The purpose of this study was to determine whether botulinum toxin A (BTX-A) was efficacious for ... more The purpose of this study was to determine whether botulinum toxin A (BTX-A) was efficacious for the treatment of chronic moderate to severe jaw muscle pain in females. This was a randomized double-blind, placebo-controlled crossover trial of BTX-A. Twenty five units injected into each temporalis muscle and 50 U injected into each masseter muscle using three sites per muscle with 0.2 cm 3 per site. Data were collected at baseline, 8, 16, 24 weeks, with crossover occurring at 16 weeks. Primary outcome variables were pain intensity and unpleasantness, measured by horizontal visual analog scale (VAS). Secondary outcome variables were maximum interincisal opening without and irrespective of pain, muscle palpation tenderness (12 points), and four general questions. Fifteen female patients were enrolled (18-45 years), but only ten completed the trial. Of those who finished, no statistically significant difference was found in pain intensity (P ¼ 0:10), unpleasantness (P ¼ 0:40), palpation...
Nasolabial cyst is a rare non-odontogenic, soft-tissue, developmental cyst occurring inferior to ... more Nasolabial cyst is a rare non-odontogenic, soft-tissue, developmental cyst occurring inferior to the nasal alar region. The patient usually presents with a slowly enlarging asymptomatic swelling, typically without radiographic abnormalities. This paper documents the presentation and management of a 46-year-old woman with a nasolabial cyst. The histopathologic features, differential diagnosis, treatment and prognosis are discussed.
Complex regional pain syndrome (CRPS) is a chronic condition that usually affects extremities, su... more Complex regional pain syndrome (CRPS) is a chronic condition that usually affects extremities, such as the arms or legs. It is characterized by intense pain, swelling, redness, hypersensitivity in a region not defined by a single peripheral nerve and additional sudomotor effects, such as excessive sweating. The clinical criteria for the diagnosis of sympathetically maintained pain as outlined by the International Association for the Study of Pain include: Onset following an initiating noxious event (CRPS-type I) or nerve injury (CRPS-type II). Spontaneous allodynia that is not limited to peripheral nerve distribution and is not proportionate to the inciting event; abnormal sudomotor activity, skin blood flow abnormality, edema, other autonomic symptoms; and exclusion of other conditions that may otherwise contribute to the extent of the symptoms. Only 13 cases of CRPS involving sympathetically maintained pain in the head and neck region have been described, and all reported trauma a...
Non-odontogenic “tooth” pain characteristics are the key to identifying the underlying disorder: ... more Non-odontogenic “tooth” pain characteristics are the key to identifying the underlying disorder: a detailed pain history will guide most of the diagnostic process. Pain can be referred from local and distant structures, including musculoskeletal, neuropathic, and neurovascular sources. Response to provocation tests and administration of local anesthetic may help to rule out or confirm the origin of the pain, as well as determine therapeutic approaches. Treatment options vary widely by diagnosis and are directed at the mechanism of the source of pain. Missed non-odontogenic “tooth” pain diagnoses may result in unnecessary dental procedures, as well as continued symptomatology.
INTRODUCTION Examining the evolution of research parameters helps scientists to discover the well... more INTRODUCTION Examining the evolution of research parameters helps scientists to discover the well-developed and the neglected aspects of knowledge. Pain after root canal treatment is a health problem affecting millions of patients. Research in this field has a meaningful impact on quality of lives. The aim of this study was to analyze the evolution of research on post-operative pain over the past 50 years. METHODS Electronic searches were performed in Scopus and MEDLINE databases to identify studies on pain after non-surgical root canal treatments/retreatments. The full texts of eligible articles were reviewed to determine the study category, and to extract and analyze the methodological variables. A series of statistical analyses were performed to determine the trend of publications based on variable of interest overtime. RESULTS 424 articles were included. There was a positive trend for systematic reviews, studies with sample size <200, studies on single-visit treatment, and clinical trials on instrumentation and adjunct treatments (P<0.05). There was a negative trend for use of numeric rating scales, studies on multiple-visit treatments, clinical trials on medication/medicament, and studies on pain in maxillary incisors (P<0.05). No trend was observed based on pulpal diagnosis or for studies with longer observation periods (>8 weeks) (P>0.05). CONCLUSIONS A paradigm shift is needed towards clinical studies with larger sample sizes, longer observation periods, and more focus on pulpal diagnoses associated with higher rates of post-operative pain. There is a need to view post-operative pain as an important patient-centered outcome, and to develop and disseminate standard reporting guidelines for future studies.
INTRODUCTION The aim of this study was to identify preoperative factors associated with local ane... more INTRODUCTION The aim of this study was to identify preoperative factors associated with local anesthesia failure. METHODS The National Dental Practice-Based Research Network (www.NationalDentalPBRN.org) data from 534 patients that received a non-surgical root canal treatment completed in a single appointment were included in this analysis. Three methods for defining anesthesia failure were used: Definition 1- patient-reported level of numbness, Definition 2- provider-reported quality of anesthesia, and definition 3- provider reported use of supplemental anesthesia. Fifty-one pre-operative factors were investigated and analyzed individually against the overall failure rate for each method, and multivariate GEE logistic models were fit with predictors chosen using stepwise model selection to evaluate factors that may interact with each other. RESULTS Overall anesthesia failure rates were 5%, 15% and 30% for definitions 1, 2 and 3 respectively. Provider experience, diabetes, absence of sharp or ache pain, absence of smoking, and a fair expected outcome were associated with anesthesia failure (definition 1). Provider level of training, absence of sinus tract, bite sensitivity, and stress making the pain worse were associated with anesthesia failure (definition 2). Provider level of training, pain provoked by stimulus, mandibular teeth, teeth with vital pulps and pain interfering with daily activities were associated with the use of supplemental anesthesia (definition 3). CONCLUSIONS With the range of 5% to 30% of anesthesia failures, a few common factors across the models assessed were elucidated. Providers with higher levels of training had significantly fewer anesthesia failures. Patient self-reported history of diabetes and preoperative pain-related interference with daily activities was associated with more anesthesia failures. Greater severity of various tooth-related pain characteristics, as a group but not individually, accounted for more anesthesia failures.
INTRODUCTION Periapical images are routinely made in endodontics to support diagnosis and treatme... more INTRODUCTION Periapical images are routinely made in endodontics to support diagnosis and treatment decisions, but conventional imaging may not readily demonstrate inflammatory changes. This study aims to 1) quantify disagreement in the radiologic interpretation of apical periodontitis/rarefying osteitis between 2 expert examiners; and 2) determine if differences exist based on anatomical location. METHODS We used 1717 pre-treatment periapical images made prior to orthograde endodontic treatment as part of the Predicting Outcomes of Root Canal Treatment (PREDICT) study conducted within the National Dental Practice-Based Research Network. Periapical changes were assessed independently by two board-certified specialists, an oral and maxillofacial radiologist and an endodontist, blinded to other clinical information. If the examiners disagreed about whether a diagnosis of apical periodontitis/rarefying osteitis was justified, an adjudication was made by a third examiner. RESULTS The overall prevalence of this radiologic diagnosis in the periapical images was 55% and inter-examiner agreement measured with Cohen's kappa was calculated to be 0.56 (95% Confidence Interval 0.52, 0.60). Diagnostic disagreements between the two examiners occurred for 377 teeth (22%) with disagreements more frequent for jaw location (p=0.038) and tooth type (p=0.021). Differences between root number (p=0.058), and jaw location and tooth groups (p=0.069) were found not to be statistically significant. CONCLUSIONS The variability of diagnostic disagreements across anatomical location and tooth type may reflect the inability of periapical images to reveal bone changes masked by the complexity and density of overlying anatomical structures; a limitation that could potentially be overcome with the use of three-dimensional imaging.
INTRODUCTION Clinical presentation of oromandibular dystonia (OMD) is variable that can be furthe... more INTRODUCTION Clinical presentation of oromandibular dystonia (OMD) is variable that can be further complicated by the presence of temporomandibular disorder (TMD) symptoms. We sought to evaluate variations in the clinical presentation of OMD patients, particularly TMD-related characteristics, in two clinical settings. METHODS In a cross-sectional study design, a Web-based data collection survey was provided to eligible patients with OMD from movement disorder (MD) and oro-facial pain (OFP) clinics. The survey questionnaire was designed to collect information on demographic characteristics, clinical presentation particularly related to TMD, quality of life and treatment outcomes. Validated questionnaires were used when available such as the TMD Pain Screener, EuroQol 5-Dimensions 5-Levels (EQ-5D-5L), Jaw Functional Limitation Scale and Global Rating of Change Scale. RESULTS Of 53 eligible patients, 31 responded to the survey for a 58% response rate. Forty-eight per cent of patients in the MD clinic and 60% of patients in the OFP clinic reported jaw pain along with involuntary movements. Of those, 90% from the MD group and 83% from the OFP group screened positive with the TMD Pain Screener at the onset of symptoms based on recall. Positive TMD Pain Screener response was observed in about 40% of patients in both clinics within 30 days of questionnaire response. No statistically significant differences were observed between two groups for any measured variables. CONCLUSION Patients with OMD have features of TMD, irrespective of the clinical setting in which they seek and receive care. OMD patients from both clinics were similar in terms of clinical presentation, quality of life and treatment outcomes.
Pain is a common symptom in endodontic conditions, but differential diagnostic procedures are oft... more Pain is a common symptom in endodontic conditions, but differential diagnostic procedures are often needed to exclude other pain origins. General dentists and endodontists thus need to be aware of alternative painful orofacial conditions, and be able to identify them. The new International Classification of Orofacial Pain (ICOP, 2020) is the first comprehensive classification that uniquely deals with orofacial pain. The ICOP is a hierarchical classification, modelled on the International Classification of Headache Disorders (ICHD-3) and covers pain in dentoalveolar and anatomically related tissues, muscle pain, temporomandibular joint (TMJ) pain, neuropathic pain affecting cranial nerves, pain resembling primary headaches, and idiopathic pain in the orofacial region. A description of each condition is given, and structured diagnostic criteria for each condition are proposed based on research data when available. This narrative review aims to (i) give an overview and brief explanation of the ICOP system, (ii) describe and give examples of how it can be of use to general dentists and endodontists with special attention to differential diagnosis of tooth pain, and (iii) highlight how endodontic research can contribute to validation and improvement of the classification. A comparison to other classification and diagnostic systems is also included.
Aim Little is known about short-lasting unilateral neuralgiform headache attacks with conjunctiva... more Aim Little is known about short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). We present our experience with SUNCT/SUNA patients to aid identification and management of these disorders. Methods A retrospective review of patient records of one orofacial pain clinic was performed. Inclusion criteria was a diagnosis of SUNCT/SUNA confirmed with at least one follow-up visit. Results Six of the 2464 new patients seen between 2015–2018 met the selection criteria (SUNCT n = 2, SUNA n = 4). Gender distribution was one male to one female and average age of diagnosis was 52 years (range 26–62). Attacks were located in the V1/V2 trigeminal distributions, and five patients reported associated intraoral pain. Pain quality was sharp, shooting, and burning with two patients reporting “numbness”. Pain was moderate-severe in intensity, with daily episo...
INTRODUCTION Magnetic resonance imaging (MRI) has the potential to aid in determining the presenc... more INTRODUCTION Magnetic resonance imaging (MRI) has the potential to aid in determining the presence and extent of cracks/fractures in teeth because of better contrast without ionizing radiation. The objectives were to develop MRI criteria for root crack/fracture identification and to establish reliability and accuracy in their detection. METHODS MRI-based criteria for crack/fracture appearance was developed by an MRI physicist and a panel of 6 dentists. Twenty-nine human adult teeth previously extracted after a clinical diagnosis of a root crack/fracture were frequency matched to 29 controls. Samples were scanned using an in vivo MRI protocol and the reference standard (ie, ex vivo limited field of view cone-beam computed tomographic [CBCT] imaging). A blinded, 4-member panel evaluated the images with a proportion randomly retested to establish intrarater reliability. Overall observer agreement, sensitivity, and specificity were computed for each imaging modality. RESULTS Subjectively, MRI has increased crack/fracture contrast and is less prone to artifacts from radiodense materials relative to CBCT imaging. Intrarater reliability for MRI was fair to excellent (κ = 0.38-1.00), and for CBCT imaging, it was moderate to excellent (κ = 0.66-1.00). Sensitivity for MRI was 0.59 (95% confidence interval [CI], 0.39-0.76; P = .46), and for CBCT imaging, it was 0.59 (95% CI, 0.59-0.76; P = .46). Specificity for MRI was 0.83 (95% CI, 0.64-0.94; P < .01), and for CBCT imaging, it was 0.90 (95% CI, 0.73-0.98; P < .01). CONCLUSIONS Despite advantages of increased contrast and the absence of artifacts from radiodense materials in MRI, comparable measures of sensitivity and specificity (to limited field of view CBCT imaging) suggest MRI quality improvements are needed, specifically in image acquisition and postprocessing parameters. Given the early stage of technology development, there may be a use for MRI in detecting cracks/fractures in teeth.
Measurement error of intraoral quantitative sensory testing (QST) has been assessed using traditi... more Measurement error of intraoral quantitative sensory testing (QST) has been assessed using traditional methods for reliability, such as intraclass correlation coefficients (ICCs). Most studies reporting QST reliability focused on assessing one source of measurement error at a time, e.g., inter- or intra-examiner (test-retest) reliabilities and employed two examiners to test inter-examiner reliability. The present study used a complex design with multiple examiners with the aim of assessing the reliability of intraoral QST taking account of multiple sources of error simultaneously. Four examiners of varied experience assessed 12 healthy participants in two visits separated by 48h. Seven QST procedures to determine sensory thresholds were used: cold detection (CDT), warmth detection (WDT), cold pain (CPT), heat pain (HPT), mechanical detection (MDT), mechanical pain (MPT) and pressure pain (PPT). Mixed linear models were used to estimate variance components for reliability assessment; ...
Quintessence international (Berlin, Germany : 1985), Jan 15, 2016
To evaluate the accuracy of a questionnaire modified for the identification of intraoral pain wit... more To evaluate the accuracy of a questionnaire modified for the identification of intraoral pain with neuropathic characteristics in a clinical orofacial pain sample population. 136 participants with at least one of four orofacial pain diagnoses (temporomandibular disorders [TMD, n = 41], acute dental pain [ADP, n = 41], trigeminal neuralgia [TN, n = 19], persistent dentoalveolar pain disorder [PDAP, n = 14]) and a group of pain-free controls (n = 21) completed the modified S-LANSS, a previously adapted version of the original questionnaire devised to detected patients suffering from intraoral pain with neuropathic characteristics. Psychometric properties (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) were calculated in two analyses with two different thresholds: (1) Detection of pain with neuropathic characteristics: PDAP + TN were considered positive, and TMD + ADP + controls were considered negative per gold standard (expert opinion). (2...
Two groups of patients with orofacial pains that are clinically important to distinguish from eac... more Two groups of patients with orofacial pains that are clinically important to distinguish from each other are patients with odontogenic pain and temporomandibular disorder (TMD) pain. The aim of this study was to determine the sensitivity and specificity of 2 screening instruments in distinguishing between patients with these types of pain. A convenience sample of patients seeking care at an endodontic clinic and an orofacial pain clinic were recruited. The 14-item dental pain questionnaire (DePaQ) was used to screen for odontogenic pain and the 6-item TMD screener was used to screen for TMD pain. Sensitivity and specificity calculations with 95% confidence intervals (CIs) were performed for both instruments, and thresholds/acceptability/performance was assessed using published guidelines. Thirty-four patients with odontogenic pain and 37 patients with TMD pain were included in this study. The sensitivity of the DePaQ was 0.85 (95% CI, 0.69-0.95), and specificity was 0.11 (95% CI, 0....
The purpose of this study was to determine whether botulinum toxin A (BTX-A) was efficacious for ... more The purpose of this study was to determine whether botulinum toxin A (BTX-A) was efficacious for the treatment of chronic moderate to severe jaw muscle pain in females. This was a randomized double-blind, placebo-controlled crossover trial of BTX-A. Twenty five units injected into each temporalis muscle and 50 U injected into each masseter muscle using three sites per muscle with 0.2 cm 3 per site. Data were collected at baseline, 8, 16, 24 weeks, with crossover occurring at 16 weeks. Primary outcome variables were pain intensity and unpleasantness, measured by horizontal visual analog scale (VAS). Secondary outcome variables were maximum interincisal opening without and irrespective of pain, muscle palpation tenderness (12 points), and four general questions. Fifteen female patients were enrolled (18-45 years), but only ten completed the trial. Of those who finished, no statistically significant difference was found in pain intensity (P ¼ 0:10), unpleasantness (P ¼ 0:40), palpation...
Nasolabial cyst is a rare non-odontogenic, soft-tissue, developmental cyst occurring inferior to ... more Nasolabial cyst is a rare non-odontogenic, soft-tissue, developmental cyst occurring inferior to the nasal alar region. The patient usually presents with a slowly enlarging asymptomatic swelling, typically without radiographic abnormalities. This paper documents the presentation and management of a 46-year-old woman with a nasolabial cyst. The histopathologic features, differential diagnosis, treatment and prognosis are discussed.
Complex regional pain syndrome (CRPS) is a chronic condition that usually affects extremities, su... more Complex regional pain syndrome (CRPS) is a chronic condition that usually affects extremities, such as the arms or legs. It is characterized by intense pain, swelling, redness, hypersensitivity in a region not defined by a single peripheral nerve and additional sudomotor effects, such as excessive sweating. The clinical criteria for the diagnosis of sympathetically maintained pain as outlined by the International Association for the Study of Pain include: Onset following an initiating noxious event (CRPS-type I) or nerve injury (CRPS-type II). Spontaneous allodynia that is not limited to peripheral nerve distribution and is not proportionate to the inciting event; abnormal sudomotor activity, skin blood flow abnormality, edema, other autonomic symptoms; and exclusion of other conditions that may otherwise contribute to the extent of the symptoms. Only 13 cases of CRPS involving sympathetically maintained pain in the head and neck region have been described, and all reported trauma a...
Non-odontogenic “tooth” pain characteristics are the key to identifying the underlying disorder: ... more Non-odontogenic “tooth” pain characteristics are the key to identifying the underlying disorder: a detailed pain history will guide most of the diagnostic process. Pain can be referred from local and distant structures, including musculoskeletal, neuropathic, and neurovascular sources. Response to provocation tests and administration of local anesthetic may help to rule out or confirm the origin of the pain, as well as determine therapeutic approaches. Treatment options vary widely by diagnosis and are directed at the mechanism of the source of pain. Missed non-odontogenic “tooth” pain diagnoses may result in unnecessary dental procedures, as well as continued symptomatology.
INTRODUCTION Examining the evolution of research parameters helps scientists to discover the well... more INTRODUCTION Examining the evolution of research parameters helps scientists to discover the well-developed and the neglected aspects of knowledge. Pain after root canal treatment is a health problem affecting millions of patients. Research in this field has a meaningful impact on quality of lives. The aim of this study was to analyze the evolution of research on post-operative pain over the past 50 years. METHODS Electronic searches were performed in Scopus and MEDLINE databases to identify studies on pain after non-surgical root canal treatments/retreatments. The full texts of eligible articles were reviewed to determine the study category, and to extract and analyze the methodological variables. A series of statistical analyses were performed to determine the trend of publications based on variable of interest overtime. RESULTS 424 articles were included. There was a positive trend for systematic reviews, studies with sample size <200, studies on single-visit treatment, and clinical trials on instrumentation and adjunct treatments (P<0.05). There was a negative trend for use of numeric rating scales, studies on multiple-visit treatments, clinical trials on medication/medicament, and studies on pain in maxillary incisors (P<0.05). No trend was observed based on pulpal diagnosis or for studies with longer observation periods (>8 weeks) (P>0.05). CONCLUSIONS A paradigm shift is needed towards clinical studies with larger sample sizes, longer observation periods, and more focus on pulpal diagnoses associated with higher rates of post-operative pain. There is a need to view post-operative pain as an important patient-centered outcome, and to develop and disseminate standard reporting guidelines for future studies.
INTRODUCTION The aim of this study was to identify preoperative factors associated with local ane... more INTRODUCTION The aim of this study was to identify preoperative factors associated with local anesthesia failure. METHODS The National Dental Practice-Based Research Network (www.NationalDentalPBRN.org) data from 534 patients that received a non-surgical root canal treatment completed in a single appointment were included in this analysis. Three methods for defining anesthesia failure were used: Definition 1- patient-reported level of numbness, Definition 2- provider-reported quality of anesthesia, and definition 3- provider reported use of supplemental anesthesia. Fifty-one pre-operative factors were investigated and analyzed individually against the overall failure rate for each method, and multivariate GEE logistic models were fit with predictors chosen using stepwise model selection to evaluate factors that may interact with each other. RESULTS Overall anesthesia failure rates were 5%, 15% and 30% for definitions 1, 2 and 3 respectively. Provider experience, diabetes, absence of sharp or ache pain, absence of smoking, and a fair expected outcome were associated with anesthesia failure (definition 1). Provider level of training, absence of sinus tract, bite sensitivity, and stress making the pain worse were associated with anesthesia failure (definition 2). Provider level of training, pain provoked by stimulus, mandibular teeth, teeth with vital pulps and pain interfering with daily activities were associated with the use of supplemental anesthesia (definition 3). CONCLUSIONS With the range of 5% to 30% of anesthesia failures, a few common factors across the models assessed were elucidated. Providers with higher levels of training had significantly fewer anesthesia failures. Patient self-reported history of diabetes and preoperative pain-related interference with daily activities was associated with more anesthesia failures. Greater severity of various tooth-related pain characteristics, as a group but not individually, accounted for more anesthesia failures.
INTRODUCTION Periapical images are routinely made in endodontics to support diagnosis and treatme... more INTRODUCTION Periapical images are routinely made in endodontics to support diagnosis and treatment decisions, but conventional imaging may not readily demonstrate inflammatory changes. This study aims to 1) quantify disagreement in the radiologic interpretation of apical periodontitis/rarefying osteitis between 2 expert examiners; and 2) determine if differences exist based on anatomical location. METHODS We used 1717 pre-treatment periapical images made prior to orthograde endodontic treatment as part of the Predicting Outcomes of Root Canal Treatment (PREDICT) study conducted within the National Dental Practice-Based Research Network. Periapical changes were assessed independently by two board-certified specialists, an oral and maxillofacial radiologist and an endodontist, blinded to other clinical information. If the examiners disagreed about whether a diagnosis of apical periodontitis/rarefying osteitis was justified, an adjudication was made by a third examiner. RESULTS The overall prevalence of this radiologic diagnosis in the periapical images was 55% and inter-examiner agreement measured with Cohen's kappa was calculated to be 0.56 (95% Confidence Interval 0.52, 0.60). Diagnostic disagreements between the two examiners occurred for 377 teeth (22%) with disagreements more frequent for jaw location (p=0.038) and tooth type (p=0.021). Differences between root number (p=0.058), and jaw location and tooth groups (p=0.069) were found not to be statistically significant. CONCLUSIONS The variability of diagnostic disagreements across anatomical location and tooth type may reflect the inability of periapical images to reveal bone changes masked by the complexity and density of overlying anatomical structures; a limitation that could potentially be overcome with the use of three-dimensional imaging.
INTRODUCTION Clinical presentation of oromandibular dystonia (OMD) is variable that can be furthe... more INTRODUCTION Clinical presentation of oromandibular dystonia (OMD) is variable that can be further complicated by the presence of temporomandibular disorder (TMD) symptoms. We sought to evaluate variations in the clinical presentation of OMD patients, particularly TMD-related characteristics, in two clinical settings. METHODS In a cross-sectional study design, a Web-based data collection survey was provided to eligible patients with OMD from movement disorder (MD) and oro-facial pain (OFP) clinics. The survey questionnaire was designed to collect information on demographic characteristics, clinical presentation particularly related to TMD, quality of life and treatment outcomes. Validated questionnaires were used when available such as the TMD Pain Screener, EuroQol 5-Dimensions 5-Levels (EQ-5D-5L), Jaw Functional Limitation Scale and Global Rating of Change Scale. RESULTS Of 53 eligible patients, 31 responded to the survey for a 58% response rate. Forty-eight per cent of patients in the MD clinic and 60% of patients in the OFP clinic reported jaw pain along with involuntary movements. Of those, 90% from the MD group and 83% from the OFP group screened positive with the TMD Pain Screener at the onset of symptoms based on recall. Positive TMD Pain Screener response was observed in about 40% of patients in both clinics within 30 days of questionnaire response. No statistically significant differences were observed between two groups for any measured variables. CONCLUSION Patients with OMD have features of TMD, irrespective of the clinical setting in which they seek and receive care. OMD patients from both clinics were similar in terms of clinical presentation, quality of life and treatment outcomes.
Pain is a common symptom in endodontic conditions, but differential diagnostic procedures are oft... more Pain is a common symptom in endodontic conditions, but differential diagnostic procedures are often needed to exclude other pain origins. General dentists and endodontists thus need to be aware of alternative painful orofacial conditions, and be able to identify them. The new International Classification of Orofacial Pain (ICOP, 2020) is the first comprehensive classification that uniquely deals with orofacial pain. The ICOP is a hierarchical classification, modelled on the International Classification of Headache Disorders (ICHD-3) and covers pain in dentoalveolar and anatomically related tissues, muscle pain, temporomandibular joint (TMJ) pain, neuropathic pain affecting cranial nerves, pain resembling primary headaches, and idiopathic pain in the orofacial region. A description of each condition is given, and structured diagnostic criteria for each condition are proposed based on research data when available. This narrative review aims to (i) give an overview and brief explanation of the ICOP system, (ii) describe and give examples of how it can be of use to general dentists and endodontists with special attention to differential diagnosis of tooth pain, and (iii) highlight how endodontic research can contribute to validation and improvement of the classification. A comparison to other classification and diagnostic systems is also included.
Aim Little is known about short-lasting unilateral neuralgiform headache attacks with conjunctiva... more Aim Little is known about short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). We present our experience with SUNCT/SUNA patients to aid identification and management of these disorders. Methods A retrospective review of patient records of one orofacial pain clinic was performed. Inclusion criteria was a diagnosis of SUNCT/SUNA confirmed with at least one follow-up visit. Results Six of the 2464 new patients seen between 2015–2018 met the selection criteria (SUNCT n = 2, SUNA n = 4). Gender distribution was one male to one female and average age of diagnosis was 52 years (range 26–62). Attacks were located in the V1/V2 trigeminal distributions, and five patients reported associated intraoral pain. Pain quality was sharp, shooting, and burning with two patients reporting “numbness”. Pain was moderate-severe in intensity, with daily episo...
INTRODUCTION Magnetic resonance imaging (MRI) has the potential to aid in determining the presenc... more INTRODUCTION Magnetic resonance imaging (MRI) has the potential to aid in determining the presence and extent of cracks/fractures in teeth because of better contrast without ionizing radiation. The objectives were to develop MRI criteria for root crack/fracture identification and to establish reliability and accuracy in their detection. METHODS MRI-based criteria for crack/fracture appearance was developed by an MRI physicist and a panel of 6 dentists. Twenty-nine human adult teeth previously extracted after a clinical diagnosis of a root crack/fracture were frequency matched to 29 controls. Samples were scanned using an in vivo MRI protocol and the reference standard (ie, ex vivo limited field of view cone-beam computed tomographic [CBCT] imaging). A blinded, 4-member panel evaluated the images with a proportion randomly retested to establish intrarater reliability. Overall observer agreement, sensitivity, and specificity were computed for each imaging modality. RESULTS Subjectively, MRI has increased crack/fracture contrast and is less prone to artifacts from radiodense materials relative to CBCT imaging. Intrarater reliability for MRI was fair to excellent (κ = 0.38-1.00), and for CBCT imaging, it was moderate to excellent (κ = 0.66-1.00). Sensitivity for MRI was 0.59 (95% confidence interval [CI], 0.39-0.76; P = .46), and for CBCT imaging, it was 0.59 (95% CI, 0.59-0.76; P = .46). Specificity for MRI was 0.83 (95% CI, 0.64-0.94; P < .01), and for CBCT imaging, it was 0.90 (95% CI, 0.73-0.98; P < .01). CONCLUSIONS Despite advantages of increased contrast and the absence of artifacts from radiodense materials in MRI, comparable measures of sensitivity and specificity (to limited field of view CBCT imaging) suggest MRI quality improvements are needed, specifically in image acquisition and postprocessing parameters. Given the early stage of technology development, there may be a use for MRI in detecting cracks/fractures in teeth.
Measurement error of intraoral quantitative sensory testing (QST) has been assessed using traditi... more Measurement error of intraoral quantitative sensory testing (QST) has been assessed using traditional methods for reliability, such as intraclass correlation coefficients (ICCs). Most studies reporting QST reliability focused on assessing one source of measurement error at a time, e.g., inter- or intra-examiner (test-retest) reliabilities and employed two examiners to test inter-examiner reliability. The present study used a complex design with multiple examiners with the aim of assessing the reliability of intraoral QST taking account of multiple sources of error simultaneously. Four examiners of varied experience assessed 12 healthy participants in two visits separated by 48h. Seven QST procedures to determine sensory thresholds were used: cold detection (CDT), warmth detection (WDT), cold pain (CPT), heat pain (HPT), mechanical detection (MDT), mechanical pain (MPT) and pressure pain (PPT). Mixed linear models were used to estimate variance components for reliability assessment; ...
Quintessence international (Berlin, Germany : 1985), Jan 15, 2016
To evaluate the accuracy of a questionnaire modified for the identification of intraoral pain wit... more To evaluate the accuracy of a questionnaire modified for the identification of intraoral pain with neuropathic characteristics in a clinical orofacial pain sample population. 136 participants with at least one of four orofacial pain diagnoses (temporomandibular disorders [TMD, n = 41], acute dental pain [ADP, n = 41], trigeminal neuralgia [TN, n = 19], persistent dentoalveolar pain disorder [PDAP, n = 14]) and a group of pain-free controls (n = 21) completed the modified S-LANSS, a previously adapted version of the original questionnaire devised to detected patients suffering from intraoral pain with neuropathic characteristics. Psychometric properties (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) were calculated in two analyses with two different thresholds: (1) Detection of pain with neuropathic characteristics: PDAP + TN were considered positive, and TMD + ADP + controls were considered negative per gold standard (expert opinion). (2...
Two groups of patients with orofacial pains that are clinically important to distinguish from eac... more Two groups of patients with orofacial pains that are clinically important to distinguish from each other are patients with odontogenic pain and temporomandibular disorder (TMD) pain. The aim of this study was to determine the sensitivity and specificity of 2 screening instruments in distinguishing between patients with these types of pain. A convenience sample of patients seeking care at an endodontic clinic and an orofacial pain clinic were recruited. The 14-item dental pain questionnaire (DePaQ) was used to screen for odontogenic pain and the 6-item TMD screener was used to screen for TMD pain. Sensitivity and specificity calculations with 95% confidence intervals (CIs) were performed for both instruments, and thresholds/acceptability/performance was assessed using published guidelines. Thirty-four patients with odontogenic pain and 37 patients with TMD pain were included in this study. The sensitivity of the DePaQ was 0.85 (95% CI, 0.69-0.95), and specificity was 0.11 (95% CI, 0....
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