RESUMEN
OBJECTIVES: The aim of a pilot study was to clarify the question of whether mouth opening restrictions in patients with PTSD by means of splint therapy (st) show long-term therapeutic effects in the case of functional disorders. MATERIAL AND METHODS: In 31 of 36 inpatients (soldiers, average age 37.1 ± 7.3 years, 26.7 ± 2.1 teeth) with confirmed posttraumatic stress disorder, chronic pain intensity > 6 (visual analogue scale 0 to 10), the mouth opening was determined, and the functional status (RDC-TMD) was recorded. All participants received a splint that was worn at night. A control of the therapeutic effect of the splint occurred after 6 weeks, 3, 6, and 12 months. RESULTS: The mouth opening initially had an average of 30.9 ± 6.5 mm (median 31 mm). The pain intensity (PI) was reported to be on average VAS 8.3 ± 0.9, the chronic degree of pain according to von Korff was 3.9 ± 03. Six weeks after the st (n = 31), the average mouth opening was 49.5 ± 6.3 mm (median 51.5). PI was given as VAS 2.3 ± 1.1 on average. After 3, 6, and 12 months, 24, 15, and 14 subjects could be interviewed regarding PI. Based on the last examination date of all subjects, the average PI was given as 1.1 ± 0.9 (median 1). CONCLUSION: The presented data show that the therapeutic short-term results achieved by means of a splint remain valid on the long term despite continued PTSD. CLINICAL RELEVANCE: The presented study shows that patients will benefit in the long term from a splint and remain symptom-free, even if this mental illness persists.
Asunto(s)
Ferulas Oclusales , Trastornos por Estrés Postraumático/terapia , Adulto , Humanos , Personal Militar , Proyectos Piloto , Resultado del TratamientoRESUMEN
BACKGROUND: In studies on posttraumatic stress disorder (PTSD, ICD 10: F43.1) and in clinical observation, the high proportion of soldiers with painful craniomandibular dysfunction (CMD) is conspicuous. AIM: This study aimed to clarify if there is a connection between orofacial dysfunction, pain in this region, stress and PTSD. MATERIAL AND METHODS: A total of 36 inpatients (PTSD group) with specialist psychiatrically confirmed PTSD after up to 17 foreign deployments and 36 control subjects with 2-40 foreign deployments underwent a functional dental examination. All participants filled out a form for the gradation of chronic pain (GCP, degrees 0-4) as well as the depression, fear and stress scale (DFSS). RESULTS: Soldiers with PTSD had significantly worse orofacial functional diagnoses and higher pain scores, although on average they had less combat deployments (PTSD: maximum mouth opening 31.4⯱ 8.0â¯mm vs. 57⯱ 6â¯mm, GCP 3.5⯱ 1.0 vs. 0.5⯱ 0.5).The PTSD group showed a depression score of 14.9⯱ 4.2 vs. the control group 1.4⯱ 2.1, a fear score of 13.7⯱ 3.9 vs. 1.0⯱ 1.5 and a stress score of 16.1⯱ 3.4 vs. 3.3⯱ 2.9. CONCLUSION: The data from this pilot study show an obvious connection between PTSD and orofacial dysfunctions. Through further prospective studies it should be evaluated if there is a general vulnerability of those afflicted for pathological orofacial stress. This could be used for screening before combat deployment.
Asunto(s)
Discinesias , Personal Militar , Trastornos por Estrés Postraumático , Depresión/etiología , Discinesias/etiología , Humanos , Personal Militar/psicología , Personal Militar/estadística & datos numéricos , Proyectos Piloto , Trastornos por Estrés Postraumático/complicacionesRESUMEN
OBJECTIVES: The significance of occlusal disharmony for the development of painful temporomandibular disorder (TMD) is controversial. The ongoing biomechanical strain caused by occlusal disharmony might lead to sensitization processes in the nociceptive system. Understanding these processes might be an important step toward understanding the possible relationship between occlusal disharmony and TMD. In this study, we therefore investigated whether subjects with occlusal disharmony (n = 22) differ from healthy controls (n = 26) in their pain perception and pain modulation by stress and relaxation. MATERIALS AND METHODS: Trigeminal and extratrigeminal experimental pain perception (pinprick, heat, and pressure pain) was assessed before and after stress (mental arithmetic) and relaxation (viewing of low-arousal pictures). RESULTS: There were no group differences in pain perception at baseline or during the stress task. Compared with controls, the occlusal disharmony group exhibited an inadequate reduction in pain perception during relaxation, which was significant for the extratrigeminal site (P < 0.01) and reached a trend for significance at the trigeminal site (P = 0.1). CONCLUSIONS: These results suggest that subjects with occlusal disharmony show signs of disturbed endogenous pain inhibition during relaxation. CLINICAL RELEVANCE: There is evidence for the presence of sensitization of the nociceptive system in subjects with occlusal disharmony. Possibly, deficient inhibition of extratrigeminal and trigeminal pain perception by relaxation might contribute to the development of TMD or other chronic pain disorders.
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Maloclusión/fisiopatología , Percepción del Dolor , Relajación/fisiología , Estrés Psicológico/fisiopatología , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Maloclusión/complicaciones , Estrés Psicológico/complicaciones , Nervio Trigémino , Adulto JovenRESUMEN
Despite the success in preventing oral diseases, the prevalence of tooth loss in the German population remains high and increases with age. Today, the advances in prosthetic dentistry allow necessary tooth replacement following preventive strategies-after considering benefits and risks. Modern treatment options improve the overall prognosis of the stomatognathic system and the quality of life of the affected patients significantly. Hereby, adverse iatrogenic effects can be minimized or even completely avoided by extending the traditional treatment spectrum, e.g., using adhesively fixed restorations and implant-supported restorations, and refraining from placing restorations that are unnecessary from the medical point of view. Generally, patients benefit greatly from prosthetic treatment and the achieved health gain is remarkably high. It encompasses not only the recovery of the impaired oral functions but also extends to the whole human organism, including nutrition, digestion, musculoskeletal system, as well as mental and social well-being.
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Prótesis Dental , Programas Nacionales de Salud , Pérdida de Diente/prevención & control , Pérdida de Diente/cirugía , Análisis Costo-Beneficio , Prótesis Dental/economía , Prótesis Dental/psicología , Fracaso de la Restauración Dental/economía , Alemania , Humanos , Enfermedad Iatrogénica , Boca Edéntula/economía , Boca Edéntula/prevención & control , Boca Edéntula/cirugía , Programas Nacionales de Salud/economía , Complicaciones Posoperatorias/etiología , Calidad de Vida/psicología , Pérdida de Diente/economía , Pérdida de Diente/psicologíaRESUMEN
Dental education, like any other educational programme in a research-intensive university environment, must be research led or at least research informed. In this context, as the research and knowledge base of dentistry lies in the biological and physical sciences, dental education must be led by advances in research in both these areas. There is no doubt that biotechnology and nanotechnology have, over the past 25 years, led research in both these areas. It is therefore logical to assume that this has also impacted on dental education. The aim of this paper is twofold; on one hand to examine the effects of biotechnology and nanotechnology and their implications for dental education and on the other to make recommendations for future developments in dental education led by research in biotechnology and nanotechnology. It is now generally accepted that dental education should be socially and culturally relevant and directed to the community it serves. In other words, there can be no universal approach and each dental school or indeed curriculum must apply the outcomes in their own social, cultural and community settings.
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Biotecnología/educación , Educación en Odontología , Biología Molecular/educación , Materiales Biocompatibles , Tecnología Biomédica , Investigación Dental , Educación en Odontología/tendencias , Predicción , Genómica , Humanos , Nanotecnología , ProteómicaRESUMEN
BACKGROUND: Craniomandibular disorders (CMD) and atypical facial pain (AFP) represent a clinical challenge. Whereas CMD patients respond to somatic approaches, somatization should be strictly avoided in AFP. The aim of this study was to establish prognostic criteria to identify an aggravated risk of a chronic course in CMD and AFP. METHOD: A total of 124 consecutive patients with CMD ( n=108) or AFP ( n=16) were examined by two interdisciplinary academic pain centers. Psychometric evaluation was conducted with standardized questionnaires (SCL-90R, STAXI, modified SBAS-IV). All patients were clinically assessed by a maxillofacial surgeon or specialized dentist. RESULTS: The following variables proved to be significant: age (risk for AFP vs CMD increased by 6% p.a.), decreased dysfunction index (13% higher risk for AFP vs CMD), and low scores concerning outwardly directed anger (12% higher risk for AFP vs CMD). There was no correlation between initial pain intensity and somatic parameters of disease as assessed by the standardized clinical examination. Low educational status proved to be the best predictor ( p<0.001) for patients presenting high initial pain with a marked discrepancy between somatic findings and subjective status. CONCLUSIONS: CMD patients differ from AFP patients regarding age, psychosocial isolation, outwardly directed anger, and a decreased dysfunction index. Additionally, initial pain intensity in patients presenting indistinct CMD/AFP can be considered as a valid predictor for a chronic course in pain.
Asunto(s)
Neuralgia Facial/etiología , Síndrome de la Disfunción de Articulación Temporomandibular/etiología , Adolescente , Adulto , Anciano , Enfermedad Crónica , Diagnóstico Diferencial , Neuralgia Facial/diagnóstico , Neuralgia Facial/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente , Inventario de Personalidad , Factores de Riesgo , Rol del Enfermo , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/psicología , Síndrome de la Disfunción de Articulación Temporomandibular/diagnóstico , Síndrome de la Disfunción de Articulación Temporomandibular/psicologíaRESUMEN
Trigeminal neuralgia and postherpetic neuralgia are the most relevant neuralgiform facial pain syndromes. Trigeminal neuralgia is characterized by lancinating intensive pain attacks of very short duration, triggered by external cues,whereas postherpetic neuralgia consists predominantly of long-lasting burning pain. Sodium channel blocking drugs are first choice in treatment of trigeminal neuralgia, operative procedures encompass microvascular decompression,thermocoagulation and percutaneous retrogasserian glycerol rhizotomy. In the acute stage postherpetic neuralgia is treated antivirally and analgesically, in the chronic stage by tricyclic antidepressive substances. Other pain syndromes described encompass the Tolosa-Hunt-syndrome, cervicogenic headache, craniomandibular dysfunction syndrome, atypical facial pain and rarer syndromes. Therapeutic recommendations are based on evidence based medicine criteria (EBM).
Asunto(s)
Neuralgia Facial/prevención & control , Neuralgia Facial/terapia , Alemania , Cefalea/terapia , Humanos , Trastornos Migrañosos/terapia , Sociedades MédicasRESUMEN
BACKGROUND: Both for medical and dental specialists, patients with facial arthromyalgia (FAM) and acute or chronic atypical facial pain (AFP) often represent a clinical challenge. Only few empirical studies address the possible interaction between facial pain and increased psychosocial stress with a thereby heightened risk for a chronic course of disease. OBJECTIVE: To evaluate whether FAM or AFP - patients initially presenting with high vs. low pain intensity differ in somatic, psychosocial and socioeconomic parameters. METHOD: We chose to study a population with a primary diagnosis of myofascial pain of the jaw muscles or atypical facial pain and excluded patients with disc displacement, acute arthritis and severe arthrosis. Within nine months, 124 consecutive patients with FAM ( n=108) or AFP ( n=16) were referred to the departments of maxillary surgery, dentistry or neurology of two interdisciplinary academic pain centers. Using the patients'ratings on a 100 mm visual analogue scale concerning their pain intensity, the group was divided in a subgroup initially presenting with low (VAS=5; n=50) and high pain (VAS>5; n=45). Psychometric evaluation was conducted with the SCL-90R (general psychopathology), the State-Trait-Anger-Expression Inventory (STAXI) and a special questionnaire addressing different aspects of chronic pain (modified SBAS-IV). All patients were assessed by a maxillary surgeon/specialized dentist with the help of a detailed, standardized clinical examination (Helkimo-Index). RESULTS: The group of FAM-/AFP - patients according to our inclusion-/exclusion - criteria presenting with a high pain intensity showed more psychosocial withdrawal ( p=0.013), a worse self-rated psychological status ( p=0.033) and a trend towards more somatization ( p=0.093) than patients with lower pain intensity. There was no correlation between initial pain intensity and somatic parameters of disease as assessed by the standardized clinical examination. Low educational status proved to be the best predictor (p<0.001) for belonging to the high (extensive) pain group. CONCLUSIONS: These data suggest that FAM-/ AFP - patients initially presenting with a high pain intensity have an increased risk for psychosocial stress and maladaptive coping behaviour. As both variables are empirically validated risk factors for a chronic course in pain-related disease, these patients should be of special interest for an interdisciplianary therapeutic setting including psychotherapeutic approaches.
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Dolor Facial/fisiopatología , Dolor Facial/psicología , Músculos Masticadores/fisiopatología , Enfermedad Aguda , Ira , Enfermedad Crónica , Demografía , Escolaridad , Familia , Femenino , Humanos , Masculino , Dimensión del Dolor , Factores Socioeconómicos , Factores de TiempoRESUMEN
Our examination of elderly and ageing patients presented four essential classifications, including those with: 1. sufficient natural dentition; 2. dentition, with numerous missing teeth, in need of functional restoration; 3. groups of teeth remaining, but on the verge of edentulousness; 4. edentulousness with dentures in need or replacement or improvement. For the above, we recommend the following treatments, respectively: 1) prophylactic topical fluoride treatments with custom trays; 2) extendable hybrid constructions--preferably with the implementation of a telescoping design; 3) partial dentures designed for easy extension; 4) no new dentures, but rather the step-by-step correction of the old dentures.
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Cuidado Dental para Ancianos , Restauración Dental Permanente , Boca Edéntula/rehabilitación , Anciano , Dentadura Completa , Dentadura Parcial , Humanos , Persona de Mediana Edad , Higiene BucalRESUMEN
The individually produced fluoride miniplastsplint is suitable for application in preventive dentistry, for the therapy of cervical demineralisation and hypersensitive root surfaces. The models must be measured with a "parallelometer" so that the exactness and tightness of the splint can be guaranteed. A space with room for occlusal stops guarantees the necessary place for the gel containing fluorides. The patient must wear the splint once a week for half an hour.
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Sensibilidad de la Dentina/terapia , Fluoruros Tópicos/administración & dosificación , Férulas (Fijadores) , Remineralización Dental/métodos , Adolescente , HumanosRESUMEN
Coronary heart disease is a disease of epidemic proportions in our modern affluent society. Primary prevention by way of a multifrontal programme appears to offer the most effective and logical approcah to combating this disease. Effective implementation of this approach requires patients to undergo a comprehensive assessment. This establishes accurate coronary risk profiles, identifies AT RISK patients, and is the basis for planning a sound intervention programme.