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Biomedical subjects

Maria Nilner

Publications and source records attributed to Maria Nilner.

16 recordsLinked to original sources
PubMed2006

Treatment of sleep apnea in congestive heart failure with a dental device: the effect on brain natriuretic peptide and quality of life.

The aim of the present study was to investigate the effect of a mandibular advancement device (MAD) for the treatment of sleep apnea (SA) on plasma brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), and health-related qualify of life (HRQL) in patients with mild to moderate stable congestive heart failure (CHF). Seventeen male patients aged 68.4+/-5.5 with an apnea-hypopnea index (AHI) >or=10 were equipped with an individually fitted MAD. SA was evaluated using a portable respiratory multirecording system before and after the initiation of treatment. Eleven patients completed follow-up and were evaluated after 6 months of treatment. The AHI reduced from 25.4+/-10.3 to 16.5+/-10.0 (p=0.033) compared to baseline and mean plasma BNP levels decreased from 195.8+/-180.5 pg/ml to 148.1+/-139.9pg/ml (p=0.035). SA-related symptoms, e.g., excessive daytime sleepiness, were also reduced (p=0.003). LVEF and HRQL were unchanged. We conclude that SA treatment with a MAD on patients with mild to moderate stable CHF appears to result in the reduction of plasma BNP levels. Further studies to investigate if the observed reduction in BNP concentrations also result in improved prognosis are warranted.

Aged↗
PubMed2006

Patients' experiences of consultations for nonspecific chronic orofacial pain: A phenomenological study.

AIMS: To use a qualitative research study to analyze the experiences of patients with nonspecific chronic orofacial pain with respect to consultations for their pain condition. METHODS: Fourteen patients (11 women and 3 men; age range, 21 to 77 years) were strategically selected through a purposive sampling of the chronic orofacial pain patients referred to the Orofacial Pain Unit at the Faculty of Odontology, Malmö University, Malmö, Sweden. A qualitative research strategy based on phenomenological philosophy was chosen. Thematic in-depth interviews were conducted twice with each patient in order to expose the context of the orofacial pain condition. The interviews were audiotaped and transcribed verbatim. The text material was analyzed to determine the attitude of the patients concerning their experience from the consultations. RESULTS: All selected patients consented to participate. The patients expressed dissatisfaction with the consultations and related many examples of poor communication and understanding. The patients also felt a great need to be taken care of and expressed contradictory statements concerning pain improvement. CONCLUSION: The results suggest that the communication between the patients and the care providers was unsatisfactory and that the patients were limited in their ability to develop a personal coping strategy.

Adaptation, Psychological↗
PubMed2004

Treatment outcome of appliance therapy in temporomandibular disorder patients with myofascial pain after 6 and 12 months.

AIM: To compare the long-term effect of treatment with a stabilization appliance (group T) and treatment with a control appliance (group C) in temporomandibular disorder (TMD) patients with myofascial pain. METHODS: In this controlled trial, 60 patients (mean age 29 years) with myofascial pain were evaluated after 10 weeks of treatment with either a stabilization appliance or a control appliance. All 60 patients were then assigned to 1 of 3 groups according to demand for treatment. Seventeen patients from group C requested another appliance and were given a stabilization appliance, thus creating a mixed group (group M). RESULTS: A significant difference in improvement of overall subjective symptoms in an intent-to-treat analysis between groups T and C was found at the follow-ups. In a survival analysis of treatment compliance, a significant difference was found between groups T and C. At the 6- and 12-month follow-ups, a significant reduction in myofascial pain, as measured on a visual analog scale, was found in all three groups. A significant decrease in frequency and intensity of myofascial pain was found in group T at the follow-ups. A significant decrease in number of tender sites on the masticatory muscles was found in group T at the follow-ups. CONCLUSION: The results support the conclusion that the positive treatment outcome obtained by use of a stabilization appliance to alleviate the signs and symptoms in patients with myofascial pain persisted after 6 and 12 months. Most patients in groups T and M reported positive changes in overall subjective symptoms in this trial. We therefore recommend use of the stabilization appliance in the treatment of TMD patients with myofascial pain.

Adult↗
PubMed2004

Use of a mandibular advancement device in patients with congestive heart failure and sleep apnoea.

OBJECTIVE: To evaluate the practical use of the mandibular advancement device (MAD) for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) over 1 year. SUBJECTS: Twenty-five patients aged 66 +/- 8 years (mean +/- SD) met the inclusion criteria and were included in the study. DESIGN: In a prospective, clinical trial, the apnoea-hypopnoea index (AHI), a measure of SA, was determined with a portable device. Failure to enter treatment and compliance, adverse events and signs and symptoms of temporomandibular disorders (TMD) were examined before intervention and 4-6 weeks, 6 months, and 1 year after intervention. RESULTS: Six patients had removable dentures of whom four had complete dentures. Before treatment, eight patients reported minor symptoms of TMD. The AHI fell from 19.3 +/- 12.1 to 11.8 +/- 9.5 (p = 0.004) with use of the device. In most patients, use of the MAD had no severe effects on the signs and symptoms of TMD. Adverse events such as pain in the temporomandibular joints, soreness in the teeth, and tiredness in the jaws were reported by 10 patients. Dental complications were observed in two patients. Sixty-four per cent of the patients were still using the MAD at the 1-year follow-up. CONCLUSIONS: Both the general and oral health of CHF patients were important in treatment with a MAD. The MAD therapy had no severe effect on the masticatory system and edentulous patients could be treated.

Adult↗
PubMed2004

The effect of mandibular advancement device on pharyngeal airway dimension in patients with congestive heart failure treated for sleep apnoea.

Continues positive airway pressure (CPAP) is recommended for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) but is not easily tolerated resulting in poor patient compliance. Mandibular advancement device (MAD) is designed to inhibit pharyngeal airway (PAW) obstruction and may be a valuable alternative. It has been proposed that MAD exerts its effect by increasing PAW dimensions. This has not, however, been clearly demonstrated. The aim of this study was to examine the effect of MAD on PAW dimensions and SA in patients with CHF. Seventeen CHF-patients with mild to moderate heart failure, aged 68 +/- 6 years, (mean +/- SD), range 54-75 years, with sleep apnoea-hypopnea index (AHI) > or = 10 were evaluated. PAW dimensions were studied with and without the MAD, using lateral radiographs in supine position. Nocturnal breathing patterns were studied using a portable polysomnographic device during a single night with and without MAD. A reduction of AHI > or = 30% (arbitrary level) for each individual was regarded as a successful treatment. Mean AHI was reduced from 25.1 +/- 9.4 to 14.7 +/- 9.7 (p = 0.003). The PAW increased in its inferior section in 13 patients (p = 0.0001). AHI decreased > or = 30% in 9 patients (p = 0.003) of whom 8 showed increased PAW dimensions. Reduction of AHI was not significantly related to increased PAW dimensions. In conclusion MAD increased PAW dimensions and reduced SA in patients with CHF. The results may indicate that MAD reduces SA by other mechanism than increasing PAW dimensions.

Aged↗
PubMed2004

A mandibular advancement device reduces sleep disordered breathing in patients with congestive heart failure.

Sleep disordered breathing (SDB) including obstructive and central sleep apnoea/hypopnoea as well as periodic breathing (PB) is common and is believed to increase risk for mortality in patients with congestive heart failure (CHF). Mandibular advancement device (MAD) has widely been recommended for treatment of obstructive sleep apnoea but the method has never been investigated for treatment of SDB in the patients with CHF. The aim with the present study was to examine the effect of MAD intervention on SDB in patients with CHF. The study included 17 male patients, aged 68.4+/-5.7 (mean+/-SD) with stable, mild to moderate CHF due to left ventricular systolic dysfunction and with SDB, expressed as apnoea/hypopnoea index (AHI) > or = 10. The SDB was examined during a single night using an unattended, portable polysomnographic device in the patients home, prior to and following intervention with a individually adjusted MAD. The SDB was evaluated by calculating AHI, PB expressed as the percentage of the total registration time, oxygen desaturation index (ODI) and snoring time. The AHI was reduced by MAD intervention from 25.1+/-9.4 to 14.7+/-9.7 (p=0.003). ODI reduced from 21.1+/-9.0 to 10.5+/-7.8 (p=0.007) and snoring time decreased from 53+/-111 to 18+/-47 seconds (p=0.02). PB was reduced from 55.7+/-25.6 to 40.4+/-26.4 per cent without statistical significance. In conclusion, the MAD intervention may be a feasible method for reducing SDB in patients with stable, mild to moderate CHF and left ventricular systolic dysfunction.

Aged↗
PubMed2003

The efficacy of appliance therapy in patients with temporomandibular disorders of mainly myogenous origin. A randomized, controlled, short-term trial.

AIMS: To compare the short-term efficacy of treatment with a stabilization appliance compared with that of a non-occlusal, control appliance in patients with temporomandibular disorders (TMD) of mainly myogenous origin. METHODS: A randomized, controlled trial was performed with 60 patients suffering from myofascial pain. Patients were randomly assigned to a treatment or a control group. The treatment group was treated by means of a stabilization appliance and the control group by means of a non-occlusal appliance. Symptoms and signs were registered before and after 10 weeks of treatment. RESULTS: Improvement of overall subjective symptoms was reported in both groups, but significantly more often in the treatment group than in the control group (P = .000). The prevalence of daily or constant pain showed a significant reduction in the treatment group (P = .028) compared with the control group. There was a significant decrease in the number of tender masticatory muscles in the treatment group (P = .018) compared with the control group. CONCLUSION: The results of this short-term evaluation suggest that the stabilization appliance is more effective in alleviating symptoms and signs in patients with TMD of mainly myogenous origin than a control, non-occlusal appliance. The stabilization appliance can therefore be recommended for the therapy of these patients.

Adolescent↗
PubMed2002

2.2 Continuous quality improvement.

Continuous quality improvement (CQI) can be envisaged as a circular process of goal-setting, followed by external and internal evaluations resulting in improvements that can serve as goals for a next cycle. The need for CQI is apparent, because of public accountability, maintaining European standards and the improvement of dental education. Many examples are known where recommendations from both external and internal evaluation are used for the improvement of dental education. Unfortunately, the implementation of the recommendations is inconsistent, rarely systematic and usually not transparent. This section agreed that it is essential to apply CQI in a structured, systematic and transparent way if we are to improve and maintain the quality of dental education. A model is proposed which includes three aspects: a) the process of CQI; b) the subjects to which CQI should be applied; and c) the management tools to govern CQI. It is stressed, that CQI is a process that can be applied in any dental school irrespective of curriculum or educational approach within the relevant context of the country or the region. The approach needs to recognize the complexity and the need to balance a quality improvement with accountability. A CQI system is also constrained in any organization by the attitudes and values of the staff. Inevitably there has to be a wide range in the application of CQI. Nevertheless, an agreed model on CQI might enhance convergence towards higher standards of dental education. The process of CQI can be supported by developments in information and communication technology (ICT): collection of data, identifying the steps in CQI, formats of reports, etc. The section was set, as one of its tasks, to advise on the development of a network based on a number of case studies on the application of CQI in dental education.

Cultural Diversity↗
PubMed2002

Treatment outcome of headache after occlusal appliance therapy in a randomised controlled trial among patients with temporomandibular disorders of mainly arthrogenous origin.

The aim of this study was to evaluate headaches before and after treatment with a stabilisation appliance and a control appliance in a randomised controlled trial in patients having temporomandibular disorders (TMD) of mainly arthrogenous origin. The effect of treatment was evaluated both in a short and in long-term perspective. 60 patients (mean age 30 years) with TMD of mainly arthrogenous origin were studied. The patients were selected from patients referred for treatment of TMD during a 3-year period to the Department of Stomathognathic Physiology, Faculty of Odontology, Malmö University. The 60 patients included in the study were randomly assigned to a treatment (T) or a control (C) group. The study was performed as a randomised controlled trial including evaluation of treatment effect on tension-type headache after 10 weeks, 6 and 12 months. At the 10 weeks follow-up, the patients who reported a negative treatment outcome and/or discomfort associated with the use of the appliances had their appliances readjusted. Patients who demanded further treatment received a stabilisation appliance (21 patients from the C-group), creating a new mixed (M) group. All the 60 patients reported frequency of headache from rarely up to daily at the start of the study. In the T-group 76% and in the C-group 83% of the patients reported headache at least once a week or more before treatment. At the 10 weeks follow-up, a statistically significant difference was found regarding headache several times a week or more between the T- and C-groups and within the T-group. At the 6 months follow-up, a statistically significant reduction was found in headache several times a week or more in the T- and M-groups. The number of patients with headache once a week or more decreased significantly in the T- and M-groups at the 12 months follow-up. We conclude that the stabilisation appliance seems to have an effect on the frequency of tension-type headache both in a short and in a long-term perspective in patients with TMD of mainly arthrogenous origin.

Adult↗
PubMed2002

Long-term follow-up by means of a questionnaire of 109 patients with long-lasting orofacial pain.

The aims were to follow-up, analyse and compare the pain status after 4-9 years with that at the baseline examination of 109 consecutive patients referred to the Pain Group at the Faculty of Odontology in Malmö, Sweden during the period 1988-1993 due to long-lasting orofacial pain. A further aim was to identify predictive factors of significance for pain alteration. 85 (78%) women with a median age of 51 years and 24 (22%) men with a median age of 60 years were included in the study. A survey of the pain status at the follow-up was conducted by means of a mailed questionnaire. The questionnaire covered the following aspects: pain alteration, pain intensity, pain location, medication and education. After one reminder, the non-responding patients were called for a telephone interview. A response level of 85% was obtained. Significant improvements were noted by the patients in the answers of the questionnaire in mainly three areas; the patients answered individually that pain relief had occurred, pain intensity rated on the VAS was lower at follow-up compared to the baseline examination and a decrease in drug use was reported. The responses indicated pain relief for 75% of the patients. However, only 27% of the patients experienced total disappearance of pain. Medication at baseline with opioids, muscle relaxants with central effect, antidepressants, neuroleptics, hypnotics or sedatives was found to be a predictive factor for persistent pain.

Adaptation, Psychological↗
PubMed2002

Long-term follow-up of intra-articular injections into the temporomandibular joint in patients with rheumatoid arthritis.

A long-term (12 years) follow-up of treatment with intra-articular injections into the temporomandibular joint (TMJ) of steroid or non-steroid agents was performed in 21 patients with rheumatoid arthritis (RA) and symptomatic TMJs. The aim of the study was to compare symptoms, signs and radiological appearance of the TMJ initially and at the follow-up in this group of patients. Eleven patients were assigned to a steroid group and 10 patients to a non-steroid group. Initial and follow-up clinical and radiological examination procedures were the same. The radiological evaluation was based on a grading system using standard reference films. At follow-up, 14 patients reported no pain from the TMJ and positive changes in most clinical variables were found in both groups. Radiographic follow-up examination was performed on 12 patients. Initially, all but 4 of the 24 joints had structural bone changes. At follow-up, 2 joints had lower, 11 joints had unchanged and 11 joints had higher radiological grades. Two out of 5 and 3 out of 10 joints in the steroid and non-steroid group, respectively, showed progression of structural bone changes. Among 9 untreated joints, 6 had higher radiological grades and 3 were unchanged. In the 11 TMJs with higher radiological grades at follow-up, there was in most cases moderate progression of erosive changes. The results suggest that the long-term development of symptoms and signs from the TMJ in patients previously treated was good and the long-term progression of joint destruction was low for both steroid and non-steroid agents in this patient group with RA.

Adolescent↗
PubMedDate not supplied

A 6- and 12-month follow-up of appliance therapy in TMD patients: a follow-up of a controlled trial.

PURPOSE: This study compared the long-term effects of treatment with a stabilization appliance and treatment with a control appliance in patients with temporomandibular disorders (TMD). MATERIALS AND METHODS: In a controlled trial, 60 TMD patients with temporomandibular joint (TMJ) pain were evaluated after 10 weeks of treatment with either a stabilization appliance or a control appliance. At the 10-week follow-up, the 60 patients were assigned to one of three groups according to their demand for treatment. Group T, the treatment group, comprised 30 patients treated with a stabilization appliance; group C, the control group, comprised nine patients treated with a control appliance; and group M, the mixed treatment group, comprised 21 patients treated with first a control appliance and then a stabilization appliance. Signs and symptoms were evaluated in all three groups at 6- and 12-month follow-ups. RESULTS: At the 6- and 12-month follow-ups, a significant reduction in TMJ pain as measured on a visual analogue scale was found in all three groups, and a significant decrease in signs and symptoms was found in groups T and M. CONCLUSION: After 6 and 12 months of use, the stabilization appliance was found to still be effective in the alleviation of signs and symptoms in patients with TMD. Many patients in group C changed to a stabilization appliance at the 1 0-week follow-up, which significantly reduced the number of patients in this group. Most patients reported positive change in overall subjective symptoms in this trial. The stabilization appliance can therefore be recommended for patients with TMD.

Adult↗