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The aims of this study were to investigate what kind of interocclusal appliances that were chosen among Swedish dentists when treating temporomandibular disorders (TMD), the clinical rationale for the treatment, the diagnoses that warranted the appliance treatment, the use of adjunct TMD treatments and prognostic considerations, and possible differences in these respects between children/adolescents and adults with TMD, and, finally, possible differences between private practitioners and general practitioners in the public dental service. During the 12-months-period April 2009-March 2010 all general dental practitioners in the county of Jönköping, Sweden, were asked to fill in a questionnaire when performing a TMD treatment with an interocclusal appliance. A total of 394 questionnaires were filled in and returned, 216 (55%) from dentists in public dental service and 178 (45%) from private practitioners. It was found that in 40% of the cases, no pre-treatment recording of the functional status in the masticatory system had been made. The commonest reasons for the treatment were bruxism, headache, and replacement of a previous appliance. Less than half of the appliances made were hard acrylic appliances. Some kind of adjunct therapy had been made in 22% of the cases treated in public dental service. The corresponding figure for those treated by private practitioners was 25%. Therapeutic jaw exercises was the commonest adjunct therapy followed by selective occlusal adjustment. In the vast majority of cases, the dentists judged the prognosis of the treatment to be good. It is concluded that a large number of appliances made to treat TMD were soft appliances, especially in public dental service. This reflects a possible overuse of soft appliances at the expense of hard acrylic appliances. Furthermore, in a large number of cases, the treatment was performed without any pre-treatment registrations, and adjunct therapies were rarely used. In all these respects,there is an improvement potential for the treatment of TMD in general dental practice.

The aims of the present study were to investigate if there are differences concerning preferred body posture during sleep between 100 patients, 66 women and 34 men, mean age: 49 years (range: 20-85 years) referred to a specialist clinic because of TMD and 100 matched controls from a public dental clinic. The participants were asked to answer a questionnaire with questions about TMD symptoms and neck or shoulder pain. They were also asked about preferred sleeping position as well as about perceived sleep quality. No differences could be found between the two groups in respect of sleeping position. However, significantly more individuals in the TMD group compared to the controls had changed their preferred sleeping position due to their face and/or jaw and/ or neck-shoulder symptoms. Subjects in the TMD group also more frequently stated that they often felt insufficiently rested at awakening and/or felt tired or sleepy in the daytime because of symptoms from face/jaws. A significant number in the control group reported TMD symptoms indicating a latent need for TMD treatment. It is concluded that sleep position seems to have little or no significance for the development or maintenance of TMD symptoms. However, the study indicates that TMD symptoms and associated neck- and shoulder pain affect the quality of sleep.

The aims of the present study were to investigate patient adherence to treatment with hard acrylic interocclusal appliance in general dentistry in Sweden and to see if some general factors could predict patient adherence or non-adherence. During the period January - May 2009 a postal questionnaire was sent to all adult patients (> or = 20 years of age) that had received a hard acrylic interocclusal appliance from the public dental health service in the County of Uppsala during 2007 (n=388). The same questionnaire was also sent to all adult patients that had received a hard acrylic interocclusal appliance at a specialist clinic during the same year (n=69). The response rate in general dental practice was 71% and at the specialist clinic the response rate was 91%. In general dental practice, 97% of the hard acrylic interocclusal appliances were stabilisation appliances. At the specialist clinic other types of interocclusal appliances was used to a greater extent. A vast majority of patients in both general dental practice and at the specialist clinic experienced that the interocclusal appliance had a positive treatment effect. In general dental practice, 73% of the patients still used their interocclusal appliances 1 1/2-2 years after they had received them. The corresponding figure at the specialist clinic was 54%. The main reasons for not using the interocclusal appliance, besides disappearance/reduction of TMD symptoms, were different kinds of comfort problems. From the results of this study it is concluded that the patient adherence to hard acrylic stabilisation appliances made in general dental practice in Sweden is good. It can also be concluded that a perceived good treatment effect, as well as treatment of more long-term conditions, predicted a better patient adherence to hard acrylic stabilisation appliances. More studies concerning factors affecting patient adherence in TMD therapy are warranted.

Pain of long duration is a common suffering in modern man. One such pain condition is fibromyalgia syndrome (FMS). Opinions about what treatment regimen that are to be used in these patients are diverging, and many of the treatments suggested are not, or only poorly, scientifically investigated. The aim of this pilot investigation was to evaluate if FMS patients with signs and symptoms of temporomandibular disorders (TMDs) refractory to conservative TMD treatment would respond positively to tactile stimulation in respect of local and/or general symptoms. Ten female patients fulfilling the inclusion criteria received such treatment once a week during a 10-week period. At the end of treatment, a positive effect on both clinical signs and subjective symptoms of TMD, as well as on general body pain, was registered. Eight out of 10 patients also perceived an improved quality of their sleep. At follow-ups after 3 and 6 months some relapse of both signs and symptoms could be seen, but there was still an improvement compared to the initial degree of local and general complaints. At the 6-months follow-up, half of the patients also reported a lasting improvement of their sleep quality. One hypothetical explanation to the positive treatment effect experienced by the tactile stimulation might be the resulting improvement of the patients' quality of sleep leading to increased serotonin levels. The results of the present pilot study are so encouraging that they warrant an extended, controlled study.

The aim of the investigation was to compare the effect on signs and symptoms of temporomandibular disorders (TMD) of two different interocclusal appliances. Thirty patients with signs and symptoms of TMD received either a stabilisation splint or a new kind of splint based on the concept of nociceptive trigeminal inhibition (NTI). A clinical examination was performed and subjective symptoms were registered before start of treatment and after 3 and 6 months. All participants were offered to change to the other type of splint at the 3-month follow-up in case of no improvement or impairment of their symptoms. One subject in each group was lost early during the investigation. The mean time for taking impressions, to make inter-occlusal recording and to adjust the stabilisation splints was 17 minutes. The mean time to fit and adjust the NTI splints was 27 minutes. At the 3-month follow-up, 4 patients that had received NTI splints accepted the offer to change to stabilisation splints due to no improvement or impairment of their symptoms. These treatments were judged as failures. No one in the stabilisation splint group utilised the offer to change treatment. At the 6-month follow-up, 7 of the remaining 10 subjects with NTI splints reported some (n = 1) or significant (n = 6) improvement, 2 reported no change and one reported impairment. All 14 who had been treated with a stabilisation splint reported some (n = 2) or significant (n = 12) improvement. For all variables registered, the results were in favour for the stabilisation splint. One subject treated with a NTI splint exhibited an impaired occlusion at the 6-month follow-up.

Temporomandibular joint (TMJ) sounds are very common among patients with temporomandibular disorders (TMD), but also in non-patient populations. A variety of different causes to TMJ-sounds have been suggested e.g. arthrotic changes in the TMJs, anatomical variations, muscular incoordination and disc displacement. In the present investigation, the prevalence and type of different joint sounds were registered in 125 consecutive patients with suspected TMD and in 125 matched controls. Some kind of joint sound was recorded in 56% of the TMD patients and in 36% of the controls. The awareness of joint sounds was higher among TMD patients as compared to controls (88% and 60% respectively). The most common sound recorded in both groups was reciprocal clickings indicative of a disc displacement, while not one single case fulfilling the criteria for clicking due to a muscular incoordination was found. In the TMD group women with disc displacement reported sleeping on the stomach significantly more often than women without disc displacement did. An increased general joint laxity was found in 39% of the TMD patients with disc displacement, while this was found in only 9% of the patients with disc displacement in the control group. To conclude, disc displacement is probably the most common cause to TMJ sounds, while the existence of TMJ sounds due to a muscular incoordination can be questioned. Furthermore, sleeping on the stomach might be associated with disc displacement, while general joint laxity is probably not a causative factor, but a seeking care factor in patients with disc displacement.

A rating scale based on methods used in medical and behavioral science was modified for specific assessment of the function of the masticatory system. Eleven common activities of daily living were recorded on a scale rated from 0 to 10. Thirty-one patients (23 women and 8 men) who had exhibited facial pain and/or headache for a duration of at least one year participated. Test-retest coefficients of reliability for the patients' assessment of pain and discomfort on two different occasions two weeks apart were high and varied (with the exception of one question) between r = 0.67 and r = 0.92. The correlations between the patients' own estimations and that which one member of the family made were high and varied (with the exception of one question) between r = 0.78 and r = 0.92.

Reports of prevalences of craniomandibular disorders (CMD) in children and adolescents differ markedly from one study to another. Therefore it is almost impossible to get a clear picture of the magnitude of the disorder in a child population. The aim of this study was to critically compare and analyse the results presented in recent publications in order to get a comprehensive view of the prevalence of CMD in children and adolescents. Fourty epidemiological studies on CMD symptomatology and headache in the age group three to 25 years were included. Eight symptoms and eight signs were chosen for further comparisons and analyses. The prevalences of these signs and symptoms were evaluated and classified according to a set of criteria, in either frequency of "greater clinical relevance" or frequency of "lesser clinical relevance". The evaluation was based on the presented examination methods, definitions and symptom criteria used in the studies. The reported frequencies for the sixteen signs and symptoms are presented graphically. The diagram clearly show great variation in the reported frequencies for most signs and symptoms. If only reported frequencies of "greater clinical relevance" are considered, these variations are less pronounced but still considerable. One major reason for this is inter- and intraindividual variation among the examiners. Another plausible and often overlooked reason is the fact that examination methods designed for adults uncritically have been applied on children without consideration of age and cognitive development of the child.

One hundred and ten patients, 23 males and 87 females, participated in a comparative study of the effect of acupuncture and occlusal splint therapy. All the patients exhibited signs and symptoms of craniomandibular disorders (CMD) and had had pain for more than six months. The participants were randomly assigned to three groups; acupuncture treatment, occlusal splint therapy or control. The patients were evaluated before and immediately after treatment/control time. Ten different subjective and/or clinical assessment variables were used in the evaluation of the treatment effects. Both acupuncture and occlusal splint therapy reduced the symptoms as compared with the control group in which the symptoms remained essentially unchanged. In this short-term study, acupuncture gave better subjective results (p < 0.001) than the occlusal splint therapy.

Craniomandibular function was studied in 70 subjects with juvenile chronic arthritis (JCA). The subjects represented the total group of children and adolescents with the diagnosis JCA in a Swedish county. At examination, the median age of the subjects was 11.9 years and the median duration of the disease was 2.6 years. The most important finding of the study was the high prevalence (41%) of radiographic signs of temporomandibular joint (TMJ) pathology. Few subjects showed the typical craniofacial abnormalities associated with JCA, like mandibular micrognathia, facial asymmetries and open bite. Subjective symptoms of dysfunction were almost absent in subjects younger than seven years but were reported by 56% of the older subjects. TMJ sounds and pain on jaw movements were the most frequent symptoms reported. At the clinical examination, TMJ crepitations and restricted horizontal jaw movements were noted in 26% and 32% respectively. The high prevalence of TMJ involvement found in this study underlines the importance that dentists become part of the medical team responsible for the treatment of children and adolescents with JCA.

Ten patients with chronic facial pain and long lasting mandibular dysfunction symptoms were treated with acupuncture. All patients, two men and eight women aged between 39 and 71 years (mean = 51.0 years), exhibited a complex pain symptomatology with, basically, daily constant pain with an average duration of 13 years. The patients had resisted all previous conventional stomatognathic treatment. The symptoms and signs were evaluated before and immediately after treatment and at follow-ups three and seven months later. Four methods were used for evaluating the effect of the treatment. Subjective evaluation according to a 6-graded verbal scale. Clinical dysfunction index according to Helkimo (1974). Intensity of pain according to a visual analogue scale (VAS-scale, Pilowsky & Kaufman, 1965). Medicine consumption. Six to eight acupuncture treatments were given at one week intervals. The acupuncture points were stimulated both manually and electrically for 30 minutes with a frequency of approximately 2-3 Hz and 20-30 mA. All patients reported some degree of subjectively experienced improvement. Four felt much better and six somewhat better. At the follow-ups the same reports were given with the exception for one patient who reported unchanged discomfort. The objective criteria used for assessment of a favourable response to treatment were fulfilled by three patients immediately after treatment and at 3, 7 and 14 months after treatment. No significant negative effects of the treatment were recorded. It is concluded that acupuncture may be a realistic alternative to other, conventional stomatognathic treatment for some patients with long lasting chronic facial pain.