Evaluación económica de las alternativas terapéuticas en pacientes con hiperestesia dentinaria / Economic evaluation of the therapeutic alternatives in patients with dentin hyperesthesia

Introducción: La hiperestesia dentinaria es una sensación dolorosa de intensidad variable, que va de leve a moderada y, al encontrarse la dentina expuesta, puede convertirse en una molestia constante. Objetivo: Determinar la alternativa menos costosa en el tratamiento de pacientes con hiperestesia dentinaria. Método: Se realizó una evaluación económica completa del tipo minimización de costo, en la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, desde enero hasta mayo de 2019. Se revisaron 40 historias clínicas, escogidas a conveniencia, ya que contaban con los datos necesarios para la investigación. Se crearon 2 grupos de estudios, cuyos integrantes fueron tratados con laca flúor y láser, respectivamente. Se analizaron las variables de edad, sexo, efectividad de los tratamientos, costo directo e indirecto y costo unitario. Resultados: En la serie predominaron el grupo etario de 15-24 años (30,0 %), seguido por el de 25- 34 (25,0 %), así como el sexo femenino (70,0 %). El costo unitario del tratamiento con laca flúor fue de $7,77 y con láser de $5,74, para una diferencia de $2,03. Conclusión: La alternativa menos costosa en el tratamiento de pacientes con hiperestesia dentinaria resultó ser la aplicación de láser; mientras que la evaluación económica realizada demostró ser apropiada en materia de eficiencia económica.

Introduction: Dentin hyperesthesia is a painful sensation of variable intensity that goes from light to moderate and, as dentin is exposed, it can become a constant discomfort. Objective: To determine the less expensive alternative in the treatment of patients with dentin hyperesthesia. Method: A complete economic evaluation of the cost minimization type was carried out in Martires del Moncada Teaching Provincial Stomatological Clinic in Santiago de Cuba, from January to May, 2019. Forty medical records were reviewed, chosen of convenience, since they had the necessary data for the investigation. Two groups of studies were created whose members were treated with lacquer fluorine and laser, respectively. The age, sex, effectiveness of the treatments, direct and indirect cost and unitary cost variables were analyzed. Results: In the series there was a prevalence of the 15-24 age group (30.0 %), followed by that of 25-34 (25.0 %), as well as the female sex (70.0 %). The unitary cost of the treatment with lacquer fluorine was of $7.77 and with laser of $5.74, for a difference of $2.03. Conclusion: The less expensive alternative in the treatment of patients with dentin hyperesthesia was the laser application; while the economic evaluation carried out demonstrated to be appropriate as regards economic efficiency.

Feline hyperaesthesia syndrome with self-trauma to the tail: retrospective study of seven cases and proposal for an integrated multidisciplinary diagnostic approach.

CASE SERIES SUMMARY: This was a retrospective study on the clinical features and response to treatment in seven cats with feline hyperaesthesia syndrome (FHS) and tail mutilation. FHS is a poorly understood disorder characterised by skin rippling over the dorsal lumbar area, episodes of jumping and running, excessive vocalisation, and tail chasing and self-trauma. The majority of the cats were young, with a median age of 1 year at the onset of clinical signs, male (n = 6) and with access to the outdoors (n = 5). Multiple daily episodes of tail chasing and self-trauma were reported in five cats, with tail mutilation in four cats. Vocalisation during the episodes (n = 5) and rippling of lumbar skin (n = 5) were also reported. Haematology, serum biochemistry, Toxoplasma gondii and feline immunodeficiency virus/feline leukaemia virus serology, MRI scans of brain, spinal cord and cauda equina, cerebrospinal fluid analysis and electrodiagnostic tests did not reveal any clinically significant abnormalities. A definitive final diagnosis was not reached in any of the cats, but hypersensitivity dermatitis was suspected in two cases. A variety of medications was used alone or in combination, including gabapentin (n = 6), meloxicam (n = 4), antibiotics (n = 4), phenobarbital (n = 2), prednisolone (n = 2) and topiramate (n = 2); ciclosporin, clomipramine, fluoxetine, amitriptyline and tramadol were used in one cat each. Clinical improvement was achieved in six cases; in five cats complete remission of clinical signs was achieved with gabapentin alone (n = 2), a combination of gabapentin/ciclosporin/amitriptyline (n = 1), gabapentin/prednisolone/phenobarbital (n = 1) or gabapentin/topiramate/meloxicam (n = 1). RELEVANCE AND NOVEL INFORMATION: This is the first retrospective study on a series of cats with FHS. The diagnostic work-up did not reveal any significant abnormalities of the central or peripheral nervous system; dermatological and behavioural problems could not be ruled out. We propose an integrated multidisciplinary diagnostic pathway to be used for the management of clinical cases and for future prospective studies.

Recubrimiento radicular / Root Coverage

INTRODUCCIÓN: existen varias alternativas de tratamiento para el recubrimiento radicular provocado por la recesión periodontal, la cual se caracteriza por el desplazamiento en sentido apical del margen gingival, con ello queda expuesta la raíz dental al medio bucal, lo que puede provocar sensibilidad dentinaria, caries dental y afectación de la estética. OBJETIVO: presentar un caso clínico donde se empleó una técnica quirúrgica para el recubrimiento radicular. PRESENTACIÓN DEL CASO: paciente masculino de 32 años, acudió a la consulta por molestias a los cambios térmicos en el 23 y preocupado por su estética ya que presenta la raíz expuesta al medio bucal. Al examen físico se observó alteración de la morfología gingival caracterizado solamente por cambio de la posición gingival en sentido apical en el 23, que no alcanza a la línea mucogingival. Se decidió en el plan de tratamiento correctivo no quirúrgico, tratar la hiperestesia dentinaria aplicar el desensibilizante dentinario (laca fluorada: Profilac), y en el tratamiento correctivo quirúrgico realizar un colgajo deslizante lateral para cubrir la raíz expuesta y tratar la afectación estética. CONCLUSIÓN: el procedimiento empleado tuvo los resultados previsibles y constituye una alternativa terapéutica cuando exista compromiso estético del paciente.

INTRODUCTION: there are several treatment options for root coverage caused by periodontal recession, which is characterized by displacement toward apically gingival margin, thereby dental root is exposed to the oral environment, which may cause dentine sensitivity, dental cavities, and aesthetic affectation. OBJECTIVE: present a clinical case where a surgical technique was used to root coverage. CASE REPORT: a 32 year-old male patient came to consultation due to nuisance to thermal changes in tooth 23 and he was concerned about aesthetics since he had his root exposed to the oral environment. On physical examination, altered gingival morphology was observed. It was characterized only by changing the apical gingival position in tooth 23, which does not reach the mucogingival line. It was decided a corrective plan of nonsurgical treatment, treating dentin hyperesthesia by applying dentin desensitizing (fluoridated lacquer: Profilac), and corrective surgical treatment to make a lateral sliding flap to cover the exposed root, and treating aesthetic condition. CONCLUSION: the used procedure had the expected results and it represents an alternative therapy when there is patient aesthetic compromise.

Self-management strategies used by patients who are hypersensitive to cold following a hand injury. A prospective study with two years follow-up.

STUDY DESIGN: Prospective cohort study. INTRODUCTION: Knowledge of the strategies used by patients with injuries of the hand to manage cold hypersensitivity should guide information given by health-care workers. PURPOSE: To explore the use of cold-associated self-management strategies in patients with severe hand injuries. METHODS: Seventy patients being cold hypersensitive following a hand injury, reported use of strategies to limit cold-induced symptoms in the injured hand(s) and the severity of cold-associated activity limitations one and two years after surgery. RESULTS: The patients used several strategies, including clothing (100%), use of own body (movement/use of muscles to produce heat or massage of the fingers) (94%), and heating aids (48%), but were still limited in valued cold-associated activities two years after surgery. The number of patients staying indoors, using heating aids and hand wear indoors and during summer-time increased with severity of cold hypersensitivity. Patients both implemented and discontinued different strategies after the first year, but for most strategies, the proportions of users were quite stable. CONCLUSION: The most common strategies used to limit cold-induced symptoms in the injured hand(s) were clothing and use of own body. Many patients also seemed to benefit from using heating aids. After one year, a number of patients still experimented in finding the best strategies and were still limited in valued cold-associated activities. LEVEL OF EVIDENCE: 2b.

Aplicación de Laserterapia en la hiperestesia dentinal / Application of laser therapy for the treatment of dentinal hyperesthesia

Se realizó un estudio experimental para evaluar la eficacia del láser de baja potencia combinada con barniz de flúor al 2 por ciento (Profilac) en el tratamiento de la Hiperestesia Dentinaria en pacientes atendidos en la Clínica Estomatológíca de Ciro Redondo en el periodo en el Octubre del 2007 a Enero del 2008. El universo de estudio estuvo constituido por 75 pacientes diagnosticados con hiperestesia dentinal en el periodo de tiempo antes mencionado, quedando conformada la muestra por aquellos 25 que cumplieron con los criterios preestablecidos para el estudio. Con la aplicación del láser combinado con Laca Flúor (Profilac), se observó una remisión del dolor que aumentó paulatinamente con las sesiones de tratamiento lográndose eliminar en casi la totalidad de los casos la sintomatología al finalizar el mismo, evaluándose el tratamiento de eficaz en el 100 por ciento de los casos. Solamente se encontró una recidiva al año de tratamiento.

An experimental study was carried out, to evaluate the effectiveness of the low - power laser combined with fluoride varnish to 2 percent Profilac in the treatment of the Dentinal Hyperesthesia in patients attended to in the Estomatology Clinic of Ciro Redondo in the period from October 2007 to January 2008. The universe of study was constituted by 75 patients diagnosed with dentinal hyperesthesia in the period of time indicated above, being conformed the sample by those 25 who fulfilled the pre-established criteria for the study. With the application of the laser combined with Lacquer Fluorine Profilac, a remission of the pain was observed that increased gradually with the treatment sessions, having been obtained to almost eliminate in the totality of the cases the group of symptoms when finalizing it, evaluating the treatment of effective in 100 percent of the cases. We only found a recidive after a year of treatment.

Spinal cholinergic mechanism of the relieving effects of electroacupuncture on cold and warm allodynia in a rat model of neuropathic pain.

This study was performed to determine whether spinal cholinergic systems mediate the relieving effects of electroacupuncture (EA) on cold and warm allodynia in a rat model of neuropathic pain. For neuropathic surgery, the right superior caudal trunk was resected at the level between the S1 and S2 spinal nerves innervating the tail. Two weeks after the injury, the intrathecal (i.t.) catheter was implanted. Five days after the catheterization, the rats were injected with atropine (non-selective muscarinic antagonist, 30 microg), mecamylamine (non-selective nicotinic antagonist, 50 microg), pirenzepine (M(1) muscarinic antagonist, 10 microg), methoctramine (M(2) antagonist, 10 microg) or 4-diphenylacetoxy-N-methylpiperidine methiodide (4-DAMP) (M(3) antagonist, 10 microg). Ten minutes after the injection, EA was applied to the ST36 acupoint for 30 min. The cold and warm allodynia were assessed by the tail immersion test [i.e., immersing the tail in cold (4 degrees C) or warm (40 degrees C) water and measuring the latency of an abrupt tail movement] before and after the treatments. The i.t. atropine, but not mecamylamine, blocked the relieving effects of EA on cold and warm allodynia. Furthermore, i.t. pirenzepine attenuated the antiallodynic effects of EA, whereas methoctramine and 4-DAMP did not. These results suggest that spinal muscarinic receptors, especially M(1) subtype, mediate the EA-induced antiallodynia in neuropathic rats.

Tratamento da hiperestesia dentinária com laser de GaAIAs / Dentine hyperesthesia of treatment with laser of GaAIAs

O presente trabalho demonstrou, através da descrição de um caso clínico, a efetividade da Laserterapia no tratamento da Hipersestesia Dentinária pós terapia periodontal através da utilização do laser de GaAIAs (Arseneto de Gálio e Alumínio). Para avaliar o nível da Hlperestesia Dentinária foram utilizados estímulos mecânicos com a sonda exploradora, com ar comprimido e com água resfriada, através de uma Escala Visual Numérica. Duas aplicações do Laser foram realizadas, sendo avaliado com jato de ar o nível da dor, antes e após as aplicações. Observou-se redução acentuada do grau da sensibilidade após cada aplicação, demonstrando que o Laser de baixa potência é uma terapêutica eficiente para o tratamento da Hiperestesia Dentinária

Effects of electroacupuncture on cold allodynia in a rat model of neuropathic pain: mediation by spinal adrenergic and serotonergic receptors.

The present study was performed to examine the effects of electroacupuncture (EA) on cold allodynia and its mechanisms related to the spinal adrenergic and serotonergic systems in a rat model of neuropathic pain. For the neuropathic surgery, the right superior caudal trunk was resected at the level between S1 and S2 spinal nerves innervating the tail. Two weeks after the nerve injury, EA stimulation (2 or 100 Hz) was delivered to Zusanli (ST36) for 30 min. The behavioral signs of cold allodynia were evaluated by the tail immersion test [i.e., immersing the tail in cold water (4 degrees C) and measuring the latency to an abrupt tail movement] before and after the stimulation. And then, we examined the effects of intrathecal injection of prazosin (alpha1-adrenoceptor antagonist, 30 microg), yohimbine (alpha2-adrenoceptor antagonist, 30 microg), NAN-190 (5-HT1A antagonist, 15 microg), ketanserin (5-HT2A antagonist, 30 microg), and MDL-72222 (5-HT3 antagonist, 12 microg) on the action of EA stimulation. Although both 2 Hz and 100 Hz EA significantly relieved the cold allodynia signs, 2 Hz EA induced more robust effects than 100 Hz EA. In addition, intrathecal injection of yohimbine, NAN-190, and MDL-72222, but not prazosin and ketanserin, significantly blocked the relieving effects of 2 Hz EA on cold allodynia. These results suggest that low-frequency (2 Hz) EA is more suitable for the treatment of cold allodynia than high-frequency (100 Hz) EA, and spinal alpha2-adrenergic, 5-HT1A and 5-HT3, but not alpha1-adrenergic and 5-HT2A, receptors play important roles in mediating the relieving effects of 2 Hz EA on cold allodynia in neuropathic rats.

Clinical evaluation of dentin hypersensitivity treatment with the low intensity Gallium-Aluminum-Arsenide laser - AsGaAl

A hiperestesia dentinária trata-se de uma condição dolorosa bastante prevalente nas populações mundiais. Várias são as modalidades de tratamento para tal condição, entre elas, os lasers de baixa potência. A proposta deste estudo foi a de verificar a efetividade do laser de diodo de Arseniato de Gálio-Alumínio no tratamento desta condição dolorosa, utilizando-se um placebo como controle. MATERIAIS E MÉTODOS: Foram selecionados 32 pacientes, 22 do sexo feminino e 10 do sexo masculino, com idades entre 20-52 anos. Os 32 pacientes foram distribuídos de maneira aleatória em dois grupos, um tratado e outro controle, um total de 68 dentes compôs a amostra, sendo que 35 compuseram o grupo tratado, e 33 o grupo controle. O grupo tratado foi submetido a seis sessões sucessivas de irradiações em intervalos de 48 a 72 horas, o grupo controle recebeu como placebo aplicações de luz do fotopolimerizador. RESULTADOS: observou-se redução significativa na sensação dolorosa entre a fase inicial e após as seis sessões de tratamento com laser, porém tal redução, também pode ser observada para o grupo controle, submetido ao placebo. CONCLUSAO: a terapia com laser de baixa potência de AsGaAl induz redução estatisticamente significante da sensação dolorosa, após cada uma das aplicações, e entre o início e o final do tratamento, embora não tenha havido, diferença estaticamente significante, ao final do tratamento e após a avaliação mediata dos resultados (após 6 semanas) entre o grupo tratado (laser) e o grupo controle (placebo); dificultando a mensuração real da efetividade do laser e do efeito placebo.

Hiperestesia dentinária: etiologia, diagnóstico e formas de tratamento / Dentin hyperesthesia: etiology, diagnosis and treatment

O objetivo deste trabalho foi realizar uma revisäo sobre o tema, analisando a etiologia, o corpo diagnóstico e as possibilidades de tratamento

Sympathetically mediated pain after reduction mammoplasty: an unusual complication.

We present a case report of a patient who developed an unusual bilateral breast pain syndrome after a reduction mammoplasty. Her symptoms and physical examination findings resolved after four stellate ganglion blocks, of which two on each side were performed over a period of 2 weeks. The case serves to alert clinicians to the possibility of a patient developing a sympathetically mediated pain syndrome after reduction mammoplasty.

Nuevos métodos en el tratamiento de la hipersensibilidad dentinaria: I actualización / New approaches in the treatment of dental hypersensitivity: I an update

Se presenta una actualización bibliográfica sobre dos nuevos métodos utilizados en el tratamiento de la hiperestesia dentaria: la aplicación de flúor por ionoforesis y la electrocoagulación con solución de formalina al 10 %. Se analizan los mecanismos de acción, transporte de iones, así como las conclusiones de diferentes investigaciones clínicas y de laboratorio, donde se demuestra la gran efectividad de ambos métodos en el tratamiento de los cuellos sensibles