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Taheri AA, Parvizifard AA, Reisi S, Jafari M, Mohammadian Y, Heshmati K, Foroughi A, Eivazi M, Ghasemi M. Associations between the perception of dental pain and pain anxiety, mental pain, and dental anxiety in Iranian sample. Int J Psychiatry Med 2024; 59:34-49. [PMID: 37265197 DOI: 10.1177/00912174231180855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study examined the perception of dental pain and its relationship to pain anxiety, dental anxiety, and mental pain. METHODS This cross-sectional study was conducted on 328 patients referred to dental clinics in Kermanshah (Iran) from 2020 to 2021. The instruments used in this study included scales assessing pain anxiety, dental anxiety, mental pain, and pain perception. RESULTS There was a significant relationship (p = .001) between pain perception with dental anxiety (r = .38), pain anxiety (r = .45), and mental pain (r = .25). CONCLUSION Psychological factors are associated with the perception of dental pain. Given the importance of dental care to overall health, psychological interventions may help to reduce the perception of dental pain and fear of seeing dentists in Iran.
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Affiliation(s)
- Amir Abbas Taheri
- Department of Rehabilitation Counseling, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Ali Akbar Parvizifard
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sajjad Reisi
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahsa Jafari
- Department of Psychology, University of Mohaghegh Ardebili, Ardebil, Iran
| | - Yokhabe Mohammadian
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Khatereh Heshmati
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Aliakbar Foroughi
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoome Eivazi
- Department of periodontics, school of dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Ghasemi
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Romero-Reyes M, Arman S, Teruel A, Kumar S, Hawkins J, Akerman S. Pharmacological Management of Orofacial Pain. Drugs 2023; 83:1269-1292. [PMID: 37632671 DOI: 10.1007/s40265-023-01927-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/28/2023]
Abstract
Orofacial pain is a category of complex disorders, including musculoskeletal, neuropathic and neurovascular disorders, that greatly affect the quality of life of the patient. These disorders are within the fields of dentistry and medicine and management can be challenging, requiring a referral to an orofacial pain specialist, essential for adequate evaluation, diagnosis, and care. Management is specific to the diagnosis and a treatment plan is developed with diverse pharmacological and non-pharmacological modalities. The pharmacological management of orofacial pain encompasses a vast array of medication classes and approaches. This includes anti-inflammatory drugs, muscle relaxants, anticonvulsants, antidepressants, and anesthetics. In addition, as adjunct therapy, different injections can be integrated into the management plan depending on the diagnosis and needs. These include trigger point injections, temporomandibular joint (TMJ) injections, and neurotoxin injections with botulinum toxin and nerve blocks. Multidisciplinary management is key for optimal care. New and safer therapeutic targets exclusively for the management of orofacial pain disorders are needed to offer better care for this patient population.
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Affiliation(s)
- Marcela Romero-Reyes
- Brotman Facial Pain Clinic, School of Dentistry, University of Maryland, 650 W. Baltimore St, 1st Floor, Baltimore, MD, 21201, USA.
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th Floor, Baltimore, MD, 21201, USA.
| | - Sherwin Arman
- Orofacial Pain Program, Section of Oral Medicine, Oral Pathology and Orofacial Pain, University of California, Los Angeles, School of Dentistry, Los Angeles, CA, USA
| | | | - Satish Kumar
- Department of Periodontics, Arizona School of Dentistry and Oral Health, A.T. Still University, Mesa, AZ, USA
| | - James Hawkins
- Naval Postgraduate Dental School, Naval Medical Leader and Professional Development Command, Uniformed Services University of the Health Sciences Postgraduate Dental College, Baltimore, MD, USA
| | - Simon Akerman
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th Floor, Baltimore, MD, 21201, USA
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Shin YM, Choi SY, Lee DH, Jung JK, Kwon TG. Management of chronic idiopathic pain in patients with dental implant without a clear pathological lesion: A retrospective study. J ORAL IMPLANTOL 2021; 48:301-306. [PMID: 34522975 DOI: 10.1563/aaid-joi-d-21-00094] [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: 11/22/2022]
Abstract
Non-nociceptive, persistent idiopathic facial pain (PIFP) is a poorly localized, continuous dull pain that occurs even in the absence of apparent pathological lesions or clinical neurologic deficiency. This study aimed to investigate the disease characteristics of PIFP that developed after dental implant treatments. The clinical characteristics of pain as well as treatment method and outcomes were retrospectively analyzed in 20 patients diagnosed with PIFP. The patients developed pain either after implant fixation or prosthetic treatment. In most of the patients, the pain persisted not only around the implant region but also at a distant site from the related implant (13/20, 65%). Many patients desired removal of the implants to manage the pain although the pain was not considered to be related to the implant treatment itself. In 12 patients, the related implants were removed but 67% (n = 8/12) of the patients still experienced chronic pain after implant removal. Medication helped decrease the pain in most patients (n = 17). Pregabalin and clonazepam showed relatively higher efficiency than other medications for controlling the pain. The results showed that although the onset of PIFP was related to dental implant treatment, implant removal could not be considered a reliable option for the management of PIFP. Although medication controls the pain at least partially, complete pain control with medication should not be expected. These results demonstrate that an accurate diagnosis of PIFP is important for the selection of appropriate treatment.
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Affiliation(s)
- Young-Min Shin
- Dept. of Dentistry and Oral Surgery, Dong-san Medical Center, School of Medicine, Keimyung University, Dong-san dong, Jung-gu, Daegu 41931, Republic of Korea, E-mail:
| | - So-Young Choi
- Dept. of Oral and Maxillofacial Surgery, School of Dentistry, Institute for Translational Research in Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu 41940, Republic of Korea, E-mail:
| | - Du-Hyeong Lee
- Dept. of Prosthodontics, School of Dentistry, Institute for Translational Research in Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu 41940, Republic of Korea, E-mail:
| | - Jae-Kwang Jung
- Dept. of Oral Medicine, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu 41940, Republic of Korea, E-mail:
| | - Tae-Geon Kwon
- Kyungpook National University School of Dentistry Oral & Maxillofacial Surgery 2177 Dalgubeol Daero KOREA, REPUBLIC OF Daegu Daegu 41940 +82-53-426-5365 Kyungpook National University School of Dentistry
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Slettebø H. Is this really trigeminal neuralgia? Diagnostic re-evaluation of patients referred for neurosurgery. Scand J Pain 2021; 21:788-793. [PMID: 34333890 DOI: 10.1515/sjpain-2021-0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/14/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Patients with facial pain are sometimes referred for neurosurgical treatment with a poorly documented diagnosis of trigeminal neuralgia. In such cases, neurosurgery will usually not be helpful. We conducted a re-evaluation of the diagnosis in patients referred for neurosurgical treatment of presumed trigeminal neuralgia. Our objective was to find out why and how often misdiagnosis occurred. METHODS A retrospective study was done in consecutive first-time patients referred for trigeminal neuralgia to our outpatient clinic in 2019. We used five ICHD-3-based clinical criteria to verify or exclude the diagnosis. In patients where trigeminal neuralgia was excluded, we established a diagnosis for their facial pain based upon medical history and a physical examination by a neurosurgeon - often supplemented with examination by an oral surgeon. RESULTS Thirty-eight patients were referred for presumed trigeminal neuralgia. Only 17 of them fulfilled the five criteria and were diagnosed with trigeminal neuralgia. In 20 of the remaining 21 patients trigeminal neuralgia could be clearly excluded, while one of the patients had a periodontitis closely mimicking trigeminal neuralgia. In 14 of the 21 patients we diagnosed temporomandibular dysfunction or dental conditions. MRI scans had detected low-grade neurovascular contacts in 13 of the 21 patients, a finding that was clearly overestimated by the referring neurologists in seven patients. CONCLUSIONS Overdiagnosis of trigeminal neuralgia was common in patients referred for neurosurgery, mostly due to insufficient clinical evaluation combined with an overestimation of MRI-detected NVCs. The clinical diagnosis should be critically re-evaluated before recommending neurosurgery to patients referred for presumed trigeminal neuralgia.
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Affiliation(s)
- Haldor Slettebø
- Department of Neurosurgery, Rikshospitalet, Oslo University Hospital, Pb 4950 Nydalen, 0424Oslo, Norway
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Selvido DI, Bhattarai BP, Rokaya D, Niyomtham N, Wongsirichat N. Pain in Oral and Maxillofacial Surgery and Implant Dentistry: Types and Management. Eur J Dent 2021; 15:588-598. [PMID: 34041732 PMCID: PMC8382502 DOI: 10.1055/s-0041-1725212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Over the years, the pain has been defined numerous times in several ways. In oral and maxillofacial surgery, the occurrence of pain, especially postoperatively, is anticipated. Pain arises as a combination of various processes after tissue damage. Distinct pain experiences in oral surgery were depicted in several previous studies, adding knowledge to the field. The management of these encounters has been suggested over time, improving treatment approaches in the clinical setting. This review aims to understand the pain and its types and intervention in the field of oral and maxillofacial surgery.
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Affiliation(s)
- Diane Isabel Selvido
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Bishwa Prakash Bhattarai
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Dinesh Rokaya
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Nattisa Niyomtham
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
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Potential neurovascular damage as a result of dental implant placement in the anterior maxilla. Br Dent J 2019; 226:657-661. [PMID: 31076691 DOI: 10.1038/s41415-019-0260-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Introduction A patient requested dental implant therapy to replace his missing upper left central incisor. Pre-operative cone beam computed tomography (CBCT) imaging revealed a complex neurovascular supply to the anterior maxilla.Discussion Imaging demonstrated accessory neurovascular canals around the nasopalatine foramen which directly communicate with canalis sinuosus. They are, therefore, most likely to carry branches of the anterior superior alveolar nerve and vessels. One of these canals was directly in the path of proposed dental implant placement. A review of the dental literature suggests that such anatomical variation is relatively common. Some authors have proposed that injury to these structures is a cause of intractable pain following dental implant placement. Following discussion with the patient, it was agreed that the provision of an adhesive bridge was a realistic alternative in this case.Conclusion The availability of CBCT imaging in recent years has shown that complex neurovascular anatomy in the anterior maxilla is not uncommon. Evidence is lacking regarding the relevance of this to dental implant placement but it is possible that injury to these structures explains some cases of postoperative intractable pain.
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Glare P, Aubrey KR, Myles PS. Transition from acute to chronic pain after surgery. Lancet 2019; 393:1537-1546. [PMID: 30983589 DOI: 10.1016/s0140-6736(19)30352-6] [Citation(s) in RCA: 384] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/20/2018] [Accepted: 02/07/2019] [Indexed: 12/14/2022]
Abstract
Over the past decade there has been an increasing reliance on strong opioids to treat acute and chronic pain, which has been associated with a rising epidemic of prescription opioid misuse, abuse, and overdose-related deaths. Deaths from prescription opioids have more than quadrupled in the USA since 1999, and this pattern is now occurring globally. Inappropriate opioid prescribing after surgery, particularly after discharge, is a major cause of this problem. Chronic postsurgical pain, occurring in approximately 10% of patients who have surgery, typically begins as acute postoperative pain that is difficult to control, but soon transitions into a persistent pain condition with neuropathic features that are unresponsive to opioids. Research into how and why this transition occurs has led to a stronger appreciation of opioid-induced hyperalgesia, use of more effective and safer opioid-sparing analgesic regimens, and non-pharmacological interventions for pain management. This Series provides an overview of the epidemiology and societal effect, basic science, and current recommendations for managing persistent postsurgical pain. We discuss the advances in the prevention of this transitional pain state, with the aim to promote safer analgesic regimens to better manage patients with acute and chronic pain.
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Affiliation(s)
- Paul Glare
- Pain Management Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Karin R Aubrey
- Pain Management Research Institute, University of Sydney, Sydney, NSW, Australia; Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, VIC.
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Feller L, Khammissa RAG, Bouckaert M, Ballyram R, Jadwat Y, Lemmer J. Pain: Persistent postsurgery and bone cancer-related pain. J Int Med Res 2019; 47:528-543. [PMID: 30632434 PMCID: PMC6381470 DOI: 10.1177/0300060518818296] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The generation of neuropathic pain is a complex dynamic process. Factors involved include one or more dysregulated sensory neural pathways; dysregulated activity of specific neurotransmitters, synapses, receptors and cognitive and emotional neural circuits; and the balance between degenerative and regenerative neural events. Risk factors include age, sex, cognition, emotions, genetic polymorphism, previous or ongoing chronic pain conditions and the use of certain drugs. Intense pain experienced before, during and after surgery is a risk factor for the development of central sensitization with consequent persistent postsurgery neuropathic pain. Blockade of N-methyl-D-aspartate receptors with appropriate drugs during and immediately after surgery may prevent persistent postsurgical pain. Most cancers, but particularly malignant metastases in bone, can induce persistent pain. Local factors including direct damage to sensory nerve fibres, infiltration of nerve roots by cancer cells and algogenic biological agents within the microenvironment of the tumour bring about central sensitization of dorsal horn neurons, characterized by neurochemical reorganization with persistent cancer pain. In this article, the clinical features, pathogenesis and principles of management of persistent postsurgery pain and cancer pain are briefly discussed.
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Affiliation(s)
- Liviu Feller
- 1 Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Razia Abdool Gafaar Khammissa
- 1 Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Michael Bouckaert
- 2 Department of Maxillofacial Oral Surgery, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Raoul Ballyram
- 1 Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Yusuf Jadwat
- 1 Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Johan Lemmer
- 1 Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Pain Complaints in Patients Undergoing Orthognathic Surgery. Pain Res Manag 2018; 2018:4235025. [PMID: 30123397 PMCID: PMC6079318 DOI: 10.1155/2018/4235025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/06/2018] [Accepted: 07/02/2018] [Indexed: 12/29/2022]
Abstract
The aim of this retrospective study was to assess the frequency of orofacial (nonodontogenic, neuropathic, or atypical) and temporomandibular joint (TMJ) and/or masticatory muscle pain in orthognathic patients in a tertiary institution. A total of 286 consecutive patients undergoing sagittal split osteotomy from 2014 to 2016 were included. Thirty-nine (13.6%) patients presented with TMJ pain and 10 (3.5%) with orofacial nonodontogenic pain before orthognathic surgery; 79.6% (39/49) of these patients had no pain 1 year after surgery. Twenty-nine patients (12.2%) with no preoperative orofacial pain and 22 (9.3%) without preoperative TMJ pain presented with pain 1 year after surgery. Fifty-one (17.8%) of the 286 patients treated for orthognathic cases at our center over the 3-year period presented with pain 1 year after surgery. Most patients were managed conservatively with nonsurgical therapeutic modalities including counseling, physical therapy, warmth application, and bilateral chewing and splint therapy. In patients with TMJ pain refractory to conservative treatment, arthroscopic surgery was advised and successful in all patients for both pain reduction and improvement of the maximal interincisal opening. TMJ symptoms do develop after orthognathic surgery in patients with and without a previous history of TMJ complaints. Most patients can be managed with nonsurgical therapeutic modalities.
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Abstract
The diagnosis and management of orofacial pain may be challenging due to complex histories, pathophysiology and associated psychosocial co-morbidities such as depression and anxiety. Neuropathic facial pain conditions such as burning mouth syndrome (BMS), persistent idiopathic facial pain (PIFP), atypical odontalgia (AO) and trigeminal neuralgia (TN) require early recognition by primary care clinicians and referral to secondary care. Acute pain-related temporomandibular disorder (TMD) may be managed in the primary care setting, with identification of those at risk of developing chronic TMD receiving an early referral to secondary care. Adopting a biopsychosocial approach, consisting of physical therapies, pharmacotherapy and psychological support can lead to effective management and may limit the negative impact of facial pain upon quality of life and daily functioning.
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The American Academy of Oral Medicine Clinical Practice Statement: Somatic symptom and related disorders. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:472-474. [PMID: 30084358 DOI: 10.1016/j.oooo.2017.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 01/06/2023]
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Nixdorf D, Moana-Filho E. Persistent dento-alveolar pain disorder (PDAP): Working towards a better understanding. Rev Pain 2011; 5:18-27. [PMID: 25309718 DOI: 10.1177/204946371100500404] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
• New terminology, persistent dento-alveolar pain disorder (PDAP), and diagnostic criteria have been put forward to address the shortcomings of existing nomenclature, which are associated with unclear criteria. • Arriving at an accurate diagnosis of PDAP is based on excluding other possible aetiologies, and may involve different care providers. • Synthesis of published data suggests that PDAP has a frequency of occurrence following root canal therapy of around 1.6%. • The putative risk factors involved in PDAP are largely unknown, but seem to be similar to those being identified with other post-surgical chronic pain disorders. • The underlying mechanisms involved in the development of and/or perpetuating PDAP are unknown and the approach to treatment remains empiric in nature.
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Affiliation(s)
- Donald Nixdorf
- Division of TMD & Orofacial Pain and Department of Neurology, University of Minnesota, 515 Delaware Street SE, Minneapolis, MN 55455 USA
| | - Estephan Moana-Filho
- Center for Neurosensory Disorders, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
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