Referred pain is associated with greater odontogenic spontaneous pain and a heightened pain sensitivity in patients with symptomatic irreversible pulpitis.

BACKGROUND: Symptomatic irreversible pulpitis often results in heightened reactions to thermal stimuli such as pain evoked by a cold stimulus, and spontaneous odontogenic pain (unprovoked pain). OBJECTIVE: This study primarily compared the clinical manifestations of odontogenic spontaneous pain and pain provoked by cold stimulus specifically focusing on their sensory discriminative characteristics (intensity, duration and quality) between symptomatic irreversible pulpitis patients with and without referred pain. METHODS: Twenty-three patients with symptomatic irreversible pulpitis with referred pain and 12 patients without referred pain were included in this cross-sectional study. The following outcomes were assessed: odontogenic spontaneous pain and its descriptors; pain evoked by cold stimulus and qualitative sensory testing before and after local anaesthesia; referred pain location; use of analgesic medication; complementary anaesthesia efficacy. T-test, chi-squared and McNemar tests were applied to the data (p < .50). RESULTS: Patients with referred pain presented a greater odontogenic pain intensity (p < .05) when considered the average of the last 24 h. These patients also showed higher pain rating and pain descriptors (p < .05). Intensity and duration of the pain evoked by cold stimulus in the non-affected contralateral tooth at baseline were higher for patients with referred pain (p < .05). CONCLUSION: Symptomatic irreversible pulpitis patients with referred pain present greater odontogenic spontaneous pain and a heightened pain sensitivity. Therefore, patients with referred pain seem more complex from a pain severity perspective, supporting the clinical utility of discriminating symptomatic irreversible pulpitis with and without referred pain.

Trigeminal Schwannoma simulating orofacial pain: differential diagnosis and treatment. Case report / Schwannoma trigeminal simulando dor orofacial: diagnóstico diferencial e tratamento. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Orofacial pain is a major diagnostic challenge for the most experienced clinicians. Due to the complexity regarding the trigeminal-cervical joint, orofacial pain with the same etiology may present different symptoms, and pain with similar symptomatology may have different causes. The objective of this study was to alert health professionals about the importance of differential diagnosis in the hypothesis of trigeminal neuralgia, where the inclusion of the dentist in the medical-hospital team is of paramount importance in establishing the correct diagnosis. CASE REPORT: Twenty-nine-year-old female patient complained of electric shock and pulsatile orofacial pain that covered the third division of the fifth cranial nerve on the right side. Magnetic resonance imaging revealed the presence of trigeminal Schwannoma, causing neuralgia due to its neural compressive nature. Two different neurosurgery departments suggested tumor resection. However, after the evaluation by a third neurosurgery department, in which a dentist, specialized in orofacial pain was part of the team, the complete evaluation established the final diagnosis of right lower first molar odontalgia, with irreversible acute pulpitis as the cause of the symptoms and the expansive lesion was only a radiological finding. CONCLUSION: Interdisciplinary evaluation among physicians and dental surgeons is necessary to obtain the correct diagnosis when considering the hypothesis of trigeminal neuralgia.

RESUMO JUSTIFICATIVA E OBJETIVOS: As dores orofaciais representam grande desafio diagnóstico ao mais experiente clínico. Devido à complexidade do conjunto trigeminocervical, as dores orofaciais com a mesma etiologia podem apresentar sintomas diferentes, e dores com o mesmo sintoma podem ter etiologias diferentes. O objetivo foi alertar o profissional da saúde sobre a importância do diagnóstico diferencial quando aventada a hipótese diagnóstica de neuralgia trigeminal, e a presença do cirurgião-dentista na equipe médico-hospitalar é de suma importância para o estabelecimento do diagnóstico. RELATO DO CASO: Paciente do sexo feminino, 29 anos, apresentou dor orofacial em choque elétrico e pulsátil que percorria o trajeto da terceira divisão do V par craniano, do lado direito. A ressonância nuclear magnética evidenciou Schwannoma trigeminal, sendo diagnosticada neuralgia trigeminal secundária à essa lesão expansiva. Foi sugerida ressecção tumoral em dois serviços de neurocirurgia. Contudo, após a avaliação de um terceiro serviço de neurocirurgia, com a participação de cirurgião-dentista especialista em dor orofacial, foi estabelecido o diagnóstico de odontalgia do primeiro molar inferior direito, com pulpite aguda irreversível, sendo essa a causa do quadro sintomático, e a lesão expansiva, apenas um achado radiológico. CONCLUSÃO: A avaliação interdisciplinar entre médicos e cirurgiões-dentistas é necessária para o diagnóstico correto quando a hipótese diagnóstica for neuralgia trigeminal.

Pain, click and crepitation as factors associated with temporomandibular dysfunction in Parkinson's disease / Dor, estalido e crepitação como fatores associados à disfunção temporomandibular na doença de Parkinson

ABSTRACT BACKGROUND AND OBJECTIVES: Parkinson's disease leads to mandibular movements that affect the masticatory cycle and induce orofacial pain, one of the main clinical alterations found in temporomandibular dysfunction. Thus, the present study aimed to analyze the possible factors associated with temporomandibular dysfunction and to verify the frequency of the dysfunction in this population. METHODS: This was a cross-sectional study in which the participants were evaluated using the Diagnostic Criteria for Temporomandibular Dysfunction research, used to classify the temporomandibular dysfunction and to obtain by physical examination and self-report the variables studied. RESULTS: A total of 139 people with Parkinson's disease were evaluated. Of these, 77 met the eligibility criteria, with 70% of the sample being male, with an average age of 62±9 years; Parkinson's disease diagnosis time of 6±4 years and with 71% of the sample in the moderate stage of Parkinson's disease. No significant associations were found between age, gender, time and stage of the disease with temporomandibular dysfunction. Of the variables analyzed, the significant results showed that the presence of pain (OR=10.92, 95% CI=2.25-59.93, p<0.001) has a greater chance of developing temporomandibular dysfunction, crepitation (Kappa=0.34, p<0.004) reflects moderate accuracy in the classification of temporomandibular joint disorder and the click (negative predictive value=77%, p<0.032) increases the probability of having temporomandibular dysfunction. CONCLUSION: Therefore, in this study, the frequency of the temporomandibular dysfunction was 30%, and it was observed that the factors associated with the dysfunction in people with Parkinson's disease were: pain, click, and crackle.

RESUMO JUSTIFICATIVA E OBJETIVOS: A doença de Parkinson leva a movimentos mandibulares que afetam o ciclo mastigatório e induzem a dor orofacial, uma das principais alterações clínicas encontradas na disfunção temporomandibular. Sendo assim, o presente estudo objetivou analisar os possíveis fatores associados à disfunção temporomandibular e verificar a frequência da disfunção nessa população. MÉTODOS: Trata-se de um estudo de corte transversal, no qual os participantes foram avaliados com o Critério de Diagnóstico para pesquisa em disfunção temporomandibular, utilizado para classificar a disfunção temporomandibular e obter, através do exame físico e autorrelato, as variáveis estudadas. RESULTADOS: Foram avaliadas 139 pessoas com doença de Parkinson. Dessas, 77 encontraram-se dentro dos critérios de elegibilidade, sendo que 70% da amostra era do sexo masculino, com média de idade de 62±9 anos, tempo de diagnóstico da doença de Parkinson de 6±4 anos e com 71% da amostra no estágio moderado. Não foram encontradas associações significativas entre a idade, sexo, tempo e estágio da doença com a disfunção temporomandibular. Das variáveis analisadas, os resultados significativos mostraram que a presença de dor (OR=10,92; IC95%=2,25-59,93; p<0,001) representa uma maior chance de desenvolver a disfunção temporomandibular, a crepitação (Kappa=0,34; p<0,004) reflete uma precisão moderada na classificação do transtorno da articulação temporomandibular e o estalido (valor preditivo negativo=77%; p<0,032) aumenta a probabilidade de ter a disfunção temporomandibular. CONCLUSÃO: Neste estudo, a frequência de disfunção temporomandibular foi de 30% e verificou-se que os fatores associados à disfunção em pessoas com doença de Parkinson foram dor, estalido e crepitação.

Bilateral testicular pain as an acute aortic dissection symptom / Dolor testicular bilateral como presentación de disección aórtica aguda

Abstract Acute aortic dissection is a serious cardiovascular event and the most common acute disease of the great vessels. According to the anatomical distribution of the compromised aorta, the Stanford Group classifies it into type A and type B. Its prognosis depends on its early identification and treatment, as the mortality rate in type A increases rapidly with each hour of delay of diagnosis. Clinical manifestations of aortic dissection may be varied, which makes its early diagnosis difficult. Regarding its diagnosis, genital pain is one of the rarest symptoms. In this paper, the case of a patient who initially attended a health care institution due to acute bilateral testicular pain and was eventually diagnosed with acute aortic dissection is presented.

Resumen La disección aórtica aguda es un evento cardiovascular catastrófico que corresponde a la más común de las enfermedades agudas de los grandes vasos. Según la distribución anatómica de la aorta comprometida, el grupo de Stanford la clasifica en dos tipos: A y B. Su pronóstico depende de la identificación y manejo tempranos, siendo la tasa de mortalidad rápidamente creciente en el tipo A con cada hora que se retrasa el diagnóstico. Las manifestaciones clínicas de la disección aórtica pueden ser múltiples, lo que dificulta su diagnóstico precoz. Dentro de las formas de presentación, una de las más infrecuentes es el dolor en los genitales. Se presenta el caso clínico de un paciente que consulta inicialmente por un dolor agudo testicular bilateral y que finalmente es diagnosticado con disección aórtica aguda.

Síndrome miofascial / Myofascial syndrome

El síndrome de dolor miofascial es un complejo de síntomas sensoriales, motores y autonómicos causados por puntos gatillo miofasciales y estos como puntos de exquisita sensibilidad e hiperirritabilidad localizados en una banda tensa palpable, en músculos o su fascia, que producen una respuesta de contracción local de las fibras musculares por un tipo específico de palpación y si es lo suficientemente hiperirritable, da lugar a dolor, sensibilidad y fenómenos autonómicos, así como la disfunción en zonas por lo general distantes de su sitio de origen. Con una alta prevalencia en la población general, y responsable de gran parte de discapacidades y disfunciones en ámbitos laborales y actividades de la vida cotidiana. Presenta factores precipitantes de índole mecánico, estructural, postural, nutricional y endocrino, e involucra una fisiopatología específica, con la participación de múltiples factores proinflamatorios y sustancias neuro-vasoactivas. Su diagnóstico es fundamentalmente clínico, y existen diversos tratamientos para evitar su cronicidad y avance, que usualmente involucra tratamientos accesibles y costoefectivos, los cuales pueden brindar al paciente una solución o manejo a un dolor crónico, muchas veces subdiagnosticado e infratratado, si el médico cuenta con los conocimiento adecuados sobreesta entidad.

Myofascial pain syndrome is compoused by sensory, motor and autonomic symptoms that are generated by myofascial trigger points that are exquisite in sensitivity and irritability. These trigger points are located in a palpable taut band in muscle or fascia, which produce a local twitch response of muscle fibers for a specific type of palpation and if there is enough hyperirritability results in pain, tenderness and autonomic phenomena and dysfunction that appears usually in distant areas from its site of origin. With a high prevalence in the general population, myofascial síndrome is responsible for disability and dysfunction in work areas and daily life activities. It presents precipitating factors, such mechanical, structural, postural, nutritional and endocrine, and involves a specific pathophysiology, involving multiple pro-inflammatory factors and neuro-vasoactive substances. Diagnosis is mainly clinical, and there are various treatments to prevent chronicity and development, which usually involves easy and económica access to treatments, which may give the patient a solution or managing a chronic pain, often underdiagnosed and undertreated, if it has adequate knowledge about this entity.

Frequency and Location of Referred Pain in Patients with Temporomandibular Disorder / Frecuencia y Ubicación del Dolor Referido en Pacientes con Trastornos Temporomandibulares

Based on the survey of records regarding the location and frequency of referred pain in patients with temporomandibular disorder when certain pre-established areas are palpated, we proposed an anatomical-topographical division of the head and neck to allow the standardization and reproducibility of locations of referred pain. Of the 835 charts reviewed, 419 (50.2%) patients had referred pain on palpation of the regions based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and palpation of the cervical regions, as often analyzed by the Cochran Q test. The concordance coefficient of Kendall examined the correlation between regions of referred pain concerning to palpated sites. The new regions were defined preauricular, facial lateral, temporoparietal, posterior head, posterior and lateral cervical, anterior cervical and calvaria. The region palpated that originated more referred pain was corresponding to the masseter muscle followed by the region of the sternocleidomastoid muscle, regardless of the side palpated. On palpation of the regions established by the RDC/TMD, the most frequent area of referred pain was the lateral facial region. On palpation of the neck, were the posterior and lateral cervical regions. The sites that originated more referred pain when palpated were the masseter, temporalis, sternocleidomastoid and trapezius muscles.

Basado en la encuesta de registros relativos a la ubicación y frecuencia de dolor referido en pacientes con trastorno temporomandibular al palpar ciertas áreas preestablecidas, propusimos una division topográfica anatómica de cabeza y cuello para permitir la estandarización y reproducibilidad de los lugares de dolor referido. Al examinar los gráficos de 835 sujetos, 419 un (50,2%) de los pacientes reportaron dolor referido a la palpación de las regiones sobre la base de los Criterios Diagnósticos para la Investigación de Trastornos Temporomandibulares (CDI/TTM) y palpación de la region cervical, con análisis de frecuencia con prueba de Cochran Q. El coeficiente de concordancia de Kendall examinó la correlación entre las regiones de dolor referido en relación a los sitios palpados. Las regiones nuevas fueron definidas como, pre-auricular, facial lateral, temporoparietal, cabeza posterior, posterior y lateral cervical, cervical anterior y bóveda craneal. La región de palpado en la cual se originó el dolor mencionado con mayor frecuencia, corresponde al músculo masetero, seguido por la región del músculo esternocleidomastoideo, independientemente del lado palpado. Durante la palpación de las regiones establecidas por los CDI/TTM, la zona más frecuente de dolor referido fue la región facial lateral. A la palpación del cuello, el dolor referido se reportó en la parte posterior y en las regiones cervicales laterales. Los sitios en los que se originó el mayor dolor referido a la palpación, fueron los músculos maseteros, músculos temporales, esternocleidomastoideo y trapecio.

Los aportes de Henry Head a las basesneuroanatómicas y fisiológicas de la terapia de segmento / The contributions of Henry Head to neuroanatomical and physiological bases of therapy segment

Henry Head, neurólogo británico, ha pasado a la historia de la medicina occidental por su contribución a la creación de los mapas de dermatomas. Una modalidad terapéutica dentro de la medicina neuralterapéutica es la terapia de segmento y, dentro del estudio del marco de sustentación teórica y experimental de su utilidad se encuentra este artículo. Las hipótesis planteadas por Head en cuanto a la asociación e interrelación de sensibilidad cutánea y visceral, pueden constituirse en un aporte para las bases neuroanatómicas y fisiológicas de la neuralterapia y la medicina en general. Se realiza una revisión histórica de una parte de su trabajo menos difundida, dedicada al dolor referido en la enfermedad visceral y en los cambios mentales asociados a la misma...

Henry Head, a British neurologist, carved a name for himself in the Western Medicine Annals for his contribution to the creation of dermatome maps. Segment therapy stands as one of the therapeutic modalities making up neural-therapeutic medicine, and this paper is within the theoretical and experimental support frame of the study of its utilization. The hypotheses proposed by Head in terms of association and interrelation of cutaneous and visceral sensitivity can be deemed as a contribution to the neural-anatomic physiologic grounds for not only neural-therapy, but also general medicine. This paper constitutes a historic review of one of the least known parts of his work, devoted to visceral-disease-referred pain and visceral-disease-associated mental changes...

Estudo da relação entre hiperatividade dos músculos esfenomandibulares e sintomatologia visual / Relationship between sphenomandibular muscle hyperactivity and visual symptoms

This was an observational, descriptive study developed after an anatomical investigation of cadavers to identify the sphenomandibular muscle as an independent entity. The objective here was to perform a clinical and interpretative evaluation of the physiological relationships between the functions of the sphenomandibular muscle and various symptoms, thereby associating temporomandibular disorders with ocular pain. Ten anatomical sets (five cadavers) in the Department of Anatomy of the Medicine School of the Catholic University of Goiás were examined. This study was conducted between April, 2006 and December, 2008. Patients (181 subjects) suffering from temporomandibular disorder were treated in the Federal University of Goiás Dental School. Two groups were compared: Group I consisted of 58 patients with temporomandibular disorder, referred ocular pain, and hyperactivity of the sphenomandibular muscles; Group II was comprised of 45 patients with temporomandibular disorder, ocular pain, but no hyperactivity of the sphenomandibular muscles. After a clinical exam, treatments were conducted with semi-yearly follow-up exams for 2 years. Responses to the treatment were evaluated by questionnaires thereby quantifying existing levels of ocular pain. Pain was eliminated in 46 of the 58 patients in Group I (79.31%) and 8 of the 45 patients in Group II (17.77%). Our evaluation affirms that the sphenomandibular muscle, independent of the temporal muscle, has an intimate relationship with the orbit. The clinical exam allowed an evaluation of the sphenomandibular muscles in temporomandibular disorder episodes. The hyperactivity of the sphenomandibular muscle is thus significantly related to the presence of ocular-referred pain (p<0.05).

Estudo observacional e descritivo desenvolvido após estudo anatômico feito em cadáveres para a identificação do músculo esfenomandibular como entidade independente. Pretendeuse uma avaliação clínica interpretativa das relações fisiológicas entre as funções do músculo esfenomandibular e a sintomatologia que envolve desordem temporomandibular com dor ocular. Foram examinados 10 conjuntos anatômicos (cinco cadáveres) no Departamento de Anatomia da Faculdade de Medicina da Pontifícia Universidade Católica de Goiás. Além disso, foram tratados e acompanhados 181 pacientes atendidos no Ambulatório da Faculdade de Odontologia da Universidade Federal de Goiás, portadores de Desordem Temporomandibular. O trabalho foi desenvolvido entre abril de 2006 e dezembro de 2008. Foram comparados: o Grupo I, de 58 pacientes que apresentavam desordem temporomandibular, dor ocular reflexa e hiperatividade dos músculos esfenomandibulares; e o Grupo II, composto de 45 pacientes que apresentavam a desordem, dor ocular e não apresentavam hiperatividade dos músculos esfenomandibulares. O tratamento foi realizado após exame clínico com acompanhamento durante 2 anos, em avaliações semestrais. A resposta ao tratamento foi avaliada mediante questionário de opinião que estratifica o nível da dor ocular. A dor foi eliminada em 46 dos 58 pacientes do Grupo I (79,31%) e em 8 dos 45 pacientes do Grupo II (17,77%). O resultado da avaliação permite afi rmar que o músculo esfenomandibular, músculo independente do temporal, está em íntima relação com a órbita. O exame clínico permitiu a avaliação da hiperatividade dos músculos esfenomandibulares nos episódios de desordens temporomandibulares. A hiperatividade dos músculos esfenomandibulares está significativamente associada à presença de dor ocular reflexa (p < 0,05).

Referred dental pain, an analysis of their prevalence and clinical implication / Dolor dental referido, análisis de su prevalencia e implicancias clínicas

The study objective was to evaluate the prevalence of referred dental pain (RDP) in a group of Brazilians subjects and identify possible partnerships with sex, age and the presence of periodontal or periapical lesions. A descriptive cross-sectional study was designed, 98 patients between 14 and 64 years old (59 women and 39 men), who consulted by dental pain were evaluated clinically and radiographically in order to determine the cause and partnership with periapical and periodontal lesions and its possible territories projection other than their origin. The prevalence of RDP was 31.6 percent, higher in women (67.74 percent) though without statistical significance. The RDP was presented at a 45.16 percent together with periapical lesion and a 25.8 percent along with periodontal lesion. There was no relationship between age and RDP presence. The high prevalence of RDP found reinforces the need for a diagnosis of orofacial pain.

El objetivo de este estudio fue analizar la prevalencia de dolor referido dental (DRD) en un grupo de sujetos brasileros y determinar las posibles asociaciones con sexo, edad y la presencia de lesión periapical o periodontal. Se diseñó un estudio descriptivo de corte transversal, con 98 pacientes, de entre 14 y 64 años (59 mujeres y 39 hombres), que consultaron por dolor dental, ellos fueron evaluados clínica y radiográficamente con el fin de determinar la causa y la asociación con lesión periapical y periodontal y su posible proyección a territorios distintos de su origen. La prevalencia del DRD fue de 31,6 por ciento, mayor en mujeres (67,74 por ciento) aunque sin significancia estadística. El DRD se presentó en un 45,16 por ciento junto con lesión periapical y un 25,8 por ciento junto a lesión periodontal. No se encontró asociación entre la edad y la presencia de DRD. La alta prevalencia de DRD encontrada refuerza la necesidad de un diagnóstico etiológico del dolor orofacial.

Fibromialgia: aspectos clínicos e ocupacionais / Fibromyalgia: clinical and occupational aspects

A fibromialgia (FM) é uma síndrome clínica comumente observada na prática médica diária e possui etiopatogenia ainda obscura. Caracterizada por quadro de dor musculoesquelética crônica associada a variados sintomas, a FM pode ser confundida com diversas outras doenças reumáticas e não reumáticas, quando estas cursam com quadros de dor difusa e fadiga crônica. O tratamento da FM deve ser multidisciplinar, individualizado, contar com a participação ativa do paciente e basear-se na combinação das modalidades não farmacológicas e farmacológicas. Presente tanto em ambientes laborais como não laborais, não há evidência científica na literatura de que a FM possa ser causada pelo trabalho. A FM comumente não leva à incapacidade laborativa. Nos casos em que a dor ou a fadiga não respondem ao tratamento adequado, atingindo níveis significativos, o afastamento do trabalho por curto período de tempo pode ser considerado. Pela relevância do tema, os autores elaboraram este artigo de revisão a partir de investigação exploratória, qualitativa e bibliográfica com objetivo de estudar os principais aspectos clínicos e ocupacionais da FM, dando ênfase ao embasamento teórico-conceitual e na experiência de especialistas.

Fibromyalgia (FM) is a clinical syndrome commonly observed in daily medical practice and its etiopathogenesis is still unclear. As it is characterized by chronic musculoskeletal pain associated with several symptoms, FM may be confused with several other rheumatic and nonrheumatic diseases when they course with pictures of diffuse pain and chronic fatigue. FM treatment should be multidisciplinary, individualized, count on active participation of the patient, and based on combined pharmacological and nonpharmacological modalities. It is found both in work and non-work settings, and there is no scientific evidence in the literature showing that FM might be caused by occupation. FM seldom leads to incapacity to work. In cases where pain or fatigue do not respond to appropriate treatment, reaching significant levels, a short period away from work can be considered. As FM is a relevant subject, this review article was based on exploratory, qualitative, and bibliographic investigation, aiming to study the main clinical and occupational aspects of FM, emphasizing the theoretical-conceptual background and the experience of specialists.

Avaliação da dor crônica em idosos institucionalizados / Evaluacion del dolor cronico en ancianos institucionalizados / Evaluation of chronic pain in the institutionalized elderly

Objetiva-se com esta pesquisa avaliar a dor e caracterizar os idosos institucionalizados segundo as variáveissociodemográficas e clínicas. Trata-se de estudo descritivo realizado com 124 idosos residentes nas Instituiçõesde Longa Permanência para Idosos de Minas Gerais. Para a obtenção dos dados, realizou-se entrevista, bem comoavaliação clínica. Utilizou-se estatística descritiva com análise univariada dos dados. Verificou-se a predominânciado sexo feminino, com hipertensão arterial sistêmica referida, solteiros e com filhos, média de idade 76,2 anos eIMC médio 23,1 kg/m². A dor crônica, a adoção de tratamento medicamentoso e a não realização de atividade físicaregular foram referidas pela maioria dos idosos. Os principais fatores de melhora e piora referidos foram o repouso ea movimentação física, respectivamente. A dor crônica e a não realização de atividade física regular são vivenciadaspela maioria dos idosos institucionalizados. Espera-se que novas medidas de monitoramento, prevenção e controleda dor sejam implementadas nessas instituições.

This study objective was to evaluate the pain in institutionalized elderly as well as characterize this group accordingto socio-demographic and clinical variables. It is a descriptive study with 124 elderly people living in long-term carefacilities (LTCF) in the state of Minas Gerais, Brazil. Data were obtained via interview and clinical assessment. Descriptivestatistics with univariate data were used. There was predominance of women with systemic arterial hypertension, singleand with children. The mean age was 76.2 years, and the median BMI was 23.1 kg / m². Chronic pain, the medicationtreatment and the lack of physical activity were reported. Key fators for improvement and worsening of health were thephysical rest and physical activity, respectively. Results indicated that chronic pain and lack of regular physical activityare experienced by most of the institutionalized elderly. New measures for monitoring, preventing and controlling thepain should be implemented in these institutions.

El objetivo del presente estudio fue evaluar el dolor y caracterizar ancianos institucionalizados en función de variablesdemográficas y clínicas. Se trata de un estudio descriptivo de 124 ancianos hospedados en establecimientos delarga permanencia de Minas Gerais. Llevamos a cabo entrevistas y evaluación clínica para obtener datos. Se utilizóestadística descriptiva con los datos de una variable. Los resultados indican que hay predominio de individuos delsexo femenino, hipertensos, solteros y con hijos. Edad promedio de 76,2 años y promedio de IMC de 23,1 kg / m².Dolor crónico, tratamiento con fármacos y falta de actividad física regular fueron mencionados por la mayoría de losancianos. Principales fatores de mejora y empeoramiento fueron reposo y actividad física, respectivamente. Llegamosa la conclusión que la mayoría de los ancianos vive con dolor crónico y falta de actividad física regular. Se espera quesean implementadas nuevas medidas de control, prevención y control del dolor en estas instituciones.

Dores dentárias de origem muscular em indivíduos com distúrbios crâniomandibulares e controles: estudo comparativo / Dental pains of muscle origin in craniomandibular disorders individuals and controls: a comparison study

JUSTIFICATIVA E OBJETIVOS: As dores referidas para os dentes ocorrem frequentemente na região orofacial e constituem um desafio diagnóstico para o clínico.Os objetivos deste estudo foram analisar a frequência de dores dentais de origem muscular e os dentes afetados mais frequentemente. MÉTODO: As fichas clínicas completas de 258 pacientes com distúrbios crâniomandibulares (DCM) encaminhados consecutivamente durante 8 anos foram avaliadas. Os dados foram obtidos com base na queixa principal, história dos sinais e sintomas descrição da dor,palpação muscular e critérios para DCM, bruxismo e dores referidas para os dentes. RESULTADOS: A frequência de dores nos dentes foi de 19,4% no grupo DCM e de 7,5% no grupo controle(p = 0,11). A frequência de dores dentais referidas aumentou do grupo CMD com bruxismo moderado para os grupos intenso e extremo (p = 0,47, p = 0,18), mas as diferenças não foram significativas. As dores dentais foram mais frequentes no arco superior (18,2%) do que no inferior (12,4%) e nos molares superiores e inferiores do que nos outros grupos de dentes. Trinta e três indivíduos relataram um total de 94 dentes superiores com dor e 24 sujeitos, 79 dentes inferiores com dor (p = 0,85). CONCLUSÃO: As dores musculares referidas aos dentes ocorrem com frequência em indivíduos com DCM.Os dentes superiores e o grupo de molares apresentaram dor com mais frequência do que os outros grupos de dentes.A frequência de dores dentais de origem muscular foi maior em bruxismos graves e extremos e tais dores são causa comum de dor de dente de origem não dental.

BACKGROUND AND OBJECTIVES: Pain referred to the teeth occurs frequently in the orofacial region and constitutes a diagnostic challenge for the dental practitioner. The goals of this study were to analyze the frequency of muscle pain referred to the teeth and the frequency of teeth affected more frequently.METHOD: Complete clinical charts of 258 CMD subjects referred consecutively during an eight-year period were assessed. Data were obtained based on the chief complaint, history of signs and symptoms, pain description, muscle palpation and criteria for CMD, bruxism and muscle pain referred to the teeth. RESULTS: The frequency of pain referred to the teeth was about 19.4% in the CMD group and 7.5% in the control group (p = 0.11). The frequency of pain referred to the teeth increased in the CMD group with moderate bruxism to the intense and extreme groups (p = 0.47, p= 0.18), but the differences were not significant. Pain referred to the teeth was more frequent in the upper arch(18.2%) than in the lower (12.4%) and in the upper and lower molars than in other groups of teeth. Thirty three individuals reported a total of 94 upper teeth with pain and 24 subjects, 79 lower teeth with pain (p = 0.85).CONCLUSION: Muscle pain referred to the teeth occur frequently in CMD individuals. Upper teeth and themolars group presented pain more frequently than other groups of teeth. The frequency of muscle pain referred to the teeth was higher in intense and extreme bruxers and such pain is a common cause of tooth pain of non-dental origin.

Quantidade de pressão e padrão de dor referida em pacientes portadores de dor miofascial / Pressure pain treshold and referred pain pattern in myofascial pain patients

Os propósitos deste estudo foram: determinar a quantidade de pressão que estimulasse resposta dolorosaem pacientes com pontos gatilho (PG) quando comparado ao grupo controle assintomático; determinar umintervalo de tempo de manutenção de pressão para que houvesse o surgimento do processo de dor referida(DR) e verificar o padrão de DR provocada. Selecionou-se 24 pacientes portadores de dor miofascial e parao grupo controle, 20 indivíduos livres de qualquer sintomatologia de disfunção temporomandibular. Ambos os grupos foram examinados por um único examinador em pontos gatilho previamente diagnosticados. Noitem quantidade de pressão, o intervalo no grupo portador de dor miofascial foi significantemente menor queo grupo controle. O padrão de DR obtido confere com aquele descrito na literatura. Os autores deste estudoconcluíram que o limiar de dor a palpação em portadores de dor miofascial é menor que em indivíduos nãoportadores e o padrão da manifestação de DR semelhante ao descrito na literatura.

The purposes of this study were: to determine the amount of pressure necessary to create painful responsein patients with myofascial pain in head and neck when compared with a assintomatic control group; to determineone sustained pressure time that causes referred pain and to determine the referred pain pattern whenthe trigger points were stimulated. The group A was formed by 24 patients who had myofascial pain, andgroup B was composed by 20 myofascial pain free subjects. For both groups, examination was performed byonly an experienced and trained professional. Group A had lower pressure pain threshold when comparedwith group B.( p < 0,01) The referred pain patterns was very similar to those described in literature. It wasconcluded that the pressure pain threshold in myofascial pain patients is lower than pressure pain thresholdin non-patients.

Trigeminal Autonomic Cephalalgia by Neurogenic Palatine Compression: A Clinical Report and Review / Cefalea Autonómica Trigeminal por Compresión Neurogénica Palatina: Reporte de Caso y Revisión

This clinical report presents the evolution of a possible intraoral traumatic trigeminal autonomic cephalalgia simulating a probable cluster headache. A 50-year-old female patient had severe right-hand side pain for 7 years with autonomic signs and symptoms, such as lacrimation, conjunctival injection, rhinorrhoea, nasal congestion, forehead perspiration, myosis and eyelid edema. The episodes of pain lasted 4 or 5 months with 3- or 4-month remission periods between the painful onsets. The headaches presented an episodic pattern (1 to 3 attacks daily) lasting three to six hours. The patient had used five prosthetic sets continuously (24 h) for 20 years and the current prosthesis was 7 years old. Accidentally, after the alleviation of the maxillary denture due to it rested on a marked irritated incisive papilla the symptoms disappear. The patient has been periodically checked over a 5 year period since, without recurrence of her pain and autonomic symptomatology. The possible pathophysiology is discussed.

Se presenta un caso de cefalea autonómica trigeminal que simula una cefalea en cluster probable con potencial origen traumático intraoral. Mujer de 50 años que reportaba dolor derecho de intensidad severa con 7 años de evolución. El dolor se presenta con síntomas vegetativos como epifora, irritación de la conjuntiva ocular, rinorea, congestión nasal, sudoración frontal, miosis y edema palpebral. Los episodios de dolor se presentaban intermitentemente en el año, con duración de 4 a 5 meses y periodos de remisión de 3 a 4 meses. Las cefaleas se presentaban de manera episódica en el día (1 a 3 episodios) que duraban de 3 a 6 horas. Se observa prótesis intraoral en mal estado, con 7 años de realizada. La paciente reporta la elaboración de 5 juegos protésicos hasta la fecha y que usa constantemente en el día y la noche. Accidentalmente, y antes de la remisión a otro especialista, los síntomas desaparecen después del alivio mecánico en la zona anterior de la prótesis, que comprimía e irritaba la papilla incisiva. La paciente ha estado bajo controles periódicos durante 5 años y medio, sin recurrencia de los síntomas. La posible fisiopatología es discutida.

Theories on Otic Symptoms in Temporomandibular Disorders: Past and Present / Teorías de los Síntomas Óticos en los Trastornos Temporomandibulares: Pasado y Presente

For many years otic symptoms have been closely observed in TMD clinical practice. This review includes trials that meet eligibility criteria in the field of otic symptoms diagnosed and treated by a stomatognathic focal point. The aim is centered on the implications of the debated cause-effect connection between otic symptoms and TMD offering a probable bond between the TMJ, ear and adjacent structures. The rationalization is based on an embryological and anatomical approach that offers explanations on the otic pathogenic mechanisms symptoms interconnected with TMD. The accompanying reciprocity among disciplines of odontology and otolaryngology is brought together by TMD and otic referred mutual symptomatology as is showed in multiple trials. This research is an attempt that targets the integration of these two health specialties in the diagnosis and treatment of this type of population.

Por muchos años, síntomas óticos observados en la práctica clínica se han relacionado estrechamente con trastornos temporomandibulares (TTM). Esta revisión incluye juicios que plantean criterios específicos en el campo de los síntomas óticos diagnosticados y tratados desde un punto vista estomatognático. El objetivo está centrado en las implicancias debatidas causa-efecto entre síntomas óticos y TTM estableciendo un probable vínculo entre la ATM, oído y estructuras adyacentes. La revisión está basada en una aproximación embriológica y anatómica que explica los mecanismos y síntomas de patogenia ótica interconectados con TTM. El acompañamiento recíproco entre disciplinas de odontología y otorrinolaringología estableció un equilibrio entre los TTM y la mutua sintomatología ótica remitida, como está mostrado en múltiples diagnósticos. Esta investigación constituye un intento de alcanzar una integración entre estas dos especialidades médicas en el diagnóstico y tratamiento de este tipo de patologías.