Biomedical subjects

Thomas Kocher

Publications and source records attributed to Thomas Kocher.

At least 19 recordsLinked to original sources

PubMed2007

Prevalence of oral mucosal lesions in a representative population.

OBJECTIVE: The aim of this study was to assess the prevalence and intraoral distribution of oral mucosal lesions in a representative adult population (Study of Health in Pomerania/Germany). METHOD AND MATERIALS: The study sample comprised 6267 randomly selected subjects who were scheduled for examination from 1997 to 2001 (population-based cross-sectional study; response rate: 69%; age range 20 to 81 years). RESULTS: The prevalence of oral mucosal lesions was age dependent (5.56% in 20- to 29-year-olds to 19.55% in 70- to 81-year-olds) with an overall prevalence of 11.83%. The prevalence in men (12.20%) was slightly higher than in women (11.40%). Exophytic neoplasia was the most prevalent alteration (3.00%), followed by leukoplakia simplex (prevalence 2.85%). Premalignant lesions were found in 0.57% of the participants, with lichen ruber mucosae contributing the major part (0.48%). Exophytic neoplasia was most often situated in the buccal mucosa, the hard palate, or the mucosa of the lower lip. CONCLUSION: These data stress the importance of screening for oral mucosal lesions, especially because of a predicted increase in the number of elderly persons in industrialized countries.

Adult↗

PubMed2006

IRAG mediates NO/cGMP-dependent inhibition of platelet aggregation and thrombus formation.

Defective regulation of platelet activation/aggregation is a predominant cause for arterial thrombosis, the major complication of atherosclerosis triggering myocardial infarction and stroke. A central regulatory pathway conveying inhibition of platelet activation/aggregation is nitric oxide (NO)/cyclic GMP (cGMP) signaling by cGMP-dependent protein kinase I (cGKI). However, the regulatory cascade downstream of cGKI mediating platelet inhibition is still unclear. Here, we show that the inositol-1,4,5-trisphosphate receptor-associated cGMP kinase substrate (IRAG) is abundantly expressed in platelets and assembled in a macrocomplex together with cGKIbeta and the inositol-1,4,5-trisphosphate receptor type I (InsP3RI). cGKI phosphorylates IRAG at Ser664 and Ser677 in intact platelets. Targeted deletion of the IRAG-InsP3RI interaction in IRAGDelta12/Delta12 mutant mice leads to a loss of NO/cGMP-dependent inhibition of fibrinogen-receptor activation and platelet aggregation. Intracellular calcium transients were not affected by DEA/NO or cGMP in mutant platelets. Furthermore, intravital microscopy shows that NO fails to prevent arterial thrombosis of the injured carotid artery in IRAGDelta12/Delta12 mutants. These findings reveal that interaction between IRAG and InsP3RI has a central role in NO/cGMP-dependent inhibition of platelet aggregation and in vivo thrombosis.

Animals↗

PubMed2006

Risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy: analysis of 22,953 consecutive cases from the Swiss Association of Laparoscopic and Thoracoscopic Surgery database.

BACKGROUND: Reliable risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy would be extremely useful to optimize the clinical management. This study aimed to determine risk factors that can be used for predicting perioperative complications. STUDY DESIGN: Possible risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy for acute and chronic cholecystitis were analyzed by a stepwise logistic regression model using data from the Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS) database. RESULTS: A total of 22,953 patients with a mean (+/-SD) age of 54.5+/-16.1 years (range 17 to 89 years) and a male-to-female ratio of 1:2, underwent elective (85%) and emergency (15%) laparoscopic cholecystectomy. Multivariable analysis showed that male gender (odds ratio [OR]=1.16; p<0.0001), duration of intervention (OR=1.68 per 30 minutes; p<0.0001), body weight (>90 kg versus<60 kg; OR=1.34; p<0.0001), and the surgeon's own experience (>100 versus 11 to 100 interventions; OR=1.36; p<0.0002) were independently associated with an increased intraoperative local complication rate. In addition, male gender (OR=1.21; p<0.02), age (OR=1.12 per 10 years; p<0.0001), intraoperative complications (OR=2.1; p<0.0001), conversion to open surgery (OR=1.25; p<0.01), American Society of Anesthesiologists risk score (ASA score III/IV versus I/II: OR=1.28; p<0.0005), body weight (<60 kg versus>90 kg; OR=1.53; p<0.007), emergency surgery (OR=1.36; p<0.003), and duration of surgery (OR=1.28 per 30 minutes; p<0.0001) were found to be associated with a higher incidence of postoperative local complications. Higher postoperative systemic complications were encountered with conversion (OR=1.5; p<0.0002), ASA score (III/IV versus I/II: OR=1.54; p<0.0001), emergency surgery (OR=1.41; p<0.001), and a prolonged intervention time (OR=1.16 per 30 minutes; p<0.0001). CONCLUSIONS: For patients undergoing laparoscopic cholecystectomy (LC), the risk of possible perioperative complications can be estimated based on patient characteristics (gender, age, ASA score, body weight), clinical findings (acute versus chronic cholecystitis), and the surgeon's own clinical practice with LC. So in the likelihood of a case being a "difficult cholecystectomy," an experienced surgeon should be involved both in the decision-making process and during the operation. If LC lasts longer than 2 hours, the cumulative risk for perioperative complications is four times higher compared with an intervention that lasts between 30 and 60 minutes, independent of the surgeon's personal skills with LC.

Adolescent↗

PubMed2006

Examiner differences in the assessment of different malocclusions.

BACKGROUND: In the current discussion about ensuring treatment quality and reducing costs in the health sector, indication systems with which to determine the need for a treatment and the success of therapy are increasingly being used in orthodontics. These indication systems require the objective evaluation of malocclusions. Our objective was to determine the examiner reliability in the assessment of various malocclusions. MATERIALS AND METHODS: In 180 adults (64 male, 116 female, aged 20-49) from the population-based Study of Health in Pomerania (SHIP), malocclusions were recorded clinically and on models by calibrated examiners. An experienced orthodontist conducted the clinical examination. Another orthodontically-experienced examiner analyzed the models. To compare the model examiners, two examiners with varying degrees of orthodontic experience evaluated 60 of the 180 models as well (29 male, 31 female). One of the model examiners repeated the assessment of 60 models at a later time (intra-individual comparison). RESULTS AND CONCLUSIONS: Reliability amongst the examiners depended on which malocclusions were judged: crowding and contact point displacement showed little agreement, while cross bite, edge-to-edge bite, deep bite and enlarged overjet revealed greater agreement. Comparison between the clinical examination and model analysis (kappa median 0.57) revealed the greatest differences between the examiners. Comparison of the three model examiners also showed differences. The contrast to the orthodontically least experienced examiner was greater (kappa median 0.61 and 0.62) than the divergence between the two orthodontically more experienced examiners (kappa median 0.70). The intra-individual examiner comparison revealed the smallest differences (kappa median 0.82).

Adult↗

PubMed2006

Influence of examiner differences on KIG-classification when assessing malocclusions.

OBJECTIVE: Indication systems such as the German KIG system (Kieferorthopädische Indikationsgruppen = Orthodontic Indication Groups) presuppose the objective assessment of underlying malocclusions. In this survey, we aimed to investigate the degree of agreement among the findings of several examiners in the assessment of different malocclusions and their classification according to the KIG system. SUBJECTS AND METHODS: Calibrated examiners assessed in the clinical evaluation and on plaster models orthodontic malocclusions in 180 adults (aged 20-49, 64 male, 116 female) from the population-based Study of Health in Pomerania (SHIP). Clinical examination was carried out by an experienced orthodontist, and the plaster models were also analysed by an examiner experienced in orthodontics. To compare inter- and intra-individual model examiners, we had two examiners with differing orthodontic experience carry out additional analyses of 60 of the 180 models (29 male, 31 female). RESULTS: The examiner differences yielded various KIG classifications and hence different assessments (i. e., whether KIG case-costs should be borne by health insurance). The comparison "clinical examination versus model analysis" revealed differences regarding 16.7% of the study participants in the assessment of whether the expense would be borne by the statutory health insurance fund. At 5.0-8.3%, the number of participants whose assessments had differed was much smaller in the inter-individual comparison of model-examiners and was smallest (at 3.3-6.7%) when comparison was made between intra-individual assessments (by a sole examiner). With regard to overall malocclusion assessment, the greatest examiner differences were again revealed when comparing the clinical examination with the model analysis (median kappa 0.57). The model-examiner comparison revealed larger differences among examiners with less orthodontic experience (median kappa 0.61 and 0.62) than the comparison between examiners with orthodontic experience (median kappa 0.70). CONCLUSIONS: There can occasionally be considerable examiner differences in the classification of participants according to orthodontic indication groups and hence varying assessments of whether such persons are KIG cases or not. Various means of data collection (clinical evaluation-plaster models) in the assessment of malocclusions by multiple examiners and by those with little orthodontic experience may negatively influence agreement among examiners.

Female↗

PubMed2006

MDR1 gene polymorphisms and risk of gingival hyperplasia induced by calcium antagonists.

BACKGROUND: Gingival overgrowth is a common side effect of calcium antagonists. Although the pathogenesis is unknown, several lines of evidence point to a modulation of inflammatory processes. Because the calcium antagonists, albeit to a variable degree, act as inhibitors of P-glycoprotein (P-gp), the gene product of multidrug resistance 1 (MDR1), and inflammation may modify P-gp expression, we analyzed the MDR1 polymorphisms as risk factors for gingival overgrowth induced by calcium antagonists. METHODS: Clinical, laboratory, and anamnestic data including periodontal parameters and use of calcium antagonists were assessed in a cross-sectional epidemiologic investigation (N = 1484). MDR1 polymorphisms in exon 21 G2677T/A and exon 26 C3435T were determined. P-gp expression was detected in gingival tissues. In a matched-pair analysis, 93 subjects using calcium antagonists and 186 not using them were compared. RESULTS: P-gp is expressed in the endothelial layers of blood vessels obtained from healthy or inflamed gingiva. Subjects treated with calcium antagonists had significantly deeper gingival pockets than their drug-free counterparts (P <.0001). This drug-related side effect was associated with the MDR1 2677G/G or G/TA genotype (P <.001) but not with the variant genotype T/TA. This drug effect was proved by multiple regression analysis with adjustment for the risk factors of periodontitis (age, sex, smoking, and education) (P <.0001) and was associated with elevated C-reactive protein levels. The association of probing depth with the MDR1 polymorphism was confirmed in the matched-pair analysis (P <.0001). CONCLUSION: Treatment with calcium antagonists leads to gingival hyperplasia, which is associated with the MDR1 G2677T/A polymorphism. The MDR1 genotype may modify the inflammatory response to the drugs.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

PubMed2006

Prevalence of single-tooth gaps in a population-based study and the potential for dental implants--data from the Study of Health in Pomerania (SHIP-0).

INTRODUCTION: The aim of this study was to show the prevalence of single-tooth gaps in a population-based study. MATERIAL AND METHODS: The data of 3989 subjects (20-74 years of age) were taken from the Study of Health in Pomerania (SHIP-0) and classified by age, gender, and level of education. A single-tooth gap was defined as a gap of one tooth missing bordered by one or more natural teeth on either side. RESULTS: The tooth missing most in all age groups was the first molar. There were more single-tooth gaps in the maxilla than in the mandible. The lowest single-tooth gaps were found in the mandibular anterior region (<1.1%). There were no significant differences in gender (p > 0.05). The highest frequency of single-tooth gaps among all groups was found in subjects with a medium level of education and the lowest frequency was found in subjects with a high level of education. One single-tooth gap was found in 25%, whereas 16% of all subjects had 2 single-tooth gaps. The prevalence of having 1 single-tooth gap was between 3.8% and 13.1% whereas it was less than 0.5% for subjects with 5 and more single-tooth gaps. CONCLUSION: There was a high potential for dental implants to fill single tooth gaps.

Adult↗

PubMed2006

Gender differences in the relation between number of teeth and systolic blood pressure.

BACKGROUND: Tooth loss predicts total and circulatory mortality. The reasons for the increased mortality in subjects with a low number of teeth may be related to enhanced atherosclerosis, elevated arterial pressure and more frequent hypertension. The present study was designed to investigate whether there is an association between the number of teeth and arterial pressure or hypertension. METHODS: We used data of 4185 adult subjects (2150 women) collected for the population-based Study of Health in Pomerania. The number of teeth was counted by trained and certified dentists. Hypertension was defined as systolic blood pressure >or= 140 mmHg or diastolic blood pressure >or= 90 mmHg or use of antihypertensive medication. Multivariable analyses were adjusted for relevant confounders. RESULTS: The adjusted mean (standard error) systolic blood pressure in men having 0-6 teeth was 149.6 mmHg (1.3 mmHg) compared to 142.6 mmHg (1.2 mmHg) in men having 27-28 teeth (P < 0.05). The adjusted odds for hypertension in men with 0-6 teeth compared to men with 27-28 teeth were 1.91 (95% confidence interval 1.21; 3.02, P < 0.05). In women no such relations were found. CONCLUSION: There is an inverse association between the number of teeth and systolic blood pressure and hypertension in men but not in women. The present findings partly explain the relation between tooth loss and mortality.

Adult↗

PubMed2006

Investigation of serotonin type 4 receptor expression in human and non-human primate gastrointestinal samples.

BACKGROUND: The serotonin type 4 (5-HT4) receptor has been associated with functions of the gastrointestinal tract such as modulation of the peristaltic reflex, smooth muscle tone, intestinal secretion and visceral sensitivity. The activation of peripheral 5-HT4 receptors with agonists such as tegaserod has been shown to accelerate gastric emptying and improve symptoms of constipation in animals and humans. However, detailed data on the expression profile and on the localization of this receptor subtype are lacking so far. OBJECTIVE: To study the pattern and expression levels of 5-HT4 receptor messenger RNA expression in the gut. METHOD: Normal tissue samples were collected from the whole gastrointestinal tract of patients undergoing abdominal surgery and, in addition, of monkeys. We performed a comprehensive analysis of 5-HT4 receptor expression by quantitative reverse transcription-polymerase chain reaction, using human and non-human primate tissues from the oesophagus to the rectum. In addition, the brain and heart of non-human primates were analysed. RESULTS: Significantly higher levels of 5-HT4 receptor mRNA were measured in the human stomach, duodenum, jejunum, ileum and caecum and also in the corresponding non-human primate gut segments, ranging from 2- to 12-fold compared with the liver. No differences were found between females and males of both human and non-human primates. CONCLUSIONS: These results show 5-HT4 receptor mRNA expression throughout the gastrointestinal tract in humans and primates, and also support the preclinical and clinical findings of 5-HT4 receptors ligands exhibiting multiple effects throughout the gastrointestinal tract.

Animals↗

PubMed2006

In vitro calculus detection with a moved smart ultrasonic device.

STUDY OBJECTIVE: The objective of subgingival instrumentation of periodontally diseased root surfaces is to remove the adhering microbial biofilm and calcified deposits. Recently, we have described an automated calculus detection system under static conditions. Clinically however, the tip of the system has to be moved over tooth surfaces. It was thus necessary to study the entire system in motion. METHODS: The detection device is based on a conventional dental piezoelectric ultrasonic handpiece with a conventional scaler insert. The impulse response of the mechanical oscillation system is analysed by a fuzzy logic-based computerized algorithm, which classifies various surfaces. The present study investigates dental surface recognition properties of the new system with the tip being moved over teeth surfaces in vitro. Following a training set of 7977 measurements (3960 calculus, 4017 cement) on 200 extracted teeth, 1363 measurements were conducted on 34 teeth unknown to the system. RESULTS: The surfaces cementum and calculus were correctly classified in 78% within the training set and in 81% within the set unknown, with a kappa value of 0.68. CONCLUSION: It was shown that this method of automatic recognition of tooth surfaces is able to distinguish between different tooth surfaces in vitro independently from tip movements.

Dental Calculus↗

PubMed2006

A new system to detect residual subgingival calculus: in vitro detection limits.

AIM: We recently introduced an experimental surface detection system based on a conventional dental ultrasonic scaler. This device automatically discriminates cementum and dental calculus, which is the prerequisite for complete and thorough calculus removal. In the present study, the detection limits of this device were tested in vitro. MATERIAL AND METHODS: From 50 extracted teeth, subgingival calculus was gradually removed using a Gracey curette. During this stepwise procedure, detection properties of the surface detection system were continuously monitored and systematically verified until the system stopped discriminating calculus from the root surface. By measuring the diameter, circumference and area of the smallest, yet recognizable deposit, and of the no longer recognizable deposit, the cut-off point of the discriminative capability of the detection device was determined. RESULTS: The cut-off points for the correct classification of residual deposits averaged on a diameter of 219 microm, an area of 21,600 microm2, and a circumference of 748 microm. This means a sensitivity of 73% and a specificity of 80% in this critical area. CONCLUSIONS: This calculus detection system was able to detect small deposits. In clinical practice, this device may support dentists in deciding whether to stop or to continue the debridement.

Dental Calculus↗

PubMed2006

Prevalence of dental caries and periodontal disease in patients with inflammatory bowel disease: a case-control study.

AIM: Previous reports suggest a higher incidence of dental caries in patients with inflammatory bowel disease (IBD) and similarities in the immunopathogenesis of IBD and periodontitis. This study assessed the prevalence of periodontal disease and caries in patients with IBD. METHODS: In the present case-control study, 62 patients seeking treatment of IBD and 59 matched healthy controls of a dental practice were clinically examined. Oral soft-tissue alterations, the decayed, missing and filled tooth surface (DMF-S) index, dentine caries, plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD) and clinical attachment loss (CAL) were evaluated in each patient and in the controls. RESULTS: Patients with IBD showed a significantly higher number of oral manifestations compared with controls. The DMF-S index showed no significant differences, but there was a significantly higher number of subjects with dentine caries in patients with IBD. The mean PPD in patients with IBD was 2.08 versus 2.23 mm in controls (p=0.014). Compared with controls, patients with IBD had more sites with CAL of at least 4 mm (81% versus 64% in controls, p=0.07) and 5 mm (63% versus 46%, p=0.07), respectively. CONCLUSIONS: The results of this case-control study demonstrate a higher frequency of dentine caries in patients with IBD but the periodontal findings showed no distinct differences between cases and controls.

Adult↗

PubMed2006

The influence of dynamic occlusal interferences on probing depth and attachment level: results of the Study of Health in Pomerania (SHIP).

BACKGROUND: The purpose of this study was to investigate potential associations between dynamic occlusal interferences and signs of periodontal disease in posterior teeth based on dental and medical measurements obtained from a population-based sample in the cross-sectional epidemiological study entitled, "Study of Health in Pomerania" (SHIP). METHODS: Medical history and dental and sociodemographic parameters of 2,980 representatively selected dentate subjects, 20 to 79 years of age, were collected. The analysis was performed on posterior teeth only using a mixed linear model that considers the clustered structure of the data. The model also was adjusted with respect to known risk factors for periodontal disease. RESULTS: The presence of non-working side contacts only was significantly related to probing depth (P<0.0001) and attachment loss (P=0.001). The presence of non-working side contacts and working side contacts on the same tooth was significantly related to increased probing depth (P=0.004) but not attachment level. The effect magnitude was a mean increase of 0.13 mm for probing depth and 0.14 mm in attachment loss. Known risk factors for periodontal disease that also showed significant associations with probing depth and attachment loss included male gender, age, smoking, education, and plaque score. Other factors significantly related to probing depth and/or attachment loss were tilted teeth, restored occlusal surfaces versus sound surfaces, elongated teeth, and tooth type (molar versus premolar). CONCLUSION: The effect of non-working contacts on periodontal disease status was discernible, but weak in terms of magnitude and specificity.

Adult↗

PubMed2006

Partial- or full-mouth examination assessing the dental and prosthetic status among elderly individuals.

The aim of this study was to determine whether half-mouth examinations accurately reflect the dental and prosthetic status of the entire mouth. Samples of 1,830 adults aged 55- 79 years were examined. The rate of agreement between half- and full-mouth examinations was estimated using weighted and unweighted Kappa values comparing findings of each tooth bilaterally. A power analysis was performed to estimate the number of subjects representing complete dental recordings within a certain power. Subjects showed unweighted Kappa values from 0.34-0.96. Weighted Kappa values ranged from 0. 74-0.99. A power analysis for unweighted Kappa scores computed that.findings from 122-335 individuals were necessary to equal the results obtained using complete dental recordings.

Aged↗

PubMed2005

Photodynamic therapy for periodontal diseases: state of the art.

BACKGROUND: Photodynamic killing of periodontopathogenic bacteria may be an alternative to the systemic application of antibacterial drugs used in the treatment of periodontal diseases. Even though the method is still in the experimental stage, increasing bacterial resistance problems may promote the introduction of photodynamic therapy (PDT) into periodontal practice. AIM: In this review a literature survey is given of PDT as seen from a periodontal perspective. METHODS: In this review, the present knowledge and experience of PDT is summarized. Literature data are presented on drawbacks of conventional antibiotics, the mechanism of PDT, bactericidal effects of PDT as well as results of clinical efforts. The future prospects of the method are discussed. RESULTS: The application of photosensitizing dyes and their excitation by visible light enables effective killing of periodontopathogens. Encouraging studies using PDT in periodontitis and in peri-implantitis are known. CONCLUSION: Even though PDT is still in experimental stages of development and testing, the method may be an adjunct to conventional antibacterial measures in periodontology. Clinical follow-up studies are needed to confirm the efficacy of the procedure.

Animals↗

PubMed2005

Bleeding remains a major complication during laparoscopic surgery: analysis of the SALTS database.

BACKGROUND AND AIMS: The aim of this study was to determine the incidence of bleeding complications from various laparoscopic procedures in a nationwide prospective multicentre study in Switzerland from 1995 to 2001 following an initial learning curve. PATIENTS AND METHODS: Since 1989, the Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS) has prospectively collected data from patients undergoing laparoscopic or thoracoscopic surgery at 114 surgical institutions (university, county and district hospitals, private practice). More than 130 items of data, including indication for surgery, intraoperative course, local as well as general postoperative complications, mortality and follow-up were recorded on a computerised data sheet. RESULTS: Some 43,028 procedures were assessed and analysed. Local morbidity (e.g. wound infections) occurred in 0.05% of the whole patient group, whereas 3.3% developed general postoperative complications. The overall mortality rate was 0.2%. In 1.7% of the cases, the intraoperative course was complicated by internal bleeding or haematoma of the abdominal wall. In the postoperative course, 1.5% of the patients presented with internal bleeding or bleeding of the abdominal wall. Major vascular injury occurred in 0.09%. This patient group with bleeding complications was analysed in the context of the operator's experience, instrumental lesions (Veress needle or trocar) and conversion incidence. Furthermore, a trend analysis of the complication rate from 1995 to 2001 was performed. CONCLUSION: Although the initial learning curve of laparoscopic procedures is probably finished, the rate of bleeding complications is still substantial. These results demonstrate that the collection of data in the form of multicentre studies is essential for quality control. It permits recognition and understanding of the current problems in laparoscopic surgery in order to improve the quality of daily surgical practice. The fact that the operator's experience seems to play an important role shows that improvement in learning and teaching programmes is still necessary and should be coordinated on a national basis.

Adolescent↗

PubMed2005

Tooth loss is independently associated with the risk of acquired aortic valve sclerosis.

BACKGROUND: Several studies have shown that periodontal disease and atherosclerosis are associated. Aortic valve sclerosis (AVS) represents the sum of processes that are similar to the development of atherosclerosis. The present analysis was performed to investigate associations between periodontal disease, tooth loss, and AVS. METHODS: The population-based SHIP was conducted in northeast Germany. A study population of 2341 individuals aged > or =45 years was available for the present analysis. Aortic valve sclerosis was determined by echocardiography. Periodontal status was assessed by attachment loss and tooth loss. RESULTS: The prevalence of AVS was 29.9%. Logistic regression analyses did not reveal attachment loss as an independent risk factor for AVS. However, a reduced number of teeth was independently associated with AVS. Other risk factors for AVS were age, history of myocardial infarction, body mass index, pulse pressure, plasma fibrinogen and lipoprotein (a) levels, and the use of drugs that act on the renin-angiotensin system. CONCLUSION: A reduced number of teeth was independently associated with the risk of AVS. This finding further strengthens the link between oral health and cardiovascular disorders.

Adult↗

PubMed2005

Association of malocclusion and functional occlusion with subjective symptoms of TMD in adults: results of the Study of Health in Pomerania (SHIP).

An analysis of exclusively representative population-based studies on adults has shown that only few and inconsistent associations could be detected between malocclusions and clinical signs of temporomandibular disorders (TMD)--and none for functional occlusion factors (occlusal interferences, non-working side contacts, etc). The aim of this study was to analyze associations between morphologic occlusion as well as factors of functional occlusion and subjectively perceived symptoms of TMD--again on the basis of the population-based Study of Health in Pomerania (SHIP), providing a sample of 4310 subjects (out of 7008 subjects yielding a response rate of 68.8%) aged 20 to 81 years, and other international representative studies from the systematic review. Besides occlusal factors also parafunctions and socioeconomic status (SES) were taken into account (including age and sex). Multiple logistic regression analysis was used--adjusted for SES. In this study, none of the occlusal factors were significantly associated with the indication of more frequent subjective TMD symptoms. However, the parafunction "frequent clenching" was connected with subjective TMD symptoms (odds ratio = 3.4). Compared with other population-based studies few and (across studies) inconsistent associations between malocclusions and subjective TMD symptoms could be ascertained. No significant associations of factors of functional occlusion with TMD symptoms were identifiable.

Adult↗