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1.
J Oral Facial Pain Headache ; 34(4): 364-373, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33290442

RESUMO

AIMS: To study the effect and cost-effectiveness of jaw exercise treatment in patients with masticatory myofascial pain. METHODS: A total of 97 patients with myofascial pain according to the RDC/TMD were randomized into three groups: (1) jaw exercises; (2) stabilization appliance; or (3) no treatment. After 3 months, the patients were evaluated according to the following instruments: pain intensity according to a visual analog scale (VAS); global improvement according to the Patient Global Impression of Change scale (PGIC); depression and anxiety according to the Hospital Anxiety and Depression Scale (HADS); jaw function according to the Jaw Functional Limitation Scale (JFLS-20); consumption of analgesics; and frequency of tension-type headache. RESULTS: Pain intensity during jaw movement decreased significantly more in the jaw exercise group compared to the no treatment group (P < .001). There was no statistically significant difference between the jaw exercise and stabilization appliance groups in this aspect. The patients in the treatment groups reported greater improvement on the PGIC compared to the no treatment group (P < .001). There was a significant decrease in headache frequency (P = .028), consumption of analgesics (P = .007), and JFLS scores (P = .008) in the jaw exercise group compared to the no treatment group. In the jaw exercise group, patients had fewer appointments and a lower mean treatment time compared to the group that received stabilization appliance treatment. CONCLUSION: Jaw exercises are effective in reducing pain intensity, headache, and consumption of analgesics in patients with masticatory myofascial pain. Jaw exercises are also cost-effective when compared to treatment with a stabilization appliance.


Assuntos
Terapia por Exercício , Dor Facial , Dor Facial/terapia , Humanos , Arcada Osseodentária , Medição da Dor , Resultado do Tratamento
2.
J Oral Facial Pain Headache ; 33(4): 389­398, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31247061

RESUMO

AIMS: To investigate whether an international consensus exists among TMD experts regarding indications, performance, follow-up, and effectiveness of jaw exercises. METHODS: A questionnaire with 31 statements regarding jaw exercises was constructed. Fourteen international experts with some geographic dispersion were asked to participate in this Delphi study, and all accepted. The experts were asked to respond to the statements according to a 5-item verbal Likert scale that ranged from "strongly agree" to "strongly disagree." The experts could also leave free-text comments, which was encouraged. After the first round, the experts received a compilation of the other experts' earlier responses. Some statements were then rephrased and divided to clarify the essence of the statement. Subsequently, the experts were then asked to answer the questionnaire (32 statements) again for the second round. Consensus was set to 80% agreement or disagreement. RESULTS: There is consensus among TMD experts that jaw exercises are effective and can be recommended to patients with myalgia in the jaw muscles, restricted mouth opening capacity due to hyperactivity in the jaw closing muscles, and disc displacement without reduction. The patients should always be instructed in an individualized jaw exercise program and also receive both verbal advice and written information about the treatment modality. CONCLUSION: This Delphi study showed that there is an international consensus among TMD experts that jaw exercises are an effective treatment and can be recommended to patients with TMD pain and disturbed jaw function.


Assuntos
Transtornos da Articulação Temporomandibular , Consenso , Técnica Delfos , Terapia por Exercício , Humanos , Mialgia
3.
J Oral Rehabil ; 46(9): 800-806, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31074880

RESUMO

BACKGROUND: The most common non-dental pain in the orofacial region is pain associated with temporomandibular disorders (TMD), and jaw exercises are a common treatment in these cases. Since masticatory myofascial pain has components of an affective and cognitive nature, knowledge about the patients' experiences of the condition and treatment is important. OBJECTIVE: The aim was to study the patients' experiences of jaw exercises in the treatment of masticatory myofascial pain. METHODS: A questionnaire, containing 24 statements that should be answered according to a five-item verbal Likert scale, was sent to 150 consecutive patients with masticatory myofascial pain according to the Research Diagnostic Criteria for TMD after they had been treated with jaw exercises for 3-12 months. RESULTS: The response rate was 73% (n = 109), and 79% of the responders were women. 71% of the patients reported that it was easier to remember the jaw exercises if they put them in conjunction with an already established routine. Before examination, 49% of the patients suspected serious disease behind their symptoms, but these concerns were greatly relieved by the information provided. As a result, 78% reported that information about the underlying cause of their symptoms made them more involved in the treatment. Finally, 72% of the respondents reported that the jaw exercises were effective in reducing their symptoms. CONCLUSIONS: Information about the cause of the symptoms and the treatment is important to reassure and make the patient involved in the treatment. Most patients report that jaw exercises are an effective treatment and they appreciated to have tools to tackle the problems themselves if the symptoms should return.


Assuntos
Síndromes da Dor Miofascial , Transtornos da Articulação Temporomandibular , Terapia por Exercício , Dor Facial , Feminino , Humanos , Inquéritos e Questionários
4.
J Oral Facial Pain Headache ; 31(1): 46-54, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28118420

RESUMO

AIMS: To investigate patients' experiences of therapeutic jaw exercises for treating masticatory myofascial pain. METHODS: A total of 10 patients were selected for the interview study. All patients had received treatment with jaw exercises at a specialist clinic. Semi-structured interviews were conducted in a nonclinical environment according to an interview guide with 10 domains. The interviews were transcribed and translated into English. Systematic text condensation (STC) was used to arrange and analyze the text material. RESULTS: In the systematic process of analyzing the qualitative data, four main themes were identified: "Patient Adherence," "Symptoms," "Treatment Effect," and "Participation." Most informants were initially skeptical of the jaw exercises due to their simplicity. Later on, the simplicity of the exercises and the fact that they did not need more advanced treatment were valued most by a majority of patients. Some informants suspected serious disease behind their symptoms. Treatment effects on pain and physical impairment were reported. To do the jaw exercises in conjunction with an already established routine seemed important to enhance adherence. Trust in the caregiver and being able to remedy their pain by themselves were also important to the informants. CONCLUSION: Jaw exercises are a useful treatment valued by patients due to their simplicity and effectiveness. However, before the treatment, patients should be informed about the cause of the symptoms, and any skepticism should be addressed. Results from this qualitative study cannot be generalized, but the study design and the selected population allow the results to be transferable to similar contexts.


Assuntos
Terapia por Exercício , Doenças Maxilomandibulares/terapia , Músculos da Mastigação , Mialgia/terapia , Manejo da Dor , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Cooperação do Paciente , Adulto Jovem
5.
Acta Odontol Scand ; 74(6): 460-5, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27327618

RESUMO

OBJECTIVE: The aim of the study was to investigate the self-perceived level of knowledge, attitudes and clinical experience in treatment of temporomandibular disorders (TMD) among general practising dentists (GPDs). MATERIAL AND METHODS: A web-based questionnaire was sent to all GPDs in the public dental health service in the County of Uppsala in 2010 (n = 128) and 2014 (n = 113). The GPDs were asked to answer questions in the following categories: Demographic information, Quality assurance, Clinical experience and treatment, Need for specialist resources in the field of TMD and Attitudes. Between the two questionnaires, the GPDs were offered TMD education and an examination template including three TMD questions was introduced in the computer case files. The results were also compared with a previous questionnaire from 2001. RESULTS: The response rate was 71% (2010) and 73% (2014). The majority of the GPDs were women (70% in 2010 and 72% in 2014). The reported frequency of taking a case history of facial pain and headache increased between 2010 and 2014. In 2014, the GPDs were more secure and reported higher frequency of good clinical routines in treatment with jaw exercises and pharmacological intervention compared to 2001. Interocclusal appliance was the treatment with which most dentists felt confident and reported good clinical routines. CONCLUSIONS: The GPDs felt more insecure concerning TMD diagnostics, therapy decisions and treatment in children/adolescents compared to adults. There is a high need for orofacial pain/TMD specialists and a majority of the GPDs wants the specialists to offer continuing education in TMD.


Assuntos
Atitude do Pessoal de Saúde , Odontologia Geral/organização & administração , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/terapia , Adolescente , Adulto , Criança , Dor Facial/diagnóstico , Dor Facial/terapia , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Odontologia em Saúde Pública , Inquéritos e Questionários , Suécia , Adulto Jovem
6.
Swed Dent J ; 35(3): 133-42, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22135944

RESUMO

The aims of the present study were to investigate patient adherence to treatment with hard acrylic interocclusal appliance in general dentistry in Sweden and to see if some general factors could predict patient adherence or non-adherence. During the period January - May 2009 a postal questionnaire was sent to all adult patients (> or = 20 years of age) that had received a hard acrylic interocclusal appliance from the public dental health service in the County of Uppsala during 2007 (n=388). The same questionnaire was also sent to all adult patients that had received a hard acrylic interocclusal appliance at a specialist clinic during the same year (n=69). The response rate in general dental practice was 71% and at the specialist clinic the response rate was 91%. In general dental practice, 97% of the hard acrylic interocclusal appliances were stabilisation appliances. At the specialist clinic other types of interocclusal appliances was used to a greater extent. A vast majority of patients in both general dental practice and at the specialist clinic experienced that the interocclusal appliance had a positive treatment effect. In general dental practice, 73% of the patients still used their interocclusal appliances 1 1/2-2 years after they had received them. The corresponding figure at the specialist clinic was 54%. The main reasons for not using the interocclusal appliance, besides disappearance/reduction of TMD symptoms, were different kinds of comfort problems. From the results of this study it is concluded that the patient adherence to hard acrylic stabilisation appliances made in general dental practice in Sweden is good. It can also be concluded that a perceived good treatment effect, as well as treatment of more long-term conditions, predicted a better patient adherence to hard acrylic stabilisation appliances. More studies concerning factors affecting patient adherence in TMD therapy are warranted.


Assuntos
Placas Oclusais , Desenho de Aparelho Ortodôntico , Cooperação do Paciente , Transtornos da Articulação Temporomandibular/terapia , Resinas Acrílicas , Adulto , Bruxismo/terapia , Odontologia Geral , Humanos , Placas Oclusais/efeitos adversos , Especialidades Odontológicas , Inquéritos e Questionários , Resultado do Tratamento
7.
Swed Dent J ; 32(1): 9-16, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18540516

RESUMO

The aim of this study was to evaluate the treatment effect of a combined treatment with a stabilisation appliance and a soft appliance in the opposing jaw in patients refractory to previous TMD treatment. During a 5-year-period, 2001-2005, a total of 98 patients received the combined treatment at the Department of Stomatognathic Physiology, the Institute for Postgraduate Dental Education, Jönköping, Sweden. Before the patients received the combined treatment, they had already been given several different TMD treatments during a long period of time, either before referral or at the specialist clinic, with only minor or no effect on their TMD symptoms. The patients were followed prospectively (n=10), or analysed retrospectively (n=88). The data registered were gender, age, main indication for TMD treatment, number of visits to the clinic before and after the introduction of the combined treatment, as well as according to a clinical (Di) and anamnestic (Ai) dysfunction index. The most common causes for treatment in the retrospective material were problems of muscular origin and problems of both muscular and TMJ origin. In the prospective material, most of the patients had mainly muscular symptoms. Both the clinical and anamnestic dysfunction index decreased statistically significantly in the retrospective material after the introduction of the combined treatment. There was a numerical improvement of both indices also in the prospective material. In conclusion, the present investigation showed that a combined treatment with a hard acrylic stabilisation appliance and a soft appliance in the opposing jaw seems to give a remarkable improvement of TMD signs and symptoms in apparently therapy resistant TMD patients. General conclusions should, however, be made with caution due to the fact that the study did not include any control group. There is an obvious need for randomized controlled studies concerning the efficacy and effectiveness of the combined treatment presented in this study.


Assuntos
Placas Oclusais , Transtornos da Articulação Temporomandibular/terapia , Resinas Acrílicas , Adolescente , Adulto , Idoso , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Aparelho Ortodôntico , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Estudos Retrospectivos , Transtornos da Articulação Temporomandibular/diagnóstico , Síndrome da Disfunção da Articulação Temporomandibular/diagnóstico , Síndrome da Disfunção da Articulação Temporomandibular/terapia
8.
Swed Dent J ; 30(3): 123-34, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17233329

RESUMO

The aim of this study was to analyse what kind of interocclusal appliances that are used in general dental practice in Sweden, the indications for such treatment, to what extent a clinical status is recorded before treatment, as well as the routines for evaluation of treatment results. The study was a retrospective analysis of patient records from 320 adult patients who had been treated by general dental practitioners in the Public Dental Service in Sweden. For comparison a group of 88 consecutive patients who had received interocclusal appliance therapy at a specialist clinic was used. The most common indication for treatment with hard acrylic stabilisation appliances, as well as with soft appliances, was occlusal wear due to tooth grinding. The second most common indication for treatment with hard acrylic stabilisation appliances was pain from masticatory muscles, while the second most common indication for soft appliances was tension-type headache. Treatment with soft appliances was more often combined with other treatment modalities compared to treatment with hard acrylic stabilisation appliances. Large variations were found between the 3 general dental clinics and the specialist clinic in respect of treatment indications, combinations with other treatment modalities, recording of clinical findings, follow-ups and evaluation of treatment results. General conclusion should, however, be made with caution due to the risk of selection bias. From the results of this study it is obvious that treatment with soft appliances is common in general dental practice in Sweden, despite the lack of scientific support for their efficacy, as well as effectiveness, compared to hard acrylic stabilisation appliances. There is an obvious need for investigations of the decision-making processes among dentists when performing treatment with interocclusal appliances, as well as for randomised controlled studies concerning efficacy and effectiveness of soft appliances.


Assuntos
Bruxismo/terapia , Placas Oclusais , Transtornos da Articulação Temporomandibular/terapia , Adulto , Seguimentos , Humanos , Músculos da Mastigação/fisiopatologia , Desenho de Aparelho Ortodôntico , Estudos Retrospectivos , Cefaleia do Tipo Tensional/terapia , Abrasão Dentária/prevenção & controle , Resultado do Tratamento
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