Evaluación económica de las alternativas terapéuticas en pacientes con hiperestesia dentinaria / Economic evaluation of the therapeutic alternatives in patients with dentin hyperesthesia

Introducción: La hiperestesia dentinaria es una sensación dolorosa de intensidad variable, que va de leve a moderada y, al encontrarse la dentina expuesta, puede convertirse en una molestia constante. Objetivo: Determinar la alternativa menos costosa en el tratamiento de pacientes con hiperestesia dentinaria. Método: Se realizó una evaluación económica completa del tipo minimización de costo, en la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, desde enero hasta mayo de 2019. Se revisaron 40 historias clínicas, escogidas a conveniencia, ya que contaban con los datos necesarios para la investigación. Se crearon 2 grupos de estudios, cuyos integrantes fueron tratados con laca flúor y láser, respectivamente. Se analizaron las variables de edad, sexo, efectividad de los tratamientos, costo directo e indirecto y costo unitario. Resultados: En la serie predominaron el grupo etario de 15-24 años (30,0 %), seguido por el de 25- 34 (25,0 %), así como el sexo femenino (70,0 %). El costo unitario del tratamiento con laca flúor fue de $7,77 y con láser de $5,74, para una diferencia de $2,03. Conclusión: La alternativa menos costosa en el tratamiento de pacientes con hiperestesia dentinaria resultó ser la aplicación de láser; mientras que la evaluación económica realizada demostró ser apropiada en materia de eficiencia económica.

Introduction: Dentin hyperesthesia is a painful sensation of variable intensity that goes from light to moderate and, as dentin is exposed, it can become a constant discomfort. Objective: To determine the less expensive alternative in the treatment of patients with dentin hyperesthesia. Method: A complete economic evaluation of the cost minimization type was carried out in Martires del Moncada Teaching Provincial Stomatological Clinic in Santiago de Cuba, from January to May, 2019. Forty medical records were reviewed, chosen of convenience, since they had the necessary data for the investigation. Two groups of studies were created whose members were treated with lacquer fluorine and laser, respectively. The age, sex, effectiveness of the treatments, direct and indirect cost and unitary cost variables were analyzed. Results: In the series there was a prevalence of the 15-24 age group (30.0 %), followed by that of 25-34 (25.0 %), as well as the female sex (70.0 %). The unitary cost of the treatment with lacquer fluorine was of $7.77 and with laser of $5.74, for a difference of $2.03. Conclusion: The less expensive alternative in the treatment of patients with dentin hyperesthesia was the laser application; while the economic evaluation carried out demonstrated to be appropriate as regards economic efficiency.

Sensitive Skin Syndrome: An Update.

Sensitive skin syndrome is a widely reported complaint but a diagnostic challenge because of its subjective symptoms and lack of clearly visible manifestations. Epidemiological studies have shown the prevalence of sensitive skin to be as high as 60-70% among women and 50-60% among men. Patients with this syndrome usually have unpleasant sensations when exposed to physical, thermal, or chemical stimuli that normally cause no provocation on healthy skin. Recent studies and newly accepted position papers have provided a more in-depth understanding and consensus of its underlying pathophysiology, associations, diagnosis, and treatment. Since no clinical studies have been conducted about specific treatment protocols, patients with this condition should be provided with personalized skin management. Given this updated knowledge, our review offers an approach to sensitive skin syndrome, with differential diagnoses, and interventions targeting its pathophysiology.

Diagnosis and Treatment of Sensitive Skin Syndrome: An Algorithm for Clinical Practice. / Diagnóstico y tratamiento del síndrome de piel sensible: un algoritmo para la práctica clínica habitual.

Sensitive skin has traditionally been viewed as a cosmetic problem or as a purely psychosomatic alteration with a major subjective component. Different studies of its pathophysiologic etiology, however, have shown it to be a complex entity that several authors now consider to be a neurodermatological syndrome. Because of this complexity, skin sensitivity can be difficult to diagnose and treat, particularly considering that it may present with another disease. Simple tools applicable to clinical practice are thus necessary to identify and manage this disease as an independent entity. In this study, we perform a practical review of the most recent scientific advances in the area of sensitive skin that justify it being considered an individual entity, and provide tools for its identification and treatment. We propose diagnostic and treatment algorithms based on evidence from the literature and our experience and expertise.

Feline hyperaesthesia syndrome with self-trauma to the tail: retrospective study of seven cases and proposal for an integrated multidisciplinary diagnostic approach.

CASE SERIES SUMMARY: This was a retrospective study on the clinical features and response to treatment in seven cats with feline hyperaesthesia syndrome (FHS) and tail mutilation. FHS is a poorly understood disorder characterised by skin rippling over the dorsal lumbar area, episodes of jumping and running, excessive vocalisation, and tail chasing and self-trauma. The majority of the cats were young, with a median age of 1 year at the onset of clinical signs, male (n = 6) and with access to the outdoors (n = 5). Multiple daily episodes of tail chasing and self-trauma were reported in five cats, with tail mutilation in four cats. Vocalisation during the episodes (n = 5) and rippling of lumbar skin (n = 5) were also reported. Haematology, serum biochemistry, Toxoplasma gondii and feline immunodeficiency virus/feline leukaemia virus serology, MRI scans of brain, spinal cord and cauda equina, cerebrospinal fluid analysis and electrodiagnostic tests did not reveal any clinically significant abnormalities. A definitive final diagnosis was not reached in any of the cats, but hypersensitivity dermatitis was suspected in two cases. A variety of medications was used alone or in combination, including gabapentin (n = 6), meloxicam (n = 4), antibiotics (n = 4), phenobarbital (n = 2), prednisolone (n = 2) and topiramate (n = 2); ciclosporin, clomipramine, fluoxetine, amitriptyline and tramadol were used in one cat each. Clinical improvement was achieved in six cases; in five cats complete remission of clinical signs was achieved with gabapentin alone (n = 2), a combination of gabapentin/ciclosporin/amitriptyline (n = 1), gabapentin/prednisolone/phenobarbital (n = 1) or gabapentin/topiramate/meloxicam (n = 1). RELEVANCE AND NOVEL INFORMATION: This is the first retrospective study on a series of cats with FHS. The diagnostic work-up did not reveal any significant abnormalities of the central or peripheral nervous system; dermatological and behavioural problems could not be ruled out. We propose an integrated multidisciplinary diagnostic pathway to be used for the management of clinical cases and for future prospective studies.

NOTALGIA PARESTHETICA.

- Notalgia paresthetica is a common, although under-recognized condition characterized by localized chronic pruritus in the upper back, most often affecting middle-aged women. Apart from pruritus, patients may present with a burning or cold sensation, tingling, surface numbness, tenderness and foreign body sensation. Additionally, patients often present with hyperpigmented skin at the site of symptoms. The etiology of this condition is still poorly understood, although a number of hypotheses have been described. It is widely accepted that notalgia paresthetica is a sensory neuropathy caused by alteration and damage to posterior rami of thoracic spinal nerves T2 through T6. To date, no well-defined treatment has been found, although many treatment modalities have been reported with varying success, usually providing only temporary relief.

Notalgia Paresthetica Relieved by Cervical Traction.

Notalgia paresthetica is a syndrome of unilateral, chronic pruritis that is associated with burning pain, paresthesia, numbness, and hyperesthesia localized to the medial and inferior scapula. The condition does not respond to anti-inflammatory drugs or traditional antipruritic agents and has variable responses to numerous other reported pharmacologic and nonpharmacologic therapies. Although the etiology is thought to be nerve impingement, neurologic and musculoskeletal causes are often not considered in the differential diagnosis. We present a report of a woman with a 2-year history of refractory notalgia paresthetica. Based on spinal imaging showing cervical neuroforaminal stenosis, the patient was prescribed a course of cervical traction. Her symptoms resolved and have not returned after 2 years of followup. We believe this is the first case report of successful treatment of notalgia paresthetica with cervical traction.

Recubrimiento radicular / Root Coverage

Introducción: existen varias alternativas de tratamiento para el recubrimiento radicular provocado por la recesión periodontal, la cual se caracteriza por el desplazamiento en sentido apical del margen gingival, con ello queda expuesta la raíz dental al medio bucal, lo que puede provocar sensibilidad dentinaria, caries dental y afectación de la estética. Objetivo: presentar un caso clínico donde se empleó una técnica quirúrgica para el recubrimiento radicular. Presentación del caso: paciente masculino de 32 años, acudió a la consulta por molestias a los cambios térmicos en el 23 y preocupado por su estética ya que presenta la raíz expuesta al medio bucal. Al examen físico se observó alteración de la morfología gingival caracterizado solamente por cambio de la posición gingival en sentido apical en el 23, que no alcanza a la línea mucogingival. Se decidió en el plan de tratamiento correctivo no quirúrgico, tratar la hiperestesia dentinaria aplicar el desensibilizante dentinario (laca fluorada: Profilac), y en el tratamiento correctivo quirúrgico realizar un colgajo deslizante lateral para cubrir la raíz expuesta y tratar la afectación estética. Conclusión: el procedimiento empleado tuvo los resultados previsibles y constituye una alternativa terapéutica cuando exista compromiso estético del paciente(AU)

Introduction: there are several treatment options for root coverage caused by periodontal recession, which is characterized by displacement toward apically gingival margin, thereby dental root is exposed to the oral environment, which may cause dentine sensitivity, dental cavities, and aesthetic affectation. Objective: present a clinical case where a surgical technique was used to root coverage. Case report: a 32 year-old male patient came to consultation due to nuisance to thermal changes in tooth 23 and he was concerned about aesthetics since he had his root exposed to the oral environment. On physical examination, altered gingival morphology was observed. It was characterized only by changing the apical gingival position in tooth 23, which does not reach the mucogingival line. It was decided a corrective plan of nonsurgical treatment, treating dentin hyperesthesia by applying dentin desensitizing (fluoridated lacquer: Profilac), and corrective surgical treatment to make a lateral sliding flap to cover the exposed root, and treating aesthetic condition. Conclusion: the used procedure had the expected results and it represents an alternative therapy when there is patient aesthetic compromise(AU)

Recubrimiento radicular / Root Coverage

INTRODUCCIÓN: existen varias alternativas de tratamiento para el recubrimiento radicular provocado por la recesión periodontal, la cual se caracteriza por el desplazamiento en sentido apical del margen gingival, con ello queda expuesta la raíz dental al medio bucal, lo que puede provocar sensibilidad dentinaria, caries dental y afectación de la estética. OBJETIVO: presentar un caso clínico donde se empleó una técnica quirúrgica para el recubrimiento radicular. PRESENTACIÓN DEL CASO: paciente masculino de 32 años, acudió a la consulta por molestias a los cambios térmicos en el 23 y preocupado por su estética ya que presenta la raíz expuesta al medio bucal. Al examen físico se observó alteración de la morfología gingival caracterizado solamente por cambio de la posición gingival en sentido apical en el 23, que no alcanza a la línea mucogingival. Se decidió en el plan de tratamiento correctivo no quirúrgico, tratar la hiperestesia dentinaria aplicar el desensibilizante dentinario (laca fluorada: Profilac), y en el tratamiento correctivo quirúrgico realizar un colgajo deslizante lateral para cubrir la raíz expuesta y tratar la afectación estética. CONCLUSIÓN: el procedimiento empleado tuvo los resultados previsibles y constituye una alternativa terapéutica cuando exista compromiso estético del paciente.

INTRODUCTION: there are several treatment options for root coverage caused by periodontal recession, which is characterized by displacement toward apically gingival margin, thereby dental root is exposed to the oral environment, which may cause dentine sensitivity, dental cavities, and aesthetic affectation. OBJECTIVE: present a clinical case where a surgical technique was used to root coverage. CASE REPORT: a 32 year-old male patient came to consultation due to nuisance to thermal changes in tooth 23 and he was concerned about aesthetics since he had his root exposed to the oral environment. On physical examination, altered gingival morphology was observed. It was characterized only by changing the apical gingival position in tooth 23, which does not reach the mucogingival line. It was decided a corrective plan of nonsurgical treatment, treating dentin hyperesthesia by applying dentin desensitizing (fluoridated lacquer: Profilac), and corrective surgical treatment to make a lateral sliding flap to cover the exposed root, and treating aesthetic condition. CONCLUSION: the used procedure had the expected results and it represents an alternative therapy when there is patient aesthetic compromise.

Self-management strategies used by patients who are hypersensitive to cold following a hand injury. A prospective study with two years follow-up.

STUDY DESIGN: Prospective cohort study. INTRODUCTION: Knowledge of the strategies used by patients with injuries of the hand to manage cold hypersensitivity should guide information given by health-care workers. PURPOSE: To explore the use of cold-associated self-management strategies in patients with severe hand injuries. METHODS: Seventy patients being cold hypersensitive following a hand injury, reported use of strategies to limit cold-induced symptoms in the injured hand(s) and the severity of cold-associated activity limitations one and two years after surgery. RESULTS: The patients used several strategies, including clothing (100%), use of own body (movement/use of muscles to produce heat or massage of the fingers) (94%), and heating aids (48%), but were still limited in valued cold-associated activities two years after surgery. The number of patients staying indoors, using heating aids and hand wear indoors and during summer-time increased with severity of cold hypersensitivity. Patients both implemented and discontinued different strategies after the first year, but for most strategies, the proportions of users were quite stable. CONCLUSION: The most common strategies used to limit cold-induced symptoms in the injured hand(s) were clothing and use of own body. Many patients also seemed to benefit from using heating aids. After one year, a number of patients still experimented in finding the best strategies and were still limited in valued cold-associated activities. LEVEL OF EVIDENCE: 2b.

[Optimization of treatment of wedge-shaped tooth defects with hyperesthesia].

Development of tooth wedge-shaped defect leads to a gradual loss of hard tissue and is characterized by pain. Most often patients complain of pain and aesthetic defect that adversely affects the emotional status and quality of life. Search for adequate means and methods of treatment providing increased resistance of dental hard tissues and reducing hyperesthesia is challenging for dentists. Wedge-shaped defect and hyperesthesia as concomitant symptom was found in the city of Ufa in the 5.65 and 63.0% of dental patients, respectively. Analysis of the questionnaires revealed a relationship between the sociological parameters (gender, age, profession) and the patient's quality of life. Improvement of all clinical manifestations was observed in the result of complex treatment.

Stronger evidence for small fiber sensory neuropathy in restless genital syndrome: two case reports in males.

INTRODUCTION: Restless genital syndrome (ReGS) is characterized by unwanted, unpleasant genital sensations, restless legs, and/or overactive bladder, as well as neuropathy of the dorsal nerve of the clitoris. So far, ReGS has only been reported in females. AIM: To report the occurrence of ReGS in two males. METHODS: Two males with unwanted genital sensations presented in our clinic. In-depth interview, routine and hormonal investigations, electro-encephalography, magnetic resonance imaging of brain and pelvis, manual examination of the pubic bone, and sensory testing of genital dermatomes were performed. In both males, conventional transcutaneous electrical nerve stimulation was applied bilaterally at the pudendal dermatome. MAIN OUTCOME MEASURES: Oral report, questionnaire on frequency and intensity of restless genital feelings, restless legs, overactive bladder, and satisfaction with the transcutaneous electrical nerve stimulation (TENS) treatment. RESULTS: ReGS in a 74-year-old male manifested as unpleasant genital sensations of being on the edge of an orgasm with overactive bladder, in the absence of erection and ejaculation. Genital sensory testing elicited bilateral points of static mechanical hyperesthesia in the pudendal dermatome. Manual examination of the dorsal nerve of the penis (DNP) elicited the genital sensations. TENS application resulted in a 90% reduction of genital sensations and complaints of overactive bladder syndrome (OAB). ReGS in a 38-year-old male manifested as unwanted and unpleasant spontaneous ejaculations and complaints of OAB. Genital sensory testing elicited bilateral points of static mechanical hyperesthesia in the pudendal dermatome. Manual examination of the DNP elicited the genital sensations. TENS application had no effect on genital complaints and complaints of OAB. CONCLUSIONS: ReGS is not a typical female disorder as it also affects males. This notion and the finding of typical sensory abnormalities of the genital end branches of the pudendal nerve in males and females--as previously reported--provides strong evidence for Small Fiber Sensory Neuropathy as a common cause of ReGS.

Láser combinado con laca flúor en el tratamiento de hiperestesia dentinaria / Laser combined with fluoride varnish in the treatment of dentin hyperesthesia

Se realiza un estudio experimental en 113 pacientes con diagnóstico de hiperestesia dentinaria, en la Clínica Estomatológica Julio Antonio Mella de Guantánamo, en el período febrero julio de 2010, para analizar resultados de la aplicación de láser combinado con laca flúor. Los pacientes se seleccionan aleatoriamente y se dividen en dos grupos (control y experimental) aplicando al grupo experimental el tratamiento de láser de baja potencia con laca flúor (60 pacientes) y al otro grupo control (53 pacientes) solo se aplica laca flúor. Los resultados muestran ventajas de la radiación láser en el tratamiento de esta enfermedad cuando se combina con solución de laca flúor. Se obtiene una efectividad del 100 por ciento de los pacientes tratados, con la eliminación del dolor entre la segunda y tercera aplicación mientras que en el grupocontrol se logró entre las cinco y siete aplicaciones (AU)

Aplicación de Laserterapia en la hiperestesia dentinal / Application of laser therapy for the treatment of dentinal hyperesthesia

Se realizó un estudio experimental para evaluar la eficacia del láser de baja potencia combinada con barniz de flúor al 2 por ciento (Profilac) en el tratamiento de la Hiperestesia Dentinaria en pacientes atendidos en la Clínica Estomatológíca de Ciro Redondo en el periodo en el Octubre del 2007 a Enero del 2008. El universo de estudio estuvo constituido por 75 pacientes diagnosticados con hiperestesia dentinal en el periodo de tiempo antes mencionado, quedando conformada la muestra por aquellos 25 que cumplieron con los criterios preestablecidos para el estudio. Con la aplicación del láser combinado con Laca Flúor (Profilac), se observó una remisión del dolor que aumentó paulatinamente con las sesiones de tratamiento lográndose eliminar en casi la totalidad de los casos la sintomatología al finalizar el mismo, evaluándose el tratamiento de eficaz en el 100 por ciento de los casos. Solamente se encontró una recidiva al año de tratamiento.

An experimental study was carried out, to evaluate the effectiveness of the low - power laser combined with fluoride varnish to 2 percent Profilac in the treatment of the Dentinal Hyperesthesia in patients attended to in the Estomatology Clinic of Ciro Redondo in the period from October 2007 to January 2008. The universe of study was constituted by 75 patients diagnosed with dentinal hyperesthesia in the period of time indicated above, being conformed the sample by those 25 who fulfilled the pre-established criteria for the study. With the application of the laser combined with Lacquer Fluorine Profilac, a remission of the pain was observed that increased gradually with the treatment sessions, having been obtained to almost eliminate in the totality of the cases the group of symptoms when finalizing it, evaluating the treatment of effective in 100 percent of the cases. We only found a recidive after a year of treatment.

Aplicación de Laserterapia en la hiperestesia dentinal / Application of laser therapy for the treatment of dentinal hyperesthesia

Se realizó un estudio experimental para evaluar la eficacia del láser de baja potencia combinada con barniz de flúor al 2 por ciento (Profilac) en el tratamiento de la Hiperestesia Dentinaria en pacientes atendidos en la Clínica Estomatológíca de Ciro Redondo en el periodo en el Octubre del 2007 a Enero del 2008. El universo de estudio estuvo constituido por 75 pacientes diagnosticados con hiperestesia dentinal en el periodo de tiempo antes mencionado, quedando conformada la muestra por aquellos 25 que cumplieron con los criterios preestablecidos para el estudio. Con la aplicación del láser combinado con Laca Flúor (Profilac), se observó una remisión del dolor que aumentó paulatinamente con las sesiones de tratamiento lográndose eliminar en casi la totalidad de los casos la sintomatología al finalizar el mismo, evaluándose el tratamiento de eficaz en el 100 por ciento de los casos. Solamente se encontró una recidiva al año de tratamiento(au)

An experimental study was carried out, to evaluate the effectiveness of the low - power laser combined with fluoride varnish to 2 percent Profilac in the treatment of the Dentinal Hyperesthesia in patients attended to in the Estomatology Clinic of Ciro Redondo in the period from October 2007 to January 2008. The universe of study was constituted by 75 patients diagnosed with dentinal hyperesthesia in the period of time indicated above, being conformed the sample by those 25 who fulfilled the pre-established criteria for the study. With the application of the laser combined with Lacquer Fluorine Profilac, a remission of the pain was observed that increased gradually with the treatment sessions, having been obtained to almost eliminate in the totality of the cases the group of symptoms when finalizing it, evaluating the treatment of effective in 100 percent of the cases. We only found a recidive after a year of treatment

Chronic regional pain syndrome after subtalar arthrodesis is not prevented by early hyperbaric oxygen.

Subtalar arthrodesis was performed on a 48-year-old, non-insulin-dependent diabetic with a history of chronic ankle instability and lateral ankle pain. In the early post-operative period he presented as an emergency with an infection at the operative site. This was treated with 2 returns to the operating theatre for washout and debridement. His wounds were left open and at 3 weeks after emergency admission he was referred for adjunctive hyperbaric oxygen (HBO) therapy to aid healing by secondary intention. He received a total of 19 hyperbaric sessions, at a pressure of 2.2 ATA, one treatment per day for 5 days a week. Shortly after commencing HBO therapy his ankle became increasingly painful, despite the introduction of analgesia. By 7 weeks after emergency admission his wounds had virtually healed but hyperesthesia persisted over the dorsum of the foot. A computerized tomography scan at 5 1/2 months post-operatively showed satisfactory joint fusion and revealed no evidence of infection. Symptoms and signs at this time were compatible with a diagnosis of chronic regional pain syndrome (CRPS). There is published evidence to suggest that HBO therapy may be a useful modality in the treatment of established CRPS. Here, we seek to publicize a case in which early treatment with HBO for another indication did not prevent the simultaneous development of CRPS Type 1.

Understanding behavior: feline hyperesthesia syndrome.

The etiology of feline hyperesthesia syndrome can be difficult to determine. Behavior modification and medications may help in treatment.

Spinal cholinergic mechanism of the relieving effects of electroacupuncture on cold and warm allodynia in a rat model of neuropathic pain.

This study was performed to determine whether spinal cholinergic systems mediate the relieving effects of electroacupuncture (EA) on cold and warm allodynia in a rat model of neuropathic pain. For neuropathic surgery, the right superior caudal trunk was resected at the level between the S1 and S2 spinal nerves innervating the tail. Two weeks after the injury, the intrathecal (i.t.) catheter was implanted. Five days after the catheterization, the rats were injected with atropine (non-selective muscarinic antagonist, 30 microg), mecamylamine (non-selective nicotinic antagonist, 50 microg), pirenzepine (M(1) muscarinic antagonist, 10 microg), methoctramine (M(2) antagonist, 10 microg) or 4-diphenylacetoxy-N-methylpiperidine methiodide (4-DAMP) (M(3) antagonist, 10 microg). Ten minutes after the injection, EA was applied to the ST36 acupoint for 30 min. The cold and warm allodynia were assessed by the tail immersion test [i.e., immersing the tail in cold (4 degrees C) or warm (40 degrees C) water and measuring the latency of an abrupt tail movement] before and after the treatments. The i.t. atropine, but not mecamylamine, blocked the relieving effects of EA on cold and warm allodynia. Furthermore, i.t. pirenzepine attenuated the antiallodynic effects of EA, whereas methoctramine and 4-DAMP did not. These results suggest that spinal muscarinic receptors, especially M(1) subtype, mediate the EA-induced antiallodynia in neuropathic rats.

Oxygen therapy influences episodic cluster headache and related cutaneous brush and cold allodynia.

Cluster headache (CH) is characterized by a series of sudden attacks of short-lasting severe headache pain with ipsilateral autonomic features, including lacrimation, rhinorrhea, localized sweating, eyelid edema, and partial or complete Horner's syndrome. Just like in migraine, brush allodynia has been described for CH and for short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome. Administration of normobaric oxygen is part of the standard therapy for CH attacks. Here, we describe a young male with a first CH attack and the influence of oxygen on pain and concomitant cutaneous allodynia.