A Comparative Pilot Study to Evaluate the Adjunctive Role of Levosulpride with Trigger Point Injection Therapy in the Management of Myofascial Pain Syndrome of Orofacial Region

Purpose

To evaluate the effect of therapy with levosulpride combined with conventional trigger point injection therapy in terms of pain and depression in the chronic myofascial pain syndrome patients.

Materials and Methods

This was a comparative prospective study in which subjects with at least one trigger point and symptom duration of at least 3 months were recruited and randomized into two groups. Group A subjects received trigger point injections with 0.5 % bupivacaine and tablet levosulpride and group B received trigger point injections and a placebo. Subjects were assessed for pain with visual analog scale (VAS) and depression with Beck’s depression inventory (BDI) at the follow-up periods of 1, 4, 6 and 12 weeks. The treatment effect was measured in terms of mean difference of BDI and VAS scores at various studied intervals from the baseline values.

Results

The sample was composed of 15 subjects with 8 in group A (6 females and 2 males, with a mean age of 41.88 ± 15.13 years, disease duration of 12.37 ± 16.11 months) and 7 in group B (6 females and 1 male, with a mean age of 43.86 ± 12.34 years, disease duration of 9.64 ± 9.34 months). The mean baseline VAS score and BDI score was 6.75 ± 1.03 in group A and 6.86 ± 1.06 in group B and 24.25 ± 10.20 in group A and 24.43 ± 11.16 in group B respectively. The mean difference of VAS scores at 12th week interval from the baseline values was highly significant. Although the mean difference of VAS scores at all the other intervals and mean difference of BDI scores at all the intervals was statistically nonsignificant, there was improvement in the mean differences at all the follow-up intervals in terms of both pain as well as depression.

Conclusions

The combined therapy with conventional trigger point injection and levosulpride as antidepressant significantly reduce pain and depression in the study subjects suffering from chronic myofascial pain with moderate to severe depression in the orofacial region.     

Orofacial pain associated with an infected complex odontome. Case report

A case of complex odontome of the mandible associated with severe pain was presented. The pain regressed after removal of the lesion.     

Prevalence of Various Orofacial Pain Symptoms and Their Overall Impact on Quality of Life in a Tertiary Care Hospital in India

Background

Pain is a major public health problem and is the most commonly reported symptom of oral and dental disease that has a significant impact on both individual and community. The present study was prevalence of various orofacial pain symptoms and their overall impact on the quality of life in a tertiary care hospital.

Materials and Methods

This study was carried out in the outpatient department of the Government Dental College and Research Institute, Bangalore. The severity of the chronic orofacial pain symptoms was assessed using the Chronic Pain Grade Questionnaire by Von Korff.

Results

The results showed that toothache (57.6 %) was the most commonly reported symptom and burning mouth sensation (6.4 %) was the least commonly reported. Majority of the patients had grade 3 level of pain-related disability (34.8 %) followed by grade 2 (26.8 %), grade 1 (22.4 %) and grade 4 levels (16 %). The mean pain intensity was reported to be more among females and maximum among patients with facial pain.

Conclusion

The present study demonstrated that orofacial pain symptoms have a significant impact on the patients suffering from it. Therefore, proper measures should be taken for the management of the patients with these symptoms and associated conditions.     

Key factors associated with oral health-related quality of life (OHRQOL) in Hong Kong Chinese adults with orofacial pain

Objectives

To investigate key factors associated with oral health-related quality of life (OHRQOL) of Hong Kong Chinese adults with orofacial pain (OFP) symptoms.

Methods

A cross-sectional study was conducted amongst a random sample of registered patients at a primary medical care teaching clinic in Hong Kong. Patients who were aged 35-70 years and had experienced OFP symptoms in the past 1 month were included. The OHRQOL was assessed by the Chinese version of the Oral Health Impact Profile (OHIP-14). A structured questionnaire on OFP symptoms and characteristics in the past 1 month, the depression and non-specific physical symptoms (NPS) scale in the research diagnostic criteria for temporomandibular disorders (RDC/TMD) questionnaire, and questions about professional treatment and dental attendance were administered before a standard clinical assessment. Negative binomial regression with forward stepwise selection was used to investigate key factors associated with the OHIP-14 additive score.

Results

The mean OHIP-14 additive score of the 200 participants was 10.1 (SD 9.4). Regression analysis revealed that five independent factors were significantly associated with higher OHIP-14 additive scores (indicating a poorer OHRQOL): a higher pain scale rating in the past 1 month (p = 0.001), OFP clinical classification as musculoligamentous/soft tissue (MST) or dentoalveolar (DA) instead of neurological/vascular (NV) (p < 0.001), more frequent dental attendance (p = 0.008), moderate/severe RDC/TMD depression (p = 0.005) and moderate/severe RDC/TMD NPS with pain (p = 0.003).

Conclusion

Various factors were associated with OHRQOL and could have implications for the improvement of OHRQOL in people in the community who have OFP symptoms.     

Internal carotid artery aneurysm with prominent calcification: Report of a case

A case of internal carotid artery aneurysm with prominent calcification is presented. A 73-year-old woman came to Okayama University Hospital afflicted to Dental School complaining of dry mouth. The panoramic radiograph and the lateral view showed an oval radiopaque body with a smooth margin at the posterior border of the right mandibular ramus. The CT scan showed a spherically-shaped calcification about 3 cm in diameter with liquid content lying medial to the right parotid gland and posterior to the right maxillary bone. Follicular adenoma of thyroid was also found by the CT examination. But the correlation between the calcified body and the tumor was denied by the laboratory data and the histology of the tumor. When the results of the 3D-CT view, the patient's advanced age and the history of renal disease were considered together, the calcified body was thought to be the calcified aneurysm of the internal carotid artery induced by arteriosclerosis. Though it is quite rare for the image of a calcified aneurysm to appear on the radiograph incidental to routine dental radiographic examination, the possibility of a calcified aneurysm also should be taken into consideration whenever localized calcifications are detected.     

Incidence of cerebral concussions associated with type of mouthguard used in college football

Abstract –  Controversy exists among sports dentists as to whether or not a 'custom made' mouthguard is more effective in reducing the incidence of cerebral concussion than the boil-and-bite 'non-custom made' mouthguard. While members on each side remain steadfast in their opinion, not a single epidemiological study has been conducted to investigate the effect of type of mouthguard worn on the incidence of cerebral concussion. The aim of this study was to determine if there was a difference between the type of mouthguard worn and the incidence of cerebral concussions among National Collegiate Athletic Association (NCAA) Division I-A football players. During the 15-week 2001 college football season, trainers entered, via an interactive web site, weekly data for each game and practice sessions for the preceding week. Eighty-seven (76%) out of a possible 114 Division I teams participated. A total of 506 297 athletic exposures were recorded; 369 brain concussions were reported. The incidence of cerebral concussions per 1000 exposures was 0.73. Utilizing a risk ratio with a 95% confidence interval, no statistical difference occurred in the incidence of cerebral concussions between football players wearing custom made versus non-custom made mouthguards (0.990,1.750). In this study, there was no advantage of wearing a custom made mouthguard over a boil-and-bite mouthguard to reduce the risk of cerebral concussion in football players.     

Autonomic nervous system in individuals with cerebral palsy: a controlled study

J Oral Pathol Med (2011) 40 : 576–581 Background: Disturbances in homeostatic functions have been observed in individuals with cerebral palsy (CP), possibly resulting from autonomic dysfunction. Salivary flow rate and saliva composition are controlled by the autonomic nervous system, and CP individuals exhibit alterations in salivary parameters that suggest autonomic impairment. This study aimed to investigate cardiac parameters as indicative of autonomic disturbances, possibly associated with salivary changes observed in CP individuals. Methods: Ninety individuals with CP were compared with 35 sibling volunteers with no neurological damage (CG). Twenty‐four‐hour ECG/Holter monitoring (SEER^® Light; GE Medical Systems, Milwaukee, WI, USA) and 12‐lead electrocardiographic recordings were performed on the CP and control groups. Total saliva was collected, and the salivary flow rate and total protein concentration were determined. Results: Cerebral palsy (CP) individuals presented a significant reduction in salivary flow rate (P < 0.01) and increased protein concentrations (P < 0.01) compared to CG. Twenty‐four‐hour Holter ECG analysis showed differences for high frequency (HF), low frequency (LF) and LF/HF ratio between the groups, with the CP group presenting higher HF and LF values and lower LF/HF. Electrocardiographic parameters showed a statistically significant difference for heart rate, and its correlates, and mean corrected QT interval between the groups studied (P < 0.05). Snoring was frequent among CP patients. ECG and autonomic changes were independently associated with CP. Conclusion: Individuals with cerebral palsy present cardiovascular changes principally manifested as disturbed sympathovagal balance. These autonomic dysfunctions could contribute to the salivary changes observed.     

复杂颈动脉畸形伴颈动脉瘤带膜支架治疗1例

<正>1临床资料患者,男性,30岁,汉族。因“右颈部上份肿物发现1月”,于2005年7月23日收入院。入院前1月无明显诱因发现右颈上份有一约“鸡蛋”大肿块,伴     

疼痛性冷刺激和非痛温热刺激口腔时对大脑皮层反应强度的影响

目的 探索疼痛性冷刺激和非痛温热刺激口腔时对大脑皮层反应强度的影响。方法 选取6名健康志愿者,采用组块设计方法,利用水传递装置分别用冷水（4 ℃）和温水（23 ℃）刺激其口腔,采集全脑血氧水平依赖对比的功能性磁共振成像（fMRI）扫描数据进行分析。结果 冷水和温水刺激共同激活了左侧中央前后回、岛叶/岛盖、前扣带回（ACC）、眶额皮层,右侧中脑红核和丘脑。此外,冷水刺激还激活了左侧枕叶、运动前皮层布罗德曼分区（BA）6、右侧BA44、舌回,以及顶叶BA7和BA40,初级躯体感觉皮层SⅠ。疼痛性冷水刺激激活的脑区多于无痛温水,而激活脑区的强度小于温水,但是疼痛冷水刺激在ACC的激活强度明显大于无痛温水刺激。结论 大脑皮层对疼痛性冷刺激口腔时反应的脑区的激活强度小于非痛性温热水刺激,但是ACC脑区的激活强度大于非痛性温水刺激。     

Occurrence of bruxism in a sample of Brazilian children with cerebral palsy

Bruxism has been reported to exist in many children with cerebral palsy; however, only a few studies confirm this fact. The objective of this study was to determine the rate of bruxism in children with cerebral palsy and to relate its presence to the following factors: kind of cerebral palsy, gender, age, dentition, degree of malocclusion. oral mucous membrane trauma, trismus, and number of wear facets on specific teeth. The guardians of 121 children with cerebral palsy between the ages of 4 and 9 years were interviewed and the children were clinically examined. Bruxism was detected in 69.4% of the children and reported by 57% of the guardians. In 4-and 5-year-old children, the rate of wear facets was small. Children with athetosis and spastic tetraplegia had a higher rate of bruxism than all others.     

Treatment of muscle spasticity in patients with cerebral palsy using BTX-A: a pilot study

This study was designed to verify the safety and efficacy of botulinum toxin type A (BTX-A) used as a neuromuscular block on spastic masticatory musculature of children with cerebral palsy. Six patients who had spastic-tetraplegic cerebral-palsy, aged 5 to 20 years were selected. All patients had spasticity of the jaw muscles, bruxism, lower lip trauma, limited mouth opening, and difficulties in cleaning the oral cavity. The patients were sedated under general anesthesia, while the dentist injected the masseter and temporalis muscles bilaterally with 150 and 75 units of BTX-A each. Clinical examinations were conducted at 7, 14, 30, and 90 days after the initial appointment. We found statistically significant decreases in muscle spasticity and bruxism ( p = 0.002), improved inter-incisal opening ( p = 0.002), improved oral hygiene ( p = 0.031), and less lower lip trauma ( p = 0.060) after the neuromuscular blocking.