J Orofac Pain
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The case of a patient with bilateral preauricular pain and tinnitus is reported. Minimal relief was obtained with traditional temporomandibular disorders therapy, and complete relief was obtained after endodontic therapy. Pulpal conditions that can refer pain are discussed, and recommendations are made to help practitioners identify a possible pulpal etiology for symptoms and tests of temporomandibular disorders.
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Seventeen patients with neuropathic orofacial pain are presented with reference to precipitating events, pain descriptions, response to treatment, and other aspects of their histories and clinical presentation. Stellate ganglion blocks were done on 14 patients. Ten of 14 patients reported temporary relief of pain with stellate ganglion blocks. ⋯ It is argued that sympathetically maintained pain involving orofacial locations does occur and that stellate ganglion blocks may benefit a subgroup of these patients. It is noted that current diagnostic categories are inadequate to describe a subgroup of these patients. New categories are suggested, and further study is recommended.
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This study explored psychologic and physiologic factors differentiating patients with temporomandibular disorders (n = 23) from sex-, age-, and weight-matched asymptomatic control subjects. Each subject completed several standard psychologic questionnaires and then underwent two laboratory stressors (mental arithmetic and pressure-pain stimulation). Results indicated that patients with temporomandibular disorders had greater resting respiration rates and reported greater anxiety, sadness, and guilt relative to control subjects. ⋯ There were no differences between patients with temporomandibular disorders and control subjects on pain measures or any other measured variable for the pressure-pain stimulation trial. In addition, there were no differences in electromyography levels between patients with temporomandibular disorders and control subjects. The results are discussed in terms of their implications for the etiology and treatment of this common and debilitating set of disorders.
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Comparative Study Clinical Trial Controlled Clinical Trial
Thermographic assessment of neuropathic facial pain.
Ongoing pain, intermittent sharp pain, or intermittent dull aching pain around the teeth can evoke the suspicion of tooth pathology. However, when no dental cause can be found clinically or radiographically, the differential diagnosis involving neuropathic pain and pulpal pathology is still a challenge. Neuropathic facial pains are still too often misdiagnosed as tooth pain of dental origin, resulting in unnecessary dental extraction or endodontic therapy. ⋯ The other half of the patients with sympathetically independent traumatic trigeminal neuralgia displayed "cold" thermograms in the area of their pain complaints. Electronic thermography was the least selective test for the group showing "cold" thermogram patterns (80% agreement with the thermographic characterization criteria). These data suggest that electronic thermography may be helpful in differentiating neuropathic pains from pulpal pathology.
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Comparative Study
Pain-related limitation in activities of daily living in patients with chronic orofacial pain: psychometric properties of a disability index.
Pain-related limitations in activities of daily living are presented for 272 patients reporting orofacial pain of the temporomandibular region using the seven-item Pain Disability Index. Results showed that the factor structure for orofacial pain patients differed little from the factor structure for outpatients visiting chronic pain clinic settings. ⋯ The factor analytical findings indicated that these patients share common pain-related limitations in activities of daily living. These findings are also consistent with previous results indicating greater pain in orofacial pain patients diagnosed with pain complaints primarily myogenous in origin than in pain patients having discal disorders.