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.

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.

Oral infections, comorbidities and sensory evidences in elderly: Cross-sectional study.

BACKGROUND: Oral infections affect the general health and overlap with chronic diseases due to infectious-immune mechanisms. On the other side, sensory abnormalities may be symptoms of this association. OBJECTIVE: To evaluate the prevalence of oral infections, comorbidities, health parameters and sensory abnormalities in elderly patients. METHODS: Thirty (30) elderly with mean age 70.4 yo, distributed according to ages were evaluated with a protocol that included demographics, comorbidities, medications, laboratory tests, blood pressure, heart rate, mini-mental state examination, clinical oral evaluation and systematized sensory testing (gustative, olfactory, thermal, mechanical and pain thresholds). Data were tabled and statistically analyzed. RESULTS: Twenty-three (76.6%) subjects had chronic diseases that increased according to the age. Seventeen (56.7%) elderly were having medication. Mean probing pocket depth was 1.90mm±0.39mm, mean clinical attachment level was 0.76mm±0.54mm and mean gingival bleeding index was 29.10%±29.05%. All periodontal indexes increased with age (p <0.05) and were associated with comorbidities and use of medication. Patients with chronic diseases had more numbness and pricking sensations (p=0.031; p=0.000). Main sensory findings were: abnormal gustative and vibratory thresholds, which were associated with hematological parameters (blood count, cholesterol levels and glycaemia). Periodontal parameters were associated with facial cold threshold (p=0.000). CONCLUSION: This study showed an association between systemic diseases, periodontal indexes and sensory thresholds. Sensory findings were associated with blood parameters and are potential tools for periodical health evaluation. Inflammatory or neural mechanisms need further investigation.

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.

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.

Evaluation of patients with Alzheimer's disease before and after dental treatment.

Oral infections may play a role in Alzheimer's disease (AD). Objective To describe the orofacial pain, dental characteristics and associated factors in patients with Alzheimer's Disease that underwent dental treatment. Method 29 patients with mild AD diagnosed by a neurologist were included. They fulfilled the Mini Mental State Exam and Pfeffer's questionnaire. A dentist performed a complete evaluation: clinical questionnaire; research diagnostic criteria for temporomandibular disorders; McGill pain questionnaire; oral health impact profile; decayed, missing and filled teeth index; and complete periodontal investigation. The protocol was applied before and after the dental treatment. Periodontal treatments (scaling), extractions and topic nystatin were the most frequent. Results There was a reduction in pain frequency (p=0.014), mandibular functional limitations (p=0.011) and periodontal indexes (p<0.05), and an improvement in quality of life (p=0.009) and functional impairment due to cognitive compromise (p<0.001) after the dental treatment. Orofacial complaints and intensity of pain also diminished. Conclusion The dental treatment contributed to reduce co-morbidities associated with AD and should be routinely included in the assessment of these patients.

Orofacial neuropathic pain / Algias neuropáticas orofaciais

ABSTRACT BACKGROUND AND OBJECTIVES: To carry out a literature review on major orofacial neuropathic pains, their differential diagnosis and therapies. CONTENTS: Neuropathic pains may be classified as episodic or continuous. They may be unilateral and more infrequently bilateral. They may last for seconds, hours or days and may present as electrical shock or burning pain, favorably responding to pharmacological treatment. There are situations in which the first therapeutic choice is dental surgery and/or neurosurgery, especially in cases of malignancies. Without accurate diagnosis there is major possibility of poor results. Diagnosis is based on clinical history associated to pain quality, duration and clinical, surgical or combined therapeutic response. Additional exams may be needed in some cases, such as standard periapical radiography of the area to be investigated, panoramic X-rays, computerized tomography and magnetic resonance of the skull base for possible diagnostic confirmation. Treatment may be conservative using anticonvulsants associated or not to antidepressants, local anesthetic infiltration with or without steroid, and orofacial and neurosurgical procedures. CONCLUSION: Health professionals acting in the area of orofacial pain have to be able to establish the differential diagnosis of different neuropathic orofacial pains, since they may have similar clinical presentations involving a same facial territory in a same temporal space, responding differently to the same therapies. Understanding all of this makes available basically two favorable outcomes: improved quality of life or cure of existing neuropathic pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: Realizar uma revisão da literatura sobre as principais dores orofaciais neuropáticas seu diagnóstico diferencial e as suas terapias. CONTEÚDO: As dores neuropáticas podem ser classificadas em episódicas ou continuas. Pode ter caráter unilateral e, mais raramente, de forma bilateral. Podem durar segundos, ou horas a dias. Ter uma natureza em choque elétrico, ou em queimação. Respondem, favoravelmente, ao emprego farmacológico. Há situações em que a primeira escolha terapêutica é a cirúrgica odontológica, e/ou neurocirúrgica principalmente nos casos de neoplasias. Sem o correto diagnóstico há grande possibilidade de um fraco resultado. Esse se baseia na história clínica associada à qualidade da dor, duração e a resposta terapêutica clínica, cirúrgica ou combinada. Pode ser necessário, em alguns casos, solicitar-se exames complementares, como radiografia periapical padrão da área a ser investigada, radiografia panorâmica, tomografia computadorizada e exame de ressonância nuclear magnética nuclear da base do crânio no intuito de uma possível confirmação diagnóstica. O tratamento pode ser clínico conservador utilizando anticonvulsivantes associados ou não a antidepressivos, infiltração anestésica local, com ou sem corticosteroide e procedimentos orofaciais e neurocirúrgicos. CONCLUSÃO: Os profissionais da área da saúde, que medeiam na área da dor orofacial, têm de serem capazes de estabelecer o diagnóstico diferencial das diferentes algias orofaciais neuropáticas, uma vez que podem apresentar quadros clínicos similares envolvendo um mesmo território facial em um mesmo espaço temporal, respondendo diferentemente as mesmas terapêuticas. A compreensão de tudo isso, disponibiliza basicamente dois desfechos favoráveis: a melhora da qualidade de vida do paciente ou a cura da dor neuropática presente.

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.

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. .

Evaluation of patients with Alzheimer's disease before and after dental treatment / Avaliação de pacientes com doença de Alzheimer antes e depois do tratamento dentário

Oral infections may play a role in Alzheimer's disease (AD). Objective To describe the orofacial pain, dental characteristics and associated factors in patients with Alzheimer's Disease that underwent dental treatment. Method 29 patients with mild AD diagnosed by a neurologist were included. They fulfilled the Mini Mental State Exam and Pfeffer's questionnaire. A dentist performed a complete evaluation: clinical questionnaire; research diagnostic criteria for temporomandibular disorders; McGill pain questionnaire; oral health impact profile; decayed, missing and filled teeth index; and complete periodontal investigation. The protocol was applied before and after the dental treatment. Periodontal treatments (scaling), extractions and topic nystatin were the most frequent. Results There was a reduction in pain frequency (p=0.014), mandibular functional limitations (p=0.011) and periodontal indexes (p<0.05), and an improvement in quality of life (p=0.009) and functional impairment due to cognitive compromise (p<0.001) after the dental treatment. Orofacial complaints and intensity of pain also diminished. Conclusion The dental treatment contributed to reduce co-morbidities associated with AD and should be routinely included in the assessment of these patients. .

Infecções orais podem ter um papel na doença de Alzheimer (DA). Objetivo Descrever as características orofaciais, dor, odontológicas e fatores associados em doentes com DA submetidos a tratamento dentário. Método 29 doentes diagnosticados com DA por neurologista foram avaliados através do Mini Exame do Estado Mental e questionário Pfeffer. O exame odontológico foi realizado antes e depois do tratamento dentário e incluiu: questionário clínico; critérios diagnósticos de pesquisa para disfunção temporomandibular; questionário de dor McGill; protocolo de impacto de saúde oral; dentes cariados, perdidos e obturados; e avaliação periodontal. Os procedimentos mais frequentes foram raspagem periodontal, exodontias e prescrição de nistatina tópica. Resultados Houve uma redução na frequência de dor (p=0,014), limitações mandibulares (p=0,011), índices periodontais (p<0.05), e melhora na qualidade de vida (p=0,009) e no comprometimento funcional e cognitivo (p<0,001) após o tratamento dentário. Queixas orofaciais e intensidade de dor também diminuíram. Conclusão O tratamento dentário contribuiu para reduzir comorbidades associadas à DA e deveria ser incluído na rotina de avaliação desses pacientes. .

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.

Dor orofacial pós-operatória persistente: o risco de iatrogenia: relato de caso / Persistent postoperative orofacial pain: the risk of iatrogenesis: case report

JUSTIFICATIVA E OBJETIVOS: A dor persistente pós-operatória é considerada um importante problema, por diferir da dor pós-operatória clássica, após cirurgias orais, e por ser difícil ao cirurgião e ao paciente entender porque uma pequena intervenção possa causar tanta dor e sofrimento. O objetivo deste estudo foi apresentar um caso de paciente que apresentou dor gengival intensa refratária ao tratamento habitual, que surgiu após cirurgia odontológica.RELATO DO CASO: Paciente do sexo masculino, 80 anos, com antecedentes de várias cirurgias na cavidade oral, sem quaisquer complicações, que ao receber mais um implante dentário, passou a ter dor intensa diária em crises que dificultavam o sono, a mastigação e a rotina.CONCLUSÃO: Este relato mostrou a importância de considerar a individualidade da dor e a compreensão do sofrimento e angústia do paciente, mesmo quando ele se submete a cirurgias consideradas de pequeno porte, como as odontológicas, pois a dor e o sofrimento, não são obrigatoriamente decorrentes de grandes lesões ou de doenças graves.

BACKGROUND AND OBJECTIVES: Persistent postoperative pain is a major problem because it differs from classic postoperative pain after oral surgeries and because it is difficult for the surgeon and the patient to understand why a minor intervention may cause such pain and distress. This study aimed at presenting the case of a patient with severe gingival pain refractory to normal treatment, which started after dental surgery.CASE REPORT: Male patient, 80 years old, with several previous oral cavity surgeries, without any complication, which after receiving another dental implant developed severe daily pain in crises impairing sleep, chewing and daily routine.CONCLUSION: This report shows the importance of taking into consideration pain individuality and the understanding of patients? suffering and distress even when they are submitted to so-called minor surgeries, such as dental surgeries, because pain and distress are not compulsorily caused by major injuries or severe diseases.

Persistent atypical odontalgia treated with transcranial magnetic stimulation: case report / Odontalgia atípica persistente tratada com estimulação magnética transcraniana: relato de caso

BACKGROUND AND OBJECTIVES: Atypical odontalgia (AO) is a complex orofacial pain syndrome with difficult treatment. Transcranial magnetic stimulation (TMS) has shown good results for chronic pain patients. The objective of this study is to present a case of a patient with AO treated with TMS.CASE REPORT: Female patient, 39 year-old patient, with a five year history of clinically refractory dental pain (#46) (VAS = 8). During that time, she had received dental and medical treatment without any improvement of her pain complaint. According the International Classification of Headache Disorders criteria she received the diagnosis of AO and was treated with several medications, with no improvement after six months; thus, she was referred to transcranial magnetic stimulation of the motor cortex. After TMS, she had complete improvement of pain which lasted two months; after that, the pain restarted with low intensity (VAS = 3); complete follow-up was of 1 year.CONCLUSION: Transcranial magnetic stimulation is new possibility for refractory cases of chronic facial pain.

JUSTIFICATIVA E OBJETIVOS: Odontalgia atípica (OA) é uma síndrome dolorosa orofacial de difícil tratamento. A estimulação magnética transcraniana (EMT) tem dado bons resultados em pacientes com dor crônica. O objetivo deste estudo foi apresentar um caso de paciente com OA tratada com EMT.RELATO DO CASO: Paciente do sexo feminino, 39 anos com histórico de cinco anos de odontalgia clinicamente refratária (#46) (EAV = 8). Durante esse tempo ela recebeu tratamento dentário e médico sem nenhuma melhora de sua dor. De acordo com os critérios da Classificação Internacional de Distúrbios da Cefaleia, ela foi diagnosticada como sofrendo de OA e foi tratada com vários medicamentos, sem nenhuma melhora após seis meses; então, foi enviada para estimulação magnética transcraniana do córtex motor. Após a EMT ela apresentou melhora completa da dor que durou dois meses; após esse tempo a dor recomeçou, porém com baixa intensidade (EAV = 3); o acompanhamento completo foi de um ano.CONCLUSÃO: A estimulação magnética transcraniana é uma nova possibilidade para casos refratários de dor crônica.

Diferential diagnosis in atypical facial pain: a clinical study

OBJETIVE: 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 percent) were considered AFP and 20 (48.8 percent) (SFP) received the following diagnosis: 8 (40.0 percent) had temporomandibular disorders (TMD); 3 (15.0 percent) had TMD associated to systemic disease (fibromyalgia, systemic erythematosus lupus); 4 (20.0 percent) had neuropathy after ear, nose and throat (ENT) surgery for petroclival tumor; 2 (10.0 percent) had Wallenberg syndrome; 1 (5.0 percent) had intracranial tumor; 1 (5.0 percent) had oral cancer (epidermoid carcinoma), and 1 (5.0 percent) 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.

OBJETIVO: Avaliar uma amostra de pacientes com dor facial atípica (DFA) e compará-la a outra com dor facial sintomática (DFS). MÉTODO: 41 pacientes com diagnóstico prévio de DFA foram submetidos a um protocolo padronizado de avaliação aplicado por uma equipe multidisciplinar. RESULTADOS: 21 (51,2 por cento) foram mantidos com o diagnóstico de DFA e 20 (48,8 por cento) (DFS) receberam os seguintes diagnósticos: 8 (40.0 por cento) tinham disfunções temporomandibulares (DTM); 3 (15,0 por cento) tinham DTM associada a doença sistêmica (fibromialgia, lupus eritematoso sistêmico); 4 (20,0 por cento) tinham neuropatia após cirurgia otorrinolaringológica (ORL) para tumor petroclival; 2 (10,0 por cento) tinham síndrome de Wallenberg; 1 (5,0 por cento) tinha um tumor intracraniano; 1 (5,0 por cento) tinha câncer oral (carcinoma epidermóide), e 1 (5,0 por cento) tinha síndrome da ardência bucal (SAB) associada à fibromialgia. Expressões espontâneas utilizadas para a dor não diferiram entre os 2 grupos (p=0,82). Alodínia foi freqüente nos doentes com DFS (p=0,05) e emoções foi o fator desencadeante mais comum no grupo com DFA (p=0,06). Doentes com DFA apresentaram mais eventos traumáticos anteriores ao início da dor (p=0,001). CONCLUSÃO: Pacientes com DFA apresentaram mais: a) eventos traumáticos anteriores à cirurgia e b) emoções como fator desencadeante de dor. Estes dados realçam a necessidade de profissionais treinados em dor nas equipes multidisciplinares para o diagnóstico preciso e tratamento adequado desses doentes.

Clinical study of patients with persistent orofacial pain

OBJETIVO: Avaliar uma amostra de doentes com dor facial persistente. MÉTODO: Foram revisados 26 prontuários de doentes com dor facial persistente (20 mulheres e 6 homens). RESULTADOS: Classificação dos doentes, após o diagnóstico: a)Grupo I, oito pacientes (30,7%) com dor facial difusa de fortíssima intensidade; b)Grupo II, oito pacientes (30,7%) com dor crônica de natureza não-miofascial e; c)Grupo III, dez pacientes com dor crônica miofascial (38,4%). Foram encontrados 11 diagnósticos diferentes entre os 26 pacientes: pulpites(7), leucemia(1), tumor de orofaringe(1), odontalgia atípica(1), síndrome de Eagle(1), neuralgia idiopática do trigêmeo(4), neuralgia atípica(1), disordens temporomandibular (9), fibromialgia(2) cefaléia tipo-tensão(1), histeria de conversão(2). O acompanhamento dos doentes, após receberem a respectiva terapia, foi de seis meses, com alívio da dor, exceto para o doente com tumor de orofaringe. CONCLUSAO: A variabilidade das fontes da dor facial inclui doenças benignas e doenças graves, sendo indispensável a reavaliaçâo de doentes que não respondem aos tratamentos convencionais para a dor.

Avaliação funcional mandibular e sensitiva orofacial de doentes com neuralgia trigeminal tratados com compressão do gânglio trigeminal com balão / Sensitive and functional evaluation of the orofacial region of patients with trigeminal neuralgia treated with balloon compression

Esse trabalho teve como objetivos avaliar as características odontológicas, verificar a ocorrência de complicações sensitivas orofaciais e determinar os aspectos funcionais mandibulares de 105 doentes com neuralgia idiopática do trigêmeo (NIT) submetidos 'a compressão radiculo-ganglionar com balão inflável. Foram realizadas 5 avaliações para cada doente: uma pré-cirúrgica e 4 pós-cirúrgicas (7, 30, 120 e 210 dias). Ocorreu comprometimento sensitivo mais intenso no território dos ramos maxilar e mandibular do nervo trigêmeo (p < 0,001) e poucas anormalidades no território do ramo oftálmico (p = 0,1815). As qualidades sensitivas calor, frio, tato, e dor foram afetadas. As queixas subjetivas de dormência foram mais frequentes do que as objetivadas durante o exame de sensibilidade facial (p < 0,001). foi elevada a ocorrência de disfunção oclusal (62,9%); 42,6% dos doentes apresentaram queixas espontâneas relacionadas à mastigação; houve intensificação da dor miofascial na musculatura mastigatória após a cirurgia (p < 0,001), que retornou aos valores iniciais após os 210 dias; a mobilidade mandibular também agravou-se (p < 0,001). Os autores concluiram que o procedimento é eficaz e seguro quando aplicado em doentes com NIT envolvendo o ramo oftálmico. Entretanto, recidiva é frequente e as complicações sensitivas e ou motoras orofaciais poderiam comprometer a qualidade de vida e dificultar a reabilitação funcional dos doentes.

The aim of this study was to determine dental characteristics, abnormalities in masticatory function and ocurrence of orofacial sensorial complications in 105 patients with trigeminal neuralgia treated with radiculo-ganglionar compression of the trigeminal ganglion with balloon. The patients were evaluated in the pre-operative period and in 4 post-operative evaluations (7, 30, 120 and 210 days). Sensory deficits were more severe in the area innervated by the maxillary and the mandibular trigeminal branches (p < 0.001); the ophthalmic branch presented abnormalities in few cases. The sensory qualities heat, cold, tactile and pain were affected. Subjective numbness was more frequent than sensory abnormalities findings at the post-operative sensitive evaluation (p < 0.001). Dental occlusion abnormalities were observed in 62.9% of the patients and 42.6% of patients' complaints were spontaneous masticatory difficulties. During the post-operative period, myofascial pain of the masticatory muscles was statistically significant (p < 0.001), but normalized after 210 days in average. It also compromised the jaw mobility (p < 0.001). It was concluded that this procedure is safe for patients with idiopathic trigeminal neuralgia involving the ophthalmic branch; however, sensory and motor complications of the method can affect the quality of life and rehabilitation of the patient.