Temporomandibular disorder pain in adult Saudi Arabians referred for specialised dental treatment.

The aim of this study was to determine the frequency of Temporomandibular Disorders (TMD) pain in Saudi Arabians,aged 20-40, who were referred to the Specialist Dental Centre in Makkah. The material included 325 patients (135 males,190 females) who answered a history questionnaire. Patients reportingTMD pain in the last month were offered a clinical examination. History questionnaires and clinical examinations were done according to the Arabic version of the Research Diagnostic Criteria for TMD (RDC/TMD). Fifty-eight patients (18%) reported TMD pain; 46 were clinically examined. Mean age of clinically examined TMD pain patients was 30 +/- 7 years with a male-female ratio of 1:6 (P < 0.001). All TMD pain patients had a diagnosis of myofascial pain, and 65% had diagnoses of arthralgia or osteoarthritis. Headaches or migraines in the last 6 months and headaches in the last month were reported in high frequencies in the TMD pain group, 93% and 71% respectively, with differences (P < 0.001) between the TMD pain and non-TMD pain groups. Graded Chronic Pain Scale assessments classified 45% of the TMD pain patients in grade 1, 53% in grade II, 2% in grade III, and 0% in grade IV. Severe depression scores were found in 38% of the TMD pain patients and severe somatisation scores in 60% with differences (P < 0.001) between the TMD pain and non-TMD pain groups. In conclusion, the study found a frequency of TMD pain in this Saudi Arabian cohort of 18%. The TMD pain group presented high scores of depression and somatisation but low disability grades on the Graded Chronic Pain Scale.

Effect of betamethasone on the degree of macrophage recruitment and nerve growth factor receptor p75 immunoreaction during recovery of the sciatic nerve after injury: an experimental study in rats.

PURPOSE: This study was designed to explain our previous findings of beneficial effects of betamethasone given perioperatively on decreasing the incidence of neurosensory disturbance after sagittal split osteotomy and improving functional recovery after crush injury to rat sciatic nerves. We analysed the pattern of macrophage recruitment and expression of nerve growth factor p75. MATERIAL AND METHODS: The sciatic nerve was crushed in each of 42 animals by tying the nerve against a glass rod for 30s. Half the rats were given betamethasone and half were not. The effect of betamethasone was evaluated immunohistochemically in a double blind manner after 2, 7 and 17 days using antibodies against macrophage marker (ED1) and p75. RESULTS: We found an initial and significant decrease in the number of macrophages recruited after two days in the group treated with betamethasone compared with controls (p=0.001). By 7 days there were significantly more macrophages in the steroid group than in the control group (p=0.001). There was however, a tendency for the number of p75R to be higher in the in the steroid group but the difference was not significant. At 17 days, there were significantly fewer macrophages in the steroid group (p=0.008) than in the control. CONCLUSION: We conclude that the beneficial effect of a moderate perioperative dose of betamethasone on recovery of a nerve is reflected in the recruitment of macrophages but to only a small extent in expression of p75.

Systemic betamethasone accelerates functional recovery after a crush injury to rat sciatic nerve.

PURPOSE: The aim of the study was to evaluate the effect of perioperatively systemically administered betamethasone on nerve recovery (within or outside a confined space) after induced nerve crush injury. MATERIALS AND METHODS: The sciatic nerve of 40 adult Wistar rats was crushed. In half of the animals, the injured nerve was entrapped in a silicone tube to simulate the environment of a closed space, and in the other half the nerve was left to heal. Half of the rats in each group were treated with subcutaneous betamethasone (2 mg/kg body weight/day) during the first 24 hours, starting preoperatively, whereas the other half, the control animals, were given the same amount of physiological saline. All animals underwent preoperative and postoperative walking track analysis (toe spread [TS] and intermediate toe spread [ITS]) twice weekly for 6 weeks. RESULTS: For nonconfined space groups, there was no significant difference between the 2 groups (P = .052 for ITS and P = .315 for TS) during the first 2 weeks. Starting from the end of the second week, animals treated with betamethasone recovered more rapidly than did the controls (P < .001) and continued to do so until the end of the observation period. In the confined space groups, there was a significant difference between the 2 groups for ITS (P < .001) and for TS (P < .05) during the first 2 weeks. The difference continued at almost the same level of significance (P = .001) for ITS, whereas for TS, the difference disappeared after the second week. CONCLUSIONS: We conclude that short-term perioperative administration of betamethasone has a beneficial effect on the recovery of the injured rat sciatic nerve.

On neurosensory disturbance after sagittal split osteotomy.

PURPOSE: The purpose of this retrospective study was to assess the incidence of the neurosensory disturbance (NSD) after sagittal split osteotomy and evaluate NSD in relation to patient age, gender, satisfaction, and effect of steroids. PATIENTS AND METHODS: Questionnaires were mailed to all patients (31 women, 19 men) who underwent bilateral sagittal split osteotomy between 1995 and 1999, at least 1 year after the operation. Patients were queried about perceived NSD in the distribution of both inferior alveolar and lingual nerves, duration of these changes, and any influence of these changes on their quality of life. RESULTS: Eighty-six percent of the mailed questionnaires were returned and analyzed (27 women, 16 men). Eight patients with 10 affected sides (11.6% of sides) reported long lasting NSD corresponding to the distribution of the inferior alveolar nerve. NSD was reported in 16.7% of the operated sides in women, while 3% of the operated sides in the men had such changes. Fifty percent of the operated sides in patients over 40 years of age were affected. Steroid treatment seemed to decrease NSD. Four patients (9%) were not satisfied, but only 1 attributed the dissatisfaction to sensory impairment. CONCLUSION: The incidence of NSD after sagittal split osteotomy increases in patients over the age of 40. Steroid regimen might be beneficial in reducing NSD after sagittal split osteotomy, although further investigation is required. The discomfort of the nerve damage seems outweighed by the result of function and esthetics.

Incidence of neurosensory disturbance after sagittal split osteotomy alone or combined with genioplasty.

We mailed questionnaires to all patients who had had sagittal split osteotomies alone (n= 84) or in combination with genioplasty (n = 37) between 1995 and 2000, to find out the incidence of postoperative sensory disturbances. The patients with sagittal split osteotomies alone reported sensory disturbance in 48/131 (37%) operated sides. When combined with genioplasty patients experienced them in 20/54 (37%) operated sides. The incidences were 36/101 (36%) for mandibular advancement and 12/30 (40%) for mandibular setback. Out of the patients with sagittal split osteotomies alone, 59/66 (89%) were satisfied with the result of the operation, and when combined with the genioplasty the corresponding figure was 23/27 (85%). We conclude that differences in the incidence of sensory disturbance after sagittal split osteotomy for mandibular advancement and setback were not significant. The combination with genioplasty did not increase the incidence of sensory disturbance. Sensory changes after the osteotomies do not serve to be the main determinant of the patients' satisfaction.