Can Intra-Oral Qualitative Sensory Testing Foretell Postoperative Dental Pain? A Preliminary Report.

Pain prevention and management is one of the primary goals of dental care. Postoperative dental pain (PDP) following caries removal and performance of a restorative dental treatment is a common clinical phenomenon, often causing significant discomfort to dental patients. In the present study, a psychophysical non-invasive method, qualitative sensory testing (QualST), was used in an attempt to foretell PDP following dental restorative procedures. Forty-two dental patients underwent an intra-oral cold QualST four times: immediately prior to a restorative dental procedure and at a follow-up meeting 1−3 weeks later, on the treated and on the contralateral oral sides. The QualST measures included subjects' evaluation of the magnitude of pain and cold sensations experienced (on visual analogue scales) and the duration of the cold sensation (in seconds). Additional measures included age, gender, level of dental anxiety, jaw treated, and type of dental restoration performed (Class I or Class V). Subjects' PDP was assessed through the phone using numeric rating scales 24, 48, and 72 h postoperatively. The highest level of PDP experienced by subjects occurred 24 h postoperatively (ANOVA with repeated measures). Of the study variables, the QualST pain sensation (B = 0.645, p < 0.001), duration of the cold sensation (B = 0.042, p < 0.05), and an interaction between gender and dental anxiety (B = 0.136, p < 0.05) emerged as possible predictors of the highest PDP experienced by subjects (stepwise regression). The results suggest that subjects' reaction to an intra-oral cold stimulation of the oral mucosa can serve as a potential tool to foretell postoperative dental pain following restorative dental procedures.

Symptoms of Nocturnal Masticatory Muscle Activity among Women of Different Age Groups and Their Association to Obstructive Sleep Apnea-A Cross Sectional Study.

Sleep bruxism (SB), snoring, and excessive daytime sleepiness are often associated with obstructive sleep apnea (OSA). OSA, which is characterized by a repetitive collapse of the upper airway during sleep, can cause oxygen desaturation and lead to adverse medical conditions, such as cardiovascular events, hypertension, heart attack, and stroke. In the present study, 112 Arab women aged 20−40 years (Early Adulthood/Adulthood−EarlyA) and 116 Arab women aged 50 and above (Middle Age−MiddleA), were requested to complete questionnaires regarding demographic variables, symptoms of nocturnal masticatory muscle activity (possible SB, headache, and stiffness of the oral and/or neck musculature upon awakening), risk of OSA (STOP-BANG questionnaire), and daytime sleepiness (Epworth sleepiness scale­ESS). Women, who reported snoring, experienced more SB (35.8% vs. 20.6%, chi-square, p < 0.05), more headaches (33.3% vs. 19.3%, p < 0.05), and more muscle stiffness upon awakening (34.3% vs. 16.3%, p < 0.005), than their non-snoring counterparts. Out of the women who snore, 11% showed high risk for OSA, as compared to only 1% among the non-snoring participants (p < 0.000). Symptoms of nocturnal masticatory muscle activity and/or snoring can serve as initial indicators of OSA. Higher awareness of dentists to such symptoms, particularly among their middle-aged female patients, can prevent a development of harmful conditions associated with OSA.

Psychosocial and Behavioral Factors in Awake Bruxism-Self-Report versus Ecological Momentary Assessment.

The issue of psychosocial factors and concurrent conditions associated with AB is a relatively new approach in the study of Awake Bruxism (AB). In the present study a population of 84 dental students were assessed for probable AB with two modes of AB assessment: Single point self-report (SR) and ecological momentary assessment through a designated smartphone application (BA). The two assessment modes were compared with regard to their ability to phenotype subjects as far as the following psychosocial and behavioral variables are concerned: Gender; depression; somatization; oral behaviors; chronic pain and associated pain symptoms in the head, neck and scapula. Two-way ANOVA showed main effect of SR for the following variables: Chronic Pain Intensity score (F(1,49) = 6.441, p < 0.02), migraine/headache (F(1,81) = 7.396, p < 0.01), pain in neck (F(1,81) = 6.726, p < 0.05), pain in scapula (F(1,81) = 8.546, p < 0.005) and the oral behaviors of pushing the tongue forcefully against the teeth (F(1,81) = 5.222, p < 0.05) and inserting the tongue between the upper and lower teeth (F(1,81) = 5.344, p < 0.03). The effect of SR on the habit of chewing gum was borderline (F(1,81) = 3.369, p = 0.07). Main effect of BA was found for depression (F(1,81) = 6.049, p < 0.05), while the effect of BA on somatization was borderline (F(1,81) = 3.657, p = 0.059). An interaction between SR and BA groups could be observed for the behavior of biting, chewing or playing with the tongue, cheeks or lips (F(1,81) = 4.117, p < 0.05). The results suggest that a combination of a single-point self-report referring to the past 30 days, and an ecological momentary assessment supplying information about the actual timing of the report, can help us to better assess AB, as well as increase our ability to define the phenotype of subjects with AB as far as psychosocial and behavioral factors are concerned.

Awake Bruxism-Single-Point Self-Report versus Ecological Momentary Assessment.

Assessment of awake bruxism (AB) is problematic due to the inability to use continuous recordings during daytime activities. Recently, a new semi-instrumental approach was suggested, namely, ecological momentary assessment (EMA), via the use of a smartphone application. With the application, subjects are requested to report, at least 12 times per day, the status of their masticatory muscle activity (relaxed muscles, muscle bracing without tooth contact, teeth contact, teeth clenching, or teeth grinding). The aim of the present study was to test the association between a single observation point self-report and EMA assessment of AB. The most frequent condition recorded by the EMA was relaxed muscles (ca. 60%) and the least frequent was teeth grinding (less than 1%). The relaxed muscle condition also showed the lowest coefficient of variance over a seven-day period of report. Additionally, only the relaxed muscles and the muscle bracing conditions presented an acceptable ability to assess AB-positive and AB-negative subjects, as defined by single-point self-report questions. The combination between self-report and EMA may have the potential to promote our ability to assess AB. We suggest to re-consider the conditions of teeth contact and teeth grinding while using EMA to evaluate AB.