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Biomedical subjects

P Alanen

Publications and source records attributed to P Alanen.

At least 19 recordsLinked to original sources
PubMed1998

Occlusal adjustment and the incidence of demand for temporomandibular disorder treatment.

STATEMENT OF PROBLEM: Contrary to clinical opinion, the structural risk from dental occlusion in temporomandibular disorders has been questioned or considered to be insignificant in clinical practice. PURPOSE: This study tested the effect of elimination of occlusal interference through occlusal adjustment, on the incidence of temporomandibular disorders. MATERIAL AND METHODS: In a controlled clinical trial of 146 healthy children and adolescents, half of the subjects underwent occlusal adjustment aimed at elimination of the presumed structural risk, and the other half underwent mock adjustment. Adjustments were repeated every 6 months over a period of 4 years. The outcome variable was the incidence of temporomandibular disorders, operatively defined as request for treatment of symptoms characteristic of the disorders with presence of clinical signs demonstrated in the muscles of mastication and/or jaw joint. RESULTS: The cumulative incidence rate was 9/67 in the mock adjustment group and 1/60 in the real adjustment group, for a relative risk of 8.06. The difference between groups was statistically significant (p = 0.019). CONCLUSIONS: Elimination of the presumed structural risk from the dental occlusion appeared to significantly reduce the incidence of temporomandibular disorders in a select group of young subjects.

Adolescent↗
PubMed1998

Tooth and tooth surface survival rates in birth cohorts from 1965, 1970, 1975, and 1980 in Lahti, Finland.

Differences in the tooth and tooth surface survival rates between four cohorts born in 1965, 1970, 1975, and 1980 were analysed in a historical cohort study including data on the permanent teeth of children aged 5-7 years at baseline and 19 years at the end of the study. A statistically significant reduction in caries occurrence in fissured surfaces in the three oldest cohorts was seen during the 3 years after the eruption of the teeth. Caries occurrence in the cohorts born in 1975 and 1980 did not differ from each other. The occurrence of caries in smooth surfaces was low in all age cohorts. Therefore, despite a systematic decrease in caries occurrence towards the younger cohorts, no significant differences were found between the cohorts in smooth surface decay. After the 3 first posteruptive years, practically no differences in survival rates between the cohorts were observed. In the two youngest cohorts, the figures during the 3 first years after eruption did not differ from the figures for the later years. Throughout the study, caries occurrence was symmetric and no gender differences were observed. No postponement of decay was found by the end of the follow-up time.

Adolescent↗
PubMed1998

Cost and productivity analysis of orthodontic care in Finland.

The aim of the study was to investigate the costs of orthodontic care provided for children and adolescents up to the age of 18 by municipal health centers in Finland, and to study the productivity of these services. The data were gathered by a questionnaire sent to all health centers; 96% responded. The majority of respondents estimated the share of orthodontic care as 10% of the total gross costs of dental care, given that 14% of all dental visits were for orthodontic reasons. To study the productivity in individual health centers, the output was measured by the estimated number of completely treated patients. The cost of orthodontic treatment per completely treated patient was, on average, FIM 7358, ranging from FIM 1299 to FIM 24751. The strongest explanatory factor for the average total costs of orthodontic clinics was the number of general dentists with little experience in providing orthodontic treatment. Other explanatory factors were the number of orthodontists or experienced dentists, the percentage of orthodontic tasks performed by auxiliary personnel, and the timing of treatment. Savings might be obtained by devolving treatment to orthodontists or experienced dentists instead of to dentists with little orthodontic experience, and by starting treatment early. The estimated optimal size for an orthodontic clinic was found to be a unit with 830 completely treated patients per year, but most of the orthodontic clinics were in fact much smaller with, on average, 133 completely treated patients per year.

Cost-Benefit Analysis↗
PubMed1998

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.

Adult↗
PubMed1997

The occlusal theory further complicated.

This paper reviews the critique presented against the occlusal theory of the temporomandibular disorders (TMD) and presents a new hypothesis. Although no empirical evidence has been found to refute the role of occlusion in the etiology of TMD, we argue that the occlusal theory in its present form is biased in that it is based on the findings in adults and assumes that the causal chain proceeds from structure to function. However, the close developmental relationship between function and structure and the recent changes in the functional environment of the stomatognathic organ indicate that the causal influences take place in both directions. We suggest that the occlusal theory should be reformulated in such a way that it includes mutual interactions between function and structure during growth. We assume that the structural adaptations taking place in the growing child in response to functional stimuli may play an important role in the etiology of TMD. Testing of our hypothesis requires longitudinal studies which focus on both functional and structural development.

Adaptation, Physiological↗
PubMed1997

Extent and provision of orthodontic services for children and adolescents in Finland.

Orthodontic services for Finnish children and adolescents up to the age of 18 in 1992 were monitored by a questionnaire sent to all municipal health centres responsible for children's dental care in Finland, and 96% responded. All health centres provided some orthodontic treatment, but the percentage of 0 18-year-old children receiving treatment ranged from 1% to 19%. One-quarter of all dental visits of the 0 18-year-olds were in connection with orthodontics. The timing of treatment was early, the average age for starting was 9.5 years. In statistical analyses, the number of children receiving treatment was associated with the timing of treatment. At the age of 7, the most frequently used appliances were quad helix, removable appliance and orthopaedic headgear and, at the age of 13, fixed appliance and activator. Most treatments were provided by nonspecialists. The specialist expertise needed was usually purchased from an outside orthodontist by means of consultation contracts. Every fifth health centre, usually the largest, had employed one or more specialist orthodontists. The regional distribution of orthodontists was uneven, emphasizing regional variation in the delivery of orthodontic services.

Adolescent↗
PubMed1997

Fluctuation of treatment need for temporomandibular disorders and age, gender, stress, and diagnostic subgroup.

Associations between fluctuation of treatment need for temporomandibular disorders (TMD) and age, gender, stress, and diagnostic subgrouping were analyzed in a 2-year follow-up of 391 subjects. All the studied factors were significantly associated with the treatment need for TMD at all examinations. The diagnostic subgroup (TMD arthro, TMD myo, TMD comb, or non-classified) at base line was significantly associated with the fluctuation of the treatment need for TMD also during the follow-up, but age, gender, and stress score were not. In the subgroup needing active treatment for TMD at least once during the follow-up (n = 65), the stress score did not show statistically significant covariation with the treatment need. The diagnostic subgrouping of these 65 subjects at the second and third examination at 12-month intervals did not show any association with the subgrouping at base line or with any studied variable. Detailed descriptive diagnostics may serve well in treatment planning but do not necessarily help us in understanding the nature of TMD.

Adult↗
PubMed1997

Fluctuation of temporomandibular disorders in accordance with two classifications: the Helkimo dysfunction index and treatment need grouping.

We studied the fluctuation of temporomandibular disorders, applying two classifications systems, in a 2-year follow-up study of 411 subjects. In general, the fluctuation was not large. There were no major differences between the two classifications. In our opinion, a decision to treat a patient on the basis of the treatment need grouping would not lead to overtreatment. The study design suffered from the fact that it is not possible to separate the fluctuation of the TMD itself and the fluctuation of its signs and symptoms from each other, owing to the descriptive nature of the diagnosis 'temporomandibular disorder'.

Adult↗
PubMed1997

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.

Adult↗
PubMed1996

The concepts prevalence, need for treatment, and prevention of temporomandibular disorders: a suggestion for terminology.

The concepts active and passive treatment need and active and passive prevention need are suggested, to systematize some concepts used in discussions about temporomandibular disorders (TMD), to separate the treatment need figures from the prevalence figures, and to understand the great variation among TMD prevalence studies. On the basis of a summary of recently published papers and on a clinical 2-year follow-up study of 411 subjects, the suggestions seem to provide a reasonably good fit with clinical experience and earlier epidemiologic studies of TMD.

Adult↗
PubMed1995

Odds ratio in the estimation of the significance of occlusal factors in craniomandibular disorders.

The usage of odds ratios for estimating the significance of occlusion is based on the assumption that the aetiological factors are additive and interchangeable in several different composite causes. If the factor studied is a necessary causal factor, odds ratios cannot be used in risk estimation. The present study analysed odds ratios in a sample of children half of whom had undergone an annual prophylactic elimination of occlusal interferences. The sample consisted of 178 children followed up for 5 years from the baseline age of 5 or 10. The distribution of interferences was computed for children with tenderness of the masticatory muscles ('cases'), and for children without ('controls'). Although the increase in the number of children free from interferences was not remarkable, the overall result was statistically significant (P < 0.01). None of the children free from interferences showed muscular tenderness at any of the annual examinations. Therefore, odds ratios could not be calculated in our study sample. It is concluded that estimation by means of odds ratios of the significance of occlusal factors in CMD may be misleading.

Case-Control Studies↗
PubMed1994

Clinician's ability to identify caries risk subjects.

The clinician's ability to identify caries risk children without saliva tests was studied in five health care centers. 77 examiners predicted, after the annual check-up and treatment, whether, during the following 12 months, the child would develop new dentinal caries lesions to be filled. 7917 children aged 5-16 yr were included. Only information routinely available at clinical examinations was used. In general, the overall sensitivity was 44% and specificity 90%. Some clinicians were able to identify the caries risk children with high sensitivity and specificity figures.

Adolescent↗
PubMed1994

Incidence of edentulousness, reasons for full clearance, and health status of teeth before extractions in rural Finland.

Incidence of edentulousness, reasons for full clearance, and clinical status before extractions were studied in a longitudinal setting in 47 rural communities in Finland. The annual incidence of total loss of teeth was 50/100,000 inhabitants and loss of maxillary teeth 20/100,000 inhabitants. The rates were about twice as high for men as for women. Of the teeth to be extracted, 70% were roots or decayed, 20% were affected by severe periodontal disease and 10% were extracted for prosthetic reasons without caries or periodontal disease. The incidence rates indicate that the number of dentulous subjects in Finland is growing very rapidly.

Adult↗
PubMed1993

Salivary flow rate, buffer effect, sodium, and amylase in adolescents: a longitudinal study.

The study aimed to provide information on salivary secretion rate, buffer effect, sodium, total protein, and amylase in adolescence. Paraffin-wax-stimulated saliva was collected annually in 69 initially 10-yr-olds and in 98 initially 15-yr-olds. During the 5-yr follow-up, the rate of flow increased in both sexes in the younger age group. In the older age group there was only a slight increase in the flow within the 2-yr follow-up. In both age groups, girls tended to have lower secretion than boys. In cross-sectional analyses, the rate of flow correlated positively with buffer effect and sodium, and negatively with proteins. These findings are in line with earlier observations. However, with age, the buffer effect did not parallel the flow. At the base-line examination the buffer effect was lower in the 15-yr-old than in the younger age group. In line with that, a decrease was found at the final examination in the initially 10-yr-olds. This decrease was stronger in girls than in boys. The observed change in the buffer effect was not related to a parallel change in the flow rate or total protein and amylase content of saliva. In girls the change was, however, associated with a small, but statistically significant drop in the salivary sodium level. The variation in the buffer effect increased from the age of 12 to 15, especially in girls. This effect could not be demonstrated for the other flow-rate-associated variables used to monitor the functioning of the salivary glands.

Adolescent↗
PubMed1993

The Finnish Family Competence Study: the relationship between caries, dental health habits and general health in 3-year-old Finnish children.

The aim of this study was to examine how dental health related habits, infectious diseases and long-term illness are associated with dental health at the age of 3 in first-born children resident in a Finnish province. The study was designed as a survey using stratified randomised cluster sampling, confidential questionnaires and clinical dental examinations. The results were analysed using polytomous logistic models. In the stepwise analysis the only statistically significant explanatory factors were the use of juice at night and dental cleanliness. Antibiotic treatment or long-term illness was not significantly associated with dental health.

Anti-Bacterial Agents↗
PubMed1993

Long-term effect of xylitol chewing gum in the prevention of dental caries: a follow-up 5 years after termination of a prevention program.

About 65% of the original 258 children who participated in 1982-1984 in a caries prevention program involving the use of xylitol chewing gum were retrieved in 1989 for a follow-up study. Ninety-five subjects from the original xylitol (X) group and 70 subjects from the original control (no-gum, C) group were available. In 1984, when the children completed the program at the age of 13-14 years, the caries scores were significantly lower in children who had used xylitol gums daily, compared with the C group. In 1989, 5 years after the discontinuation of the gum program, the difference between the X and C groups had continued to increase in favor of the X group. These effects were explained by assuming that the X gum program had facilitated the establishment of a low-virulent bacterial flora on the surfaces of the teeth, and especially on those teeth that erupted during the trial proper. This type of results are possibly helpful when evaluating cost-benefit ratios of caries prevention.

Chewing Gum↗