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AIM: To provide a systematic description of clinical findings and psychosocial factors in patients suffering from atypical odontalgia (AO). METHODS: Forty-six consecutive AO patients (7 men and 39 women; mean age, 56 years; range, 31 to 81 years) were compared with 35 control subjects (11 men and 24 women; mean age, 59 years; range, 31 to 79 years). RESULTS: The pain of the AO patients was characterized by persistent, moderate pain intensity (mean, 5.6 +/- 1.9) with long pain duration (mean, 7.7 +/- 7.8 years). Eighty-three percent reported that onset of pain occurred in conjunction with dental treatment. No significant difference was found between the groups in number of remaining teeth or number of root fillings. Temporomandibular disorder (TMD) pain (P < .001), tension-type headache (P < .002), and widespread pain (P < .001) were significantly more common among AO patients than controls. Significantly higher scores for somatization (P < .01) and depression (P < .01) and limitations in jaw function (P < .001) were found for the AO group compared with the control group. Significant differences between groups were found in 4 general health domains: role-physical (P < .001), bodily pain (P < .001), vitality (P < .004), and social functioning (P < .001). CONCLUSION: A majority of the AO patients reported persistent, moderately intense intraoral pain that in most cases had an onset in conjunction with dental treatment. AO patients had more comorbid pain conditions and higher scores for depression and somatization. Significant limitation in jaw function and significantly lower scores on quality of life measures were found for AO patients compared with controls. [ABSTRACT FROM AUTHOR]

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.

The aim of the study was to evaluate the analgesic effect of lidocaine in a double-blind, controlled multi-center study on patients with atypical odontalgia (AO)--a possible orofacial neuropathic pain condition. Thirty-five consecutive AO patients (range 31-81 years) with a mean pain duration of 7.2 years (range 1-30 years) were recruited from four different orofacial pain clinics in Sweden. In a randomized cross-over design, 1.5 ml local anesthesia (20mg/ml lidocaine and 12.5 microg/ml adrenaline) or 1.5 ml saline (9 mg/ml NaCl solution) (placebo) was injected to block the painful area. The VAS pain scores showed an overall effect of time (ANOVA: P<0.001) and treatment (ANOVA: P=0.018) with a significant interaction between the factors (ANOVA: P<0.001). Overall, VAS pain relief was significantly greater at 15-120 min following the lidocaine injections compared to the placebo injections (Tukey: P<0.05). All patients demonstrated significant disturbances in somatosensory function on the painful side compared to the non-painful side as revealed by quantitative sensory tests, however, only one significant inverse correlation was found between percentage pain relief and the magnitude of brush-evoked allodynia (Spearman: P<0.01). In conclusion, AO patients experienced significant, but not complete, pain relief from administration of local anesthetics compared with placebo. The findings indicate that the spontaneous pain in AO patients only to some extent is dependent on peripheral afferent inputs and that sensitization of higher order neurons may be involved in the pathophysiology of AO.

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.

Fifty-five patients (46 women and 9 men) with craniomandibular disorders and a history of pain of at least 6 months' duration participated in this trial. The patients were randomly assigned to three groups: one group to receive acupuncture; one group to receive occlusal splint therapy; and one group to act as controls. Pressure pain threshold, clinical dysfunction score, and visual analog scale measures were used to evaluate patients before, immediately after, and 6 months after treatment. A moderate, but statistically significant, correlation was found between pressure pain threshold and the number of tender spots in the masticatory muscles (tau = -.43; P < .001), degree of tenderness in the masticatory muscles (tau = -.43; P < .001), clinical dysfunction score (tau = .32; P < .001), and the visual analog scale (tau = -.25; P < .01). The short-term results showed a statistically significant improvement in all evaluations for both treatment groups. No significant differences were found in the control group. The improvements resulted in significant differences between the control and each treatment group immediately after treatment. At the 6-month follow-up, no significant differences in pressure pain threshold or clinical dysfunction score were found in the two treatment groups compared with the short-term results.

Eighty patients, of whom 22 were men and 58 women, participated in a 1-year follow-up study. All participants in the study showed signs and symptoms of craniomandibular disorders (CMD) and had had pain for more than 6 months at treatment start. The patients were randomly assigned to either acupuncture or occlusal splint therapy. Those patients who did not respond to either of the treatment modes were offered various additional therapies. The result showed that 57% of the patients who received acupuncture and 68% of the patients treated with occlusal splint therapy benefited subjectively (p < 0.01) and clinically (p < 0.001) from the treatment over a 12-month period. No statistically significant difference was found between the two groups as to the assessment variables. Those patients who received various additional therapies after acupuncture and/or occlusal splint therapy responded favorably to additional treatment in only a few instances. The study showed that acupuncture gave positive results similar to those of occlusal splint therapy in patients with primarily myogenic CMD symptoms over a 1-year follow-up period.

Occlusal splint therapy and acupuncture have been found to provide positive treatment in a number of studies. As with other therapies, adverse events may occur. In this paper, adverse event refers to any reaction to a treatment besides the intended treatment effect--irrespective of any correlation between the treatment and the reaction. This reaction can be positive, as well as negative, to the patient. In the present study, 61 patients with craniomandibular dysfunction (CMD) were treated with acupuncture or occlusal splint therapy and the adverse events were carefully recorded. The results show that the profile of the adverse events differed between the two treatment modes. Acupuncture seemed to have adverse events of a more general nature, e.g., relaxed feeling, improved sleep, temporarily increased pain; whereas, adverse events of occlusal splint therapy seemed to be more locally related to the orofacial region, e.g., increased/decreased salivation and tension in the teeth. The majority of the patients responded positively to both treatment modalities. Only in a few cases did the patients consider the treatment uncomfortable. No serious adverse event or complication was observed in this study.

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.

The relationship between the rate of pressure applied over the masseter muscle and the pressure pain threshold was studied with the aid of an algometer (pressure threshold meter, PTM) connected to a stopwatch. Twenty consecutive patients with various degrees of craniomandibular dysfunction were included in the study. In 10 of the patients, the belly of the right superficial masseter muscle was recorded with the algometer 10 times using different pressure rates arbitrarily and unsystematically ranging from low to high values. The correlation between pressure rate and the PTM value was high. An increased pressure rate increased the PTM value (mean regression coefficient b = 0.70). A PTM value range of 0.5 kg/cm2 was found to correspond to a pressure rate range of 0.50 kg/cm2/s. In the remaining 10 patients, repeated recordings of the same site with a constant pressure rate did not influence the PTM value significantly.

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.

The aim of the study was to introduce an individual tooth wear index and to use this index to investigate factors correlated to occlusal wear. The material consisted of 585 randomly selected dentate individuals from the community of Jönköping, Sweden, who in 1983 reached the age of 20, 30, 40, 50, 60, 70, or 80 years. The degree of incisal and occlusal wear was evaluated for each single tooth in accordance with criteria presented earlier. An individual tooth wear index, which made it possible to rank individuals in accordance with incisal and occlusal wear, was used as dependent variable to investigate factors related to incisal and occlusal wear. Of all factors analyzed, the following were found to correlate significantly with increased incisal and occlusal wear: number of existing teeth, age, sex, occurrence of bruxism, use of snuff, and saliva buffer capacity. Stepwise multiple regression analysis gave a total explanation factor of R2 = 0.41. It was also possible to distinguish well between groups of individuals with and without tooth wear by means of these factors.

Seventy-four female patients referred to a CMD clinic were randomly selected for an examination of general joint mobility according to Beighton. Thirty of the patients (41%) were classified as hypermobile. Eighty-three percent of the patients with generally lax joints had TMJ involvement in comparison to 41% of the patients with no joint laxity. The difference between these groups was statistically significant (P less than 0.001). Parafunctions and trauma were associated with increased symptoms and signs in individuals with lax joints. In nonlax joint patients, trauma to the head and jaw was significantly correlated to TMJ disorders. The results indicate that general joint hypermobility should be taken into consideration in the diagnosis and treatment of CMD.

Findings in epidemiologic studies referred to in this review appear to warrant the following conclusions: 1. Symptoms of dysfunction of the masticatory system are very common in unselected materials - much more common than hitherto assumed. This implies that dentists in the future must interest themselves more than hitherto for diagnosis and treatment of functional disturbances of the masticatory system in general practice. 2. There are no differences in frequency of dysfunction between men and women in the general population. Why women dominate in patient materials has not been convincingly explained in the literature. 3. Symptoms of mandibular dysfunction have been found in perons in all age groups. The slight differences as to age distribution reported, indicate more frequent symptoms in old individuals than in young ones. 4. No predominant etiologic factor of dysfunction of the masticatory system has been found in the population studies. Various factors are obviously involved in the etiology of functional disorders. A certain correlation between the degree of dysfunction and the general state of health and the number of residual teeth has, however, been demonstrated. Besides occlusal disturbances and psyhic factors the general health therefore should be observed as an important variable in mandilular dysfunction. 5. In order to faciliate future comparisons between different materials and interpretation of results it is necessary to use the same dignostic criteria and to collect data by reference to suitalbe induces permitting assessment of the prevalence of different symptoms with their severity. 6. With the aid of a generally accepted dysfunction index it should be possible further to elucidate the still many obscure aspects of the etiology and further course of dysfunctional diseases of the masticatory system in clinical materials and population studies. 7. More epidemiologic research of different populations is necessary to increase our knowledge in this field.

Changes in the sagittal and transverse profiles of the anterior and posterior parts of the alveolar process after extraction of all teeth and insertion of immediate dentures were studied during a five-year period using casts of 14 patients. The casts were oriented in a uniform way with the help of reference points in the hard palate. The desired profiles could then be reproduced with a special tracing apparatus. Four profiles made during the five-year period were compared for each patient. Changes in shape of the upper jaws in the median sagittal plane agreed well with the results obtained in earlier investigations and showed a reduction of the anterior part of the alveolar process for each patient. In the posterior part of the upper jaw, on the other hand, an increase in size was seen in the transverse section of the alveolar process in most patients examined.

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.

The reliability and validity of an algometer pressure threshold meter (PTM) was evaluated on 45 individuals, 25 healthy volunteers and 20 patients with craniomandibular dysfunction. Tenderness upon palpation was measured at six points located on the masseter muscle, the anterior temporal muscle, and on the zygomatic arch. The validity of the PTM was evaluated by comparison of the PTM values obtained by one examiner with the finger palpation score obtained by another examiner (Part 1). A statistically significant correlation between PTM values and finger-palpation scores was found at all of the points recorded (p less than 0.05). A statistically significant difference between PTM values was obtained for the symptom-free group and the patient group. The reliability of the PTM was evaluated at six points by repeated recordings at each marked point (Part 2). High reliability coefficients (r = 0.79-0.94) were found at all the points. The study also showed that if the points were located with a certain inaccuracy (1.0 mm less than x less than 2.6 mm), the reliability coefficients were still of the same magnitude. The PTM can be recommended for evaluation of pressure pain thresholds in the masticatory system in clinical and experimental studies.

Chewing efficiency, defined as the ability to grind a certain portion of a test food during a given time, was tested in 139 Skolt Lapps, ages 14-65. 94 persons had natural teeth and the remaining 45 wore dentures (partial and/or complete). The test food was almonds. Number of chewing strokes, swallowings and chewing time was denoted. The chewing efficiency was classified after a scale from 1 to 5 where 1 meant very good and 5 very poor ability to reduce the particle size of the test food. Clear associations were found between chewing efficiency and dental state. Number of occluding pairs of teeth was closely correlated with chewing efficiency and individuals with less than 20 teeth had a higher index score than those with more than 20 teeth. The values noted for number of chewing strokes, swallowings and chewing time were smaller for those with a good chewing efficiency, but the variation was not linear and not always significant. Denture wearers had statistically significantly higher chewing efficiency score than those with natural teeth, without dentures, and needed more chewing time before swallowing.

The material consisted of 585 randomly selected dentate individuals from the community of Jönköping, Sweden, who in 1983 reached the age of 20, 30, 40, 50, 60, 70, or 80 years. The degree of incisal or occlusal wear was evaluated for each single tooth in accordance with the following criteria: 0 = no wear or negligible wear of enamel; 1 = obvious wear of enamel or wear through the enamel to dentin in single spots; 2 = wear of dentin up to one-third of the crown height; 3 = wear of dentin more than one-third of the crown height and/or excessive wear of tooth restorative material. Among the 20-year-olds 35% of the subjects had no or slight incisal or occlusal wear. The corresponding figures for the 30- to 80-year age groups were 20%, 32%, 18%, 14%, 26%, and 23%, respectively. For the age groups 20-80 years, the percentage of teeth with incisal or occlusal wear in accordance with criteria 1-3 was 13%, 20%, 16%, 24%, 23%, 23%, and 23%, respectively. Men presented more teeth with wear than women, the difference being significant for all age groups except the 20- and 60-year-olds. Among the 20-year-olds 6% had one or more teeth with wear scored 2. Among subjects aged 30 and 70 years 10% and 31%, respectively, showed tooth wear with score 2. Wear with score 3 was only found in 2% of the total population. There was an increase in the number of teeth with incisal or occlusal wear with age. With increasing age, there was also a change in distribution of wear within the dentition.

A case of multiple myeloma was reported in which the initial symptom was pain and dysfunction of the TMJ that resulted from pathological fracture of the mandibular condyle. An initial radiographic skeletal survey showed no evidence of further lesions, although hematological and biochemical tests indicated a diagnosis of multiple myeloma. Treatment resulted in improvement of symptoms and of an evident regression of the lesion after 18 months. After a year, however, radiographs disclosed generalized skeletal involvement; deterioration of the general condition followed.