Journal of dental research
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Comparative Study
Reliability of visual analog and verbal descriptor scales for "objective" measurement of temporomandibular disorder pain.
Eight dentists viewed standardized videotapes showing palpations of the temporomandibular joint and muscles of mastication and recorded their judgments concerning the amount of pain the patient was experiencing. Judgments were recorded using a four-point verbal descriptor scale (VDS) ("none", "mild", "moderate", "severe" pain) or a 100-mm visual analog scale (VAS) anchored with the terms "no pain" and "worst pain possible". Test/re-test reliability over a one-week period and interjudge reliabilities were calculated for each scale; reliabilities of the two scales were directly compared based on the statistical equivalence of weighted kappa and the Intraclass Correlation Coefficient. ⋯ Interjudge reliabilities averaged k = 0.394 for the VDS and r = 0.735 for the VAS. Direct comparison of reliabilities for the two scales showed no clear advantage for either scale. The marginal reliabilities of these scales, when used by dentists to quantify the patient's pain, suggest that neither scale should be regarded as an "objective" pain measure.
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The Craniomandibular Index (CMI) was developed to provide a standardized measure of severity of problems in mandibular movement, TMJ noise, and muscle and joint tenderness for use in epidemiological and clinical outcome studies. The instrument was designed to have clearly defined objective criteria, simple clinical methods, and ease in scoring; it is divided into the Dysfunction Index and the Palpation Index. Inter-rater reliability (three raters) and intra-rater reliability (19 patients examined twice by one rater) were tested to determine whether the instrument has operational definitions sufficiently precise to allow for consistency in use between different raters and with one rater over time. ⋯ Correlation for intra-rater reliability was 0.92 for the Dysfunction Index, 0.86 for the Palpation Index, and 0.96 for the CMI. These results support the reliability of the CMI for use in epidemiological and clinical studies. Users are cautioned about the subjectivity of numerous items within the CMI and the strict methodological guidelines that must be followed in order to assure accuracy and reproducibility of results.
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The search for new anesthetic and analgesic drugs will be aided by analysis of the structures of chemical compounds which variously stimulate the five proposed opioid receptors or the benzodiazepine receptors. The mechanism of interaction between the benzodiazepines, opioids, and the neuroleptics will be further elucidated. These studies will result in discovery of drugs with fewer side-effects and more specific clinical effects.
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Recent experiments are reviewed to present a current view of the mechanisms of conduction block by local anesthetics. Local anesthetics block the sodium channels whose opening causes the rising phase of the action potential. ⋯ This site is only available to charged compounds when the gate of the channel is open. In contrast, uncharged compounds (including the free base form of local anesthetics) appear to reach the site through the membrane's lipid interior, bypassing the channel "gates." Anesthetics blocking the gate of the channel can either enhance or inhibit the normal inactivation mechanism of the sodium channel, depending on the particular anesthetic.
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Local anesthetic agents may be classified according to their intrinsic anesthetic potency and duration of activity. Procaine and chloroprocaine are relatively weak, short-acting drugs. Lidocaine, mepivacaine, and prilocaine represent agents of intermediate potency and duration of action. ⋯ The central nervous system is most susceptible to the toxic effects of local anesthetic agents. Signs and symptoms of CNS excitation followed by depression are the most common manifestations of local anesthetic toxicity. Cardiovascular depression may also occur following administration of excessive doses of local anesthetic agents or following high spinal or epidural anesthesia.