Serotonergic Mechanisms Influence the Response to Glucocorticoid Treatment in TMJ Arthritis

The aims of this study were to investigate the influence of serotonin (5-HT) on the effects of intra-articular injections of glucocorticoid on pain of the temporomandibular joint (TMJ) in patients with inflammatory disorders of the TMJ. The pretreatment synovial fluid 5-HT was negatively, and plasma 5-HT positively, correlated to change in TMJ pain after treatment. The pretreatment plasma 5-HT was positively correlated to change in pressure-pain threshold after treatment. In conclusion, this study shows that local and systemic serotonergic mechanisms partly determine the effect of intra-articular glucocorticoid treatment on TMJ pain in patients with chronic TMJ arthritis of systemic nature, while change in pressure-pain threshold over the TMJ is influenced by systemic serotonergic mechanisms

Tumor Necrosis Factor-α in Temporomandibular Joint Synovial Fluid Predicts Treatment Effects on Pain by Intra-Articular Glucocorticoid Treatment

The aim of this study was to investigate the influence of tumor necrosis factor-α (TNF-α) in temporomandibular joint (TMJ) synovial fluid and blood on the treatment effect on TMJ pain by intra-articular injection of glucocorticoid in patients with chronic inflammatory TMJ disorders. High pretreatment level of TNF-α in the synovial fluid was associated with a decrease of TNF-α and elimination of pain upon maximal mouth opening. Elimination of this TMJ pain was accordingly associated with decrease in synovial fluid level of TNF-α. There was also a significant decrease of C-reactive protein and TMJ resting pain after treatment. In conclusion, this study indicates that presence of TNF-α in the synovial fluid predicts a treatment effect of intra-articular injection of glucocorticoid on TMJ movement pain in patients with chronic TMJ inflammatory disorders

Diabetes mellitus i Forsvaret – en undersøkelse av omfang og sammenheng med overvekt

Bakgrunn: Folkehelseinstituttet rapporterer at mellom 316 000 – 345 000 har diabetes i Norge. Diabetes type II utgjør 90 % av alle diabetestilfeller (1). Prevalensen av diabetes i Norge antas å være doblet de siste 20 årene. Fedme og spesielt abdominal fedme, ses som en viktig faktor i utviklingen av insulinresistens og diabetes type II. Forsvaret stiller strenge fysiske og psykiske helsekrav til militært personell. Militært personell er derfor som regel friskere enn den generelle befolkningen. Forsvaret stiller ikke like strenge helsekrav til sivilt personale. Overvekt og livsstilssykdommen diabetes type II er et svært aktuelt tema, også i Forsvaret. En undersøkelse av diabetes - forekomst og sammenheng med overvekt og fedme - blant de ansatte i Forsvaret kan sette lys på potensiale for forebygging. Formål: Formålet med undersøkelsen er å kartlegge omfanget av egenrapportert diabetes, fordelt på ulike aldersgrupper, kjønn og militært og sivilt ansatte i Forsvaret. Videre ønsker jeg å undersøke om det finnes en sammenheng mellom egenapportert kroppsmasseindeks (KMI) og diabetes. Metode: Datamaterialet er hentet fra Forsvarets helseregister. Oppgaven bruker data fra Forsvarets Helseundersøkelse fra 2017. Totalt 8918 personer ble inkludert i utvalget. Analysene ble utført i SPSS. Jeg brukte Pearson kji-kvadrattest og logistisk regresjon for å analysere forskjeller mellom grupper og undersøke sammenhengen mellom kroppsvekt og egenrapportert diabetes. P-verdi < 0,05 ble satt som nivå for statistisk signifikans. Resultater: I 2017 rapporterte 1,3 % av Forsvarets ansatte diabetes. 1,4 % (n=104) av mennene oppga diabetes i forhold til 1 % (n=16) av kvinnene. Andelen med diabetes var høyere blant sivilt ansatte. Blant de totalt 16 kvinnene som oppga å ha diabetes var 15 sivilt ansatt. 70 % av tilfellene med diabetes forekom i aldersgruppen over 50 år. 77,5 % av alle tilfellene med diabetes faller under KMI-kategoriene «overvekt» og «fedme». Konklusjon: Andelen som rapporterer diabetes i Forsvaret er lav. Militært ansatte rapporterer om mindre diabetes enn sivilt ansatte, militært ansatte har også lavere KMI. Prevalensen av diabetes i Forsvaret øker med økende alder og økende KMI. Det er signifikant sammenheng mellom diabetes og høyere KMI

Foreldre-erfaringer etter COS-P (Circle of Security – Parenting)

Helsestasjonstjenesten har som oppgave å fremme barns fysisk, psykisk og sosial utvikling, og skal være et lett tilgjengelig gratis lavterskeltilbud. Ny nasjonal faglig retningslinje (Helsedirektoratet, 2017) vektlegger tilknytning mellom foreldre og barn for å gjøre foreldre trygge. COS-P står for Circle of Security Parenting og er en tilknytningsbasert intervensjon, der målet er å fremme tilknytningen mellom barn og omsorgsgiver. Verktøyet er utviklet i USA ved Cooper, Hoffmann og Powell (2006). COS-P har vært i bruk i Norge siden 2010, og er således en forholdsvis ny intervensjon i Norge. COS-P kurs gjennomføres ved flere helsestasjoner, og det kan nyttes universelt til alle foreldre. Studien søker innsikt i opplevelser og erfaring foreldrene sitter igjen med etter å ha deltatt på COS-P kurs i regi av helsestasjonen. Det var naturlig å velge kvalitativ metode som bygger på teorier om menneskelig erfaring og fortolkning, hvor målet er og utforske mennesker erfaringer, tanker, meninger og opplevelser. Fremgangsmåten ble å foreta semi-strukturerte intervju av åtte foreldre rekruttert fra to ulike kommuner. De hadde alle fått COS-P kurset gjennom tilbud fra helsestasjonen. Tilknytningsteorien (Bowlby, 1969) som COS-P er fundamentert etter og Antonovskys teori (Antonovsky A. , 2012) om opplevelsen av sammenheng danner grunnlag for teoretisk tilnærming og forståelse. Dette er teori hvor jeg ønsker å få frem deler av en helhet og tilnærmer meg temaene fenomenologisk-hermeneutisk. Foreldrenes erfaringer tilsier at de har lært mye og sitter igjen med ny kunnskap. De forteller om en større forståelse for barnas behov og samtlige snakket begeistret om kurset, også 1-3 år etter intervensjonen. Resultatene viser at de alle opplever bedret relasjon til egne barn. De formidler å ha fått en ny forståelse for barnas behov. De beskriver at de har blitt mere klar over sin egen påvirkning i relasjonen og at egen barndomserfaring kan virke inn på egne reaksjoner, og alle opplever bedret relasjon til egne barn. Resultatene gir oss ny innsikt og kunnskap om erfaringer og opplevelser foreldrene har etter gjennomført intervensjon, og indikerer et positivt utbytte av intervensjonen for deltakerne

Influence of serotonin on the analgesic effect of granisetron on temporomandibular joint arthritis.

The influence of circulating serotonin (5-HT) on the effects of intra-articular administration of granisetron on temporomandibular joint (TMJ) pain was investigated in 11 patients with chronic polyarthritides. An analgesic effect superior to placebo has been shown previously. The change in TMJ movement pain intensity was negatively correlated to circulating 5-HT; that is, the higher the 5-HT before injection, the greater the reduction of pain intensity. The resting pain intensity reduction was not related to 5-HT. In conclusion, this study indicates a stronger short-term analgesic effect on TMJ movement pain by intra-articular administration of the 5-HT3 receptor antagonist granisetron in patients with high levels of circulating 5-HT

Temporomandibular Joint Bone Tissue Resorption in Patients with Early Rheumatoid Arthritis Can Be Predicted by Joint Crepitus and Plasma Glutamate Level

The aim was to investigate whether bone tissue resorption in early RA is related to crepitus of the temporomandibular joint (TMJ) and systemic levels of inflammatory mediators and markers and sex steroid hormones. Twentynine women and 18 men with recently diagnosed RA were examined for TMJ bone erosions with computerized tomography and TMJ crepitus was assessed. Blood samples were analyzed for glutamate, 5-HT, TNF, IL-1β, IL-6, VEGF, inflammatory markers, and estradiol, progesterone and testosterone. The TMJ erosion score was positively correlated to glutamate, and TMJ crepitus where crepitus, glutamate and ESR explained 40% of the variation in the bone erosion score. In the patients without crepitus, bone erosion score was positively correlated to glutamate, which was not the case in the patients with crepitus. In conclusion, the results of this study show that TMJ bone tissue resorption can be predicted by TMJ crepitus and glutamate in early RA

Evaluation of Panoramic Radiographs in Relation to the Mandibular Third Molar and to Incidental Findings in an Adult Population

Objectives  The aim was to evaluate the characteristics of the mandibular third molars, especially in relation to the inferior alveolar nerve. Further aims were to investigate incidental findings in panoramic radiographs in an adult population, and to investigate image quality related to patient positioning. Materials and Methods  From a previous study with 451 randomly selected adult participants who lived in Sweden, 442 panoramic radiographs from four dental public health clinics were used. The third molars’ characteristics and relation to inferior alveolar nerve were evaluated. Incidental findings and patient positioning were recorded. Statistical Analysis  Frequency analysis was used to investigate the occurrence of all findings and their possible interconnections. Whether the patients’ age or gender had an impact or not was also analyzed. Results  The third molars were erupted in vertical position among 73% regardless of age. When retained or semi-retained, they were most commonly in mesioangular positions. The inferior alveolar nerve was located inferior to the roots in 52%, whereas an overlapped position was most common if the third molar was retained (90%), semi-retained (83%) or the age was less than 30 years (66%). Common incidental findings were apical radiolucencies, idiopathic osteosclerosis, and tooth fragments. Suboptimal patient positioning was found in one-third of the radiographs. Conclusions  Panoramic radiography is a useful method to evaluate third molar prior to surgical removal and may be the only image required. Most incidental findings on panoramic radiographs does not seem to require any further odontological management.publishedVersio

Intra-articular vs. systemic administration of etanercept in antigen-induced arthritis in the temporomandibular joint. Part II: mandibular growth

<p>Abstract</p> <p>Background</p> <p>Temporomandibular joint (TMJ) arthritis in children causes alterations in the craniomandibular growth. Resultant abnormalities include; condylar erosions, a posterior mandibular rotation pattern, micrognathia, malocclusion with an anterior open bite, altered joint and muscular function occasionally associated with pain. These alterations may be prevented by early aggressive anti-inflammatory intervention. Previously, we have shown that intra-articular (IA) corticosteroid reduces TMJ inflammation but causes additional mandibular growth inhibition in young rabbits. Local blockage of TNF-α may be an alternative treatment approach against TMJ involvement in juvenile idiopathic arthritis (JIA). We evaluated the anti-inflammatory effect of IA etanercept compared to subcutaneous etanercept in antigen-induced TMJ-arthritis in young rabbits in terms of mandibular growth. This article (Part II) presents the data and discussion on the effects on facial growth. In Part I the anti-inflammatory effects of systemic and IA etanercept administration are discussed.</p> <p>Methods</p> <p>Arthritis was induced and maintained in the TMJs of 10-week old pre-sensitized rabbits (n = 42) by four repeated IA TMJ injections with ovalbumin, over a 12-week period. One group was treated weekly with systemic etanercept (0.8 mg/kg) (n = 14), another group (n = 14) received IA etanercept (0.1 mg/kg) bilaterally one week after induction of arthritis and one group (n = 14) served as an untreated arthritis group receiving IA TMJ saline injections. Head computerized tomographic scans were done before arthritis was induced and at the end of the study. Three small tantalum implants were inserted into the mandible, serving as stable landmarks for the super-impositions. Nineteen variables were evaluated in a mandibular growth analysis for inter-group differences. All data was evaluated blindedly. ANOVA and T-tests were applied for statistical evaluation using p < 0.05 as significance level.</p> <p>Results</p> <p>Significant larger mandibular growth disturbances were observed in the group receiving IA saline injections compared with the systemic etanercept group. The most pronounced unfavourable posterior mandibular rotation pattern was observed in the group receiving IA saline injections.</p> <p>Conclusion</p> <p>Intervention with systemic etanercept monotherapy equivalent to the recommended human dose allows a mandibular growth towards an original morphology in experimental TMJ arthritis. Systemic administrations of etanercept are superior to IA TMJ administration of etanercept in maintaining mandibular vertical growth.</p