Biomedical subjects
Publications and source records attributed to Robert L Merrill.
The orofacial pain clinician must understand the difference between peripheral and central mechanisms of pain. Particularly, one has to understand the process of central sensitization as it relates to the various orofacial pain conditions to understand orofacial pain. Understanding leads to more effective treatment.
BACKGROUND: The authors conducted a cross-sectional survey to assess headache disability in patients with orofacial pain. METHODS: The authors administered a Migraine Disability Assessment (MIDAS) questionnaire to 337 university-based clinic patients with OFP and 367 general dental (GD) patients, who served as controls. They made primary and secondary diagnoses in patients with OFP according to standard diagnostic criteria. The authors classified the patients into three major categories: primary headache (PH), musculoskeletal disorders (MS) and neuropathic pain (NP). They categorized the MIDAS score into four severity grades (I, the lowest, through IV, the highest). The authors analyzed the data using chi(2), t test, one-way analysis of variance and logistic regression for calculated odds ratios. RESULTS: Patients with OFP had a greater prevalence of headache than did patients in the GD group (72.7 percent versus 31.9 percent, respectively; P < .001), with a higher total MIDAS score, number of headache days in the previous three months and headache severity (P < .001). Within the OFP group, the diagnostic prevalence of PH, MS and NP was 7.1 percent, 79.8 percent and 13.1 percent, respectively (P < .001). The authors categorized 56 percent of patients with OFP and headache into the high-impact headache group (MIDAS grades III and IV; P < .001). CONCLUSIONS: Patients with OFP had a higher prevalence of headache with greater disability impact than did control subjects. The degree of disability was related strongly to the MS diagnosis. CLINICAL IMPLICATIONS: The coexistence of PH and MS disorders can lead to higher headache disability. Clinicians need to treat both disorders concomitantly, which will result in improved treatment outcomes.
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Chronic nonodontogenic toothache has been reported in the literature since the 1700s. This problem has followed a similar scenario since those first reports. The patient typically is misdiagnosed and then subjected to multiple unnecessary procedures, ultimately resulting in tooth extractions because of dentists and physicians being unaware of the existence of atypical odontalgia and other types of intraoral neuropathic pain that are treatable without sacrificing the teeth. This paper reviews the medications and procedures used to treat nonodontogenic toothache.