OHRQoL: Children and Cranio Facial Pain Dr. Sven Widmalm

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OHRQoL Children and Cranio Facial PainDr.
Sven Widmalm
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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.

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• 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).

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• 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.

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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 .

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Palpation pain

• Lateral TMJ area 16
• Posterior TMJ area in 25
• Temporalis and masseter areas in 10

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Two Willow Run variables that are also part of
the present survey
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34 of the African-American, and 15 of the
Caucasian children admitted to having ear noises
(plt0.01).
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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.

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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.

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Is it difficult for you to bite hard?

• Can be related to
• intra- or extra articular TMJ dysfunction/patholog
  y.
• muscle soreness in heavy bruxism.
• damaged muscle or joint ligaments.
• mandibular fractures after trauma.

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Fractures are sometimes difficult to diagnose.
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Few people know that a slap on the face can be a
causative factor in TMD
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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.

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These structures are easily damaged by trauma to
the face.
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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 SS are found
  in children, there are no methods for prevention.

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• 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.

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• 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.