Trigeminal neuralgia--an update.

The purpose of this article is to give a concise review of the diagnosis and management of trigeminal neuralgia (TN), with particular emphasis on idiopathic TN and symptomatic TN. The clinical characteristics of both conditions are presented, and the suspected underlying etiologies are discussed. Because it is crucial for clinicians to be able to rule out pain unrelated to TN, a list of differential diagnoses is presented. The authors stress that the diagnosis of TN is made clinically; however, diagnostic imaging may be indicated in selected cases. Current pharmacological and neurosurgical options for the management of TN are discussed in detail. In light of the popularity of unconventional treatments in the United States, the value of acupuncture and homeopathy, both of which have been suggested by some authors for the treatment of TN, is critically assessed.

Fibrosarcoma misdiagnosed as a temporomandibular disorder: a cautionary tale.

Because of the abundance of articles on temporomandibular disorders in the dental literature, other sources of facial pain and mandibular dysfunction do not receive adequate diagnostic attention. The case report in this article describes a female patient who appeared for treatment with symptoms and signs similar to those encountered in subsets of temporomandibular disorders. Her condition was misdiagnosed, and she was treated for a temporomandibular disorder over an extended period before the correct diagnosis of high-grade pharyngeal fibrosarcoma was established. Once diagnosed, the tumor was treated aggressively with preoperative and postoperative combinations of chemotherapy and radiation. Despite the intensive therapy, the patient died. This case should remind the clinician that nonmusculoskeletal sources of persistent facial pain and dysfunction, including tumors, may be masked by or mimic temporomandibular disorders. If therapy does not produce the expected outcome, the diagnosis should be reexamined.

Postexposure chemoprophylaxis for occupational exposure to HIV in the dental office.

Occupational exposure to HIV continues to be a concern for health care workers. Preventing exposure through the use of universal precautions is the primary means of protection. New Public Health Service interagency work group recommendations for postexposure chemoprophylaxis provide information to help manage occupational exposure to HIV.

Sjögren's syndrome: a challenge for dentistry.

Sjögren's syndrome presents dentists with many challenges, from diagnosis to therapy. The secondary effects of xerostomia cause a spectrum of oral problems, including caries, candidal infection, and inflammation of the oral mucosa. The oral signs and symptoms may be the first manifestations of systemic aspects of the disease. Sjögren's syndrome requires both dental and medical management, and a program of home care.

The cracked tooth syndrome: an elusive diagnosis.

The authors review the literature and present a case of cracked tooth syndrome. Special emphasis is placed on diagnostic problems associated with this syndrome. The case report demonstrates classic and atypical features of cracked tooth syndrome.

Incidence and significance of cardiac arrhythmia in geriatric oral surgery patients.

We recorded heart rhythms of 40 older patients (20 medicated for cardiovascular disease and 20 not medicated for cardiovascular disease) during an outpatient oral surgery visit to determine overall arrhythmia incidence and severity, differences in incidence associated with cardiovascular medication status, and the impact of surgical intervention on arrhythmia incidence. We hypothesized that both groups would show similar arrhythmia numbers and types during surgical visits and that a history of medication for cardiovascular disease would not be an indicator of cardiac arrhythmia. Enrollment remained open until 20 patients older than 60 years of age from each group agreed to participate. Data were analyzed using the chi square statistic and Fisher's exact test (2-tailed). Included in the study were 24 women and 16 men; their mean age was 70.5 years (range, 60 to 86 years). Arrhythmias were detected in 17 patients and 33 of the 160 recorded rhythms. None of the detected arrhythmias were considered life-threatening. Significantly more arrhythmias occurred before administration of anesthesia than during administration of epinephrine-containing local anesthetics (p = 0.0001), and a greater number of rhythm disturbances were seen during the surgical procedure when compared with anesthesia administration (p = 0.0170). No differences in arrhythmia incidence were seen with increasing age, when male patients were compared with female patients, or when patients pharmacologically treated for cardiovascular disease were compared with patients not taking cardiovascular therapeutic medications. We conclude that although arrhythmias in this ambulatory population are common, they are typically benign in character and cardiovascular medication status is not indicative of their presence. In addition, minor oral surgery intervention with local anesthetics used in recommended dosages has no effect on cardiac arrhythmia status in the ambulatory geriatric population.

The past and present legal weight of bite marks as evidence.

Bite mark evidence, which is most often associated with violent crimes, is legally accepted and admissible in a court of law. However, current legal attacks are underway against the admission of such evidence. Indeed, over the last 20 years, bite mark forensics have sustained a multitude of legal challenges, some concerning the constitutional rights of the accused and others the scientific acceptance of such an approach. Bite marks are considered hard evidence and are highly persuasive to juries who weigh the evidence.

Trigeminal neuralgia versus atypical facial pain. A review of the literature and case report.

Trigeminal neuralgia and atypical facial pain are common conditions of facial pain. Although these two pain conditions are classically well separated in textbooks, a straightforward diagnosis may not always be possible because of the overlapping clinical signs and symptoms. In this article, a comparison and differentiation between the clinical and diagnostic features of these two pain conditions are presented. The general characteristics, etiologic characteristics, pathophysiology, differential diagnostic criteria, and therapeutic options of trigeminal neuralgia and atypical facial pain are described. A case report demonstrates the difficulties that can arise in the diagnosis and differentiation between the two disease entities. The article underscores the responsibility clinicians have in correctly diagnosing and managing patients with facial pain conditions.

Occipital neuralgia manifesting as orofacial pain.

This is a case report and brief review of the literature on occipital neuralgia presenting as dental pain. A patient with a chief complaint of long-standing pain in the maxillary right posterior quadrant was evaluated. Dental examination demonstrated the pain was not of odontogenic origin. The patient was referred to a neurologist who was a chronic pain specialist and was diagnosed with a rare neurologic disorder, occipital neuralgia referring to the facial region. After conservative treatment, local nerve blocks, and physical therapy, the patient reported a dramatic improvement of symptoms and total absence of all orofacial pain. The case demonstrates an unusual cause of orofacial pain.

Head and neck lesions commonly found in musicians.

Common problems in playing musical instruments include soft tissue lesions, tooth mobility, malocclusion, TMD and endodontic pathoses. This article illustrates the basic playing positions of the instruments and their effects on head and neck structures to help dentists provide appropriate diagnosis and treatment.

Patient and dental student responses to a survey about AIDS in the dental setting.

The purpose of the study was to gain information about patients' and dental students' attitudes concerning AIDS and dentistry. Opinions of patients and students at a Midwestern dental school were surveyed. The dental students' responses were not as consistent as the patient responses. Both groups felt there was a risk to patients and dentists of HIV infection. Both groups had confidence in the CDC infection control guidelines. The patient responses to the testing questions were significantly more positive than the student responses. The patients responded positively to the concept that healthcare professionals had the right to ask patients to be tested and to being required to be tested if a healthcare provider is accidentally stuck by a needle used on a patient. The dental students were more cautious with both issues. Patients would use knowledge about a healthcare provider's HIV status and the office treatment of AIDS patients to determine if they should continue treatment at that dental office.

Controlling dental pain.

The obligation to manage pain and relieve a patient's suffering is an important part of dentistry. The practitioner must balance pain control, concern for patient safety and side effects of pain treatment. There are no rigid prescriptions to manage postoperative pain.

Diagnosis and treatment of orofacial herpes zoster: report of cases.

Herpes zoster is considered a disease of elderly or immunocompromised patients. These cases are unusual since clinical signs of the disease occurred in two healthy, young adults. Various diagnostic and treatment considerations for herpes zoster infections are presented.