Factors that affect pain behavior.

Emotions can and do affect the way one perceives pain, both acute and chronic. Many factors unconsciously alter the intensity in which pain is perceived even though human beings all have the same anatomical structures to convey nociception to the central nervous system. Pain cannot be measured, only observed by one's behavior to pain. Those who diagnose and treat craniofacial pain quickly realize that many factors in addition to pathological conditions affect patients differently and oftentimes, unpredictably. We, as those who attempt to treat these patients, need to recognize these factors and how they can influence our treatment and a patient's recovery. In this short article, factors that affect pain behavior are described.

Temporal tendinitis: a modified Levandoski panoramic analysis of 21 cases.

UNLABELLED: In 1993, Levandoski published the details of a system to analyze panoramic radiographs and especially, the temporomandibular joints. Piedra expanded the work of Levandoski to analyze facial and dental asymmetries. In this brief treatise, the disorder of temporal tendinitis was explored. A modified Levandoski technique was used to compare the lengths of the coronoid and condylar processes in an attempt to demonstrate how the panoramic radiograph can be simply used in the diagnosis of temporal tendinitis in the retrospective study of 21 such cases. CONCLUSIONS: a total of 18 of the 21 coronoid processes (85%) were equal to or longer than their condylar process counterparts, thus indicating that a panoramic radiograph may be useful in the diagnosis of temporal tendinitis.

Evaluation of the oral flora in 150 patients suffering from chronic craniofacial pain: a retrospective study.

This study was conducted to determine if microbial infection was a significant factor in patients with undiagnosed craniofacial pain. Of the 150 patients from whom intra-bony cultures were obtained, 23 different groups of isolates were obtained. There were 49 (32.67%) patients whose cultures exhibited growth of microbes other than routine oral flora, mixed skin flora or routine respiratory flora. The most common was of the Streptococcus species (11 or 22.91%) of the 49. Sixty-seven (67) (44.67%) of the total cultures demonstrated the growth of mixed skin flora, nineteen (12.67%) demonstrated the growth of routine respiratory flora and sixteen (10.67%) demonstrated the growth of routine oral flora. No bacterial isolates were found in 16 (10.67%) cultures. The most common histological diagnoses of those who exhibited pathogenic microbial growth were, in order: 1. focal osteoporotic marrow defect; 2. ischemic osteonecrosis; and 3. chronic nonsuppurative osteomyelitis.

Anterior throat pain syndromes: causes for undiagnosed craniofacial pain.

It is not uncommon for practitioners who treat craniofacial pain to see patients with undiagnosed throat and submandibular pain. Usually, these patients will already have been seen by their primary care physician and frequently, several others doctors including otolaryngologists, oral and maxillofacial surgeons, and even neurologists. Far too often these patients have three common features: 1. they have endured multiple expensive diagnostic tests; 2. they have received treatment of multiple courses of antibiotics; and 3. no specific diagnosis for their pain complaints has been determined and their pain persists. In this article, five disorders, Ernest syndrome, Eagle's syndrome, carotid artery syndrome, hyoid bone syndrome and superior pharyngeal constrictor syndrome are briefly described. All five produce common symptoms, making diagnosis difficult, which is often followed by ineffective or no treatment being provided to the patient. Diagnostic criteria and suggested treatment modalities are also presented.

Four common herbs seen in dental practice: properties and potential adverse effects.

The use of herbal supplements in North America is steadily growing and raises concerns about safety, efficacy, and how they affect safe patient care. The most notable and direct health risks associated with herbal supplements include hypertension, prolonged bleeding, and the potential for drug-herb interactions, which is of particular concern for patients undergoing anesthesia, both general and local anesthesia. In this article, four of the most commonly used herbs today in North America will be discussed: garlic, gingko, ginseng, and ginger. The pharmacology, benefits, and possible side effects of these herbs will be presented. Awareness of the rising use of herbs is important to prevent, recognize, and treat potential problems that can arise from herbal preparations taken alone or in conjunction with prescription medications.

Atypical trigeminal neuralgia of the mental nerve: a case study.

Any division or branch of the trigeminal nerve can exhibit signs and symptoms of neuralgia. Those who treat patients suffering with craniofacial pain are frequently charged with determining the cause of illusive pain complaints and if objective signs are not discovered, the patient may not be treated and may be forced to seek help elsewhere. Trigeminal neuralgia-like pain is often seen in the mental nerve region of the mandible, but frequently, there is no radiographic evidence for the source of such pain. In the current case report, it was discovered that the patient's mental nerve pain was cause by an irregular surface of the anterior portion of the mental foramen. Successful treatment was provided by surgically recontouring the edge or lip of the mental foramen without injury to the mental nerve.

Patients seeking treatment for craniofacial pain: a retrospective study of 300 patients.

Those engaged in any type of pain practice will encounter patients who have seen many practitioners. This is especially true for clinicians who treat craniofacial pain and temporomandibular disorders. In this retrospective study of 300 patients seeking treatment for various types of craniofacial pain, the average age was 43.05 years. A mean average of 3.92 clinicians was consulted with the range of practitioners being one to 26. The average time of pain was 4.15 years. Most of the subjects (210) were in the age groups 21 years to 60 years old. Females comprised 85.30% of the subjects with a mean average age of 43.43 years; 14.70% were male with a mean average age of 41.02 years.

Focal osteoporotic marrow defect: report of 100 new cases with ultrasonography scans.

Focal osteoporotic marrow defect (FOMD) may be the earliest detectable form of the ischemic marrow disorders. The exact cause is unknown, but three theories have been proposed in the literature. A fourth is presented in this paper. In this study, 100 biopsies were examined histologically and were diagnosed as FOMD, based upon consistent histological characteristics. Until recently, the only diagnostic criteria were radiographic evaluation and incisional biopsy. In February 2002, a through-transmission alveolar ultrasonic test (Cavitat 4000, Cavitat Medical Technologies, Inc., Aurora, CO) was approved by the US Food and Drug Administration and by Health Canada for detection of low bone density and bone desiccation, both features of FOMD and chronic ischemic bone disease. Within this article, the diagnostic criteria and pathological findings of FOMD will be presented. The three current theories concerning its etiology will be briefly presented and a fourth theory will be proposed.

Temporomandibular disorders: standard treatment options.

Proper diagnosis is essential in all phases of health care, and dentistry certainly is no exception. Without a proper diagnosis, effective treatment may never be rendered and the patient's suffering and costs will continue to escalate. Dentists who treat patients who have temporomandibular disorders (TMDs) and orofacial pain also must strive to stay abreast of the latest treatment options. This article summarizes the current recommended treatment options for TMDs. Because it would be virtually impossible to cover every type of treatment available, only standard recognized types of treatment will be presented.

Medullary and odontogenic disease in the painful jaw: clinicopathologic review of 500 consecutive lesions.

Ischemic jawbone lesions were first discussed in the dental literature more than a century ago, but then seemingly forgotten. In recent years, there has been considerable resurgence in interest in this unique pathological condition. Controversy surrounds the subject. Some proclaim these lesions to be mere fabrications of the imaginations of non-traditional or alternative dental surgeons. Others attribute all human maladies to these maxillofacial lesions. Aside from these philosophical and metaphysical arguments, are there common diagnoses of jawbone pathologies that produce pain? This present investigation reviews the clinicopathologic features of 500 consecutive jawbone surgeries with pathological confirmation in patients with idiopathic facial pain. Four hundred seventy-six (476) of the 500 lesions (95.2%) were directly attributed to impaired blood flow in the jawbone, tooth, or both, according to histopathological analysis and confirming Cavitat (bone ultrasound) examination. Statistical data concerning the location, frequency, and pathological diagnoses of these bony lesions are presented, as are brief methods of diagnosis, and treatment is also discussed.

Nociceptive trigeminal inhibition--tension suppression system: a method of preventing migraine and tension headaches.

Dentists and physicians see countless patients suffering from various types of headaches. Various modes of therapy are used in an attempt to treat these patients. As a result of this study, it appears that a common factor to migraine and tension-type headaches may be chronic clenching. If this is the case, then dentists may be able to treat headache patients more effectively than previously suspected through the use of a dental appliance.