects had restored dentitions at both examinations (group F), 18 subjects with previously intact dentitions had had fillings in their teeth during the follow-up period (group FI), and 11 subjects had intact dentitions at both examinations (group I). Signs and symptoms of CMD were more common among the subjects in group F than in the original group of subjects with intact teeth (group 10). In accordance with the first study most of the symptoms were mild and of low frequency. However, frequent symptoms were only found among the subjects in group FI and group F and more severe frequent symptoms only in group F. There was an increase of the symptoms in group FI and group F. Frequent tooth clenching and frequent tongue pressing were more common in group F and there was a statistically significant increase in group FI concerning tooth clenching and tooth grinding and in group F concerning tooth grinding, tooth clenching and tongue pressing. Together with the correlations found between tooth clenching and signs and symptoms of CMD, the findings in this study and the personality study indicate a possible causal relationship between oral parafunctions, signs and symptoms of CMD, personality and fillings. A hypothesis for the possible mechanisms is presented. However, the findings are not conclusive and more studies are necessary, and for further interpretation of the results, studies from other research centres would be of interest.

Five-year follow-up study of adolescents with intact and restored dentitions: personality traits.

The personality traits of 66 of a sample of 70 adolescents aged 19-21 years were re-examined after 5 years by means of a personality inventory (KSP). A total of 15 subjects had intact dentitions (group I), while 13 subjects had had some fillings in their teeth since the first examination (group FI), and 38 subjects had restored dentitions at both examinations (group F). The findings of this study are in agreement with those of the earlier study of Kampe, Edman and Molin (1986). On both occasions the subjects with restored dentitions had higher scores on the Somatic Anxiety and Muscular Tension scales. The differences were more pronounced for the female subjects. With regard to muscular tension, there was a significant interactive effect, with higher values for the female subjects in group F. Individuals with high scores for the Clinical Dysfunction Index (DiII and DiIII) also had the highest scores on the Somatic Anxiety and Muscular Tension scales, thus confirming the validity of the muscle palpation. The hypothesis of a correlation between personality factors and dental-filling therapy was neither accepted nor rejected. The subjects in group F had the highest scores on both occasions on the Somatic Anxiety and Muscular Tension scales, although the subjects in group FI had the lowest scores. Further studies are required, and another 5-year follow-up study of this material could be conclusive.

Five-year longitudinal study of adolescents with intact and restored dentitions: signs and symptoms of temporomandibular dysfunction and functional recordings.

Signs and symptoms of temporomandibular dysfunction (TMD) and functional recordings were re-examined in subjects, 19-21 years of age, 5 years after the first examination. Thirty-seven subjects had restored dentitions at both examinations (group F), 13 subjects with previously intact dentitions had had fillings in their teeth during the follow-up period (group FI), and 14 subjects had intact dentitions at both examinations (group I). In agreement with the first examination, the subjects with restored dentitions had a higher degree and frequency of TMD than the subjects with intact teeth. Most of the symptoms were mild, but more severe symptoms were reported by the subjects in group F, and female subjects in group F had more signs than male subjects. The subjects who had received fillings during the follow-up period (group FI) constituted a group intermediate between group F and group I with regard to signs and symptoms of TMD. Frequent parafunction and more attrition were more common in group F. Together with the finding of increased muscle tenderness, this indicates more functional activity in restored dentitions. Correlation analysis did not reveal any relationship between occlusal factors and TMD. The findings of this study are consistent with those of the earlier investigation. Dental filling therapy appears to be an aetiological factor in TMD worthy of more consideration and more extensive research.

Five-year longitudinal recordings of functional variables of the masticatory system in adolescents with intact and restored dentitions. A comparative anamnestic and clinical study.

Recordings of functional variables of the masticatory system were made in 184 subjects, 18-20 years old, 5 years after the first examination. One hundred and six subjects had restored dentitions at both examinations (group F), 35 subjects with previously intact dentitions had received fillings during the follow-up period (group FI), and 43 subjects had intact dentitions at both examinations (group I). In conformity with the first examination 5 years earlier, the subjects in group F had higher scores for dentin facets on the first lower molar. Together with the finding of more frequent attrition on the distal part of the occlusal surface of the second lower molar, this finding indicates more functional or parafunctional activity in restored dentitions. Unilateral contacts in the retruded contact position (RCP) were equally common in all three groups, but the contacts in RCP were more often located in the molar region in group F. The finding at the first examination that interference causing a lateral slide of the mandible between RCP and the intercuspal position (ICP) was commoner in restored dentitions was not confirmed in the present study. Nor did the correlation analysis show any relationship between occlusal factors and signs and symptoms of mandibular dysfunction. However, the differences found between subjects with intact and restored dentitions indicate that the iatrogenic effect of dental filling therapy merits more consideration and more extensive research.

Five-year follow-up of mandibular dysfunction in adolescents with intact and restored dentitions: a comparative anamnestic and clinical study.

Signs and symptoms of mandibular dysfunction were re-examined in 189 subjects, aged 18 to 20 years, 5 years after the first examination. One hundred nine subjects had restored dentitions at both examinations (group F), 36 subjects with previously intact dentitions had had fillings in their teeth during the follow-up period (group FI), and 44 subjects had intact dentitions at both examinations (group I). The subjects with restored dentitions had a higher degree and frequency of mandibular dysfunction than the subjects with intact teeth. The subjects who had had fillings during the follow-up period (group FI) constituted a group between groups F and I with respect to signs and symptoms of mandibular dysfunction. This strengthens the authors' earlier suspicions that dental filling therapy is of greater etiologic importance in mandibular dysfunction than had been thought previously. However, more studies are necessary to find the exact mechanisms involved.

Occlusal perception and bite force in young subjects with and without dental fillings.

Interocclusal thickness discrimination (occlusal perception) and bite force was investigated in 29 young adults (16-18 years old). Thirteen individuals had intact dentitions (group I), whereas 16 individuals had minor restorations in posterior teeth (group C). Bite force was tested during 'gentle biting', 'biting as when chewing', and 'maximal clenching'. Endurance tests and bite force discrimination tests were also performed. The best occlusal perception was found in the incisor region in both groups, whereas the occlusal perception was somewhat smaller in the canine and premolar regions. Fifty-four per cent of the subjects in group I and 81% in group C reached certain perceptiveness at the 9-micron level. There were no statistically significant differences between test locations or groups, however. Group I had a significantly greater bite force in the incisor region during gentle biting than group C. The maximal bite force was on an average 532 N in group I and 516 N in group C. In the endurance tests, group I could withstand the muscle fatigue longer than group C, but the difference was not statistically significant. In the bite force discrimination test both groups showed a similar pattern. Group I showed a closer correlation than group C between recordings in a test of stepwise increase of force and a randomized test of five force levels. Both groups appeared functionally normal in the masticatory system and reacted similarly in the physiologic experiments.(ABSTRACT TRUNCATED AT 250 WORDS)

Three-year longitudinal study of mandibular dysfunction in young adults with intact and restored dentitions.

Thirteen adolescents with intact dentitions and 16 with restored dentitions were re-examined after 3 years for signs and symptoms of mandibular dysfunction. In accordance with the results of the first examination, a lower prevalence and degree of clinically recorded dysfunction was found at the follow-up study in subjects with intact teeth than in those with dental restorations. This difference was especially explained by more muscle tenderness recorded in the individuals with restored dentitions than in those with intact teeth. However, the reported symptoms were as a rule mild and relatively evenly distributed in the two groups.

Differences in occlusion and some functional variables in adolescents with intact and restored dentitions. A comparative study.

A group of 96 individuals 13 to 15 years of age, with intact teeth, was compared with a control group of 129 individuals with dental restorations, with regard to reported symptoms and functional recordings of the stomatognathic system. Differences between the groups were established, with higher scores in the dentally treated group with regard to the occurrence of headache, distance between the retruded contact position (RCP) and the intercuspal contact position (ICP), lateral slide between RCP and ICP more than or equal to 0.5 mm, and attrition recorded as dentin facets in the lower first molars. The prevalence of different malocclusions was very similar in the groups, and there were practically no sex differences. The findings are not contradictory to the hypothesis that fillings may be related to mandibular dysfunction, but more studies are necessary to explain fully the mechanisms involved.

Function and dysfunction of the masticatory system in individuals with intact and restored dentitions. A clinical, psychological and physiological study.

In all, 125 individuals, 13-23 years old, with intact dentitions and 163 individuals, 13-20 years old, with dental fillings were included in a series of studies. The results of the studies suggest that subjects with intact dentitions have a lower prevalence and degree of signs and symptoms of mandibular dysfunction than subjects with restorations in the teeth. However, most signs and symptoms in both groups were mild and infrequent. The most common symptoms in both groups were TMJ-sounds, tiredness during chewing, and headache, and the most common clinical signs were TMJ-sounds and muscles tender to palpation. Fossa bottom facets were more common in restored dentitions and they often involved fillings. In restored dentitions, dentin facets were more common, the worn area was on average larger and the distal marginal crest of the second lower molars were more often worn indicating a difference in functional activity between the groups, with more parafunctional activity in restored dentitions. According to the Karolinska Scales of Personality (KSP), the subjects with restored dentitions had higher values on the "muscular tension" and "somatic anxiety" scales, i.e. dental restorations were more common in subjects with autonomic and motor disturbances related to anxiety-proneness. The subjects with restored dentitions had lower bite force values during "gentle biting" in the frontal region. The occlusal perception increased from the more posterior test position to the anterior one in both groups. The best tactile sensibility was found in the incisor region, where the subjects with restored dentitions tended to have better values. The higher prevalence and degree of clinically recorded dysfunction in subjects with restored dentitions was confirmed in the follow-up study. The findings of this investigation indicate a possible etiological significance of dental filling therapy in mandibular dysfunction. For the moment, however, we do not know if, how and to what extent occlusal factors, psychological differences between the subjects, or combinations of these or other factors are responsible for the development of signs and symptoms in the masticatory system. Nevertheless, the findings indicate that the factor "dental filling therapy" merits more consideration and more extensive research and should be included in epidemiological studies in the future. There is no indication in the results that toxic effects of the fillings could have influenced the results but further studies might be desirable, especially longitudinal comparisons between subjects with intact and restored dentitions.

Mandibular dysfunction related to dental filling therapy. A comparative anamnestic and clinical study.

A group of 96 individuals, 13 to 15 years of age, with intact teeth was compared with a control group of 129 individuals with dental restorations, with regard to occurrence of mandibular dysfunction. Statistically significant differences between the groups were established at both the anamnestic and the clinical examination, with a lower frequency and degree of dysfunction among those with intact teeth. Conforming with the findings of a previous study on 17- to 23-year-olds, these findings indicate that filling therapy may be associated with mandibular dysfunction.

Personality traits of adolescents with intact and restored dentitions.

The personality pattern of 29 subjects aged 15 years with intact dentitions was studied by means of a personality inventory (KSP) and compared with that of 41 subjects of the same age with repaired dentitions. The subjects with repaired dentitions showed significantly higher scores in the somatic anxiety and the muscular tension scales; that is, dental restorations were commoner in subjects with autonomic and motor disturbances related to anxiety-proneness. Furthermore, subjects in the control group with high clinical dysfunction index (CDI) had higher scores in the muscular tension, the inhibition of aggression, and the irritability scales. The finding of higher scores in the muscular tension scale was validated in the clinical examination. Possible explanations of the differences in the personality patterns between individuals with intact and repaired dentitions are discussed. Clenching and gnashing of the teeth was also studied in relation to the personality variables. Teeth clenchers in both groups were more anxiety-prone, less self-assertive, and less socialized.

Facet pattern in intact and restored dentitions of young adults. A comparative study.

The attritional dental pattern was studied clinically and on plaster casts in a group of individuals, 17-22 years old, with intact teeth and in a control group with a 'normal' distribution of dental restorations. The following observations were made: 1) all contact areas between occluding teeth exhibited facets; 2) most facets were located on inclines; 3) facets in the fossa bottom occurred oftenest in the control group and often involved fillings; 4) attritional facets on the distal marginal crest of the lower second molars were oftenest found in the control group; 5) denuded dentin in facets occurred oftenest in the control group; and 6) the number of facets and the worn areas were on an average largest in the control group. The findings in this study indicate a difference in the functional activity between the groups and support the hypothesis that dental fillings can induce changes in the neuromuscular pattern of the masticatory system.

Dental filling therapy as a possible etiological factor regarding mandibular dysfunction. A comparative anamnestic and clinical study.

A group of 29 individuals, 17-23 years old, with intact teeth, has been compared with a control group with respect to occurrence of mandibular dysfunction. A statistically significant difference between the groups, with a lower frequency and degree of dysfunction among the intact individuals was established. The results suggest that filling therapy per se may be a possible etiological factor in the mandibular dysfunction. Disorders in the masticatory neuromuscular system may arise from an abnormal tactile response to contacts on fillings, including an abnormal pattern of mandibular movement, possibly exceeding the tolerance level of the system.