Annika Rosen - Academia.edu (original) (raw)

Papers by Annika Rosen

Journal of Pain Research

To investigate the outcome of patients with long-term refractory temporomandibular disorders (TMD... more To investigate the outcome of patients with long-term refractory temporomandibular disorders (TMD) three years after a Norwegian interdisciplinary evaluation program with attention to patient satisfaction, function, pain, and psychosocial variables. Patients and Methods: The study population consisted of 60 long-term refractory TMD patients who were investigated by a Norwegian interdisciplinary team. A questionnaire that covered medical history, function, pain, lifestyle factors, TMD-status and follow-up from their general medical practitioner (GMP) was sent to the patients three years after the evaluation. Questionnaires that assessed function (Mandibular Functional Index Questionnaire [MFIQ] and Roland Morrison Scale [RMS]), pain intensity (General Pain Intensity questionnaire [GPI]) and psychosocial factors (Hospital Anxiety and Depression scale [HADS]); a 2-item version of the Coping Strategies Questionnaire [CSQ]) were included in the package. Results: Thirty-nine out of 60 TMD patients completed the questionnaires. Improvements in TMD symptoms were reported in 10 patients (26%), were unchanged in 16 patients (41%) and worsened in 13 patients (33%). Only 8 patients (21%) were satisfied with the follow-up of the suggested treatments from their GMP. Significant improvements of symptoms were noted in MFIQ (jaw function), GPI (including pain intensity at maximum and suffering from pain), and CSQ (pain related catastrophizing), in all 39 TMD patients as one group. However, a subgroup analysis showed that the significant improvements were mostly within patients who reported improvement of TMD symptoms. A high pain intensity at baseline was a significant risk factor (OR = 5.79, 95% CI: 1.34, 24.96) for patients who reported worsening of TMD symptoms at follow-up. Conclusion: High pain intensity at baseline was a significant risk factor for poorer recovery three years after an interdisciplinary evaluation. Our data support the notion that improved coping with TMD pain includes both decreased pain intensity, CSQ and MFIQ scores.

Journal of Dental Education, 2016

The aim of this study was to evaluate a web-based simulation of patients (Web-SP) program on lear... more The aim of this study was to evaluate a web-based simulation of patients (Web-SP) program on learning skills in clinical reasoning and patient evaluation in the oral surgery education of third-year dental students. A secondary aim was to investigate the program's effect on students' learning, knowledge, and attitudes towards virtual patient simulations. Authentic virtual oral surgery patient cases were created at a dental school in Sweden using the Web-SP platform. The Web-SP program was introduced in a two-hour seminar. A 20-minute pre-seminar test (test A) was administered to assess the students' knowledge of oral surgery prior to experiencing the Web-SP program. Ten days after the seminar, another test (test B) was administered to evaluate the increase in oral surgery knowledge as a result of using the program, and an emailed survey of the students was conducted. Of 70 students in the course, 67 (95.7%) agreed to participate in the study and took test A; of these, 59 (88%) took test B. Of the 59 students who took both tests, 28 (42%) completed the survey. The results of the two tests showed a statistically significant increase in knowledge, which was in accordance with the learning goals (p<0.0001). The survey results showed that the students had a positive attitude towards the teaching method. In this study, Web-SP was found to be a valuable tool for teaching clinical reasoning and patient evaluation in an undergraduate oral surgery education setting by improving learning outcomes in comparison with traditional teaching alone.

International journal of oral and maxillofacial surgery, 2011

Orthognathic surgery in patients with osteogenesis imperfecta is rare. Most cases result in a suc... more Orthognathic surgery in patients with osteogenesis imperfecta is rare. Most cases result in a successful outcome with stable and good occlusion. Two patients with, probably severe types III and IV, and malocclusion class III with retrognathic maxilla and prognathic mandible, were treated with orthodontic treatment and bimaxillary surgical correction. The surgical outcome and follow up are presented together with a review of published cases of orthognathic surgery in patients with different types of osteogenesis imperfecta. The authors conclude that it is possible to perform combined orthodontic and orthognathic surgery in patients with osteogenesis imperfecta despite the greater risk of complications. The treatments were successful with follow up times of 5-6 years.

Regulatory Peptides, 1994

Various procedures for extraction at acid, neutral and alkaline pH were compared with regard to t... more Various procedures for extraction at acid, neutral and alkaline pH were compared with regard to the yield of different tachykinins and tachykinin-like substances from rat spinal cord. Reverse phase high performance liquid chromatography (RP-HPLC) and radioimmunoassay with various C-terminally directed tachykinin antisera and a newly developed N-terminally directed substance P (SP)-antiserum (SPN 1) were used. Antiserum SPN 1 fully reacts with SP-analogues modified at the C-terminal end (SP free acid and SP-Gly-Lys) and also (77%) with SP(1-9) but not with C-terminal SP-fragments lacking 2 or more N-terminal amino acids. The highest levels of SP-like immunoreactivity (LI) and neurokinin A (NKA)-LI were measured after combined water and acetic acid extraction procedures. Also when measuring cholecystokinin-like immunoreactivity the highest level was obtained following this extraction procedure. RP-HPLC revealed a major component of SP-LI at the position of synthetic SP irrespectively of the extraction method and if the C-or N-terminally directed antiserum was used. Neutral water extracts contained a late eluting component detected with the C-terminally, but not with the N-terminally, directed antiserum. Acid and alkaline extracts, in contrast, contained components which could be detected with the N-terminally, but not with the C-terminally, directed SP-antiserum. Immunoreactive components eluting at the position of NKA and NKB were found in all types of extracts with NKA-, kassinin-and eledoisin-antisera. The NKB-and neuropeptide K (NPK)-components were more prominent in acid than in neutral and alkaline extracts. In conclusion, the present results indicate that rat spinal cord may contain molecular forms of tachykinin-like immunoreactivity in addition to those previously described and illustrate the importance of the choice

Regulatory Peptides, 1988

Three tachykinins, substance P (SP) neurokinin A (NKA) and neurokinin B (NKB) and various elongat... more Three tachykinins, substance P (SP) neurokinin A (NKA) and neurokinin B (NKB) and various elongated (precursor) forms of SP and NKA, e.g. neuropeptide K (NPK), have been identified in mammalian tissues. However, there may exist additional molecular forms of mammalian tachykinins. Five previously described extraction methods were used: I. Incubation of the minced rat spinal cord 10 min at 95'C in 1.0 M acetic acid followed by homogenization (1). II. Same as in I but with distilled water as extraction medium (2). III. Same as in I but with 0.1M NaOH as extraction medium (previously used for extraction of cholecystokinin, 3). IV. Homogenization at 4°C in 1.0 M acetic acid containing 10 mM HC1, 0.1% betamercaptoethanol and 0.1~ trifluoroacetic acid (4). V. Same as in IV but with O.t M HC1 as extraction medium (5). For radioimmunoassay (RIA), antisera raised against SP, NKA, kassinin (KAS) and eledoisin (ELE) were used. All antisera (except one N-terminally directed SP-antiserum) were Cterminally directed. The immunoreactive material was characterized with reversed phase (RP)-HPLC. Extraction in hot acetic acid (method I) yielded the highest levels of immunoreactivity measured with both C-and N-terminally directed antisera againist SP as well as with the NKA-and KAS-antisera. However, when the ELE-antiserum was used, the highest levels were obtained with hot water as extraction medium (method II). Similar levels were measured with the Cand N-terminally directed SP-antiserum in all types of extracts except in alkaline extracts (method III) in which the N-terminally directed antiserum measured two times higher levels compared to the C-terminally directed antiserum. All acid extracts (method I, IV and V) contained immunoreactive components which coeluted on RP-HPLC with SP, NKA, NPK and NKB. Only very minor components were found at the position of the sulfoxide forms of these peptides. In acid extracts the antisera raised against NKA, KAS and ELE also reacted with components eluting immediately before and after NKA, respectively. Neutral water extracts (method II) contained components coeluting with SP, NKA (but not NPK), NKB and a late eluting component which was detected with the C-terminal but not with the N-terminal SP-antiserum. Alkaline extracts (method III) contained at least 5 immunoreactive components detectable with the N-terminally directed, but not with the C-terminally directed antiserum. The present results suggest that rat spinal cord contains molecular forms of tachykinins in addition to those previously described. Furthermore, the results illustrate the importance of the choice of extraction method in immunochemical studies on tachykinins.

Neuroscience, 1991

The levels of 5-hydroxytryptamine and tachykinin neuropeptides substance P, neurokinin A, neuroki... more The levels of 5-hydroxytryptamine and tachykinin neuropeptides substance P, neurokinin A, neurokinin B and neuropeptide K were measured in the spinal cord of rats treated by intraventricular injection of the selective serotonergic neurotoxin 5,7-dihydroxytryptamine. The spinal cord levels of 5-hydroxytryptamine as measured by high performance liquid chromatography with electrochemical detection decreased by more than 90% in the ventral and dorsal cord compared to controls. The levels of substance P as measured by radioimmunoassay were significantly reduced (66%, P less than 0.01) in the ventral lumbar cord only. In this region, neurokinin A, neurokinin B and neuropeptide K levels were determined by combined high performance liquid chromatography and radioimmunoassay. The neurotoxin treatment also caused a significant reduction of neurokinin A (72% reduction, P less than 0.01) and a non-significant reduction of neuropeptide K, but virtually no change in the neurokinin B level. Immunohistochemical studies of the ventral lumbar cord of sham-operated animals showed immunoreactivity for 5-hydroxytryptamine as well as for substance P and neurokinin A in nerve fibres around motor neurons. In neurotoxin-treated rats this region was devoid of immunohistochemically detectable substance P- and neurokinin A-positive fibres and showed very sparse or no 5-hydroxytryptamine immunoreactivity. We conclude that among the tachykinins both neurokinin A and substance P, but probably not neurokinin B, co-exist with 5-hydroxytryptamine in nerve terminals in the rat ventral spinal cord.

Neuropharmacology, 1996

The effect of opioid receptor agonists and antagonists on the electrically evoked release of endo... more The effect of opioid receptor agonists and antagonists on the electrically evoked release of endogenous serotonin (5_hydroxytryptamine, 5-HT) was studied in superfused slices of the rat ventral lumbar spinal cord. Met-ENK (1 x 10-8M-1 x lo-"M) and DPDPE (1 x 10psM-l x lo-"M) reduced the evoked 5-HT release in a concentration dependent fashion. DAMGO (1 x 10-'-l x lo-"M) and (-)-trans-(lSJS)-U-50488 (1 x 10e6M) had no effect on the 5-HT release. The inhibitory effect of met-ENK was completely abolished by ICI-174,864, but neither by naloxonazine nor nor-binaltorphimine. Following i.c.v. treatment with 5,7_dihydroxytryptamine (5,7-DHT), the tissue concentration of 5-HT was reduced by 97%, whereas the concentration of noradrenaline was reduced by only 5%. The tissue concentration of met-ENK, as measured by radioimmunoassay, was not significantly altered. The results suggest that met-ENK is present in the rat ventral spinal cord mainly in non-serotonergic nerve terminals and exerts an inhibitory action on 5-HT release via S opioid receptors.

Neuropeptides, 1995

The effects of acute systemic treatment with alaproclate, a serotonin uptake blocker on regional ... more The effects of acute systemic treatment with alaproclate, a serotonin uptake blocker on regional brain tissue levels of substance P, neurokinin A and cholecystokinin were studied in the rat. The peptide levels of all three peptides were increased (23-35%) in the rat periaqueductal grey 60 min after treatment with alaproclate (20 #mol/kg peroral, p.o.), compared to controls. In the cingulate cortex, the tissue levels of substance P and cholecystokinin were increased (19-32%) after subcutaneous (s.c.) treatment with alaproclate, compared to controls. Higher tissue levels of all three peptides (20-38%) in the periaqueductal grey, and lower levels of substance P and cholecystokinin in the cingulate cortex were found following saline s.c. compared to saline p.o., probably due to different degrees of stress. In microdialysis experiments, a s.c. injection of either saline (2 ml/kg), alaproclate (20/~mol/kg) or morphine (3 mg/kg) was found to slowly increase the substance P release in the periaqueductal grey. Experiments with the selective 5-HT neurotoxin, 5,7-dihydroxytryptamine indicated no neuronal coexistence of substance P and serotonin in the periaqueductal grey and cingulate cortex. In conclusion, acute treatment with the serotonin uptake blocker alaproclate increases both the tissue level and the release of substance P in the periaqueductal grey.

Neuropeptides, 1994

The effect of specific stressful stimuli on neuropeptide levels was studied in rat brain regions ... more The effect of specific stressful stimuli on neuropeptide levels was studied in rat brain regions known to be involved in the mediation of stress responses and anxiety. Rats were sequentially removed, one by one with 20-min intervals from group cages and immediately decapitated. A selective increase of the somatostatin level was observed in the amygdala in the rats taken for sacrifice second last and last, compared to the rats taken earlier from the respective group cage (increases by 40 to 69%, p c 0.05 or p c 0.01). Isolation of rats in single cages for 24 h or 1 week before sacrifice, increased the substance P level in the dorsal periaqueductal grey by 26 and 27% (p c 0.05 in both cases), respectively, compared to group housed rats. In group housed rats treated with diazepam (5 mg/kg, s.c.) 140 min before sacrifice, the level of substance P in the rostra1 hippocampus and dorsal periaqueductal grey was reduced by 40% (p e 0.001) and 28% (p < 0.05), respectively, compared to saline treated controls. In conclusion, handling, as well as a single dose of the anxiolytic drug diazepam, appears to induce rapid, selective and region-specific changes of regional brain peptide levels in the rat. The effects of handling are likely to be related to the acute stress response and are probably not secondary to increased plasma glucocorticoid levels.

Journal of Oral and Maxillofacial Surgery, 2007

Purpose: To evaluate retrospectively the surgical outcome of tilted implants in severely resorbed... more Purpose: To evaluate retrospectively the surgical outcome of tilted implants in severely resorbed edentulous maxillas as an alternative to bone grafting and the prosthodontic outcome of posterior extension bridges on tilted implants. Patients and Methods: A total of 33 consecutive patients with severely resorbed edentulous maxillas participated in the study. In these patients, the maxillary bone volumes were insufficient for conventional placement of implants to support a fixed prosthesis. As an alternative to bone transplantation, a surgical technique with fenestration of the maxillary sinus to visualize the total amount of maxillary bone was used, followed by implant placement in a tilted manner along the anterior maxillary sinus wall. Thus, 4 to 6 implants of optimal length could be installed in each patient. Nineteen patients were included in this long-term follow-up study and were eligible for clinical evaluation at 8 to 12 years (mean, 10 years) after second-stage surgery. Each patient was examined clinically and radiographically. Results: The 19 patients had a total of 103 implants. In 2 of these patients, 3 fixtures were lost during the first year after second-stage surgery. All other patients had all implants intact with functionally fixed dental prostheses, corresponding to a success rate of 97%. Radiographic examination showed bone resorption in 10% of the implants (10 implants in 5 patients with a total number of 27 implants), with a mean bone loss of 1.2 mm. Mucositis was seen in 47% of the patients. Conclusions: This long-term follow-up study (mean time, 10 years) demonstrates that patients with a severely resorbed maxilla can be treated successfully with conventional implant treatment. This simplified surgical technique can be an alternative to the more resource-demanding technique with bone grafting.

Journal of Oral and Maxillofacial Surgery, 2012

Purpose: Patients with limited jaw opening and movement-evoked pain from the temporomandibular jo... more Purpose: Patients with limited jaw opening and movement-evoked pain from the temporomandibular joint have moderate to severe pain that may be relieved by surgery. The purpose of this study was to investigate if the preoperative state is associated with alterations in plasma ␤-endorphin (␤E) levels and pain thresholds. Patients and Methods: Eighteen female patients with painful unilateral temporomandibular joint and 18 age-matched healthy women participated. After blood sampling for analysis of plasma ␤E levels, pressure pain thresholds over the masseter muscles and index fingers were recorded with an electronic algometer. Electrical detection and pain thresholds were recorded with the PainMatcher (Cefar Medical AB, Lund, Sweden) device. Nonparametric statistics, ie, Mann-Whitney U test and Spearman correlation test, was used for statistical analyses. Results: The patients showed higher plasma ␤E levels (P ϭ .013) and lower pressure pain thresholds over the masseter muscle at the painful side (P ϭ .041) and bilaterally over the index fingers compared with the controls (P Ͻ .05 for all comparisons). High plasma ␤E levels correlated to increased electrical detection thresholds (n ϭ 36, r ϭ 0.347, P ϭ .038). Conclusions: This study showed that patients with limited jaw opening and movement-evoked pain from the temporomandibular joint had significantly higher plasma ␤E levels and lower pressure pain thresholds in the orofacial area and at remote sites compared with pain-free, healthy, age-matched controls. An increased level of ␤E seems insufficient to inhibit pain and central sensitization. Further studies are warranted to elucidate the relation between ␤E and pain thresholds secondary to stress, inflammation, and discectomy.

European Journal of Pain, 2009

dose of 2.1 joule was used. The control group was exposed with an indifferent dose. The maximal r... more dose of 2.1 joule was used. The control group was exposed with an indifferent dose. The maximal range of painless mouth opening was measured pre and post laser exposure. Using a VAS, patients reported their pain felt at the end of that range. The maximal mouth opening (MMO) was measured at the end of each session. Results: In the experimental group, the maximal range of painless opening increased significantly (p = 0.019 and p=0.005) after the first and second session but not after the 3 and 4 session (p =0.160 and p=0.228) (paired t-test ANOVA). Less pain was reported on a VAS in the first and second session (p =0.041 and p=0.023), but not in the 3 and 4 session (p =0.408 and p=0.414) (Wilcoxon). However, the MMO did not increase significantly (Friedman’s test). Conclusion: Low power laser exposure could increase the range of painless mouth opening in patients with arthrogenous TMJ disorder but not the MMO.

European Journal of Neuroscience, 2005

British Journal of Oral and Maxillofacial Surgery, 2008

Excessive blood loss is a serious but rare complication of orthognathic surgery. The aim of this ... more Excessive blood loss is a serious but rare complication of orthognathic surgery. The aim of this study was to find out whether template bleeding time (TBT) could detect primary bleeding disorders in patients having orthognathic operations and how many false positive tests there were. We also examined the correlation between the perioperative bleeding rate and the result of preoperative TBT. Patients who had orthognathic operations at Karolinska University Hospital, Huddinge, from August 2001 to December 2006, were screened preoperatively by measuring TBT and the records of their operations were reviewed retrospectively. Prolonged TBT was recorded in 20 patients (13%), 19 female and 1 male (P=0.02). After further examination, 10 of these patients were found to have a primary disorder of haemostasis. No detectable reason for the prolonged TBT could be found in the others. There was no significant difference in perioperative bleeding rate between patients with prolonged and normal TBT or between TBT and perioperative bleeding rate. In conclusion, the routine use of preoperative TBT for haemostatic screening in orthognathic surgery cannot be recommended because of the large number of false positive results. There was no significant correlation between prolonged TBT and bleeding during orthognathic surgery.

Brain Research, 2000

The newly identified neuropeptide nociceptinrorphanin FQ NOC was measured in different rat brain ... more The newly identified neuropeptide nociceptinrorphanin FQ NOC was measured in different rat brain areas related to the descending Ž. Ž. anti-nociceptive pathways and compared to two opioid peptides, dynorphin B DYN B and Met-enkephalinArgPhe MEAP. Two experimental models of chronic nociception, one neurogenic and one inflammatory, used in this study, reveal how different pathological conditions may influence these endogenous systems. Nerve injury is induced by ligation of the sciatic nerve and inflammation by a carrageenan injection in the gluteal muscle, 2 weeks prior to decapitation. Selected brain areas were dissected out and frozen. NOC-, Ž. DYN Band MEAP-like immunoreactivity LI is determined by radioimmunoassay. Nerve injury increased the NOC-LI levels in the cortex cinguli, DYN B-LI levels in the dorsal and the ventral part of the spinal cord, whereas a decrease in the MEAP-LI levels is seen in Ž. the dorsal part of the periaqueductal grey PAG. After inflammation, the NOC-LI levels increased in cortex cinguli, hypothalamus and in the dorsal spinal cord, whereas DYN B-LI levels increased in the dorsal part of the PAG. A general increase in MEAP-LI levels is found after inflammation in all analyzed brain areas except in hippocampus. In conclusion, increased levels of NOC-LI were found in cortex cinguli in both treatment groups and in hypothalamus and spinal cord following carrageenan treatment. The changes in the NOC-LI concentrations were not parallelled by changes in DYN B-LI and MEAP-LI, suggesting that NOC and opioid peptides elicit different reactions in the systems of nociceptionrantinociception.

Acta Physiologica Scandinavica, 1989

L'effet de chocs electriques convulsifs sur les taux de tachykinine dans les centres nerveux ... more L'effet de chocs electriques convulsifs sur les taux de tachykinine dans les centres nerveux superieurs du rat est compare a celui d'un traitement subchronique d'inhibiteurs de la 5-hydroxytryptamine. Les taux tissulaires des cholecystokinine sont mesures dans la substance grise peri-aquaducale

BMC Oral Health

Background Vitamin D deficiency has been associated with autoimmune diseases and oral health. Kno... more Background Vitamin D deficiency has been associated with autoimmune diseases and oral health. Knowledge about the association between vitamin D status and oral conditions in JIA is limited. We aimed to investigate vitamin D status in a cohort of Norwegian children and adolescents with JIA and possible associations between serum vitamin D levels, clinical indicators of oral health, and JIA disease characteristics. Methods This multi-center, cross-sectional study, included individuals with JIA aged 4–16 years from three geographically spread regions in Norway. Demographic data, age at disease onset, disease duration, JIA category, disease status, medication, and vitamin D intake were registered. One blood sample per individual was analyzed for 25(OH) vitamin D, and the level of insufficiency was defined as < 50 nmol/L. A clinical oral examination was performed applying commonly used indices in epidemiological studies of dental caries, dental erosion, enamel defects, gingival bleedi...

ABSTRACT    39 Correlations between TMJ disorders and systemic diseases. A retrospective mappi... more ABSTRACT    39 Correlations between TMJ disorders and systemic diseases. A retrospective mapping study from patients’ journals. A Salinas Fredricson, A Rosén Division of Oral and Maxillofacial Surgery, Depart¬ment of Dental Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden Aim: The purpose of this study was to map the correla¬tion between systemic diseases and temporoman¬dibular joint (TMJ) disorders in patients suffering from painful (PC) clicking or chronic closed lock (CCL) of the disc. TMJ disorders (TMJD) is a term encompassing functional problems and give rise to pain both in movement and in rest. The disorders involve muscular problems, which can be stress in¬duced or due to bruxism and disc displacement in the joint. There is an obvious female predominance and preliminary data have shown that TMJ patients have other diseases that may involve the lungs. Materials and Methods: The study population consisted of patients that had been diagnosed with chronic closed lock or painful clicking and treated surgically during the years 2007- 2011 at the Division of Oral and Maxillofacial Sur¬gery, Karolinska University Hospital, Huddinge. 261 patient journals were thoroughly gone through and their medical history was recorded in accordance to the auto anamnesis that is given to all patients at their first visit to the clinic. Results: The study showed a higher percentage of asthmatics in the patient group compared to the general public health. It was also shown that a lot of the patients suffer from headaches, neck and back problems, and general joint diseases. The age median was 44, similar to reports from earlier studies. However, the male/female ratio was shown to be 1:6.5 in patients suffering from CCL and 1:4 in patients suffering from PC, the results differ slightly from earlier stu¬dies, as the percentage of female patients suffering from CCL was higher than other studies claim. Conclusion: This study showed that the dominance of women was higher for CCL patients than for PC. TMJ dis-orders were more frequent in the age of 30-50. The most common diseases in patients suffering from TMJ disorders were general muscle and/or joint di¬seases and allergy and/or asthma. It is essential to expand the case group and also investigate what sort of treatment that has been given to these patients. Future studies should emphasize on the correlation between TMJ disorders and asthma, hypermobility, general joint diseases and neck and/or back pro¬blems. swedish dental journal vol. 37 issue 4 2013