Sleep quality and psychosocial characteristics of patients with painful post-traumatic trigeminal neuropathies.

OBJECTIVES: The aim of this study was to explore how pain and psychological distress influence the sleep quality of patients with painful post-traumatic trigeminal neuropathy (PPTN). STUDY DESIGN: Thirty-two patients with a diagnosis of PPTN according to the International Classification for Headache Disorders of the International Headache Society were enrolled. All patients completed a number of questionnaires that examined sleep quality, psychological distress, and quality of life. RESULTS: The global Pittsburg Sleep Quality Index (PSQI) score was "5" or greater in 75% of the patients. Additionally, the Symptom Check List-90-Revised (SCL-90-R) global severity index (GSI) revealed that 71.9% of the study sample reported values of psychological distress over the level of clinical significance. Sleep quality was analyzed through a linear regression model of global PSQI (dependent variable) that included gender, age, pain intensity, and pain duration (independent variables). This model revealed a significant positive association between the PSQI global score and the SCL-90-R GSI that was independent of age, gender, pain intensity, and duration. CONCLUSIONS: Patients with PPTN present higher levels of sleep disturbance and psychological distress compared with the general population. Sleep quality disturbances and levels of psychological distress are strongly associated and seem to be independent of age, gender, medication use, pain intensity and duration.

Prevalence of neuropathic pain and sensory alterations after dental implant placement in a university-based oral surgery department: A retrospective cohort study.

OBJECTIVE: To determine the prevalence and the clinical features of patients with neuropathic pain and sensory alterations after dental implant placement. BACKGROUND: Literature is very scarce concerning the prevalence of neuropathic pain after dental implant placement. PATIENTS AND METHODS: A retrospective cohort study was made in patients submitted to dental implant placement in the Dental Hospital of the University of Barcelona. A descriptive analysis of the data was made, and the 95% confidence intervals (95% CI) were calculated for the prevalences. RESULTS: The study sample was composed of 1156 subjects of whom, 1012 patients (3743 dental implants) met the study inclusion criteria. Four hundred and seventeen patients (41.2%) were male and 595 (58.8%) were female, with a mean age of 60.7 years (range 16-90 years). Three patients were diagnosed as having painful post-traumatic trigeminal neuropathy (PPTN), which corresponds to a prevalence of 0.3% (95% CI: 0%-0.6%). Additionally, 5 patients (0.5%; 95% CI: 0%-1.07%) presented trigeminal neuropathy without pain (TNWP). The combined prevalence of both disorders was 0.8% (95% CI: 0.02%-1.3%). All patients with PPTN and TNWP were 60 years old or older, with a total combined prevalence of 1.48% (95% CI: 0.46%-2.5%) in this age group. Additionally, the prevalence in this age group for women was 1.85% (95%CI: 0.38%-3.31%). CONCLUSIONS: Neuropathic pain after dental implant placement is very infrequent (0.3%) in a University Oral Surgery department. However, the presence of trigeminal neuropathies can be slightly higher and can affect up to 0.5% of patients. Older female patients seem to be more prone to this rare and disabling complication.

The use of low level laser therapy in the treatment of temporomandibular joint disorders. Review of the literature.

INTRODUCTION: The temporomandibular disorders (TMDs) have been identified as the most important cause of pain in the facial region. The low level laser therapy (LLLT) has demonstrated to have an analgesic, anti-inflammatory and biostimulating effects. The LLLT is a noninvasive, quick and safe, non-pharmaceutical intervention that may be beneficial for patients with TMDs. However the clinical efficiency of LLLT in the treatment of this kind of disorders is controversial. OBJECTIVES: Literature review in reference to the use of LLLT in the treatment of TMDs, considering the scientific evidence level of the published studies. MATERIAL AND METHODS: A MEDLINE and COCHRANE database search was made for articles. The keywords used were "temporomandibular disorders" and "low level laser therapy" or "phototherapy" and by means of the Boolean operator "AND". The search provided a bank of 35 articles, and 16 relevant articles were selected to this review. These articles were critically analyzed and classified according to their level of scientific evidence. This analysis produced 3 literature review articles and 13 are clinical trials. The SORT criteria (Strength of Recommendation Taxonomy) was used to classify the articles. RESULTS: Only one article presented an evidence level 1, twelve presented an evidence level 2, and three presented an evidence level 3. According to the principle of evidence-based dentistry, currently there is a scientific evidence level B in favor of using LLLT for treatment of TMDs. DISCUSSION AND CONCLUSIONS: Publications on the use of LLLT for treatment of TMDs are limited making difficult to compare the different studies due to the great variability of the studied variables and the selected laser parameters. The great majority of the studies concluded that the results should be taken with caution due to the methodological limitations.

Use of autologous conditioned serum (Orthokine) for the treatment of the degenerative osteoarthritis of the temporomandibular joint. Review of the literature.

OBJECTIVES: Treatment of osteoarthritis (OA) using autologous conditioned serum (ACS) has become in recent years an alternative to consider in the approach of the degenerative joint disease of the knee. There is no support in the literature for the use of ACS for the treatment of OA of the temporomandibular joint (TMJ), although the promising results obtained in human patients with knee joint disease and in animal studies are opening the way for its use at the TMJ. The aim of this paper is to conduct a review of the published literature regarding the use of the ACS for the treatment of OA in humans, considering the level of scientific evidence, and following the principles of the evidence-based medicine and dentistry. MATERIAL AND METHODS: A PubMed-MEDLINE search was carried out of articles published between 1980 and 2011. After an initial search, a total of 102 articles were obtained, followed by a selection of the most relevant articles according to the topic; a total of 8 articles were selected, which were stratified according to their level of scientific evidence using SORT criteria (Strength of Recommendation Taxonomy). RESULTS: At the time of this review, there is no available literature referring the use of ACS at the TMJ. However, the use of the ACS in other joints is well documented, both experimentally and clinically, in humans and animals. The reviewed articles, with a level of evidence 1 and 2 according to the SORT criteria, have generally promising results. DISCUSSION AND CONCLUSIONS: The use of ACS in the treatment of OA in joints other than the TMJ, is endorsed by the level of evidence found in the literature, which opens the door to future studies to determine the feasibility of the use of the ACS in the treatment of degenerative OA that affects TMJ.

Antiepileptic drugs for the treatment of neuropathic pain: a systematic review.

Many therapies have been proposed for the management of neuropathic pain, and they include the use of different antiepileptic drugs. However, the lack of high quality studies indicates that results on the different neuropathic disorders under study do not recommend a particular drug treatment. This study makes a systematic review of the published literature on the use of several antiepileptic drugs to treat neuropathic pain, and has the objective of considering both its clinical characteristics and pharmacological use, which will depend on their level of scientific evidence and will follow the principles of evidence-based dentistry. The articles were stratified according to their scientific evidence using the SORT criteria (Strength of Recommendation Taxonomy), and it included those articles that only have level 1 or 2. Randomized clinical trials were stratified according to their level of quality using the JADAD scale, an instrument described by Jadad et al. (7). to assess the quality of clinical trials, while studies with a level below 3 were discarded. Recently, type A or B recommendations are given in favor or against the use of antiepileptic drugs to treat neuropathic pain on the basis of their scientific quality.

Atypical odontalgia: a systematic review following the evidence-based principles of dentistry.

Atypical odontalgia (AO) is a severe and persistent pain involving controversial pathophysiological mechanisms and clinical management. Presented here is a systematic review of the literature on AO, using the SORT criteria (Strength of Recommendation Taxonomy) to assess the level of evidence and the quality of randomized clinical trials (RCT). A total of 54 articles were obtained of which 34 belonged to level 3 evidence, 17 to level 2, and 3 to level 1. Of these, only 8 RCT had an average quality of four points. The main finding of this systematic review is that only a few studies have systematically evaluated AO. It also determines a strength recommendation of level B to the theory of neuropathic origin of pain in AO and strength of recommendation level C for the pharmacological management of this condition. The aim of this study was to carry out a systematic review of the published literature on AO in order to determine the physiopathology and treatment based on the level of scientific evidence and following the evidence-based principles of dentistry.

Bifid mandibular condyle: a disorder in its own right?

BACKGROUND: The authors present six cases of mandibular condyle malformation. They also conducted a literature review of bifid mandibular condyle (BMC) to analyze the various hypotheses that have been made regarding the etiopathogenesis of this entity. Type of Studies Reviewed. The authors searched the PubMed database for all instances of BMC and similar anatomical alterations, and they included non-English-language published reports. The inclusion criterion was the presence of a multilobular mandibular condyle. RESULTS: Mandibular condyle may manifest in different anatomical forms; bilobular is the most common, although triple lobular morphology also has been observed. A congenital origin has been suggested as the primary cause. In addition, trauma may alter the growth of the condylar cartilage, inducing an anatomical defect. However, the majority of participants in this study had no history of trauma. The authors reviewed a total of 198 cases in study participants and cadavers. CLINICAL IMPLICATIONS: In the absence of traumatic antecedents or other alterations of the temporomandibular joint, the presence of a BMC may be associated with developmental anomalies.

Scientific evidence on the usefulness of intraarticular hyaluronic acid injection in the management of temporomandibular dysfunction.

Hyaluronic acid (HA) is found in high concentrations in cartilage and synovial fluid, and is an important component of the extracellular matrixes-exerting joint lubrication and buffering actions thanks to its viscoelastic properties. The present study examines the scientific evidence found in the current literature on the usefulness of the intraarticular injection of HA in patients with temporomandibular dysfunction. A literature search was made up until May 2008 in the following databases: PubMed / MEDLINE. Of the articles found in the literature, the present review included 18 relevant studies on the application of HA in the temporomandibular joint (TMJ). The quality, level of evidence and strength of recommendation of the articles was evaluated based on the "Strength of Recommendation Taxonomy" criteria. It is concluded that type A level of recommendation exists in favor of the intraarticular injection of HA in dysfunction of the TMJ. However, further studies are needed to establish the true therapeutic effects and to identify the best dosing regimen.

Myofascial pain associated to trigger points: a literature review. Part 2: differential diagnosis and treatment.

During the last decades the advance in knowledge of myofascial pain has been constant in the medical and dental community. However, although several aspects have been clarified in relation to its epidemiology, clinical characteristics and etiopathogenesis, many uncertainties remain. Many clinical conditions are included in the differential diagnosis of myofascial pain associated to trigger points. A good anamnesis and clinical exploration is thus required in order to ensure correct diagnosis and treatment. Among the numerous treatments used in application to trigger points, the spray-and-stretch technique and direct injection targeted to such trigger points have been found to be the most effective options. In chronic cases, psychosocial intervention is required, due to the high incidence of mood disorders and/or anxiety observed in these patients, who in turn present a poorer prognosis. This underscores the importance of early diagnosis and treatment.

Myofascial pain syndrome associated with trigger points: a literature review. (I): Epidemiology, clinical treatment and etiopathogeny.

Over the last few decades, advances have been made in the understanding of myofascial pain syndrome epidemiology, clinical characteristics and aetiopathogenesis, but many unknowns remain. An integrated hypothesis has provided a greater understanding of the physiopathology of trigger points, which may allow the development of new diagnostic, and above all, therapeutic methods, as well as the establishment of prevention policies and protocols by the health profession. Nevertheless, randomized studies are needed to provide a better understanding and detection of the different factors involved in the origin of trigger points.

The use of tricyclic antidepressants in the treatment of temporomandibular joint disorders: systematic review of the literature of the last 20 years.

Many therapies have been proposed for the management of temporomandibular disorders, including the use of different drugs. However, lack of knowledge about the mechanisms behind the pain associated with this pathology, and the fact that the studies carried out so far use highly disparate patient selection criteria, mean that results on the effectiveness of the different medications are inconclusive. This study makes a systematic review of the literature published on the use of tricyclic antidepressants for the treatment of temporomandibular disorders, using the SORT criteria (Strength of recommendation taxonomy) to consider the level of scientific evidence of the different studies. Following analysis of the articles, and in function of their scientific quality, a type B recommendation is given in favor of the use of tricyclic antidepressants for the treatment of temporomandibular disorders.

Use of amitriptyline for the treatment of chronic tension-type headache. Review of the literature.

Amitriptyline is a tricyclic antidepressant, considered the treatment of choice for different types of chronic pain, including chronic myofascial pain. Its antinociceptive property is independent of its antidepressant effect. Although its analgesic mechanism is not precisely known, it is believed that the serotonin reuptake inhibition in the central nervous system plays a fundamental role in pain control. Although this medication is widely used in the prevention of chronic tension-type headache, few studies have investigated the efficacy of this treatment and the published results are contradictory. The objective of this article was to review the literature published on the use of amitriptyline in the prophylactic treatment of chronic tension-type headache, considering the level of scientific evidence of the different studies using the SORT criteria. From this review, 5 articles of evidence level 1, and another 5 articles of evidence level 2 were selected. Following analysis of the 10 studies, and in function of their scientific quality, a level A recommendation was made in favor of using amitriptyline in the treatment of chronic tension-type headache.

Nervus intermedius neuralgia: a case report.

Nervus intermedius neuralgia (NIN) is an uncommon disorder that affects a sensory branch of the facial nerve. This condition usually provokes a very intense and stabbing pain localized in the depth of the ear canal. Due to the close anatomical proximity, temporomandibular joint (TMJ) pathologies should be included in the differential diagnosis. The treatment of NIN has not been established, although it seems reasonable that the therapeutic approaches used in other more common craniofacial neuralgias, such as trigeminal neuralgia, should be effective. In this paper, the authors present a case report of a female patient diagnosed with NIN who was successfully managed with pharmacological treatment.

Persistent idiopathic facial pain following dental implant placement: a case report.

The present case report depicts the management of a patient with persistent idiopathic facial pain following the placement of 2 dental implants in the mandibular anterior alveolar ridge. After 15 months of unsuccessful diagnosis and management, the patient was seen at the Orofacial Pain Unit of the Oral Surgery and Implantology master's degree program of the University of Barcelona. Seven months after treatment onset, a combination of nortriptyline, clonazepam, and relaxation procedures has successfully controlled the patient's facial pain symptoms.

Treatment of inferior lateral pterygoid muscle dystonia with zolpidem tartrate, botulinum toxin injections, and physical self-regulation procedures: a case report.

The following case report depicts the management of a patient suffering with a jaw opening oromandibular dystonia using a combination of botulinum toxin injections, zolpidem, and relaxation procedures. Eventually the botulinum toxin injections were eliminated, and the patient was maintained with only zolpidem and relaxation procedures.