OROFACIAL PAIN - DIAGNOSTIC AND THERAPEUTIC CHALLENGES.

The concept of diagnostics and therapy of musculoskeletal and neuropathic diseases of the stomatognathic system, which are the subject of this paper, has been developing for decades. It can be said that in order to avoid misunderstanding, the orofacial pain as a clinical problem, in the narrower sense, involves non-odontogenic and non-malignant causes of orofacial region. In this study, the results of clinical diagnosis of the population of 557 consecutive patients with orofacial pain based on multidisciplinary diagnostics were evaluated. 15.6% of patients have given up on the participation in the study. It has been shown that the patients who dropped out of the study were significantly older (p=0.0411) than those who agreed to participate, but there was no difference in gender ratio (p=0.185) since the proportion of female patients prevailed. In an analysis of 84.4% of patients participating in the study, the elevated anxiety values were established (mean value on STAI 1 was 39.2 and STAI 2 was 41.1) and statistical significance was found in correlation between elevated anxiety and intensity of pain as shown on visual analogue scale on open mouth (p<0.0001). Compared to the age, the statistical significance was for STAI 1 (p=0.0097) but not for STAI 2 (p=0.5599). The most common form of therapy is Michigan stabilization splint: for disc displacement of temporomandibular joint (TMJ) in 38.9% of patients and in combination with physiotherapy in 18.7% of patients; for osteoarthritis of TMJ in 28.4% and in combination with physiotherapy in 26.4% of patients. The treatment with anticonvulsant drugs for trigeminal neuralgia predominates in 54.3% of patients, which is combined with acupuncture in 25.7% of patients and only acupuncture in 17.1% of patients. In this study, a multidisciplinary co-operation in initial diagnostics and differential was designed to develop subspecialist knowledge on orofacial pain.

Psoriatic arthritis and temporomandibular joint involvement - literature review with a reported case.

In addition to psoriasis, between 5% and 24% of patients will develop psoriatic arthritis simultaneously after or even prior to skin manifestations. Psoriatic arthritis belongs to the group of seronegative spondyloarthritis. Collaboration between a dermatologist and a rheumatologist plays a more important role in cases where there is a complete absence of clinical signs of psoriasis. Since rheumatic diseases may also involve the temporomandibular joints (TMJ), psoriatic arthritis can cause problems that are an aspect of systemic disease. In general, the clinical and radiological description of a population of patients suffering from psoriasis and/or psoriatic arthritis does not mention TMJ involvement. However, as is the case with intraoral psoriasis, psoriatic changes to the TMJ also show characteristic signs of erosion, deplaned condyles, and articular effusion. Magnetic resonance imaging has shown itself to be the gold standard in the diagnostics of joints afflicted by psoriatic arthritis and TMJ disorders, regardless of the existence of a systemic disease. This paper aims to present a review of the relevant literature describing different epidemiological, clinical, and radiological characteristics of psoriasis and psoriatic arthritis, with emphasis on the involvement of TMJs in the general manifestation of the disease, illustrated by a description of the clinical case of a 77-year-old female patient.

Osteoarthritic temporomandibular joint changes confirmed by magnetic resonance imaging.

Clinical and radiological findings were compared between the patients with osteoarthritis (OA) of temporomandibularjoint (TMJ) with or without disc displacement (DD), and asymptomatic volunteers. This study included 30 patients with OA of TMJs (mean age 52.6). All the patients were examined clinically by manual functional analysis and using magnetic resonance imaging. The inclusion criteria for patients comprised: pain referred to the TMJ and/or crepitation in the TMJ. A second group consisted of 20 asymptomatic dental school students (mean age 23.5). There is a statistically significant difference between degenerative changes of the condyle of TMJs with and without clinical signs of OA of patients (p=0.009). In 28% of osteoarthritic joints, flattening of condylar joint surfaces was observed and 17.4% of the joints were without clinical signs of OA. Osteophyte formations were found in 8% of asymptomatic and 25.7% of osteoarthritic patients' joints. There is a statistically significant difference between patients' TMJs with and without OA (p=0.0003): pronounced shape loss and severe sclerosation of the articular eminence were found in 12% of the joints without OA, and 42.9% of joints with OA. There is no difference between students' joints and patients' TMJs without OA (p=0.804). The most common imaging findings of osteoarthritic TMJs were sclerosis of the condyle and osteophyte formation.

Muscle strength and bone density in patients with different rheumatic conditions: cross-sectional study.

AIM: To explore the relationship between muscle strength and bone density in patients with different rheumatic diseases and to examine whether inflammatory arthritis was more harmful for muscle strength and bone loss than degenerative joint diseases. METHODS: The study included 361 men and women with a mean±standard deviation age of 60.5±11.4 years and different rheumatic conditions: regional syndromes, osteoarthritis of the hands, shoulders, knees, and hips, and inflammatory arthritis. Maximum voluntary back strength was measured by isometric dynamometry. Bone mineral density (BMD; g/cm2) of the lumbar spine, femoral neck, and distal radius was measured by dual-energy x-ray absorptiometry. Anthropometry and lifestyle characteristics were also assessed. RESULTS: Back strength was lowest in patients with hand and shoulder osteoarthritis (20.0±17.9 kg), followed by patients with inflammatory arthritis (24.8±19.2 kg). Patients with inflammatory arthritis had the lowest BMD at the mid-radius (0.650±0.115 g/cm2) and femoral neck (0.873±0.137 g/cm2), while patients with hand and shoulder osteoarthritis had the lowest BMD at the mid-radius (0.660±0.101). In both sexes, muscle strength was significantly lower in patients who had lower BMD (T score<-1.0). Multiple regression analysis identified significant predictors of back strength to be spine BMD (P=0.024) and body mass index (P=0.004) in men and femoral neck BMD in women (P=0.004). CONCLUSION: Muscle strength decline may be connected to bone loss in patients with rheumatic conditions, especially those with inflammatory joint diseases.

[Relationship between osteonecrosis of the jaw and bisphosphonate treatment]. / Povezanost osteonekroze celjusti i terapije bisfosfonatima.

Bisphosphonate treatment and its aetiopathogenic association with aseptic osteonecrosis of the jaw is one of the more prominent public health issues today. The aim of this review is to see into the mechanisms of bisphosphonate effects on bones described in literature (anti-osteoclastic activity, cytotoxicity, antiangiogenesis, genetic factors, and imbalance between osteoclasts and osteoblasts). Bisphosphonate treatment is the dominant cause of jaw necrosis. Epidemiological data show an exclusive incidence of osteonecrosis of the jaw in patients who took one or a combination of nitrogen-containing bisphosphonates. Risk factors vary by the bisphosphonate potency (particularly risky are the highly potent pamidronate and zoledronate, which are given intravenously), dosage, duration of treatment, and the illness. Jaw necrosis is most common in oncology patients, and only 5 % in patients with osteoporosis. From a dental-medical point of view, a good oral health is important because osteonecrosis often appears after a periodontal or oral surgical procedure.

[Cycling in Zagreb]. / Biciklizam u Zagrebu.

Cycling in Zagreb, as means of urban transport inside and outside the city, has a bright past, hazy presence but a promising future. Every day, aggressive citizens who lack urban traffic culture mistreat many cyclists but also many pedestrians. Sedentary way of living, unhealthy eating habits and inadequate recreation would surely be reduced if Zagreb had a network of cycling tracks (190 cm) or lanes (80 cm). Main city roads were constructed at the beginning of the 20th century. Today, the lack of cycling tracks is particularly evident in terms of missing connections between northern and southern parts of the city. Transportation of bikes in public vehicles, parking of bikes as well as cycling along the foot of the mountains Medvednica and Zumberacko gorje is not adequately organized. Better organization is necessary not only because of the present young generation but also because of the young who will shortly become citizens of the EU, where cycling is enormously popular. Cycling tourism is not known in Zagreb, partly due to inadequate roads. The surroundings of Zagreb are more suitable for cycling tourism and attractive brochures and tourist guides offer information to tourists on bikes. Professional, acrobatic and sports cycling do not have a tradition in Zagreb and in Croatia. The same holds true for recreational cycling and indoor exercise cycling. The authors discuss the impact of popularization of cycling using print and electronic media. The role of district and local self-government in the construction and improvement of traffic roads in Zagreb is very important. It is also significant for the implementation of legal regulations that must be obeyed by all traffic participants in order to protect cyclists, the most vulnerable group of traffic participants besides passengers. Multidisciplinary action of all benevolent experts would surely increase safety and pleasure of cycling in the city and its surroundings. This would also help reduce daily stress and improve the quality of living in the capital of Croatia.

[Role of district and local self-government in disability prevention]. / Uloga mjesne i lokalne samouprave u prevenciji invalidnosti.

Prevention of common chronic diseases in the development of temporary and/or permanent working disability is not only a significant public health problem but also a serious economic and social issue. The epidemic of traffic-related injuries, work-related injuries and, unfortunately, injuries sustained during sports and recreational activities is pretty disturbing. Article 69 of the Croatian Constitution states that all residents of Croatia have a right to healthy life. The State provides special care for disabled persons and promotes their inclusion into the society (Article 57), and each Croatian citizen is entitled to health care and protection (Article 58). In addition to the issue of disabled workers in the Zagreb area, there is an ever-growing problem of disabled veterans and persons with congenital physical and/or psychological disorders. Article 2, item 2 of the Health Care Act states that "citizens should participate in all health prevention activities introduced at their place of residence and work for the purpose of improvement and protection of their health as well as prevention of diseases". Item 5 relates to the treatment and rehabilitation of diseased, physically and mentally handicapped and injured persons, and item 6 quotes measures of special health surveillance in the victims of war and in the population over 60 years of age. Primary prevention measures are as follows: (1) Identification, recording, follow-up, analysis, reporting and assessment of health needs and functional abilities of the elderly. (2) Prophylactic individual counseling of healthy and ill health care users, (3) Stimulation of self-responsibility for own health. (4) Coordination of services engaged in health protection of the elderly and continuous education of workers and volunteers engaged in health protection. (5) Social, psychological and even legal counseling of health care users and their family members. (6) Identification of environmental conditions in which elderly persons live (ergonomics of their environment) in order to estimate the needs for home treatment, care, rehabilitation and physical and spiritual recreation. The author discusses the need for closer cooperation between gerontology centers and non-government professional organizations, voluntary associations of citizens and corporations for the purpose of promoting common interests (ecological, economic, humanitarian, cultural, sports, health, scientific, informative and other). In addition to positive laws of the Republic of Croatia, the Act on Legal Position of Religious Communities allows comprehensive charitable activities. Accordingly, sports and recreation must be incorporated into projects of collaboration aimed at prevention and/or solution of health issues of disabled persons. Past experience and the possibility of joining European and international processes of integration are also discussed.