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Chronic orofacial pain is a complex condition with consequences that affect daily living. The aim was to analyse nonspecific chronic orofacial pain patients'experiences of everyday life situations, using a qualitative approach. Eleven women and 3 men (21 to 77years) were selected through a purposive sampling among chronic orofacial pain patients referred to the Faculty of Odontology's orofacial pain unit at Malmö University, Malmö Sweden. All selected subjects agreed to participate. Data were obtained via two thematic in-depth interviews with each subject. Interviews were taped and transcribed verbatim.Text dealing with the subjects' daily experiences was identified in all interviews and analysed using qualitative content analysis that focused on manifest content. In everyday life situations, the analysis of nonspecific chronic orofacial pain patients' narrations exposed a fear of conflict, of personal weakness, and of the intangible; they also exposed self-blame and avoidance of fear-triggering situations. Eight of the 14 subjects did not spontaneously mention any situation in which they were content during daily living. When the patients spoke about everyday life experiences, the main finding was that unpleasant emotions dominated the subjects'experiences. In conclusion, the chronic orofacial pain condition cannot be understood as an isolated phenomenon; it must be considered in rela- tion to the person who is suffering from the condition.

The aim of this study was to determine the frequency of Temporomandibular Disorders (TMD) pain in Saudi Arabians,aged 20-40, who were referred to the Specialist Dental Centre in Makkah. The material included 325 patients (135 males,190 females) who answered a history questionnaire. Patients reportingTMD pain in the last month were offered a clinical examination. History questionnaires and clinical examinations were done according to the Arabic version of the Research Diagnostic Criteria for TMD (RDC/TMD). Fifty-eight patients (18%) reported TMD pain; 46 were clinically examined. Mean age of clinically examined TMD pain patients was 30 +/- 7 years with a male-female ratio of 1:6 (P < 0.001). All TMD pain patients had a diagnosis of myofascial pain, and 65% had diagnoses of arthralgia or osteoarthritis. Headaches or migraines in the last 6 months and headaches in the last month were reported in high frequencies in the TMD pain group, 93% and 71% respectively, with differences (P < 0.001) between the TMD pain and non-TMD pain groups. Graded Chronic Pain Scale assessments classified 45% of the TMD pain patients in grade 1, 53% in grade II, 2% in grade III, and 0% in grade IV. Severe depression scores were found in 38% of the TMD pain patients and severe somatisation scores in 60% with differences (P < 0.001) between the TMD pain and non-TMD pain groups. In conclusion, the study found a frequency of TMD pain in this Saudi Arabian cohort of 18%. The TMD pain group presented high scores of depression and somatisation but low disability grades on the Graded Chronic Pain Scale.

This study describes some characteristics of graduates of the five first classes from the Malmö dental programme, their overall experience of the programme, and their professional situation. Of 166 graduates (graduated 1995-1999) who were invited to participate, 128 responded (response rate 77%). The questionnaire queried participant characteristics, undergraduate education, and professional situation. The median age of the respondents at graduation was 26 years (range: 24-43 years, female: 56%). One-fourth of the respondents were born outside Sweden.Two-thirds of the respondents answered that they enrolled in the dental education because they wanted to become a dentist. Most respondents (97%) were working as a dentist, and a majority (82%) worked full-time. The respondents thought their dental education had prepared them well for their profession. About one-third of the respondents worked outside Sweden; the majority had been born outside of Sweden. The respondents' satisfaction with their professional situation, which was high overall, correlated to how much they were able to influence their work situation. About one-fourth expressed interest in specialist training. Respondents differed on the topic of research education: 64% of the female graduates and 42% of the male graduates were interested. We conclude that the respondents were satisfied with their professional situation as a dentist and that most were interested in postgraduate education.

Sleep disordered breathing (SDB) including obstructive and central sleep apnoea/hypopnoea as well as periodic breathing (PB) is common and is believed to increase risk for mortality in patients with congestive heart failure (CHF). Mandibular advancement device (MAD) has widely been recommended for treatment of obstructive sleep apnoea but the method has never been investigated for treatment of SDB in the patients with CHF. The aim with the present study was to examine the effect of MAD intervention on SDB in patients with CHF. The study included 17 male patients, aged 68.4+/-5.7 (mean+/-SD) with stable, mild to moderate CHF due to left ventricular systolic dysfunction and with SDB, expressed as apnoea/hypopnoea index (AHI) > or = 10. The SDB was examined during a single night using an unattended, portable polysomnographic device in the patients home, prior to and following intervention with a individually adjusted MAD. The SDB was evaluated by calculating AHI, PB expressed as the percentage of the total registration time, oxygen desaturation index (ODI) and snoring time. The AHI was reduced by MAD intervention from 25.1+/-9.4 to 14.7+/-9.7 (p=0.003). ODI reduced from 21.1+/-9.0 to 10.5+/-7.8 (p=0.007) and snoring time decreased from 53+/-111 to 18+/-47 seconds (p=0.02). PB was reduced from 55.7+/-25.6 to 40.4+/-26.4 per cent without statistical significance. In conclusion, the MAD intervention may be a feasible method for reducing SDB in patients with stable, mild to moderate CHF and left ventricular systolic dysfunction.

Continues positive airway pressure (CPAP) is recommended for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) but is not easily tolerated resulting in poor patient compliance. Mandibular advancement device (MAD) is designed to inhibit pharyngeal airway (PAW) obstruction and may be a valuable alternative. It has been proposed that MAD exerts its effect by increasing PAW dimensions. This has not, however, been clearly demonstrated. The aim of this study was to examine the effect of MAD on PAW dimensions and SA in patients with CHF. Seventeen CHF-patients with mild to moderate heart failure, aged 68 +/- 6 years, (mean +/- SD), range 54-75 years, with sleep apnoea-hypopnea index (AHI) > or = 10 were evaluated. PAW dimensions were studied with and without the MAD, using lateral radiographs in supine position. Nocturnal breathing patterns were studied using a portable polysomnographic device during a single night with and without MAD. A reduction of AHI > or = 30% (arbitrary level) for each individual was regarded as a successful treatment. Mean AHI was reduced from 25.1 +/- 9.4 to 14.7 +/- 9.7 (p = 0.003). The PAW increased in its inferior section in 13 patients (p = 0.0001). AHI decreased > or = 30% in 9 patients (p = 0.003) of whom 8 showed increased PAW dimensions. Reduction of AHI was not significantly related to increased PAW dimensions. In conclusion MAD increased PAW dimensions and reduced SA in patients with CHF. The results may indicate that MAD reduces SA by other mechanism than increasing PAW dimensions.

The aims were to follow-up, analyse and compare the pain status after 4-9 years with that at the baseline examination of 109 consecutive patients referred to the Pain Group at the Faculty of Odontology in Malmö, Sweden during the period 1988-1993 due to long-lasting orofacial pain. A further aim was to identify predictive factors of significance for pain alteration. 85 (78%) women with a median age of 51 years and 24 (22%) men with a median age of 60 years were included in the study. A survey of the pain status at the follow-up was conducted by means of a mailed questionnaire. The questionnaire covered the following aspects: pain alteration, pain intensity, pain location, medication and education. After one reminder, the non-responding patients were called for a telephone interview. A response level of 85% was obtained. Significant improvements were noted by the patients in the answers of the questionnaire in mainly three areas; the patients answered individually that pain relief had occurred, pain intensity rated on the VAS was lower at follow-up compared to the baseline examination and a decrease in drug use was reported. The responses indicated pain relief for 75% of the patients. However, only 27% of the patients experienced total disappearance of pain. Medication at baseline with opioids, muscle relaxants with central effect, antidepressants, neuroleptics, hypnotics or sedatives was found to be a predictive factor for persistent pain.

A long-term (12 years) follow-up of treatment with intra-articular injections into the temporomandibular joint (TMJ) of steroid or non-steroid agents was performed in 21 patients with rheumatoid arthritis (RA) and symptomatic TMJs. The aim of the study was to compare symptoms, signs and radiological appearance of the TMJ initially and at the follow-up in this group of patients. Eleven patients were assigned to a steroid group and 10 patients to a non-steroid group. Initial and follow-up clinical and radiological examination procedures were the same. The radiological evaluation was based on a grading system using standard reference films. At follow-up, 14 patients reported no pain from the TMJ and positive changes in most clinical variables were found in both groups. Radiographic follow-up examination was performed on 12 patients. Initially, all but 4 of the 24 joints had structural bone changes. At follow-up, 2 joints had lower, 11 joints had unchanged and 11 joints had higher radiological grades. Two out of 5 and 3 out of 10 joints in the steroid and non-steroid group, respectively, showed progression of structural bone changes. Among 9 untreated joints, 6 had higher radiological grades and 3 were unchanged. In the 11 TMJs with higher radiological grades at follow-up, there was in most cases moderate progression of erosive changes. The results suggest that the long-term development of symptoms and signs from the TMJ in patients previously treated was good and the long-term progression of joint destruction was low for both steroid and non-steroid agents in this patient group with RA.

The aim of this study was to evaluate headaches before and after treatment with a stabilisation appliance and a control appliance in a randomised controlled trial in patients having temporomandibular disorders (TMD) of mainly arthrogenous origin. The effect of treatment was evaluated both in a short and in long-term perspective. 60 patients (mean age 30 years) with TMD of mainly arthrogenous origin were studied. The patients were selected from patients referred for treatment of TMD during a 3-year period to the Department of Stomathognathic Physiology, Faculty of Odontology, Malmö University. The 60 patients included in the study were randomly assigned to a treatment (T) or a control (C) group. The study was performed as a randomised controlled trial including evaluation of treatment effect on tension-type headache after 10 weeks, 6 and 12 months. At the 10 weeks follow-up, the patients who reported a negative treatment outcome and/or discomfort associated with the use of the appliances had their appliances readjusted. Patients who demanded further treatment received a stabilisation appliance (21 patients from the C-group), creating a new mixed (M) group. All the 60 patients reported frequency of headache from rarely up to daily at the start of the study. In the T-group 76% and in the C-group 83% of the patients reported headache at least once a week or more before treatment. At the 10 weeks follow-up, a statistically significant difference was found regarding headache several times a week or more between the T- and C-groups and within the T-group. At the 6 months follow-up, a statistically significant reduction was found in headache several times a week or more in the T- and M-groups. The number of patients with headache once a week or more decreased significantly in the T- and M-groups at the 12 months follow-up. We conclude that the stabilisation appliance seems to have an effect on the frequency of tension-type headache both in a short and in a long-term perspective in patients with TMD of mainly arthrogenous origin.

The aim was to register and evaluate the orofacial pain condition, with special focus on the equalities/inequalities between the sexes, in consecutive patients referred to the pain group at the Centre for Oral Health Sciences in Malmö, Sweden. The 109 patients, 85 (78%) women and 24 (22%) men, were referred to the pain group during the years 1988 to 1993 and were clinically examined using a standardised procedure. Pain duration of one year or more was experienced by 83% of the patients. The pain onset was related to dental care or toothache by 56% of the patients. Temporomandibular disorders were the most common diagnoses (52%) and were more common among women than among men (p < 0.05). Multiple pain locations were frequently reported, range 1-47 locations, and the women had significantly (p < 0.05) more pain locations than the men. Equalities between the sexes were more frequent than inequalities among patients referred for long-lasting orofacial pain. It can be discussed whether the sex difference in the prevalence of pain of musculoskeletal origin emerges from biological differences or can be explained by different psychosocial circumstances.

The relationship between orthodontic treatment and symptoms and signs of temporomandibular disorders (TMD) was studied prospectively and longitudinally in 65 adolescent girls with Class II malocclusion. The subjects received orthodontic fixed appliance treatment with the straight-wire technique combined with or without extractions and were examined for symptoms and signs of TMD before, during, after, and finally one year post-treatment. Both symptoms and signs of TMD showed considerable fluctuations over the three-year period within the individuals. The general tendency was a decreased prevalence of symptoms of TMD over the three years. The prevalence of pain on mandibular movement and tenderness to palpation of the masticatory muscles was significantly less common during and after orthodontic treatment than before. Clinically registered TMJ clicking increased slightly over the three year period. One orthodontic treatment effect when normalizing Class II malocclusions with fixed appliances was a decreased prevalence of functional occlusal interferences. We concluded that the orthodontic treatment either with or without tooth extractions did not increase the risk for TMD or worsen pre-treatment signs of TMD. Subjects with Class II malocclusion and pre-treatment signs of TMD of muscular origin seemed rather to benefit functionally from orthodontic treatment in a three-year perspective.

The aim of this study was to investigate if the difference in treatment outcome between patients provided with a stabilisation appliance and a control appliance was due to the treatment and/or other factors in patients with temporomandibular disorders (TMD) of arthrogeneous origin. Sixty patients were assigned to two equally sized groups: a treatment group, treated with a stabilisation appliance, and a control group given a control appliance. Thirteen possible background variables for the treatment outcome were correlated to changes in severity of temporomandibular joint (TMJ) pain on a verbal scale in the two patient groups. The logistic regression analyses revealed that, after correcting for the background variables, stabilisation appliance treatment was a strong explanatory factor for a positive treatment outcome, with a significance of P = 0.0013 compared to patients belonging to the control group. Background variables of significant importance for the treatment outcome were male sex (positive) (P = 0.0268), and severe or very severe TMJ pain (negative) (P = 0.0034). These findings indicate that not only the treatment with a stabilisation appliance but also sex and the intensity of the TMJ pain before treatment might influence the treatment outcome in patients with TMD of arthrogeneous origin.

The aim of this study was to evaluate the effect of occlusal adjustment in a prospective longitudinal study. Fifty selected patients with craniomandibular disorders (CMD) including headaches were randomly assigned to a treatment (T) or a control (C) group. Both groups received counselling and occlusal adjustment was performed in T group. Subjective symptoms and clinical findings were registered before and 2 years after treatment. At a follow-up 48% in the T group and 84% in the C group had demanded rescue treatment. Eleven patients in the T group (48%) and 3 patients in the C group (13%) without rescue treatment, reported overall subjective improvement. No difference was found between the groups regarding overall intensity of pain expressed by the visual analogue scale. When all kinds of treatment were taken into account, 70% and 79% of the patients in the T and C group reported overall subjective improvement at follow-up. The conclusions from this study were that in a two-year perspective only single patients improved from counselling alone. A few more patients improved if one more kind of treatment, for example occlusal adjustment, was added to the initial counselling, but the majority of the patients required a comprehensive treatment program.

51 healthy dentate subjects aged between 20 and 60 years were evaluated with regard to their masticatory efficiency using a sieving test. A subjective evaluation of difficulty in chewing different kinds of food was also obtained by means of a questionnaire. The occlusal and restorative status were assessed using specific indices. The masticatory efficiency was shown to be lower with increasing age 20-39 years, mean = 39.8 and 40-60 years, mean = 27.1, respectively (p < 0.05). Males had a statistically significantly higher masticatory efficiency index than females. Multiple regression analysis showed that age, sex, the number of occluding teeth and the orthodontic treatment need index can predict half the variance in masticatory efficiency. It is concluded that it is more appropriate to describe masticatory efficiency with an average value for different age groups.

An epidemiological investigation was carried out in Malmö/Sweden to determine the prevalence of symptoms and signs of functional disturbances and diseases of the stomatognathic system in children aged 7-14. Four-hundred and forty children (440) were randomly selected, interviewed and clinically examined. The interview revealed 36% with symptoms, 15% with recurrent headaches and 13% reported clicking sounds from the temporomandibular joints. Seventy-seven per cent (77%) of the children reported at least one of the following oral parafunctions grinding clenching lip- and cheek-biting, nail-biting or thumb-sucking. In the clinical examination occlusal interferences in RP were found in 79% and mediotrusion interferences in 78%. More than half of the children 64%, claimed pain on palpation of the temporomandibular joint muscles and more than one third (39%) claimed pain on palpation of the temporomandibular joint. It is concluded that children are suffering from diseases and functional disturbances of the stomatognathic system.

The investigation consisted of 749 randomly selected subjects between 7-18 years of age. The subjects were interviewed for symptoms and oral parafunctions and examined clinically for occlusal interferences, malocclusions and signs of functional disturbances and diseases in the stomatognathic system. The group with one or more symptoms indicated no sex difference but the symptoms showed a gradual increase with age. Recurrent headaches were evenly distributed between the ages, but more commonly reported among girls in the age range 7-14 years. Clickings increased by age and some sex differences were found in the age distribution. Grinding and clenching showed a negative correlation with age. Boys reported clenching more often than girls between 7-14 years of age. Lip-cheek-biting and nailbiting were frequently reported in all ages. Girls in the age group of 15-18 years reported lip-cheek-biting more often than boys of the same age group; who on the other hand reported nailbiting more often. A correlation was found between thumbsucking and anterior open bite.

Three hundred and nine teenagers were interviewed and clinically examined in an stomatognathic epidemiological study of young people aged 15-18 in Malmö, Sweden. The youngsters were randomly selected. Forty-one per cent (41%) claimed symptoms, 16% recurrent headaches and 17% had noticed clicking sounds from the temporomandibular joints. At least one of following parafunctions: grinding, clenching, lip- and cheek-biting, nailbiting were stated by 74% of the young adults. Occlusal interferences were found in 83% and mediotrusion interferences in 77%. More than half (55%) of the young people exhibited temporomandibular joint muscles tender on palpation and 34% stated that they experienced pain on palpation of the temporomandibular joints. It is concluded that there is a higher prevalence of symptoms among the young adults than among children (Nilner & Lassing 1981).