ohrqol children and cranio facial pain dr sven widmalm l.
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willow run
Together with Drs Richard Christiansen & Sondra Gunn I took part 10 years ago in studies of 540 4-6 year old pre-school children in Willow Run. I will give a few examples from that research. They may be of interest in relation to our present survey questions and statements.Willow Run
We found that
    • signs and symptoms of TMD, headache, and neck pain are common already in 5 year old children.
    • there were differences related to gender, race (Caucacian vs. African-American), and oral para-functions (thumb/finger sucking, nail biting, bruxism).
We strongly suspected that socio economic factors, that we could not include, had effect.
  • The Willow Run study was cross-sectional and we understood that prospective longitudinal studies in cooperation with relevant experts are needed.
some prevalence results from willow run
Some “prevalence results” from Willow Run
  • Recurrent pain (at least a couple of times every week)
    • TMJ pain 8 %
    • Neck pain 5 %
    • Headache 17 %
    • Earache 3 %
  • 25 % had pain or tiredness in the jaws during chewing.
  • 10 % had pain at jaw opening.
  • 13 % had problems in opening the mouth.
  • Reduced opening in 2 %.
palpation pain
Palpation pain
  • Lateral TMJ area 16 %
  • Posterior TMJ area in 25 %
  • Temporalis and masseter areas in 10 %
34 of the african american and 15 of the caucasian children admitted to having ear noises p 0 01
34 % of the African-American, and 15% of the Caucasian children admitted to having ear noises (p<0.01).
does it hurt when you open your mouth wide
“Does it hurt when you open your mouth wide?”
  • Strong indication of TMJ problem.
  • Can also indicate muscle-ligament damage.
  • A slap on the face can be the cause.
  • Some parents think it is OK to slap the face.
do you hear a noise clicking when you open your mouth wide and close it
“Do you hear a noise (clicking) when you open your mouth wide and close it?”
  • Clicking during opening and closing is a cardinal sign of disk displacement with reduction which may or may not be painful.
  • Crepitation is a cardinal sign of TMJ arthritis but seldom painful.
  • Juvenile Rheumatoid Arthritis (JRA) typically starts in the 2-4 year old group. The TMJs are affected eventually in more than 70% of all RA patients.
is it difficult for you to bite hard
“Is it difficult for you to bite hard?”
  • Can be related to
    • intra- or extra articular TMJ dysfunction/pathology.
    • muscle soreness in heavy bruxism.
    • damaged muscle or joint ligaments.
    • mandibular fractures after trauma.
does your face hurt when you chew on tough food
“Does your face hurt when you chew on tough food?”
  • Such pain is a cardinal symptom in TMD patients and can be related to
    • TMJ pathology
    • Muscle ligament damage
  • A standard advice to TMD patients is to avoid chewing on tough food.
old and new myths
Old and New Myths
  • Myth #1. TMD does not occur in children or young teenagers.
  • Myth # 2. You cannot trust answers from children.
  • Myth # 3. Even if TMD and related S&S are found in children, there are no methods for prevention.
Craniofacial pain and related pain, headache, neck pain, and TMJ pain, are costing the society a lot of money and have significant negative impact on Quality of Life.
I strongly believe that educational intervention can significantly reduce suffering from craniofacial pain by
    • identifying risk groups and risk factors
    • paying more attention to and helping children in risk groups
    • educate children, parents, teachers, and ourselves about how to recognize risk factors and reduce their influence.
  • Part of that can be done in this study. Many factors may deserve additional separate studies.