1
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Rossi-Fedele G, Ng YL. Effectiveness of root canal treatment for vital pulps compared with necrotic pulps in the presence or absence of signs of periradicular pathosis: A systematic review and meta-analysis. Int Endod J 2023; 56 Suppl 3:370-394. [PMID: 36107038 DOI: 10.1111/iej.13833] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/30/2022] [Accepted: 09/12/2022] [Indexed: 10/20/2023]
Abstract
BACKGROUND Preoperative pulpal status may influence the outcomes of root canal treatment (RCTx) according to various measures used. OBJECTIVES To compare the effectiveness of RCTx of teeth with a vital pulp versus a necrotic pulp, using a range of clinical and patient-related outcomes proposed for the development of S3-level clinical practice guidelines. METHODS A search was conducted in the PubMed-MEDLINE, Scopus, EMBASE, Google scholar databases and available repositories, followed by hand searches, until 29 March 2022. Clinical studies published in the English language comparing the stipulated outcomes of RCTx of teeth with vital versus necrotic pulp were included. The Newcastle-Ottawa Scale was adapted to assess study quality. Effects of pulpal status were estimated and expressed as risk ratio (RR) using fixed- and random-effect meta-analyses. The quality of evidence was assessed through the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS Twenty-eight studies published between 1961 and 2021 were included. Five studies have investigated the "tooth survival" outcome, four reported pulpal status was not a significant predictor, consistent with meta-analysis findings (RR: 1.00; 95% CI: 1.00, 1.00; n = 3). Seven studies reported pulpal status had no significant influence on postoperative pain, regardless of duration after treatment. Sixteen studies have analysed "periapical health," and 11 revealed pulpal status had no significant influence. Meta-analyses revealed the influence was not significant if preoperative periapical radiolucency was absent (RR: 0.95; 95% CI: 0.90, 1.00; n = 9) but significant if it was present (RR: 1.12; 95% CI: 1.05, 1.19; n = 11). Most studies were classified as "some concerns" (n = 17) to "low" (n = 9) risk of bias RoB. DISCUSSION Evidence is limited and only available for three outcomes when comparing the effectiveness of RCTx in permanent teeth with vital pulp versus pulp necrosis. Nevertheless, the quality of available evidence was moderate to high. The "periapical health" data heterogeneity could be explained by preoperative radiolucency, thus RCTx was found more effective for prevention than the resolution of apical periodontitis. CONCLUSIONS There was no significant difference in the "tooth survival," "postoperative pain" and "evidence of apical radiolucency" outcomes of RCTx in teeth with vital or necrotic pulps. REGISTRATION PROSPERO database (CRD42021260280).
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Affiliation(s)
| | - Yuan-Ling Ng
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, UK
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2
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Klasser GD, Goulet JP, Moreno-Hay I. Classification and Diagnosis of Temporomandibular Disorders and Temporomandibular Disorder Pain. Dent Clin North Am 2023; 67:211-225. [PMID: 36965927 DOI: 10.1016/j.cden.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Designing classification systems and developing diagnostic criteria for temporomandibular disorders is difficult. An appreciation of the utility and applicability of these entities requires an understanding of the importance of each, the differences between the two, and how they may be optimally operationalized for both clinical and research activities in light of their inherent advantages and limitations. In addition, consideration for adopting newer approaches, such as following ontological and precision-based medicine principles, accounting for genetics/epigenetic and neurobiological factors, and the inclusion of biomarkers will potentially result in more thorough and comprehensive classification systems and diagnostic criteria.
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Affiliation(s)
- Gary D Klasser
- Department of Diagnostic Sciences, School of Dentistry, Louisiana State University Health Sciences Center, 1100 Florida Avenue, Box #8, New Orleans, LA 70119, USA.
| | - Jean-Paul Goulet
- Pavillon de Médecine Dentaire, Université Laval, 2420 Rue de La Terrasse, Québec, G1V 0A6, Canada
| | - Isabel Moreno-Hay
- Orofacial Pain, College of Dentistry, University of Kentucky, Kentucky Clinic, Room E214, 740 S Limestone, Lexington, KY 40536, USA
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3
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Abstract
The International Classification of Orofacial Pain (ICOP) describes idiopathic pain as "unilateral or bilateral intraoral or facial pain in the distribution(s) of one or more branches of the trigeminal nerve(s) for which the etiology is unknown. Pain is usually persistent, of moderate intensity, poorly localized and described as dull, pressing or of burning character." Several diagnoses are included in the ICOP Idiopathic pain section, burning mouth syndrome and persistent idiopathic facial and dentoalveolar pain. This article, with a representative case presentation, briefly discusses common features that may lead to a common central cause for a variety of peripheral complaints.
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4
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Yang J, Shao Y, Li B, Yu QY, Ge QM, Li B, Pan YC, Liang RB, Wu SN, Li QY, He YL. Altered regional homogeneity of spontaneous brain activity in patients with toothache: A resting-state functional magnetic resonance imaging study. Front Neurosci 2022; 16:1019989. [PMID: 36248652 PMCID: PMC9554534 DOI: 10.3389/fnins.2022.1019989] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Toothache (TA) is a common and severe pain, but its effects on the brain are somewhat unclear. In this study, functional magnetic resonance imaging (fMRI) was used to compare regional homogeneity (ReHo) between TA patients and a normal control group and to explore the brain activity changes during TA, establishing the theoretical basis for the mechanism of neuropathic pain. In total, 20 TA patients and 20 healthy controls (HCs) were recruited and underwent assessment of pain, and then resting-state fMRI (rs-fMRI). The ReHo method was used to analyze the original whole-brain images. Pearson’s correlation analysis was used to assess the relationship between mean ReHo values in each brain region and clinical symptoms, and the receiver operating characteristic (ROC) curve was used to conduct correlation analysis on the brain regions studied. The ReHo values of the right lingual gyrus (RLG), right superior occipital gyrus (RSOG), left middle occipital gyrus (LMOG) and right postcentral gyrus (RPG) in the TA group were significantly higher than in HCs. The mean ReHo values in the RLG were positively correlated with the anxiety score (AS) (r = 0.723, p < 0.001), depression score (DS) (r = 0.850, p < 0.001) and visual analogue score (VAS) (r = 0.837, p < 0.001). The mean ReHo values of RSOG were also positively correlated with AS (r = 0.687, p = 0.001), DS (r = 0.661, p = 0.002) and VAS (r = 0.712, p < 0.001). The areas under the ROC curve of specific brain area ReHo values were as follows: RLG, 0.975; RSOG, 0.959; LMOG, 0.975; RPG, 1.000. Various degrees of brain activity changes reflected by ReHo values in different areas of the brain indicate the impact of TA on brain function. These findings may reveal related neural mechanisms underlying TA.
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Affiliation(s)
- Jun Yang
- The Key Laboratory of Oral Biomedicine, The Affiliated Stomatological Hospital of Nanchang University, Nanchang, China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiu-Yue Yu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qian-Min Ge
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Biao Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi-Cong Pan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Rong-Bin Liang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shi-Nan Wu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiu-Yu Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu-Lin He
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Yu-Lin He,
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5
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Sanner F, Sonntag D, Hambrock N, Zehnder M. Patients with persistent idiopathic dentoalveolar pain in dental practice. Int Endod J 2021; 55:231-239. [PMID: 34792207 PMCID: PMC9300172 DOI: 10.1111/iej.13664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
Abstract
Aim To assess whether persistent idiopathic dentoalveolar pain (PIDAP), a diagnosis of exclusion, exhibits common features that can facilitate its diagnosis. PIDAP is defined by the International Classification of Orofacial Pain (ICOP 6.3.) as ‘Persistent unilateral intraoral dentoalveolar pain, rarely occurring in multiple sites, with variable features but recurring daily for more than 2 h per day for more than 3 months, in the absence of any preceding causative event’. Methodology In this observational study, participants fulfilling the new ICOP diagnostic criteria of PIDAP were included, covering 16 years of consecutive data. A systematic, retrospective assessment of patients utilizing the new PIDAP criteria on complaints of chronic tooth pain in a referral‐based endodontic practice was undertaken. Non‐idiopathic cases were excluded on the basis of clinical and radiologic findings. A modified neuropathic pain questionnaire was used to describe the painful sensations. Furthermore, allodynia in the periodontal space and sensory changes in the oral mucosa were assessed using a periodontal probe. Results Amongst the 160 patients assessed, 78 (63 women) fulfilled the strict PIDAP criteria. Pain history of PIDAP included no nocturnal awakening (85%) and a ‘pulling/dragging’ pain quality (59%). In 69% of the patients with PIDAP, pain was associated with a root filled tooth at the same site. In 14% of the cases, no endodontic treatment was performed in the affected quadrant. Mechanical allodynia in the gingival sulcus was observed in 91% of patients with painful teeth or implants. Conclusions In this observational study, PIDAP mainly affected females and was associated with undisturbed sleep and periodontal allodynia.
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Affiliation(s)
| | - David Sonntag
- Carolinum, Clinic of Conservative and Preventive Dentistry, Frankfurt am Main, Germany
| | | | - Matthias Zehnder
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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6
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Pigg M, Nixdorf DR, Law AS, Renton T, Sharav Y, Baad-Hansen L, List T. New International Classification of Orofacial Pain: What Is in It For Endodontists? J Endod 2020; 47:345-357. [PMID: 33340605 DOI: 10.1016/j.joen.2020.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/14/2020] [Accepted: 12/09/2020] [Indexed: 12/15/2022]
Abstract
Pain is a common symptom in endodontic conditions, but differential diagnostic procedures are often needed to exclude other pain origins. Thus, general dentists and endodontists need to be aware of alternative painful orofacial conditions and be able to identify them. The new International Classification of Orofacial Pain (ICOP) is the first comprehensive classification that uniquely deals with orofacial pain. The ICOP is a hierarchical classification modeled on the International Classification of Headache Disorders and covers pain in dentoalveolar and anatomically related tissues, muscle pain, temporomandibular joint pain, neuropathic pain affecting cranial nerves, pain resembling primary headaches, and idiopathic pain in the orofacial region. A description of each condition is given, and structured diagnostic criteria for each condition are proposed based on research data when available. This narrative review aims (1) to give an overview and brief explanation of the ICOP system, (2) to describe and give examples of how it can be of use to general dentists and endodontists with special attention to differential diagnosis of tooth pain, and (3) to highlight how endodontic research can contribute to validation and improvement of the classification. A comparison to other classification and diagnostic systems is also included.
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Affiliation(s)
- Maria Pigg
- Department of Endodontics, Malmö University, Malmö, Sweden; Scandinavian Centre for Orofacial Neurosciences, Aarhus, Denmark.
| | - Donald R Nixdorf
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minnesota; Department of Neurology, University of Minnesota, Minnesota; Department of Radiology, Medical School, University of Minnesota, Minnesota
| | - Alan S Law
- Division of Endodontics, School of Dentistry, University of Minnesota, Minnesota; Private Practice, The Dental Specialists, Lake Elmo, Minnesota
| | - Tara Renton
- Oral Surgery, Centre for Oral, Clinical and Translational Sciences, King's College Hospital, London, United Kingdom; Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, United Kingdom
| | - Yair Sharav
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Lene Baad-Hansen
- Scandinavian Centre for Orofacial Neurosciences, Aarhus, Denmark; Department of Dentistry and Oral Health, Section for Orofacial Pain and Jaw Function, Aarhus University, Aarhus, Denmark
| | - Thomas List
- Scandinavian Centre for Orofacial Neurosciences, Aarhus, Denmark; Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden
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7
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Currie CC, Ohrbach R, De Leeuw R, Forssell H, Imamura Y, Jääskeläinen SK, Koutris M, Nasri-Heir C, Huann T, Renton T, Svensson P, Durham J. Developing a research diagnostic criteria for burning mouth syndrome: Results from an international Delphi process. J Oral Rehabil 2020; 48:308-331. [PMID: 33155292 DOI: 10.1111/joor.13123] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/30/2020] [Accepted: 10/30/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To develop a beta version of a preliminary set of empirically derived research diagnostic criteria (RDC) for burning mouth syndrome (BMS) through expert consensus, which can then be taken into a test period before publication of a final RDC/BMS. DESIGN A 6 round Delphi process with twelve experts in the field of BMS was used. The first round formed a focus group during which the purpose of the RDC and the definition of BMS was agreed upon, as well as the structure and contents. The remaining rounds were carried out virtually via email to achieve a consensus of the beta version of the RDC/BMS. RESULTS The definition of BMS was agreed to be 'an intraoral burning or dysaesthetic sensation, recurring daily for more than 2 hours per day over more than 3 months, without evident causative lesions on clinical examination and investigation'. The RDC was based upon the already developed and validated RDC/TMD and formed three main parts: patient self-report; examination; and psychosocial self-report. A fourth additional part was also developed listing aspirational biomarkers which could be used as part of the BMS diagnosis where available, or to inform future research. CONCLUSION This Delphi process has created a beta version of an RDC for use with BMS. This will allow future clinical research within BMS to be carried out to a higher standard, ensuring only patients with true BMS are included. Further validation studies will be required alongside refinement of the RDC as trialling progresses.
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Affiliation(s)
- Charlotte C Currie
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Ohrbach
- School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - Reny De Leeuw
- College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - Heli Forssell
- Institute of Dentistry, University of Turku, Turku, Finland
| | | | | | - Michail Koutris
- Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Tan Huann
- King's College London Dental Institute, London, UK
| | - Tara Renton
- King's College London Dental Institute, London, UK
| | - Peter Svensson
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Justin Durham
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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8
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Dawson A, Dawson J, Ernberg M. The effect of botulinum toxin A on patients with persistent idiopathic dentoalveolar pain-A systematic review. J Oral Rehabil 2020; 47:1184-1191. [PMID: 32640063 DOI: 10.1111/joor.13053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/01/2020] [Accepted: 06/30/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND It has been suggested that botulinum toxin A (BONT-A) is a safe and effective treatment in relieving pain in patients with persistent idiopathic dentoalveolar pain (PIDP). OBJECTIVES This study aimed to systematically evaluate all the available studies investigating the pain-relieving effects of BONT-A in patients with PIDP. METHODS A systematic search with specific search terms was made in PubMed, Web of Science and Scopus. Two authors screened titles and abstracts and selected eligible studies for inclusion in the systematic review. The quality of the studies was evaluated by the 12 items Quality Assessment Tool for Observational studies (Pre-Post) Studies with No Control Group, and the level of evidence was assessed according to GRADE. RESULTS Three observational studies of 3695 identified were included (445 overlapping studies; 3247 excluded studies). All studies were uncontrolled observational studies investigating the pain-relieving effect of BONT-A in patients with PIDP. The included studies had a fair quality (moderate risk of bias) and insufficient level of evidence. The pain reducing effect by BONT-A injections was in average 50% or more in two studies, in one study 3 out of 4 patients became almost pain free. CONCLUSIONS This systematic review shows that presently the level of scientific evidence is insufficient to evaluate the pain-relieving effect of BONT-A injections in patients with PIDP. There are indications that BONT-A injections could be a possible management option for patients with PIDP that seems to be safe and with few adverse events. There is a need for well-designed placebo-controlled, double-blind RCTs.
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Affiliation(s)
- Andreas Dawson
- Centre for Oral Rehabilitation, Östergötland County Council, Linköping, Sweden.,Faculty of Odontology, Malmö University, Malmö, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden
| | - Jenny Dawson
- Centre for Oral Rehabilitation, Östergötland County Council, Linköping, Sweden
| | - Malin Ernberg
- Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden.,Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
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9
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Herrero Babiloni A, Lam JTAT, Exposto FG, Beetz G, Provost C, Gagnon DH, Lavigne GJ. Interprofessional Collaboration in Dentistry: Role of physiotherapists to improve care and outcomes for chronic pain conditions and sleep disorders. J Oral Pathol Med 2020; 49:529-537. [PMID: 32531851 DOI: 10.1111/jop.13068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 01/10/2023]
Abstract
Physiotherapists can manage chronic pain patients by using technical interventions such as mobility, strengthening, manual therapy, or flexibility in a specific and functional manner, being a key component of a multidisciplinary team. Dentists are involved in the management of different chronic pain conditions such as temporomandibular disorders and sleep disorders such as obstructive sleep apnea. However, they are frequently unaware of the benefits of collaborating with physical therapists. In this review, the collaboration of physical therapists and dentists will be explored when managing orofacial pain, headaches, and sleep disorders. The physical therapist is important in the management of these disorders and also in the screening of risk factors.
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Affiliation(s)
- Alberto Herrero Babiloni
- Sacre-Cœur Hospital, CIUSS du Nord-de-l'île-de-Montréal, Montreal, Canada.,Faculté de Medicine Dentaire, Université de Montréal, Montreal, Canada.,Division of Experimental Medicine, McGill University, Montreal, Canada
| | - Jacqueline T A T Lam
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Fernando G Exposto
- Section of Orofacial Pain and Jaw Function, Department of Dentistry, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Gabrielle Beetz
- Sacre-Cœur Hospital, CIUSS du Nord-de-l'île-de-Montréal, Montreal, Canada
| | - Catherine Provost
- Sacre-Cœur Hospital, CIUSS du Nord-de-l'île-de-Montréal, Montreal, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Gilles J Lavigne
- Sacre-Cœur Hospital, CIUSS du Nord-de-l'île-de-Montréal, Montreal, Canada.,Faculté de Medicine Dentaire, Université de Montréal, Montreal, Canada.,Division of Experimental Medicine, McGill University, Montreal, Canada
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10
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Van Deun L, de Witte M, Goessens T, Halewyck S, Ketelaer MC, Matic M, Moens M, Vaes P, Van Lint M, Versijpt J. Facial Pain: A Comprehensive Review and Proposal for a Pragmatic Diagnostic Approach. Eur Neurol 2020; 83:5-16. [PMID: 32222701 DOI: 10.1159/000505727] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/01/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Facial pain, alone or combined with other symptoms, is a frequent complaint. Moreover, it is a symptom situated at, more than any other pain condition, a crosspoint where several disciplines meet, for example, dentists; manual therapists; ophthalmologists; psychologists; and ear-nose-throat, pain, and internal medicine physicians besides neurologists and neurosurgeons. Recently, a new version of the most widely used classification system among neurologists for headache and facial pain, the International Classification of Headache Disorders, has been published. OBJECTIVE The aims of this study were to provide an overview of the most prevalent etiologies of facial pain and to provide a generic framework for the neurologist on how to manage patients presenting with facial pain. METHODS An overview of the different etiologies of facial pain is provided from the viewpoint of the respective clinical specialties that are confronted with facial pain. Key message: Caregivers should "think outside their own box" and refer to other disciplines when indicated. If not, a correct diagnosis can be delayed and unnecessary treatments might be given. The presented framework is aimed at excluding life- or organ-threatening diseases, providing several clinical clues and indications for technical investigations, and ultimately leading to the correct diagnosis and/or referral to other disciplines.
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Affiliation(s)
- Laura Van Deun
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Muriel de Witte
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Clinical Psychology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Thaïs Goessens
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Clinical Psychology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Stijn Halewyck
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Otorhinolaryngology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Marie-Christine Ketelaer
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium
| | - Milica Matic
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Anesthesiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Maarten Moens
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Neurosurgery, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Peter Vaes
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Manual Therapy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Michel Van Lint
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Ophthalmology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Jan Versijpt
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium, .,Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium,
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11
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Herrero Babiloni A, Nixdorf DR, Moana-Filho EJ. Persistent dentoalveolar pain disorder: A putative intraoral chronic overlapping pain condition. Oral Dis 2019; 26:1601-1609. [PMID: 31797486 DOI: 10.1111/odi.13248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/05/2019] [Accepted: 11/24/2019] [Indexed: 01/06/2023]
Abstract
Chronic overlapping pain conditions (COPCs) are conditions that share several clinical characteristics and symptomatology, are usually considered idiopathic in nature, and are frequently comorbid. Currently, there are no established inclusion criteria to determine which conditions should be included under this umbrella term despite different systems proposed. Persistent dentoalveolar pain disorder (PDAP), also referred to as atypical odontalgia and thought to be a component of persistent idiopathic facial pain, is a chronic pain condition that manifests as a persistent tooth pain or pain over a dentoalveolar site formerly occupied by a tooth in the absence of detectable pathology during clinical or radiological examination. PDAP is considered idiopathic in nature, and its pathophysiological mechanisms are not fully understood. Our objective was to investigate whether PDAP fits the conceptual paradigm of COPC given its characteristics and commonalities with other COPC, based on published literature identified through a scoping review. We found that PDAP fits 16 out of 18 common characteristics among COPCs, and based on this finding, we discuss the implications of PDAP being considered a COPC.
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Affiliation(s)
- Alberto Herrero Babiloni
- Research Center, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Faculty of Dental Medicine, Université De Montréal, Montreal, Canada.,Division of Experimental Medicine, McGill University, Montreal, Canada
| | - Donald R Nixdorf
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, USA.,HealthPartners Institute for Education and Research, Bloomington, MN, USA
| | - Estephan J Moana-Filho
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
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12
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Thirteen maxillary full dentures over 10 years: A case of peripheral painful traumatic trigeminal neuropathy. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:e180-e186. [DOI: 10.1016/j.oooo.2019.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/15/2019] [Accepted: 07/21/2019] [Indexed: 11/15/2022]
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13
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Jonsson Sjögren J, Kvist T, Eliasson A, Pigg M. The frequency and characteristics of pain and discomfort associated with root filled teeth: a practice‐based study. Int Endod J 2019; 52:1264-1273. [DOI: 10.1111/iej.13124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/09/2019] [Indexed: 11/27/2022]
Affiliation(s)
- J. Jonsson Sjögren
- Dental Research Department Public Dental Health Service Örebro County Örebro Sweden
- Department of Endodontics Faculty of Odontology Malmö University Malmö Sweden
| | - T. Kvist
- Department of Endodontology Institute of Odontology at the Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - A. Eliasson
- Dental Research Department Public Dental Health Service Örebro County Örebro Sweden
- Faculty of Medicine and Health Örebro University Örebro Sweden
| | - M. Pigg
- Department of Endodontics Faculty of Odontology Malmö University Malmö Sweden
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14
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Ohrbach R, Dworkin SF. AAPT Diagnostic Criteria for Chronic Painful Temporomandibular Disorders. THE JOURNAL OF PAIN 2019; 20:1276-1292. [PMID: 31004786 DOI: 10.1016/j.jpain.2019.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 12/24/2018] [Accepted: 04/01/2019] [Indexed: 01/03/2023]
Abstract
The classification of temporomandibular disorders (TMD) has progressed substantially over the past 25 years owing to the strategic implementation of an initial classification system based on core taxonomic principles. In this article, we describe the development of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and its translation into the multidimensional Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks-AAPT for chronic pain disorders. The initial scientific classification system (Research Diagnostic Criteria for Temporomandibular Disorders) relied on a boot-strapping process that did not attempt to solve all known clinical problems but, rather, focused on problems that could be solved at that time. The core design principles included using epidemiologic data, operationalized concepts, reliable methods, and the incorporation of the biopsychosocial model into a dual axis system. This system led to sufficient data collection internationally that the system itself could be revised, first by critical evaluation of all aspects, second by review from invited experts, and third by the construction of a revised taxonomy (DC/TMD) that maintained the core design principles of the Research Diagnostic Criteria for Temporomandibular Disorders. The resultant disorders with pain as a dominant feature exhibit substantial sensitivity and specificity, and they have been translated into the AAPT framework. The AAPT TMD criteria are part of an evidence-based classification system providing a systematic structure that includes 5 dimensions: diagnostic criteria, common features, comorbidities, consequences, and putative mechanisms. Future research will attempt to extend this AAPT domain from solely TMDs to include other orofacial pain conditions. PERSPECTIVE: The painful TMDs have well-established sensitivity and specificity, as based on the DC/TMD; their translation to the AAPT framework for chronic pain conditions provides a structure for consistent clinical application within the broader health care settings and for future research on the TMDs.
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Affiliation(s)
- Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York.
| | - Samuel F Dworkin
- Departments of Psychiatry and Behavioral Sciences, and Oral Medicine, Schools of Medicine and Dentistry, University of Washington (Emeritus), Seattle, Washington
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15
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Wagner M, Gander T, Blumer M, Valdec S, Schumann P, Essig H, Rücker M. [CAD/CAM Revolution in Craniofacial Reconstruction]. PRAXIS 2019; 108:321-328. [PMID: 30940044 DOI: 10.1024/1661-8157/a003185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CAD/CAM Revolution in Craniofacial Reconstruction Abstract. The face is an important part of the personality and at the same time fulfils a variety of tasks. Aesthetics and function form a unique unit. The formation of the field of oral and maxillofacial surgery began in the first decades of the last century. It includes the prevention, diagnosis, therapy and rehabilitation of diseases, injuries, malformations and changes of the complex structures of the face, oral cavity, jaw and teeth. In the meantime, oral and maxillofacial surgery has arrived in the 21st century. Today's oral and maxillofacial surgery is a link between medicine and dentistry and a protagonist in the implementation of digital workflows in clinical care. Individual solutions with patient-specific implants are the rule, computer-assisted techniques support the surgeon in the planning and performing of surgical procedures. This article intends to give you an insight into how our patients benefit from advanced technologies.
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Affiliation(s)
- Maximilian Wagner
- 1 Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsspital Zürich
| | - Thomas Gander
- 1 Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsspital Zürich
| | - Michael Blumer
- 1 Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsspital Zürich
| | - Silvio Valdec
- 1 Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsspital Zürich
| | - Paul Schumann
- 1 Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsspital Zürich
| | - Harald Essig
- 1 Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsspital Zürich
| | - Martin Rücker
- 1 Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsspital Zürich
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16
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Philpott R, Gulabivala K, Leeson R, Ng YL. Prevalence, predictive factors and clinical course of persistent pain associated with teeth displaying periapical healing following nonsurgical root canal treatment: a prospective study. Int Endod J 2018; 52:407-415. [PMID: 30332512 DOI: 10.1111/iej.13029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/13/2018] [Indexed: 11/26/2022]
Abstract
AIMS To investigate the prevalence, pain catastrophizing and other predictive factors and clinical course of persistent pain/discomfort associated with teeth displaying periapical healing following nonsurgical root canal treatment (NSRCT). METHODOLOGY One hundred and ninety-eight patients (264 teeth) who had NSRCT were reviewed at 5-14 months, postoperatively. Teeth with persistent post-treatment pain or discomfort, plus evidence of periapical healing were further monitored 0.5, 4 and 10 years later. Pain Catastrophizing Scale (PCS) and Short Form of the McGill Pain Questionnaire (SF-MPQ) were completed. Predictive factors were investigated using logistic regression models. RESULTS Twenty-four per cent (60/249) of teeth displaying periapical healing at first review were associated with persistent pain or discomfort. Fifty-five teeth monitored 6-7 months later were associated with reduction in pain (17/30) or discomfort (7/25). Cone beam computed tomography (CBCT) of eight teeth with persistent symptoms and complete periapical healing (by conventional radiographs) revealed distinct, small apical radiolucencies (n = 3) or root apex fenestration through the buccal plate (n = 2). History of chronic pain (headache, temporo-mandibular joint, masticatory muscle, neck, shoulder or back pain; P = 0.005), preoperative pain (P = 0.04), responsive pulp (P = 0.009), tooth crack (P = 0.05) and small periapical radiolucency (P = 0.005) were significant predictive factors. The PCS revealed 16 patients (22 teeth) were catastrophizers (PCS ≥ 30), but this had no influence on post-treatment symptoms (P = 0.5). CONCLUSIONS Persistent pain or discomfort associated with teeth showing periapical healing at the first review after NSRCT, decreased in intensity in most cases over the following 6 months. Longer-term follow-up revealed spontaneous improvement or symptom resolution in the majority of those with confirmed radiographic the absence of periapical disease. Five predictive factors (history of chronic pain, teeth with responsive pulps, association with pain, diagnosis of tooth crack before treatment and diameter of preoperative radiolucency) were identified.
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Affiliation(s)
- R Philpott
- Department of Restorative Dentistry, Edinburgh Dental Institute, University of Edinburgh, Edinburgh, UK
| | - K Gulabivala
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, UK
| | - R Leeson
- Unit of Maxillo-Facial Surgery, UCL Eastman Dental Institute, University College London, London, UK
| | - Y-L Ng
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, UK
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17
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Durham J, Stone SJ, Robinson LJ, Ohrbach R, Nixdorf DR. Development and preliminary evaluation of a new screening instrument for atypical odontalgia and persistent dentoalveolar pain disorder. Int Endod J 2018; 52:279-287. [PMID: 30229950 DOI: 10.1111/iej.13017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/13/2018] [Indexed: 01/03/2023]
Abstract
AIM To develop and preliminarily evaluate a new screening instrument for atypical odontalgia (AO) or persistent dentoalveolar pain disorder (PDAP). To evaluate the instrument's performance in detecting AO/PDAP amongst a heterogeneous group of orofacial pain conditions and pain-free controls and empirically compare its performance with an established neuropathic screening instrument (S-LANSS), which is the best available standard. METHODS The study design was cross-sectional; subjects recruited included a convenience sample of pain-free controls (n = 21) and four groups of orofacial pain conditions: AO/PDAP (n = 22); trigeminal neuralgia (n = 21); temporomandibular disorder (n = 41); and acute dental pain (n = 41). The instrument's internal reliability and factor structure were examined alongside its sensitivity and specificity and ROC-determined threshold score. RESULTS The 9 AO/PDAP-specific items were found to moderately correlate with the S-LANSS (r = 0.58; P < 0.01). The 14-items of the full instrument were examined using exploratory factor analysis and reduced to ten items in a two-factor structure that explained 96% of the variance. This 10-item final instrument had a ROC area of 0.77 (95% CI: 0.67; 0.88), sensitivity of 77% (95% CI: 55; 92%), and specificity of 69% (95% CI: 60; 77%) with an intentionally higher false-positive rate than false-negative rate. In contrast, the S-LANSS exhibited sensitivity of 32% (95% CI: 14;55%) and specificity of 78% (95% CI: 70;85%) with less optimal false-positive versus false-negative rates. CONCLUSION This preliminary study confirms the new screening instrument for AO/PDAP merits progression to field testing.
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Affiliation(s)
- J Durham
- Centre for Oral Health Research, School of Dental Sciences, Newcastle upon Tyne, UK.,Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,Dental Hospital, Newcastle-Upon-Tyne Hospitals' NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S J Stone
- Centre for Oral Health Research, School of Dental Sciences, Newcastle upon Tyne, UK.,Dental Hospital, Newcastle-Upon-Tyne Hospitals' NHS Foundation Trust, Newcastle upon Tyne, UK
| | - L J Robinson
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - R Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo School of Dental Medicine, Buffalo, NY, USA
| | - D R Nixdorf
- Division of TMD & Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, USA.,HealthPartners Institute for Education and Research, Bloomington, MN, USA
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18
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García-Sáez R, Gutiérrez-Viedma Á, González-García N, Gómez-Mayordomo V, Porta-Etessam J, Cuadrado ML. OnabotulinumtoxinA injections for atypical odontalgia: an open-label study on nine patients. J Pain Res 2018; 11:1583-1588. [PMID: 30197533 PMCID: PMC6112804 DOI: 10.2147/jpr.s169701] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Atypical odontalgia (AO) manifests as continuous pain in the region of one or several teeth, in the absence of signs of dental pathology. Currently, there is insufficient evidence to establish treatment guidelines for AO. The aim of this study was to describe the effectiveness and safety of treatment with OnabotulinumtoxinA (OnabotA) on a series of patients with AO. Methods Nine patients with AO (four males and five females, aged between 31 and 77 years) received injections of OnabotA in the region of pain. The dosage used in each procedure ranged between 10 and 30 U, spread between 4 and 12 injection sites along the gums (n=9), the lips (n=3), and the hard palate (n=1). The median follow-up time was 27 months (interquartile range, IQR 20–40) and the median number of injection sessions per patient was seven (IQR 4.5–9). The assessment variables included the change in the maximal intensity of pain on a 0–10 numerical rating scale (NRS), the response latency, and the duration of the effect. Results All patients experienced a significant improvement, with ≥50% of reduction in the intensity of the maximal pain. The median of reduction of maximal pain after treatment was six points on the NRS (IQR 5–8.5). The response latency was 2–15 days and the duration of the effect was 2–6 months. No significant adverse reactions were registered. Conclusion OnabotA may be a safe and effective option for the treatment of AO.
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Affiliation(s)
- Rafael García-Sáez
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain,
| | - Álvaro Gutiérrez-Viedma
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain, .,Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain,
| | - Nuria González-García
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain,
| | - Víctor Gómez-Mayordomo
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain,
| | - Jesús Porta-Etessam
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain, .,Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain,
| | - María-Luz Cuadrado
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain, .,Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain,
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19
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Delcanho R, Peck C. Neuropathic pain: Diagnosis and treatment from the dental clinic to the multidisciplinary pain clinic. AUST ENDOD J 2018. [DOI: 10.1111/aej.12276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Robert Delcanho
- Perth Orofacial Pain and TMJ Clinic; Subiaco Western Australia Australia
| | - Chris Peck
- Faculty of Dentistry; University of Sydney; Westmead New South Wales Australia
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20
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Endogenous pain modulation in chronic orofacial pain: a systematic review and meta-analysis. Pain 2018; 159:1441-1455. [DOI: 10.1097/j.pain.0000000000001263] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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21
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Malacarne A, Spierings EL, Lu C, Maloney GE. Persistent Dentoalveolar Pain Disorder: A Comprehensive Review. J Endod 2018; 44:206-211. [DOI: 10.1016/j.joen.2017.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/19/2017] [Accepted: 09/22/2017] [Indexed: 01/03/2023]
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22
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Klasser GD, Manfredini D, Goulet JP, De Laat A. Oro-facial pain and temporomandibular disorders classification systems: A critical appraisal and future directions. J Oral Rehabil 2017; 45:258-268. [PMID: 29197095 DOI: 10.1111/joor.12590] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 01/03/2023]
Abstract
It is a difficult undertaking to design a classification system for any disease entity, let alone for oro-facial pain (OFP) and more specifically for temporomandibular disorders (TMD). A further complication of this task is that both physical and psychosocial variables must be included. To augment this process, a two-step systematic review, adhering to PRISMA guidelines, of the classification systems published during the last 20 years for OFP and TMD was performed. The first search step identified 190 potential citations which ultimately resulted in only 17 articles being included for in-depth analysis and review. The second step resulted in only 5 articles being selected for inclusion in this review. Five additional articles and four classification guidelines/criteria were also included due to expansion of the search criteria. Thus, in total, 14 documents comprising articles and guidelines/criteria (8 proposals of classification systems for OFP; 6 for TMD) were selected for inclusion in the systematic review. For each, a discussion as to their advantages, strengths and limitations was provided. Suggestions regarding the future direction for improving the classification process with the use of ontological principles rather than taxonomy are discussed. Furthermore, the potential for expanding the scope of axes included in existing classification systems, to include genetic, epigenetic and neurobiological variables, is explored. It is therefore recommended that future classification system proposals be based on combined approaches aiming to provide archetypal treatment-oriented classifications.
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Affiliation(s)
- G D Klasser
- Department of Diagnostic Sciences, School of Dentistry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - D Manfredini
- School of Dentistry, University of Padova, Padova, Italy
| | - J-P Goulet
- Faculté de Médecine dentaire, Université Laval, Québec, QC, Canada
| | - A De Laat
- Department of Oral Health Sciences, K.U. Leuven, Leuven, Belgium.,Department of Dentistry, University Hospitals Leuven, Leuven, Belgium
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23
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Takenoshita M, Miura A, Shinohara Y, Mikuzuki R, Sugawara S, Tu TTH, Kawasaki K, Kyuragi T, Umezaki Y, Toyofuku A. Clinical features of atypical odontalgia; three cases and literature reviews. Biopsychosoc Med 2017; 11:21. [PMID: 28785306 PMCID: PMC5541751 DOI: 10.1186/s13030-017-0106-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 07/03/2017] [Indexed: 01/03/2023] Open
Abstract
Background Atypical odontalgia (AO) is a disease characterized by continuous pain affecting the teeth or tooth sockets after extraction in the absence of any identifiable cause on clinical or radiographic examination. Antidepressants, such as amitriptyline, are reported to be effective in the treatment of AO; however, their efficacy varies depending on the case. In this article, we report three types of AO and discuss its heterogeneity and management. Case presentation In the first case, a 58-year-old woman presented with a heavy, splitting pain in the four maxillary front post-crown teeth, as if they were being pressed from the side. Her symptoms abated with 20 mg of amitriptyline. In the second case, a 39-year-old woman presented with a feeling of heaviness pain on the right side of maxillary and mandibular molar teeth, face, whole palate, and throat. She was unable to function because of her pain. Her symptoms drastically subsided with 3 mg of aripiprazole. In the third case, a 54-year-old woman presented with a tingling sensation on the left mandibular second premolar and first molar, and an uncomfortable feeling on her provisional prosthesis that made it unbearable to keep the caps on. Her symptoms diminished with 2 mg of aripiprazole added to 30 mg of mirtazapine. Conclusions AO shows various features and responses to drugs. It is considered not only a purely sensory problem, but also a considerably complex psychological problem, such as rumination about the pain. Investigating the difference in pharmacotherapeutic responses might help to advance the treatment of AO.
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Affiliation(s)
- Miho Takenoshita
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549 Japan.,Psychosomatic Dentistry Clinic, Dental Hospital, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549 Japan
| | - Anna Miura
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549 Japan
| | - Yukiko Shinohara
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549 Japan
| | - Rou Mikuzuki
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549 Japan
| | - Shiori Sugawara
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549 Japan
| | - Trang Thi Huyen Tu
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549 Japan
| | - Kaoru Kawasaki
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549 Japan
| | - Takeru Kyuragi
- Psychosomatic Dentistry Clinic, Dental Hospital, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549 Japan
| | - Yojiro Umezaki
- Psychosomatic Dentistry Clinic, Dental Hospital, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549 Japan
| | - Akira Toyofuku
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549 Japan.,Psychosomatic Dentistry Clinic, Dental Hospital, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549 Japan
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24
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Zakrzewska JM, Jensen TS. History of facial pain diagnosis. Cephalalgia 2017; 37:604-608. [PMID: 28181442 PMCID: PMC5458869 DOI: 10.1177/0333102417691045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/01/2016] [Accepted: 12/06/2016] [Indexed: 01/03/2023]
Abstract
Premise Facial pain refers to a heterogeneous group of clinically and etiologically different conditions with the common clinical feature of pain in the facial area. Among these conditions, trigeminal neuralgia (TN), persistent idiopathic facial pain, temporomandibular joint pain, and trigeminal autonomic cephalalgias (TAC) are the most well described conditions. Conclusion TN has been known for centuries, and is recognised by its characteristic and almost pathognomonic clinical features. The other facial pain conditions are less well defined, and over the years there has been confusion about their classification.
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Affiliation(s)
| | - Troels S Jensen
- IDNC and DPRC Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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25
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Abstract
Definition and taxonomy This review deals with neuropathic pain of traumatic origin affecting the trigeminal nerve, i.e. painful post-traumatic trigeminal neuropathy (PTTN). Symptomatology The clinical characteristics of PTTN vary considerably, partly due to the type and extent of injury. Symptoms involve combinations of spontaneous and evoked pain and of positive and negative somatosensory signs. These patients are at risk of going through unnecessary dental/surgical procedures in the attempt to eradicate the cause of the pain, due to the fact that most dentists only rarely encounter PTTN. Epidemiology Overall, approximately 3% of patients with trigeminal nerve injuries develop PTTN. Patients are most often female above the age of 45 years, and both physical and psychological comorbidities are common. Pathophysiology PTTN shares many pathophysiological mechanisms with other peripheral neuropathic pain conditions. Diagnostic considerations PTTN may be confused with one of the regional neuralgias or other orofacial pain conditions. For intraoral PTTN, early stages are often misdiagnosed as odontogenic pain. Pain management Management of PTTN generally follows recommendations for peripheral neuropathic pain. Expert opinion International consensus on classification and taxonomy is urgently needed in order to advance the field related to this condition.
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Affiliation(s)
- Lene Baad-Hansen
- 1 Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,2 Scandinavian Center for Orofacial Neurosciences (SCON), Denmark/Sweden
| | - Rafael Benoliel
- 3 Rutgers School of Dental Medicine, Rutgers State University of New Jersey, Newark, NJ, USA
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26
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Ettlin DA, Sommer I, Brönnimann B, Maffioletti S, Scheidt J, Hou MY, Lukic N, Steiger B. Design, construction, and technical implementation of a web-based interdisciplinary symptom evaluation (WISE) - a heuristic proposal for orofacial pain and temporomandibular disorders. J Headache Pain 2016; 17:77. [PMID: 27581159 PMCID: PMC5007232 DOI: 10.1186/s10194-016-0670-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/17/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Medical symptoms independent of body location burden individuals to varying degrees and may require care by more than one expert. Various paper and computer-based tools exist that aim to comprehensively capture data for optimal clinical management and research. METHODS A web-based interdisciplinary symptom evaluation (WISE) was newly designed, constructed, and technically implemented. For worldwide applicability and to avoid copyright infringements, open source software tools and free validated questionnaires available in multiple languages were used. Highly secure data storage limits access strictly to those who use the tool for collecting, storing, and evaluating their data. Concept and implementation is illustrated by a WISE sample tailored for the requirements of a single center in Switzerland providing interdisciplinary care to orofacial pain and temporomandibular disorder patients. RESULTS By combining a symptom- burden checklist with in-depth questionnaires serving as case-finding instruments, an algorithm was developed that assists in clarifying case complexity and need for targeted expert evaluation. This novel modular approach provides a personalized, response-tailored instrument for the time- and cost-effective collection of symptom-burden focused quantitative data. The tool includes body drawing options and instructional videos. It is applicable for biopsychosocial evaluation in a variety of clinical settings and offers direct feedback by a case report summary. CONCLUSIONS In clinical practice, the new instrument assists in clarifying case complexity and referral need, based on symptom burden and response -tailored case finding. It provides single-case summary reports from a biopsychosocial perspective and includes graphical symptom maps. Secure, centrally stored data collection of anonymous data is possible. The tool enables personalized medicine, facilitates interprofessional education and collaboration, and allows for multicenter patient-reported outcomes research.
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Affiliation(s)
- Dominik A Ettlin
- Orofacial Pain Unit of the Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Isabelle Sommer
- Orofacial Pain Unit of the Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ben Brönnimann
- Orofacial Pain Unit of the Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Sergio Maffioletti
- S3IT: Service and Support for ScienceIT, University of Zurich, Zurich, Switzerland
| | - Jörg Scheidt
- Institut für Informationssysteme, Hochschule für Angewandte Wissenschaften Hof, Hof, Germany
| | - Mei-Yin Hou
- Orofacial Pain Unit of the Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Nenad Lukic
- Orofacial Pain Unit of the Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Beat Steiger
- Orofacial Pain Unit of the Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
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Frequency, impact, and predictors of persistent pain after root canal treatment: a national dental PBRN study. Pain 2016; 157:159-165. [PMID: 26335907 DOI: 10.1097/j.pain.0000000000000343] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Root canal treatment (RCT) is commonly performed surgery and persistent pain is known to occur, but little is known about how these patients are affected by this pain. Although biopsychosocial mechanisms are thought to be associated with the development of such pain, similar to persistent pain after surgery in other body sites, little is known about the baseline predictors for persistent pain. We assessed the frequency of persistent pain 6 months after RCT, measured the impact this pain had on patients, and determined predictive factors for persistent tooth pain in a multicenter prospective cohort study conducted within the National Dental Practice-Based Research Network. Of 708 patients enrolled, 651 (91.9%) provided follow-up data, with 65 (10.0%) meeting criteria for pain 6 months after RCT. On average, these patients reported their pain as mild to moderate in intensity, present for approximately 10 days in the preceding month, and minimally interfered with daily activities. After adjusting for the type of dental practitioner and patient age, gender, and household income, pain duration over the week before RCT significantly increased the risk of developing persistent pain (odds ratio = 1.19 per 1 day increase in pain duration, 95% confidence interval: 1.07-1.33), whereas optimism about the procedure reduced the risk (odds ratio = 0.39, 95% confidence interval: 0.22-0.67). Our data suggest that persistent pain 6 months after RCT is fairly common, but generally does not have a large impact on those experiencing it. Furthermore, patient age and gender did not predict persistent pain, whereas preoperative pain duration and the patient's expectation did.
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Abstract
The issues specific to trigeminal pain include the complexity of the region, the problematic impact on daily function and significant psychological impact (J Dent, 43, 2015, 1203). By nature of the geography of the pain (affecting the face, eyes, scalp, nose, mouth), it may interfere with just about every social function we take for granted and enjoy (J Orofac Pain, 25, 2011, 333). The trigeminal nerve is the largest sensory nerve in the body, protecting the essential organs that underpin our very existence (brain, eyes, nose, mouth). It is no wonder that pain within the trigeminal system in the face is often overwhelming and inescapable for the affected individual.
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Affiliation(s)
- T Renton
- Oral Surgery, Kings College London, London, UK
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Castrillon EE, Ou KL, Wang K, Zhang J, Zhou X, Svensson P. Sleep bruxism: an updated review of an old problem. Acta Odontol Scand 2016; 74:328-34. [PMID: 26758348 DOI: 10.3109/00016357.2015.1125943] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective To provide an update on what is known about bruxism and some of the major clinical highlights derived from new insights into this old problem in dentistry. Materials and methods A selective, non-systematic but critical review of the available scientific literature was performed. Results There are two main different types of bruxism, which are related to different circadian periods (sleep and awake bruxism) that may differ in terms of pathophysiology, but they share some common signs and symptoms. Approximately one out of 10 adult individuals may suffer from bruxism, but not all bruxers may need treatment. Bruxism is complicated to diagnose in the clinic and self-report of bruxism may not necessarily reflect the true presence of jaw muscle activity. Better understanding has been acquired of bruxism relationships with sleep stages, arousal responses and autonomic function with the help of polysomnography and controlled sleep studies. Meanwhile, there is still much more to learn about awake bruxism. With the available scientific knowledge it is possible to systematically assess the effects of bruxism and its potential risk factors for oral and general health. Moreover, we can be aware of the realistic possibilities to manage/treat the patient suffering from bruxism. Conclusion Bruxism is a parafunctional activity involving the masticatory muscles and probably it is as old as human mankind. Different ways have been proposed to define, diagnose, assess the impact and consequences, understand the pathophysiology and treat or manage bruxism. Despite the vast research efforts made in this field, there are still significant gaps in our knowledge.
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Affiliation(s)
- Eduardo E. Castrillon
- Section of Orofacial Pain and Jaw Function, Department of Dentistry, HEALTH Aarhus University, Denmark
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus University, Denmark
| | - Keng-Liang Ou
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Oral Medicine, Research Center for Biomedical Devices and Prototyping Production, Taipei Medical University, Taiwan
| | - Kelun Wang
- Department of Health Science and Technology, the Faculty of Medicine, Aalborg University, Denmark
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, PR China
| | - Jinglu Zhang
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, PR China
| | - Xinwen Zhou
- Department of Stomatology, Beijing Shijitan Hospital, Capital Medical University, PR China
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry, HEALTH Aarhus University, Denmark
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus University, Denmark
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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Cuadrado ML, García-Moreno H, Arias JA, Pareja JA. Botulinum Neurotoxin Type-A for the Treatment of Atypical Odontalgia. PAIN MEDICINE 2016; 17:1717-21. [DOI: 10.1093/pm/pnw040] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Herrero Babiloni A, Kapos FP, Nixdorf DR. Intraoral administration of botulinum toxin for trigeminal neuropathic pain. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:e148-53. [PMID: 27181448 DOI: 10.1016/j.oooo.2016.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/14/2016] [Accepted: 03/15/2016] [Indexed: 12/22/2022]
Abstract
This article presents 2 cases of different neuropathic trigeminal pain conditions treated with intraoral botulinum toxin injections. There is a growing body of evidence to support the use of this substance when administered subcutaneously in the treatment of neuropathic pain, such as in extraoral injections for trigeminal neuralgia. However, reports of intraoral submucosal administration are still lacking. In the 2 cases presented here, neuropathic pain was refractory to treatment with an important intraoral peripheral component, so onabotulinum toxin A was introduced as an adjuvant therapy. The technique, doses, and dilution are discussed. The patients reported significant reductions in pain frequency and intensity, with minimal side effects of temporary mucosal dryness and smile droopiness. The analgesic benefits of botulinum toxin may be utilized to address intraoral neuropathic pain. Further studies are needed to confirm safety and effectiveness in larger samples.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of TMD & Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.
| | - Flavia P Kapos
- Division of TMD & Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Donald R Nixdorf
- Division of TMD & Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, MN, USA; Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minneapolis, MN, USA; HealthPartners Institute for Education and Research, Bloomington, MN, USA
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Farag AM, Spierings EL, Maloney GE. Intermittent sharp facial pain starting at the mandibular right first molar. J Am Dent Assoc 2016; 147:196-9. [DOI: 10.1016/j.adaj.2015.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 01/03/2023]
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Thieme V. Orofazialer Schmerz - Trigeminusneuralgie und posttraumatische Trigeminusneuropathie. Schmerz 2016; 30:99-117. [DOI: 10.1007/s00482-016-0097-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Moana-Filho EJ, Bereiter DA, Nixdorf DR. Amplified Brain Processing of Dentoalveolar Pressure Stimulus in Persistent Dentoalveolar Pain Disorder Patients. J Oral Facial Pain Headache 2016; 29:349-62. [PMID: 26485382 DOI: 10.11607/ofph.1463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS (1) To determine the brain regions activated by dentoalveolar pressure stimulation in persistent dentoalveolar pain disorder (PDAP) patients, and (2) to compare these activation patterns to those seen in pain-free control subjects. METHODS A total of 13 PDAP patients and 13 matched controls completed the study. Clinical pain characteristics and psychosocial data were collected. Dentoalveolar mechanical pain thresholds were determined with a custom-made device over the painful area for patients and were used as the stimulation level during functional magnetic resonance imaging (fMRI) data acquisition. Control subjects received two stimulation levels over matched locations during fMRI scanning: one determined (as above) that evoked equally subjective pain ratings matching those of patients (subjective-pain match) and another nonpainful stimulation level matching the average stimulus intensity provided to patients (stimulus-intensity match). Clinical and psychosocial data were analyzed using independent samples t tests, Mann-Whitney U test, and Spearman rank-order correlation coefficient. fMRI data were analyzed using validated neuroimaging software and tested using a general linear model. RESULTS PDAP patients had greater anxiety (P<.0001) and depression scores (P=.001), more jaw function impairment (P<.0001), and greater social impact (P<.0001) than controls. No significant differences were found for brain activation spatial extent (PDAP X Controls subjective pain: P=.48; PDAP X Controls stimulus intensity: P=.12). Brain activations were significantly increased for PDAP patients compared to control subjects when matched to stimulus intensity in several regions related to the sensory-discriminative and cognitive components of pain perception, including the primary and secondary somatosensory cortices, inferior parietal lobule, insula, premotor cortex, prefrontal cortex, and thalamus. When matched to subjective pain ratings, increased brain activations were still present for PDAP patients compared to controls, although to a lesser extent. CONCLUSION The present results suggest that dentoalveolar pressure is processed differently in the brain of PDAP patients, and the increased activation in several brain areas is consistent with amplified pain processing.
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Porporatti AL, Costa YM, Stuginski-Barbosa J, Bonjardim LR, Duarte MAH, Conti PCR. Diagnostic Accuracy of Quantitative Sensory Testing to Discriminate Inflammatory Toothache and Intraoral Neuropathic Pain. J Endod 2015; 41:1606-13. [DOI: 10.1016/j.joen.2015.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/13/2015] [Accepted: 07/19/2015] [Indexed: 01/28/2023]
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Effects of Kamishoyosan, a Traditional Japanese Kampo Medicine, on Pain Conditions in Patients with Intractable Persistent Dentoalveolar Pain Disorder. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:750345. [PMID: 26495024 PMCID: PMC4606112 DOI: 10.1155/2015/750345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/01/2014] [Accepted: 07/21/2014] [Indexed: 01/19/2023]
Abstract
There are patients who suffer from persistent dentoalveolar pain disorder (PDAP) which is a pain of the teeth, either dentoalveolar pain or nonodontogenic toothache, and its cause has not yet been identified. An effective intervention for PDAP has not yet been established. Interventions for patients with PDAP are generally pharmacological treatments such as antidepressants, anticonvulsants, and pregabalin. However, these medicines are not always effective for patients. The pain disorder in the orofacial region including temporomandibular disorder (TMD) and PDAP was effectively treated with our original exercise therapy. However, we did observe some intractable cases of PDAP even when our original exercise therapy was used. This paper presents our findings in which Kamishoyosan improved the pain intensity in 14 out of 15 PDAP patients refractory to our original exercise therapy.
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Shueb S, Nixdorf D, John M, Alonso BF, Durham J. What is the impact of acute and chronic orofacial pain on quality of life? J Dent 2015; 43:1203-10. [DOI: 10.1016/j.jdent.2015.06.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022] Open
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Durham J, Raphael KG, Benoliel R, Ceusters W, Michelotti A, Ohrbach R. Perspectives on next steps in classification of oro-facial pain - part 2: role of psychosocial factors. J Oral Rehabil 2015; 42:942-55. [PMID: 26257252 DOI: 10.1111/joor.12329] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2015] [Indexed: 11/30/2022]
Abstract
This study was initiated by a symposium, in which the present authors contributed, organised by the International RDC/TMD Consortium Network in March 2013. The purpose of the study was to review the status of biobehavioural research - both quantitative and qualitative - related to oro-facial pain (OFP) with respect to the aetiology, pathophysiology, diagnosis and management of OFP conditions, and how this information can optimally be used for developing a structured OFP classification system for research. In particular, we address representation of psychosocial entities in classification systems, use of qualitative research to identify and understand the full scope of psychosocial entities and their interaction, and the usage of classification system for guiding treatment. We then provide recommendations for addressing these problems, including how ontological principles can inform this process.
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Affiliation(s)
- J Durham
- Centre for Oral Health Research & Institute of Health & Society, Newcastle University, Newcastle, UK
| | - K G Raphael
- New York University College of Dentistry, New York, NY, USA
| | - R Benoliel
- Rutgers School of Dental Medicine, Newark, NJ, USA
| | | | | | - R Ohrbach
- University at Buffalo, Buffalo, NY, USA
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Ceusters W, Michelotti A, Raphael KG, Durham J, Ohrbach R. Perspectives on next steps in classification of oro-facial pain - part 1: role of ontology. J Oral Rehabil 2015. [PMID: 26212927 DOI: 10.1111/joor.12336] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to review existing principles of oro-facial pain classifications and to specify design recommendations for a new system that would reflect recent insights in biomedical classification systems, terminologies and ontologies. The study was initiated by a symposium organised by the International RDC/TMD Consortium Network in March 2013, to which the present authors contributed. The following areas are addressed: problems with current classification approaches, status of the ontological basis of pain disorders, insufficient diagnostic aids and biomarkers for pain disorders, exploratory nature of current pain terminology and classification systems, and problems with prevailing classification methods from an ontological perspective. Four recommendations for addressing these problems are as follows: (i) develop a hypothesis-driven classification structure built on principles that ensure to our best understanding an accurate description of the relations among all entities involved in oro-facial pain disorders; (ii) take into account the physiology and phenomenology of oro-facial pain disorders to adequately represent both domains including psychosocial entities in a classification system; (iii) plan at the beginning for field-testing at strategic development stages; and (iv) consider how the classification system will be implemented. Implications in relation to the specific domains of psychosocial factors and biomarkers for inclusion into an oro-facial pain classification system are described in two separate papers.
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Affiliation(s)
| | | | - K G Raphael
- New York University College of Dentistry, New York, NY, USA
| | - J Durham
- Newcastle University, Newcastle, UK
| | - R Ohrbach
- University at Buffalo, Buffalo, NY, USA
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Preparation, Characterization, and Pharmacological Activity of Cymbopogon winterianus Jowitt ex Bor (Poaceae) Leaf Essential Oil of β-Cyclodextrin Inclusion Complexes. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:502454. [PMID: 26246838 PMCID: PMC4515525 DOI: 10.1155/2015/502454] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/11/2015] [Accepted: 06/16/2015] [Indexed: 01/09/2023]
Abstract
This study aimed to evaluate the orofacial antinociceptive effect of the Cymbopogon winterianus essential oil (LEO) complexed in β-cyclodextrin (LEO-CD) and to assess the possible involvement of the central nervous system (CNS). The LEO was extracted, chromatographed, and complexed in β-cyclodextrin. The complex was characterized by differential scanning calorimetry (DSC) and thermogravimetry derivative (TG/DTG). Male Swiss mice (2-3 months) were treated with LEO-CD (50-200 mg/kg, p.o.), vehicle (distilled water, p.o.), or standard drug (i.p.) and subjected to the orofacial nociception formalin-, capsaicin-, and glutamate-induced. After the formalin test, the animals were perfused and the brains subjected to immunofluorescence for Fos. The rota-rod test (7 rpm/min) was carried out. Geraniol (37.57%) was the main compound of LEO. DSC and TG/DTG proved the complexation. The orofacial nociceptive behavior was significantly (p < 0.05) reduced. The number of Fos-positive cells was significantly changed in the dorsal raphe nucleus (p < 0.01), locus coeruleus (p < 0.001), trigeminal nucleus (p < 0.05), and trigeminal thalamic tract (p < 0.05). LEO-CD did not cause changes in motor coordination in the rota-rod test. Thus, our results suggested that LEO-CD has an orofacial antinociceptive profile, probably mediated by the activation of the CNS without changing the motor coordination.
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Porporatti AL, Costa YM, Stuginski-Barbosa J, Bonjardim LR, Conti PCR. Effect of topical anaesthesia in patients with persistent dentoalveolar pain disorders: A quantitative sensory testing evaluation. Arch Oral Biol 2015; 60:973-81. [DOI: 10.1016/j.archoralbio.2015.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 02/25/2015] [Accepted: 02/28/2015] [Indexed: 12/29/2022]
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43
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Wright EF. Nonodontogenic toothaches. J Am Dent Assoc 2015; 146:406-8. [DOI: 10.1016/j.adaj.2014.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 07/14/2014] [Indexed: 11/16/2022]
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Differential diagnoses for persistent pain after root canal treatment: a study in the National Dental Practice-based Research Network. J Endod 2015; 41:457-63. [PMID: 25732400 DOI: 10.1016/j.joen.2014.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/01/2014] [Accepted: 12/13/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Pain present 6 months after root canal treatment (RCT) may be of odontogenic or nonodontogenic origin. This is important because treatments and prognoses are different; therefore, the aim of this study was to provide specific diagnoses of patients reporting pain 6 months after receiving initial orthograde RCT. METHODS We enrolled patients from the Midwest region of an existing prospective observational study of pain after RCT. Pain at 6 months was defined as ≥1 day of pain and average pain intensity of at least 1 of 10 over the preceding month. An endodontist and an orofacial pain practitioner independently performed clinical evaluations, which included periapical and cone-beam computed tomographic radiographs, to determine diagnoses. RESULTS Thirty-eight of the 354 eligible patients in the geographic area (11%) met the pain criteria, with 19 (50%) consenting to be clinically evaluated. As the sole reason for pain, 7 patients (37%) were given odontogenic diagnoses (4 involving the RCT tooth and 3 involving an adjacent tooth). Eight patients (42%) were given nonodontogenic pain diagnoses (7 from referred temporomandibular disorder pain and 1 from persistent dentoalveolar pain disorder). Two patients (11%) had both odontogenic and nonodontogenic diagnoses, whereas 2 (11%) no longer fit the pain criteria at the time of the clinical evaluation. CONCLUSIONS Patients reporting "tooth" pain 6 months after RCT had a nonodontogenic pain diagnosis accounting for some of this pain, with temporomandibular disorder being the most frequent nonodontogenic diagnosis. Dentists should have the necessary knowledge to differentiate between these diagnoses to adequately manage their patients.
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Meier ML, Widmayer S, Abazi J, Brügger M, Lukic N, Lüchinger R, Ettlin DA. The human brain response to dental pain relief. J Dent Res 2015; 94:690-6. [PMID: 25691071 DOI: 10.1177/0022034515572022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Local anesthesia has made dental treatment more comfortable since 1884, but little is known about associated brain mechanisms. Functional magnetic resonance imaging is a modern neuroimaging tool widely used for investigating human brain activity related to sensory perceptions, including pain. Most brain regions that respond to experimental noxious stimuli have recently been found to react not only to nociception alone, but also to visual, auditory, and other stimuli. Thus, presumed functional attributions have come under scrutiny regarding selective pain processing in the brain. Evidently, innovative approaches are warranted to identify cerebral regions that are nociceptive specific. In this study, we aimed at circumventing known methodological confounders by applying a novel paradigm in 14 volunteers: rather than varying the intensity and thus the salience of painful stimuli, we applied repetitive noxious dental stimuli at constant intensity to the left mandibular canine. During the functional magnetic resonance imaging paradigm, we suppressed the nociceptive barrage by a mental nerve block. Brain activity before and after injection of 4% articaine was compared intraindividually on a group level. Dental pain extinction was observed to correspond to activity reduction in a discrete region of the left posterior insular cortex. These results confirm previous reports demonstrating that direct electrical stimulation of this brain region-but not of others-evokes bodily pain sensations. Hence, our investigation adds further evidence to the notion that the posterior insula plays a unique role in nociceptive processing.
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Affiliation(s)
- M L Meier
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland Balgrist University Hospital, Zurich, Switzerland
| | - S Widmayer
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland Department of Psychiatry (UPK), University of Basel, Switzerland
| | - J Abazi
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - M Brügger
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland
| | - N Lukic
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - R Lüchinger
- Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland
| | - D A Ettlin
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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PORPORATTI AL, COSTA YM, STUGINSKI-BARBOSA J, BONJARDIM LR, CONTI PCR, SVENSSON P. Quantitative methods for somatosensory evaluation in atypical odontalgia. Braz Oral Res 2015; 29:S1806-83242015000100400. [DOI: 10.1590/1807-3107bor-2015.vol29.0020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/17/2014] [Indexed: 11/21/2022] Open
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Baad-Hansen L, Lu S, Kemppainen P, List T, Zhang Z, Svensson P. Differential changes in gingival somatosensory sensitivity after painful electrical tooth stimulation. Exp Brain Res 2015; 233:1109-18. [DOI: 10.1007/s00221-014-4186-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
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Forssell H, Jääskeläinen S, List T, Svensson P, Baad-Hansen L. An update on pathophysiological mechanisms related to idiopathic oro-facial pain conditions with implications for management. J Oral Rehabil 2014; 42:300-22. [DOI: 10.1111/joor.12256] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 01/03/2023]
Affiliation(s)
- H. Forssell
- Department of Oral and Maxillofacial Surgery; Institute of Dentistry; University of Turku; Turku Finland
| | - S. Jääskeläinen
- Department of Clinical Neurophysiology; University of Turku and Turku University Hospital; Turku Finland
| | - T. List
- Department of Orofacial Pain and Jaw Function; Faculty of Odontology; Malmö University; Malmö Denmark
- Department of Rehabilitation Medicine; Skåne University Hospital; Lund Denmark
- Scandinavian Center for Orofacial Neuroscience (SCON); Aarhus University; Aarhus Denmark
| | - P. Svensson
- Scandinavian Center for Orofacial Neuroscience (SCON); Aarhus University; Aarhus Denmark
- Section of Clinical Oral Physiology; Department of Dentistry; HEALTH; Aarhus University; Aarhus Denmark
| | - L. Baad-Hansen
- Scandinavian Center for Orofacial Neuroscience (SCON); Aarhus University; Aarhus Denmark
- Section of Clinical Oral Physiology; Department of Dentistry; HEALTH; Aarhus University; Aarhus Denmark
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Baad-Hansen L, Pigg M, Yang G, List T, Svensson P, Drangsholt M. Reliability of intra-oral quantitative sensory testing (QST) in patients with atypical odontalgia and healthy controls - a multicentre study. J Oral Rehabil 2014; 42:127-35. [PMID: 25284726 DOI: 10.1111/joor.12245] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2014] [Indexed: 11/27/2022]
Abstract
The reliability of comprehensive intra-oral quantitative sensory testing (QST) protocol has not been examined systematically in patients with chronic oro-facial pain. The aim of the present multicentre study was to examine test-retest and interexaminer reliability of intra-oral QST measures in terms of absolute values and z-scores as well as within-session coefficients of variation (CV) values in patients with atypical odontalgia (AO) and healthy pain-free controls. Forty-five patients with AO and 68 healthy controls were subjected to bilateral intra-oral gingival QST and unilateral extratrigeminal QST (thenar) on three occasions (twice on 1 day by two different examiners and once approximately 1 week later by one of the examiners). Intra-class correlation coefficients and kappa values for interexaminer and test-retest reliability were computed. Most of the standardised intra-oral QST measures showed fair to excellent interexaminer (9-12 of 13 measures) and test-retest (7-11 of 13 measures) reliability. Furthermore, no robust differences in reliability measures or within-session variability (CV) were detected between patients with AO and the healthy reference group. These reliability results in chronic orofacial pain patients support earlier suggestions based on data from healthy subjects that intra-oral QST is sufficiently reliable for use as a part of a comprehensive evaluation of patients with somatosensory disturbances or neuropathic pain in the trigeminal region.
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Affiliation(s)
- L Baad-Hansen
- Section of Clinical Oral Physiology, Department of Dentistry, HEALTH, Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neuroscience (SCON), Faculty of Odontology, Malmö University, Malmö, Sweden
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Vena DA, Collie D, Wu H, Gibbs JL, Broder HL, Curro FA, Thompson VP, Craig RG. Prevalence of persistent pain 3 to 5 years post primary root canal therapy and its impact on oral health-related quality of life: PEARL Network findings. J Endod 2014; 40:1917-21. [PMID: 25220076 DOI: 10.1016/j.joen.2014.07.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 06/30/2014] [Accepted: 07/20/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The frequency of persistent pain 3-5 years after primary root canal therapy and its impact on the patient's perceived oral health-related quality of life was determined in a practice-based research network. METHODS All patients presenting to participating network practices who received primary root canal therapy and restoration for a permanent tooth 3-5 years previously were invited to enroll. Persistent pain was defined as pain occurring spontaneously or elicited by percussion, palpation, or biting. The patient also completed an oral health-related quality of life questionnaire (Oral Health Impact Profile-14). RESULTS Sixty-four network practices enrolled 1323 patients; 13 were ineligible, 12 did not receive a final restoration, and 41 were extracted, leaving 1257 for analysis. The average time to follow-up was 3.9 ± 0.6 years. Five percent (63/1257) of the patients reported persistent pain, whereas 24 of 63 (38%) exhibited periapical pathosis and/or root fracture (odontogenic pain). No obvious odontogenic cause for persistent pain was found for 39 of 63 (62%). Teeth treated by specialists had a greater frequency of persistent pain than teeth treated by generalists (9.3% vs 3.0%, respectively; P < .0001). Sex, age, tooth type, type of dentist, and arch were not found to be associated with nonodontogenic persistent pain; however, ethnicity and a preoperative diagnosis of pulpitis without periapical pathosis were. Patients reporting pain with percussion tended to experience pain with other stimuli that negatively impacted quality of life including oral function and psychological discomfort and disability. CONCLUSIONS These results suggest that a small percentage (3.1%) of patients experience persistent pain not attributable to odontogenic causes 3-5 years after primary root canal therapy that may adversely impact their quality of life.
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Affiliation(s)
- Donald A Vena
- The EMMES Corporation, Rockville, Maryland; PEARL Network Coordinating Center, New York, New York
| | | | - Hongyu Wu
- The EMMES Corporation, Rockville, Maryland
| | - Jennifer L Gibbs
- Department of Endodontics, New York University College of Dentistry, New York, New York
| | - Hillary L Broder
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, New York
| | - Frederick A Curro
- Department of Oral and Maxillofacial Pathology, Radiology, and Medicine, Clinical Pharmacology/Regulatory Affairs, Bluestone Center for Clinical Research, New York University College of Dentistry, New York, New York
| | - Van P Thompson
- PEARL Network, New York, New York; Department of Biomaterials, Biomemitics and Biophotonics, King's College London Dental Institute, Guy's Hospital, London, United Kingdom
| | - Ronald G Craig
- Department of Basic Sciences and Craniofacial Biology, New York University College of Dentistry, New York, New York; Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, New York.
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