Showing papers on "Orofacial pain published in 2009"

Motor cortex stimulation for the treatment of refractory peripheral neuropathic pain

Abstract: Epidural motor cortex stimulation (MCS) has been proposed as a treatment for chronic, drug-resistant neuropathic pain of various origins. Regarding pain syndromes due to peripheral nerve lesion, only case series have previously been reported. We present the results of the first randomized controlled trial using chronic MCS in this indication. Sixteen patients were included with pain origin as follows: trigeminal neuralgia (n = 4), brachial plexus lesion (n = 4), neurofibromatosis type-1 (n = 3), upper limb amputation (n = 2), herpes zoster ophthalmicus (n = 1), atypical orofacial pain secondary to dental extraction (n = 1) and traumatic nerve trunk transection in a lower limb (n = 1). A quadripolar lead was implanted, under radiological and electrophysiological guidance, for epidural cortical stimulation. A randomized crossover trial was performed between 1 and 3 months postoperative, during which the stimulator was alternatively switched 'on' and 'off' for 1 month, followed by an open phase during which the stimulator was switched 'on' in all patients. Clinical assessment was performed up to 1 year after implantation and was based on the following evaluations: visual analogue scale (VAS), brief pain inventory, McGill Pain questionnaire, sickness impact profile and medication quantification scale. The crossover trial included 13 patients and showed a reduction of the McGill Pain questionnaire-pain rating index (P = 0.0166, Wilcoxon test) and McGill Pain questionnaire sensory subscore (P = 0.01) when the stimulator was switched 'on' compared to the 'off-stimulation' condition. However, these differences did not persist after adjustment for multiple comparisons. In the 12 patients who completed the open study, the VAS and sickness impact profile scores varied significantly in the follow-up and were reduced at 9-12 months postoperative, compared to the preoperative baseline. At final examination, the mean rate of pain relief on VAS scores was 48% (individual results ranging from 0% to 95%) and MCS efficacy was considered as good or satisfactory in 60% of the patients. Pain relief after 1 year tended to correlate with pain scores at 1 month postoperative, but not with age, pain duration or location, preoperative pain scores or sensory-motor status. Although the results of the crossover trial were slightly negative, which may have been due to carry-over effects from the operative and immediate postoperative phases, observations made during the open trial were in favour of a real efficacy of MCS in peripheral neuropathic pain. Analgesic effects were obtained on the sensory-discriminative rather than on the affective aspect of pain. These results suggest that the indication of MCS might be extended to various types of refractory, chronic peripheral pain beyond trigeminal neuropathic pain.

The impact of orofacial pain on the quality of life of patients with temporomandibular disorder.

Abstract: Aims: To evaluate the relationships between gender, diagnosis, and severity of temporomandibular disorders (TMD) with self-reports of the impact of TMD on the quality of life. Methods: Eighty-three individuals seeking TMD treatment at the Dental School of Pontifical Catholic University Minas from May to August 2005 were evaluated by a single examiner who was trained and calibrated for diagnosis according to criteria of Axis I of the Research Diagnostic Criteria for TMD (RDC/TMD). The severity of TMD was established by the Temporomandibular Index and the impact on quality of life by the Oral Health Impact Profile (OHIP 14). Complete data were available for 78 of the 83 initial patients and evaluated by the Mann-Whitney test and Spearman correlation analysis. Results: Except for one patient, all individuals showed some impact related to physical pain. Of the seven aspects evaluated on the OHIP 14, women presented a greater impact than men only for functional limitations (Mann-Whitney, P < .05). Patients presenting with diagnoses of muscular disorders (group I) or osteoarthritis (group III) reported a greater impact than those without (P < .05). The Spearman test demonstrated a significant correlation between impact on quality of life and severity of TMD (P < .05). Conclusion: Orofacial pain had a great impact on the quality of life of individuals with TMD, without group difference between genders. The presence of muscular disorders (group I) and osteoarthritis (group III) was related to greater impact on quality of life, which was not observed for diagnoses of disc displacement (group II). A correlation between severity of TMD and impact on quality of life was clearly observed.

Neuropathic and nociceptive pain in head and neck cancer patients receiving radiation therapy

Abstract: Background Pain is common in head and neck cancer (HNC) patients and may be attributed to the malignancy and/or cancer treatment. Pain mechanisms and patient report of pain in HNC are expected to include both nociceptive and neuropathic components. The purpose of this study was to assess the trajectory of orofacial and other pain during and following treatment, using patient reports of neuropathic pain and nociceptive pain and pain impact.

Burning mouth syndrome and psychological disorders

Abstract: Burning mouth syndrome (BMS) is an oral dysaesthesia that causes chronic orofacial pain in the absence of a detectable organic cause. The aetiology of BMS is complex and multifactorial, and has been associated in the literature with menopause, trigger events and even genetic polymorphisms. Other studies have found evidence for mechanisms such as central and peripheral nervous system changes, with clinical and laboratory investigations supporting a neuropathologic cause. These physiological explanations notwithstanding, there is still much evidence that BMS aetiology has at least some psychological elements. Somatoform pain disorder has been suggested as a mechanism and factors such as personality, stress, anxiety, depression and other psychological, psychosocial and even psychiatric disorders play a demonstrable role in BMS aetiology and symptomatology. In order to treat BMS patients, both physiological and psychological factors must be managed, but patient acceptance of possible components of psychological disease basis is a major hurdle. Clinical signs of patient stress, anxiety or depression are a useful reinforcement of clinical discussions. The current paper proposes a number of clinical signs that may be useful for both clinical assessment and subsequent patient discussions by providing visible supportive evidence of the diagnosis.

Momentary pain and coping in temporomandibular disorder pain: exploring mechanisms of cognitive behavioral treatment for chronic pain.

Abstract: The purpose of this study was to determine whether cognitive–behavioral treatment (CBT) operates by effecting changes in cognitions, affects, and coping behaviors in the context of painful episodes. Patients were 54 men and women with temporomandibular dysfunction-related orofacial pain (TMD) enrolled in a study of brief (6 weeks) standard conservative treatment (STD) or standard treatment plus CBT (STD + CBT). Momentary affects, pain, and coping processes were recorded on a cell phone keypad four times per day for 7 days prior to treatment, and for 14 days after treatment had finished, in an experience sampling paradigm. Analyses indicated no treatment effects on general retrospective measures of pain, depression, or pain-related interference with lifestyle at post-treatment. However, mixed model analyses on momentary pain and coping recorded pre- and post-treatment indicated that STD + CBT patients reported greater decreases in pain than did STD patients, significantly greater increases in the use of active cognitive and behavioral coping, and significantly decreased catastrophization. Analyses of experience sampling data indicated that post-treatment momentary pain was negatively predicted by concurrent active coping, self-efficacy, perceived control over pain, and positive-high arousal affect. Concurrent catastrophization was strongly predictive of pain. Active behavioral coping and self-efficacy reported at the prior time point (about 3 h previously) were also protective, while prior catastrophization and negative-high arousal mood were predictive of momentary pain. The results suggest that CB treatment for TMD pain can help patients alter their coping behaviors, and that these changes translate into improved outcomes.

Differential involvement of trigeminal transition zone and laminated subnucleus caudalis in orofacial deep and cutaneous hyperalgesia: the effects of interleukin-10 and glial inhibitors

Abstract: Background In addition to caudal subnucleus caudalis (Vc) of the spinal trigeminal complex, recent studies indicate that the subnuclei interpolaris/caudalis (Vi/Vc) transition zone plays a unique role in processing deep orofacial nociceptive input. Studies also suggest that glia and inflammatory cytokines contribute to the development of persistent pain. By systematically comparing the effects of microinjection of the antiinflammatory cytokine interleukin (IL)-10 and two glial inhibitors, fluorocitrate and minocycline, we tested the hypothesis that there was a differential involvement of Vi/Vc and caudal Vc structures in deep and cutaneous orofacial pain.

Evaluation of antihyperalgesic effect of curcumin on formalin-induced orofacial pain in rat.

Abstract: The present study was planned to evaluate the role of curcumin in the formalin-induced orofacial pain in rats that mimics typical human orofacial pain. Adult Wistar rats of either sex received an injection of 50 microL of 5% v/v subcutaneous formalin injection into one vibrissal pad and consequent facial grooming behavior was monitored. Animals exhibited two distinct periods of nocifensive grooming: (a) an acute phase lasting 0-6 min; and (b) a tonic phase lasting 6-45 min. The analgesic response of curcumin was observed at doses of 25, 50, 100, 200, 400 and 600 mg/kg i.p., administered 15 min prior to formalin injection. Another group received subanalgesic dose of diclofenac (0.2 mg/kg) and curcumin 25 mg/kg. Curcumin and diclofenac were administered 15 and 5 min prior to formalin injection respectively. Curcumin produced a dose-dependent inhibition of facial grooming in both acute and tonic phases compared to vehicle and potentiated the subanalgesic dose of diclofenac. The study results for the first time demonstrated the per se antinocifensive effect of curcumin and also exhibited a synergistic interaction with the subanalgesic dose of an NSAID in the facial pain model. More studies are necessary to elucidate the mechanisms of curcumin in this model of pain.

Experimental occlusal interference induces long-term masticatory muscle hyperalgesia in rats.

Abstract: Temporomandibular joint or related masticatory muscle pain represents the most common chronic orofacial pain condition. Patients frequently report this kind of pain after dental alterations in occlusion. However, lack of understanding of the mechanisms of occlusion-related temporomandibular joint and muscle pain prevents treating this problem successfully. To explore the relationship between improper occlusion (occlusal interference) and masticatory muscle pain, we created an occlusal interference animal model by directly bonding a crown to a maxillary molar to raise the masticating surface of the tooth in rats. We raised the occlusal surface to three different heights (0.2, 0.4, and 0.6mm), and for one month we quantitatively measured mechanical nociceptive thresholds of the temporal and masseter muscles on both sides. Results showed a stimulus-response relationship between the height of occlusal interference and muscle hyperalgesia. Removal of the crown 6 days after occlusal interference showed that the removal at this time could not terminate the 1 month duration of mechanical hyperalgesia in the masticatory muscles. Lastly, we systemically administered NMDA antagonist MK801 (0.2, 0.1, and 0.05 mg/kg) to the treated rats and found that MK801 dose dependently attenuated the occlusal interference-induced hyperalgesia. These findings suggest that occlusal interference is directly related to masticatory muscle pain, and that central sensitization mechanisms are involved in the maintenance of the occlusal interference-induced mechanical hyperalgesia.

The prevalence of clinical diagnostic groups in patients with temporomandibular disorders.

Abstract: The aim of this study was to observe the prevalence of diagnostic groups of temporomandibular disorders (TMD) in patients who were referred or sought treatment for TMD and/or orofacial pain in a private clinic. The clinical records of 357 patients were evaluated and selected based on inclusion/exclusion criteria; the mean age was 32 years. A clinical examination was performed and the diagnosis was based on the American Academy of Orofacial Pain criteria. Results showed that 86.8% of patients were women and 93.3% of the patients presented more than one diagnosis. The most frequent chief complaint (n=216, χ2= 30.68, p=0.001) and total diagnosis realized (n= 748, χ2=14.14, p=0.001) were muscle related. We concluded that women seek treatment for dysfunction/disorders of orofacial structures more than men do; patients seeking specialized treatment have more than one diagnosis and muscle dysfunction is more prevalent than intra-articular disorders.

The changing field of temporomandibular disorders: what dentists need to know.

Abstract: Diagnosis and treatment of temporomandibular disorders (TMDs) have been within the domain of dentistry for many decades. However, the field of TMDs and other causes of orofacial pain is undergoing a radical change, primarily because of an explosion of knowledge about pain management in general. As a result, etiological theories about TMDs are evolving toward a biopsychosocial medical model from the traditional dental framework. Conservative and reversible management approaches (especially of chronic pain conditions) are becoming the norm rather than the exception in treating TMD patients, and already certain biological and psychosocial factors are known to affect the outcomes. Current research in this field is focused on genetic and environmental susceptibility factors as well as individual adaptive potentials. To continue as the main providers of care for TMD patients, dentists will need to recognize and appreciate these important changes.

Diagnostic accuracy of temporomandibular disorder pain tests : a multicenter study

Abstract: AIMS: To estimate the diagnostic accuracy of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) clinical examination and of the dynamic/static tests for the recognition of TMD pain. Since the diagnosis of TMD pain is especially complicated in persistent orofacial pain patients, the test outcomes in persistent TMD pain patients were contrasted to those in two control groups: a group of persistent dental pain patients and a group of pain-free subjects. METHODS: In 125 persistent TMD pain patients, 88 persistent dental pain patients, and 121 pain-free subjects, a blind and standardized clinical examination was performed. RESULTS: For the RDC/TMD, sensitivity (88%) was high and specificity was low (pain-free group: 71%; dental pain group: 45%). For the dynamic/static tests, sensitivity was 65% and specificities were 91% and 84%, respectively. Comparing the outcomes of the two examinations showed higher positive likelihood ratios for dynamic/static tests (P < .001), and lower negative likelihood ratios for the RDC/TMD examination (P < .01). CONCLUSION: For the confirmation of a suspicion of TMD pain, it is better to rely on positive dynamic/static tests. To confirm the absence of TMD pain, it is better to rely on a negative RDC/TMD examination.

Clinical characteristics and diagnosis of atypical odontalgia: implications for dentists.

Abstract: Background Atypical odontalgia (AO) is a poorly understood and commonly misdiagnosed condition for which patients often undergo multiple unsuccessful dental or surgical procedures. The authors conducted a study to determine the prevalence and describe the characteristics of patients with AO seen at the University of Southern California Orofacial Pain and Oral Medicine Center (USC OFP-OM Center), Los Angeles. Methods The authors conducted a retrospective record review from a database of more than 3,000 patient records from June 2003 to August 2007 to identify patients diagnosed with AO. Results The authors identified 64 patients (44 women and 20 men) between the ages of 26 and 93 years as having a diagnosis of AO. Of those 64 patients, 71 percent initially consulted a dentist regarding their pain, and 79 percent had undergone dental treatment that failed to resolve the pain. The pain of 64 percent of the patients had no known cause. Conclusions Dentists, who often are the first health care providers to see patients with AO, must be aware of this condition and must follow the appropriate steps to determine its diagnosis. Clinical Implications Dentists and physicians should understand the implications and importance of early diagnosis of patients with AO and of referral to pain specialists for treatment.

Synergism between NSAIDs in the orofacial formalin test in mice.

Abstract: Opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are used to relieve acute and chronic pain. The purpose of this study was to determine the degree of interaction between dexketoprofen and NSAID examples of COXs inhibitors using the isobolographic analysis in the formalin orofacial test in mice. The drugs, i.p., induced a dose-dependent antinociception with different potencies in both test phases. Combinations of dexketoprofen with naproxen, nimesulide, ibuprofen or paracetamol on the basis of the fixed ratio (1:1) of their ED(50)'s values alone demonstrated synergism in both phases. This is important since the orofacial pain is a test not currently used in mice; the drugs are all analgesic for humans and phase II is representative of inflammatory pain. The synergism was: COX-3>COX-2>COX-1 inhibitors, this is particularly interesting since the inhibitor of COX-3, paracetamol, displayed a robust anti-inflammatory activity in an assay of acute and inflammatory pain that mimics inflammatory pain in humans. In conclusion, the synergism of the dexketoprofen/NSAID combinations may improve this type of therapeutic profile, since with low doses of the components, side effects are not likely to occur, and they may be used in long-term treatments.

Clinical Oral Medicine and Pathology

Abstract: 1. Normal Oral Anatomy 2. Variants of Normal and Common Benign Conditions 3. Diagnostic Tests and Studies 4. White Lesions 5. Ulcerative Lesions and immune-mediated lesions 6. Pigmented Lesions 7. Infectious Lesions 8. Salivary Gland Disease 9. Oral Cancer 10. Orofacial Pain Conditions 11. Oral Manifestations of Systemic Disease 12. Differential Diagnosis Algorithms

Temporomandibular disorders and orofacial pain

Abstract: Summary Temporomandibular disorders (TMDs) is a collective term for a number of pathologic conditions of the masticatory system. Their symptomatology is diverse, with orofacial pain being one of the most common symptoms which causes a particular discomfort to the patients. Often, TMDs have a very clear etiology, but sometimes it is completely unknown. They are related to different etiologic factors and comorbid conditions, which aggravates precise diagnostics. This pathology requires team work and a multidisciplinary approach, timely detection of causes and a meticulous selection of treatment procedures, particularly for management of orofacial pain, which can be very demanding in terms of differential diagnostics. There are certain facts which are still unclear; hence notable improvements in approaching this issue are expected. The existing diagnostic classification should be changed and primarily based on etiology instead of symptomatology, which is the current tendency. Also, uniform diagnostic guidelines as well as treatment protocols should be established and that would enhance a multidisciplinary collaboration, which is essential while dealing with this kind of pathology. Special attention should be paid to the development of preventive measures based on scientific evidence that is still ne glected.

Self-reports of pain-related awakenings in persistent orofacial pain patients.

Abstract: Aims: To assess whether pain-related awakenings occur with persistent orofacial pain conditions and whether it is related to pain severity. Methods: Reports of pain-related awakening were prospectively collected at initial interview, prior to treatment, during a 24-month period from 328 patients with orofacial pain. The pain conditions were diagnosed according to the International Headache Society, the American Academy of Orofacial Pain, and the Research Diagnostic Criteria for Temporomandibular Disorders. Results: Pain-related awakening was significantly correlated to pain intensity (odds ratio [OR] 1.5, 95% confidence intervals [CI] 1.3-1.8; P < .001), the total muscle tenderness score (OR 1.1, 95% CI 1.01-1.14; P = .03), and the presence of lacrimation (OR 4.6, 95% CI 1.7-12.3; P = .002) but not to the clinical diagnosis. Two groups of patients were specifically examined; patients with masticatory myofascial pain (MMP) and patients with classical trigeminal neuralgia (CTN). Twenty-eight of the 120 MMP patients (23.3%) reported pain-related awakening and this was associated with a high muscle tenderness score (OR 1.13, 95% CI 1.01-1.3; P = .02) and unilaterality of pain (OR 3.9, 95% CI 1.2-12.3; P = .02). Seven of the 31 patients with CTN (22.6%) reported pain-related awakenings. Continuous background pain was the most significant parameter associated with awakening (OR 26, 95% CI 1.1-594; P < .05). Conclusion: Persistent orofacial pain often induced pain-related awakening and this was significantly associated with pain intensity.

Orofacial pain in young adults and associated childhood and adulthood factors: results of the population study, Wales, United Kingdom.

Abstract: Objectives: The aim of the study was to investigate the prevalence of orofacial pain (OFP) among young adults (30-31 years old) and to determine the effect of childhood and adulthood risk factors on the occurrence of OFP. Methods: Prospective cohort study to investigate dental and social effects of malocclusion and effectiveness of orthodontic treatment was conducted in Wales, United Kingdom. At 20-year follow-up 337 subjects aged 30-31 participated (74% from previous follow-up aged 19-20 and 33% from the baseline) and were asked about OFP. Results: The prevalence of OFP was 23% (95% CI: 19%, 28%). Childhood factors, socio-demographic, lifestyle, health behavior factors, history of orthodontic treatment and tooth wear were not associated with OFP. Participants with OFP were more likely to report that their teeth did not fit together properly [odds ratio (OR) = 12.4, 95% CI: 2.7-56.5) and reported previous trauma to the jaws (2.3; 1.3-4.2). Both diurnal and nocturnal teeth clenching and grinding were significantly associated with OFP (3.1; 1.4-7.1). Participants with frequent headaches had increased risk of having OFP (3.7; 1.6-8.4) while having reported 4-10 types of pain in other parts of the body other than the head, was associated with OR = 9.2 (3.7-23.0). An increased tendency to have OFP was seen in those individuals with higher levels of psychological distress (2.3; 1.4-3.9), high score on Life Event Inventory (2.6; 1.3-5.3), depressive symptoms (2.2; 1.2-4.0) and stress (2.2; 1.2-4.0). High self-esteem associated with lower risk of OFP (0.5; 0.3-0.9). Conclusions: This study shows that OFP is frequently reported by young adults aged 30-31 and supports a multifactorial etiology with factors from many domains, including local mechanical factors, psychological and co-morbidities. However, none of the childhood factors considered in this study were associated with OFP in adulthood.

A retrospective analysis of temporomandibular findings among Israeli-born patients based on the RDC/TMD.

Abstract: The purpose of this study was to evaluate temporomandibular disorders (TMD) Axis I and II among Israeli-Jewish patients using the Hebrew version of the Research Diagnostic Criteria (RDC) for TMD and to compare the results with Swedish, United States, Asian and Israeli-Arab populations. The study consisted of 298 Israeli-born, Jewish patients (male/female ratio 3.5:1), arriving at an Orofacial Pain Clinic during the year 2001-2004. A complete clinical examination was carried out according to the RDC/TMD protocol. Axis I diagnoses: 65% of the Israeli-Jewish patients exhibited myofacial pain (Group I disorder), 38% disc displacement (Group II disorder) and 18% arthralgia, osteoarthritis or osteoarthrosis (Group III disorder). Axis II diagnoses: 20% of the patients scored severe depression and 35% scored somatization. Pain was reported in 82% of the patients (mean pain duration 35.7-33.8 months for women, 44.1 for men). Patients had an average disability score of 30.0 +/- 30.2. Chronic pain grade IV was present in 4% of the patients. Israeli-Jewish temporomandibular disorder patients showed results similar to those reported for other countries, further supporting the use of the RDC/TMD internationally as a reliable epidemiological tool. Globally, Axis I scores were similar, while Axis II scores were more susceptible to geographic/ethnic differences. Gender can influence Axis I and Axis II as well as possible gender specific association with socio-economic status. In future comparisons, men and women should be considered separately.

PRISM (pictorial representation of illness and self measure): a novel visual instrument to assess pain and suffering in orofacial pain patients.

Abstract: AIMS: To use PRISM (Pictorial Representation of Illness and Self Measure), a visual instrument that has recently been developed and validated to assess suffering in patients with chronic physical illness, in orofacial pain patients and test for associations of PRISM with established assessment tools for pain, affective symptoms, and sleep. Of particular interest was the utility of PRISM as a screening tool for severely suffering patients. METHODS: One hundred and two orofacial pain patients recruited from a specialized outpatient service completed a questionnaire-based survey, including established assessment tools: the Visual Analog Scale (VAS), Graded Chronic Pain Scale (GCPS), the Hospital Anxiety and Depression Scale (HADS), and the Insomnia Severity Index (ISI), as well as a paper and pencil version of PRISM. RESULTS: Of the 102 patients who submitted the clinical questionnaire, 74 performed the PRISM-test (response rate: 72%). PRISM scores correlated strongly with all subscores of pain (measured by GCPS) and sleep (measured by ISI). Further, a trend was observed in the correlation with affective symptoms measured by the HADS. PRISM could readily detect patients with high, pain-related suffering. CONCLUSION: These data add support to the hypothesis that the PRISM task in its paper and pencil version is measuring the burden of suffering. The clinical utility of this simple graphic tool therefore lies in its potential to alert clinicians to a high burden of suffering and thus it may help to identify orofacial pain patients who may benefit from more comprehensive assessment and treatment. Prospective studies are needed to clarify this claim.

An up-to-date view on persistent idiopathic facial pain.

Abstract: Previously called atypical facial pain, persistent idiopathic facial pain (PIFP) is a common, but poorly defined entity. The cause of PIFP is unknown, but surgery or injury in the distribution of the trigeminal nerve could be reported as early event. Treatment is often unsatisfactory and quality research relating management of this condition is missing. Psychologi-cal distress is frequently observed in patients suffering from persistent idiopathic facial pain. The present review aims at presenting the available knowledge of this elusive orofacial pain condition.

Posttraumatic stress disorder symptoms and chronic orofacial pain: an empirical examination of the mutual maintenance model.

Abstract: Aims: As there is a high correspondence between the experience of trauma and posttraumatic stress disorder (PTSD) symptoms among chronic orofacial pain patients, study objectives included: (1) to document the nature of traumatic experiences and severity of PTSD symptoms among a female sample of orofacial pain patients, (2) to examine the relationship between PTSD symptoms and both pain-related and psychosocial outcomes, and (3) to use structural equation modeling (SEM) to test hypotheses of mediation derived from the Mutual Maintenance Model of chronic pain and PTSD. Methods: The study design was a cross-sectional, retrospective case series of 411 female patients (mean age 41.0, SD 13.1) who were seen at the University of Kentucky Orofacial Pain Center between 1997 and 2007. A series of correlational and SEM analyses were conducted to test study hypotheses. Results: Of the total sample, 23.6% (n = 97) reported PTSD symptoms consistent with a diagnosis of PTSD. Higher PTSD symptom reports were associated significantly (P < .01) with the following outcomes: symptoms of psychological and affective distress, life interference due to pain, receipt of punishing responses from one's spouse, limited activity levels, and poor sleep quality. SEM analyses indicated PTSD symptoms likely exert their influence on pain severity through depression and sleep quality. Conclusion: PTSD and depression screening as well as thorough sleep evaluations should be included in the routine assessment for orofacial pain patients and, if appropriate, referrals for treatment of PTSD symptoms should be considered part of the standard of care.

Role of psychosocial factors in the etiology of temporomandibular disorders: relevance of a biaxial diagnosis.

Abstract: AIM The prevalence of temporomandibular disorders (TMD) is higher among women than men, indicating a multifactorial role for gender-related differences in the etiology of TMD: physiological hormonal differences, inflammatory response to stress, and sociocultural differences in response to pain. The aim of this study was to draw a biobehavioral picture of the TMD patient based on Research Diagnostic Criteria for TMD (RDC/TM) Axis II diagnosis and analysis of gender-related differences. METHODS Between January 2006 and January 2008, 362 subjects were consecutively enrolled from patients who presented at the Clinic for Temporomandibular Disorders, School of Dental Medicine, University of Pavia, because of orofacial pain, limitation or joint sounds on mandibular movement. Of the 362 subjects evaluated, 308 met the inclusion criteria. RESULTS The average age of the study population was 41 years; the female: male ratio was 4:1. When stratified according to chronic pain intensity grade and gender, 26% of the women had grade I, 36.4% grade II, 17% grade III, and 9.7% grade IV; 34.4% of the men had grade I, 32.8% grade II, 6.5% grade III, and 3.3% grade IV. Depression was moderate in 35 women and in 6 men and severe in 138 women and in 24 men; somatization was moderate in 59 women and in 20 men and severe in 143 women and in 19 men. CONCLUSIONS Gender-related differences may be considered risk factors for TMD; psychological characteristics, including somatization, depression, and anxiety related to gender, appear to have a significant impact on the prevalence of TMD.

Impact of tobacco use on the symptoms of painful temporomandibular joint disorders.

Abstract: This study examines the relationship between the severity of painful temporomandibular joint disorders (TMD) symptoms and current tobacco use in patients evaluated at a specialized orofacial pain clinic. Medical records, including responses to the Chronic Pain Grading Scale (CPGS), from 606 consecutive patients evaluated at the Mayo Clinic orofacial pain clinic with TMD by RDC-TMD criteria were retrospectively reviewed. Univariate analyses were performed comparing tobacco users and non-users. Analysis of covariance and multiple logistic regression models were used to adjust for demographic variables. A p value

The prevalence of orofacial pain and tooth fracture (odontocrexis) associated with SCUBA diving.

Abstract: AimTo assess the prevalence of orofacial complications associated with SCUBA (self-contained underwater breathing apparatus) diving Main outcome measures were prevalence of orofacial pain and odon