[Acute pain service. Organization and results]. / Akut smerteservice. Organisation og resultater.

Postoperative pain therapy in modern clinical practice still has significant deficits. Establishing acute pain services is reported to be a method of improving pain therapy. In this prospective study, 104 orthopaedic patients were treated with a postoperative epidural infusion of a combination of bupivacaine and sufentanil. Pain intensity and side effects were recorded daily by pain management personnel, and the pain therapy was adjusted according to the patients' need. The results showed that pain control was insufficient in 29 patients, and that side effects developed in 45 patients, included one patient with late respiratory depression. We conclude that acute pain service is essential in order to improve postoperative analgesia.

Chewing movements in TMD patients and a control group before and after use of a stabilization splint.

PURPOSE: This study assessed the effect of using an occlusal stabilization splint in the maxilla for 6 weeks on certain parameters of chewing movements in subjects with and without temporomandibular disorder symptoms. MATERIALS AND METHODS: Twelve male and 30 female temporomandibular disorder patients with and without a prior whiplash incidence, and individuals without signs and symptoms of temporomandibular disorders participated. The participants formed three groups matched according to gender and age (n = 3 x 14). A maxillary stabilization splint was used during sleep for 6 weeks. An optoelectronic system (MacReflex, Qualisys) was used to record chewing movements at baseline, before using the splint, and after 6-weeks' use of the splint. Calculated parameters were the duration of the chewing cycles, the spatial displacement, and the mean velocity of the mandible while chewing paraffin wax for 20 seconds. RESULTS: On a group basis, the use of an occlusal stabilization splint for 6 weeks did not change the jaw movement parameters in a predictable pattern as recorded under the conditions of this study. On an intraindividual basis, large variations in changes of chewing parameters over time were observed. CONCLUSION: The use of an occlusal stabilization splint for 6 weeks did not alter the jaw movements when chewing a substance with a soft consistency.

Somatic complaints, psychologic distress, and treatment outcome in two groups of TMD patients, one previously subjected to whiplash injury.

The aim of this study was to compare somatic complaints and psychologic distress in a group of whiplash patients with temporomandibular disorders (TMD) and a group of patients with TMD only, and to assess the outcome after conservative TMD treatment consisting of counseling, muscle exercises, and a stabilization splint. Each group consisted of 16 patients (12 women and 4 men) with a mean age of 42 years. The duration of the symptoms was from 1 to 3 years. In addition to a functional clinical examination and a recording of headache frequency and intensity, the patients answered three questionnaires: a Somatic Complaints Questionnaire (SCQ); the trait portion of Spielberger's State-Trait Anxiety Inventory; and the Symptom Checklist-90-Revised (SCL-90-R). The whiplash patients had higher scores than the TMD patients on the SCQ muscle score and on the following subscores of SCL-90-R: obsession, somatization, depression, and anger/hostility. The treatment outcome as assessed by the change of self-reported frequency of headache, number of tender muscles upon palpation, and change of values on a visual analogue scale for headache intensity showed that the whiplash patients obtained only a decrease in the proportion of tender muscles, while those in the TMD only group showed improvement on all treatment criteria.

[CO2 and indomethacin vasoreactivity in patients with cranial trauma]. / CO2-og indometacinvasoreaktivitet hos patienter med kranietraume.

The purpose of this study was to compare the effect of hyperventilation and indomethacin on cerebral circulation, metabolism and systemic and intracerebral pressures in patients with severe head injury. Fourteen moderately (PaCO2 = 4.05 kPa) hyperventilated patients with median [CP = 14.8 mmHg entered the study. Cerebral blood flow (CBF), intracranial pressure (ICP), arteriovenous difference of oxygen (AVDO2) and lactate (AVdL) and oxygen saturation in the jugular bulb (SvjO2) were measured before and after hyperventilation and after a bolus dose of indomethacin (30 mg). During hyperventilation CBF decreased by 11.8%/kPa and ICP decreased by 3.8 mmHg. AVDO2 increased by 34.0%/kPa. After indomethacin CBF decreased by 14.7% and ICP decreased by 4.3 mmHg. AVDO2 increased with 27.8%. No changes in median SvjO2 and AVdL were observed after the two treatments. The risk of cerebral ischaemia seems identical after the two treatments. No correlations between the effects of the two treatments on CBF, ICP and AVDO2 were found. These results suggest that indomethacin and hyperventilation might act independently or in a complementary fashion in the treatment of patients with severe head injury.

The reporting of pain, somatic complaints, and anxiety in a group of patients with TMD before and 2 years after treatment: sex differences.

The aim of this study was to assess possible gender differences regarding the reporting of pain, somatic complaints, and anxiety in a group of patients suffering from temporomandibular disorders (TMD). The group consisted of 40 females and 13 males who received conservative TMD treatment comprising counseling, muscle exercises, and a stabilization splint. Before and 2 years after treatment, the patients answered three questionnaires (McGill Pain Questionnaire [Norwegian version] including a six-point scale, the Present Pain Intensity; a Somatic Complaints Questionnaire; and the trait part of Spielberger's State-Trait Anxiety Inventory. Before treatment, females reported greater present pain intensity than did males. Two years after treatment, females reported less sensory and emotional pain than at the initial stage; males presented no reduction in these pain scores. There were no gender differences at either stage regarding somatic complaints or anxiety level scores.

Relationships between risk factors and treatment outcome in a group of patients with temporomandibular disorders.

The aim of this study was to compare somatic complaints, anxiety, and pain related to temporomandibular disorders (TMD) in a group of TMD patients who had high scores for headache and muscle palpation compared with that of a group of TMD patients who had low or medium scores for headache and palpation before and 2 years after conservative TMD treatment, consisting of counseling, muscle exercises, and a stabilization splint. The high-score group consisted of 23 patients who had headaches several times a week or daily and had more than three muscles graded as severely tender to palpation. The low/medium-score group comprised 28 patients who had headaches hardly ever, once or twice a month, or several times a month, and with muscles graded as slightly or medium tender to palpation. The patients answered three questionnaires (McGill Pain Questionnaire [Norwegian version], a somatic complaints questionnaire, and the trait part of Spielberger Stait-Trait Anxiety Inventory) before and 2 years after treatment. The findings showed differences between the two groups concerning pain description, general muscle complaints, and anxiety both before and after the treatment, with the high-score group showing the highest values. In general, the treatment outcome had improved in the low/medium-score group but remained unchanged in the high-score group.

Negative affectivity, somatic complaints, and symptoms of temporomandibular disorders.

This study examined the relationship between trait anxiety, subjective somatic symptoms, and pain associated with temporomandibular disorders (TMD) in a combined cross-sectional and prospective study. Compared with the initial measurements, a significant reduction in anxiety and pain was observed in the follow-up phase (two years after evaluation and therapy). No change in general somatic complaints was found. In both the initial phase and the follow-up phase, a consistent relationship between anxiety, somatic complaints, and TMD-related pain was demonstrated. The results are in agreement with a conceptualization of negative affectivity (e.g., anxiety, distress, tension) as a general dimension of somatopsychic distress. The best predictors of later TMD pain were general somatic complaints, followed by initial pain, and trait anxiety. Significant moderate correlations between anxiety, somatic complaints, and response to muscle palpation (feelings of tenderness) were also found. It is concluded that studies of TMD should incorporate measures of negative affectivity and general somatic complaints because these factors are important predictors of TMD pain, response to treatment, and chronicity.

The face height in adult dentate humans. A discussion of physiological and prosthodontic principles illustrated through a case report.

The adaptability of the stomatognathic system to alterations in the vertical dimension is discussed based on scientific reports and clinical experience. A case is reported demonstrating the stability of a therapeutically induced increase in the occlusal vertical dimension over a 10 year period. In conclusion, it is stated that moderate alterations in the occlusal vertical dimension of patients are generally well tolerated if necessary for therapeutic measures.

In vivo wear ranking of some restorative materials.

An in vivo experiment to determine the wear of restorative materials (gold, ceramic, and microfilled resin) was performed in a patient with bruxism. Telescopic crowns were placed on teeth 35, 36, and 37. The opposing surfaces were all made from ceramic material. The weight loss of the materials was recorded after 30, 60, and 90 days and converted to volume loss. Replicas for scanning electron microscopic studies were obtained. Gold and ceramic material wore equally, while the wear of microfilled resin was two and a half times as much. The ceramic material and the microfilled resin chipped and fractured, but the gold did not. Mainly abrasive and fatigue types of wear were found in all materials.

Occlusal wear of teeth and restorative materials. A review of classification, etiology, mechanisms of wear, and some aspects of restorative procedures.

This paper is a literature review of various aspects of the wear of occluding tooth surfaces. It presents classification and terminology of occlusal tooth wear, and discusses etiology and differential diagnosis. It may be difficult to differentiate among abrasion, attrition, and erosion because there is nearly always a combination of the various processes. These processes of wear are described, and the in vitro and in vivo wear of some restorative materials is discussed. Treatment of severe tooth wear is considered difficult; prophylactic measures are therefore important. Some guidelines for restorative treatment of patients with extensive occlusal tooth wear are given, with special emphasis on the type of treatment, the vertical dimension of occlusion, the space available, and choice of material for the restorations.

Sex differences in signs and symptoms from masticatory and other muscles in 19-year-old individuals.

Pain and tenderness of masticatory muscles are often related to muscle tenderness elsewhere in the body. It has been shown that women are more prone to musculoskeletal disorders than men. We sought to determine whether sex differences of muscular symptoms were established by the age of 19. The subjects comprised 51 boys and girls who received a questionnaire regarding the function of their masticatory system, frequency of headache, and neck, shoulder and low back pain. Their masticatory system was examined, and neck and shoulders were palpated. For all variables in the questionnaire girls reported symptoms more often than the boys. Of the subjects 50% had tender chewing muscles upon palpation. Again the girls had the most. There was good correlation between reports of pain in one area as compared to others. The number of clinically tender neck and shoulder muscles correlated with the number of tender masticatory muscles. It was concluded that girls presented more muscular symptoms than boys.

Assessment of adverse reactions to prosthodontic materials.

In 1978 five cases of so-called hypersensitivity reactions to Scutan and two to Impregum were reported (Dahl, 1978). The aim of the present study was to assess whether hypersensitivity or cell-mediated immune reactions were associated with the adverse clinical reactions in these patients or in others who had experienced the same reactions. Epicutaneous patch testing and lymphocyte transformation tests were carried out in a total of 13 individuals. The findings were difficult to interpret, because there was no consistent association between skin reactions and cell-mediated immune responses in subjects with suspected allergies. Other possible reasons for the reactions originally recorded were therefore discussed. It was concluded that adverse reactions associated with immune-mediated, delayed type hypersensitivity reactions may be elicited by prosthodontic materials, but other pathogenic mechanisms and aetiological factors responsible for the reactions observed should also be considered.

Wear of teeth in a mentally retarded population.

The study includes an evaluation of dental wear in 69 individuals, 44 men and 25 women, of mean age 35 years and range 18-59 years, living in a home for mentally retarded persons. Wear was evaluated with a newly developed index based on Ryges' system, where the need for treatment is the key issue. The index consisted of three categories representing clinical situations from no wear to moderate, age dependent wear without problems for the patient, and two categories in which treatment was found to be necessary either to prevent future problems or to improve the present situation. A relatively large number of teeth showed considerable wear in the 20-29 year age group. Wear was observed predominantly in incisors and canines. Only 1% of cases were considered to require treatment. Wear increased with age, and more than 5% of teeth were diagnosed as needing treatment in the 30-39 year and 40-49 year age groups. Wear in the studied population was found to be more severe than that observed in an urban population from the same area in a parallel study.

The suitability of a new index for the evaluation of dental wear.

The suitability of a new index for rating dental wear by different observers was tested. Four dentists, who were first calibrated using the scoring system and then subjected to an inter-examiner agreement test before and after a field study, rated 167 individuals in total in their private dental practices. The incisal/occlusal state of the teeth with regard to restorations and dental wear was recorded. The inter-examiner agreement test proved satisfactory when rating main groups of wear but not so good when rating subcategories. However, a marked improvement in agreement developed between the first and the second test. The individuals composing the field study group are probably not representative of Scandinavian populations in general. Relatively few teeth were missing, and the teeth were well restored. Only the highest age group (80-89 years) displayed the most severe degree of wear to any extent. However, wear into the dentin was observed in 20% of the teeth already in the youngest age group (20-29 years). These teeth were solely incisors and canines of both jaws. In conclusion, we found that the index should be well suited for the evaluation of dental wear in large groups of people by different investigators after adequate training in use of the system has been provided and that tooth wear may be a relatively small problem in urban Scandinavian populations with regular dental care.

Abrasives in snuff?

The purpose of this study was to determine and calculate the inorganic contents of four brands of snuff. Visual inspection of wet snuff showed fairly large, yellow crystal-like particles. Scanning electron microscopy and X-ray dispersive (EDX) analyses were used to study both wet snuff and ashes of snuff, whereas light emission spectrography was used to determine elements in the ashes. The crystal-like particles did not dissolve in distilled water or in ethanol heated to 60 degrees C. EDX analyses showed that most elements remained in the particles after washing. The total weight percentage of inorganic material in snuff was calculated after burning dried snuff until constant weight was obtained. The ashes of snuff did not contain any crystal-like particles but consisted of a small-grained amorphous mass. The following elements were detected: Ag, Al, Ba, Ca, Co, Cr, Cu, Fe, K, Li, Mg, Mn, Na, P, Pb, Si, Sr, Ti, Va, and Zr. Other elements such as rare earths were not searched for. The weight percentage of inorganic elements ranged between 12.35 +/- 0.69 and 20.95 +/- 0.81. Provided snuff is used in the same manner as chewing tobacco, and some people admit to doing so, there is a risk that its relatively high contents of inorganic material and heavily soluble salts may be conducive to excessive abrasion of teeth and restorations.

Differences in functional variables, fillings, and tooth wear in two groups of 19-year-old individuals.

Fifty-one individuals (28 girls and 23 boys) who had received orthodontic treatment were compared with 47 subjects (19 girls and 28 boys) without such treatment as to maximal mandibular mobility, chewing muscle tenderness, morphologic occlusion, occlusal/incisal state, and degree of tooth wear. All were 19 years old. There were no statistically significant differences between the groups except for the number of teeth present and maximal mouth opening, which were both smallest in those who had received treatment. The first finding is evident, extraction of premolars being an accepted mode of orthodontic treatment. The reduced mouth opening capacity was related to an increased number of individuals with four or more palpably tender muscle sites in that group of individuals.

Signs and symptoms of craniomandibular disorders in two groups of 19-year-old individuals, one treated orthodontically and the other not.

Fifty-one individuals (28 girls and 23 boys) who had received orthodontic treatment were compared as to signs and symptoms of craniomandibular disorders with 47 individuals (19 girls and 28 boys) without such treatment. All were 19 years old. An average of 5 years had elapsed since the termination of the treatment. The examinations enabled calculations of the anamnestic, the clinical dysfunction, and the occlusal indices of Helkimo. There were no statistically significant differences between the groups except with regard to the anamnestic index. Subjects who had not received orthodontic treatment reported most symptoms, but none were severe. In conclusion, there were no substantial differences as to signs and symptoms of craniomandibular disorders in these two groups of individuals.

An index for evaluating wear of teeth.

An index for evaluation of dental wear based on Ryge's system comprising three satisfactory and two not acceptable categories was tested in two different age groups of individuals with brain damage. Group 1 consisted of 12 individuals, 3 women and 9 men, with a mean age of 34.5 years. Group 2 consisted of 13 individuals, 4 women and 9 men, with a mean age of 45.1 years. The wear was evaluated by three examiners, two dentists and one dental hygienist. The examiners worked independently, having available at all times the written criteria and a photographic guide illustrating the lowest limit of each category. Each tooth was given a rating in accordance with the index, and the interexaminer agreement of 612 such evaluations was approximately 85%. Each person was given an individual wear rating corresponding to the most severe category comprising 90% of the tooth ratings. The difference in the distribution of individual ratings between the two groups was tested for significance by the ridit method. Significantly greater wear was observed in group 2 than in group 1, indicating a good sensitivity of the index.