Sensorial differences according to sex and ages.

OBJECTIVE: To investigate age and sex differences in orofacial sensory detection. METHODS: One hundred and twenty-six (126) healthy subjects were divided into five groups according to their ages. They were assessed with a quantitative sensory testing protocol for gustative, olfactory, thermal (cold/warm), mechanical (tactile/vibration/electric), and pain (deep/superficial) detection thresholds. The corneal reflex was also evaluated. Data were analyzed with the one-way ANOVA, chi-squared, Fisher's exact, Mann-Whitney, and Kruskal-Wallis tests. RESULTS: The groups of subjects over 61 years old had higher olfactory (P < 0.001), gustative (sweet P = 0.004, salty P = 0.007, sour P = 0.006), thermal (warm P < 0.001, cold P < 0.001), and tactile (P < 0.001) detection thresholds than the others. The vibration detection threshold was high only for subjects over 75 years old (P < 0.001). The electric and deep pain detection thresholds were different for the 61-75 years old group (P ≤ 0.001). Women in all age groups had lower gustative (sweet P = 0.020, salty P = 0.002, sour P < 0.001, and bitter P = 0.002), olfactory (P = 0.010), warm (P < 0.001) and deep (P < 0.001), and superficial pain (P = 0.008) detection thresholds than men, and men from all age groups had lower vibratory detection thresholds (P = 0.006) than women. CONCLUSION: High sensory detection thresholds were observed in subjects over the 6th decade of life, and women had a more accurate sensory perception than men.

Polysomnographic study of the prevalence of sleep bruxism in a population sample.

The goal of the current study was to estimate the prevalence of sleep bruxism (SB) in the general population using a representative sample of 1,042 individuals who answered questionnaires and underwent polysomnography (PSG) examinations. After PSG, the individuals were classified into 3 groups: absence of SB, low-frequency SB, and high-frequency SB. The results indicated that the prevalence of SB, indicated by questionnaires and confirmed by PSG, was 5.5%. With PSG used exclusively as the criterion for diagnosis, the prevalence was 7.4% regardless of SB self-reported complaints. With questionnaires alone, the prevalence was 12.5%. Of the 5.5% (n = 56) with confirmed SB, 26 were classified as low-frequency SB, and 30 as high-frequency. The episodes of SB were more frequent in stage 2 sleep, and the phasic bruxism events were more frequent than tonic or mixed events in all sleep stages in individuals with SB. A positive association was observed between SB and insomnia, higher degree of schooling, and a normal/overweight body mass index (BMI). These findings demonstrate the prevalence of SB in a population sampled by PSG, the gold standard methodology in the investigation of sleep disorders, combined with validated questionnaires.

Sleep bruxism increases the risk for painful temporomandibular disorder, depression and non-specific physical symptoms.

To explore the relationship between sleep bruxism (SB), painful temporomandibular disorders (TMD) and psychologic status in a cross-sectional study. The sample consisted of 272 individuals. The Research Diagnostic Criteria for TMD (RDC/TMD) was used to diagnose TMD; SB was diagnosed by clinical criteria proposed by The American Academy of Sleep Medicine. The sample was divided into four groups: (1) patients without painful TMD and without SB, (2) patients without painful TMD and with SB, (3) patients with painful TMD and without SB and (4) patients with painful TMD and with SB. Data were analysed by Odds Ratio test with a 95% confidence interval. Patients with SB had an increased risk for the occurrence of myofascial pain (OR = 5·93, 95% CI: 3·19-11·02) and arthralgia (2·34, 1·58-3·46). Group 3 had an increased risk for moderate/severe depression and non-specific physical symptoms (10·1, 3·67-27·79; 14·7, 5·39-39·92, respectively), and this risk increased in the presence of SB (25·0, 9·65-64·77; 35·8, 13·94-91·90, respectively). SB seems to be a risk factor for painful TMD, and this in turn is a risk factor for the occurrence of higher depression and non-specific physical symptoms levels, but a cause-effect relationship could not be established.

Somesthetic, gustatory, olfactory function and salivary flow in patients with neuropathic trigeminal pain.

OBJECTIVES: To determine somesthetic, olfactory, gustative and salivary abnormalities in patients with burning mouth syndrome (BMS), idiopathic trigeminal neuralgia (ITN) and trigeminal postherpetic neuralgia (PHN). SUBJECTS AND METHODS: Twenty patients from each group (BMS, ITN, PHN) and 60 healthy controls were evaluated with a systematized quantitative approach of thermal (cold and warm), mechanical, pain, gustation, olfaction and salivary flow; data were analyzed with ANOVA, Tukey, Kruskal-Wallis and Dunn tests with a level of significance of 5%. RESULTS: There were no salivary differences among the groups with matched ages; the cold perception was abnormal only at the mandibular branch of PHN (P = 0.001) and warm was abnormal in all trigeminal branches of PHN and BMS; mechanical sensitivity was altered at the mandibular branch of PHN and in all trigeminal branches of BMS. The salty, sweet and olfactory thresholds were higher in all studied groups; the sour threshold was lower and there were no differences of bitter. CONCLUSION: All groups showed abnormal thresholds of gustation and olfaction; somesthetic findings were discrete in ITN and more common in PHN and BMS; central mechanisms of balance of sensorial inputs might be underlying these observations.

Post-craniotomy headache: a proposed revision of IHS diagnostic criteria.

Seventy-nine patients with intracranial aneurysms were evaluated in the presurgical period, and followed up to 6 months after surgery. We compare patients who fulfilled with those that did not post-craniotomy headache (PCH) diagnostic criteria, according to the International Classification of Headache Disorders. Semistructured interviews, headache diaries, Short Form-36 and McGill Pain Questionnaire were used. Seventy-two patients (91%) had headaches during the follow-up period. The incidence of PCH according to the International Headache Society diagnostic criteria was 40%. Age, sex, type of surgery, temporomandibular disorder, vasospasm, presence and type of previous headaches, and subarachnoid haemorrhage were not related to headache classification. There were no differences in the quality of life, headache frequency and characteristics or pain intensity between patients with headache that fulfilled or not PCH criteria. We proposed a revision of the diagnostic criteria for PCH, extending the headache outset after surgery from 7 to 30 days, and including the presence of headaches after surgery in patients with no past history of headaches, or an increase in headache frequency during the first 30 days of the postsurgical period followed by a decrease over time. Using these criteria we would classify 65% of our patients as having PCH.

Abnormal expression of voltage-gated sodium channels Nav1.7, Nav1.3 and Nav1.8 in trigeminal neuralgia.

Voltage-gated sodium channels have been implicated in acute and chronic neuropathic pain. Among subtypes, Nav1.7 single mutations can cause congenital indifference to pain or chronic neuropathic pain syndromes, including paroxysmal ones. This channel is co-expressed with Nav1.8, which sustains the initial action potential; Nav1.3 is an embrionary channel which is expressed in neurons after injury, as in neuropathic conditions. Few studies are focused on the expression of these molecules in human tissues having chronic pain. Trigeminal neuralgia (TN) is an idiopathic paroxysmal pain treated with sodium channel blockers. The aim of this study was to investigate the expression of Nav1.3, Nav1.7 and Nav1.8 by RT-PCR in patients with TN, compared to controls. The gingival tissue was removed from the correspondent trigeminal area affected. We found that Nav1.7 was downregulated in TN (P=0.017) and Nav1.3 was upregulated in these patients (P=0.043). We propose a physiopathological mechanism for these findings. Besides vascular compression of TN, this disease might be also a channelopathy.

Emotional aspects of chronic orofacial pain and surgical treatment.

OBJECTIVE: The aim of this pilot study was to investigate the psychological factors of chronic orofacial pain patients regarding hospitalization for surgical treatment. METHODS: We evaluated 30 patients (15 with temporomandibular disorder and 15 with trigeminal neuralgia) of three groups: 10 were hospitalized for surgery, 10 were newly diagnosed, and 10 had been clinically treated. Data were collected using a semi-structured interview and the Hospital Anxiety Depression Scale. RESULTS: Eighty percent reported lack of family support, 90% had important limitations in daily activities, and social aspects were the most affected (34%). Patients who were hospitalized for surgery had the highest degree of anxiety and expectation (90%; p<0.05). CONCLUSION: Surgery for chronic pain generates great expectations especially because it is considered a hope of cure. Clinically treated patients also might understand the factors associated to surgery choices and participate at the process of choosing. In general, chronic treatment for facial pain needs psychological support to cope with it.

Evaluation of pain before and after vaginal delivery.

PURPOSE: The objective of this pilot study was to determine pain characteristics of pregnant women immediately before and after childbirth by vaginal delivery and to compare them with the pain intensity reported by physicians. METHODS: We evaluated 20 Brazilian women between September and December 2007 with the WHOQOL-Bref instrument, VAS, McGill Pain Questionnaire, and Anxiety Adapted Scale. We interviewed the obstetrician with the VAS about the patient's pain. Data were analyzed with the chi-square test. RESULTS: Mean age was 22.35 years (SD = 6.24, range 15-39 years). It was necessary to use oxytocin in 15 (75%) patients, which had no correlation with anxiety degree. Higher intensity of pain (p < 0.05) and higher anxiety index (p < 0.05) were more common in women in the first pregnancy. CONCLUSIONS: Higher pain intensity was associated with higher anxiety levels (p < 0.05). Around half of the obstetricians' VAS scores were lower than the VAS scores of women, and probably pain at labor was underestimated and not controlled. Higher indices of anxiety and pain were associated, and were more frequent in women in the first pregnancy.

Post-craniotomy headache: characteristics, behaviour and effect on quality of life in patients operated for treatment of supratentorial intracranial aneurysms.

We prospectively studied headache characteristics during 6 months after craniotomy performed for treatment of cerebral aneurysms in 79 patients. Semistructured interviews, headache diaries, the Hospital Anxiety and Depression Scale and the Epworth Sleepiness Scales, the Short Form-36 Health Survey (SF-36) and McGill Pain Questionnaire were used. Seventy-two patients had headaches, half before the fifth day after surgery. Changes were observed in headache diagnosis, side and site in the postoperative period. Headache frequency increased immediately after surgery and then decreased over time. Headache frequency was associated with depressive and anxiety symptoms. Pain intensity was higher in women and in patients with more anxiety symptoms. An incidence of post-craniotomy headache of 40% was observed according to International Headache Society classification criteria, 10.7% of the acute and 29.3% of the chronic type. The bodily pain domain of the SF-36 was worse in patients with more anxiety symptoms. Greater frequencies of headache were associated with lower scores on bodily pain and social functioning.

Oral health and the masticatory system in juvenile systemic lupus erythematosus.

Our objectives were to evaluate the oral health and the masticatory system of 48 juvenile systemic lupus erythematosus (JSLE) patients and to compare them with 48 healthy children and adolescents. Demographic data, clinical manifestations and therapies of JSLE were reviewed. The DMFT index (DMFTI), the plaque (PI) and the gingival bleeding (GI) indices, dental relationship, facial profile, clinical dysfunction and mandibular mobility indices were evaluated. The two groups were homogeneous regarding age, gender, Brazilian social-economic class and dental decay index (P > 0.05). Of note, the medians of the PI and the GI were higher in JSLE patients than in controls (61.5 versus 38.10, P = 0.003 and 26.0 versus 15.95, P = 0.014; respectively). Likewise, a linear statistical correlation was evidenced between the JSLE duration and the GI (P = 0.017, r = 0.11), cumulative dose of prednisone and the PI (P = 0.01, r = 0.385) and cumulative dose of prednisone and the GI ( P = 0.001, r = 0.471). The clinical dysfunction and mandibular mobility indices were higher in JSLE patients versus controls (P = 0.002, P = 0.025). Moreover, the median of the mandibular mobility index was higher in JSLE patients who used at least one immunosuppressive than on those who did not use this medication (P = 0.0001). These results suggest that JSLE patients had an inadequate oral hygiene, higher incidence of gingivitis and temporomandibular joint dysfunction.

Masticatory problems after balloon compression for trigeminal neuralgia: a longitudinal study.

Idiopathic trigeminal neuralgia (ITN) is a chronic neuropathic pain that affects the masticatory system. The objective of this study was to identify orofacial pain and temporomandibular characteristics, including temporomandibular disorder (TMD), in a sample of 105 ITN patients treated with compression of the trigeminal ganglion. The evaluations occurred before, 7, 30 (1 month), 120 (3 months) and 210 days (7 months) after surgery. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), the Clinical Questionnaire (EDOF-HC) and Helkimo Indexes were used. Findings before neurosurgery were used as control for parameters. McNemar test and variance analysis for repetitive measurements were used for statistical analysis; 45.3% of the edentulous patients presented severe dental occlusion index; numbness was an important masticatory complaint in 42.6%; mastication became bilateral, but its discomfort continued during all period; headache and body pain reduced after surgery; TMD, present in 43.8% before surgery, increased but normalized after 7 months; jaw mobility compromise was still present, but daily activities improved after 7 months. We concluded that: (i) ITN relief reduced headache, body pain, depression and unspecific symptoms; and (ii) TMD before surgery and at 7 months suggests that this may be a contributory factor to patients' pain complaints.

Proposal for a standardized protocol for the systematic orofacial examination of patients with Hereditary Sensory Radicular Neuropathy.

AIM: To apply a standardized protocol for the orofacial evaluation of two adult siblings (one male and one female) with Hereditary Sensory Radicular Neuropathy (HSRN) that presented with dental problems. SUMMARY: The systematic evaluation consisted of (a) clinical questionnaire; (b) radiographs [orthopantomography and computarized tomography (CT)]; (c) orofacial psychophysical tests (pain, thermal, mechanical and electrical sensation); and (d) histology of gingiva and pulp (optical and transmission electronic microscopy). The female patient had complete insensitivity to orofacial pain and partial facial heat sensitivity, and received dental treatment without anaesthesia or pain. She had a severe and painless jaw infection due to pulp necrosis in tooth 37. The male patient had partial insensitivity to orofacial pain and required anaesthesia for dental treatment. Histological examination of gingivae and pulpal tissue revealed an altered proportion of unmyelinated and myelinated sensory nerve fibres. KEY LEARNING POINTS: * Patients with HSRN may present with significant, silent dental disease. * A standard protocol is helpful when evaluating such patients. * If the opportunity arises, evaluation of pulp tissue may reveal an altered proportion of myelinated and unmyelinated nerve fibres. This may avoid the more estabilished sural nerve biopsy.

Sleep bruxism: clinical aspects and characteristics in patients with and without chronic orofacial pain.

OBJECTIVE: Evaluation of long-standing sleep bruxism (SB) patients. STUDY DESIGN: Descriptive study. RESULTS: One hundred subjects with SB (80 women and 20 men, mean age: 36.1+/-11.3 years) were evaluated according to the RDC/TMD and a pain questionnaire (EDOF-HC). The patients were divided into 2 groups: Group A-without (30.0%) and Group B-with orofacial pain (70.0%). AM stiffness: 36.4% in Group A and 88.6% in Group B; mean pain duration: 6.92 years; mean intensity of pain: 4.33 (VAS); quality of pain: tightness/pressure (84.3%); 95.7% of Group B had myofascial pain. Depression and somatization levels were different between the groups (p = 0.001). Higher frequency of depression was found with body pain or presence of comorbidities. CONCLUSION: The data presented in this study showed statistical differences between long-standing bruxism without and with chronic facial pain; the two questionnaires allowed interaction between the chief complaint and the clinical findings; depression levels increased with pain in several regions of the body.

Olfactory threshold increase in trigeminal neuralgia after balloon compression.

Idiopathic trigeminal neuralgia (ITN) is a well-known disease often treated with neurosurgical procedures, which may produce sensorial abnormalities, such as numbness, dysesthesia and taste complaints. We studied 12 patients that underwent this technique, in order to verify pain, gustative and olfactory thresholds abnormalities, with a follow-up of 120 days. We compared the patients with a matched control group of 12 patients. Our results found a significant difference in the olfactory threshold at the immediate post-operative period (p=0.048). We concluded that injured trigeminal fibers are probably associated with the increase in the olfactory threshold after the surgery, supporting the sensorial interaction theory.

Clinical evaluation of tinnitus in patients with sleep bruxism: prevalence and characteristics.

Evaluation of the prevalence and characteristics of tinnitus in a Brazilian series of sleep bruxism patients. In this descriptive study, 100 patients (80 women and 20 men) were selected through the self-report of grinding teeth during sleep, confirmed by room mate or family member. They were evaluated according to a systematized approach: a questionnaire for orofacial pain and the Portuguese version of the Research Diagnostic Criteria for Temporomandibular Disorders. The patients were divided into two groups: group A, 54 patients with complaint of tinnitus and group B, 46 patients without tinnitus complaint. The mean age was 37.85 (13-66 years) and 34.02 years (20-59 years), respectively, for groups A and B (P = 0.1164). There was statistically significant difference between the two groups, with higher prevalence for the group A, in relation to: presence of chronic facial pain (P = 0.0007); number of areas painful to palpation in the masticatory and cervical muscles (P = 0.0032); myofascial pain in the masticatory muscles (P = 0.0003); absence of teeth without prosthetic replacement (P = 0.0145) and indices of depression (P = 0.0234). Structural alterations of the TMJ, like disc displacement and vertical dimension loss did not differ for the two groups. Tinnitus frequency was higher in patients with sleep bruxism and chronic facial pain. Myofascial pain, number of areas painful to palpation in the masticatory and cervical muscles, higher levels of depression and tooth absence without prosthetic replacement were more frequent in the group with tinnitus.