Chronic migraine headache and multiple dental pathologies causing cranial pain for 35 years: the neurodental nexus.

We report a case that illustrates how chronic migraine headaches and multiple dental pathologies caused severe and long-standing cranial pain that affected the quality of life of a man for more than 35 years. His case was investigated at several settings including the neurology outpatient clinic of the hospital without a definitive diagnosis or resolution. After investigations, multiple oral pathologies including two occult dental abscesses were diagnosed. Once both affected teeth and associated abscesses were surgically removed, with subsequent antibiotic therapy the headaches resolved.

Screening preschool children with toothache: validation of the Brazilian version of the Dental Discomfort Questionnaire.

BACKGROUND: The Dental Discomfort Questionnaire (DDQ) is an observational instrument intended to measure dental discomfort and/or pain in children under 5 years of age. This study aimed to validate a previously cross-culturally adapted version of DDQ in a Brazilian children sample. METHODS: Participants included 263 children (58.6% boys, mean age 43.5 months) that underwent a dental examination to assess dental caries, and their parent that filled out the cross-culturally adapted DDQ on their behalf. Exploratory factor analysis (principal component analysis form) and psychometric tests were done to assess instrument's dimensionality and reliability. RESULTS: Exploratory factor analysis revealed a multidimensional instrument with 3 domains: 'eating and sleeping problems' (Cronbach's alpha 0.81), 'earache problems' (alpha 0.75), and 'problems with brushing teeth' (alpha 0.78). The assessment had excellent stability (weighted-kappa varying from 0.68 to 0.97). Based on the factor analysis, the model with all 7 items included only in the first domain (named DDQ-B) was further explored. The items and total median score of the DDQ-B were related to parent-reported toothache and the number of decayed teeth, demonstrating good construct and discriminant validities. CONCLUSIONS: DDQ-B was proven a reliable pain assessment tool to screen this group of Brazilian children for caries-related toothache, with good psychometric properties.

Degree of dental anxiety in children with and without toothache: prospective assessment.

BACKGROUND: Few prospective studies on the anxiety of children in the dental office have been published. AIMS: To monitor dental anxiety levels in children with and without previous experience with toothache over a period of six consecutive visits. DESIGN: A longitudinal study was carried out involving 167 children treated at a public dental service. Levels of anxiety in the dental setting were assessed in children without toothache (G1) and those with toothache (G2) using the modified Venham picture test (VPT). Data acquisition was carried out over a 6-week period, with each child treated in the dental office once a week. Six assessments of anxiety were performed in the waiting room prior to dental treatment. RESULTS: A significant reduction in anxiety scores occurred between appointments in both groups. In the inter-group comparison, G2 had significantly higher anxiety scores than G1. Although statistically significant reductions in anxiety scores occurred through to the fifth appointment, a tendency toward stagnation in anxiety scores was observed beginning with the fourth appointment. CONCLUSIONS: Dental anxiety scores were reduced over the course of six appointments. Children with toothache had higher levels of dental anxiety than those that had never experienced toothache.

Toothache referred from auriculotemporal neuralgia: case report.

AIM: To present a 52-year-old male patient who complained of intense pain of short duration in the region of the left external ear and in the ipsilateral maxillary second molar that was relieved by blockade of the auriculotemporal nerve in the infratemporal fossa. SUMMARY: Extra- and intraoral physical examination revealed a trigger point that reproduced the symptoms upon finger pressure in the ipsilateral auriculotemporal nerve and in the outer auricular pavilion. The patient's medical history was unremarkable. The maxillary left second molar tooth was not responsive to pulp sensitivity testing and there was no pain upon percussion or palpation of the buccal sulcus. Periapical radiographs revealed a satisfactory root filling in the maxillary left second molar. On the basis of the clinical signs and symptoms, the auriculotemporal was blocked with 0.5 mL 2% lidocaine and 0.5 mL of a suspension containing dexamethasone acetate (8 mg mL(-1)) and dexamethasone disodium sulfate (2 mg mL(-1)), with full remission of pain 6 months later. The diagnosis was auriculotemporal neuralgia. KEY LEARNING POINT: Auriculotemporal neuralgia should be considered as a possible cause of nonodontogenic toothache and thus included in the differential diagnoses. The blockade of the auriculotemporal nerve in the infratemporal fossa is diagnostic and therapeutic. It can be achieved with a solution of lidocaine and dexamethasone.

Puerto Rican athletes with special health care needs: an evaluation of oral health status.

PURPOSE: Limited data are available regarding the oral health of individuals with disabilities who reside in Puerto Rico. The Special Olympics Special Smiles oral health screening, education, and referral program provides an opportunity to explore the dental status and needs of Special Olympics athletes with intellectual and developmental disabilities. The purpose of this paper was to evaluate the oral health status of Special Olympics athletes participating in an event in Villalba, Puerto Rico in 2004. METHODS: A total of 161 self-selected athletes with intellectual disabilities were screened by 4 trained and calibrated dentists utilizing the criteria standards of the National Institute of Dental and Craniofacial Research, Special Olympics Special Smiles, and the Centers for Disease Control and Prevention developed for decayed, filled, and missing teeth. Oral hygiene, reports of oral pain, and sociodemographic information were recorded. The statistical test used was the chi-square test to establish associations and logistic regressions. Data were analyzed using EPI-INFO and SPSS programs. RESULTS: Almost 45% of examined athletes (mean age=19 years) had untreated dental decay; 33% had missing teeth, 60% had gingival signs of periodontal disease, and 16% reported dental pain. CONCLUSION: Results of clinical examinations indicate a population with intellectual disabilities that is in significant need of preventive and restorative oral health needs.

A produção das perdas dentárias: narrativas de usuários do SUS / The production of tooth loss: narratives users of the SUS

A compreensão ampliada dos efeitos da perda dentária exige escuta dos sujeitos que a experimenta. Este estudo, de abordagem qualitativa, investigou, na história odontológica de usuários do SUS, a partir do relato de suas experiências com os serviços de saúde bucal, os motivos que os levaram à perda dentária e as repercussões desta em suas vidas. A coleta de dados foi realizada por meio da técnica de entrevista narrativa, adaptada, utilizando-se roteiro semi-estruturado. Os sujeitos entrevistados, num total de seis (três da zona urbana e três da zona rural), foram usuários de Unidades de Saúde da Família. Consideraram-se os seguintes critérios de inclusão: presença de desdentamento (perda total em ambas as arcadas, ou em uma delas, ou perda parcial a partir de seis elementos em uma das arcadas); idade ente 25 e 59 anos; qualquer gênero; ser morador dos municípios de São Tomé/RN e Natal/RN. A partir do conteúdo das entrevistas foi elaborada a história odontológica de cada entrevistado. Tais narrativas, sistematizadas em histórias odontológicas, foram analisadas com base em estudo de Souza e na proposta de Schütze, sugerida por Jovchelovitch, Bauer. Os resultados indicaram que a experiência de dor foi o principal motivo pela procura por assistência odontológica. As formas de enfrentamento da dor deram-se pelo uso de medicações caseiras e alopáticas e pela busca do serviço de saúde. A procura pela exodontia foi favorecida pela dificuldade de acesso geográfico ou pela grande demanda reprimida, o que produziu agravamento das lesões e descrédito na eficácia do tratamento restaurador. A prática do auto cuidado através da escovação com juá ou creme dental e o controle do consumo de açúcar não foram suficientes para evitar a perda dentária. Foram identificados sentimentos de culpa relacionados à falta de cuidado. A aceitação da perda dentária como natural teve forte relação com a garantia de ausência de dor e a crença de fazer parte do processo de envelhecimento

A convivência das pessoas com a prótese dentária mostrou a diferença entre o que era natural e o que era artificial e, a partir daí, foram aparecendo situações de estranhamento com a prótese. A limitação da prótese quanto ao aspecto funcional pode ser compensada pela restituição da estética, ao possibilitar a expressão do sorriso. A partir deste estudo e considerando o elevado número de perdas dentárias, especialmente em populações de menor poder aquisitivo, que convivem com limitações próprias da condição de desdentado e ou com próteses de má qualidade que não reabilitam, adequadamente, sugere-se a realização de pesquisas de abordagem qualitativa que inclua, também, outros atores implicados na produção de cuidados e serviços de saúde - profissionais e gestores

Automedicaçäo em odontologia / Self-medication in dentistry

A utilizaçäo de medicamentos sem a orientaçäo profissional adequada é perigosa, e näo respeita as diferenças individuais de cada paciente. Através de 141 questionários aplicados juntamente com a anamneses, foi estudada a incidência de automedicaçäo em pacientes com odontalgia que procuraram os serviços de pronto atendimento odontológico em Curitiba. As drogas e práticas mais comuns para o alívio da dor foram identificadas, a indicaçäo e a posologia desses produtos avaliadas, bem como a ocorrência de associaçäo de medicamentos. A automedicaçäo é muito frequente na Odontologia, assim como na Medicina. Em nosso estudo o índice encontrado foi de 78 por cento, sendo que as mulheres se medicaram mais que os homens. Os medicamentos mais utilizados foram os analgésicos, com destaque para a dipirona, já em desuso em outros países. Observamos que 1/4 dos pacientes usaram produtos tópicos, sendo alguns de aplicaçäo duvidosa e sem comprovaçäo científica

Dental pain and sleep. Experimental study on guinea pigs (Cavia porcellus).

The relationship between pain and sleep was studied by using electrocorticograms (ECoG) taken from guinea pigs submitted to noxious stimulation (NS) of the dental pulp of the upper incisors, after local application of serotonin (5-HT) to the obex (a brain region inductive to sleep). The results showed that the dental electrical stimulation of the sleepy animal was capable of keeping this animal in a state of vigilance and excitation, suggesting that the trigeminal system probably acts on the sleep regulating centers.