Prolonged gingival cold allodynia: a novel finding in patients with atypical odontalgia.

OBJECTIVE: The aim of this study was to examine atypical odontalgia (AO) patients with extraoral quantitative sensory testing (EQST) and an intraoral mucosal cold test. STUDY DESIGN: Twenty-one subjects with AO and 18 control subjects underwent EQST for electrical and thermal pain and detection thresholds. Cold was applied to painful mucosal areas in AO patients and randomly in control subjects. RESULTS: Electrical pain thresholds were higher in AO patients than in control subjects in the same dermatome affected by the pain (P = .03), but no significant differences were observed in electrical detection thresholds and heat pain and detection thresholds at other sites. Cold application was painful in control and AO subjects, but duration of pain sensation was significantly longer in AO patients (P = .019 in contralateral side; P = .029 in affected side). CONCLUSIONS: The finding of extended painful aftersensation following cold application in AO patients supports the involvement of central mechanisms. The cold test is clinically easy to apply and of clinically significant value.

Exéresis de las lesiones hiperplásicas de la cavidad bucal. Estudio retrospectivo de 128 casos / Removal of hyperplastic lesions of the oral cavity. A retrospective study of 128 cases

Objetivos: Este trabajo pretende, en base a nuestra experiencia, valorar y discutir las indicaciones, ventajas e inconvenientes de la exéresis de los épulis de la cavidad bucal con el láser de dióxido de carbono (CO2) respecto al láser de Erbio:YAG (Er:YAG), el láser de diodo y el bisturí frío.Material y método: Se ha realizado un estudio retrospectivo de un grupo de 120 pacientes en los que se extirparon 128 épulis con el láser de CO2, láser de Er:YAG, láser de diodo y bisturí frío. Se realizaron controles postoperatorios a los 7, 15 y 30 días para comprobar la cicatrización y la evolución de la herida y a los 3, 6 y 12 meses verificando si se había producido o no la recidiva de la lesión.Resultados: Según las características clínicas y etiopatogénicas de las lesiones extirpadas, se han formado dos grupos: las lesiones hiperplásicas gingivales (77 casos) y los épulis fisurados (51 casos). La localización más frecuente de las hiperplasias gingivales fue la mandíbula (51.9%). Se encontró que la hiperplasia fibrosa fue el diagnóstico histopatológico más frecuente con 49 casos (63.6%). El porcentaje de recidiva tras su extirpación fue del 9,1%, de los cuales 5 casos eran hiperplasias fibrosas. Sólo hubo un caso de lesión maligna que fue diagnosticada de carcinoma de células escamosas infiltrante.Por otro lado, de los 51 épulis fisurados tratados, el 58.8% se encontraban en el maxilar superior. Éstos fueron diagnosticados histológicamente como hiperplasias fibrosas, recidivando en el 19.6% de los casos.Conclusiones: Aunque las diferentes técnicas quirúrgicas utilizadas en la extirpación del épulis de la cavidad bucal son correctas, en nuestra opinión, el láser de CO2 es el tratamiento de elección, ya que ofrece ventajas tanto intra como postoperatorias. Por otro lado, es indispensable analizar histopatológicamente toda lesión de la cavidad bucal para establecer un diagnóstico de certeza

Aims: Based on our accumulated experience, the present study evaluates and discusses the indications, advantages and inconveniences of oral cavity epulis resection using the carbon dioxide laser (CO2) versus the Erbium:YAG laser (Er:YAG), diode laser and surgical scalpel.Material and methods: A retrospective study has been made of 120 patients involving the removal of 128 epulis lesions with the CO2 laser, Er:YAG laser, diode laser and surgical scalpel. Postoperative controls were carried out after 7, 15 and 30 days to evaluate healing and wound evolution, and after 3, 6 and 12 months to assess possible relapse.Results: Two groups were defined, based on the clinical and etiopathogenic characteristics of the excised lesions: gingival hyperplastic lesions (77 cases) and fibromatous hyperplasia (51 cases). The lower jaw was the most frequent location of gingival hyperplasia (51.9%). Fibrous hyperplasia was the most common histological diagnosis (49 cases; 63.6%). Percentage relapse following removal was 9.1%, of which 5 cases corresponded to fibrous hyperplasia. Only one malignancy was identified, corresponding to infiltrating squamous cell carcinoma.On the other hand, of the 51 treated cases of fibromatous hyperplasia, 58.8% were located in the upper jaw. These were histologically confirmed to be fibrous hyperplasia, with relapse in 19.6% of the cases.Conclusions: Although the different surgical techniques used for removal of epulis of the oral cavity are appropriate, we consider the CO2 laser to be the treatment of choice, since it offers a number of both intra- and postoperative advantages. On the other hand, all oral lesions require histological study to establish a firm diagnosis

The natural history and clinical course of calculus formation in man.

This paper describes levels and progression of supra- and subgingival calculus undisturbed by active professional intervention or home care between 1970 and 1985 in Sri Lanka, or when removed at regular intervals between 1969 and 1988 in Norway. In the Sri Lankan tea laborers, both supra- and subgingival calculus formation started before age 14 years. At 40 years of age, all participants and almost all teeth and tooth surfaces had calculus. Tea laborers who both smoked tobacco and chewed betel had significantly higher calculus scores than those who only had one of these habits, and those who neither chewed nor smoked had the lowest calculus scores. Teeth with calculus showed a significantly higher rate of loss of attachment than teeth that remained calculus free. For the Norwegians who had enjoyed regular dental care throughout their lives, supragingival calculus did not increase in frequency from adolescence to the forties. Approximately 70% of the interproximal surfaces were calculus free after 40-50 years of age. Subgingival calculus scores, although low, showed some increase with longer times of exposure. On average, each person had 0.4 interproximal surfaces with subgingival calculus as they approached 50 years of age. In this Norwegian population, subgingival calculus had no impact on loss of attachment.