Orofacial pain and dysfunction in children with juvenile idiopathic arthritis: a case-control study.

OBJECTIVES: Juvenile idiopathic arthritis (JIA) frequently causes temporomandibular joint (TMJ) inflammation. The aim of this study was to evaluate the presence of orofacial pain and temporomandibular dysfunction in patients with JIA and controls. METHODS. Forty-one patients with JIA and 41 age- and sex-matched healthy controls participated. Subjects were asked about facial pain variables and their influence on daily life. A clinical examination was performed. Panoramic radiograph and medical data were extracted from the records. RESULTS: Thirty-three of the JIA patients reported TMJ or facial pain compared to four of the controls (p < 0.001). Nine of the JIA patients, compared to none of the controls, reported that their orofacial symptoms influenced daily life severely (p < 0.001). Clinical findings were more prevalent in JIA (p < 0.001). The assessments of disease activity correlated to palpation pain of jaw muscles (p < 0.001) whereas the presence of structural TMJ changes correlated to reduced jaw opening (p < 0.001). CONCLUSIONS: TMJ pain was prevalent in patients with JIA and influenced daily life severely for nearly a quarter of them. Collaboration between medical and dental care is therefore important.

Inhibition studies of alkaline phosphatase in hard tissue-forming cells.

The effects of the alkaline phosphatase inhibitors levamisole and R 8231 on p-nitro-phenylphosphatase, inorganic pyrophosphatase and adenosine triphosphatase (ATPase) activities in dentingenically active odontoblasts were studied. The p-nitrophenylphosphatase and inorganic pyrophosphatase activities were inhibited, while 40% of the ATP-splitting enzyme activity remained under the assay condition used. This finding, togeather with earlier studies, indicates that at least two different phosphatase are active at alkaline pH in hard tissue-forming cells; on nonspecific alkaline phosphatase and one specific ATPase. The ATPase activity is uninfluenced by ouabain and ruthenium red and is activated by Ca-2+ ions.

Short-term effect of glucocorticoid injection into the superficial masseter muscle of patients with chronic myalgia: a comparison between fibromyalgia and localized myalgia.

The aim of this study was to investigate whether the treatment effect of intramuscular glucocorticoid injection differs between patients with fibromyalgia and those with localized myalgia of the masseter muscle concerning pain, tenderness to digital palpation, pressure pain threshold, pressure pain tolerance level, maximum voluntary occlusal force, or intramuscular temperature. Twenty-five patients with fibromyalgia and 25 patients with localized myalgia of the masseter muscle were first asked to assess their pain on a visual analogue scale; afterward, a routine clinical examination, including tenderness to digital palpation, was performed. For each patient, the pressure pain threshold, pressure pain tolerance level, and maximum voluntary occlusal force, as well as the intramuscular temperature, were recorded. Finally each patient received an injection of glucocorticoid. The examination and glucocorticoid treatment were repeated after approximately 2 weeks, and a follow-up was performed after another 5 weeks. In the fibromyalgia group, there was a reduced tenderness to digital palpation in response to the treatment. The localized myalgia group responded with a general improvement of symptoms as well as a significant reduction of pain intensity and tenderness to digital palpation. The results of this study indicate that patients with fibromyalgia and localized myalgia in many respects show a similar response to local glucocorticoid treatment.

Chronic recurrent multifocal osteomyelitis involving both jaws: report of a case including magnetic resonance correlation.

A case of chronic recurrent multifocal osteomyelitis in a 14-year-old girl is presented. The disease had an initial aggressive osteolytic appearance involving both the maxilla and the mandible. Conservative treatment with minimal surgical intervention has been successful in this case during a 2-year follow-up period. The value of magnetic resonance imaging and bone scintigraphy in this case and the cause of chronic recurrent multifocal osteomyelitis is discussed.

The lateral periodontal cyst. A histopathological and radiographic study of 32 cases.

The lateral periodontal cyst is a developmental odontogenic cyst usually found in the premolar area of the lower jaw. The clinical, radiographic and histopathological features of 32 previously unreported lateral periodontal cysts were reviewed. In four cases the follow-up, which extended over several years, was also studied. Different theories of pathogenesis are discussed.

Metaplastic formation of bone and chondroid in flabby ridges.

The present study was undertaken to demonstrate certain histological characteristics of biopsies from flabby ridges. Our results show that metaplastic formation of bone and chondroid are found in specimens from patients where radiopaque structures were visible on radiographs outside the alveolar ridge. Another aim was to demonstrate the metabolic activity of these zones especially as formerly they were believed to be non-vital. The cells in the vicinity of the bone and cartilage showed a higher activity of all metabolic enzymes studied than did ordinary fibroblasts; also the osteocytes and chondrocytes showed positive reactions for several enzymes.

Odontogenic myxoma--a radiographic study of 21 tumours.

Radiological features of 21 odontogenic myxomas found in 14 women and 7 men were analysed. Ten of the tumors were unilocular and 11 were multilocular. Unilocular lesions were mostly located in the anterior and multilocular in the posterior areas of the jaws. Intralesional trabeculation was seen in all multilocular but only in 3 unilocular lesions. Because radiological appearance of myxoma may be essentially similar with many other lesions of the jaws careful radiological examination is mandatory for planning of proper treatment.

The paradental cyst a clinicopathologic study of 26 cases.

This retrospective study describes the clinical, radiographic and histological features of 26 paradental cysts. These cysts comprised 0.9% of the 2700 cases of jaw cysts diagnosed in 9 years. The true incidence is, however, probably greater since many cases are misdiagnosed. The cysts occurred in relation to partly or fully erupted teeth and were all located in the mandible. An equal sex distribution was found and clinical symptoms in the form of swelling was the main finding especially for the paradental cysts located in the first and second molar area. The radiographic characteristics of the paradental cysts were found to be rather variable. The borders of the cysts adjacent and distal to the third molars were more distinct than the borders of the cysts in the first and second molar area. Histologically, all the cysts were lined by a nonkeratinized stratified squamous epithelium with edema and migration of neutrophils through the epithelium. In most cases, the epithelium was markedly hyperplastic. The connective tissue wall was infiltrated by neutrophils, lymphocytes and plasma cells.

Structural alterations in the TMJ disk in patients surgically treated for internal derangements (ADD).

Twenty-eight patients with temporomandibular dysfunction problem have been subjected to diskectomy unilaterally. The diagnosis was in 23 patients ADD (anterior disk displacement) without reduction and in another five ADD with reduction. The disk was removed in total according to a routine procedure. Surgical observation of a firm connection between the inferior surface of the disk and the condylar head was noted in eighteen patients. The disk tissue was orientated on a cork sheet according to its position in the fossa and subjected to histological examination. Histopathological analysis showed that the posterior attachment was a considerable part of the specimen in 12 out of 28 disks. Splitting of the disk was confined to the inferior surface. Chondrocytes were found close to the inferior surface. Surface irregularities, tags, were noticed on the inferior surface in thirteen cases. However, cellular signs of inflammation were found in the retrodiskal tissue in eight cases.

Presence of orofacial pain and temporomandibular disorder in fibromyalgia. A study by questionnaire.

The objective of this study was to evaluate subjective symptoms from the temporomandibular system in patients with fibromyalgia. Two hundred and thirty-seven individuals with fibromyalgia affiliated to the Stockholm Rheumatologic Association were included in the study. A questionnaire about symptoms of temporomandibular disorders (TMD) was mailed and returned by 191 (81%). The participants reported frequent and severe symptoms of TMD, 94% reported local pain from the temporomandibular system with a mean duration of 12 years. The most frequent sites were the temple, temporomandibular joint and neck regions. General body pain had a significantly longer duration than TMD, which indicates that fibromyalgia starts in other parts of the body and later extends to the temporomandibular region. The severity of general pain scored significantly higher than local pain, but there was a significant positive correlation between the two conditions. High frequency, 73-78 %, of headache, facial pain and tiredness of the jaws was found and about fifty percent of the patients also complained about difficulties to open the mouth and to chew. Fibromyalgia is thus a probable cause of TMD. In conclusion this study shows that patients with fibromyalgia often suffer from symptoms of TMD, and that the intensity of the pain is correlated to general body pain. These findings indicate that fibromyalgia is one of the causes of TMD.

[Conservative treatment of deciduous teeth--a review]. / Konservierende Behandlung des Milchzahns--Eine Ubersicht

In all countries with a lack of manpower in dentistry, there is an unfortunate tendency to leave the primary teeth without proper conservative treatment. In addition to toothaches and poor esthetics, a neglected care of the primary dentition may result in several other untoward effects. Decayed deciduous teeth may cause such a discomfort during tooth-brushing that the child is prevented from learning good oral hygiene habits. With bad primary molars the child cannot chew properly, and may have to choose soft and often cariogenic food. When the permanent teeth erupt among the decayed deciduous teeth, there will be a greater chance for them to have carious attacks as well. Premature loss of primary molars may lead to malocclusion. It must also be kept in mind that the treatment of badly decayed teeth, including necessary extractions, may be difficult. This may cause fear of dental treatment. On the basis of current Swedish philosophies of treatment the author surveys various conservative procedures for deciduous teeth-amalgam therapy, stainless steel crowns, composites and disking.

Odontogenic keratocysts: a clinical and histological study with special reference to enzyme histochemistry.

Of a total of 1,420 odontogenic cysts, 52 (3.3%) were diagnosed as odontogenic keratocysts. Clinical and histological findings in these 52 cysts are reported. Frozen sections of 26 of the keratocysts were incubated to show the following enzyme activities: NADH2- and NADPH2-diaphorase, glucose-6-phosphate dehydrogenase, glutamate dehydrogenase, acid phosphatase, leucine aminopeptidase and ATPase. Furthermore, keratinization was studied with the rhodamine B method and lipids with the oil red O, the OTAN and the acid hematein methods. Sections from epidermis, oral mucosa, radicular cysts, residual cysts and follicular cysts served as reference material. The oxidative enzymes showed strong activity in the keratocyst epithelium which contrasted with weak activity in the reference cysts. Acid phosphatase activity was weak in all epithelia except that in keratocysts, which displayed a marked activity. In the fibrous capsule of the keratocyst a high activity of leucine aminopeptidase was recorded. This high activity contrasted with a weak activity in the reference material. The significance of the histochemical results in relation to the aggressive behavior of the keratocyst is discussed.

Therapeutic pulpotomies in primary molars with the formocresol technique. A clinical and histological follow-up.

The results of therapeutic pulpotomies in primary molars with formocresol technique were studied by systematic follow-up. Of 84 primary lower molars in the clinical study, 56 became available for histological examination. The radiographic follow-up revealed periradicular osteitis in 10 per cent of the teeth treated. Internal root resorption was seen in 37 per cent of the teeth, or one-fifth of the roots treated. The histological examination revealed a very capricious diffusion of the medicament throughout the pulp tissue. Vital pulp remnants in the apical part of the treated roots showed no signs of healing. All pulps presented a varying number of inflammatory cells in the border zone adjacent to the formocresol-fixed region. In 80 per cent of the roots the histological sections revealed signs signs of internal resorption with or without incomplete repair tissue formation.

Lactate dehydrogenase isoenzyme changes during facial development.

Lactate dehydrogenase activity (LDH) was demonstrated by a histochemical technique in free, dissected, facial processes of rats from the ninth embryonic day. Facial processes of embryonic rats aged 9-15 days were analysed by isoelectric focusing for their isoenzymic distribution of LDH. A dominance of LDH-5, LDH-4 and LDH-3 isoenzymes was observed. As a comparison, LDH isoenzymes from mandibular and maxillary processes of rat embryos aged 9-11 days revealed only LDH-5 and, to a smaller extent, LDH-4. These results constitute evidence for prominent anaerobic metabolism in these tissues during early facial development. Intense staining for LDH was seen in surface epithelium, respiratory epithelium and in myogenic and osteogenic areas.