J Orofac Pain
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Randomized Controlled Trial Clinical Trial
Pressure pain threshold with and without iontophoretic anesthesia of the masseter muscle in asymptomatic males.
The pressure pain threshold (PPT) in the superficial masseter muscle was measured with and without cutaneous anesthesia to determine whether there would be a difference in PPT scores. ⋯ Pressure pain sensation in the human masseter is not derived predominantly from the cutaneous tissues, but from the muscle itself.
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Nerve signals arising from sites of tissue or nerve injury lead to long-term changes in the central nervous system and contribute to hyperalgesia and the amplification and persistence of pain. These nociceptor activity-induced changes are referred to as central sensitization. Central sensitization involves an increase in the excitability of medullary and spinal dorsal horn neurons brought about by a cascade of events, including neuronal depolarization, removal of the voltage-dependent magnesium block of the N-methyl-D-aspartate (NMDA) receptor, calcium entry into neurons, phosphorylation of the NMDA receptor, a change in the cell's excitability, and an increase in synaptic strength. ⋯ The latter exhibits changes very similar to those in the spinal dorsal horn, but the Vi/Vc zone likely is involved in autonomic nervous system processing and activation of the pituitary-adrenal axis. Descending systems are also an important component of the central sensitization process and provide the neural networks by which cognitive, attentional, and motivational aspects of the pain experience modulate pain transmission. These findings of nociceptor activity-induced neuronal plasticity have important clinical implications in the development of new approaches to the management of persistent pain.
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Pain referred to the orofacial structures can sometimes be a diagnostic challenge for the clinician. In some instances, a patient may complain of tooth pain that is completely unrelated to any dental source. This poses a diagnostic and therapeutic problem for the dentist. ⋯ This delay may result in the patient experiencing an acute myocardial infarction. It is the dentist's responsibility to establish a proper diagnosis so that the treatment will be directed toward the source of pain and not to the site of pain. This article reviews the literature concerning referred pain of cardiac origin and presents a case report of toothache of cardiac origin.
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A case of episodic, spontaneous odontalgia, aggravated by ingestion of cold food, with no apparent dental pathology is presented. Attempts at alleviating the pain by means of root canal treatment had failed in previous, similar episodes, and pain and pulpal hyperalgesia had shifted to other locations. ⋯ A prophylactic attempt with nifedipine, a calcium channel blocker, failed to alleviate the pain. This diagnostic entity and possible therapeutic approaches are discussed.
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Comparative Study
TMD in patients with primary Sjögren syndrome: a comparison with temporomandibular clinic cases and controls.
The aim of this study was to investigate the prevalence of temporomandibular disorders (TMD) in patients with primary Sjögren syndrome (1 degree SS), analyze the impact of the disease on mandibular function, and assess psychosocial distress. ⋯ Both 1 degree SS and chronic TMD may be associated with appreciable physical discomfort and psychosocial dysfunction. However, the underlying mechanisms of the oral dysfunction of 1 degree SS and TMD are quite different and essentially unrelated.