Relationship between increased blood pressure and hypoalgesia: additional evidence for the existence of an abnormality of pain perception in arterial hypertension in humans.

An association between hypertension and decreased pain perception (hypoalgesia) has been shown in experimental hypertension and confirmed in humans by electrical tooth pulp stimulation. The aim of this study was to confirm, using two other techniques, whether hypertension is associated with hypoalgesia in humans. In 77 untreated essential hypertensive outpatients, 37 normotensive outpatients and 27 normotensive volunteers subjective cutaneous sensitivity was assessed by an electrical stimulator. Thirty-three measurements were repeated after one month. In addition, in eight normotensive volunteers and eight hypertensives the thresholds of the polysynaptic components R2 and R3 of the blink reflex to electrical stimulation of the supraorbitalis nerve were evaluated. Tooth pulp stimulation was done in 85 of the subjects who measured cutaneous sensitivity and in all of the blink reflex study. Cutaneous perceptive, pain and tolerance thresholds were significantly higher in the hypertensives compared with both normotensive groups, with no significant difference between these two. The results were identical when age and sex-matched subgroups were compared and a high reproducibility was found for all three parameters. Similar findings were obtained for the tooth pulp thresholds and highly statistically significant correlations were found between cutaneous and tooth pulp sensitivity and between these indices and blood pressure. The thresholds of R2 and R3 were also significantly higher in the hypertensives and a significant correlation was found between R3 threshold and diastolic pressure. These results confirm that hypertension is associated to hypoalgesia in humans.

[Stomatological problems related to pregnancy. A statistical study]. / Problematiche odontostomatologiche connesse alla gravidanza. Un'indagine statistica.

Pregnancy is related to particular dental issues, such as the increased incidence of diseases( gingivitis, caries, epulis), the fluoride supplementation, and the limits of diagnostics and therapy. Moreover, the mysterious halo surrounding pregnancy often makes the dentist uneasy. In order to objectively evaluate the implications of pregnancy in dentistry, we distributed a form to 100 pregnant women. The results of the form showed that 53 of them had gingival bleeding, 22 had toothache, 19 had caries but that just 12 of them had gone to the dentist because of dental troubles while 54 had not gone at all. Among the pluri-gravidae, all the women with dental diseases in their previous pregnancies had them again in their current pregnancy but nonetheless only some had undergone a dental check-up. The dentists did not show any uneasiness, as they performed tooth extractions in 5 women, endodontics in 2 women and fillings in 11 women. Just 4 out of 100 women had taken a fluoride supplementation. We deem advisable a stronger collaboration between physician, gynecologist and dentist in order to resolve specialist problems and to make pregnant women more aware of the need for dental follow-ups and fluoride supplementations.

[The clinical efficacy of roxithromycin in patients with acute odontogenic infections]. / Efficacia clinica della roxitromicina in pazienti affetti da infezioni odontogene acute.

The clinical efficacy of a macrolide antibiotic, roxithromycin, was evaluated in 24 patients affected by acute odontogenic infections. Patients were treated with a first dose of 300 mg p.o. which was followed by 150 mg p.o. 12-hourly for the following two days. Total responses were evaluated by an arbitrary scale. The results showed that an excellent and good response was obtained in 99.96% of treated patients. On the basis of clinically compared data and the drug safety it may be concluded that roxithromycin can be successfully used in the treatment of odontogenic infections.

Roxithromycin penetration into gingiva and alveolar bone of odontoiatric patients.

The concentrations of the new macrolide antibiotic roxithromycin in plasma, saliva, gingiva, and alveolar bone were studied in 24 odontoiatric patients treated with a first dose of 300 mg p.o. followed by three maintenance doses of 150 mg p.o., 12-hourly. Samples of blood, saliva, gingiva, and bone were collected at various time points up to 24 h after the last dosing, and the roxithromycin concentration was measured microbiologically, using Bacillus subtilis ATCC 6633 as the reference organism. Pharmacokinetic analysis was performed according to a two-compartment open model with first-order absorption. The plasma, gingiva, and alveolar bone peak concentrations were 6.12 +/- 1.94 mg/l, 6.55 +/- 2.54 mg/kg, and 5.09 +/- 1.60 mg/kg, respectively. Low levels of roxithromycin were detected in saliva (0.67 +/- 0.12 mg/l at the 3rd h). The values of the area under the concentration-time curve for plasma, gingiva, and bone were 59.47 mg/l.h, 51.88 mg/kg.h and 46.80 mg/kg.h, respectively; the half-life values were 7.52 h for plasma and 6.36 and 5.20 h for gingiva and bone, respectively. These results indicate that roxithromycin reaches high levels in periodontal tissues.

Arterial hypertension is associated with hypalgesia in humans.

An association between increased blood pressure and hypalgesia has been reported in several studies in animals and in a few reports in humans. We investigated the relationship between hypertension and pain perception by comparing the response to graded electrical stimulation of the tooth pulp, which is thought to represent an exclusively nociceptive system. The test was performed with a commercial tooth pulp tester in a large series of subjects with borderline or established hypertension and in three groups of normotensive controls: volunteers, nonhypertensive patients, and medical students with a well-established or no family history of hypertension. Subjects had to report when they started to feel pulp stimulation (sensory threshold) and when this became painful (pain threshold). Sensory and pain thresholds were obtained as means of the measurements on four healthy, unfilled teeth. Sensory thresholds were significantly higher in subjects with borderline or established hypertension than in two of the three normotensive groups (volunteers and normotensive patients), whereas no significant difference was observed between the two hypertensive groups. The results for the pain threshold were qualitatively similar but less clear and less amenable to statistical analysis because this parameter could not be determined with accuracy in a number of subjects in whom the subjective pain threshold was above the upper range of stimulation of the instrument. The association between blood pressure levels and pain perception was further confirmed by the highly significant correlation found for the overall data between mean arterial blood pressure and both thresholds.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of pain perception in normotensives and borderline hypertensives by means of a tooth pulp-stimulation test.

Recent studies indicate a reduced sensitivity to pain in genetically and experimentally hypertensive rats. A similar finding is also reported for human established hypertension. However, to our knowledge, no data have been reported in borderline hypertension. The aim of this study was to assess in subjects with borderline hypertension the sensory and pain thresholds by a noninvasive pulp-stimulation test performed with a commercial pulp tester that delivered stepwise increased electrical stimuli to four healthy teeth. The data reported are the means of measurements. In order to assess the possible importance of differences in the selection of the controls, two distinct groups of normotensives were chosen, one of volunteers and the other of outpatients. Significantly higher values for the pain and sensory thresholds were observed in borderline hypertensives compared with pooled normotensives. No significant effect on pain perception could be observed for sex, whereas a significant tendency toward higher threshold levels was found for younger subjects. In two normotensive groups, the sensory and pain thresholds were significantly higher in volunteers than in patients. These results suggest that changes in pain perception are present not only in established hypertension but also in borderline hypertension and, moreover, that differences in the selection of normotensive controls can have important influences on the results.

Comparison of sensory and pain threshold in tooth pulp stimulation in normotensive man and essential hypertension.

Recent studies indicate a diminished responsiveness to noxious stimuli in arterial hypertension in the experimental animal. A similar finding is also reported in the only study published to our knowledge on this subject in man. The aim of the study was to assess in humans the sensory and pain threshold by a non-invasive tooth pulp stimulation test (stepwise increased electrical stimuli delivered by a commercial pulp tester). Subjects had to report when they started to feel pulp stimulation and when this became painful. The data reported are the means of the measurements on four healthy teeth in each subject. Significantly higher values (expressed as relative units [RU]) were found in 28 non-treated essential hypertensives compared with 33 normotensive controls for sensory threshold (40.64 +/- 8.07 versus 29.96 +/- 6.82 RU, P < 0.0001) and for pain threshold (55.67 +/- 12.74 versus 42.08 +/- 12.58 RU, P < 0.001). Multivariate analysis of variance showed that this difference was apparently not related to age and sex. These data lend further support to the view that pain modulation may be altered in the hypertensive state in man.