Atypical odontalgia and trigeminal neuralgia: psychological, behavioral and psychopharmacological approach in a dental clinic - an overview of pathologies related to the challenging differential diagnosis in orofacial pain.

Orofacial pain represents a challenge for dentists, especially if with a non-odontogenic basis. Orofacial neuropathic pain is chronic, arduous to localize and develops without obvious pathology. Comorbid psychiatric disorders, such as anxiety and depression, coexist and negatively affect the condition. This article presents one case of atypical odontalgia and one of trigeminal neuralgia treated with psychological and psychopharmacologic tailored and adapted therapies, after conventional medications had failed.  In addition, an overview of the pathologies related to the challenging differential diagnosis in orofacial pain is given, since current data are insufficient.   A 68-year-old male complained of chronic throbbing, burning pain in a maxillary tooth, worsening upon digital pressure. Symptoms did not abate after conventional amitriptyline therapy; psychological intervention and antianxiety drug were supplemented and antidepressant agent dosage incremented; the patient revealed improvement and satisfaction with the multidisciplinary approach to his pathology. A 72-year-old male lamented chronic stabbing, intermittent, sharp, shooting and electric shock-like pain in an upper tooth, radiating and following the distribution of the trigeminal nerve. Pain did not recur after psychological intervention and a prescription of antidepressant and antianxiety agents, while conventional carbamazepine therapy had not been sufficient to control pain. Due to concern with comorbid psychiatric disorders, we adopted a patient-centered, tailored and balanced therapy, favourably changing the clinical outcome.  Comorbid psychiatric disorders have a negative impact on orofacial pain and dentists should consider adopting tailored therapies, such as psychological counselling and behavioural and psychopharmacologic strategies, besides conventional treatments. They also need to be familiar with the signs and symptoms of orofacial pain, recollecting a comprehensive view of the pathologies concerning the differential diagnosis. A prompt diagnosis prevents pain chronicity, avoiding an increase in complexity and a shift to orofacial neuropathic pain and legal claims.

How do GTR and GBR Differ? A Periodontitis Case Treated Using an Equine-derived, Enzyme-deantigenic, Collagenpreserving Bone Graft, and Collagen Membranes.

AIM: The present case illustrates how a tooth, which had a highly questionable prognosis, was preserved by carrying out a periodontal regeneration surgery. BACKGROUND: Treatment of periodontitis involves a careful consideration of all the factors that may allow the achievement of a favorable outcome; among those, the skillful use of guided tissue regeneration (GTR) membranes is of paramount importance. CASE DESCRIPTION: A 39-year-old patient presented with a mobile central upper incisor due to severe periodontitis and was treated according to GTR principles using a collagen membrane. A collagen-preserving bone graft was also used, as a scaffold for clot formation and cellular infiltration, which was covered with a second collagen membrane. The patient was contacted for follow-up assessment at 3, 6, 12, and 18 months after surgery. Follow-up radiographs showed that bone regeneration occurred around the involved tooth and very little tooth mobility was observed. The patient's masticatory function, appearance, and comfort were favorable. CONCLUSION: The use of two equine collagen membranes with the purpose of creating the best conditions to carry out periodontal regeneration according to GTR principles, in association with an equine, collagen-preserving, enzyme-deantigenic bone graft, allowed sufficient bone regeneration to salvage a tooth that was deemed otherwise lost because of periodontitis. CLINICAL SIGNIFICANCE: In cases of teeth that are severely compromised by periodontitis, the use of collagen membranes according to GTR principles can allow the regeneration of the periodontal tissues; the association with a bone substitute having well-known performance rates, covered with a collagen membrane (guided bone regeneration, GBR) can, in some cases, improve bone regeneration at the defect site.

A case series analysing patients with dental anxiety: a patient-centered model based on psychological profiling.

Anxiety and distress can jeopardize dental care experience of patients and may affect the clinical result. Although a wide range of sedation and analgesia techniques are currently available to relieve distress and pain during dental procedures, operative models to choose the most effective sedation-analgesic strategies are lacking. This case series proposes a patient-centred model to optimize patients' cooperation during dental care delivery. We describe how to achieve correct anaesthesia by using the least sedative procedure, accounting for the dental procedure needed and patient's psychological profile. Five patients were considered as paradigmatic to show the balance between patients' subjective experiences and the clinical procedures: a patient with low stress, good compliance (case 1); moderate stress and reduction in compliance (case 2); anxious patient (case 3); patient with acute anxiety and emotional distress (case 4); anguished patient (case 5). A multimodal treatment of emotional and behavioural condition and a patient-centred model approach contributed to achieve the best patient satisfaction in the five cases detailed here.