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Biomedical subjects

L Dahlström

Publications and source records attributed to L Dahlström.

At least 19 recordsLinked to original sources
PubMed2000

Changes in function and in pain-related and cognitive-behavioral variables after arthroscopy of temporomandibular joints.

The purpose was to prospectively evaluate changes in clinical, pain, and cognitive-behavioral variables in a structurally homogenous group of patients with painful temporomandibular joints (TMJ), who had undergone an identical intervention, arthroscopy. Twenty-six consecutive patients who had previously undergone unsuccessful conservative treatment participated. They were evaluated with the Craniomandibular Index (CMI), pain-related measures on visual analogue scales (VASs) for 1 wk, questionnaires, and the Multidimensional Pain Inventory (MPI). The mean CMI decreased significantly, from 0.28 to 0.18, 3 months after surgery. Pain measures also decreased significantly as rated on questionnaires, and "at worst" and "most of the time" on VASs. Intrapsychic variables related to pain also decreased significantly, while interpersonal and activity measures remained unchanged. An overall MPI dysfunctional variable correlated significantly with pain. Few further changes were observed at 12 months. Lysis and lavage of the upper TMJ compartment appears to effectively alleviate persisting functional and pain-related symptoms with low morbidity, in line with previous findings. Recoveries seem to be accompanied by changes in certain pain-related cognitive-behavioral variables within a limited sphere. Biological and intrapsychic features may interact with interpersonal factors in a complicated way in patients with orofacial pain.

Adaptation, Psychological↗
PubMed1998

Background pain in burn patients: routine measurement and recording of pain intensity in a burn unit.

It goes without saying that pain following a burn must be treated but it is not so evident to measure and document the intensity of pain and the efficacy of treatment. Since 1994 the authors have routinely measured background pain, that is, at rest, along with temperature and pulse rate. For analysis and quality assessment a relational database programme is used in the ward. In this paper the authors' experience is reported from a consecutive series of 98 patients with burn injuries who assessed the intensity of pain on a visual analogue scale. There were great intra- and inter-individual variations in pain intensity. Highest values were found during the first week of treatment when female patients experienced pain more intensively than male. For other time periods there was no statistical significant difference between the sexes. Pain intensity and severity of burn was not related except during the second week when patients with major burns had a tendency to express more pain than moderate burns. Measurement of background pain along with other routine registrations is easy and not time-consuming. Patients needing intensified pain treatment can be identified. For research and quality assessment a computerized patient register is of great help.

Adolescent↗
PubMed1998

Diagnoses among referrals to a Swedish clinic specialized in temporomandibular disorders.

The purpose was to describe the distribution of diagnoses among all referrals to a clinic specialized in temporomandibular disorders (TMD). A series of 1500 consecutive patients, evaluated by 1 dentist, were diagnosed according to the criteria of The International Classification of Diseases, 9th Revision, Clinical Modification: ICD-9-CM. Some referrals (12%) were never evaluated, were symptom-free, or were forwarded to other clinics. Various dental, neurogenic, occlusal, dentofacial, and other problems occurred. Vague orofacial pain was common, as was tension-type headache (6% each). More than 5% of the patients were affected by systemic disorders with manifestations in the temporomandibular joints. About half of all referrals could be strictly diagnosed with TMD. Myalgia was diagnosed as the main complaint in 19%. Internal derangement 'clicking' (15%) and 'closed lock' (6%) were more common than traumatic/ unspecified arthritis (6%) or osteoarthrosis (5%). A combination of myalgia and clicking appears to be the core sign in patients referred with TMD.

Adolescent↗
PubMed1998

Perception of treatment need among orthodontic patients compared with professionals.

The aim was to evaluate estimated need for orthodontic treatment, as judged from intraoral photographs, among orthodontic patients and professionals. Twenty consecutive prospective orthodontic patients, 20 consecutive orthodontically treated patients, 10 randomized general dentists, and 10 orthodontists participated. Seventy pairs of anonymous intraoral photographs of dentitions with varying degrees of objective treatment need were randomly arranged in a notebook. The general dentists and orthodontists rated orthodontic treatment need on a visual analog scale in a similar way among themselves and were more reserved than both patient categories, who also scored similarly among themselves. Professional raters also had similar inter- and intra-rater reliability among themselves, and it was higher than in either of the patient categories. Treatment providers appear to be more restrictive, consistent, and reliable in their judgement of orthodontic treatment need from intraoral photographs than the target group, patients positive toward orthodontic treatment.

Adolescent↗
PubMed1997

Diskectomy in temporomandibular joints with internal derangement: a follow-up study.

OBJECTIVE: To follow up a series of patients treated consecutively who had undergone a diskectomy 2 years previously because of persistent pain and disk displacement in the temporomandibular joint. STUDY DESIGN: Sixteen subjects rated their current symptoms during 1 week and were systematically examined for signs of temporomandibular disorders clinically and radiographically by independent observers. RESULTS: Subjectively, all subjects were satisfied with the operation. Five rated their current pain as significant during masticatory function. Some signs of temporomandibular disorders, usually related to function, were registered in all subjects. Postoperative mandibular movements were improved but still below normal range. Signs and symptoms correlated significantly. Surgical complications were nonexistent, but radiographic changes were extensive. Erosion and flattening of the condyle were common. CONCLUSIONS: It was verified that subjects with persistent pain and disk displacement benefit subjectively and clinically from diskectomy. The radiographic outcomes appear less encouraging. Only prospective, randomized, and controlled studies can eventually clarify the effectiveness of diskectomy in relieving pain caused by displacements in the temporomandibular joint.

Adult↗
PubMed1997

Cognitive-behavioral profiles among different categories of orofacial pain patients: diagnostic and treatment implications.

Psychological homogeneity in temporomandibular disorders (TMD) is not conclusive. The multidimensional pain inventory (MPI) has previously identified 3 cognitive-behavioral profiles in TMD and chronic pain patients. Our aims were to replicate these findings in another cultural setting and relate the profiles to the diagnosis and to the treatment demand and outcome. The MPI was administered to 112 referrals comprising 6 categories of patients diagnosed with TMD or intractable orofacial pain. Dysfunctional profiles (high in pain and distress) were most common in patients with orofacial pain of obscure origin and more common in myofascial pain patients than in patients with other TMD diagnoses. Interpersonally-distressed profiles were found in all categories. Among patients with disk displacement, the 3rd profile (adaptive copers with low pain and distress and high control and activity) was most common in earlier successfully diskectomized patients and least common in those about to undergo invasive interventions. A dysfunctional profile was associated with treatment failure, conservative or surgical, and with the demand for radical therapy. Some support for a cyclical causality between pain and psychological factors was found. It is concluded that the robustness of the MPI as a relevant assessment instrument was further strengthened.

Adaptation, Psychological↗
PubMed1997

Management of chronic orofacial pain: attitudes among patients and dentists in a Swedish county.

The purpose was to survey attitudes towards management of chronic orofacial pain (COP). Questionnaires were mailed to 30 randomized dentists and to 30 consecutive COP patients, examined 16 months earlier by a pain group of dental specialists. Fifty-seven per cent of the patients reported that their pain was the same as or worse than before and was disturbing. Few were dissatisfied with the examinations. Fifty-nine per cent thought that the consultations had been good. The surveyed dentists judged the most common causes of COP to be neurogenic and psychogenic in origin; they were overwhelmingly positive to the idea of a pain group (93%) and could consider referring patients (97%). Pain-inducing local diseases occurred but were not dominant among these COP patients. We concluded that management of COP in a pain group appears to be meaningful, as reflected by the respondents' attitudes but would gain by a closer collaboration with medical expertise.

Adult↗
PubMed1996

Assessment of temporomandibular joint disease by panoramic radiography: reliability and validity in relation to tomography.

OBJECTIVES: To assess the reliability and validity of panoramic radiography for TMJ evaluation in comparison with tomography. METHODS: One TMD specialist assessed the panoramic radiographs of 50 TMD patients and 20 non-TMD subjects on two occasions. A third evaluation was made after calibration with an oral radiologist who also assessed the radiographs twice and the patients' corresponding tomograms. Each TMJ was assessed for five features. RESULTS: Absence of TMJ disease varied between 56 and 87% for the different features and the two observers on the panoramic radiographs. Condylar flattening was the most frequent positive finding. Mean intra-observer agreement varied between 0.34 and 0.79. Mean inter-observer agreement varied between 0.22 and 0.65 and increased after calibration. Agreement was worse for the temporal component. Pathological findings were more frequent on the tomograms and varied between 6 and 19%. Mean sensitivity varied between 0.00 and 0.60 and mean specificity between 0.59 and 0.95. Mean PPV ranged from 0.25 to 0.90 and NPV from 0.02 to 0.22. CONCLUSIONS: Evaluation of bony changes on the condyles has acceptable reliability and specificity but low sensitivity, whereas the temporal component has low reliability and accuracy. Positive findings often correspond to disease while negative findings do not exclude it. If bony abnormality is suspected in the TMJ, and the panoramic radiograph is negative, tomography may be indicated.

Adult↗
PubMed1994

Evaluation of a training program intended to calibrate examiners of temporomandibular disorders.

The adequacy of a training program intended to calibrate examiners of temporomandibular disorders (TMD) was evaluated. Eight examiners blindly rated 12 subjects with various TMD signs and symptoms after participating in a 5-h intense training procedure. Some examiners had earlier experience of TMD examinations, and some were newly trained. The Craniomandibular Index was used as the assessment instrument. Agreement within the whole group of examiners was low. Training tended to increase the probability of correctly registering signs. It is concluded that the program was not sufficient to create reliability among multiple examiners. More extensive training, not only to a standard but also between the different examiners, appears necessary. Revision of the examination technique is suggested, and recommendations for strengthening the calibration procedures are made.

Adult↗
PubMed1993

Temporomandibular disorders: assessment of psychological factors.

Factors such as psychological stress, anxiety, depression, oral habits, and chronic pain behaviors have been found in subgroups of Temporomandibular Disorders (TMD) patients. This paper reviews the current status of diagnostic methods and instruments designed to identify various psychological factors. The authors offer the following general conclusions: Although the DSM-III-R has significant limitations, it is currently the most common gold standard with which other psychological instruments are compared. There are several specific assessment instruments, such as the Beck Depression Inventory and the Zung Self-Rating Depression Scale, which have been found to have acceptable sensitivity and specificity scores. In addition, certain simple screening questions may be cost-effective for the identification of psychological factors. Because of studies indicating that the dentists' recognition of psychological factors is inaccurate, a brief screening questionnaire may be useful in TMD patients. The literature does not support the routine use of the MMPI. A major conclusion of this review is that there are several psychological instruments available which have demonstrated reasonable validity through a blind comparison with a gold standard. There is need for further development and testing of brief screening instruments using clinical decision methods.

Anxiety↗
PubMed1993

Psychometrics in temporomandibular disorders. An overview.

The purpose of this paper is to review the methods and results of psychometric testings in temporomandibular disorders (TMD) during the past decade. Assessments of psychologic and behavioral factors have been performed for various reasons. The results are often ambiguous and comparisons troublesome. No encompassing psychologic TMD profile has been identified, but small elevations in anxiety, depression, somatization, and stress are often reported; they may be cause or effect. Subcategorization of the patients into diagnostic subgroups suggests that psychologic differences exist but may be small; myogenic patients may have more psychologic difficulties than 'joint' patients. More distinct, robust psychologic subsets of patients, unrelated to the structural diagnosis, have been identified by means of clustering techniques. Irrespective of clinical signs, a certain proportion of the patients are psychologically distressed, whereas others easily adapt to the pain and dysfunction. No single variable has been identified that can predict outcome or compliance. Several psychometric instruments are described.

Adaptation, Psychological↗
PubMed1992

Evaluation of masticatory function before and after treatment in patients with craniomandibular disorders.

The masticatory function was evaluated in 12 patients with signs and symptoms of craniomandibular disorders of mainly muscular origin. Palpation of the masticatory muscles and measurements of occlusal force endurance, on a submaximal level with visual feedback, and of masticatory efficiency were performed before and after treatment. Significant changes occurred between the two measurements. Of a total of 10 masticatory muscles, 8 were sensitive to palpation before treatment and 2 after treatment. Occlusal force endurance increased from 92.5 seconds before treatment to 132 seconds after treatment, and masticatory efficiency increased from 54% to 65%, respectively. It is concluded that the masticatory muscle function of these patients is compromised and that treatment had a positive effect on the masticatory function.

Adult↗
PubMed1992

Conservative treatment methods in craniomandibular disorder.

Conservative methods should be a basic treatment principle in CMD. In spite of similar signs and symptoms, the etiology may vary and treatment should, if possible, be directed towards the cause, but the management may often just be mitigating. Counselling may be crucial. Occlusal appliances of different design obviously influence the muscular activity significantly but equilibration may include a strong placebo effect. While relaxation is incompletely investigated, biofeedback seem possibly effective. The application of physical medicine procedures is almost entirely empirically based. Experience from other areas also motivates pharmacotherapy in CMD while intra-articular injections seem reasonably well founded. Investigations of pain-alleviating methods like TENS and acupuncture, though sometimes promising, are often uncontrolled. Manipulation, even if effective, may not necessarily be a "disc recapturing" manoeuvre. The results of conservative treatment for joint clicking seem unpredictable and long-term results of treatment with repositioning splints are not encouraging. A need for well-controlled, randomised clinical studies in diagnostic subgroups and controls has been expressed. Although most patients with CMD can be successfully treated with different conservative methods, often with remarkably similar results, other options must be considered for some.

Biofeedback, Psychology↗
PubMed1989

15 years follow-up on condylar fractures.

The masticatory system was examined, clinically and radiographically, in 14 children, 8 teenagers and 14 adults, 15 years after conservatively treated condylar fractures. In children, no major growth disturbances were observed and in most cases, there were no signs of the earlier fracture and the function of the masticatory system was good. In teenagers, the anatomical and functional restitution of the TMJ was not as good as in the children, but hardly gave rise to objective symptoms. In the adult group, signs of dysfunction were frequently observed but were not considered serious by the patients.

Adolescent↗
PubMed1989

Electromyographic studies of craniomandibular disorders: a review of the literature.

Craniomandibular disorders have been investigated from many points of view, structurally and functionally. To evaluate the behaviour of the masticatory muscles, electromyography (EMG) has been widely used and the studies have emanated from many different paradigms. The purpose of this paper is to review articles in which EMG has been used to study symptomatic subjects. Findings from sleep studies and basic laboratory studies seem to support the hypothesis of a correlation between masticatory muscle hyperactivity and symptoms. Experimentally induced stress studies consistently show an increased activity in symptomatic subjects. Investigations of motor pauses, the often lengthened silent period, are summarized and discussed. Several different treatment strategies, particularly splints and biofeedback, have been evaluated using EMG, indicating a normalization, but controlled outcome studies are sparse. The use of EMG has thus substantially increased our knowledge of dysfunction of the masticatory system.

Biofeedback, Psychology↗
PubMed1989

Immediate electromyographic response in masseter and temporal muscles to bite plates and stabilization splints.

The immediate influence on masticatory muscle activity of bite plates and stabilization splints was investigated in control subjects and patients with craniomandibular disorders. Electromyographic surface recordings were performed from the masseter and temporal muscles bilaterally with and without the appliances in situ. In the rest position, no significant change in average activity was registered in any muscle with either appliance. Activity during maximal biting on stabilization splints was not different from that without the appliance while bite plates caused a decrease in activity in both muscles in both groups. The reduced maximal activity was probably due to the smaller number and exclusively anterior positioned occlusal contacts on the bite plate.

Adult↗