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Böthun, A., Lövgren, A., Stålnacke, B.-M., Lampa, E., Österlund, C., Häggman-Henrikson, B. & Hellström, F. (2024). Whiplash trauma did not predict jaw pain after 2 years: an explorative study. Clinical Oral Investigations, 28, Article ID 165.
Open this publication in new window or tab >>Whiplash trauma did not predict jaw pain after 2 years: an explorative study
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2024 (English)In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 28, article id 165Article in journal (Refereed) Published
Abstract [en]

Objectives

To explore predictive factors for the development and maintenance of jaw pain over a 2-year period.

Methods

One hundred nineteen cases (73 women) and 104 controls (59 women), mean age 34.9 years (SD 13.9), attended baseline and 2-year follow-up examinations. The whiplash cases visited the emergency department at Umeå University Hospital, Sweden, with neck pain within 72 h following a car accident, and baseline questionnaires were answered within a month after trauma. Controls were recruited via advertising. Inclusion criteria were age 18–70 years, living in Umeå municipality and Swedish speaking. The exclusion criterion was neck fracture for cases and a previous neck trauma for controls. Validated questionnaires recommended in the standardized Research Diagnostic Criteria for temporomandibular disorders were used. Jaw pain was assessed by two validated screening questions answered with “yes” or “no.” A logistic regression analysis was used to predict the outcome variable jaw pain (yes/no) after 2 years.

Results

Whiplash trauma did not increase the odds of development of jaw pain over a 2-year period (OR 1.97, 95% CI 0.53–7.38). However, non-specific physical symptoms (OR 8.56, 95% CI 1.08–67.67) and female gender (OR 4.89, 95% CI 1.09–22.02) did increase the odds for jaw pain after 2 years.

Conclusion

The development and maintenance of jaw pain after whiplash trauma are primarily not related to the trauma itself, but more associated with physical symptoms.

Clinical relevance

The development of jaw pain in connection with a whiplash trauma needs to be seen in a biopsychosocial perspective, and early assessment is recommended.

Place, publisher, year, edition, pages
Wiley, 2024
Keywords
Facial pain; Jaw pain; Neck pain; Temporomandibular disorders; Whiplash injuries
National Category
Clinical Medicine
Identifiers
urn:nbn:se:hig:diva-43832 (URN)10.1007/s00784-024-05555-z (DOI)001169289000002 ()38383824 (PubMedID)2-s2.0-85185695499 (Scopus ID)
Funder
Västerbotten County Council, RV-909851Västerbotten County Council, VLL-324631
Available from: 2024-02-22 Created: 2024-02-22 Last updated: 2024-03-15Bibliographically approved
Böthun, A., Häggman‐Henrikson, B., Stålnacke, B.-M., Wänman, A., Nordh, E., Lampa, E. & Hellström, F. (2023). Clinical signs in the jaw and neck region following whiplash trauma – a 2‐year follow‐up. European Journal of Pain, 27(6), 699-709
Open this publication in new window or tab >>Clinical signs in the jaw and neck region following whiplash trauma – a 2‐year follow‐up
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2023 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 27, no 6, p. 699-709Article in journal (Refereed) Published
Abstract [en]

Background

Pain in the orofacial region is often reported after whiplash trauma. However, prospective studies evaluating clinical signs related to orofacial pain and disability in whiplash populations are rare. The aim of the present study was to evaluate clinical signs related to pain and dysfunction in orofacial and neck regions after whiplash trauma, in a short- and long-term perspective.

Methods

In total, 84 cases (48 women) diagnosed with neck distortion after a car accident and 116 controls (68 women) were examined within one month, and 49 cases (27 women) and 71 controls (41 women) were reexamined two years later. Outcome measures were pain on palpation of jaw and neck muscles and maximal jaw opening. Analysis was performed using mixed-models.

Results

Cases and women were at higher risk for pain on palpation of jaw muscles (OR:7.7;P<0.001 and OR:3.2;P=0.010, respectively) and neck muscles (OR:12.7;P<0.001 and OR:2.9;P=0.020, respectively) but with no significant effect of time. Cases and women also had lower maximal jaw opening (-3.1;P=0.001 and -3.3;P=0.001, respectively). There was no significant time effect, but a significant interaction between cases and time (2.2;P=0.004).

Conclusion

Individuals with a whiplash trauma present a higher risk for pain on palpation in jaw and neck muscles both in a short- and long-term perspective, but show normal jaw movements. No time effect suggest that cases do not spontaneously improve nor get worse. Investigating pain on palpation in the jaw and neck muscles after whiplash trauma can identify individuals at risk for developing long-term orofacial pain and dysfunction.

Place, publisher, year, edition, pages
Wiley, 2023
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-41121 (URN)10.1002/ejp.2099 (DOI)000945366500001 ()36806817 (PubMedID)2-s2.0-85150413156 (Scopus ID)
Available from: 2023-02-23 Created: 2023-02-23 Last updated: 2023-11-23Bibliographically approved
Nilsson, E., Häggman‐Henrikson, B., Domellöf, E., Hellström, F., Häger, C. K. & Österlund, C. (2023). Development of integrated jaw‐neck motor function in children at 6, 10 and 13 years of age compared to adults: a kinematic longitudinal study. Journal of Oral Rehabilitation, 50(10), 1002-1011
Open this publication in new window or tab >>Development of integrated jaw‐neck motor function in children at 6, 10 and 13 years of age compared to adults: a kinematic longitudinal study
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2023 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 50, no 10, p. 1002-1011Article in journal (Refereed) Published
Abstract [en]

Background

The functional integration of the jaw and neck motor systems, of great importance to everyday oral activities, is established in early childhood. Detailed characterization of this developmental progress is largely unknown.ObjectiveTo establish developmental changes in jaw-neck motor function in children over the ages 6 to 13 years compared to adults.

Methods

Jaw and head movement kinematics during jaw opening-closing and chewing were longitudinally recorded in 20 Swedish children (8 girls) at 6 (6.3 ± 0.4), 10 (10.3 ± 0.3) and 13 (13.5 ± 0.7) years of age and 20 adults (9 women, 28.2 ± 6.7). Movement amplitudes, jaw movement cycle time (CT), coefficient of variation (CV), and head/jaw ratio for amplitudes were analysed. Linear mixed effect analysis and Welch's t-test were used.

Results

Children showed pronounced movement variability and longer CT at 6 and 10 years-old during opening and chewing (p<.001). Compared to adults, 6-year-olds showed higher head/jaw ratios (p<.02) and longer CT (p<.001) during opening and chewing, and higher CV-head (p<.001) during chewing. Whereas 10-year-olds showed larger jaw and head amplitudes (p<.02) and longer CT (P<.001) during opening, and longer CT(p<.001) and higher CV-head (p<.001) during chewing. For 13-year-olds, longer CT (p<.001) during chewing was found.

Conclusion

Children showed pronounced movement variability and longer movement cycle time at 6 to10 years and developmental progress in jaw-neck integration from 6 to 13 years, with 13-year-olds displaying adult-like movements. These results add new detailed understanding to the typical development of integrated jaw-neck motor function.

Place, publisher, year, edition, pages
Wiley, 2023
Keywords
adult; child; head; jaw; motor activity; movement
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-42397 (URN)10.1111/joor.13539 (DOI)001014595400001 ()37323062 (PubMedID)2-s2.0-85162668468 (Scopus ID)
Available from: 2023-06-22 Created: 2023-06-22 Last updated: 2024-01-17Bibliographically approved
Böthun, A., Häggman‐Henrikson, B., Wiesinger, B., Wänman, A., Hellström, F. & Österlund, C. (2022). Jaw–neck motor strategy during jaw‐opening with resistance load. Journal of Oral Rehabilitation, 49(5), 514-521
Open this publication in new window or tab >>Jaw–neck motor strategy during jaw‐opening with resistance load
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2022 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 49, no 5, p. 514-521Article in journal (Refereed) Published
Abstract [en]

Background

The jaw and neck motor systems have a close functional integration but the effect of resistance load to the mandible during jaw opening on the jaw–neck integration is not known.

Objectives

To evaluate the effect of resistance load compared to no load on integrated jaw and neck motor function in individuals free from pain and dysfunction in the jaw and neck regions.

Methods

Jaw and head movements during continuous jaw opening were recorded with an optoelectronic system (MacReflex®) in 26 pain-free individuals (14 women, 12 men, mean age 22 years). Jaw opening was performed with and without resistance load (1600 g) to the mandible. The relationship between jaw movement amplitude, head movement amplitude, head/jaw ratio (quotient of head and jaw movement amplitude) and resistance load were modelled using linear mixed-model analysis. A p-value <.05 was considered statistically significant.

Results

The expected head/jaw ratio mean was increased by 0.05 (95% CI: 0.03, 0.08, p < .001) with resistance load as compared to no load. This corresponds to an increase in expected mean by 55.6%. With resistance load, expected mean head movement amplitude increased by 1.4 mm (95% CI: 0.2, 2.5, p = .018), and expected mean jaw movement amplitude decreased by 3.7 mm (95% CI: −7.0, −0.5, p = .025).

Conclusion

There is a compensation and adaptation of integrated jaw–neck motor function with an altered jaw–neck motor strategy during jaw opening with resistance load compared to no load. The head/jaw ratio demonstrates increased proportional involvement of the neck during increased load on the jaw system.

Place, publisher, year, edition, pages
Wiley, 2022
Keywords
exercise; jaw; motor activity; motor skills; movement; neck
National Category
Clinical Medicine
Identifiers
urn:nbn:se:hig:diva-37543 (URN)10.1111/joor.13291 (DOI)000731492000001 ()34878690 (PubMedID)2-s2.0-85121471921 (Scopus ID)
Available from: 2021-12-20 Created: 2021-12-20 Last updated: 2024-01-17Bibliographically approved
Rudolfsson, T. & Hellström, F. (2021). Utvärdering av fyra arbetsmiljöåtgärder inom schemalagt och flexibelt arbete. Gävle: Högskolan i Gävle; Trafikverket
Open this publication in new window or tab >>Utvärdering av fyra arbetsmiljöåtgärder inom schemalagt och flexibelt arbete
2021 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Gävle: Högskolan i Gävle; Trafikverket, 2021. p. 46
National Category
Health Sciences
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-35723 (URN)
Available from: 2021-04-27 Created: 2021-04-27 Last updated: 2021-04-28Bibliographically approved
Sjödin, A., Hellström, F., Sehlstedt, E., Svensson, M. & Burén, J. (2020). Effects of a ketogenic diet on muscle fatigue in healthy, young, normal-weight women: a randomized controlled feeding trial. Nutrients, 12(4), Article ID 955.
Open this publication in new window or tab >>Effects of a ketogenic diet on muscle fatigue in healthy, young, normal-weight women: a randomized controlled feeding trial
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2020 (English)In: Nutrients, E-ISSN 2072-6643, Vol. 12, no 4, article id 955Article in journal (Refereed) Published
Abstract [en]

Ketogenic low-carbohydrate high-fat (LCHF) diets are increasingly popular in broad sections of the population. The main objective of this study was to evaluate the effects of a non-energy-restricted ketogenic LCHF diet on muscle fatigue in healthy, young, and normal-weight women. Twenty-four women were randomly allocated to a 4-week ketogenic LCHF diet followed by a 4-week control diet (a National Food Agency recommended diet), or the reverse sequence due to the crossover design. Treatment periods were separated by a 15 week washout period. Seventeen women completed the study and were included in the analyses. Treatment effects were evaluated using mixed models. The ketogenic LCHF diet had no effect on grip strength or time to fatigue, measured with handgrip test (day 24&ndash;26). However, cycling time to fatigue decreased with almost two minutes (&minus;1.85 min 95% CI:[&minus;2.30;&minus;1.40]; p &lt; 0.001) during incremental cycling (day 25&ndash;27), accommodated with higher ratings of perceived exertion using the Borg scale (p &lt; 0.01). Participants&rsquo; own diary notes revealed experiences of muscle fatigue during daily life activities, as well as during exercise. We conclude that in young and healthy women, a ketogenic LCHF diet has an unfavorable effect on muscle fatigue and might affect perceived exertion during daily life activities.

Place, publisher, year, edition, pages
MDPI, 2020
Keywords
sports nutrition, fat adaptation, saturated fat, diet intervention, female, food, nutrition, low carbohydrate diet (LCD)
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-32127 (URN)10.3390/nu12040955 (DOI)000531831300075 ()32235518 (PubMedID)2-s2.0-85082733010 (Scopus ID)
Available from: 2020-04-09 Created: 2020-04-09 Last updated: 2023-08-28Bibliographically approved
Österlund, C., Nilsson, E., Hellström, F., Häger, C. K. & Häggman-Henrikson, B. (2020). Jaw-neck movement integration in 6-year old children differs from that of adults. Journal of Oral Rehabilitation, 47(1), 27-35
Open this publication in new window or tab >>Jaw-neck movement integration in 6-year old children differs from that of adults
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2020 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 47, no 1, p. 27-35Article in journal (Refereed) Published
Abstract [en]

Background: A functional integration between the jaw and neck regions during purposive jaw movements is well described in adults, but there is a lack of knowledge of such integration during jaw function in children.; Objectives: To determine the movement integration between the jaw and neck during jaw motor tasks in 6-year-olds, whether there is a difference between children and adults.; Methods: Jaw and neck movements were recorded with an optoelectronic 3D system in 25 healthy 6-year-olds (12 girls, 13 boys) and 24 healthy adults (12 women, 12 men) during paced jaw opening-closing and self-paced gum chewing. Jaw and neck movement amplitudes, intra-individual variation in movement amplitude, ratio between neck-jaw movement amplitudes, and movement cycle time were analysed. Differences between children and adults were evaluated with Mann-Whitney U test for independent samples.; Results: Compared to adults, 6-year old children showed larger neck movement amplitudes (P=0.008) during chewing, higher intra-individual variability in amplitudes of jaw (P=0.008) and neck (P=0.001) movements, higher ratio between neck-jaw movement amplitudes for jaw opening-closing (P=0.026) and chewing (P=0.003), and longer jaw movement cycle time (P≤0.0001) during the jaw opening-closing task.; Conclusion: Despite integrated jaw-neck movements in 6-year old children, the movement pattern differs from that of adults and may be interpreted as an immature programming of jaw-neck motor behavior. The well-integrated movements observed in adults most likely develop over years, perhaps into adolescence, and needs further research including well controlled longitudinal studies to map this development in order to provide appropriate age-related clinical treatment for functional disorders. This article is protected by copyright. All rights reserved.; This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
Blackwell Scientific Publications, 2020
Keywords
adult, child, head, jaw, motor activity, movements
National Category
Other Medical Sciences
Research subject
no Strategic Research Area (SFO)
Identifiers
urn:nbn:se:hig:diva-30573 (URN)10.1111/joor.12865 (DOI)000483252900001 ()31357241 (PubMedID)2-s2.0-85070938798 (Scopus ID)
Note

Funding agency:

-Umeå University- Västerbotten County Council

Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2024-02-12Bibliographically approved
Wiesinger, B., Häggman-Henrikson, B., Eklund, A., Wänman, A. & Hellström, F. (2019). Multimodal Sensory Stimulation of the Masseter Muscle Reduced Precision but Not Accuracy of Jaw-Opening Movements. Frontiers in Neuroscience, 13, Article ID 1083.
Open this publication in new window or tab >>Multimodal Sensory Stimulation of the Masseter Muscle Reduced Precision but Not Accuracy of Jaw-Opening Movements
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2019 (English)In: Frontiers in Neuroscience, ISSN 1662-4548, E-ISSN 1662-453X, Vol. 13, article id 1083Article in journal (Refereed) Published
Abstract [en]

A functional integration between the trigeminal and craniocervical sensorimotor systems has been demonstrated, with simultaneous jaw and head–neck movements during jaw opening–closing. We previously showed that pain induction in the masseter muscle increased the relative contribution of the neck component of integrated jaw–neck movements. Induced pain or manipulation of proprioception by vibration did not affect accuracy during a jaw-opening task in men. It is not known how multimodal sensory stimulation, with a combination of pain induction and vibration, affects jaw-opening accuracy and precision. The aim was to investigate how jaw–neck movements, and specifically accuracy and precision of jaw-opening, are affected during concomitant nociceptive and proprioceptive stimulation of the masseter muscle. Twenty-one healthy men performed jaw-opening to a target position, defined as 75% of individual maximum jaw opening, during control (Ctr), vibration of masseter muscles (Vib), pain induction in the masseter (Pain), and concomitant vibration and pain induction in the masseter muscle (VibPain). Simultaneous jaw and head movements were recorded with an optoelectronic system and amplitudes calculated for each jaw opening–closing cycle. Accuracy of jaw movements was defined as the achievement of the target position. Precision of jaw movements was defined as the cycle-to-cycle variability from the mean of cycles 2–10 (coefficient of variation, CV). Differences between the trials were analyzed with Friedman’s test, Dunn’s test, and Benjamini–Hochberg correction. There were no significant differences between the trials for jaw movement amplitudes. For head movements, amplitudes for cycles 2–10 were larger during Pain compared to Ctr and Vib (both p = 0.034), and larger during VibPain compared to Ctr (p = 0.034) and Vib (p = 0.035). There were no differences in accuracy of jaw movements between the trials. For precision of jaw movements, the cycle-to-cycle variability was larger during VibPain compared to Ctr (p = 0.027) and Vib (p = 0.018). For integrated jaw–neck motor strategy, there was a difference between pain and non-pain trials, but no differences between unimodal and multimodal stimulation trials. For achievement of jaw-opening to a target position, the results show no effect on accuracy, but a reduced precision of jaw movements during combined proprioceptive and nociceptive multimodal stimulation. 

Place, publisher, year, edition, pages
Frontiers Media S.A., 2019
Keywords
accuracy, head–neck movements, jaw movements, multimodal sensory stimulation, pain, precision, sensorimotor control, vibration
National Category
Occupational Health and Environmental Health
Research subject
no Strategic Research Area (SFO)
Identifiers
urn:nbn:se:hig:diva-30887 (URN)10.3389/fnins.2019.01083 (DOI)000497579400003 ()2-s2.0-85074161116 (Scopus ID)
Note

Funding: This study was supported by grants from Region Västernorrland, Research and Development.

Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2020-11-23Bibliographically approved
Lövgren, A., Österlund, C., Lampa, E., Ilgunas, A. & Hellström, F. (2018). A high prevalence of TMD is related to somatic awareness and pain intensity among healthy dental students. Acta Odontologica Scandinavica, 76(6), 387-393
Open this publication in new window or tab >>A high prevalence of TMD is related to somatic awareness and pain intensity among healthy dental students
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2018 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, no 6, p. 387-393Article in journal (Refereed) Published
Abstract [en]

Objective: Dental students have been identified as a group with high risks of developing both temporomandibular disorders (TMD) and psychosocial conditions. Our primary aim was to evaluate the cross-sectional prevalence of TMD diagnoses, as defined in the Diagnostic Criteria (DC)/TMD, among dental students. The secondary aim was to evaluate the prevalence and association of behavioural and psychosocial factors in relation to DC/TMD diagnoses.

Materials and methods: The study was conducted among undergraduate dental students during the second semester of their third year at the Department of Odontology, Medical Faculty, Umeå University, Sweden. Three consecutive cohorts were recruited during August in 2013, 2014, 2015. In total, 54 students were included and examined according the DC/TMD procedure.

Results and conclusions: The prevalence of any DC/TMD diagnosis was 30%. The most prevalent TMD diagnosis was myalgia. Individuals with a TMD-pain diagnosis (i.e. myalgia or arthralgia) reported significantly higher pain intensity levels according to the Graded Chronic Pain Scale (GCPS) as compared to individuals without TMD-pain (Fisher’s exact test p < .001, two-sided). In addition, individuals with any TMD scored significantly higher jaw functional limitations according to the Jaw Functional Limitation Scale 20 (JFLS-20, p < .001) and oral parafunctions according to the Oral Behavior Checklist (OBC, p = .005) as compared to individuals without TMD. The psychosocial factors evaluated did not differ between individual with or without a TMD diagnosis. The majority of the dental students reported symptoms that are already identified as risk factors for developing TMD and pain conditions. However, longitudinal data are needed to evaluate how this evolves over time.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Temporomandibular disorders, diagnostic criteria for temporomandibular disorders, psychosocial assessment, dental students
National Category
Dentistry
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-25619 (URN)10.1080/00016357.2018.1440322 (DOI)000439703200002 ()29457522 (PubMedID)2-s2.0-85042236037 (Scopus ID)
Available from: 2017-11-28 Created: 2017-11-28 Last updated: 2021-05-05Bibliographically approved
Rasmussen, C., Hallman, D. & Hellström, F. (2018). Symposia: Musculoskeletal pain as an outcome - how can we get better insight into the time course of musculoskeletal pain?. In: : . Paper presented at 20th Congress International Ergonomics Association, 26-30 augusti, 2018, Florens, Italy.
Open this publication in new window or tab >>Symposia: Musculoskeletal pain as an outcome - how can we get better insight into the time course of musculoskeletal pain?
2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Occupational Health and Environmental Health
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-28816 (URN)
Conference
20th Congress International Ergonomics Association, 26-30 augusti, 2018, Florens, Italy
Projects
PAINclass
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2009-1761
Available from: 2018-12-13 Created: 2018-12-13 Last updated: 2020-11-23Bibliographically approved
Projects
A longitudinal study to determine physiological biomarkers of relevance for the occurrence of neck pain in dentists. [2012-00726_Forte]; University of GävleUppkomst av nackbesvär inom tandläkaryrket, en longitudinell studie av arbetsställningens betydelse för besvärsutveckling [120336]; University of Gävle; Publications
Borg, T., Björklund, M., Djupsjöbacka, M., Wänman, A. & Hellström, F. (2016). Perceived muscular tension in healthy subjects: a cross-sectional study. In: PREMUS2016: Book of abstracts. Paper presented at 9th International Scientific Conference on the Prevention of Work-Related Musculoskeletal Disorders, Toronto, June 20-23, 2016. (pp. 411-411).
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4556-2846

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