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1.
Oral Maxillofac Surg Clin North Am ; 34(1): 61-81, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34802616

RESUMO

This article aims to provide the practitioner with therapeutic options to treat a broad spectrum of acute and chronic orofacial pain syndromes. The focus will be nonsurgical that the oral health care physician can implement to treat this population of patients. The World Health Organization estimated that more than 1 in every 3 people suffers from acute or chronic pain. This article is primarily devoted to medication management once the diagnosis of neuropathic pain, a true trigeminal neuralgia, or a variant of trigeminal neuralgia often referred to as traumatic neuropathic pain or traumatic trigeminal neuralgia.


Assuntos
Dor Crônica , Neuralgia , Neuralgia do Trigêmeo , Dor Crônica/tratamento farmacológico , Dor Facial/tratamento farmacológico , Humanos , Neuralgia/tratamento farmacológico , Síndrome , Neuralgia do Trigêmeo/tratamento farmacológico
2.
J Appl Oral Sci ; 29: e20210122, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34614122

RESUMO

OBJECTIVES: This study aims to assess the impact of social isolation, due to the Covid-19 pandemic, on mental health, Temporomandibular Disorder (TMD) and orofacial pain in men and women. METHODOLOGY: Individuals living in Brazil answered an online questionnaire on their sociodemographic and behavioral aspects, emotional scale (DASS-21), Impact of Event Scale, and Pain Screener in Temporomandibular Disorders (TMD-Pain Screener) during June 2020. Descriptive statistical analyses and logistic and linear regressions were applied (5% significance). RESULTS: Overall, 2301 individuals were included, 89.1% practiced social isolation, 72.6% were employed/studying, at least 15% presented severe or extremely severe levels of emotional distress and presence of powerful (34.1%) and severe impact event (15%). During the outbreak, 53.2% perceived feeling worse and 31.8% reported that orofacial pain started or worsened after the pandemic outbreak. Gender was associated with "social class" (P=0.036), "pain/stiffness in the jaw on awakening" (P=0.037), "change of pain during jaw habits" (P=0.034) and "perception of change in the situations mentioned in the TMD-Pain Screener" (P=0.020), "depression" (P=0.012), "anxiety" (P=0.006) and "impact of the event" (P=8.3E-11). Social isolation had a lesser chance to change the routine, to be practiced by the unemployed/not studying, and to be practiced by men (all with P<0.001). Associations were found between social class and all subscales of the DASS-21 and IES, all with P<0.001. CONCLUSIONS: The practice of social isolation has social determinants. High levels of psychological and event impacts were detected. The presence of orofacial pain seemed to increase during the health crisis, and there were gender differences in the response to the COVID-19 pandemic.


Assuntos
COVID-19 , Pandemias , Brasil/epidemiologia , Estudos Transversais , Dor Facial/epidemiologia , Dor Facial/etiologia , Humanos , SARS-CoV-2
3.
J Oral Facial Pain Headache ; 35(3): 241-252, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34609381

RESUMO

AIMS: To assess the speed and accuracy of a checklist user interface for the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). METHODS: A diagnostic tool formatted as a checklist was developed and compared to an existing diagnostic tool, the DC/TMD diagnsostic decision trees. Both types of tools use the DC/TMD and were tested by dental students, interns, and residents in the USA and Japan for diagnosis of hypothetical patients. The comparisons were done in a randomized, crossover, controlled, double-blinded trial. RESULTS: Overall, subjects using the experimental tool answered 25% more correct diagnoses (P < .001) and missed 27% fewer diagnoses (P < .01). They were also able to finalize their diagnoses faster than those using the control tool, in 16% less time (P < .05). The difference in accuracy was more pronounced in complex cases, while the difference in speed was more pronounced in simple cases. CONCLUSION: This checklist is an alternative user interface for the DC/TMD.


Assuntos
Transtornos da Articulação Temporomandibular , Comportamento de Utilização de Ferramentas , Estudos Cross-Over , Dor Facial , Humanos , Transtornos da Articulação Temporomandibular/diagnóstico
4.
J Oral Facial Pain Headache ; 35(3): 199-207, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34609378

RESUMO

AIMS: To evaluate the efficacy of a gluten-free diet (GFD) as a treatment modality for pain management in women with chronic myofascial pain in masticatory muscles. METHODS: In this randomized controlled trial, 39 female subjects were evaluated according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and divided into three groups: a healthy group (n = 14; mean ± SD age = 34.57 ± 9.14 years); a control group (n = 12; age = 31.50 ± 7.38 years); and an experimental group (n = 13; age 30.00 ± 7.64 years). The outcome variables were: pain intensity, mechanical pain threshold (MPT), and pressure pain threshold (PPT). MPT was performed on the masseter muscle, and PPT was performed on both the masseter and anterior temporalis muscles. A nutritionist prescribed a 4-week individualized GFD for the experimental group. The healthy group was analyzed only initially, whereas the control and experimental groups were analyzed again after 4 weeks. Data were subjected to statistical analysis with a significance level of 5% (one-way analysis of variance followed by Bonferroni post hoc, paired t, Wilcoxon signed rank, Kruskal-Wallis/Dunn, and Pearson chi-square tests). RESULTS: Participants who underwent a GFD showed reduction in pain intensity (P = .006) and an increase in PPT of the masseter (P = .017) and anterior temporalis (P = .033) muscles. The intervention did not influence the MPT of the masseter muscle (P = .26). In contrast, the control group showed no improvement in any parameter evaluated. CONCLUSION: GFD seemed to reduce pain sensitivity in women with TMD and may be beneficial as an adjunctive therapy for chronic myofascial pain in masticatory muscles; however, further studies in the fields of orofacial pain and nutrition are required.


Assuntos
Dieta Livre de Glúten , Músculos da Mastigação , Adulto , Dor Facial , Feminino , Humanos , Medição da Dor , Limiar da Dor , Adulto Jovem
5.
J Oral Facial Pain Headache ; 35(3): 208-217, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34609379

RESUMO

AIMS: To understand the experiences of patients diagnosed with chronic facial pain (CFP) who attended a specialist facial pain management program (PMP); specifically, to explore how they experienced attending the facial PMP itself and how they felt it impacted their management of CFP. METHODS: Qualitative methodology and focus groups were used to gather patients' views and experiences of attending a facial PMP. Two focus groups were conducted for patients who had all completed the facial PMP. Discussions were recorded and transcribed. Data were then analyzed using thematic analysis to establish key themes relating to participants' experiences of the facial PMP. RESULTS: Thematic analysis identified three main themes, with numerous subthemes within them. The theme "psychologic change" had subthemes of self-compassion, acceptance, and reflection. The theme "behavioral change" contained subthemes of re-engagement with valued activity, medication, and communication. The theme "structure and process" contained subthemes of concentration, need for one-on-one time with the clinician, meeting others, and not enough time (clinical and nonclinical). CONCLUSION: Facial PMPs may provide a valuable treatment to support long-term coping and adaptation for patients with CFP. Positive changes to coping include both psychologic and behavioral elements. Further research is necessary to clarify how group-based facial PMPs should be structured and delivered.


Assuntos
Adaptação Psicológica , Manejo da Dor , Dor Facial/terapia , Grupos Focais , Humanos , Pesquisa Qualitativa
6.
BMC Oral Health ; 21(1): 497, 2021 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-34615517

RESUMO

BACKGROUND: To determine whether capsular distention in the painful temporomandibular joint (TMJ) can be assessed by ultrasonography, we compared the capsular width between painful TMJs and painless TMJ. The risk factors for TMJ pain were also investigated including capsular width and other clinical factors such as TMJ sounds that may affect the occurrence and persistence of TMJ pain. METHODS: TMJ ultrasonography was performed on 87 temporomandibular disorder (TMD) patients, including 47 unilateral and 29 bilateral TMJ pain patients, and 11 patients without TMJ pain. RESULTS: The capsular width was greater in the 105 painful joints than in the 69 painless joints. Considering individual anatomical variations, the differences between painful and painless joints in unilateral TMJ pain patients were also analyzed, revealing a greater width in painful joints. Capsular width was a risk factor for TMJ pain with an adjusted odds ratio of 1.496 (95% confidence interval 1.312-1.706; p < 0.001) and was significantly correlated with pain scores. CONCLUSION: This correlation may suggest that pain intensity is associated with widened capsular width because of joint effusion or synovitis. Further studies are required to refine and establish the protocols for standard examinations using ultrasound imaging.


Assuntos
Disco da Articulação Temporomandibular , Transtornos da Articulação Temporomandibular , Dor Facial , Humanos , Imageamento por Ressonância Magnética , Disco da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Ultrassonografia
7.
Neuroimaging Clin N Am ; 31(4): 485-508, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34689929

RESUMO

We review and illustrate the radiology of facial pain, emphasizing trigeminal neuralgia, relevant anatomy, current classification, concepts about etiology, and the role of imaging and its influence on the choice of treatment. We discuss glossopharyngeal neuralgia, other neuropathic causes of facial pain, postinflammatory and neoplastic causes, and nociceptive (end-organ) causes of facial pain, as well as referred otalgia. Other conditions that may present with facial pain, including trigeminal autonomic cephalgias and giant cell arteritis, are reviewed briefly. We discuss the elements of a comprehensive MR imaging protocol to enable detection of these diverse causes of facial pain.


Assuntos
Doenças do Nervo Glossofaríngeo , Neuralgia do Trigêmeo , Diagnóstico por Imagem , Dor Facial/diagnóstico por imagem , Dor Facial/etiologia , Humanos , Neuralgia do Trigêmeo/diagnóstico por imagem
8.
BMC Oral Health ; 21(1): 474, 2021 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-34579713

RESUMO

BACKGROUND: There is limited data on Pakistani dental students perceived competence in managing orofacial pain (OFP). This study aims to evaluate dental students self-perceived competence regarding the management of orofacial pain. METHODS: This cross-sectional study was conducted in Karachi at randomly selected two public and four private dental schools. This survey was conducted online from November 2020 to December 2020 in six dental schools. A questionnaire link was sent to the 475 students. A chi-square test and independent-sample t-test were conducted to assess the frequency distribution and compare mean scores of knowledge, diagnosis, and management parameters. RESULTS: Of the 475 students, 280 students filled the online survey leaving a response rate of 59%. A significant number of fourth-year students, 65 (51%, p = 0.005), feels knowledgeable regarding neuropathic pain compared to third-year students. The majority of the fourth-year students, 100 (78%, p = 0.010), feel comfortable managing intraoral pain. Almost all the students reported thinking that they need more knowledge related to five types of OFP. The fourth-year students had high mean scores related to knowledge, comfort in diagnosing and managing OFP categories. CONCLUSION: This study found that dental students perceived competence regarding orofacial pain management varies in relation to specific categories, being lowest for psychogenic pain.


Assuntos
Estudantes de Odontologia , Transtornos da Articulação Temporomandibular , Competência Clínica , Estudos Transversais , Educação em Odontologia , Dor Facial/terapia , Humanos , Inquéritos e Questionários
9.
Pain Physician ; 24(6): E857-E866, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34554706

RESUMO

BACKGROUND: The Craniofacial Pain and Disability Inventory (CF-PDI) is a cross-culturally adapted instrument designed from a biopsychosocial perspective to measure pain, disability, and function in orofacial head and neck pain with shown psychometric properties; however, the German cross-cultural adaption is lacking. OBJECTIVES: To carry out a transcultural translation of CF-PDI into German and assess its psychometric properties in patients with painful temporomandibular disorders (TMD) with respect to construct and clinical validity, internal consistency and reproducibility. STUDY DESIGN: Multicenter, prospective, cross-sectional design. SETTING: Patients (n = 398) were recruited from dental and physical therapy clinics in middle and south Germany. METHODS: Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). We investigated know-group validity by means of the scale's potential to discriminate between affected and unaffected subjects. Multiple linear regression analysis was used to estimate convergent validity. We tested test-retest reliability by the intraclass correlation coefficient and the Internal consistency by Cronbach's alpha, or each dimension separately, and the total score. Multiple linear regression analysis was used to estimate convergent validity. RESULTS: Two hundred forty-six heterogeneous chronic craniofacial pain patients and 152 patients without complaints were recruited from the middle and south of Germany. The German version CF-PDI-G presents 21 items, 4 factors, and adequate psychometric properties. The test-retest reliability and internal consistency of the CF-PDI-G were both excellent for the entire instrument and also for all sub-scales (intraclass correlation coefficient [ICC] > 0.90) except for the comorbidities and interference with work which was acceptable (ICC = 0.69). Standard error of the measurement (SEM) and minimal detectable change values are sufficiently low. Assessment of clinical validity shows good potential of discrimination and classification into categories "no," "mild," "moderate," and "severe." The multiple linear regression model showed a strong association between neck disability index, Visual Analog Scale, and anamnestic questionnaire (supporting the scale's convergent validity). LIMITATIONS: Our sample has a higher prevalence of women and the sample was not recruited consecutively, which may lead to a biased estimation of psychometric properties. CONCLUSIONS: The CF-PDI-G represents valid and reliable instrument to assess pain and disability in patients with orofacial pain and headache suitable for research and clinical practice.


Assuntos
Comparação Transcultural , Dor Facial , Estudos Transversais , Avaliação da Deficiência , Dor Facial/diagnóstico , Feminino , Humanos , Estudos Prospectivos , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
10.
J Oral Rehabil ; 48(12): 1295-1306, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34537976

RESUMO

BACKGROUND: The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and Diagnostic Criteria for TMD (DC/TMD) include Axis II instruments for psychosocial assessment. OBJECTIVES: The aims were to compare the Finnish versions of Axis II psychosocial assessment methods of the RDC/TMD and DC/TMD and to study their internal reliability. METHODS: The sample comprised 197 tertiary care referral TMD pain patients. The associations between RDC/TMD [Graded Chronic Pain Scale (GCPS) 1.0, Symptom Check List 90-revised (SCL-90R)] and DC/TMD (GCPS 2.0, Patient Health Questionnaire-9 (PHQ-9), PHQ-15) assessment instruments were evaluated using Spearman correlation coefficients, Wilcoxon Signed Rank s, chi-squared test and gamma statistics. The internal reliability and internal inter-item consistency of SCL-90-R, PHQ-9, PHQ-15 and Generalized Anxiety Disorder-7 (GAD-7) were evaluated using Cronbach's alpha coefficient values. RESULTS: The DC/TMD and RDC/TMD Axis II psychosocial instruments correlated strongly (p < .001). GCPS 1.0 and GCPS 2.0 grades were similarly distributed based on both criteria. The RDC/TMD psychological instruments had a higher tendency to subclassify patients with more severe symptoms of depression and non-specific physical symptoms compared to DC/TMD. The internal reliability and internal inter-item consistency were high for the psychological assessment instruments. CONCLUSION: The Finnish versions of the RDC/TMD and DC/TMD Axis II psychosocial instruments correlated strongly among tertiary care TMD pain patients. Furthermore, the Axis II psychological assessment instruments indicated high validity and internal inter-item consistency and are applicable in Finnish TMD pain patients as part of other comprehensive specialist level assessments, but further psychometric and cut-off evaluations are still needed.


Assuntos
Depressão , Dor Facial , Transtornos da Articulação Temporomandibular/diagnóstico , Dor Facial/diagnóstico , Finlândia , Humanos , Reprodutibilidade dos Testes , Atenção Terciária à Saúde
11.
J Oral Rehabil ; 48(10): 1089-1098, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34370315

RESUMO

BACKGROUND: Amplified muscle activity in reaction to daily life stressors might explain chronic pain in temporomandibular disorder (TMD). OBJECTIVES: To assess whether patients with myofascial TMD pain (MFP) react to standardised stressors with greater masticatory muscle activity than demographically matched controls. METHODS: A total of 124 female MFP patients and 46 demographically matched and pain-free controls rated distress while performing a series of standardised stress-reactivity tasks (viz., cold pressor test, mental arithmetic test, speech stressor test and reaction time/startle response test) as well as a vanilla baseline control task. Blood pressure was measured before and after each task, and electromyographic (EMG) activity was continuously recorded over the jaw-closing muscles and several non-masticatory muscles during each task. Linear mixed model analyses were used to test the hypothesis that case status, stress-reactivity task and muscle recording site influenced EMG activity. RESULTS: Stress induction was successful, as evidenced by distress ratings and blood pressure measurements that were significantly elevated during performance of the stress tasks. Participants reported that some of the tasks were stressful in a way that resembled stressors experienced in their daily lives. Elevated muscle activity could be confirmed only for the reaction time/startle response task, where mean EMG activity was elevated more in cases than in controls, specifically in the jaw-closing muscles. CONCLUSION: These data could not provide clear support for the theory that psychological stressors produce a differential increase in masticatory muscle activity in MFP patients than pain-free controls.


Assuntos
Dor Crônica , Transtornos da Articulação Temporomandibular , Eletromiografia , Dor Facial , Feminino , Humanos , Músculos da Mastigação
12.
J Indian Prosthodont Soc ; 21(3): 308-310, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34380820

RESUMO

Secondary trigeminal neuralgia might be very rarely preceded by trigeminal neuropathic pain. The patient, in this case, presented with paroxysmal pain in the left mandible and numbness of the lower lip and tongue. Sensory testing of these areas revealed cold and heat hyperalgesia and mechanical hyposensitivity in the mandibular region. Magnetic resonance imaging showed a mass in the left cerebellopontine angle. The patient was prescribed systemic mirogabalin (2.5 mg/day), which provided some relief until the tumor was removed. The histopathological diagnosis was an epidermoid tumor. This article discusses the clinical characteristics and sensory testing findings that distinguish secondary trigeminal neuralgia from trigeminal neuropathic pain based on the International Classification of Orofacial Pain.


Assuntos
Neuralgia do Trigêmeo , Ângulo Cerebelopontino , Dor Facial , Humanos , Hiperalgesia , Imageamento por Ressonância Magnética
13.
J Oral Rehabil ; 48(11): 1210-1218, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34382229

RESUMO

BACKGROUND: Persistent oro-facial pain (POFP) is disabling, and patients' treatment outcomes are difficult to predict; psychosocial factors play a role. The West Haven-Yale Multidimensional Pain Inventory (MPI) is a self-report measure, which to our knowledge, has not been studied across primary and secondary care in heterogeneous POFP. OBJECTIVE: Assess the MPI's ability to predict clinical outcome in POFP patients across primary and secondary care settings receiving usual care. METHODS: About 146 patients receiving usual care for POFP were recruited from primary and secondary care medical and dental practices in north-east England. Participants completed the MPI (v3) and Graded Chronic Pain Scale (GCPS) at recruitment, and after 6, 12, 18 and 24 months. The Patient Health Questionnaire-4 (PHQ-4) was completed at recruitment, 12, and 24 months. 'Good' and 'poor' outcome status was assigned to participants based on their mode dichotomised GCPS score across timepoints. Logistic regression was used with overall GCPS outcome (good/poor) as the dependent variable and MPI subscale scores, demographic variables, and PHQ-4 scores as predictors. RESULTS: 110 participants had a 'good', and 36 had a 'poor' outcome. In the 'poor' outcome group, age, mean income, and life control scores were lower; deprivation, months in pain, PHQ-4, pain severity, interference, and affective distress scores were higher. In the 'good' group, MPI scores improved over time. Interference was the only consistent predictor of 'poor' outcome in the logistic regression model (OR: 1.14-1.98, p < 0.05). CONCLUSION: The MPI interference subscale may help to identify patients with POFP who are likely to have consistent pain-related disability over time; it may therefore be useful clinically to identify patients likely to need early intervention.


Assuntos
Dor Crônica , Dor Facial , Inglaterra , Humanos , Medição da Dor , Autorrelato , Inquéritos e Questionários
14.
J Oral Rehabil ; 48(11): 1193-1200, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34462940

RESUMO

AIMS: Temporomandibular disorders (TMD) are often associated with psychological comorbidities. One such comorbidity is pain catastrophising, that is, exaggeration of negative consequences of a painful event. The aim was to investigate catastrophising in individuals with painful TMD compared to controls and the association between catastrophising and pain intensity, number of pain sites and functional limitations. METHODS: A community-based sample of 110 individuals (83 women; 20-69 yrs) with painful TMDs (myalgia/arthralgia as per Diagnostic Criteria for TMD) and 190 age- and gender-matched controls (119 women; 20-69 yrs) from the Public Dental services in Västerbotten, Sweden, participated. Associations between catastrophising and functional jaw limitations, respectively, and painful TMD were evaluated with ordinal regression adjusted for the effect of gender and age. Associations (Spearman's correlation) of the Pain catastrophising Scale (PCS) with Jaw Functional Limitation Scale (JFLS-20), pain site number (whole-body pain map), and characteristic pain intensity (CPI) and intergroup comparisons (Mann-Whitney U test) of these variables were also calculated. RESULTS: Levels of catastrophising were associated with TMD pain (OR 1.6, 95%CI 1.1-2.6). Among individuals with painful TMD, catastrophising was correlated to pain intensity (r=0.458, p<0.01) and functional limitations (r=0.294-0.321, p≤0.002), but not to number of pain sites. CONCLUSION: Compared to controls, community-based individuals with painful TMD demonstrated higher levels of pain catastrophising, and this catastrophising was associated with increased pain intensity and jaw dysfunction. The relatively low scores of pain catastrophising suggest that even mild catastrophic thinking is associated with pain perception and jaw function, and should be considered in patient management.


Assuntos
Dor Facial , Transtornos da Articulação Temporomandibular , Artralgia , Dor Facial/epidemiologia , Feminino , Humanos , Mialgia , Medição da Dor , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/epidemiologia
15.
Pain ; 162(9): 2397-2404, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34448753

RESUMO

ABSTRACT: Pain is a subjective experience with significant individual differences. Laboratory studies investigating pain thresholds and experimental acute pain have identified structural and functional neural correlates. However, these types of pain stimuli have limited ecological validity to real-life pain experiences. Here, we use an orthodontic procedure-the insertion of an elastomeric separator between teeth-which typically induces mild to moderate pain that peaks within 2 days and lasts several days. We aimed to determine whether the baseline structure and resting-state functional connectivity of key regions along the trigeminal nociceptive and pain modulatory pathways correlate with subsequent peak pain ratings. Twenty-six healthy individuals underwent structural and resting-state functional MRI scanning before the placement of a separator between the first molar and second premolar, which was kept in place for 5 days. Participants recorded pain ratings 3 times daily on a 100-mm visual analogue scale. Peak pain was not significantly correlated with diffusion metrics of the trigeminal nerve or gray matter volume of any brain region. Peak pain did, however, positively correlate with baseline resting-state functional connectivity between the thalamus contralateral to the separator and bilateral insula, and negatively correlated with connectivity between the periaqueductal gray (PAG) and core nodes of the default mode network (medial prefrontal and posterior cingulate cortices). The ascending (thalamic) nociceptive and the descending (PAG) pain modulatory pathways at baseline each explained unique variation in peak pain intensity ratings. In sum, preinterventional functional neural architecture of both systems determined the individual pain experience to a subsequent ecologically valid pain stimulus.


Assuntos
Dor Aguda , Descanso , Dor Facial , Humanos , Imageamento por Ressonância Magnética , Modelos Teóricos
16.
J Dent ; 113: 103788, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34425171

RESUMO

OBJECTIVES: This study aimed to explore the association between occlusal features and temporomandibular disorder (TMD) pain complaints and probable awake or sleep bruxism METHODS: Path analysis was used to estimate direct, indirect and total effects of occlusal features on probable bruxism and pain-related TMD in adults aged 31 years from the 1982 Pelotas Birth Cohort. A total of 539 cohort members had an oral examination in 2013. Occlusal features were assessed through the Dental Aesthetic Index (DAI), orofacial pain complaints through the TMD pain screener and probable bruxism based on self-reports in combination with clinical findings. RESULTS: Malocclusions were found in 28.8% of the participants, while awake bruxism was reported in 35.2%, sleep bruxism in 15.2%, and pain-related TMD in 52.5% of the sample. Occlusion had no direct effect on either awake bruxism [standardized coefficient (SC) -0.002; p = 0.995] or pain-related TMD (SC -0.06; p = 0.115). Conversely, probable awake bruxism was associated with pain-related TMD (SC 0.35; p < 0.001). Similar results were found when sleep bruxism was set as the mediator of interest, as malocclusion did not directly affect sleep bruxism (SC 0.05; p= 0.220) nor pain-related TMD (SC -0.06; p = 0.167). A direct effect of sleep bruxism on pain-related TMD was observed with an SC of 0.16 (p < 0.001). CONCLUSION: Our findings suggested that malocclusion during adulthood did not directly influence probable awake or sleep bruxism nor TMD pain complaints. Instead, probable awake and sleep bruxism was associated with TMD pain complaints. CLINICAL SIGNIFICANCE: Malocclusion did not impact the presence of bruxism nor TMD complaints in adulthood, but awake and sleep bruxism were associated with TMD pain complaints. The significance of malocclusion should be reconsidered in contemporary dentistry and oral rehabilitation.


Assuntos
Má Oclusão , Bruxismo do Sono , Transtornos da Articulação Temporomandibular , Adulto , Estudos de Coortes , Dor Facial/etiologia , Humanos , Má Oclusão/complicações , Bruxismo do Sono/complicações , Transtornos da Articulação Temporomandibular/epidemiologia , Transtornos da Articulação Temporomandibular/etiologia
17.
J Endod ; 47(11): 1801-1807, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34400198

RESUMO

Referred orofacial pain as the first symptom of an otherwise silent distant, nonmetastatic cancer has been reported, but there is sparse literature on the subject. Referred pain may not be considered in the orofacial pain differential diagnosis because of its rarity; however, this may delay a cancer diagnosis. The authors present a case report and a review of the English literature. Peer-reviewed publications were identified through a systematic search of MEDLINE, Embase, and Cochrane CENTRAL. Historic cases were reviewed, and available data regarding demographics, pain characteristics, treatment, cancer diagnosis, and outcome were extracted. Thirty-seven cases were identified. All cancers were intrathoracic. The average age was 54.1 years with a slight female predominance (3:2). Common pain characteristics were (1) diffuse location affecting the ear (76%), jaw (46%), and temple (30%); (2) constant duration (65%); (3) aching quality (74%); (4) severe intensity (94%); and (5) associated systemic symptoms (68%) such as weight loss and digital clubbing. The average time from the onset of facial pain to seeking medical attention was 9 months, and the average time from seeking medication attention to cancer diagnosis was 8 months. Orofacial pain was often attributed to odontogenic (35%) or neuropathic (25%) causes, and treatments for these conditions were also common. The impact of referred orofacial pain on the cancer prognosis was not possible because of the nature of the reviewed studies (case reports with no comparison group). Cancer-associated referred orofacial pain as a first symptom is rare but should be considered in cases with intractable pain and associated systemic symptoms.


Assuntos
Neoplasias , Dor Referida , Diagnóstico Diferencial , Dor Facial/diagnóstico , Dor Facial/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Encaminhamento e Consulta
18.
Quintessence Int ; 52(10): 888-895, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34410072

RESUMO

OBJECTIVE: Persistent idiopathic facial pain (PIFP) is a condition in the absence of clear pathology. Pathogenesis is still enigmatic, although comorbidity with mood/affective disorders is observed. The aim of this study was to investigate the association between personality traits, mood and sleep disorders, and PIFP; and to compare them with posttraumatic chronic orofacial pain. METHOD AND MATERIALS: A cross-sectional, single-center study was designed to evaluate patients diagnosed with PIFP according to ICOP (International Classification of Orofacial Pain) diagnostic criteria through Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Five Factor Model, and visual analog scale indexes. Data were analyzed and compared with patients suffering from organic pathology - unilateral chronic mandibular fracture pain. RESULTS: A total of 67 respondents enrolled as the experimental group and 28 participants as a control group. Pain scores were higher in the experimental group (P < .001) and had positive correlation with depression (r = .44, P < .001) and sleep index scores (r = .415, P < .001). Personality trait scores did not differ between the groups. However, neuroticism correlated with depression (r = .466, P < .01) and anxiety (r = .634, P < .01) scores in the experimental group. Depression (P = .002) and anxiety scores (P = .007) were higher in the experimental group, as well as sleep indexes (P = .038). Depression (r = .609, P < .001) and anxiety (r = .655, P < .001) scores had positive correlation with sleep index scores. Sleep scores in the experimental group positively correlated with neuroticism score (r = .442, P < .001). PIFP increases the chance of experiencing depression (OR 10.688; 95% CI 1.355-84.309, P = .006) as well as poor quality of sleep (OR 3.389; 95% CI 1.023-11.228, P = .006). CONCLUSIONS: The results suggest that personality traits (neuroticism), anxiety, depression, and sleep disorders are associated with PIFP.


Assuntos
Dor Crônica , Transtornos do Humor , Ansiedade , Dor Crônica/etiologia , Estudos Transversais , Dor Facial/etiologia , Humanos
19.
J Oral Rehabil ; 48(9): 1066-1076, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34213796

RESUMO

AIM: This critical review describes key methodological aspects for a successful oro-facial psychophysical evaluation of the somatosensory system and highlights the diagnostic value of somatosensory assessment and management perspectives based on somatosensory profiling. METHODS: This topical review was based on a non-systematic search for studies about somatosensory evaluation in oro-facial pain in PubMed and Embase. RESULTS: The recent progress regarding the psychophysical evaluation of somatosensory function was largely possible due to the development and application of valid, reliable and standardised psychophysical methods. Qualitative sensory testing may be useful as a screening tool to rule out relevant somatosensory abnormalities. Nevertheless, the patient should preferably be referred to a more comprehensive assessment with the quantitative sensory testing battery if confirmation of somatosensory abnormalities is necessary. Moreover, the identification of relevant somatosensory alterations in chronic pain disorders that do not fulfil the current criteria to be regarded as neuropathic has also increased the usefulness of somatosensory evaluation as a feasible method to better characterise the patients and perhaps elucidate some underpinnings of the so-called 'nociplastic' pain disorders. Finally, an additional benefit of oro-facial pain treatment based on somatosensory profiling still needs to be demonstrated and convincing evidence of somatosensory findings as predictors of treatment efficacy in chronic oro-facial pain awaits further studies. CONCLUSION: Psychophysical evaluation of somatosensory function in oro-facial pain is still in its infancy but with a clear potential to continue to improve the assessment, diagnosis and management of oro-facial pain patients.


Assuntos
Dor Crônica , Dor Facial , Dor Facial/diagnóstico , Humanos , Manejo da Dor , Medição da Dor , Reprodutibilidade dos Testes
20.
Artigo em Russo | MEDLINE | ID: mdl-34283533

RESUMO

A clinical analysis of a patient with a rare form of secondary facial pain (Herzenberg's disease) is presented. The conducted research and pharmacological tests made it possible to exclude such diseases as trigeminal neuralgia, stylohyoid syndrome, TMJ pain dysfunction, dental plexalgia, myofascial facial pain syndrome. The patient is consulted by a dental surgeon to exclude pathology of the parotid salivary gland and sialolithiasis. The patient was treated with broad-spectrum antibiotics for 8 days. Also, supportive therapy was prescribed: desensitizing, vitamins, as well as an anxiolytic and an antidepressant in minimum therapeutic doses for a course of 14 days (with subsequent correction of the dosage and duration of administration) to correct the emotional state of the patient. We recommend a gentle diet (alkaline warm drink, soft food), and a diet that does not provoke salivation. Locally it was recommended to rinse with antimicrobial drugs, phonophoresis, electrophoresis, magnetotherapy. On the 6th day of therapy, the therapeutic effect was obtained. By the 14th day of therapy, the pain syndrome was leveled.


Assuntos
Síndrome da Disfunção da Articulação Temporomandibular , Neuralgia do Trigêmeo , Dor Facial/diagnóstico , Dor Facial/tratamento farmacológico , Dor Facial/etiologia , Humanos
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