Реферат
ABSTRACT: Persistent Idiopathic Dentoalveolar Pain (PIDAP) is an orofacial neuropathic pain, which can be difficult to diagnose and is usually accompanied by increasing anxiety from both the patient and the treating dentist. A case of a 38-year-old female patient is presented, and it is shown the diagnostic process and therapeutic approach. The interdisciplinary management accompanied by several pharmacological lines is highlighted: Botulinum toxin was used as an adjunctive treatment allowing it to decrease systemically administered medications dosing and therefore its possible side effects. This condition usually affects psychosocial aspects of the patient and has a major impact on his quality of life. It is very important before initiating an invasive clinical treatment, obtaining a clear differential diagnosis and assessing in some cases the presence of non-odontogenic pain, such as PIDAP.
RESUMEN: El Dolor Idiopático Dentoalveolar Persistente (DIDAP), es un dolor neuropático orofacial, que puede resultar difícil de diagnosticar y generalmente se acompaña de creciente angustia tanto de parte del paciente como también del odontólogo tratante. Se presenta un caso de una paciente femenina de 38 años en donde se demuestra el proceso diagnóstico y abordaje terapéutico. Se resalta el manejo interdisciplinario acompañado de varias lineas farmacológica: la toxina Botulínica se utilizó como tratamiento coadyuvante para disminuir la dosis de medicamentos administrados por vía sistémica y por ende sus posibles efectos secundarios. Esta condición habitualmente abarca aspectos psicosociales del paciente y tiende a verse sumamente afectada su calidad de vida. Es de suma relevancia antes de iniciar un tratamiento clínico invasivo, obtener un diagnóstico diferencial claro y valorar en algunos casos la presencia de dolor no ontogénico, como el DIDAP.
Тема - темы
Humans , Female , Adult , Botulinum Toxins/analysis , Facial Pain/diagnosisРеферат
ABSTRACT Background: Diagnostic tools are necessary for the anamnesis and examination of orofacial pain, in order to fulfill diagnostic criteria and to screen potential causes of pain. Objective: To evaluate the Orofacial Pain Clinic Questionnaire (EDOF-HC) in the assessment and diagnosis of orofacial pain. Methods: Overall, 142 patients were evaluated and classified according to the criteria of the International Headache Society and International Association for the Study of Pain. All of them were evaluated with the EDOF-HC questionnaire, which consists of the orofacial and medical history, as well as the orofacial examination. Data were statistically analyzed with chi-square test and Bonferroni correction, one-way ANOVA with Tukey post hoc test, the two-step cluster and decision tree methods. Results: There were diferences in pain descriptors, pain in maximum mouth opening, number of trigger points, and history of previous surgery between the groups, which were classified into trigeminal neuralgia, burning mouth syndrome, temporomandibular disorders and trigeminal posttraumatic neuropathic pain with classification analysis. Conclusions: The EDOF-HC is a clinical supportive tool for the assessment of orofacial pain. The instrument may be used to support data collection from anamnesis and examination of patients according to the diagnostic criteria of most common orofacial conditions. It is also useful in the investigation of local and systemic abnormalities and contributes for the diagnosis of conditions that depend on exclusion criteria.
RESUMO Introdução: Instrumentos diagnósticos são necessários para a anamnese e exame da dor orofacial, auxiliando na identificação das causas potenciais de dor. Objetivo: Avaliar o Questionário da Equipe de Dor Orofacial (EDOF-HC) na abordagem e diagnóstico da dor orofacial. Métodos: Ao todo, 142 pacientes foram avaliados e classificados de acordo com os critérios da Sociedade Internacional de Cefaleias e da Associação Internacional para o Estudo da Dor. Todos foram avaliados com o questionário EDOF-HC, que consiste na anamnese orofacial e médica, além do exame físico orofacial. Os dados foram analisados estatisticamente com os testes qui-quadrado com correção de Bonferroni, ANOVA de um fator e post hoc de Tukey, além dos métodos de classificação em cluster e árvore decisória. Resultados: Houve diferenças entre os diagnósticos quanto aos descritores da dor, dor na abertura bucal máxima, número de pontos-gatilho mastigatórios e história prévia de cirurgia, o que esteve de acordo com a classificação nos diagnósticos de neuralgia do trigêmeo, síndrome da ardência bucal, disfunção temporomandibular e dor neuropática pós-traumática trigeminal. Conclusões: O Questionário da Equipe de Dor Orofacial (EDOF-HC) mostrou ser um instrumento de apoio para a avaliação da dor orofacial, útil na coleta de dados de anamnese e exame clínico dos pacientes, observando os principais sinais e sintomas relacionados aos critérios diagnósticos das condições orofaciais dolorosas mais comuns. Também é útil na avaliação de comorbidades locais e sistêmicas e contribui para o diagnóstico de condições que dependem em critérios de exclusão.
Тема - темы
Humans , Trigeminal Neuralgia/diagnosis , Temporomandibular Joint Disorders/diagnosis , Facial Pain/diagnosis , Facial Pain/etiology , Facial Pain/physiopathology , Surveys and Questionnaires , HeadacheРеферат
Objective: Morphological changes in sinuses are commonly observed through routine Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans. The present study aims to assess the prevalence of nasal and sinus pathology in the Jordanian patients undergoing head MRI or CT scans for a non-ENT cause. Materials and Methods: Prospective study was conducted at Alkarak hospital, Jordan. CT/MRI scan images of patients were reviewed over a period of 6-months. Data about ENT symptoms, history of allergic rhinitis, and abnormalities was also collected. Results: Of the 600 patients (445 MRI, 145 CT Scans), sinus pathology was observed in 170 patients (28.33%). The most common sinus abnormality was mucosal thickening (n=135, 79.41%), followed by complete opacification and cysts. A significant correlation was observed between sex, sinonasal symptoms, facial pain, and asthma in both sinus pathology and nasal pathology. Nasal obstruction (p=0.000) and allergic rhinitis (p=0.000) were significantly correlated with nasal pathology. Conclusion: A significant correlation between incidental sinonasal pathology and both facial pain and allergic rhinitis was observed. However, the incidental findings are overestimated due to lack of correlation to symptoms and underlying conditions
Тема - темы
Humans , Facial Pain/diagnosis , Prospective Studies , Rhinitis, Allergic/complications , Nasal Cavity/pathologyРеферат
The aim of this study was to screen for painful TMD conditions by implementing the validated Axis I screening instrument from the Diagnostic Criteria for Temporomandibular Disorders. Using the screener as a surrogate, the prevalence of the conditions was estimated among a convenience sample of dental students in Peru. A total 2,562 dental students, 63.7% women, aged 18 to 62 completed the instrument. Prevalence was estimated using both the short and long versions. The prevalence of painful TMD conditions was 19.4% with the short and 16.1% with the long version. The distribution of the conditions according to gender differed significantly between groups (p<.001). Prevalence estimates of painful TMD conditions using the screening instrument seems to be logistically adequate in a field assessment involving multiple geographic and cultural regions in Peru. These estimates seem to be consistent with internationally reported values.
El objetivo de este estudio fue tener una estimación de las condiciones de los trastornos temporomandibulares asociados al dolor, mediante la implementación de un instrumento validado de triaje para la medición del Eje I de los Criterios Diagnósticos para los Trastornos Temporomandibulares (CD/TTM). Usando este instrumento como un sustituto, se estimó la prevalencia de estas condiciones en una muestra por conveniencia de estudiantes de Odontología en el Perú. Un total de 2,562 estudiantes de Odontología, 63.7% mujeres, entre las edades de 18 a 62 años de edad, completaron el instrumento. La prevalencia fue estimada empleando las versiones corta y larga del instrumento. La prevalencia de los TTM asociados al dolor fue de 19.4% con la versión corta y 16.1% con la versión larga. La distribución de estas condiciones fue estadísticamente diferente según el sexo (p<.001). El empleo del instrumento de triaje para estimar la prevalencia de los TTMs asociados al dolor parece ser logísticamente adecuado en un escenario de diversas regiones geográficas y culturales en el Perú. Estas estimaciones parecen ser consistentes con valores internacionalmente reportados.
Тема - темы
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Students, Dental/psychology , Facial Pain/diagnosis , Temporomandibular Joint Disorders/diagnosis , Peru/epidemiology , Students, Dental/statistics & numerical data , Facial Pain/etiology , Temporomandibular Joint Disorders/complications , Temporomandibular Joint Disorders/epidemiology , Prevalence , Surveys and QuestionnairesРеферат
Objetivo: esclarecer a importância de interação diagnóstica, tratamento e desordens temporomandibulares. Revisão de literatura: a necessidade de conhecimento para avaliar o funcionamento do sistema estomatognático identificando possíveis desordens temporomandibulares e mialgias faciais é de suma importância. Por meio de anamnese e exame clínico detalhado, é possível selecionar e instituir um plano de tratamento. Tratar desordens temporomandibulares e mialgias faciais associadas às deformidades dentoesqueléticas depende de um diagnóstico correto e, principalmente, de um plano de tratamento adequado, pois, havendo equívoco, poderá resultar em um mau prognóstico. As modalidades de tratamento das desordens articulares incluem os tratamentos conservadores e os não conservadores. Presume-se que a grande maioria dos pacientes que buscam um tratamento cirúrgico baseiam-se nas recomendações dos ortodontistas, porém, nem sempre enfocam os aspectos esqueletais de uma má oclusão severa, o que pode não ser conduzido da maneira mais adequada para o reestabelecimento da funcionalidade facial. Considerações finais: condutas terapêuticas instituídas nas desordens temporomandibulares não orientadas, descartando hipóteses fatoriais diversas, podem comprometer um futuro tratamento ou agravar a situação patológica presente.(AU)
Objective: to clarify the importance of diagnostic interaction, treatment and temporomandibular disorders. Literature review: the need for knowledge in assessing the functioning of the stomatognathic system by identifying possible temporomandibular disorders and facial myalgias is of paramount importance. Through anamnesis and detailed clinical examination it is possible to select and institute a treatment plan. Treating temporomandibular disorders and facial myalgias associated with dento-skeletal deformities depends on a correct diagnosis and, above all, on an adequate treatment plan, since doing so may result in poor prognosis. The mode of treatment of joint disorders includes conservative and non-conservative treatments. It is presumed that the vast majority of patients seeking surgical treatment are based on the recommendations of orthodontists, but they do not always focus on the skeletal aspects of severe malocclusion, which may not be conducted in the most appropriate way for reestablishment of facial functionality. Final considerations: therapeutic behaviors instituted in non-oriented temporomandibular disorders, discarding several factorial hypotheses may compromise a future treatment or exacerbate the present pathological situation. (AU)
Тема - темы
Humans , Temporomandibular Joint Disorders/diagnosis , Temporomandibular Joint Disorders/therapy , Stomatognathic System/physiopathology , Facial Pain/diagnosis , Facial Pain/physiopathology , Facial Pain/therapy , Temporomandibular Joint Disorders/physiopathologyРеферат
Objective: To investigate the efficacy of transdermal high-frequency ozone therapy in the management of pain and pain-related restricted jaw movements in patients with internal derangement of the temporomandibular joint (TMJ). Material and Methods: This retrospective study included 40 patients who had received transdermal high-frequency ozone therapy for the management of disc displacement with reduction of the TMJ. Subjects were treated 3 times for one week with a bio-oxidative high-frequency ozone generator with an intensity of 80% for ten minutes bilaterally. Pain scores and maximal interincisal opening (MIO) values of the patients were evaluated before and after the treatment. Results: An increase in the mean MIO value was achieved following the ozone therapy, however, the difference was not statistically significant (p=0.350). A statistically significant decrease in the mean pain score (48.13 ± 27.75) was observed following the ozone therapy. Conclusion: Transdermal application of high frequency ozone may be a good alternative for management of pain and pain-related restricted jaw movements in patients with internal derangement of the TMJ.
Тема - темы
Humans , Ozone/therapeutic use , Temporomandibular Joint , Facial Pain/diagnosis , Temporomandibular Joint Disorders , Peru , Analysis of Variance , Statistics, NonparametricРеферат
OBJECTIVES: This study aims to evaluate the self-perception of oral health according to the physical, psychosocial and pain/discomfort dimensions related to clinical conditions and orofacial pain of elderly people living in three different environments. METHODS: This was an observational, cross-sectional, quantitative study with a population-based approach and nonprobabilistic convenience sampling that included 81 elderly people: 27 resided in institutional homes for elderly individuals, 27 resided in an urban area and 27 resided in a rural area in the interior of Paraíba (PB) in northeastern Brazil. RESULTS: The Geriatric Oral Health Assessment Index (GOHAI) was used to assess self-perception of oral health, while the Questionnaire for Screening of Patients with Temporomandibular Disorders (QST/TMD) was used to assess the influences of orofacial pain and the biofilm indexes of teeth and prostheses. There was a statistically significant difference in the GOHAI scores among the places of residence, with the worst values associated with the rural area. According to the QST/TMD, the majority of individuals were affected by TMDs, with statistical differences for both sex and income. CONCLUSION: The biofilm analysis showed a higher incidence of clinical conditions in the rural population. The place of residence also influenced self-perception and the clinical oral health condition of elderly people; the rural population presented the worst results.
Тема - темы
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Self Concept , Geriatric Assessment/statistics & numerical data , Oral Health , Quality of Life , Rural Population , Facial Pain/diagnosis , Brazil/epidemiology , Geriatric Assessment/methods , Sex Factors , Urban Health , Cross-Sectional Studies , Surveys and Questionnaires , Homes for the AgedРеферат
Abstract - Changes in the suboccipital muscles and the hamstrings may interfere with head posture and the biomechanics of the temporomandibular joint, both of which contribute to the severity of temporomandibular disorders (TMD). The objective of this investigation was to evaluate the effects of a global postural exercise program (GPEP) on pain intensity and mouth-opening range of motion (ROM) in women with TMD. The participants were comprised of 30 women with TMD who were divided into two groups: an experimental group (EG) and a control group (CG). A pressure algometer was used for pain assessment and a paquimeter was used to measure ROM. The duration of the GPEP was six weeks. In the EG, there was a reduction in pain intensity and an increase in mouth-opening ROM compared to the CG. Therefore, we concluded that the GPEP was effective in relieving pain in all of the evaluated muscles and regions, and in increasing mouth-opening ROM in women with TMD.
Тема - темы
Humans , Female , Adult , Middle Aged , Facial Pain/diagnosis , Range of Motion, Articular , Temporomandibular Joint , Temporomandibular Joint Disorders/diagnosisРеферат
Abstract The prevalence of temporomandibular disorders (TMD) is higher in females, reaching their high peak during reproductive years, probably because of the action of some female hormones, which alter pain threshold. This study aimed to investigate the prevalence of TMD in postmenopausal women and its relationship with pain and hormone replacement therapy (HRT). In total, 284 patients were evaluated and classified using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Pain was measured using the Visual Analogue Scale (VAS), and patients were also asked about the use of HRT. All data was analyzed using analysis of variance (ANOVA) and chi-square test. In total, 155 subjects did not have TMD and 129 had TMD; TMD group patients were classified according to RDC/TMD axis I classification as follows: muscle disorder group (1.6%), disk displacement group (72.87%), and arthralgia, osteoarthritis, and osteoarthrosis group (37.98%). Pain was registered in 35 patients who belonged to the TMD group, while 48 patients reported the use of HRT. There was a similar percentage of TMD and non TMD patients; moreover, the use of exogenous hormones was no associated with TMD, suggesting that there is no influence on the pain threshold.
Тема - темы
Humans , Male , Female , Middle Aged , Aged , Facial Pain/physiopathology , Facial Pain/epidemiology , Temporomandibular Joint Disorders/physiopathology , Temporomandibular Joint Disorders/epidemiology , Estrogen Replacement Therapy , Postmenopause/physiology , Osteoarthritis/physiopathology , Osteoarthritis/epidemiology , Severity of Illness Index , Pain Measurement , Facial Pain/diagnosis , Brazil/epidemiology , Temporomandibular Joint Disorders/diagnosis , Prevalence , Analysis of Variance , Arthralgia/physiopathology , Arthralgia/epidemiology , Middle AgedРеферат
Orofacial pain conditions can be classified into somatic, visceral or neuropathic pain. Somatic pain is triggered by a noxious stimulus generally inducted by peripheral traumas, such as dental implants surgeries (IMP). Visceral pain initiates within internal body tissues and is normally triggered by inflammation, as in inflammatory toothaches (IT). The third condition is neuropathic pain, which results from persistent injury to the peripheral nerve as in Atypical Odontalgia (AO). The aims of this study were: 1- to investigate somatosensory abnormalities, using mechanical, painful, and electrical quantitative sensory testing (QST), in somatic (IMP patients), visceral (IT) and neuropathic pain (AO); 2- to quantify how accurately QST discriminates an IT or AO diagnosis; and 3- to investigate the influence implant surgeries or pulpectomy may have on somatosensory system and sensory nerve fibers. Sixty subjects were divided in three groups: IMP (n = 20), IT (n = 20) and AO group (n = 20). A sequence of five QSTs and the Conditioned Pain Modulation Test (CPM) were performed one month and three months after dental implant surgery (IMP group) or pulpectomy (IT group). AO group was evaluated only at baseline. QST comprehended Mechanical Detection Threshold (MDT), Mechanical Pain Threshold (MPT), Dynamical Mechanical Allodynia (DMA), Current Perception Threshold (CPT) for A-beta (frequency of 2000Hz), A-delta (250Hz) and C fibers (5Hz) and Temporal Summation Test (TS). "Z" score transformation were applied to the data, and within and between groups were statistically analyzed using two-way ANOVA. In addition, the receiver operating characteristic curve analysis, diagnostic accuracy, sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of QSTs were calculated (α = 5%). The findings of this study proved that: 1- loss of function for touch threshold and electrical threshold of C fibers is present in inflammatory toothache; 2- allodynia, hyperalgesia, gain of function for touch and pain thresholds and impaired pain modulation is detected in atypical odontalgia; 3- some QSTs may be used as complementary tests in the differential diagnosis of atypical odontalgia and inflammatory toothache with strong accuracy; 4- the most accurate QSTs for differential diagnosis between subjects with AO and IT were MDT, MPT and DMA where touch threshold forces > 1 g/mm2 and pain threshold forces > 10g/mm2 can be used to accurately discriminate AO from IT; and 5- no somatosensory modification is found after implant surgery and reduced electrical threshold in C fiber is found for patients with inflammatory toothache after 3 months of pulpectomy.(AU)
As dores orofaciais podem ser classificadas em dores somáticas, viscerais ou neuropáticas. A dor somática está relacionada a um estímulo nocivo evidente, geralmente associada a um trauma periférico, como por exemplo, nas cirurgias de implantes (IMP). As dores viscerais têm origem dentro dos órgãos e cavidades internas do corpo e são ativadas pela inflamação, como no exemplo da dor de dente do tipo Pulpite Aguda (PA). A terceira condição é a dor neuropática, que resulta de uma lesão persistente ao nervo periférico, como ocorre na Odontalgia Atípica (OA). Os objetivos deste estudo foram: 1- avaliar as alterações somatossensoriais, por meio do uso de Testes Sensoriais Quantitativos (TSQ) mecânicos, dolorosos e elétricos em dores somáticas (pacientes IMP), viscerais (PA) e neuropáticas (OA); 2- quantificar a acurácia dos TSQs na descriminação diagnóstica de uma PA ou OA; e 3- investigar alterações somatossensoriais e nas fibras nervosas sensoriais após cirurgia de instalação de implantes dentários ou pulpectomia. Sessenta sujeitos foram divididos em três grupos: IMP (n = 20), PA (n = 20) e OA (n = 20). Uma sequência de cinco TSQs e o teste de Controle da Modulação da Dor (CMD) foram realizados um mês e três meses após cirurgia de implantes (grupo IMP) ou pulpectomia (grupo PA). No grupo OA, os testes foram realizados somente uma vez no início do estudo. Os TSQs englobaram o Limiar de Detecção Mecânica (LDM), Limiar de Dor Mecânica (LDoM), Alodinia Mecânica Dinâmica (AMD), Limiar de Percepção de Corrente (LPC) para fibras A-beta (frequência de 2000Hz), A-delta (250Hz) e C (5 Hz), e o teste de Somação Temporal (ST). A transformação em escores de "Z" foi aplicada aos dados, e diferenças intra e inter-grupos foram analisadas usando ANOVA de medidas repetidas. Ainda, a acurácia diagnóstica dos TSQs foi medida por meio da sensibilidade, especificidade, razão de verossimilhança e razão de chances para diagnóstico (α = 5%). Os resultados deste estudo mostraram que: 1- perda da função em limiar táctil e limiar elétrico de fibras C está presente na Pulpite Aguda; 2- alodinia, hiperalgesia, ganho de função nos limiares de tato e de dor, e modulação da dor prejudicada são encontrados em pacientes com odontalgia atípica; 3- alguns TSQs podem ser usados como testes diagnósticos complementares ao diagnóstico diferencial entre PA e OA; 4- os TSQs com maior acurácia para o diagnóstico diferencial entre indivíduos com PA e OA foram LDM LDoM e AMD, onde uma força maior que 1 g/mm2 para limiar de tato e maior que 10 g/mm2 para limiar de dor podem ser usados com precisão; e 5- nenhuma alteração somatossensorial é encontrada após cirurgia de implantes e uma redução no limiar elétrico em fibras C é encontrado em pacientes com PA após 3 meses da pulpectomia.(AU)
Тема - темы
Humans , Male , Female , Adult , Middle Aged , Aged , Facial Neuralgia/physiopathology , Facial Pain/diagnosis , Facial Pain/etiology , Facial Pain/physiopathology , Hyperalgesia/physiopathology , Pain Measurement/methods , Visceral Pain/physiopathology , Analysis of Variance , Case-Control Studies , Diagnosis, Differential , Pain Threshold/physiology , Reference Values , ROC CurveРеферат
El objetivo del presente trabajo fue establecer valores de referencia de movimientos mandibulares en niños de 10-15 años sin disfunción; compararlos con los de pacientes de la misma edad con trastornos temporomandibulares (TTM) y con los hallados anteriormente en un grupo menor de 11 años sinTTM. Niños de ambos sexos que acudieron a la Cátedra Odontología Integral Niños de UBA en 2013 y cuyos responsables brindaron consentimiento fueron evaluados con CDI/TTM por odontopediatras estandarizados (Kappa 0.88) conformándose 3 grupos en función del resumen diagnóstico; C: sin TTM, Ia: con dolor miofacial e Ib: dolor con limitación de la apertura bucal, para el análisis de las siguientes variables: edad, sexo y movimientos mandibulares. La muestra quedó constituida por169 pacientes de 12.5±1.76 años. El 62.36 por ciento no presentó TTM (C) y en el 37.27 por ciento se estableció un diagnóstico de trastorno muscular (29.58 por ciento Ia y 7.69 por ciento Ib). En C se registraron lossiguientes valores en mm: Apertura máxima no asistida: 48.28±6.14; Lateralidad derecha 8.78±2.50; izquierda: 9.60±2.64; Protrusión: 4.94±2.58 y Sobremordida: 2.98 ± 2.5sin variaciones en relación al sexo, pero con diferencias en los registros de todos los movimientos comparados con losobtenidos en dentición mixta. (p=0.0001). El análisis de los valores medios de los movimientos mandibulares entre los 3 grupos sólo reveló diferencias para la apertura máxima no asistida (p= 0.0317). En relación al sexo, los TTM fueron másfrecuentes en niñas siendo significativa la diferencia entre C e Ia (p=0.019). En los niños sin disfunción se estableció unaapertura máxima promedio de 48.28±6.14mm, observándose valores inferiores en los pacientes con TTM. Los movimientos mandibulares en pacientes pediátricos sin TTM mostrarondiferencias significativas en función del tipo de dentición y la edad...
Тема - темы
Humans , Child , Mandible/physiology , Temporomandibular Joint Disorders/classification , Temporomandibular Joint Disorders/diagnosis , Temporomandibular Joint Disorders/epidemiology , Analysis of Variance , Argentina , Cross-Sectional Studies , Facial Pain/diagnosis , Facial Pain/epidemiology , Schools, Dental , Observational Studies as Topic , Prospective Studies , Range of Motion, Articular/physiology , Data Interpretation, StatisticalРеферат
Objetivo: Relatar a conduta semiológica de três casos clínicos de dor orofacial em pacientes com câncer de cabeça e pescoço e descrever a abordagem terapêutica utilizada, discutindo a escada analgésica da Organização Mundial de Saúde (OMS). Material e Métodos: Este estudo relata três casos clínicos que foram encaminhados para tratamento odontológico por um hospital referência em câncer. Os dados foram obtidos a partir dos prontuários e um anexo de disfunção temporomandibular (DTM). A intensidade da dor foi obtida através da escala visual analógica (EVA). Resultados: A dor foi a queixa mais relatada nos três pacientes do gênero masculino e acometidos por carcinoma de células escamosas de cabeça e pescoço. Após o diagnóstico e tratamento da dor oncológica, houve redução da sua intensidade e da medicação utilizada. Conclusão: Pelo diagnóstico preciso e individualizado da dor orofacial, é possível aplicar cuidados curativos e paliativos reduzindo a intensidade da dor, número de queixas e quantidade de medicação. Descritores: Neoplasias - Diagnóstico. Dor facial. Percepção da dor. Relato de casos.
Aim: To report the semiological conduct taken in three clinical cases of orofacial pain in patients with head and neck cancer and to describe the therapeutic approach adopted, discussing the analgesic ladder as set forth by the World Health Organization (WHO). Methods: This study presents three clinical case reports of patients referred for dental treatment by a renowned cancer hospital. The data were collected through medical records and attachments concerning temporomandibular disorders (TMD). Pain intensity was evaluated through the visual analogic scale (VAS). Results: The most commonly reported complaint was orofacial pain in the three male patients with head and neck squamous cell carcinoma. After the diagnosis and treatment of orofacial pain, the pain intensity and drug intake were reduced. Conclusion: The preciseand individual diagnosis of orofacial pain allows for a more effective pain management, thus reducing the pain intensity, the number of complaints, and the amount of medicine
Тема - темы
Humans , Male , Adult , Facial Pain/diagnosis , Pain Perception , Cancer Pain/diagnosis , Facial Pain , Head and Neck Neoplasms , Therapeutics , Case Reports , Dental Care , Therapeutic Uses , Neoplasms/diagnosisТема - темы
Humans , Adult , Primary Health Care/standards , Clinical Protocols/standards , Rheumatology/standards , Arthritis, Psoriatic/diagnosis , Arthritis, Rheumatoid/diagnosis , Secondary Care/standards , Bursitis/diagnosis , Facial Pain/diagnosis , Low Back Pain/diagnosis , Fibromyalgia/diagnosis , Gout/diagnosis , Lupus Erythematosus, Systemic/diagnosis , Osteoarthritis/diagnosisРеферат
Objetivo Caracterizar a pressão da língua em idosos. Métodos Estudo transversal, com a participação de 45 idosos, de 61 a 96 anos, sendo 34 (75,6%) do gênero feminino e 11 (24,4%) do masculino, sem distúrbios neurológicos e cognitivos, sem histórico de câncer de cabeça e pescoço e de procedimento radioterápico. Consistiu na aplicação de questionário, com registro da presença ou ausência de queixa de problemas na deglutição, seguido da avaliação miofuncional orofacial, enfocando a mobilidade e tensão de língua. Para a mensuração da pressão da língua, foi utilizado o Iowa Oral Performance Instrument (IOPI). A análise dos dados foi descritiva, com nível de significância de 5%. Resultados A média do pico pressórico foi de 44,6 KPa (±16), com os valores mínimo e máximo entre 9 e 88 KPa. Houve correlação moderada negativa entre pico pressórico e idade. Os longevos apresentaram a menor média de pico pressórico e inferior ao padrão de normalidade. Houve diferença entre a média de pico pressórico e uso de próteses, tensão de língua e mobilidade de língua no estalo. Conclusão Houve diminuição moderada do pico pressórico da língua com o aumento da idade e redução pressórica com o decréscimo da tensão da língua e de sua mobilidade no estalo. Em contrapartida, os valores de pico foram maiores nos idosos que utilizam próteses dentárias, quando comparados aos que destas não fazem uso. .
Purpose To characterize tongue pressure in elderly individuals. Methods This was a cross-sectional study involving 45 individuals aged between 61 and 96 years old (34 [75.6%] women; 11 [24.4%] men) with no neurological or cognitive disorders, no history of head or neck cancer, and no history of radiotherapy. The subjects were surveyed with a questionnaire that recorded the presence or absence of complaints about swallowing problems and an orofacial myofunctional evaluation, which examined the movement and tension of the tongue. The Iowa Oral Performance Instrument (IOPI) was used to measure tongue pressure. The data analysis was descriptive, with significance set at the 5% level. Results The mean pressure peak was 44.6 kPa (±16), with minimum and maximum values of 9 and 88 kPa, respectively. Pressure peak and age were moderately and negatively correlated. The oldest subject had the lowest average pressure peak, which was less than the normal range. The mean pressure peak differed according to the use of dentures, tongue pressure, and tongue mobility during clicking. Conclusion The pressure peak and the pressure of the tongue decreased moderately with increasing age, decreasing tongue tension, and mobility during clicking. In contrast, the pressure peak values were higher in the elderly who used dentures than those who did not. .
Тема - темы
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Deglutition Disorders/diagnosis , Dental Prosthesis , Facial Pain/diagnosis , Tongue Diseases/pathology , Age and Sex Distribution , Cross-Sectional Studies , Dysarthria/diagnosis , Health of the ElderlyРеферат
Este estudo teve como objetivo relatar um caso de bruxismo e cefaleia matinal, o qual foi tratado com placa estabilizadora para impedir o desgaste dentário e reduzir a dor orofacial de origem muscular. A paciente procurou a disciplina de Clínica Integrada com queixa de dores de cabeça e na face frequentes logo ao acordar. Após anamnese, exame físico intraoral e palpação muscular, a paciente foi diagnosticada com cefaleia matutina e dor facial de origem muscular relacionadas com bruxismo noturno (atividade parafuncional). Como tratamento, foi proposta a confecção de uma placa estabilizadora para uso noturno. No primeiro retorno após uma semana, a paciente relatou melhora na cefaleia matutina, e após um mês, os sintomas praticamente desapareceram. A mesma foi instruída a continuar usando a placa para dormir com o objetivo de proteger seus dentes de um desgaste maior, mesmo que as dores cessassem ompletamente. Recomendou-se retorno após 3 meses para acompanhamento dos sinais e sintomas. Apesar da inexistência de tratamento curativo, o tratamento com placa estabilizadora apresenta-se como uma importante opção terapêutica no controle da dor muscular e prevenção dos desgastes dentários.
This study aimed to report a clinical case of bruxism and morning headaches in which the patient was treated with a stabilization splint to prevent tooth wear and reduce muscular orofacial pain. The patient complained of frequent headaches and facial pain upon waking. After anamnesis, intraoral examination, and muscle palpation, the patient was diagnosed with morning headaches and muscular orofacial pain caused by nocturnal bruxism (parafunctional activity). The patient was treated with a stabilization splint for nocturnal use. One week after the insertion of the splint, the patient reported relief in morning headache, and after a month the symptoms had almost completely disappeared. The patient was instructed to keep using the splint to sleep in order to prevent tooth wear, even if the pain ceased completely. An appointment at 3 months post-insertion was scheduled for follow-up of signs and symptoms. Despite the lack of curative treatment for sleeping bruxism, the stabilization splint therapy is an important therapeutic option for pain control and prevention of tooth wear
Тема - темы
Young Adult , Sleep Bruxism/diagnosis , Sleep Bruxism/prevention & control , Headache/etiology , Headache/prevention & control , Facial Pain/diagnosis , Occlusal Splints , Temporomandibular Joint Disorders/diagnosis , Radiography, Dental/instrumentationРеферат
Temporomandibular disorders (TMD) screeners assume significant item overlap with the screening questionnaire proposed by the American Academy of Orofacial Pain (AAOP). Objective: To test the reliability and validity of the Portuguese version of AAOP questions for TMD screening among adolescents. Material and Methods: Diagnoses from Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I were used as reference standard. Reliability was evaluated by internal consistency (KR-20) and inter-item correlation. Validity was tested by sensitivity, specificity, predictive values, accuracy and receiver operating characteristic (ROC) curves, the relationship between the true-positive rate (sensitivity) and the false-positive rate (specificity). Test-retest reliability of AAOP questions and intra-examiner reproducibility of RDC/TMD Axis I were tested with kappa statistics. Results: The sample consisted of 1307 Brazilian adolescents (56.8% girls; n=742), with mean age of 12.72 years (12.69 F/12.75 M). According to RDC/TMD, 397 [30.4% (32.7% F/27.3% M)] of adolescents presented TMD, of which 330 [25.2% (27.6% F/22.2% M)] were painful TMD. Because of low consistency, items #8 and #10 of the AAOP questionnaire were excluded. Remaining items (of the long questionnaire version) showed good consistency and validity for three positive responses or more. After logistic regression, items #4, #6, #7 and #9 also showed satisfactory consistency and validity for two or more positive responses (short questionnaire version). Both versions demonstrated excellent specificity (about 90%), but higher sensitivity for detecting painful TMD (78.2%). Better reproducibility was obtained for the short version (k=0.840). Conclusions: The Portuguese version of AAOP questions showed both good reliability and validity for the screening of TMD among adolescents, especially painful TMD, according to RDC/TMD. .
Тема - темы
Humans , Male , Female , Child , Adolescent , Facial Pain/diagnosis , Language , Pain Measurement/methods , Surveys and Questionnaires/standards , Temporomandibular Joint Disorders/diagnosis , Brazil , Multivariate Analysis , Reproducibility of Results , Sensitivity and Specificity , TranslationsРеферат
INTRODUCTION: Temporomandibular disorders (TMD) and eating disorders (ED) affect function and parafunction of the oral cavity and have high rates of medical and psychological comorbidity. However, little is known about the possible associations between them, and few studies have investigated the existence of such associations. METHODS: A search was conducted on the SciELO, LILACS, and PubMed/MEDLINE databases to find relevant articles written in English and Portuguese. Only studies involving human beings were included, and there was no limit for year of publication. RESULTS AND CONCLUSIONS: There is evidence of the correlation between TMD and ED, but their comorbidity must be better understood. The presence of depressive symptoms is an aggravating factor that must also be taken into account during the diagnosis and treatment of those patients (AU)
INTRODUÇÃO: As disfunções temporomandibulares (DTM) e os transtornos alimentares (TA) envolvem a função e a parafunção da cavidade oral e apresentam altos índices de comorbidade médica e psicológica. No entanto, pouco se sabe sobre as possíveis associações entre essas entidades clínicas, e poucos artigos avaliaram a existência de uma relação elas. MÉTODOS: Uma busca foi realizada nas bases de dados SciELO, LILACS e PubMed/MEDLINE a fim de encontrar artigos relevantes escritos em inglês e português. Apenas estudos envolvendo seres humanos foram incluídos, e não foi estabelecido um limite para ano de publicação. RESULTADOS E CONCLUSÕES: Há evidências da correlação entre DTM e TA, mas essa comorbidade precisa ser melhor compreendida. A presença de sintomas depressivos é um fator agravante que também precisa ser levado em consideração durante o diagnóstico e tratamento desses pacientes (AU)
Тема - темы
Humans , Temporomandibular Joint Disorders/complications , Temporomandibular Joint Disorders/psychology , Feeding and Eating Disorders/complications , Feeding and Eating Disorders/psychology , Facial Pain/complications , Facial Pain/diagnosis , Facial Pain/psychology , Facial Pain/therapy , Temporomandibular Joint Disorders/diagnosis , Temporomandibular Joint Disorders/therapy , Feeding and Eating Disorders/diagnosis , Feeding and Eating Disorders/therapy , Depression/diagnosis , Depression/psychology , Chronic Pain/psychologyРеферат
Paroxysmal hemicrania (PH) is a trigeminal autonomic cephalalgia, a rare primary headache characterized by unilateral periorbital and/or temporal attacks of severe intensity and short duration. In this situation, the determination of a correct diagnosis is crucial for the establishment of a proper management strategy. In the case of head and facial pain, this step is usually a big challenge since many conditions share the same features, as some primary headaches and temporomandibular disorders (TMD). The relationship between PH and TMD has not been determined. This paper describes a case of a female patient diagnosed with TMD and presenting concomitant headache attacks fulfilling the International Headache Society's criteria for PH. It is also emphasized the importance of dentist in this scenario, for many times responsible for the initial diagnosis of facial/head pain. Moreover, it is presented an integrated and simultaneously approach of both conditions, PH and TMD.