Effect of clinical experience and training with visual feedback on standardized palpation outcomes-Potential implications for assessment of jaw muscle sensitivity.

BACKGROUND: The evaluation of muscle pain and sensitivity by manual palpation is an important part of the clinical examination in patients with myalgia. However, the effects of clinical experience and visual feedback on palpation of the masticatory muscles with or without a palpometer are not known. OBJECTIVE: To estimate the effects of clinical experience and visual feedback on the accuracy of palpation in standardized settings. METHODS: Thirty-two dentists (age 35 ± 11 years) classified as either specialists (n = 16) or generalists (n = 16) participated in this experiment. All dentists were instructed to target force levels of 500- or 1000-gf, as determined on an electronic scale using either standardized palpometers or manual palpation (MP). All dentists participated in four different tests: MP, MP with visual feedback (MPVF), palpometer (PAL) and PAL with visual feedback (PALVF). Actual force values for each type of palpation from 0 to 2, 2 to 5 and 0 to 5 s were analysed by calculating target force level. RESULTS: The relative differences during 2-5 and 0-5 s with 1000 gf were significantly lower for generalists than for specialists (p < .05). In generalists and specialists, the coefficients of variation and the relative differences during 2-5 s were significantly lower for PAL and PALVF than for MP (p < .05). CONCLUSIONS: These findings suggest that the use of a palpometer, but not clinical experience with palpation of masticatory muscles, increases the accuracy of palpation, and ≥2 s of palpation with a palpometer is optimal for masticatory muscles.

Quantitative and qualitative assessment of sensory changes induced by local anesthetics block of two different trigeminal nerve branches.

OBJECTIVES: The aims were to use different techniques to assess the degree of sensory changes and magnitude of perceived size changes in the facial region induced by nerve blocks of two different trigeminal nerve branches in healthy participants. MATERIALS AND METHODS: This placebo-controlled study included 30 healthy volunteers. The participants underwent quantitative and qualitative sensory testing (QST and QualST) thrice: before, 10 min, and 2 h after mental (n = 15) and infraorbital (n = 15) nerve blocks and during control (saline) sessions. Perceived numbness, temperature changes, and perceptual distortion were also measured at all time points during the nerve block and control sessions. Differences in outcome parameters between the sessions and time points were analyzed using analyses of variance and McNemar's tests. RESULTS: There was a significant degree of sensory loss to most QST and all QualST parameters, with significant numbness and increased perceived size at the injection site 10 min and 2 h after the nerve blocks compared with saline (P < 0.030) and the baseline (P < 0.042). Two hours after the nerve blocks, the sensitivity was significantly closer to baseline than after 10 min to most of the QST parameters (P < 0.011). CONCLUSIONS: QST and QualST revealed that the nerve blocks in the orofacial region resulted in complete or partial blockade of afferent nerve fibers mediating thermal and mechanical function for more than 2 h with significant numbness and perceptual distortion. CLINICAL RELEVANCE: Both QST and QualST can provide information on the degree of blockade of afferent nerve fibers after nerve blocks in the orofacial region.

Assessment of human intraoral thermal sensitivity with simple devices in the clinic: implications for orofacial pain conditions.

AIMS: To use simple thermal devices with different diameters and temperatures to investigate reliability and magnitude of human intraoral thermal sensitivity. METHODS: Sixteen healthy volunteers participated. Six thermal devices with tapered circular ends (stimulus diameter 3, 5, and 10 mm) were used. Three different temperatures (room temperature, heat, and cold) were applied with each of the three diameters, ie, nine combinations. Participants were stimulated in randomized order at nine different sites: tongue, lip, maxillary attached gingiva adjacent to the left and right central incisors (without touching the lip) and to the left and right premolars (with or without touching the lip), and the left and right cheeks extraorally. Participants rated the perceived stimulus intensity on 0-50- 100 numeric rating scales (NRS). The number of paradoxical thermal sensations was also recorded. Ten volunteers were examined twice on the same day and recalled for a second session for assessment with the 5-mm-diameter device of within- and between-session reliability (interclass correlation coefficients [ICC]). The results were analyzed using a three-way analysis of variance. RESULTS: Reliability of NRS scores ranged from poor (ICC = 0.09, with cold stimulation at the premolar region) to excellent (ICC > 0.92, with cold stimulation at the cheek or tongue). NRS values varied with stimulus diameter (P < .050), temperature (P < .001), and sites (P < .001), with significant size x site and temperature x site interactions (P < .001). The tongue was the most sensitive site (P < .001) and the gingiva was the least sensitive site (P < .050). The 10-mm-diameter device produced higher NRS scores than the 3-mm-diameter device. CONCLUSION: The reliability of intraoral thermal sensitivity recorded with the 5-mm-diameter device varied greatly between different sites. Nonetheless, with this caveat in mind, the study did document that semiquantitative assessment of intraoral thermal sensitivity is feasible and applicable for clinical studies in different intraoral pain conditions.

Simultaneous determination of 18 tetrahydrocorticosteroid sulfates in human urine by liquid chromatography/electrospray ionization-tandem mass spectrometry.

A liquid chromatography (LC)/electrospray ionization (ESI)-mass spectrometry (MS) method for the direct determination of eighteen tetrahydrocorticosteroid sulfates in human urine has been developed. The analytes were 3- and 21-monosulfates and 3,21-disulfates of tetrahydrocortisol (THF), tetrahydrocortisone (THE), tetrahydro-11-deoxycortisol (THS), and their corresponding 5α-H stereoisomers. The mass spectrometric behavior of these sulfates in negative-ion ESI-MS/MS revealed the production of intense structure specific product ions within the same group of sulfates and permitted distinction between regioisomeric sulfates by collision-induced fragmentation with the MS/MS technique using a linear ion-trap instrument. For the quantitative analysis, selected reaction monitoring analysis in the negative-ion detection mode using triple-stage quadrupole mass spectrometer was performed by monitoring transitions from [M-H](-) to the most abundant product ion of each tetrahydrocorticosteroid sulfate. After addition of 3- and 21-monosulfates of [2,2,3ß,4,4-d5]-THF, -THE, and -THS as internal standards, urine sample was applied to a solid phase extraction using a lipophilic-weak anion exchange cartridge column, and then analyzed by LC/ESI-MS/MS. The method had satisfactory performance in terms of intra- and inter-assay precision (less than 9.7% and 9.6%, respectively), and accuracy (91.2-108.2%). The limit of quantification was lower than 2.5 ng/mL for all sulfates examined. We applied this method to determine the concentration of eighteen tetrahydrocorticosteroid sulfates in the urine of healthy subjects. Thus, we have developed a sensitive, precise and accurate assay for urinary tetrahydrocorticosteroid sulfates that should be useful for clinical and biological studies.

Application of a new palpometer for intraoral mechanical pain sensitivity assessment.

AIMS: To investigate the reliability and magnitude of intraoral mechanical pain sensitivity by using a palpometer with add-on devices with different physical properties. METHODS: Sixteen healthy volunteers participated. Three palpometers (0.5, 1.0, and 2.0 kg) were used. Add-on devices were put on the circular metal stamp of the palpometer. Four diameters (3, 4, 5, and 10 mm) and two shapes of the rubber-top (flat and round) of the add-on devices were tested at each force level, ie, a total of 24 combinations. Participants were stimulated at the gingival mucosa around the maxillary central incisors and first molars on both sides by using the palpometers in randomized order. Participants rated perceived stimulus intensity on a 0-50-100 numerical rating scale (NRS). Ten volunteers were examined twice on the same day and recalled for a second session for assessment of within- and between-session reliability. Intraclass correlation coefficients were calculated for reliability measures, and NRS scores were analyzed with analysis of variance. RESULTS: Reliability of NRS scores was excellent (interclass correlation coefficients 0.76 to 0.99). Analysis of NRS values corrected for pressure level revealed that there were main effects of site (P = .006), force (P < .001), size (P < .001), and shape (P < .001) but not side (P = .051). CONCLUSION: Reliability of intraoral novel palpometer measures of pressure sensitivity was excellent, and sensitivity to pressure stimulation was dependent on the applied force and physical properties of the add-on device. The study indicated that semi-quantitative assessment of intraoral mechanical sensitivity is feasible and could be applied in further studies on different intraoral pain conditions.