Effect of comorbid migraine on propranolol efficacy for painful TMD in a randomized controlled trial.

INTRODUCTION: The migraine-preventive drug propranolol is efficacious in reducing pain from temporomandibular disorder, suggesting potential modifying or mediating effects of comorbid migraine. METHODS: In this randomized controlled trial, myofascial temporomandibular disorder patients were treated with propranolol or placebo for 9 weeks. The primary endpoint was change in a facial pain index derived from daily symptom diaries. Linear and logistic regression models tested for a migraine × treatment-group interaction in reducing facial pain index. Counterfactual models explored changes in headache impact and heart rate as mediators of propranolol's efficacy. RESULTS: Propranolol's efficacy in reducing facial pain index was greater among the 104 migraineurs than the 95 non-migraineurs: For example, for the binary ≥ 30% reduction in facial pain index, odds ratios were 3.3 (95% confidence limits: 1.4, 8.1) versus 1.3 (0.5, 3.2), respectively, although the interaction was statistically non-significant (p = 0.139). Cumulative response curves confirmed greater efficacy for migraineurs than non-migraineurs (differences in area under the curve 26% and 6%, respectively; p = 0.081). While 9% of the treatment effect was mediated by reduced headache impact, 46% was mediated by reduced heart rate. CONCLUSIONS: Propranolol was more efficacious in reducing temporomandibular disorder pain among migraineurs than non-migraineurs, with more of the effect mediated by reduced heart rate than by reduced headache impact. STUDY IDENTIFICATION AND REGISTRATION: SOPPRANO; NCT02437383; https://clinicaltrials.gov/ct2/show/NCT02437383.

Efficacy and safety of propranolol for treatment of temporomandibular disorder pain: a randomized, placebo-controlled clinical trial.

Propranolol is a nonselective beta-adrenergic receptor antagonist. A multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase 2b trial enrolled participants aged 18 to 65 years with temporomandibular disorder myalgia to evaluate efficacy and safety of propranolol compared with placebo in reducing facial pain. Participants were randomized 1:1 to either extended-release propranolol hydrochloride (60 mg, BID) or placebo. The primary endpoint was change in facial pain index (FPI = facial pain intensity multiplied by facial pain duration, divided by 100). Efficacy was analyzed as a mean change in FPI from randomization to week 9 and as the proportion of participants with ≥30% or ≥50% reductions in FPI at week 9. Regression models tested for treatment-group differences adjusting for study site, sex, race, and FPI at randomization. Of 299 participants screened, 200 were randomized; 199 had at least one postrandomization FPI measurement and were included in intention-to-treat analysis. At week 9, model-adjusted reductions in mean FPI did not differ significantly between treatment groups (-1.8, 95% CL: -6.2, 2.6; P = 0.41). However, the proportion with a ≥30% reduction in FPI was significantly greater for propranolol (69.0%) than placebo (52.6%), and the associated number-needed-to-treat was 6.1 (P = 0.03). Propranolol was likewise efficacious for a ≥50% reduction in FPI (number-needed-to-treat = 6.1, P = 0.03). Adverse event rates were similar between treatment groups, except for more frequent fatigue, dizziness, and sleep disorder in the propranolol group. Propranolol was not different from placebo in reducing mean FPI but was efficacious in achieving ≥30% and ≥50% FPI reductions after 9 weeks of treatment among temporomandibular disorder participants.

Deformation Behavior of Foam Laser Targets Fabricated by Two-Photon Polymerization.

Two-photon polymerization (2PP), which is a three-dimensional micro/nano-scale additive manufacturing process, is used to fabricate component for small custom experimental packages (“targets”) to support laser-driven, high-energy-density physics research. Of particular interest is the use of 2PP to deterministically print millimeter-scale, low-density, and low atomic number (CHO) polymer matrices (“foams”). Deformation during development and drying of the foam structures remains a challenge when using certain commercial acrylic photo-resins. Acrylic resins were chosen in order to meet the low atomic number requirement for the foam; that requirement precludes the use of low-shrinkage organic/inorganic hybrid resins. Here, we compare the use of acrylic resins IP-S and IP-Dip. Infrared and Raman spectroscopy are used to quantify the extent of the polymerization during 2PP vs. UV curing. The mechanical strength of beam and foam structures is examined, particularly the degree of deformation that occurs during the development and drying processes. The magnitude of the shrinkage is quantified, and finite element analysis is used in order to simulate the resulting deformation. Capillary drying forces during development are shown to be small and are likely below the elastic limit of the foam log-pile structures. In contrast, the substantial shrinkage in IP-Dip (~5⁻10%) causes large shear stresses and associated plastic deformation, particularly near constrained boundaries and locations with sharp density transitions. Use of IP-S with an improved writing procedure results in a marked reduction in deformation with a minor loss of resolution.

Oral lichen planus.

Oral lichen planus is a common immunologically mediated mucocutaneous disease. These lesions have varied clinical presentations and symptoms, which include reticular, erosive, or erythematous forms. This article reviews the diagnosis and management of oral lichen planus.

Pathology associated with the third molar.

Several studies have reported the prevalence of pathology associated with retained third molar teeth. Although most oral surgeons have encountered many patients with infection and lytic lesions associated with retained third molars, assessment of the frequency of abnormality around these teeth has previously been hampered by the lack of well-designed studies to investigate a subject so important to oral and maxillofacial surgeons. This article reviews what is known--and what isn't known--about pathologic conditions associated with both symptomatic and asymptomatic third molar teeth.

Student and program director perceptions of oral and maxillofacial surgery as career for women.

This article investigates reasons for the relatively low number of women entering oral and maxillofacial surgery training. An anonymous online survey was developed to assess the perceptions of senior women dental students and oral and maxillofacial surgery (OMS) program directors about oral surgery as a career choice for women. It was found that female dental students perceive bias against women in oral surgery, but that most program directors report a favorable view of women. The authors concluded that although a higher percentage of women than men do not complete OMS training, bias against women in OMS does not appear to be prevalent.

Controlled phase III clinical trial of diclofenac potassium liquid-filled soft gelatin capsule for treatment of postoperative dental pain.

PURPOSE: The purpose of the present study was to assess the safety and efficacy of oral diclofenac potassium liquid-filled soft gelatin capsule (DPSGC) that uses ProSorb dispersion technology (Xanodyne Pharmaceuticals, Inc, licensed from AAIPharma, Wilmington, NC), to treat adult patients with acute pain after third molar extraction. PATIENTS AND METHODS: In the present multicenter, randomized, double-blind, placebo-controlled trial, patients experiencing a baseline level of pain (≥ 50 mm on a 100-mm visual analog scale within 4 hours after surgery) were randomized to receive a single dose of DPSGC at 25, 50, or 100 mg or placebo. Pain intensity and relief were assessed for 6 hours after dosing. The efficacy endpoints included the summed pain intensity difference, total pain relief, and the median time to the onset of perceptible and meaningful pain relief (using the 2-stopwatch method). RESULTS: A total of 249 randomized patients had a significant increase in the summed pain intensity difference and total pain relief values at 3 and 6 hours across all DPSGC-treated groups compared with the placebo group (P < .0001). The onset of perceptible and meaningful pain relief was significantly faster in all DPSGC groups than in the placebo group, including the DPSGC 25-mg group (25 minutes [P = .0002] and 52 minutes [P < .0001] for perceptible and meaningful pain relief, respectively). Significantly fewer patients in the DPSGC groups required rescue medication compared with those in the placebo group (P < .0001). The global evaluation scores were significantly greater for the patients who received DPSGC than for those who received placebo (P < .0001), and more than 65% of DPSGC-treated patients rated the medication as good, very good, or excellent compared with 18% of the placebo-treated patients. DPSGC was generally well tolerated, and no serious adverse events were reported. CONCLUSIONS: The results from the present single-dose study of postoperative dental pain suggest that DPSGC offers significant pain relief compared with placebo and that the study medication provided was well tolerated by patients who required pain relief after third molar extraction.

The effect of platelet-altering medications on bleeding from minor oral surgery procedures.

PURPOSE: This study was performed to assess the extent of bleeding from minor oral surgical procedures in patients taking platelet-altering medications. They were compared with patients who were not taking platelet-altering medicines to assess differences in extent of blood loss. MATERIALS AND METHODS: A prospective observational study design was used to quantitatively assess the amount and severity of bleeding encountered with dentoalveolar surgery in 2 groups. The experimental group consisted of people taking therapeutic doses of platelet-altering medications, and the control group was composed of patients who had not taken a platelet-altering medication for at least 10 days prior to surgery. Surgical blood loss was measured, and the groups were compared for statistically significant differences in blood loss. RESULTS: There was no difference in blood loss detected between the experimental or control groups. No bleeding complications were encountered. CONCLUSION: Our data suggest that patients on aspirin and NSAIDs can safely undergo routine minor outpatient oral surgical procedures without modification of their platelet-altering medication.

Bisphosphonate-associated osteonecrosis of the jaws: a review of current knowledge.

BACKGROUND: Increasing numbers of dental patients are taking bisphosphonate medications for a variety of indications. These drugs may be associated with poor healing, spontaneous intraoral ulceration and bone necrosis in the oral and maxillofacial region. CASE DESCRIPTION: The authors describe a case of osteonecroSis of the jaws in a patient receiving long-term bisphosphonate therapy for cancer. They offer recommendations for management and prevention of oral complications. CONCLUSION AND CLINICAL IMPLICATIONS: It is important that clinicians are aware of the association between bisphosphonate treatment and delayed wound healing and osteonecrosis of the jaws. They should consider referring patients in this population to specialists for even the most routine oral surgery. Clinicians should perform a thorough oral examination in patients before they begin any chemotherapy regimen.

Handpiece speed and postoperative outcomes in third molar surgery.

OBJECTIVE: This study was performed to assess surgical outcomes when externally irrigated slow-speed surgical handpieces (30,000 rpm) were compared to externally irrigated high-speed handpieces (90,000 rpm) in the removal of impacted lower third molar teeth. STUDY DESIGN: One hundred patients with bilater ally impacted third molar s were enrolled in the study; 53 remained to completion. Each patient served as his/her own control. The experimental side was treated using a 30,000 rpm electric rotary drill incorporating irrigation, while the control side was treated using the same drill system, but with a 90,000 rpm handpiece. Drill speeds used were alternated between the right and left sides of patients to avoid bias introduced by the dominant hand of the surgeon. Patients were blinded to drill speed, and were asked to complete a standardized pain/swelling questionnaire for seven days immediately following surgery. Data was analyzed to determine differences in pain, swelling, and complications in relation to the drill type used. RESULTS: No statistically significant differences were found in degree of pain, swelling, or complications when the slower drill was compared to the high-speed instrument. CONCLUSIONS: The study suggests that there is no difference in postoperative outcome when impacted third molar teeth are removed with either slow- or high-speed instrumentation, and that the choice of the drill type should be determined solely by the preference of the operator.

Oral malignancies associated with negative transepithelial brush biopsy.

PURPOSE: This study was performed to assess the incidence of negative brush biopsy for oral lesions later demonstrated histologically to be squamous cell carcinoma. METHODS: All diagnoses of oral squamous cell carcinoma from a university oral pathology service for the period June 2000 through March 2002 were reviewed to determine if any had previously undergone brush biopsy reported to be "negative for epithelial abnormality." Those cases identified were further investigated to determine the time lapse between brush biopsy and definitive tissue diagnosis. RESULTS: Four cases of brush biopsy negative squamous cell carcinoma were identified from 115 total cases of malignancy (3.5%). The average time from brush biopsy to tissue diagnosis was 117.25 days (range, 5 to 292 days). CONCLUSION: False negative reports are possible with the oral brush biopsy technique. Persistent lesions should undergo tissue biopsy for definitive diagnosis.