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  • 1.
    Nilsson, Håkan
    Malmö högskola, Faculty of Odontology (OD).
    Resilient Appliance Therapy of Temporomandibular Disorders. Subdiagnoses, Sense of Coherence and Treatment Outcome2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Temporomandibular disorders (TMD) with orofacial pain with orwithout reduced jaw function, are frequent conditions in the generalpopulation. Different factors such as tooth clenching andgrinding, sometimes due to enhanced psychosocial stress, andtrauma to the jaws may be important as etiologic factors. Signs andsymptoms of TMD are a common cause for general practitionersto use different intraoral appliances as pain and bite-force reducingdevices and for improvement of a reduced jaw function. Intraoralappliances are often used parallel to other treatment modalities.Before treatment start a thorough history taking and clinical examinationis necessary for a relevant diagnosis. Sometimes the diagnosticprocess has to be complemented with proper radiographicimaging in order to support the diagnostic process.The overall aim of this thesis was to compare magnetic resonanceimaging (MRI) findings of the TMJ on the clinically assesseddiagnoses and to evaluate short- and long-term treatment outcomeof a resilient intraoral appliance, in patients with TMD pain. A furtheraim was to study Sense of Coherence as an influencing factoron treatment outcome, on these patients.In article I the aim was to compare findings on MRI in TMDpain patients with clinical diagnoses of myofascial pain or arthralgia/osteoarthritis in combination with myofascial pain accordingto the Research Diagnostic Criteria for TMD (RDC/TMD). Thetemporomandibular joints of 60 consecutive patients, 19 withmyofascial pain and 41 patients with arthralgia/osteoarthritis incombination with myofascial pain were examined clinically andwith MRI. The most common MRI findings were disc displacements with or without reduction and structural bone changes.These findings were found in both pain groups, however, disc displacementswere found significantly more often in patients with arthralgia/osteoarthritis in combination with myofascial pain. Jointfluid was found in both pain groups. The clinical diagnoses forsubdivision into myogenous only or combined arthrogenous andmyogenous pain groups were not confirmed by MRI findings.In article II the short-term efficacy of a resilient appliance comparedto a non-occluding control appliance was studied in a randomised,controlled trial with 80 recruited TMD pain patients.They were randomly allocated to one of two groups: treatmentwith a resilient appliance or treatment with a hard, palatal, nonoccludingappliance. After 6 and 10 weeks of treatment, characteristicpain intensity (CPI) decreased in both groups. There was nostatistically significant difference found between the resilient applianceand the non-occluding control appliance in reducing TMDpain in a short-term perspective.In article III possible factors of importance for treatment outcomewere studied as well as the association between Sense of Coherenceand grade of depression, and grade of non-specific physicalsymptoms and general health, in the TMD pain patients. A total of73 TMD pain patients participated; 36 were treated with a resilientappliance and 37 with a non-occluding control appliance. Thefindings indicated that none of the studied background variables(age, gender, SoC, depression, nonspecific physical symptoms orgeneral health) seemed to influence the short-term efficacy of intraoralappliances. In the TMD pain patients, no associations werefound between SoC and depression, non-specific physical symptomsor general health.In article IV the long-term efficacy was evaluated of the resilientappliance compared to the non-occluding control appliance in theTMD pain patients. Appliance wear was also studied in this article.As in the short-term follow-up, there was no statistically significantdifference between the resilient appliance and the non-occludingcontrol appliance in reducing TMD pain in the long-term perspective.

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