The Orofacial Pain Clinic Questionnaire (EDOF-HC) in the evaluation and diagnosis of orofacial pain.

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.

Burning mouth complaints: clinical characteristics of a Brazilian sample.

OBJECTIVE: Evaluation of the clinical characteristics of burning mouth complaints (BMC) in a series of Brazilian patients referred to a large teaching hospital. MATERIALS AND METHODS: 66 patients with burning mouth complaints were evaluated through a standardized protocol. RESULTS: 56 women and 10 men were examined, ranging in age from 35-83 years. The primary location of the complaints was reported to be the tongue. Thirty-six patients reported a precipitating event. The mean VAS pain levels were 7.5 in women and 6.11 in men. The average estradiol levels in women were low (<13 pg/ml); 80% of all patients reported a concomitant chronic disease, 55% of all patients wore total dentures, 54% of all patients reported subjective xerostomia, 48% of all patients reported sleep disturbances and 66% reported phantom taste. No statistical differences were found between groups with or without a precipitating event in VAS: (p=0.139), in the Number of Words Chosen (NWC) (p=0.259) and Pain Rating Index (PRI) (p=0.276) sections of the McGill Pain Questionnaire (MPQ). CONCLUSION: The existence of systemic comorbidities, self-reported sleep disturbances and taste alterations indicates possible correlations and the need for a careful systemic evaluation of each patient; there were no differences between patients with and without precipitating events.

Diferential diagnosis in atypical facial pain: a clinical study.

OBJECTIVE: To evaluate a sample of patients with atypical facial pain (AFP) in comparison to patients with symptomatic facial pain (SFP). METHOD: 41 patients with previous diagnostic of AFP were submitted to a standardized evaluation protocol, by a multidisciplinary pain team. RESULTS: 21 (51.2%) were considered AFP and 20 (48.8%) (SFP) received the following diagnosis: 8 (40.0%) had temporomandibular disorders (TMD); 3 (15.0%) had TMD associated to systemic disease (fibromyalgia, systemic erythematosus lupus); 4 (20.0%) had neuropathy after ear, nose and throat (ENT) surgery for petroclival tumor; 2 (10.0%) had Wallenberg syndrome; 1 (5.0%) had intracranial tumor; 1 (5.0%) had oral cancer (epidermoid carcinoma), and 1 (5.0%) had burning mouth syndrome (BMS) associated to fibromyalgia. Spontaneous descriptors of pain were not different between AFP and SFP groups (p=0.82). Allodynia was frequent in SFP (p=0.05) and emotion was the triggering factor most prevalent in AFP (p=0.06). AFP patients had more traumatic events previously to pain (p=0.001). CONCLUSION: AFP patients had more: a) traumatic events previously to pain onset, and b) emotions as a triggering factor for pain. These data support the need of trained health professionals in multidisciplinary groups for the accurate diagnosis and treatment of these patients.

Facial pain of cardiac origin: a case report.

CONTEXT: Cardiac pain may radiate to the face and lead patients to seek dental care. Dentists may contribute towards the diagnosing of ischemic heart disease and thus refer patients for cardiological evaluation. CASE REPORT: A 50-year-old female patient was referred to a dentist for evaluation of a suspected temporomandibular disorder after repeated visits to medical emergency departments due to excruciating facial and left temporal pain associated with exertion. The pain would start in the chest and radiate to the neck, face and left temporal region. The patient's chief complaint was the facial pain; hence, she sought dental care. The dental examination revealed an edentulous upper jaw and partially edentulous lower jaw with full upper prosthetic set of teeth and decreased vertical dimension. X-ray of facial bones did not reveal any bone abnormalities. A diagnosis of temporomandibular disorder was made. However, she was referred for cardiological evaluation, since her pain was starting in the chest and because she had a past medical history of surgical treatment for coronary artery disease. A diagnosis of angina pectoris was made, the therapeutic regimen was optimized and her angina was brought under control.

Temporomandibular disorders in fibromyalgia patients: are there different pain onset?

OBJECTIVE: To identify temporomandibular disorders (TMD) symptoms in two groups of fibromyalgia patients according to the temporal relation between the onset of facial pain (FP) and generalized body pain (GBP). CROSS-SECTIONAL STUDY DESIGN: Fifty-three consecutive women with fibromyalgia and FP were stratified according to the onset of orofacial pain: Group-A (mean age 47.30 ± 14.20 years old), onset of FP preceded GBP; Group-B (mean age 51.33 ± 11.03 years old), the FP started concomitant or after GBP. CLINICAL ASSESSMENT: Research Diagnostic Criteria for Temporomandibular Disorders and the Visual Analogue Scale. RESULTS: Myofascial pain with mouth opening limitation (p = 0.038); right disc displacement with reduction (p = 0.012) and jaw stiffness (p = 0.004) were predominant in Group A. Myofascial pain without mouth opening limitation (p = 0.038) and numbness/burning were more common in Group B. CONCLUSION: All patients had temporomandibular joint symptoms, mainly muscle disorders. The prevalence of myofascial pain with limited mouth opening and right TMJ disc displacement with reduction were higher in Group A.

The Orofacial Pain Clinic Questionnaire (EDOF-HC) in the evaluation and diagnosis of orofacial pain / Questionário da Equipe de Dor Orofacial (EDOF-HC) na avaliação e diagnóstico da dor orofacial

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.

Chronic pain relief after the exposure of nitrous oxide during dental treatment: longitudinal retrospective study.

The objective was to investigate the effect of nitrous/oxygen in chronic pain. Seventy-seven chronic pain patients referred to dental treatment with conscious sedation with nitrous oxide/oxygen had their records included in this research. Data were collected regarding the location and intensity of pain by the visual analogue scale before and after the treatment. Statistical analysis was performed comparing pre- and post-treatment findings. It was observed a remarkable decrease in the prevalence of pain in this sample (only 18 patients still had chronic pain, p < 0.001) and in its intensity (p < 0.001). Patients that needed fewer sessions received higher proportions of nitrous oxide/oxygen. Nitrous oxide may be a tool to be used in the treatment of chronic pain, and future prospective studies are necessary to understand the underlying mechanisms and the effect of nitrous oxide/oxygen in patients according to the pain diagnosis and other characteristics.

Clinical study of patients with persistent orofacial pain.

OBJECTIVE: [corrected] To evaluate a sample of patients with persistent facial pain unresponsive to prior treatments. METHODS: Hospital records of 26 patients with persistent facial pain were reviewed (20 female and 6 male). RESULTS: Patients were classified into three groups according to their presenting symptoms: a)Group I, eight patients (30.7%) with severe, diffuse pain at the face, teeth or head; b)Group II, eight patients (30.7%) with chronic non-myofascial pain and; c)Group III, ten patients with chronic myofascial pain (38.4%). We find 11 different diagnoses among the 26 patients: pulpitis(7), leukemia(1), oropharyngeal tumor(1), atypical odontalgia(1), Eagle's syndrome(1), trigeminal neuralgia(4), continuous neuralgia(1), temporomandibular disorders (9), fibromyalgia (2), tension-type headache(1), conversion hysteria(2). After the treatment program all patients had a six-month follow-up period with pain relief, except the patient with tumor. CONCLUSION: The wide variability of orofacial pain diagnosis (benign to life-threatening diseases) indicates the necessity to reevaluate patients presenting recurrent pain that is refractory to the usual treatments.

Association between painful temporomandibular disorders, sleep bruxism and tinnitus.

The present cross-sectional study was designed to investigate the association between sleep bruxism (SB), tinnitus and temporomandibular disorders (TMD). The sample consisted of 261 women (mean age of 37.0 years). The Research Diagnostic Criteria for Temporomandibular Disorders were used to classify TMD and self-reported tinnitus. SB was diagnosed by clinical criteria proposed by the American Academy of Sleep Medicine. The results showed an association between painful TMD and tinnitus (OR=7.3; 95%CI=3.50-15.39; p<0.001). With regard to SB, the association was of lower magnitude (OR=1.9; 95%CI=1.16-3.26; p<0.0163). When the sample was stratified by the presence of SB and painful TMD, only SB showed no association with tinnitus. The presence of painful TMD without SB was significantly associated with tinnitus (OR=6.7; 95%CI=2.64-17.22; p<0.0001). The concomitant presence of painful TMD and SB was associated with a higher degree of tinnitus severity (OR=7.0; 95%CI=3.00-15.89; p<0.0001). It may be concluded that there is an association between SB, painful TMD and self-reported tinnitus; however, no relationship of a causal nature could be established.

The role of xerostomia in burning mouth syndrome: a case-control study.

OBJECTIVE: To assess the efficacy of anti-xerostomic topical medication (urea 10%) in patients with burning mouth syndrome (BMS). METHOD: Thirty-eight subjects diagnosed with BMS according to the International Association for the Study of Pain guidelines were randomized to either placebo (5% sodium carboxymethylcellulose, 0.15% methyl paraben, and 10% glycerol in distilled water qsp 100 g) or treatment (urea 10%) to be applied to the oral cavity 3-4 times per day for 3 months. The patients were evaluated before and after treatment with the following instruments: the EDOF-HC protocol (Orofacial Pain Clinic - Hospital das Clínicas), a xerostomia questionnaire, and quantitative sensory testing. RESULTS: There were no differences in salivary flow or gustative, olfactory, or sensory thresholds (P>0.05). Fifteen (60%) patients reported improvement with the treatments (P=0.336). CONCLUSION: In conclusion, there were no differences between groups, and both exhibited an association between reported improvement and salivation.

Medical conditions and body pain in patients presenting orofacial pain.

OBJECTIVE: To verify the frequency of self-reported medical conditions and pain areas in orofacial pain patients, comparing them with patients from the routine dental care. METHODS: Data were collected from archives of the Orofacial Pain Clinic (Group A, n=319) and of the routine dental care clinics (Group B, n=84) at Faculdade de Odontologia de Araraquara, São Paulo, in Brazil. All individuals answered a standardized clinical questionnaire and completed a body map indicating their pain areas. RESULTS: The Mann-Whitney's test demonstrated that Group A presented a higher mean number of medical reports than Group B (p=0.004). In both groups, Pearson's correlation test showed that the highest frequencies of medical conditions were positively correlated to highest frequencies of painful areas (0.478, p=0.001 and 0.246, p=0.000, respectively). CONCLUSIONS: Group A tended to report more medical conditions and there was a positive correlation between the number of medical conditions and the one of pain areas for both groups.

Temporomandibular disorders in fibromyalgia patients: are there different pain onset? / Disfunção termomandibuar em doentes com fibromialgia: há diferença no início das dores?

ABSTRACT Objective To identify temporomandibular disorders (TMD) symptoms in two groups of fibromyalgia patients according to the temporal relation between the onset of facial pain (FP) and generalized body pain (GBP). Cross-sectional study design: Fifty-three consecutive women with fibromyalgia and FP were stratified according to the onset of orofacial pain: Group-A (mean age 47.30 ± 14.20 years old), onset of FP preceded GBP; Group-B (mean age 51.33 ± 11.03 years old), the FP started concomitant or after GBP. Clinical assessment Research Diagnostic Criteria for Temporomandibular Disorders and the Visual Analogue Scale. Results Myofascial pain with mouth opening limitation (p = 0.038); right disc displacement with reduction (p = 0.012) and jaw stiffness (p = 0.004) were predominant in Group A. Myofascial pain without mouth opening limitation (p = 0.038) and numbness/burning were more common in Group B. Conclusion All patients had temporomandibular joint symptoms, mainly muscle disorders. The prevalence of myofascial pain with limited mouth opening and right TMJ disc displacement with reduction were higher in Group A.

RESUMO Objetivo Identificar sintomas de disfunção temporomandibular (DTM) em dois grupos de pacientes fibromiálgicas, segundo a relação temporal entre o início da dor facial (DF) e das dores generalizadas no corpo (DGC). Estudo transversal: 53 pacientes consecutivas com fibromialgia e DF foram divididas de acordo com o início da dor orofacial: Grupo A (média de idade 47,30 ± 14,20anos), o início da DF precedeu o da DGC; Grupo-B (idade média 51,33 ± 11,03anos), a DF iniciou concomitantemente ou após a DGC. Avaliação clínica: Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) e escala visual analógica (EVA). Resultados Dor miofascial com limitação de abertura bucal (p = 0,038); deslocamento de disco à direita com redução (p = 0,012) e rigidez mandibular (p = 0,004) foram predominantes no Grupo A. Dor miofascial sem limitação de abertura bucal (p = 0,038) e dormência/queimação foram mais comuns no Grupo-B. Conclusão Todos os pacientes tiveram sintomas de DTM, principalmente disfunção muscular. A prevalência de dor miofascial com limitação de abertura bucal e deslocamento de disco à direita com redução foi maior no Grupo A.

Chronic pain relief after the exposure of nitrous oxide during dental treatment: longitudinal retrospective study / Alívio da dor crônica após exposição ao óxido nitroso durante tratamento odontológico: estudo retrospectivo longitudinal

The objective was to investigate the effect of nitrous/oxygen in chronic pain. Seventy-seven chronic pain patients referred to dental treatment with conscious sedation with nitrous oxide/oxygen had their records included in this research. Data were collected regarding the location and intensity of pain by the visual analogue scale before and after the treatment. Statistical analysis was performed comparing pre- and post-treatment findings. It was observed a remarkable decrease in the prevalence of pain in this sample (only 18 patients still had chronic pain, p < 0.001) and in its intensity (p < 0.001). Patients that needed fewer sessions received higher proportions of nitrous oxide/oxygen. Nitrous oxide may be a tool to be used in the treatment of chronic pain, and future prospective studies are necessary to understand the underlying mechanisms and the effect of nitrous oxide/oxygen in patients according to the pain diagnosis and other characteristics.

O objetivo deste estudo foi investigar o efeito do óxido nitroso na dor crônica. Os prontuários de 77 pacientes com dor crônica submetidos a tratamento odontológico com sedação consciente (óxido nitroso/oxigênio) foram incluídos. Os dados sobre localização e intensidade de dor pela escala visual analógica foram considerados, e foi realizada comparação e análise estatística entre os momentos pré- e pós-tratamento. Foi observada redução marcante na prevalência de dor nesta amostra (apenas 18 doentes ainda tinham dor, p < 0,001) e na intensidade de dor (p < 0,001). Os doentes que precisaram de menor quantidade de sessões receberam maiores proporções de óxido nitroso/oxigênio. Em conclusão, pode-se considerar o oxido nitroso como uma ferramenta a ser investigada no tratamento da dor crônica em estudos futuros prospectivos, que poderão identificar os mecanismos associados de acordo com o diagnóstico de dor e outras características.

Effects of acupuncture in adults with temporomandibular disorders / Efeito da acupuntura em adultos com disfunção temporomandibular

BACKGROUND AND OBJECTIVES: Temporomandibular disorders are functional and/or structural temporomandibular joint changes, of multifactorial origin, thus difficult to treat. So, acupuncture is a very useful alternative to handle such disorders. This study aimed at evaluating in adults with temporomandibular disorders, after at least 12 months of acupuncture treatment, whether results were maintained. METHODS: Participated in the study 20 patients with temporomandibular disorders, treated in the acupuncture clinic of the Dentistry School of Piracicaba, State University of Campinas, who were evaluated in the beginning, immediately after treatment and at least 12 months after treatment, through the visual analog scale (VAS). Patients' history was obtained in the initial visit, according to Traditional Chinese Medicine patterns, being checked pain intensity reported by patients (VAS0). Acupuncture was performed aiming at the energetic balance according to diagnosed pattern and reported pain (VAS1) was again evaluated at treatment completion (mean of six sessions lasting 20 minutes). Patients were revaluated (VAS2) after at least 12 months (12 to 18 months). ANOVA was used to compare moments initial, post-treatment and one year after, with significance of 5%. RESULTS: Means for VAS0, VAS1 and VAS2 were 5.9, 1.65 and 2.45, respectively. There has been statistical difference between VAS0 and VAS1 (p<0.01) and between VAS0 and VAS2 (p<0.01), however not between VAS1 and VAS2 (p>0.05). CONCLUSION: Data have shown that acupuncture treatment in adults with temporomandibular disorders has decreased pain and that such decrease was maintained for at least 12 months. .

JUSTIFICATIVA E OBJETIVOS: As disfunções temporomandibulares são alterações funcionais e/ou estruturais das articulações temporomandibulares, de origem multifatorial e, portanto de difícil tratamento. Sendo assim, a acupuntura apresenta-se como uma alternativa muito útil no manuseio dessas disfunções. O objetivo deste estudo foi avaliar em adultos com disfunções temporomandibulares, após no mínimo 12 meses do tratamento com acupuntura, se houve manutenção dos resultados. MÉTODOS: Foram avaliados 20 pacientes com disfunções temporomandibulares, na clínica de acupuntura da Faculdade de Odontologia de Piracicaba da Universidade Estadual de Campinas, ao início, imediatamente após tratamento e após no mínimo 12 meses do tratamento com acupuntura, através da escala analógica visual (EAV). Na consulta inicial foi realizada uma anamnese segundo os padrões da Medicina Tradicional Chinesa sendo verificada a intensidade de dor relatada pelo paciente (EAV0). A acupuntura foi realizada buscando-se o equilíbrio energético de acordo com o padrão diagnosticado, sendo ao final do tratamento (em média seis sessões de 20 minutos) avaliada novamente a dor relatada (EAV1). Após no mínimo 12 meses (12 a 18 meses) os pacientes foram reavaliados (EAV2). Utilizou-se a ANOVA para comparação entre os momentos inicial, pós-tratamento e após um ano, com significância de 5%. RESULTADOS: As médias para EAV0, EAV1 e EAV2 foram 5,9, 1,65 e 2,45 respectivamente. Houve diferença estatística entre EAV0 e EAV1 (p<0,01), e entre EAV0 e EAV2 (p<0,01), porém não entre EAV1 e EAV2 (p>0,05). CONCLUSÃO: Os dados apontaram que o tratamento com acupuntura em adultos com disfunção temporomandibular reduziu a dor e que essa redução ...

The role of xerostomia in burning mouth syndrome: a case-control study / O papel da xerostomia na sindrome da ardencia bucal: estudo caso controle

Objective : To assess the efficacy of anti-xerostomic topical medication (urea 10%) in patients with burning mouth syndrome (BMS). Method : Thirty-eight subjects diagnosed with BMS according to the International Association for the Study of Pain guidelines were randomized to either placebo (5% sodium carboxymethylcellulose, 0.15% methyl paraben, and 10% glycerol in distilled water qsp 100 g) or treatment (urea 10%) to be applied to the oral cavity 3-4 times per day for 3 months. The patients were evaluated before and after treatment with the following instruments: the EDOF-HC protocol (Orofacial Pain Clinic – Hospital das Clínicas), a xerostomia questionnaire, and quantitative sensory testing. Results : There were no differences in salivary flow or gustative, olfactory, or sensory thresholds (P>0.05). Fifteen (60%) patients reported improvement with the treatments (P=0.336). Conclusion : In conclusion, there were no differences between groups, and both exhibited an association between reported improvement and salivation. .

Objetivo : Avaliar a eficácia do uso de medicação tópica anti xerostomica (ureia 10%) em pacientes com síndrome de ardência bucal. Método : Trinta e oito sujeitos diagnosticados com síndrome de ardência bucal de acordo com os critérios da Associação Internacional para Estudo da Dor foram randomizados para grupo placebo (5% de carboximetilcelulose de sódio, 0,15% de metilparabeno e 10% de glicerol em água destilada qsp 100g) ou grupo tratamento (ureia 10%) para ser aplicada na cavidade oral 3-4 vezes ao dia, durante três meses. Os pacientes foram avaliados antes e depois do tratamento: protocolo EDOF-HC, questionário de xerostomia, testes sensitivos quantitativos. Resultados : Não houve diferenças no fluxo salivar, limiares gustativos, olfativos e somestésicos (Mann-Whitney P>0,05). Quinze (60%) dos pacientes tiveram melhora com o tratamento (P=0,336, oneway ANOVA ). Conclusão : Em conclusão não houve diferenças entre os grupos, ambos apresentaram uma associação entre melhora e salivação. .

Periodontitis and Metabolic Control: A Preliminary Study / Periodontitis y Control Metabólico: Estudio Preliminar

The aim of this study was to evaluate the periodontal condition and the metabolic control of patients with diabetes mellitus type 2. Patients with diabetes mellitus type 2 were evaluated pre- and post (30 days) treatment of the periodontitis through the following exams: glycemia, glycosylated hemoglobin, plaque index, gingival bleeding index and periodontal pocket depth index. Periodontal treatment consisted of: Scaling, root planning and plaque control, associated with systemic antibiotic therapy with amoxicillin. Seventeen patients (12 women and 5 men; mean age = 55.94 years) were included. The chief complaints were: gingival bleeding (n=13); gingival pain (n=8), tooth mobility (n=3), gingival swelling (n=2) and halitosis (n=2). The mean time of these complaints ranged from 2 months to 20 years. None of them had ever received guidance on oral hygiene or dental assessment. There was a reduction in the following indexes (30 days after the periodontal treatment): plaque, from 41.79±24% to 12.26±13%) (p0.0005), gingival bleeding from 51.58±25%) to 15.77±15% (p0.0005), periodontal pocket depth from 0.98±0.91 mm to 1.76±0.63 mm) (p0.0005). In 15 patients there was a reduction in the glycosylated hemoglobin (10.85±3.03% to 8.72±1.68%) (p0.0005). This preliminary study shows that patients of this sample had chronic and severe periodontal disease; there was a reduction in the glycosylated hemoglobin levels, but not of glycemia, 30 days after periodontal treatment. Long-standing studies are necessary; however patients with diabetes mellitus need control of chronic infections, including periodontal disease.

El objetivo fue evaluar la condición periodontal y el control metabólico de pacientes con diabetes mellitus tipo 2. En los pacientes con diabetes mellitus tipo 2 se evaluaron previo y posterior (30 días) al tratamiento de la periodontitis los siguientes exámenes: glucemia, hemoglobina glicosilada, índice de placa bacteriana, índice de sangrado gingival e índice de profundidad de la bolsa periodontal. El tratamiento periodontal consistió en: curetage, alisado radicular y control de placa, asociado a la terapia sistémica antibiótica con amoxicilina. Se evaluaron 17 pacientes (12 mujeres y 5 hombres, con una edad media de 55,94 años). Las principales complicaciones fueron: sangrado gingival (n= 13), dolor gingival (n= 8), movilidad dental (n= 3), edema gingival (n= 2) y halitosis (n= 2). El tiempo medio de estas complicaciones varió entre 2 meses y 20 años. Ninguno de ellos reconoció haber recibido orientación sobre higiene oral o evaluación dental. Hubo una reducción (30 días después del tratamiento periodontal) en los siguientes índices: placa, de 41,79±24% a 12,26±13%) (p0,0005); sangrado gingival, de 51,58±25%) a 15,77±15% (p0,0005), profundidad de la bolsa periodontal, de 0,98±0,91 mm a 1,76±0,63 mm) (p0,0005). En 15 pacientes se observó una reducción en la hemoglobina glucosilada (10,85±3,03% a 8,72±1,68%) (p0,0005). Observamos que los pacientes de esta muestra tenían enfermedad periodontal crónica y severa; que hubo una reducción en los niveles de hemoglobina glucosilada, pero no de la glucemia, 30 días después del tratamiento periodontal. Estudios longitudinales son necesarias, sin embargo los pacientes con diabetes mellitus requieren control de las infecciones crónicas, como la enfermedad periodontal.

Mapas de dor corporal aprimoram os relatos das queixas dolorosas em pacientes com dor orofacial / Body pain maps improve the report of painful complaints in patients with orofacial pain

JUSTIFICATIVA E OBJETIVOS: Identificar as queixas dolorosas dos pacientes é essencial para determinar diagnósticos e intervenções terapêuticas adequadas em dor orofacial (DOF). Assim, o objetivo deste estudo foi verificar a frequência das queixas de dor relatadas comparando-as àquelas marcadas pelos pacientes em mapas de dor. MÉTODO: Os dados foram coletados dos prontuários de 532 pacientes da Clínica de Dor Orofacial da Faculdade de Odontologia de Araraquara. Os indivíduos responderam a um questionário informando suas queixas de dor e completaram um mapa corporal indicando as áreas dolorosas. A frequência dos relatos foi comparada à frequência dos locais identificados nos mapas. Foram consideradas nove regiões anatômicas: cabeça, face, pescoço, ombros, braços, tórax, abdômen, costas e pernas. Também foram calculados sensibilidade, especificidade e valores kappa comparando os relatos de dor aos mapas, os últimos considerados padrão-ouro. RESULTADOS: A média etária da amostra foi de 33,5 ± 13,8 anos, 33,9 ± 13,9 anos para as mulheres e 31,7 ± 13,1 anos para os homens. Foi observada maior prevalência de dor entre as mulheres. Em ambos os gêneros, as regiões com mais queixas de dor estavam localizadas na parte superior do corpo e uma diferença significativa entre os relatos de dor e os desenhos de dor foi observada para as regiões abaixo do pescoço. Os mapas de dor corporal demonstraram superioridade sobre os relatos de dor na identificação das queixas dolorosas durante a anamnese. CONCLUSÃO: O relato da queixa principal não foi um método eficiente para conhecer todas as queixas dolorosas, pois os mapas corporais evidenciaram a presença de dores adicionais em pacientes com DOF.

BACKGROUND AND OBJECTIVES: Assessing patients´ pain complaints is essential for determining adequate diagnosis and therapeutic interventions in orofacial pain (OFP). Thus, the aim of this study was to verify the frequency of reported pain complaints compared to those marked on patients´ body pain maps. METHOD: Data was collected from the Orofacial Pain Clinic archives (532 patients) of Araraquara Dental School. All individuals answered a standardized clinical questionnaire to report their chief complaints and completed a body map indicating their pain areas. The frequency of reported pain complaints was compared to the frequency of painful sites identified on body maps. Nine anatomic regions were considered: head, face, neck, shoulders, arms, chest, abdomen, back, and legs. In addition, sensitivity, specificity and kappa values were calculated comparing the pain reports to body pain drawings, the latter being considered as gold standard. RESULTS: The mean age of total sample was 33.5 ± 13.8 years, 33.9 ± 13.9 years for women and 31.7 ± 13.1 years for men. Higher prevalence of pain was observed among female patients. Overall, the regions of greater pain reports were located in the upper body areas, both for women and men. A significant difference between the pain reports and the pain drawings was observed for the body regions below the neck, in both genders. The body pain maps demonstrated superiority against pain reports in assessing patients´ painful complaints during the anamnesis. CONCLUSION: Pain reports were not an efficient method for diagnosing all patient´s painful complaints, because body pain maps evidentiated additional pain complaints in OFP patients.

Medical conditions and body pain in patients presenting orofacial pain / Condições médicas e dores corporais em pacientes com dor orofacial

OBJECTIVE: To verify the frequency of self-reported medical conditions and pain areas in orofacial pain patients, comparing them with patients from the routine dental care. METHODS: Data were collected from archives of the Orofacial Pain Clinic (Group A, n=319) and of the routine dental care clinics (Group B, n=84) at Faculdade de Odontologia de Araraquara, São Paulo, in Brazil. All individuals answered a standardized clinical questionnaire and completed a body map indicating their pain areas. RESULTS: The Mann-Whitney's test demonstrated that Group A presented a higher mean number of medical reports than Group B (p=0.004). In both groups, Pearson's correlation test showed that the highest frequencies of medical conditions were positively correlated to highest frequencies of painful areas (0.478, p=0.001 and 0.246, p=0.000, respectively). CONCLUSIONS: Group A tended to report more medical conditions and there was a positive correlation between the number of medical conditions and the one of pain areas for both groups.

OBJETIVO: Verificar a frequência de problemas médicos autorrelatados e a frequência de áreas de dor no corpo em pacientes com dor orofacial, comparando-os a pacientes submetidos a tratamento odontológico de rotina. MÉTODOS: Os dados foram coletados dos arquivos da Clínica de Dor Orofacial (Grupo A, n=319) e de clínicas de tratamento odontológico rotineiro (Grupo B, n=84) da Faculdade de Odontologia de Araraquara, São Paulo, Brasil. Os indivíduos responderam a questionários e preencheram um mapa corporal indicando os locais de dor. RESULTADOS: O teste de Mann-Whitney demonstrou que o Grupo A apresentou uma média de relatos de problemas médicos superior ao Grupo B (p=0,004). Para ambos os grupos, o teste de correlação de Pearson demonstrou correlação positiva entre os problemas médicos e a frequência de áreas dolorosas (respectivamente, 0,478, p=0,001 e 0,246, p=0,000). CONCLUSÕES: O Grupo A relatou maior número de problemas médicos e houve correlação positiva entre a frequência desses problemas e a de áreas de dor para ambos os grupos.

Dor persistente, anormalidades sensitivas, lesão de nervo e perda do implante após cirurgia com implantes dentais: sugestão deabordagem clínica / Persistent pain, sensory abnormalities, nervous injury and loss of implantafter dental implant surgery: clinical approach suggestion

JUSTIFICATIVA E OBJETIVOS: Alterações de sensibilidade trigeminal podem levar à dor neuropática após manipulação cirúrgica. Essas queixas geram dúvidas. Primeiro:são reais? Pois, nem sempre há relação causal entre implante-nervo. Segundo: o implante deve ser removido? O objetivo deste estudo foi rever a literatura sobre o assunto.CONTEÚDO: A literatura é farta em informações sobre perdas de implantes relacionadas à osteointegração, mas são raros os estudos sobre perdas relacionadas à lesão de nervo ou à dor neuropática. O risco para longevidade de implantes é multifatorial. Contribuem: saúde do paciente,técnica cirúrgica, região receptora e ativação funcional,entre outros fatores. Dor é complicação com significativas implicações clínicas, psicológicas, sociais e legais; exigindo atenção especial aos pacientes, muitas vezes prolongada ou permanente. Atualmente a literatura especializada já é volumosa sobre prevalência de anormalidades sensitivas e lesão de nervo após procedimentos odontológicos. Em conjunto, essas informações sugerem conduta que inclua exame minucioso, interconsultas e adoção de medidas preventivas, curativas ou paliativas para o tratamentoda dor. A remoção do implante depende dessa análise,portanto, nem sempre é uma decisão simples.CONCLUSÃO: Informações sobre remoção de implantes dentais devido à dor ou lesão de nervo são escassas nem sempre homogêneas, porém já alertam de que essa decisão nem sempre é simples. Ela depende da adoção de medidas diagnósticas, algumas especializadas, incluindoos exames de imagem. Diagnóstico e tratamento precoceda lesão de nervo e da dor neuropática são benéficos ao paciente e têm importantes implicações éticas e legais.

BACKGROUND AND OBJECTIVES: Trigeminal sensitivity changes may lead to neuropathic pain after surgical handling. These complaints generate questions.First: are they real? Because a causal relationship between implant and nerve is not always present. Second: shouldthe implant be removed? This study aimed at reviewing the literature on the subject.CONTENTS: The literature is prodigal on information about loss of implants related to osteointegration, butthere are few studies on losses related to nerve loss or to neuropathic pain. The risk for implants longevity is multifactorial.Contributors are: patients' health, surgical technique, receptor region and functional activation, amongo ther factors. Pain is a complication with significant clinical,psychological, social and legal implications, requiring special attention to patients, very often prolonged or permanent. Currently, specialized literature is already voluminous about the prevalence of sensory abnormalities and nervous injury after dental procedures. Together,these pieces of information suggest an approach including detailed exams, inter consultations and the adoption of preventive, curative or palliative measures to treat pain. Implant removal depends on this analysis and it is not always a simple decision. CONCLUSION: Information about dental implants removal due to pain or nervous injury is scarce and notalways homogeneous, however it already calls the attention to the fact that such decision is not always simple. It depends on the adoption of diagnostic measures, some of them specialized, including image exams. Early diagnosis and treatment of nervous injury and neuropathic pain are beneficial to patients and have major ethic and legal implications.