Journal of the California Dental Association
-
Since dentists can be faced by unusual cases during their professional life, this article reviews the common orofacial disorders that are of concern to a dentist trying to diagnose the source of pain or dysfunction symptoms, providing an overview of the essential knowledge and usage of nowadays available advanced diagnostic imaging modalities. In addition to symptom-driven diagnostic dilemmas, where such imaging is utilized, occasionally there are asymptomatic anomalies discovered by routine clinical care and/or on dental or panoramic images that need more discussion. The correct selection criteria of an image exam should be based on the individual characteristics of the patient, and the type of imaging technique should be selected depending on the specific clinical problem, the kind of tissue to be visualized, the information obtained from the imaging modality, radiation exposure, and the cost of the examination. The usage of more specialized imaging modalities such as magnetic resonance imaging, computed tomography, ultrasound, as well as single photon computed tomography, positron electron tomography, and their hybrid machines, SPECT/ CT and PET/CT, are discussed.
-
Chronic orofacial pain is a rapidly evolving and challenging field that deals with the management of pain originating from neurogenic, osseous, muscular, or vascular structures of the head and neck. The challenge lies in the accurate diagnosis of orofacial pain conditions, which may be difficult to differentiate in many clinical situations. As pain cannot be "seen" or precisely located or its intensity measured with any device, clinicians must rely heavily on the patient's own description of type, duration and location of pain, and thus, history plays a crucial role in diagnosis. ⋯ Based on the concept of using medications to predict which treatment would be best for certain pain conditions or to aid in better diagnosis, diagnostic intravenous infusions of lidocaine, morphine, and ketamine have been studied to test the response to adjuvant analgesics and oral dextromethorphan. Paradoxically, taking the patients off their current medications can be of diagnostic significance in conditions like medication overuse headache and serotonin selective reuptake inhibitor-induced clenching. In summary, this paper focuses on the use of medications in different forms as useful diagnostic tests for differential diagnosis of orofacial pain conditions that are difficult to diagnose or are refractory to past or current treatment.
-
Patients with unrelenting pain in the teeth, gingival, palatal or alveolar tissues often see multiple dentists and have multiple irreversible procedures performed and still have their pain. Up to one-third of patients attending a chronic facial pain clinic have undergone prior irreversible dental procedures for their pain without success. In these cases, if no local source of infectious, inflammatory, or other pathology can be found, then the differential diagnosis must include a focal neuropathic pain disorder. ⋯ A list of these medications is provided in table form. Data suggest that once the patient has failed dental treatment and pain persists, the long-term outcome is less than 25 percent will have complete pain relief with treatment. With earlier treatment, better pain control, and improved nerve activity suppression medications, this should also prevent secondary psychiatric disease from developing and lower the number of inappropriate treatments.