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Biomedical subjects

M Nilner

Publications and source records attributed to M Nilner.

At least 19 recordsLinked to original sources
PubMed2006

Treatment outcome of short- and long-term appliance therapy in patients with TMD of myogenous origin and tension-type headache.

The aim was to compare the short- and long-term effect of a stabilization appliance with a control appliance in myofascial pain patients suffering from episodic or chronic tension-type headache. Sixty patients (mean age 29 +/- 12 years) with temporomandibular disorders (TMD) of myogenous origin and headache were studied in this prospective controlled study. Seventy-seven per cent of the patients reported episodic and 23% chronic tension-type headache at the start of the study. The 60 patients were randomly assigned to a treatment group (stabilization appliance) or to a control group (control appliance). The patients were interviewed regarding symptoms of headache and myofascial pain and clinically examined for masticatory muscle tenderness. At the 10-week and the 6- and 12-month evaluations of appliance therapy, the treatment outcome of tension-type headache was studied. At the 10-week evaluation, 17 patients dropped-out from the control group by requesting another appliance and receiving a stabilization appliance. Another patient in the control group dropped out later during the trial. In an intent-to-treat analysis, significant differences in improvement of headache between treatment and control groups were found at the follow-ups. A 30% reduction of muscles tender to palpation correlated significantly to improvement of headache at all follow-ups. The stabilization appliance seems to have a positive effect on tension-type headache, both in a short- and in a long-term perspective in patients with TMD with pain of myogenous origin.

Adult↗
PubMed2003

Temporomandibular disorders, occlusion and orthodontic treatment.

OBJECTIVES: To prospectively and longitudinally study symptoms and signs of temporomandibular disorders (TMD) and occlusal changes in girls with Class II malocclusion receiving orthodontic fixed appliance treatment in comparison with untreated Class II malocclusions and with normal occlusion subjects. DESIGN: Prospective observational cohort. SUBJECTS: Sixty-five girls with Class II malocclusion who received orthodontic treatment, 58 girls with no treatment, and 60 girls with normal occlusion. METHOD: The girls were examined for symptoms and signs of TMD and re-examined 2 years later. Additional records were taken in the orthodontic group during active treatment and 1 year after treatment RESULTS: All three groups included subjects with more or less pronounced TMD, which showed individual fluctuation during the ongoing study. In the orthodontic group, the prevalence of muscular signs of TMD was significantly less common post-treatment. Temporomandibular joint clicking increased in all three groups over the 2 years, but was less common in the normal group. The normal group also had a lower overall prevalence of TMD than the orthodontic and the Class II group at both registrations. Functional occlusal interferences decreased in the orthodontic group, but remained the same in the other groups over the 2 years. CONCLUSIONS: (i) Orthodontic treatment either with or without extractions did not increase the prevalence or worsen pre-treatment symptoms and signs of TMD. (ii) Individually, TMD fluctuated substantially over time with no predictable pattern. However, on a group basis, the type of occlusion may play a role as a contributing factor for the development of TMD. (iii) The large fluctuation of TMD over time leads us to suggest a conservative treatment approach when stomatognathic treatment in children and adolescents is considered.

Adolescent↗
PubMed2001

Long-lasting orofacial pain--a study of 109 consecutive patients referred to a pain group.

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.

Adult↗
PubMed2000

Signs of temporomandibular disorders in girls receiving orthodontic treatment. A prospective and longitudinal comparison with untreated Class II malocclusions and normal occlusion subjects.

The aim of this investigation was to prospectively and longitudinally study signs of temporomandibular disorders (TMD) and occlusal changes in girls with Class II malocclusion receiving orthodontic treatment and to compare them with subjects with untreated Class II malocclusions and with normal occlusion subjects. Three groups of age-matched adolescent girls were examined for clinical signs of TMD and re-examined 2 years later. Sixty-five Class II subjects received orthodontic fixed straight-wire appliance treatment (Orthodontic group), 58 subjects were orthodontically untreated (Class II group), and 60 subjects had a normal occlusion (Normal group). In the Orthodontic group, the prevalence of muscular signs of TMD was significantly less common post-treatment. The Class II and the Normal groups showed minor changes during the 2-year period. Temporomandibular joint clicking increased in all three groups over the 2 years, but was less common in the Normal group. The Normal group also had a lower overall prevalence of signs of TMD than the Orthodontic and the Class II groups at both registrations. Functional occlusal interferences decreased in the Orthodontic group, but remained the same in the other groups over the 2 years. In conclusion, orthodontic treatment did not increase the risk for or worsen pretreatment signs of TMD. On the contrary, subjects with Class II malocclusions and signs of TMD of muscular origin seemed to benefit functionally from orthodontic treatment in a 2-year perspective. The Normal group had a lower prevalence of signs of TMD than the Orthodontic and the untreated Class II groups.

Adolescent↗
PubMed2000

Temporomandibular disorders and the need for stomatognathic treatment in orthodontically treated and untreated girls.

The aim of this investigation was to study symptoms of temporomandibular disorders (TMD) and headaches longitudinally in girls with Class II malocclusions receiving orthodontic treatment in comparison with subjects with untreated Class II malocclusions and girls with normal occlusion, and to evaluate the need and demand for stomatognathic treatment. The frequency and location of subjective symptoms of TMD and headaches were registered by means of an interview and a questionnaire in three groups of age-matched adolescent girls. Sixty-five Class II subjects received orthodontic fixed straight-wire appliance treatment (Orthodontic group), 58 with Class I malocclusion were orthodontically untreated (Class II group) and 60 had a normal occlusion (Normal group). Individual fluctuations of reported symptoms of TMD were found in all three groups over the 2-year period of the study. Subjects with untreated Class II malocclusions rated their overall symptoms of TMD as more severe than the Orthodontic and the Normal groups. In the Orthodontic group, the prevalence of symptoms of TMD decreased over the 2 years. The overall prevalence of symptoms of TMD was, however, lower in the Normal group than in the other two groups. The need for stomatognathic treatment in the whole sample was estimated to be 13 per cent, while the actual demand was 3 per cent. The large fluctuation of symptoms of TMD over time leads us to suggest a conservative treatment approach when stomatognathic treatment in children and adolescents is considered. The results show that orthodontic treatment did not increase the risk of TMD.

Adolescent↗
PubMed1999

The influence of stabilisation appliance therapy and other factors on the treatment outcome in patients with temporomandibular disorders of arthrogeneous origin.

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.

Adult↗
PubMed1999

Symptoms and signs of temporomandibular disorders before, during and after orthodontic treatment.

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.

Chi-Square Distribution↗
PubMed1998

An evaluation of digital subtraction radiography for assessment of changes in position of the mandibular condyle.

OBJECTIVE: To compare conventional visual evaluation with digital subtraction for assessing changes in condylar position on TMJ radiographs. METHODS: Horizontally corrected oblique lateral transcranial radiographs of the TMJ were taken bilaterally with and without a stabilisation or a control appliance on the same occasion in 20 patients. All of the radiographs were assessed both conventionally and following digital subtraction by seven observers. Three observers assessed both sets of radiographs twice to calculate observer agreement. RESULTS: There were no statistically significant differences in observer performance or diagnostic outcome between the two techniques. Intra-observer agreement varied between 85 and 90% for the conventional visual evaluation and between 62 and 85% for digital subtraction. Although interobserver agreement was greater with the conventional evaluation the difference was not significant. CONCLUSION: Conventional visual evaluation is recommended for the assessment changes in condylar position from TMJ radiographs.

Adolescent↗
PubMed1998

Occlusal appliance therapy in patients with temporomandibular disorders. A double-blind controlled study in a short-term perspective.

Stabilization appliances are commonly used in the treatment of temporomandibular disorders (TMD), although the treatment effects are not fully understood. This study evaluated the short-term efficacy of a stabilization appliance in patients with TMD of arthrogeneous origin, using a randomized, controlled, and double-blind design. Sixty patients were assigned to two equally sized groups: a treatment group given a stabilization appliance and a control group given a control appliance. Improvement of overall subjective symptoms was reported in both groups but significantly more often in the treatment group than in the control group (P = 0.006). Frequency of daily or constant pain showed a significant reduction in the treatment group (P = 0.02) compared with the control group. The results of this short-term evaluation showed that both the stabilization appliance and the control appliance had an effect on temporomandibular joint (TMJ) pain. It is improbable that the difference observed between the groups is due to chance alone.

Adolescent↗
PubMed1998

Treatment outcome in patients with craniomandibular disorders of muscular origin: a 7-year follow-up.

The outcome of different treatment modalities after 7 years was investigated in a selected group of 50 patients with craniomandibular disorders of muscular origin. To minimize the possible effects of selection on the clinical material, the selected treatment group was compared to a consecutive group of patients in terms of age, gender, intensity/duration of pain, and socioeconomic profile. Both groups were comparable in most respects, but the selected group had a longer duration and a higher intensity of pain at baseline. There were more men in the consecutive group than in the selected group. A combined treatment approach resulted in a better outcome than single treatments. Sixty-five percent of all patients in the selected group reported improvement at the 7-year follow-up. All of the 19 patients who received counseling combined with different occlusal treatments improved. Forty-three percent of the patients treated otherwise showed improvement. Patients who were aware of stress responded better to treatment.

Adolescent↗
PubMed1997

Symptoms and signs of temporomandibular disorders in girls with normal occlusion and Class II malocclusion.

Mandibular function, headaches, and symptoms and signs of temporomandibular disorders (TMD) were studied in one group of girls with a well-defined normal occlusion (n = 60) and another group with class II malocclusion (n = 123). Frequent headaches and temporomandibular joint clicking, muscle tenderness to palpation, pain on mandibular movement, awareness of tooth clenching, and grinding were commoner in the class II malocclusion group. Awareness of tooth clenching had the largest influence on the odds for symptoms and signs of temporomandibular disorders (TMD) in a logistic regression analysis. Occlusal variables that increased the odds for symptoms and signs of TMD were large overjet, frontal open bite, few occlusal contacts, lateral sliding retruded-intercuspal contact position, crowding, and non-working side interferences. We concluded that normal occlusions have lower odds for symptoms and signs of TMD, whereas some occlusal characteristics, more frequently found in the class II malocclusion group, increased the odds for symptoms and signs of TMD.

Adolescent↗
PubMed1997

A longitudinal follow-up of the effect of occlusal adjustment in patients with craniomandibular disorders.

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.

Adolescent↗
PubMed1995

Clinical and radiological findings related to treatment outcome in patients with temporomandibular disorders.

OBJECTIVES: To test the hypothesis that the outcome of temporomandibular disorders (TMD) is not influenced by condylar position, asymmetry, angle or structural bone changes. METHODS: Eighty consecutive patients (60 women, 20 men) with an age range of 6-81 years, referred to the Department of Stomatognathic Physiology, were included in the study. The patients were clinically and radiologically examined before and at least 1 year after treatment. RESULTS: The most common clinical diagnoses among the patients were TMD with a neuromuscular background in 35% and osteoarthritis in 21%. Seventy-two per cent of the patients were symptom-free or better, 24% unchanged and 1% worse 1 year or more after treatment. After treatment the bone structure of the TMJ was unchanged in 83% of the patients, in 12% erosions healed and in 5% erosions developed. Almost all patients had some degree of condylar displacement on tomography before treatment. In the majority the condylar position was unchanged after treatment. CONCLUSION: No single radiographic finding was found to be related to the treatment outcome and therefore plain radiography has a minor role in the management of TMD.

Adolescent↗
PubMed1995

Occlusal adjustment in patients with craniomandibular disorders including headaches. A 3- and 6-month follow-up.

The aim of this study was to evaluate the therapeutic effect of occlusal adjustment on symptoms and signs of craniomandibular disorders (CMD), including headaches, after 3 and 6 months. Fifty patients were selected and randomly assigned to a treatment (T) or a control (C) group. All patients in the treatment group were subjected to occlusal adjustment, whereas the controls were comforted only. Pre- and post-treatment assessment of subjective symptoms and clinical signs was made by a dentist not performing the occlusal adjustment. There was significant improvement in overall subjective symptoms within the T group at the 3- and 6-month follow-up visits, but a statistically significant difference between groups was found at the 3-month follow-up only. With regard to changes in frequency of facial pain a significant deterioration was reported within the C group, which resulted in a significant difference between groups at the 6-month follow-up. No other significant differences were found within or between groups at the follow-ups with regard to the variables investigated. In conclusion, the results from this study that occlusal adjustment is a treatment modality with a statistically significant short-term effect on symptoms of CMD of muscular origin and superior to counseling.

Chi-Square Distribution↗
PubMed1993

Office and ambulatory blood pressure in patients with craniomandibular disorders.

To assess the physiologic response to daily life stress in patients with craniomandibular disorders (CMD), office and ambulatory blood pressure and heart rate were studied in 25 female patients and 25 controls. Significant differences (p < 0.05) were found between the groups for heart rate before the clinical examination and that in the patient group when compared before and after the clinical examination. Higher values were found for mean daytime systolic and diastolic blood pressure in the control group compared with the patient group (p < 0.05). The mean number of systolic blood pressure > or = 140 mmHg during 24 h and daytime was significantly higher (p < 0.05) in the control group than in the patient group. In this study the CMD patients with muscular diagnosis were not more stressed than healthy subjects in the daily activities as evaluated by ambulatory blood pressure measurements.

Adult↗
PubMed1993

Treatment of craniomandibular disorders in children and young adults.

A group of 99 children and young adults referred to a Swedish oral health sciences center were retrospectively evaluated regarding symptoms, signs, diagnoses, treatment, and treatment outcome. The most common symptoms in this patient group were headaches (52%), temporomandibular joint clicking (49%), pain at chewing (47%), and pain at wide mouth opening (46%). Common diagnoses were anterior disc displacement (32%) and craniomandibular disorders of muscular origin (16%). After treatment, 91% of the children and young adults reported themselves to be better or free of symptoms. A treatment modality often used was the occlusal splint, and it was concluded that using conservative methods led to good treatment outcomes in this patient group.

Adolescent↗
PubMed1993

Clinical follow-up with different disc positions.

A clinical follow-up of 45 previously symptomatic patients with arthrographically diagnosed TMJ disc positions was performed at least 1 year (average, 4 years 4 months) after treatment. The patients were divided into three groups according to disc position: (1) superior disc position, n = 5; (2) anterior disc displacement with reduction, n = 17; and (3) anterior disc displacement without reduction, n = 23. Ninety-two percent of the patient were treated conservatively. Seventy percent of the patients reported being symptom-free or improved. The frequency of joint clicking did not change considerably, but the amount of crepitating sounds increased markedly. No difference was found regarding treatment outcome between the anterior disc displacement groups with and without reduction.

Adolescent↗