Utilization of pharmaceuticals among patients with temporomandibular disorders: a controlled study

OBJECTIVE: Pharmaceuticals are among factors that might be associated with temporomandibular disorders (TMDs), but knowledge about their utilization is limited. The purpose was to systematically register the regular use of medication in general among TMD patients and matched controls to enable comparisons to be made. MATERIAL AND METHODS: Three hundred consecutive patients referred for diagnosis and treatment of TMDs and fulfilling the Research Diagnostic Criteria were examined prospectively and any medication recorded. Matched controls were registered parallel in time. The pharmaceuticals used were categorized according to the Anatomical Therapeutic Chemical Classification System (ATC). RESULTS: Forty-four percent of the patients received a main diagnosis of "muscle disorder", 39% "disk disorder", and 17% "joint disorder". Fifty-one percent of all patients used some medication on a regular basis compared to 36% of the controls (p<0.001). The average number of ATC categories used among all patients was 0.9 and among controls 0.5 (p<0.001). Of the female patients with the diagnosis "muscle disorder", 23% used antidepressants (N06A), 6% tranquilizers (N05B), and 7% sleep medication or sedatives (N05C) significantly more frequently than controls. Of the female patients diagnosed with a "joint disorder", 26% used antidepressants (N06A) significantly more frequently than controls. All other ATC categories differed non-significantly. CONCLUSIONS: The results suggest that the use of pharmaceuticals differs between patients and controls. TMD patients, particularly women diagnosed with "muscle" or "joint" disorders, appear to use drugs for depression more frequently than ordinary dental patients.     

Dental plaque, gingival inflammation, and elevated levels of interleukin-6 and cortisol in gingival crevicular fluid from women with stress-related depression and exhaustion

BACKGROUND: The aim of the present study was to investigate the importance of stress for the development of periodontitis by comparing oral health status, proinflammatory markers, and cortisol in gingival crevicular fluid (GCF) and saliva in patients with stress-related mental depression and controls. METHODS: The participants consisted of 43 women with stress-related depression and exhaustion (Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV], with a mean age of 42.0 (+/- 9.3 SD) years, and 29 controls, with a mean age of 54.5 (+/- 2.9 SD) years. Clinical examination included the assessment of dental plaque, gingival inflammation (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and number of teeth. GCF was collected with an intracrevicular washing technique from four sites in each subject. Interleukin (IL)-1beta, IL-6, and matrix metalloproteinase-9 were determined with enzyme-linked immunosorbent assay and cortisol with radioimmunoassay (125I RIA). Analysis of covariance (one-way covariance analyses) was used to remove the influence of age and smoking. RESULTS: The amount of plaque was significantly higher in patients compared to controls (P<0.003). The patients had an average GI of 1.53 (+/-0.13 SD) compared to 0.89 (+/- 0.10 SD) for the controls (P< 0.001). The levels of cortisol in GCF was significantly higher in patients than in controls, 3.46 nmol/l (+/- 3.25 SD) and 0.30 nmol/l (+/- 0.25 SD), respectively (P<0.001), whereas cortisol in saliva did not differ between groups. The levels of IL-6 in GCF were significantly higher in the patients than in controls (P<0.05). CONCLUSION: Women with stress-related depression and exhaustion had more plaque accumulation, GI and increased levels of IL-6 and cortisol in GCF compared to normal controls, suggesting that depression might affect immune function, which could lead to impaired periodontal health.     

Caries and associated factors in a group of Swedish children 2- 3 years of age

The reported skew distribution of caries prevalence in preschool children, with a small group of children with very high caries prevalence, stresses the importance of early identification for prevention.The present study aimed to describe the caries prevalence in a group of Swedish preschool children and to identify caries risk factors in this population. 221 children, 2 to 3 years old, agreed to participate in the study (82%). A standardized questionnaire was used to describe socio-economic factors, dietary and oral hygiene habits and exposure to fluoride. Initial and manifest dental caries was diagnosed and the presence of plaque was visually observed without disclosing solution. Saliva and plaque samples were collected for identification of mutans streptococci (MS). For statistical analysis,the Student's t-test,the Chi-square test and Fisher's exact test were used. The caries prevalence among the 2 to 3 year-olds was 7 and 18 percent respectively. An association between early childhood caries and a number of factors was found e.g. the presence of MS and visible plaque, nocturnal meals, frequent sugar consumption, mothers' state of employment and immigrant background. The Public Dental Health Service has been successful in decreasing the number of children with caries, but the challenge remains to be able to control caries in the high-risk group. The skew distribution, with many children without caries and a smaller group with very high caries prevalence, was confirmed.The study provided insight into various factors, useful for monitoring children at risk of developing early childhood caries.     

Comparison of methods for measurement of hypoplastic lesions

Enamel hypoplasia is a quantitative defect of enamel thickness. Methods previously used for its measurement have limitations in clinical studies. The aim of this study was to investigate new methods of measurement using image analysis. Lesions on 8 teeth affected by enamel hypoplasia were quantified from study models and impression surfaces using an image-analysis system. The measurements made included lesion area and tooth surface area; from these the proportion of tooth surface area affected was calculated. For comparison, manual measurement was performed on impression surfaces and study models, using digital callipers. Images were also acquired of lesions on 12 exfoliated teeth, and the lesion area and total tooth area were calculated. For assessment of intra-operator reliability, the +/– repeatability coefficient was calculated. Measurement of the surface of lesions direct from the exfoliated teeth gave the best results overall, followed by direct image analysis of the silicone impression.     

Evaluation of spontaneous space closure and development of permanent dentition after extraction of hypomineralized permanent first molars

AIM: The aim of this study was to evaluate spontaneous space closure, development of the permanent dentition, and need for orthodontic treatment after extraction of permanent first molars due to severe molar-incisor hypomineralization (MIH). SUBJECTS: Twenty-seven children aged 5.6-12.7 (median 8.2) years had one to four permanent first molars extracted due to severe MIH. Each case was followed up on individual indications 3.8-8.3 (median 5.7) years after extractions. The eruption of the permanent dentition, and space closure were documented by orthopantomograms, casts, photographs, and/or bitewings. RESULTS: Fifteen children were judged to have a favourable spontaneous development of their permanent dentition without any orthodontic intervention. Seven children were or should be subjected to orthodontic treatment for other reasons registered prior to the extraction. Five children were judged to have a treatment at least caused by the extractions, but three of them abstained because of no subjective treatment need. CONCLUSION: Extraction of permanent first molars severely affected by MIH is a good treatment alternative. Favourable spontaneous space reduction and development of the permanent dentition positioning can be expected without any intervention in the majority of cases extracted prior to the eruption of the second molar.     

Dietary factors in the prevention of dental caries: a systematic review

The aim of this study was, systematically, to evaluate the effect of dietary changes in the prevention of dental caries. A search and analysis strategy was followed, as suggested by the Swedish Council on Technology Assessment in Health Care (SBU). The search strategy for articles published in 1966-2003 was performed using electronic databases and reference lists of articles and selected textbooks. Out of 714 articles originally identified, 18 met the inclusion criteria for a randomized or controlled clinical trial--at least 2 years' follow-up and caries increment as a primary endpoint. This included the total or partial substitution of sucrose with sugar substitutes or the addition of protective foods to chewing gum. No study was found evaluating the effect of information designed to reduce sugar intake/frequency as a single preventive measure. It is suggested that the evidence for the use of sorbitol or xylitol in chewing gum, or for the use of invert sugar, is inconclusive. No caries-preventive effect was found from adding calcium phosphate or dicalcium phosphate dihydrate to chewing gums. The review dearly demonstrates the need for well-designed randomized clinical studies with adequate control groups and high compliance.     

On tooth movements and associated tissue alterations related to edentulous areas and bone defects

The aim of the thesis was to study orthodontic tooth movement in relation to edentulous areas and infrabony pockets as well as the physiological movement of teeth facing an edentulous area. A dog model was used in Studies I and II. Teeth were orthodontically moved into and out from inflamed, infrabony periodontal pockets (Study I) and into areas of reduced bone height (Study II). Clinical, radiographic and histometric analyses were made with respect to changes in tooth-supporting tissues. Study III involved clinical, radiographic and 3D model assessments of changes in periodontal conditions and alveolar ridge dimensions in adult patients subjected to tooth movement into areas with reduced ridge dimensions. In Study IV, panoramic radiographs of 292 subjects, taken at an interval of 12 years, were analyzed with regard to changes in the elongation of unopposed molars and tipping of molars facing a mesial edentulous space. In the animal study orthodontic bodily movement of teeth with inflamed, infrabony pockets caused an enhanced rate of progression of the periodontal lesion (Study 1), particularly when the tooth movement was directed towards the infrabony defect. Teeth with healthy periodontium that were orthodontically moved into areas of markedly reduced bone height maintained their periodontal tissue support (Study II). Corresponding orthodontic tooth movement in humans (Study III) resulted in minor dimensional alterations of the periodontal tissues and an increased bucco-lingual width of the alveolar ridge in the area into which the tooth had been moved, whereas a decreased width of the newly established edentulous area was noted. All teeth that were moved showed lateral root resorption at the level of the bone crest on the pressure side, but signs of repair were noticed 1-year post-treatment. In the 12-year radiographic study (Study IV) unopposed molars showed a significant increase in elongation over the 12 years of follow-up. The degree of elongation increased with decreased bone support. Neither edentulous space nor alveolar bone level were found to have a significant effect on tipping. In the presence of both conditions, unopposed molars and molars facing a mesial edentulous space, an increase in elongation was associated with tipping.