Development of mirror pain following trigeminal nerve injury: a case report and review of neuropathic mechanisms.

Following injury to a peripheral nerve, patients may complain of pain over the distribution of the same contralateral nerve, a phenomenon referred to as contralateral pain or mirror pain (MP). Symptoms of MP usually begin after the neuropathic pain from the original nerve injury has become chronic. Chronic neuropathic pain can lead to sensitization and spread of pain. Because the diagnosis of MP can be missed, patients may undergo multiple treatment procedures that prove to be ineffective in relieving the pain. This article presents a case of MP that appeared approximately 20 months following inferior alveolar nerve injury that occurred during placement of a dental implant in the region of the first molar. Acutely painful nerve injuries must be aggressively treated to prevent changeover to a chronic pain state characterized by sensitization and spread of pain beyond the initial injury. Consequently, clinicians need to begin effective, early pain management to prevent the changeover to chronic pain that has become centralized and refractive to treatment.

Oral health care for the pregnant patient.

Pregnancy is a unique time in a woman's life, accompanied by a variety of physiologic, anatomic and hormonal changes that can affect how oral health care is provided. However, these patients are not medically compromised and should not be denied dental treatment simply because they are pregnant. This article discusses the normal changes associated with pregnancy, general considerations in the care of pregnant patients, and possible dental complications of pregnancy and their management.

Oral health care for the pregnant patient.

Pregnancy is a unique time in a women's life, accompanied by a variety of physiologic, anatomic and hormonal changes that can affect how oral health care is provided. However, these patients are not medically compromised and should not be denied dental treatment simply because they are pregnant. This article discusses the normal changes associated with pregnant general considerations in the care of pregnant patients, and possible dental complications of pregnancy and their management.

Oral health care for the pregnant patient.

Pregnancy is a unique time in a woman's life, accompanied by a variety of physiologic, anatomic and hormonal changes that can affect how oral health care is provided. However, these patients are not medically compromised and should not be denied dental treatment simply because they are pregnant. This article discusses the normal changes associated with pregnancy, general considerations in the care of pregnant patients, and possible dental complications of pregnancy and their management.

Oral health care for the pregnant patient.

Pregnancy is a unique time in a woman's life, accompanied by a variety of physiologic, anatomic, and hormonal changes that can affect how oral health care is provided. However, these patients are not medically compromised and should not be denied dental treatment simply because they are pregnant. This article discusses the normal changes associated with pregnancy, general considerations in the care of pregnant patients, and possible dental complications of pregnancy and their management.

Prevalence of psychiatric disorders in a group of adult patients seeking general dental care.

OBJECTIVES: To determine the prevalence of psychiatric disorders in adult patients seeking general dental care because their presence can have a significant impact on how these patients should be managed. METHOD AND MATERIALS: Medical history questionnaires from 442 randomly selected patients who presented for examination at the Virginia Commonwealth University School of Dentistry were reviewed for a positive history of psychiatric conditions, whether they were being treated for their condition, and what medications were prescribed. RESULTS: Twenty percent of the patients had a positive history of a psychiatric disorder. The most common disorder for both sexes was depression. Other disorders included anxiety, bipolar disorder, eating disorder, claustrophobia, attention deficit disorder, seasonal affective disorder, and schizophrenia. More than one disorder was reported by 50% of men and 37% of women, the most common combination being depression and anxiety. Seventy-seven percent of women and 69% of men were under active treatment. Commonly prescribed medications, which can have important adverse effects, included selective serotonin uptake inhibitors, benzodiazepines, lithium, and tricyclic antidepressants. Twenty patients reported taking more than one medication for their disorder. CONCLUSION: A significant number of dental patients have a psychiatric disorder. Because such disorders can affect the patient's response to dental treatment and require treatment modifications, and the adverse effects of the medications being used can alter the oral environment, clinicians need to be aware of their presence and the proper way to manage these patients.

The efficacy of a topical anesthetic gel in the relief of pain associated with localized alveolar osteitis.

PURPOSE: This prospective randomized clinical study assessed the efficacy of pain control for postextraction alveolar osteitis comparing the use of eugenol on a gauze strip versus a thermosetting gel containing 2.5% prilocaine and 2.5% lidocaine. PATIENTS AND METHODS: Thirty-five patients who presented with postextraction alveolar osteitis were randomly assigned to either a control group or test group. After irrigation of the extraction site with normal saline solution, the control patients were treated with eugenol on a gauze strip placed in the socket and the test patients were treated with the thermosetting gel placed directly into the socket. All patients were given a series of visual analog scales to record their pretreatment pain and post-treatment pain at 5, 10, and 15 minutes and then at 1-hour increments during waking hours for the next 48 hours. They were also given a prescription for an analgesic to use for breakthrough pain during the 48-hour period, if necessary, and instructed to record the dose and timing of any pain medication taken. All patients were seen for follow-up at 48 hours after treatment. RESULTS: The mean pretreatment pain score was 6.72 on a scale ranging from 1 to 10 for the eugenol group and 6.37 for the prilocaine-lidocaine group (SE, 0.46), and the 2 groups were not different (P = .62). In the immediate post-treatment period (0-15 minutes) the pain levels were significantly reduced in both groups (Ps < .001). However, the thermosetting gel produced a significantly greater reduction in pain (mean, 3.23; SE, 0.62) than the eugenol (mean, 4.83; SE, 0.43) (P = .022). Over the next 48 hours, the pain level was nominally less with the thermosetting gel, but this difference was not statistically significant (Ps = .2). CONCLUSION: Although the efficacy of the 2 treatments was not significantly different, the nominal superiority and ease of using the thermosetting gel warrant further investigation.

Oral health care for the pregnant patient.

Pregnancy is a unique time in a woman"s life, accompanied by a variety of physiologic, anatomic and hormonal changes that can affect how oral health care is provided. However, these patients are not medically compromised and should not be denied dental treatment simply because they are pregnant. This article discusses the normal changes associated with pregnancy, general considerations in the care of pregnant patients, and possible dental complications of pregnancy and their management.

Differential diagnosis of tongue lesions.

This article reviews the clinical characteristics of the numerous local and systemic conditions that frequently involve the tongue and presents classifications based on their appearance and common locations that can aid dentists in their early recognition and clinical diagnosis.