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.

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.

Ca2+- and Mg2+-activated ATP hydrolysis in human tooth pulp.

ATP-degrading enzyme activities in pulps of healthy and carious human teeth were quantitatively analyzed using the bioluminescence method. The patterns of both Ca2+- and MG2+-activated ATP hydrolysis resembled each other. Increased enzyme activities were observed during injured states.

Aural symptoms and signs of temporomandibular disorder in association with treatment need and visits to a physician.

OBJECTIVES: To analyze associations between aural symptoms and clinical signs of and treatment need for temporomandibular disorders, as well as visits to a physician, in a Finnish population. STUDY DESIGN: A longitudinal study of a random sample of adults. METHODS: Four hundred eleven subjects (203 men and 208 women aged 25, 35, 45, 55, or 65 years at baseline) were examined and interviewed at three consecutive examinations at 12-month intervals, and a questionnaire on visits to physician during the preceding 12 months was completed. RESULTS: The aural symptoms were common. The prevalence of otalgia without infection varied between 12% and 16%, while the prevalence of tinnitus and fullness of ears was 12% to 17% and 5% to 9%, respectively. Women had more aural symptoms than men. When compared with the other subjects, the subjects with aural symptoms more often had masticatory muscles that were tender to palpation or temporomandibular joint signs. Subjects with obvious treatment need for temporomandibular disorders had more aural symptoms than subjects in the other treatment need subgroups. They also visited a physician more often because of otalgia than the subjects with otalgia in the other treatment need subgroups. CONCLUSIONS: In patients with otalgia, infectious otolaryngologic diseases should be ruled out. Then the patients without infection should be remitted to a dentist with stomatognathic experience. In the absence of temporomandibular disorders, further medical consultations (e.g., otorhinolaryngological, neurological, physiatric, and psychiatric) are indicated.

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.

Self-reported symptoms of stress in Finnish patients with craniomandibular disorders.

This study compared the stress reports of Finnish craniomandibular disorder patients and nonpatients by using the Symptoms of Stress Inventory as a screening device. A comparison of Finnish and American craniomandibular disorder patients' stress reports was made in the same manner. The overall stress level of craniomandibular disorder patients was higher than that of nonpatients. The patients had elevated scores on somatic subscales, with muscle tension symptoms being the most characteristic. These results are in accordance with American results. However, statistically significant differences were not found for emotional symptoms.

Association between TMD treatment need, sick leaves, and use of health care services for adults.

The objective of this study was to analyze the relationship between need for treatment of temporomandibular disorders, sick leaves, and use of health care services in a study population of 441 adults born between 1927 and 1967. The findings indicated that these were strongly associated. The results were in agreement with earlier studies suggesting that stomatognathic disorders are one link between medicine and dentistry in health care. Subjects with temporomandibular disorders were significantly more often on sick leave, visited a physician more often, and had more physiotherapy and massage than subjects who did not need treatment for temporomandibular disorders. Intervention studies are needed to improve cooperation between different specialties, to eliminate unnecessary examinations as well as ineffective treatment modalities, and to decrease the cost of health care.

TMD treatment need in relation to age, gender, stress, and diagnostic subgroup.

Associations between treatment need for temporomandibular disorders (TMD) and age, gender, stress, and diagnostic subgroup were analyzed in an adult Finnish population sample of 506 subjects. When analyzed separately, the association between TMD treatment need and all the studied factors was statistically significant. This finding is in accordance with earlier results. When the studied factors were included into an explanatory model, however, the picture changed. The logistic regression analysis revealed that diagnostic subgroup was the strongest predictor for the TMD treatment need. Total stress score significantly added to the explanatory power of the model, but age and gender did not. The commonplace observation that women show more signs and symptoms of TMD seems to be explainable by their higher stress scores and by the type of symptoms.

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.

Treatment of reciprocal clicking of the temporomandibular joint with a repositioning appliance and occlusal adjustment--results after four and six years.

A follow-up study was performed on 12 subjects with unilateral and five subjects with bilateral reciprocal clicking and symptoms of craniomandibular disorders. After treatment for, on average, three months with a repositioning appliance, followed by occlusal adjustment, patients were examined every six months initially and, after the first two years, once a year. During the follow-up period, occlusal stability was maintained by readjustment and use of full occlusal splints at night, when needed. After four years there was a 57% success rate with regard to treated joints. After six years, the success rate had decreased to 41%. However, even the eight unsuccessful cases, with persistent clicking and adjusted occlusion, managed well with regard to other clinical findings and subjective symptoms. It is concluded that repositioning splint therapy followed by occlusal adjustment seems appropriate for elimination of subjective symptoms and clinical signs even though repositioning may subsequently fail. Results seem to remain relatively unchanged for several years but some decline in the success rate may occur with time.

Sealing of preventively enlarged fissures.

The occlusal fissures of 156 permanent first molars in 63 children, 7--8 years of age, were sealed with a chemically polymerizing material (Delton). Deep and narrow fissures were opened up with a pointed diamond before etching and sealing. The treatment was performed by untrained dental students. The patients were called back for treatment every 6 months. 2/3 of the patients were followed up for a period of 2 1/2 years. After that period the retention of sealants was 93% (74 sealants) in ground deep fissures and 88% (28 sealants) in unground shallow fissures.

A two-year follow-up of temporomandibular joint disk displacement without reduction in 22 subjects.

Twenty-two subjects with clinically diagnosed unilateral anterior disk displacement were followed up for two years. Seventeen of the patients were women and five were men, with ages ranging from 17 to 68 years (median 27 years). In 20 cases the duration of locking at the time of the examination was less than 6 months; the other two cases had experienced locking for more than 6 months but less than one year. Case histories were recorded and clinical examinations performed according to accepted principles, followed by calculation of Helkimo's anamnestic dysfunction index Ai and clinical dysfunction index Di. The patients were treated using full coverage splints combined with occlusal adjustment. Follow-up examinations were made after 6 months, one year and two years. At the time of the first visit, 17 patients had severe subjective symptoms such as difficulty in opening the mouth wide and pain on movement of the mandible, while five experienced locking without subjective symptoms. All patients apart from one belonged to Di III and had a maximal mouth opening capacity ranging from 24 to 38 mm. During follow-up, one patient was treated surgically because of continuous severe symptoms; in one case, spontaneous disk reduction was confirmed by MR imaging. At the last examination the rest of the patients (n = 20) had a mouth opening capacity ranging from 31 to 60 mm and belonged to Di II. However, eight patients were completely symptom free and 12 had only mild symptoms. All patients regarded their condition and good as were able to manage well.(ABSTRACT TRUNCATED AT 250 WORDS)