Diagnostic criteria for temporomandibular disorders (DC/TMD): interexaminer reliability of the Finnish version of Axis I clinical diagnoses.

Recently, updated diagnostic criteria for temporomandibular disorders (DC/TMD) were published to assess TMD in a standardised way in clinical and research settings. The DC/TMD protocol has been translated into Finnish using specific cultural equivalency procedures. To assess the interexaminer reliability using the Finnish translations of the DC/TMD-FIN Axis I clinical diagnostic assessment instruments. Reliability assessment data were collected during a 1-day DC/TMD Examiner Training Course at the University of Turku, Finland, in collaboration with the International DC/TMD Training and Calibration Center in Malmö University. Clinical TMD examinations according to the Finnish pre-final version of the DC/TMD Axis I assessment protocol were performed by four experienced TMD specialists on altogether 16 models. Kappa coefficient, overall percentage agreement (%A) as well as positive (PA) and negative (NA) agreements were used to define the reliability. Myofascial pain with referral, headache attributed to TMD and disc displacement (DD) without reduction without limited opening showed excellent kappa values (range 0·87-1·00). Fair-to-good reliability was observed for diagnoses of myalgia (k = 0·67), arthralgia (k = 0·71) and DD with reduction (k = 0·64). The PA was high for all pain-related diagnoses and DD without reduction without limited opening (medians ≥83%), and acceptable for DD with reduction (median 67%). The NA was high (medians ≥87%) for all DC/TMD diagnoses, except for myalgia which showed acceptable NA (median 75%). The %A was high for all assessed diagnoses (medians >85%). The findings of this study showed DC/TMD-FIN Axis I to demonstrate sufficiently high reliability for pain-related TMD diagnoses.

Úlcera de Lipschütz: presentación de 2 casos / Lipschütz ulcer: presentation of 2 cases

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Long-term effectiveness of a prefabricated oral appliance for myofascial pain.

The long-term effectiveness of a prefabricated oral appliance (R) was compared with a stabilisation appliance (S) in patients with myofascial pain. Sixty-five patients diagnosed with myofascial pain at two centres for Stomatognathic Physiology in Sweden and Finland were included in a randomised controlled trial using Research Diagnostic Criteria for Temporomandibular Disorders, with history questionnaires and clinical examinations performed by blinded examiners at baseline and at 6- and 12-month follow-ups. Patients were randomly assigned either to the R or the S group. Treatment outcome was measured according to IMMPACT for four chronic pain outcome domains: pain intensity, overall improvement, physical functioning and emotional functioning. Physical functioning was classified for Graded Chronic Pain severities and assessed by the Jaw Functional Limitation scale. Emotional functioning composed of scores of non-specific physical symptoms and depression. There were no differences between groups at baseline. At both follow-ups, all outcome domains showed significant within-group improvement, without significant differences between groups. At 12 months, 72% of all patients reported a 30% reduction in worst pain and 63% of the patients a 50% reduction in worst pain. Overall improvement 'better' to 'symptom-free' was observed in 81% in the R and 64% in the S group at the 12-month follow-up. Graded Chronic Pain, Functional Limitation of the Jaw, non-specific physical symptoms and depression showed statistically significant reduction at 12-month follow-up. Results support the hypothesis that the effectiveness of the prefabricated appliance is similar to that of the stabilisation appliance in the long-term when treating patients with myofascial pain.

Salivary cortisol and IgA levels in patients with myofascial pain treated with occlusal appliances in the short term.

In many studies, the endocrinological response of individuals to different kinds of stresses has been tested. There seems to be widespread agreement that stress, depression, disability and dysfunctional illness behaviors are critical aspects of patients suffering from symptoms like pain, arising out of temporomandibular disorders (TMD). We aimed to explore treatment-induced changes in salivary cortisol, IgA and flow rate values in TMD patients suffering from myofascial pain. Temporomandibular disorders patients (n = 39) were randomized into two groups and treated with two different occlusal appliances. Perceived stress regarding family, work, economy, relationships, general health and stress in general was evaluated at baseline according to a verbal scale. Paraffin-stimulated saliva samples were collected before treatment and during follow-up at 6 and 10 weeks. Flow rate was measured immediately after the saliva collection while salivary cortisol and IgA were determined from samples stored at -70 degrees C. No clear association between reported stress and cortisol or IgA values could be observed at baseline. At 10 weeks follow-up, 92% of the patients felt 'better, much better, symptom-free' and no difference was found between the two appliance groups. Cortisol, IgA and flow rate values showed no systematic between appliance groups' differences. All salivary parameters showed interindividual differences but stayed intra-individually on a similar level throughout the study and no statistically significant changes could be observed when comparing before and after treatment levels. To conclude, there were no treatment-induced changes in saliva parameters despite successful appliance therapy in myofascial pain patients.

Are signs of temporomandibular disorders stable and predictable in adolescents with headache?

The aim of the present study was to study changes in signs and symptoms of temporomandibular disorders (TMD) and factors predicting TMD signs in adolescents with and without headache. A population-based sample (n = 212) of 13-year-olds with and without headache was re-examined at the age of 16. The study included a questionnaire, face-to-face interview and somatic examination. In addition, a neurological examination, a muscle evaluation and a stomatognathic examination were performed. Significant changes were seen in TMD signs during the follow-up, but TMD signs at the end of the follow-up could not be predicted by baseline headache, sleeping difficulties, depression or muscle pain. TMD signs at the age of 16 were associated with female gender and muscle pain. We conclude that considerable changes in TMD signs occur in the follow-up of adolescents with and without headache. Headache-related TMD are not predictable in adolescents with and without headache.

Urinary tract infection in neonates with serious bacterial infections admitted to the University Hospital of the West Indies / Infección de las vías urinarias en neonatos ingresados con serias infecciones bacterianas en el Hospital Universitario de West Indies

OBJECTIVE: The aim of this study was to describe the epidemiology of urinary tract infection in neonates, with serious bacterial infections, admitted to the University Hospital of the West Indies. METHODS: Admission records of all neonates admitted to the neonatal unit of the University Hospital of the West Indies between January 1995 and December 2000 for sepsis evaluation were reviewed. Infants who had positive bacterial cultures were identified using laboratory records. Those satisfying the criteria for urinary tract infection were selected for detailed analysis. Demographic, clinical and laboratory data were collected using a pre-coded questionnaire. Descriptive analyses were performed. RESULTS: Fifty-one (38%) of 135 babies with positive bacterial isolates had confirmed urinary tract infection. Male: female ratio was 6:1. Common presenting features included fever (32%), poor feeding (30%) and irritability (22%). The mean white cell count was 14 ± 6.26. E coli and Klebsiella species were most frequently identified. Factors associated with a diagnosis of urinary tract infection included male gender (p < 0.001), age > 48 hours (p < 0.05) and a presenting complaint of poor feeding (p < 0.003). Imaging studies of the renal tract detected abnormalities in 5 (10.4%) neonates. CONCLUSIONS: Urinary tract infection is an important cause of serious bacterial infection in neonates affecting 1 in 3 babies with proven bacterial infection and may be the first indicator of underlying structural abnormalities. The absence of specific distinguishing clinical features makes it necessary to include urine cultures in the sepsis evaluation of neonates presenting with symptoms suggestive of sepsis.

OBJETIVO: El propósito de este trabajo fue describir la epidemiología de la infección de las vías urinarias en neonatos con serias infecciones bacterianas, ingresados en el Hospital Universitario de West Indies. MÉTODOS: Se revisaron las historias clínicas de todos los neonatos ingresados en la Unidad Neonatal del Hospital Universitario de West Indies entre enero de 1995 y diciembre de 2000 para una evaluación de sepsis. Los infantes que presentaron cultivos bacterianos positivos, fueron identificados usando los registros de laboratorio. Aquellos que satisfacían los criterios de infección de las vías urinarias, fueron seleccionados para un análisis detallado. Se compilaron datos demográficos, clínicos y de laboratorio usando un cuestionario pre-codificado. Se llevaron a cabo análisis descriptivos. RESULTADOS: Cincuenta y uno (38%) de los bebés con aislados bacterianos positivos tuvieron infección confirmada de las vías urinarias. La proporción varón:hembra fue 6:1. Las características comunes que se presentaron, incluyeron fiebre (32%), pobre alimentación (30%) e irritabilidad (22%). El conteo promedio de leucocitos fue 14 ± 6.26. Las especies identificadas con mayor frecuencia fueron E coli y Klebsiella. Los factores asociados con un diagnóstico de la infección de las vías urinarias incluyeron género masculino (p < 0.001), edad > 48 horas (p < 0.05) y quejas en cuanto a pobre alimentación (p < 0.003). Los estudios de imágenes de las vías renales detectaron anormalidades en 5 (10.4%) neonatos. CONCLUSIONES: La infección de las vías urinarias es una causa importante de seria infección bacteriana en neonatos, que afecta a 1 de cada 3 recién nacidos con infección bacteriana demostrada, y puede ser el primer indicador de anormalidades estructurales subyacentes. La ausencia de características clínicas distintivas, hace necesario que se incluyan cultivos de orina en la evaluación de la sepsis en neonatos que se presentan con síntomas que sugieren la presencia de sepsis.

Urinary tract infection in neonates with serious bacterial infections admitted to the University Hospital of the West Indies.

OBJECTIVE: The aim of this study was to describe the epidemiology of urinary tract infection in neonates, with serious bacterial infections, admitted to the University Hospital of the West Indies. METHODS: Admission records of all neonates admitted to the neonatal unit of the University Hospital of the West Indies between January 1995 and December 2000 for sepsis evaluation were reviewed. Infants who had positive bacterial cultures were identified using laboratory records. Those satisfying the criteria for urinary tract infection were selected for detailed analysis. Demographic, clinical and laboratory data were collected using a pre-coded questionnaire. Descriptive analyses were performed. RESULTS: Fifty-one (38%) of 135 babies with positive bacterial isolates had confirmed urinary tract infection. Male:female ratio was 6:1. Common presenting features included fever (32%), poor feeding (30%) and irritability (22%). The mean white cell count was 14 +/- 6.26. E coli and Klebsiella species were most frequently identified. Factors associated with a diagnosis of urinary tract infection included male gender (p < 0.001), age > 48 hours (p < 0.05) and a presenting complaint of poor feeding (p < 0.003). Imaging studies of the renal tract detected abnormalities in 5 (10.4%) neonates. CONCLUSIONS: Urinary tract infection is an important cause of serious bacterial infection in neonates affecting 1 in 3 babies with proven bacterial infection and may be the first indicator of underlying structural abnormalities. The absence of specific distinguishing clinical features makes it necessary to include urine cultures in the sepsis evaluation of neonates presenting with symptoms suggestive of sepsis.

Neonatal sepsis in very low birthweight infants at the University Hospital of the West indies.

A retrospective review was conducted on the charts of all very low birthweight (VLBW) infants with culture proven sepsis admitted to the neonatal unit of the University Hospital of the West Indies (UHWI) during the period January 1, 1995 to December 31, 2000. During the study period, 22 VLBW infants were admitted to the neonatal unit with culture proven sepsis, 16 (73%) survived and 6 (27%) died As birthweight and gestational age increased, outcome improved There was no difference in survival based on age at presentation. Neonates with early onset disease had a significantly longer mean duration of rupture of membranes than those with late onset disease (p = 0.009) and babies with late onset disease had a significantly lower mean Hb level than those with early onset disease (p = 0.000). Predominant isolates were Klebsiella sp (10, 37%), Streptococcus Group D (4, 15%), Escherichia coli (3, 11%) and Group B Streptococcus (3, 11%). Klebsiella sp accounted for 8/13 (62%) of late onset infections. Complications included anaemia, thrombocytopenia, bleeding and multi-organ failure. Strategies aimed at prevention, such as limiting the excessive use of broad-spectrum empiric antibiotics and the periodic review and continuous reinforcement of infection control policies will help decrease the mortality and morbidity associated with nosocomial infection in the VLBW infant.

Predictors of poor outcome in neonates with bacterial sepsis admitted to the University Hospital of the West Indies.

To determine factors that affect outcome in neonates with culture-proven sepsis, the charts of all neonates with culture-proven sepsis admitted to the University Hospital of the West Indies between January 1995 and December 2000 were reviewed retrospectively. Neonates who survived without developing any complications (favourable outcome group) were compared with those who died and/or developed severe complications during the course of treatment (poor outcome group). Chi-square tests were done to determine factors associated with poor outcome; univariate and multivariate logistic regression analyses were also performed. One hundred and thirty-five neonates had culture-proven sepsis, of which 89 (66%) were term infants and 46 (34%) were preterm. Male to female ratio was 1.6:1. One hundred and twenty-six (93%) survived and 9 (7%) died. Case fatality rates were higher for premature infants (15%) than for term infants (2%). Twenty-four (18%) of the neonates with culture proven sepsis had a poor outcome. Gram negative organisms accounted for 19 (70%) of the cases with poor outcome. Prematurity (p < 0.001), very low birthweight (p < 0.001) and female gender (p < 0.05) were factors associated with poor outcome. Strategies aimed at decreasing morbidity and mortality in neonates with sepsis must include measures that will decrease the incidence of prematurity and low birthweight.

Predictors of poor outcome in neonates with bacterial sepsis admitted to the University Hospital of the West Indies / Predictores de resultados clínicos pobres en recién nacidos con sepsis bacteriana, ingresados en el Hospital Universitario de West Indies

To determine factors that affect outcome in neonates with culture-proven sepsis, the charts of all neonates with culture-proven sepsis admitted to the University Hospital of the West Indies between January 1995 and December 2000 were reviewed retrospectively. Neonates who survived without developing any complications (favourable outcome group) were compared with those who died and/or developed severe complications during the course of treatment (poor outcome group). Chi-square tests were done to determine factors associated with poor outcome; univariate and multivariate logistic regression analyses were also performed. One hundred and thirty-five neonates had culture-proven sepsis, of which 89 (66) were term infants and 46 (34) were preterm. Male to female ratio was 1.6:1. One hundred and twenty-six (93) survived and 9 (7) died. Case fatality rates were higher for premature infants (15) than for term infants (2). Twenty-four (18) of the neonates with culture proven sepsis had a poor outcome. Gram negative organisms accounted for 19 (70) of the cases with poor outcome. Prematurity (p < 0.001), very low birthweight (p < 0.001) and female gender (p < 0.05) were factors associated with poor outcome. Strategies aimed at decreasing morbidity and mortality in neonates with sepsis must include measures that will decrease the incidence of prematurity and low birthweight.

A fin de determinar los factores que afectan la evolución clínica de los recién nacidos con sepsis probada por cultivo, se realizo un estudio retrospectivo de las estadísticas de todos los neonatos con sepsis probada por cultivo, ingresados en el Hospital Universitario de West Indies entre enero de 1995 y diciembre de 2000. Los neonatos que sobrevivieron sin desarrollar complicación alguna (el grupo de resultados clínicos favorables) fueron comparados con los que murieron y/o desarrollaron complicaciones severas durante el curso del tratamiento (el grupo de resultados clínicos pobres). Se realizaron pruebas de chi-cuadrado para determinar los factores asociados con los resultados clínicos pobres. También se llevaron a cabo análisis de regresión logística univariable y multivariable. Ciento treinta y cinco recién nacidos presentaron sepsis probada por cultivo. De ellos, 89 (66%) eran infantes de término y 46 (34%) de pre-término. La proporción varón/hembra fue 1.6:1. Ciento veintiséis (93%) sobrevivieron y 9 (7%) murieron. Las tasas de fatalidades fueron más altas para los infantes prematuros (15%) que para los infantes de término (2%). Veinticuatro (18%) de los neonatos con sepsis probada por cultivo tuvieron resultados clínicos pobres. Organismos gram-negativos fueron la causa de 19 (70%) de los casos con resultado clínico pobre. La prematuridad (p <0.001), el peso extremadamente bajo al nacer (p <0.001) y el sexo femenino (p <0.05) fueron factores asociados con el resultado clínico pobre. Las estrategias dirigidas a disminuir la morbilidad y la mortalidad en los recién nacidos con sepsis tienen que incluir medidas que reduzcan la incidencia de la prematuridad y el bajo peso.

Neonatal group B streptococcal infection at the University Hospital of the West Indies, Jamaica: a 10-year experience.

AIM: To describe the incidence, clinical presentation and outcome of neonatal group B streptococcal (GBS) infection at the University Hospital of the West Indies (UHWI). METHODS: A 10-year retrospective review of all inborn neonates admitted to the neonatal unit of UHWI with GBS infection between 1 January 1991 and 31 December 2000 was conducted. Differences in maternal and neonatal characteristics between early- and late-onset disease (EOD, LOD) were determined. RESULTS: There were 32,029 live births and 29 neonates were admitted for GBS infection, an incidence of 0.91/1000 live births (95% CI 0.58-1.23/1000). Twenty-one (72%) neonates had EOD, a rate of 0.66/1000 live births (95% CI 0.38-0.94/1000) and eight (28%) had LOD, a rate of 0.23/1000 (95% CI 0.08-0.42/1000). Seventeen of the 21 (81%) cases of EOD occurred within the 1st 24 hours of life. The most common clinical diagnosis was septicaemia (17, 61%), followed by pneumonia (8, 28%) and meningitis (3, 11%). All five (100%) babies whose mothers' membranes were ruptured for >18 hours had EOD. The babies of all six (100%) women with intrapartum pyrexia went on to have EOD. A greater proportion of babies (63%) with LOD were preterm and of low birthweight. The most common presenting symptom was respiratory distress which occurred more frequently in neonates with EOD, p=0.006. One neonate died, giving a case fatality rate of 3.6%. CONCLUSION: Although the incidence of GBS infection is relatively low at UHWI, further reduction in the incidence might be achieved by implementation of measures to prevent perinatal transmission.

Neonatal sepsis in Jamaican neonates.

AIM: To determine the incidence and causative organisms of bacterial sepsis in neonates at The University Hospital of the West Indies. METHODS: A retrospective review of all neonates with culture-proven sepsis admitted to the hospital between January 1995 and December 2000 was conducted. Incidence rates and antimicrobial susceptibility patterns were determined. RESULTS: There were 4702 admissions to the neonatal unit during the study period. Of these, 135 had culture-proven sepsis and 115 were inborn, giving an incidence of 6.7/1000 live births. There were 89 positive blood cultures, 51 positive urine cultures and two positive CSF cultures. The single most common organism was Klebsiella spp (28%). Other organisms included Escherichia coli (16%), group B Streptococcus (11%) and Enterobacter spp (10%). The aminoglycoside resistance rate of Klebsiella spp was 46% and seven isolates had multiple resistance to antibiotics. There was a case fatality rate of 6.7%. CONCLUSION: Physicians involved in newborn care at The University Hospital of the West Indies need to recognise the important role Klebsiella now plays in neonatal sepsis and its contribution to neonatal mortality. Empirical antibiotic regimens for gram-negative sepsis must take into consideration the high rates of aminoglycoside resistance that are now prevalent.

Headache children with temporomandibular disorders have several types of pain and other symptoms.

The aim was to investigate the association between temporomandibular disorders (TMD) and overall muscle tenderness, depressive symptoms, sleep difficulties, headache frequency and related symptoms in children with primary headache in comparison with controls. Based on an unselected population sample of 1135 Finnish schoolchildren classified according to the type of headache at age 12, altogether 297 children aged 13-14 from different headache groups and healthy controls were randomly selected for an interview and clinical examinations. Children with migraine had more TMD signs than children with nonmigrainous headaches or healthy controls. High TMD total scores were associated with palpation tenderness in other parts of the body and with frequent headache attacks. We conclude that children with overall headache, migraine in particular, and high total TMD scores showed an increased overall tenderness to muscle palpation and multiply manifested hypersensitivity pain.

Clinical study of 35 patients with dysarthria-clumsy hand syndrome.

OBJECTIVES: Although dysarthria-clumsy hand syndrome (DCHS) is a well known and infrequent lacunar syndrome, there are few data regarding the spectrum of associated clinical characteristics, anatomical site of lesion, and aetiopathogenetic mechanisms. We report a clinical description of this subtype of lacunar stroke based on data collected from a prospective acute stroke registry. METHODS: From 2500 acute stroke patients included in a hospital based prospective stroke registry over a 12-year period, 35 patients were identified as having DCHS. RESULTS: DCHS accounted for 1.6% of all acute stroke patients (35/2110), 1.9% of acute ischaemic stroke (35/1840), and 6.1% of lacunar syndromes (35/570) admitted consecutively to a neurology department and included in the stroke registry over this period. The results supported the lacunar hypothesis in 94.3% of patients (n = 33). Atherothrombotic and cardioembolic infarction occurred in only one patient each (2.9%). No patient with DCHS had an intracerebral haemorrhage. Outcome was good (mortality in hospital 0%, symptom free at discharge 45.7%). After multivariate analysis, absence of limitation at discharge, limb weakness but not cerebellar-type ataxia, and internal capsule (40%), pons (17%), and corona radiata (8.6%) location were significantly associated with DCHS. CONCLUSIONS: DCHS is a rare cerebrovascular syndrome, and supports the criteria of the lacunar hypothesis. The majority of patients in this study had internal capsule infarcts. The prognosis is good with striking similarity compared with other types of lacunar strokes. There are important differences between DCHS and non-lacunar strokes. Internal capsule and pons are the most frequent cerebral sites.

Factors influencing hepatitis B vaccine uptake in injecting drug users.

BACKGROUND: Hepatitis B infection in injecting drug users is an important public health problem. Active immunization against hepatitis B is immunogenic and safe, but uptake rates in targeted vaccination programmes are low. This study was undertaken to identify factors associated with the uptake of hepatitis B vaccination in injecting drug users attending a needle exchange service. METHODS: A retrospective cross-sectional survey of case-note data of injecting drug users who had no markers of hepatitis B infection or immunity was undertaken within a drop-in needle exchange service for injecting drug users in a large urban area in England. A qualitative study using semi-structured interviews with needle exchange staff was also conducted. RESULTS: Of 207 injecting drug users, 180 (87 per cent) had been offered vaccine, 123 (59 per cent) accepted at least one dose and 55 (27 per cent) received three or more doses. Vaccine was less likely to be offered to those sharing injecting equipment or known to have hepatitis C. Needle sharing was also associated with failure to accept vaccine, as was increasing age and the length of contact with the service. CONCLUSIONS: Those who are most at risk are least likely to be offered vaccine and accept it. This calls into doubt the effectiveness of hepatitis B vaccination strategies targeted at high-risk groups and adds weight to arguments for universal vaccination.

Virogenomics: a novel approach to antiviral drug discovery.

Target discovery in virology has been limited to the few open-reading frames encoded by viral genomes. However, several recent examples show that inhibiting host-cell proteins can prevent viral infection. The human genome sequence should, therefore, contain many more genes that are essential for viral propagation than viral genomes. A systematic approach to find these potential cellular antiviral targets is global host gene expression analysis using DNA microarrays. Several recent studies reveal both unique and common strategies by which viruses change the gene expression profile of the host cell. Moreover, work in progress shows that some of the host pathways discovered by expression profiling are important for viral replication. Thus, human genomics tools have the potential to deliver novel antiviral drugs.

Secondary otalgia in an adult population.

OBJECTIVE: To analyze the associations of secondary otalgia with general health, stress, insomnia, bruxism, and recurrent head and neck region pains. DESIGN: A population-based survey. SETTING: General community. SUBJECTS: A total of 391 randomly selected subjects (186 men, 205 women) aged 25, 35, 45, 55, or 65 years. METHODS: Standardized interview and self-report questionnaires of general health and stress. RESULTS: Otalgia was statistically significantly associated with all the studied factors. However, in the whole study group, independent predictors of otalgia were the obvious need for temporomandibular disorder treatment, high frequency of stress symptoms, and bruxism. When analyzed in women, the predictors of otalgia were the obvious need for temporomandibular disorder treatment, high frequency of stress symptoms, and age. When analyzed in men, recurrent neck pain was a predictor of otalgia. CONCLUSIONS: We suggest that after ruling out otorhinolaryngologic infectious diseases and temporomandibular disorder in patients with secondary otalgia, the next step is to explore the frequency of stress symptoms, bruxism, and recurrent neck pain. Furthermore, women and men may need a different approach in diagnostics of secondary otalgia. By diagnosing and treating these predictors of otalgia, it may be possible to reach a more successful outcome.

Signs and symptoms of temporomandibular disorders in children with different types of headache.

Headache is a common symptom among children and teenagers. Both bruxism and muscle and joint tenderness have been found in children with headache. Children with migraine headache report more temporomandibular disorder (TMD) symptoms than do those with tension-type headache. The aim of the present study was to investigate the association of different types of headache with TMD and sex in children. Altogether 297 randomly selected schoolchildren aged 13-14 years participated in a blind study setting. There were no statistically significant differences between the headache groups with regard to TMD signs, although the migraine and migraine-type headache groups had the highest percentage of subjects with more severe TMD signs. Nor were there any statistical differences between sexes or between the headache groups with regard to subjective symptoms of TMD. The present results with children differed from earlier results with adults. First, no association was found between tension headache and TMD, and, second, no sex difference in TMD children was observed at this age.