Pain-pressure threshold in painful jaw muscles following trigger point injection.

Pain and tenderness at trigger points and referral sites may be modified in subjects with myofascial pain in the head and neck region by injecting local anesthetic into active trigger points, but the effect of injection on jaw muscle pain-pressure thresholds has not been measured. The mechanism by which trigger-point injection affects muscle tenderness is also unclear and may be related to the "hyper-stimulation analgesia" induced by stimulation of an acupuncture point. A pressure algometer was used before and after an active trigger point injection in the masseter to measure the pain-pressure threshold in the masseter and temporal muscles of 10 subjects with jaw muscle pain of myogenous origin. The pain-pressure threshold in the masseter and temporal muscles was also measured in a matched control group before and after an acupuncture-point injection in the masseter. The pain-pressure threshold was significantly lower in myofascial pain subjects than in control subjects at all recording sites. Pain-pressure thresholds increased minimally in the masseter after trigger-point injection, whereas the temporal region was relatively unaffected. In the control group, the pain-pressure threshold increased significantly at all recording sites in the masseter after acupuncture-point injection. Although local anesthetic injection acts peripherally at the painful site and centrally where pain is sustained, pain-pressure thresholds were not dramatically increased in myofascial pain subjects, in contrast to controls. This suggests that in subjects with myofascial pain, there was continued excitability in peripheral tissues and/or central neural areas which may have contributed to the persistence of jaw muscle tenderness.

A prospective survey of hospital ambulatory dental emergencies. Part 2: Follow-up to emergency treatment.

Two hundred and fifty-three patients treated for dental emergencies at the University Hospital dental clinic over a three-month period were surveyed by telephone 24 to 48 hours and one year after treatment. The purpose was to investigate the success of treatment in resolving the chief complaint of pain and to determine the compliance with further dental care for the original dental problem. The results of the telephone survey showed that: patients available for questioning totaled 49.1% at 24 to 48 hours and 28.9% at one year; an 80.7% success rate was recorded in resolving pain within 24 to 48 hours; and the original emergency problem did not motivate a large number of these patients to seek further dental care.

A prospective survey of hospital ambulatory dental emergencies. Part 1: Patient and emergency characteristics.

Part 1 of this study describes the dental disorders and patient characteristics of 253 patients who presented as dental emergencies to the University Hospital dental clinic, Vancouver, BC, during a three-month period. Most patients had a true perception of what constitutes a dental emergency. Dental pain was the predominant reason for seeking help, and the pain existed for more than seven days prior to contact in more than 50% of patients. Patients were not always able to identify the number and location of painful teeth, and a perceived low cost for treatment was a major reason for contacting the hospital. Reliability of emergency patients in keeping scheduled appointments was very high. Almost 69% of patients did not see a dentist regularly. Referrals to the hospital dental service were most numerous in the summer months. Diagnosis of the complaints revealed infection to be the cause of pain in 76.7% of patients.

Temporomandibular pain and dysfunction syndrome associated with generalized musculoskeletal pain: a retrospective study.

Sequential patients seen in a Temporomandibular Joint Clinic were reviewed for evidence of generalized musculoskeletal pain. A greater proportion of patients with myofascial pain dysfunction syndrome than those with other causes of temporomandibular joint pain and complaints of pain outside the jaw in the head and neck region, pain on neck muscle palpation and bilateral symptoms. Demographic and other abnormalities in these patients suggest similarities to fibromyalgia syndrome.

Oral lichen planus.

Oral lichen planus is a common multifactorial disease. This article is not a complete review of the disease, but instead a discussion of selected aspects such as clinical features, possible vascular influences, and the relation of stress and drugs and metals to the disease. Immunologic theories and cancerous potentials are discussed critically. Finally, a detailed treatment plan of the inflammatory disease is presented, including avoidance of stimulating factors and the use of corticosteroids and retinoids.

A comparison of treatment modes in the management of myofascial pain dysfunction syndrome.

This research compares different treatment regimes for the management of chronic facial pain associated with the masticatory musculature. Twenty-one females meeting specific criteria were randomly assigned to one of three treatment conditions: a dental splint and physiotherapy program; a relaxation program utilizing progressive muscle relaxation, biofeedback, and stress management techniques; or a minimal treatment program involving transcutaneous electrical nerve stimulation. Improvement was assessed through a dental examination, self-monitoring of pain, and an assessment of EMG activity during resting and task conditions. Significant changes were obtained in response to all treatment programs. The treatment programs differed only in the relative pattern of treatment effects obtained from the self-report monitoring of pain. The data are consistent with the concept of MPD as a psychological response to stress which maintains chronic pain through increased muscle tension in the jaw.

Tardive dyskinesia: an unrecognized cause of orofacial pain.

Tardive dyskinesia has not previously been discussed in the dental literature. It is a drug-induced movement disorder commonly involving the perioral and masticatory muscles. It can sometimes be a cause of orofacial pain. Two brief cases reports are provided as examples. Clinical features of tardive dyskinesia are presented to assist the dental practitioner in recognizing the syndrome. Suggestions for management are included.

Oral mucosal disorders in denture wearers.

Patients who wear dentures present with a variety of symptoms and abnormal intraoral findings. The advanced age of the average denture wearer and the nature of the denture-bearing mucosa appear to influence the nature of the problems. Superimposed infection with candidal organisms and traumatic lesions are the most commonly encountered abnormalities. Patients with symptoms but no intraoral changes frequently had a psychologic component to their complaint and did not improve after alteration of their dentures.

Lichenoid lesions of the oral mucosa in rheumatoid arthritis patients treated with penicillamine.

Seven of 56 consecutive patients taking penicillamine for rheumatoid arthritis developed oral lesions that clinically and histologically resembled lichen planus. All 7 patients had rashes with prior gold therapy and 4 had rashes with penicillamine therapy. Lesions appeared between 3 and 12 months of therapy at an average dose of 400 mg/day and disappeared within 3 months of stopping the medication. Discontinuation of the drug for oral lichenoid lesions is not necessary. Topical steroids can be used for symptomatic relief.

The psychiatric referral in dentistry: indications and mechanics.

Psychiatric consultation is sometimes a part of the diagnostic evaluation of facial pain. The indications for referral arise out of the history. Several brief questions may indicate whether or not a psychiatric illness is present. Patients may hold beliefs or attitudes about their illness or about psychiatric treatment that make referral difficult. Successful referral depends on the relationship that the dentist establishes with the patient. Recommendations to facilitate the referral are presented.

Ineffective dental and surgical treatment associated with atypical facial pain.

Patients with atypical facial pain (AFP) are subject to ineffective dental and surgical procedures for their pain complaints. Twenty-one of fifty-eight patients (36.2 percent) with AFP had sixty-five dental and surgical treatments, with only one patient showing less pain as a result of the treatment. While the majority of patients (69 percent) with AFP suffered from a psychiatric illness, fourteen (24 percent) of the patients referred for AFP had a specific medical or dental disorder that was causal in their pain complaints. There is a trend for the AFP patient with a psychiatric diagnosis to receive more ineffective treatments than those AFP patients for whom a specific medical or dental diagnosis was made. Patients with AFP should receive conservative dental and medical treatment and a psychiatric assessment before dental and surgical procedures are contemplated.

Psychiatric disorders associated with atypical facial pain.

Atypical facial pain (AFP) patients classically present with a chronic discomfort that is neither anatomic nor dermatomal in distribution. Neuropsychiatric assessment of 68 patients with AFP indicated that 46 (68%) had a specific psychiatric disorder by DSM-III criteria. A wide spectrum of psychiatric disorders was present. The authors emphasize that psychiatric assessment of patients with AFP should be an integral part in early assessments of this disorder, rather than relying on psychiatric opinions after extensive dental and other invasive procedures have been tried in vain and often to the detriment of the patient. Comments on the excellent prognosis in treating the psychiatric syndromes associated with AFP are made.

Clinical aspects of xerostomia.

The physiology of saliva flow and hyposalivation is discussed. Drug-induced hyposalivation results in a higher incidence of dental caries, causes discomfort for denture wearers, and increases the risk of oral infections. Guidelines for preventing and treating drug-induced xerostomia are offered.