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Background@#The options for stabilization appliance therapy for masticatory muscle pain include soft occlusal and hard stabilization appliances. A previous study suggested that hard stabilization appliance therapy was effective for patients with local myalgia who developed long facets on their occlusal appliances. The objective of this study was to identify patients in whom a soft occlusal appliance should be used to treat masticatory muscle pain by analyzing the type of muscle pain present and patient factors that influenced the effectiveness of this treatment. @*Methods@#The study included 42 patients diagnosed with local myalgia or myofascial pain according to the Diagnostic Criteria for Temporomandibular Disorders Diagnostic Decision Tree. The analysis of patient factors included variables believed to be associated with temporomandibular disorders. First, a temporary screening appliance was used for 2 weeks to assess each patient for bruxism during sleep. Soft appliance therapy was then started. For each patient, the effectiveness of the appliance was evaluated according to the intensity of tenderness during muscle palpation and the treatment satisfaction score at one month after starting treatment. @*Results@#Data from 37 of the 42 patients were available for analysis. Twenty-five patients reported satisfaction with the appliance. In logistic regression analysis, the odds ratio for reduction of facet length was 1.998. Nineteen patients showed at least a 30% improvement in the visual analog scale score. The odds ratio for local myalgia was 18.148. @*Conclusion@#Soft appliance therapy may be used in patients with local myalgia. Moreover, patients who develop short facets on the appliance surface are likely to be satisfied with soft appliance therapy. Soft appliance therapy may be appropriate for patients with local myalgia who develop short facets on their occlusal appliance.
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Background@#Neurovascular compression (NVC) is a well-known cause of trigeminal neuralgia (TN). However, patients with idiopathic TN (ITN) do not have evidence of NVC on magnetic resonance imaging (MRI), and other patients may remain asymptomatic despite evidence of NVC on MRI. This suggests that there may be additional risk factors for TN development other than NVC. Although epidemiological factors, such as age and sex differences, are useful for understanding the pathophysiology of TN, detailed statistics for each TN subtype are currently unavailable. Therefore, this study aimed to classify patients with TN into the following groups based on data extracted from past medical records: classical TN (CTN), secondary TN, and ITN. @*Methods@#The characteristics of the groups and their differences were explored. @*Results@#CTN was more common in women than in men, as previously reported, whereas ITN was more common in men than in women. The ratio of pain sites located on the right side of the face was high in all groups. Patients with CTN were also prone to NVC on the asymptomatic side. @*Conclusion@#By investigating TN subtype, it may be possible to elucidate the pathophysiology of TN. This would greatly improve treatment outcomes.
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Background@#Neurovascular compression (NVC) is a well-known cause of trigeminal neuralgia (TN). However, patients with idiopathic TN (ITN) do not have evidence of NVC on magnetic resonance imaging (MRI), and other patients may remain asymptomatic despite evidence of NVC on MRI. This suggests that there may be additional risk factors for TN development other than NVC. Although epidemiological factors, such as age and sex differences, are useful for understanding the pathophysiology of TN, detailed statistics for each TN subtype are currently unavailable. Therefore, this study aimed to classify patients with TN into the following groups based on data extracted from past medical records: classical TN (CTN), secondary TN, and ITN. @*Methods@#The characteristics of the groups and their differences were explored. @*Results@#CTN was more common in women than in men, as previously reported, whereas ITN was more common in men than in women. The ratio of pain sites located on the right side of the face was high in all groups. Patients with CTN were also prone to NVC on the asymptomatic side. @*Conclusion@#By investigating TN subtype, it may be possible to elucidate the pathophysiology of TN. This would greatly improve treatment outcomes.
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RibotestMycoplasma (Ribotest™), a rapid antigen detection assay for ribosomal protein L7/L12 for the diagnosis of Mycoplasma pneumoniae infection, has become available in Japan. However, the clinical utility of Ribotest remains controversial. We enrolled 1,140 children admitted to our hospital between January 2014 and March 2016 due to community-acquired pneumonia. We prospectively obtained two throat swabs during the acute phase; DNA detection using a loop-mediated isothermal amplification (LAMP) assay and antigen detection using Ribotest were performed for each sample. We also collected paired serum samples during the acute and convalescent phases for determining M. pneumoniae antibody titers using the particle agglutination test. M. pneumoniae pneumonia was diagnosed through either a positive LAMP assay or a 4-fold increase in antibody titers. Overall, 237 children (21%) were diagnosed with M. pneumoniae pneumonia. We evaluated the utility of Ribotest both in the non-epidemic period (January 2014–July 2015) and the epidemic period (August 2015–March 2016). Sensitivity of Ribotest for M. pneumoniae pneumonia was 23% in the non-epidemic period and 22% in the epidemic period, respectively. When serology was used as the standard, sensitivity of Ribotest was 25% in the non-epidemic period and 22% in the epidemic period, significantly lower than those of the LAMP assay (80% and 91%, respectively). Ribotest yielded false-positive results in 16 cases in the non-epidemic period and in 6 cases in the epidemic period. Thus, positive predictive values of Ribotest were significantly lower in the non-epidemic period (50%) than in the epidemic period (86%). Multivariate analysis showed that a shorter duration of fever before sampling (OR = 1.7) and a higher incidence of co-infection with other pathogens (OR = 29.4) were observed in children showing false-positive results of Ribotest. Thus, we conclude that Ribotest is unsuitable for rapid diagnosis of pediatric M. pneumoniae pneumonia.