Compared to oxcarbazepine and carbamazepine, botulinum toxin type A is a useful therapeutic option for trigeminal neuralgia symptoms: A systematic review.

OBJECTIVES: This review aimed to compare the effectiveness of three treatments: BTX A, CBZ, and OXB, in managing trigeminal neuralgia (TN). MATERIAL AND METHODS: We conducted a thorough search for research articles related to our issue using specific keywords on several databases, including Cochrane Central Register of Controlled Trials, Science Direct, Scopus, PubMed, Elsevier, Springer Journals, Ovid Medline, EBSCO, and Web of Science. Our focus was on publications from 1965 to 2023. RESULTS: We retrieved 46 articles from the search and reviewed them carefully. Out of these, we selected 29 articles that met the inclusion criteria. Among the selected articles, 11 investigated the effects of CBZ and OXB, while 18 explored the impact of BTX A on the improvement of TN symptoms. The response rate ranged between 56% and 90.5% for CBZ and between 90.9% and 94% for OXB. The response rate for BTX A ranged between 51.4% and 100%. All these three treatments had a remarkable effect on the improvement of TN. Importantly, findings highlighted that side effects of CBZ and OXB could lead to treatment discontinuation in some cases, whereas BTX A's side effects have been minimal and less frequent. CONCLUSIONS: Consequently, BTX A emerges as a promising alternative for TN treatment. However, additional clinical trials are necessary to validate this finding, and further research is required to establish a standardized protocol for administering BTX A in TN.

A case of conversion disorder presenting as chronic trismus.

Trismus can be the symptom of several diseases. For the most part, the inability to open the mouth is due to an articular disorder but occasionally, the cause may be extra-articular. In this case, being reported, non-articular hysterical trismus caused the jaw to lock in an 11-year-old boy for 3 months. During this period the jaw was completely locked and the locking was associated with moderate to severe pain. After three sessions of therapy the patient was able to open his mouth 33 mm and his eating was back to normal. Conversion disorders often present with dramatic physical presentation including trismus and jaw lock. This report highlights the importance of complete history taking and a thorough clinical examination to make a correct diagnosis in a patient with trismus.

Comparison of low-level laser therapy and standard treatment for temporomandibular disorders: An assessment of therapeutic and placebo effects.

BACKGROUND: Despite extensive research on the use of low-power lasers for TMD treatment, the extent of their effectiveness remains uncertain. OBJECTIVE: This study aimed to investigate the therapeutic or placebo effect of LLLT for TMD, and to compare it with standard treatment methods. A unique aspect of this study was the inclusion of a control group that received only standard treatment, allowing for an assessment of the placebo effect of LLLT. METHODS: A total of 42 patients with TMD were referred to Kerman Dental School Pain Clinic and were randomly assigned to three groups: group A received LLLT, group B was a placebo group and group C was a control group that received only standard treatment. The laser groups received gallium-aluminium-arsenide laser treatment twice a week for 10 sessions. Patients' jaw movement rate indicators and VAS index were evaluated at the start of treatment, and indicators were re-recorded every week for 5 weeks. SPSS 21 was used for statistical analysis, including ANOVA and Tukey's post hoc tests for inter-group comparisons. The repeated measurement test was used to analyse the data. RESULTS: All groups showed significant improvement in VAS indicators (p = .0001), lateral jaw movements (p = .0001), forward jaw movement (p = .007) but not for maximum mouth opening. No significant difference was observed between the groups at the end of the study (p = .000). CONCLUSION: Our study provides insights into LLLT's effectiveness for TMD, suggesting it cannot replace standard treatment alone. These findings contribute to the literature and emphasise the importance of including a control group in future studies to assess the placebo effect of LLLT.

Temporomandibular treatments are significantly efficient in improving otologic symptoms.

Symptoms of temporomandibular disorders (TMD) could be present as otologic symptoms like earache and dizziness in some patients. In most cases, these symptoms are not recognized because otolaryngologists fail to diagnose TMD as a source of the problem. This investigation was conducted to evaluate the effect of TMD treatments on the otologic symptoms which after taking history and clinical examinations seemed to be related to TMD. In the present study, the patients who were complaining of otalgia, ear fullness, tinnitus, hearing loss, and dizziness were evaluated by an ear fellow. Forty patients who had no known otologic or other primary causes to explain their symptoms, were referred to the orofacial pain clinic with the possible diagnosis of TMD. If the diagnosis was confirmed by an orofacial pain specialist, a combination of TMD treatments was administered to each case and the patients were followed up. The results showed that following implementation of treatment protocols for TMD, more than 50% of the patients reported complete or partial recovery in the second follow-up (p < 0.05). The most common otologic symptom of the referred cases was earache, and the most common associated complaint was neck pain. All the patients had one or more parafunctional habits. This study showed that TMD treatments were significantly efficient in improving otologic symptoms partially or completely and the authors concluded that for the patients with otolaryngologic unexplained symptoms, an overhaul examination is needed to assess TMD as a possible cause of the patient complaint. It is recommended that in cases with unexplained otologic symptoms, otolaryngologists care more about the neck trigger points (TP) and ask about the patient's parafunctional habits. Otolaryngologists and dentists need to be aware of the risk of developing otologic symptoms caused by these habits or cervical TPs.

Nitric oxide role in anxiety-like behavior, memory and cognitive impairments in animal model of chronic migraine.

The occurrence of cognitive dysfunctions and anxiety and mood disorders has been shown to be higher in migraine patients. Nitric Oxide (NO) is a significant neurotransmitter in the pathophysiology of migraine, anxiety and neurodegenerative disorders. Therefore, the present study was conducted to evaluate the role of NO system in migraine-induced memory impairment and anxiety like behaviors. Nitroglycerin (NTG) was administered to the animals as an animal model of migraine and pretreatment with L-Arginine, L-NAME and saline were implemented to evaluate the role of NO system in possible cognitive impairments in animal model of migraine. Avoidance learning and memory performance, object recognition memory, anxiety-like behavior and motor activity were assessed using a shuttle box apparatus, novel object recognition, elevated plus-maze, and open field tests respectively. The data showed that the injection of nitroglycerin disturbs learning and memory and elicit anxiety like behavior in the animals. L-NAME administration suppressed the observed effect of nitroglycerin on memory and anxiety. Overall, the results indicated that nitric oxide system is implicated in memory impairments and anxiety like behavior in an animal model of migraine.

Chronic migraine caused a higher rate of tendency to cannabinoid agonist compared to morphine.

BACKGROUND AND AIM: Opioid and cannabinoid systems have considerable roles in modulation of chronic pain as well as regulation reward circuit and addiction responses. This study investigated the effect of nitroglycerin (NTG)-induced migraine attack on the acquisition of morphine and cannabinoid-induced conditioned place preference (CPP) in male rats. METHODS: Adult male rats (230-250 gr) were used. Experimental groups were included (n=10): control, opioid receptor agonist morphine (10mg/kg), WIN55,212-2 (1mg/kg) as a cannabinoid receptor agonist, NTG + morphine (10mg/kg) and NTG + WIN55,212-2 (1mg/kg). Nitroglycerin (10 mg/kg) was used to induce migraine attack every other day for 9 days. After migraine induction, conditioning performance was assessed by CPP test. During conditioning days, morphine and WIN55,212-2 were injected subcutaneously and intraperitoneally, respectively. Anxiety and locomotor activity were evaluated using open field test (OFT). RESULTS: According to data, conditioning score for morphine-treated rats was significantly decreased following NTG-induced migraine. However, NTG-induced migraine was able to increase the conditioning score in WIN55,212-2 as compared to control group.  In OFT, there were no significant differences in locomotor activity and grooming behaviors between experimental groups. However, time spent in the center of OFT box was significantly decreased in NTG plus morphine-treated rats as compared to control. Moreover, rearing response in NTG-treated groups which received either morphine or WIN55,212-2 decreased as compared to control group. CONCLUSION: NTG induced migraine prompts a decrease in morphine and an increase in cannabinoid performances. So, these compounds effects on drug dependency during migraine attack may occur at different mechanism or mechanisms.

Sensory and Affective Dimensions of Pain and Anxiety Like Behaviors Are Altered in an Animal Model of Pain Empathy.

Objective: Pain is a unique and subjective experience that has a prominent function in animals' survival. Observation of pain in others leads to alterations in pain sensation and affection, termed "Empathy for pain". The present study aimed to evaluate the effect of empathy on sensory and affective dimensions of pain and its effect on anxiety-like behaviors. Method : In this study, male Wistar rats were used. Two cage mates were selected, one of which underwent administration of a noxious stimuli for 10 days and the other observed the conspecific in pain. Hot plate, tail flick, and conditioned place aversion were used to evaluate sensory and affective dimensions of pain, respectively. Anxiety-like behavior was assayed using elevated plus maze paradigm and time spent in open and close arms and number of entrance into each arm was recorded as the anxiety indicator within a 5-minute framework. Results: Rats observing the cage mate in pain had a lower threshold to noxious stimuli in comparison to controls. They also had an increased aversion from painful stimuli, demonstrating heightened affective response to pain. Anxiety-like behavior was also enhanced in the observers. Conclusion: Results of this study demonstrate that both sensory and affective dimensions of pain are altered following observation of pain in a conspecific. Further studies evaluating the underlying mechanisms are encouraged to elucidate the role of different neurotransmitters in this phenomenon.

Evaluation of Honey as a Topical Therapy for Intraoral Wound Healing in Rats.

OBJECTIVE: Honey is one of the oldest known medicines. Its medical and therapeutic importance has been recently rediscovered. Honey is an effective treatment for infected wounds and ulcers. The aim of this study was to determine the effect of honey as a topical therapy for intraoral wound healing in rats. MATERIALS AND METHODS: Thirty-two male rats were divided into experimental and control groups (consisting of 16 rats, 4 animals in each group). A 2-mm mucosal defect was made to the depth of the periosteum using punch biopsy. Honey was applied to the wound every day, and the ulcer size was measured daily. On days 2, 4, 6, and 8, four rats were euthanized from each group (experimental and control groups), and tissues were histopathologically evaluated. Healing processes were studied as follows: the size of ulcer, inflammatory response, reepithelialization, and granulation tissue formation. RESULTS: The mean rank of wound size was significantly reduced in the honey group (2.50), as compared to the control group (6.50). Reepithelialization and granulation tissue formation mean rank were significantly higher in the honey group (6.50) than in the control group (2.50). Inflammation mean rank was statistically lower in the honey group (2.63) compared with the control group (6.38). CONCLUSION: Honey was shown to have a beneficial effect on the healing of oral ulcers in rats in this model. Further research may shed light on the effects of honey on different types of ulcers in humans.

Migraine patients have a higher prevalence of PTSD symptoms in comparison to chronic tension-type headache and healthy subjects: a case-control study.

OBJECTIVE: Headache is one of the most common disorders and has a heavy socioeconomic burden on both patients and society. Previous studies have demonstrated a high prevalence of psychological issues (e.g. depression and anxiety) in headache and especially migraine patients. The current study was designed to evaluate the prevalence of post-traumatic stress disorder (PTSD) symptomatology in chronic migraine (CM), chronic tension-type headache (CTTH) and healthy subjects. MATERIAL AND METHODS: CM and CTTH subjects were selected consecutively from patients referring to the department of neurology clinic at Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran. PTSD symptomatology was assessed using PTSD checklist civilian version-Persian edition (PCL-C). Control subjects were enrolled from the family members of headache patients who did not have any history of headache. Chi-square test was used to analyse data and p < .05 was considered statistically significant. RESULTS: Of the 60 control subjects, 5 had a PTSD symptomatology (8.3%); this prevalence was 13.3% for CTTH and 40% for CM groups. CM patients had a significantly higher prevalence of PTSD symptomatology in comparison to CTTH and control subjects (p < .05). With reference to gender, most of the subjects with PTSD symptomatology were female. CONCLUSION: Results of the current study demonstrated that CM patients have a higher prevalence of PTSD symptomatology compared to another chronic headache condition (CTTH) and healthy subjects, which should be considered while treating CM patients. Further studies in larger populations are demanded.

Atypical Presentation of Zoster Mimicking Headache and Temporomandibular Disorder: A Case Report.

Herpes zoster in the prodromal stage may be mistaken for other diseases characterized by pain in the area of prodrome, such as dental pain. We report on a case of trigeminal herpes zoster, which presented as sudden onset headache and acute temporomandibular pain in the prodromal phase.

Efficacy of tacrolimus and clobetasol in the treatment of oral lichen planus: a systematic review and meta-analysis.

This study was carried out to assess and compare the efficacy of tacrolimus and clobetasol in the treatment of oral lichen planus (OLP). The Cochrane Central Register of Controlled Trials, PubMed, Scopus, Science Direct, Springer Journals, and Elsevier databases were searched using specific keywords relevant to the research question for articles published from 1998 to December 31, 2012. Finally, 15 articles that assessed the effects of tacrolimus, clobetasol, and pimecrolimus on improvements in OLP were reviewed. In addition, a meta-analysis of odds ratios (ORs) was carried out for data in 10 of the 15 articles. The results showed that the ORs for improvements in OLP in patients taking clobetasol or tacrolimus, compared with those taking placebo or other drugs, were 1.19 and 8.00, respectively. It appears that topical tacrolimus is an effective alternative to topical clobetasol and may be considered as a first-line therapy in the management of OLP.

Evaluation of effects of Zingiber officinale on salivation in rats.

There are some herbal plants in Iranian traditional system of medicine which are believed to be excellent remedies to alleviate the symptoms of xerostomia. The aim of the present study was to evaluate the effect of systemic administration of seven different herbal extracts on the rate of salivation in rats. The extracts of 7 herbs; Zingiber officinale Roscoe (Zingiberaceae), Citrus sinensis (L.) Osbeck (Rutaceae), Artemisia absinthium L. (Asteraceae), Cichorium intybus L. (Asteraceae), Pimpinella anisum L.(Apiaceae), Portulaca oleracea L.(Portulacaceae), Tribulus terrestris L. (Zygophyllaceae) were prepared. Nine groups of animals (including negative and positive control groups) were used and seven rats were tested in each group. After the injection of extracts, saliva volume was measured gravimetrically in four continuous seven-minute intervals. The results showed that after injection of ginger extracts salivation was significantly higher as compared to the negative control group and other herbal extracts in all of the four intervals (P<0.01). The peak action of the ginger was during the first 7-minute interval and following this, salivation decreased to some extent. The present study suggests that the extract of Zingiber offiicianle can increase the rate of salivation significantly in animal model. Further investigations on different constituents of ginger seem to be essential to identify the responsible constituent for stimulation of saliva secretion.

Oral health status of dialysis patients based on their renal dialysis history in Kerman, Iran.

PURPOSE: Maintaining a high level of periodontal and oral health in patients undergoing renal dialysis is of paramount importance because of the inherent compromised host defence mechanisms. The aim of the present study was to determine the periodontal status and the level of dental caries in renal dialysis patients in Kerman, Iran. MATERIALS AND METHODS: A cross-sectional study was conducted on two groups of patients: one including 68 renal dialysis patients (test) and the other including 30 healthy subjects (control). Half-mouth measurements of Gingival Index (GI), Plaque Index (PI), probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL) and bleeding on probing (BOP) as well as decayed, missing or filled teeth (DMFT) index were recorded. RESULTS: The GI, BOP, PPD, CAL and GR were significantly greater among the test group as compared with the control group; however, the DMFT did not differ significantly among the groups. There was no relationship between the duration of the dialysis and the periodontal indices. CONCLUSIONS: It seems that patients with chronic renal failure have less favourable periodontal health than normal patients. The present study showed that oral home care practices were inadequate. Thus, preventive programmes to promote the oral health status of haemodialysis patients are needed.

Correlation between clinical and histopathologic diagnoses of oral lichen planus based on modified WHO diagnostic criteria.

OBJECTIVE: We studied the correlation between the clinical and histopathologic diagnoses of oral lichen planus (OLP) based on the modified World Health Organization (WHO) diagnostic criteria (2003). STUDY DESIGN: First, 4 oral pathologists and 4 clinicians reviewed and categorized 62 microscopic slides and clinical photographs based on WHO 1978 criteria, and then based on modified WHO definition. The number of photographs and microscopic slides in which all clinicians and all pathologists agreed were calculated and compared. RESULTS: Based on 1978 criteria, in 68% of cases in which all clinicians agreed about the diagnosis of OLP, all pathologists agreed about the diagnosis of OLP. Conversely, in 79% of cases in which all pathologists agreed on the diagnosis of OLP, all clinicians agreed on the diagnosis of OLP. Based on modified criteria, in 93.87% of cases in which all clinicians agreed on the diagnosis of OLP, all pathologists agreed on the diagnosis of OLP. Similarly, in 95.83% of the cases in which all pathologists agreed about the diagnosis of OLP, all clinicians agreed about the diagnosis of OLP. CONCLUSION: Results show higher clinicopathologic correlation in the diagnosis of OLP based on the modified criteria of OLP compared with the 1978 criteria.

Rising incidence of adenocarcinoma of the esophagus in Kerman, Iran.

BACKGROUND: The fall in the incidence of esophageal squamous cell cancer and noncardia gastric cancers in western countries parallels a concomitant rise in the incidence of gastric cardia cancer and distal adenocarcinoma of the esophagus. We aimed to investigate the incidence trend of different gastric and esophageal cancers in Kerman, southeast Iran. METHODS: The information of all newly diagnosed patients with gastric and esophageal cancers were collected actively from all histopathology departments around the Kerman Province during 1991 - 2002 retrospectively. RESULTS: The annual age standardized incidence risks of esophageal and gastric cancers in Kerman were 1.9 and 6.9 per 100,000 populations. In average, the risks of gastric and esophageal squamous cell cancers were more or less constant, while the risk of adenocarcinoma of the esophagus increased around 11% annually. CONCLUSION: The risks of upper gastrointestinal cancers in Kerman Province were quite lower than the average risks in the whole country. The rising incidence of adenocarcinoma of the esophagus in Kerman parallels its temporal pattern in western countries.

Reactive hyperplasia of the oral cavity in Kerman province, Iran: a review of 172 cases.

The purpose of this study was to present the clinical features of reactive hyperplasia among Iranian people. A series of 172 consecutive confirmed cases were studied using the database available at the Department of Oral Medicine, Kerman School of Dentistry. Reactive hyperplasia was classified into five groups: traumatic fibroma, peripheral fibroma with calcification, pyogenic granuloma, peripheral giant cell granuloma, and hyperplasia caused by dentures. Age, sex, site, clinical and radiographic findings, and outcome of treatment were recorded. Ages ranged from 5 to 79 years (mean 36). More women were affected than men (M/F 1:1.5). Pyogenic granuloma (M/F 1:2.2, chi(2)=6.4, p=0.011) and hyperplasia caused by dentures (M/F 1:3.7, chi(2)=10.9, p=0.001) were significantly more common among women. Peripheral giant cell granuloma was more common among men (M/F 1.4:1). Of the 172 cases, 111 (64%) involved the gingiva. Pyogenic granuloma more often affected the maxillary gingiva, while traumatic fibroma, peripheral fibroma with calcification, and peripheral giant cell granuloma, were more common in the mandibular gingiva. Twenty peripheral giant cell granulomas and 23 pyogenic granulomas had ulcers on the surface. A tendency to bleed was common among patients with pyogenic granuloma (n=31) and peripheral fibroma with calcification (n=12). We have confirmed that the clinical features of reactive hyperplasia among Iranians are, for the most part, similar to those reported by other investigators.