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Biomedical subjects

Y Sharav

Publications and source records attributed to Y Sharav.

At least 19 recordsLinked to original sources
PubMed2001

Primary vascular-type craniofacial pain.

Primary vascular-type craniofacial pain comprises a group of pain disorders that share common diagnostic features. These are unilateral, episodic, pulsatile, severe pain. Accompanying phenomena include local autonomic (e.g., tearing, rhinorrhea) and systemic signs (e.g., nausea, photophobia). Primary vascular-type craniofacial pain includes migraine, cluster headache, and paroxysmal hemicrania. A new diagnostic entity, vascular orofacial pain, is suggested. Treatment of primary vascular-type craniofacial pain depends on its more specific diagnosis, and may be abortive or prophylactic. Diagnostic features, common pathophysiological mechanisms, and treatment modalities are discussed.

Dental Pulp↗
PubMed1999

[Ramsay Hunt syndrome--differential diagnosis, pathogenesis and therapy].

Ramsay Hunt syndrome is caused by infection of the geniculate ganglion of the seventh cranial nerve by varicella-zoster virus. A case in an 82-year-old woman is described. She presented with oral lesions, right facial palsy and an eruption and pain in her right ear. Oral examination revealed small circumscribed erosions on the right anterior two-thirds of the tongue, with loss of taste. There were also lesions on her right palate. Early diagnosis and treatment are important as immediate treatment is more likely to prevent irreversible complications affecting the facial and other cranial nerves involved.

Acyclovir↗
PubMed1999

Odontalgia in vascular orofacial pain.

A case of episodic, spontaneous odontalgia, aggravated by ingestion of cold food, with no apparent dental pathology is presented. Attempts at alleviating the pain by means of root canal treatment had failed in previous, similar episodes, and pain and pulpal hyperalgesia had shifted to other locations. Primary vascular orofacial pain was diagnosed and effective control obtained by prophylactic treatment with propranolol, a beta-adrenergic blocker. A prophylactic attempt with nifedipine, a calcium channel blocker, failed to alleviate the pain. This diagnostic entity and possible therapeutic approaches are discussed.

Adult↗
PubMed1998

Paroxysmal hemicrania. Case studies and review of the literature.

Paroxysmal hemicrania is a vascular-type headache that is characterized by short bouts of severe unilateral pain in the area of the orbit and temple. A chronic and episodic form that has been described is similar to cluster headache and reflects a distinctive temporal pattern. Signs associated with paroxysmal hemicrania include ipsilateral conjunctival injection and tearing with nasal congestion and rhinorrhea. The condition's absolute response to indomethacin pharmacotherapy differentiates paroxysmal hemicrania from cluster headache. Typical symptoms usually make for a relatively straightforward diagnosis of paroxysmal hemicrania, but it may masquerade as pulpitic or temporomandibular-joint-related pain and may even herald systemic disease or malignancy. Paroxysmal hemicrania is a rare syndrome; 111 cases have been reported in the literature thus far. All of these cases have been reported by "headache specialists"; no cases of paroxysmal hemicrania were found in the dental literature. In this review, a relatively large series of seven new cases is reported; all seven were seen in an orofacial pain clinic.

Adult↗
PubMed1998

SUNCT syndrome: case report and literature review.

The case of a woman with short neuralgiform paroxysmal pain of 2 years duration is described. Pain attacks were always accompanied by ipsilateral lacrimation and conjunctival injection. Standard anti-neuralgic therapy, amitriptyline and indomethacin, failed to eliminate or reduce pain. At the end of a 30-month active period the patient seemed to have gone into remission. We believe this to be a case of short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), the first reported in the dental literature and the 24th in the general medical literature. The differential diagnosis of the case and relevant literature are discussed.

Acute Disease↗
PubMed1998

Trigeminal neuralgia with lacrimation or SUNCT syndrome?

An intimate relationship between trigeminal neuralgia (TN) and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome, based on similar clinical signs and symptoms and on cases demonstrating possible "transformation" from one entity to the other, has been widely accepted. We evaluated the presence of lacrimation in 22 consecutive cases that had been diagnosed as TN. Ipsilateral lacrimation was reported by 6 such cases (5M, 1F). These cases responded to antineuralgic therapy with concomitant resolution of lacrimation and were clinically very similar to TN. The differential diagnosis and the possibility of lacrimation in TN are discussed.

Adult↗
PubMed1998

Trigeminal neuralgic-type pain and vascular-type headache due to gustatory stimulus.

We present a case of facial pain associated with sweet stimulus. An immediate, electric-like, short, unilateral pain was evoked by strong sweet gustatory stimulation. This was followed 6 to 8 hours later by a bilateral severe headache associated with bilateral tearing, rhinorrhea, periorbital swelling, flushing, and photophobia that lasted up to 2 days. The immediate pain that was experimentally induced with 2.5 grams of sucrose placed on the tongue could be abolished with carbamazepine. However, carbamazepine did not prevent the headache complex that appeared 6 to 8 hours later. Conversely, a trial with indomethacin abolished the late-onset headache, but not the immediate neuralgic-type pain. The independent nature of these pains suggests different pathophysiological mechanisms which are discussed.

Analgesics, Non-Narcotic↗
PubMed1998

Neuropathic orofacial pain.

Neuropathic orofacial pain (NOP) is a challenging diagnostic problem. In some cases, symptomatology may be similar to that seen with dental pathology, resulting in unwarranted dental treatment. Rarely, NOP can herald serious disease or central tumors, and early diagnosis can be life-saving. The following review outlines the classification, clinical presentation, pathophysiology, and treatment of the more common NOP entities.

Chronic Disease↗
PubMed1998

Craniofacial pain of myofascial origin: temporomandibular pain & tension-type headache.

Craniofacial pain of myofascial origin is a common chronic disorder. When the pain is unilateral and located periauricularly, masticatory myalgia is likely. Tension-type headache is usually bilateral and affects the upper part of the head. The possible interrelationship with generalized myofascial disorders are discussed. Practical approaches to history-taking, diagnosis, and treatment are suggested.

Age Factors↗
PubMed1997

Orofacial pain with vascular-type features.

OBJECTIVE: To examine whether a classifiable primary vascular-type craniofacial pain subgroup exists that predominantly affects intraoral structures. STUDY DESIGN: Fifty-five patients were chosen prospectively according to the following inclusion criteria; periodic craniofacial pain that was unilateral, pulsatile, severe, and that may wake the patient from sleep. Accompanying phenomena could include local autonomic and/or systemic signs. Twenty-six cases could be further classified into one of the categories of vascular craniofacial pain. The remaining 29, all with predominantly intraoral pain, were not readily classifiable. RESULTS: Of the 29 patients 70% were women, with an average onset-age of 42.6 years. All reported severe, episodic pain that was usually unilateral and lasted minutes to hours. In all, 55% of patients had autonomic or systemic signs, 48% had pulsatile pain, and 35.4% of patients were awakened by the pain. CONCLUSION: Although clinical similarities were observed within these patients, further studies are needed to confirm vascular orofacial pain as a clear diagnostic category.

Adolescent↗
PubMed1994

Diagnosis and treatment of persistent pain after trauma to the head and neck.

PURPOSE: A retrospective and prospective study on 22 cases of persistent pain after trauma to the head and neck is presented. According to the predominant symptoms and signs, pain patterns could be divided into musculoskeletal, vascular, and neuropathic, facilitating treatment decisions. Most cases were musculoskeletal in origin, with many demonstrating a combination of two or three pain states. RESULTS: The variety of pain complaints and their underlying pathophysiology are discussed and treatments for specific pain states are examined. CONCLUSION: Amitriptyline was the most useful drug in that it provided pain relief in musculoskeletal, vascular, and some neuropathic pain conditions. Multidrug therapy may be indicated in some recalcitrant cases, and drug alternatives are discussed.

Adult↗
PubMed1991

Idiopathic trigeminal pain associated with gustatory stimuli.

We present a unique case of a patient with facial pain evoked by gustatory stimuli. Pain was typically evoked by application of sucrose to the ipsilateral anterior 2/3 of the tongue, but not to the contralateral aspect. Pain was referred to the maxillary tuberosity area and, when stronger, to the infraorbital and supraorbital regions. Sucrose was most effective in eliciting pain, whilst saline, citric acid and water had a minimal effect. Spatial or temporal summation of gustatory stimuli was associated with stronger pain of longer duration and shorter latency. Some of the pain characteristics were similar to those of idiopathic trigeminal neuralgia. Thus, pain was elicited by innocuous ipsilateral stimuli, referred out of the stimulus zone, persisted beyond the period of stimulation and could be controlled with carbamazepine. We proposed a central neural mechanism for pain induction with convergence between gustatory stimuli afferents and pain pathways in the trigeminal system.

Carbamazepine↗
PubMed1991

Faculty and staff development in dental education.

While five dental schools in the United States closed, and the total number of faculty shrunk from 3789 to 3335 in the last decade, the overall quality of faculty went up. This is because of a healthy turnover of staff; about half of the new faculty are recruited from advanced education programs, and present faculty members retire at a higher rate. Dental schools are in the midst of a revolution of health care delivery resulting from changes in disease patterns, in particular decreased caries prevalence in children, less edentulousness in adults, and increasing numbers of aging, medically compromised patients. These changes have an effect on faculty buildup and development, and there is a growing need for teachers who are more knowledgeable in medicine and better skilled in adult general dentistry. Clinical faculty will be trained in treating medically compromised patients and will be better acquainted with subjects such as oral medicine, medical emergencies, pain and anxiety control, pharmacology, anesthesia, and geriatric dentistry. Staff and faculty should also be qualified in management skills and cost effectiveness.

Administrative Personnel↗
PubMed1990

Effects of one- or two-stage deafferentation of mandibular and maxillary tooth pulps on the functional properties of trigeminal brainstem neurons.

We have recently demonstrated that deafferentation of the adult cat's maxillary or mandibular posterior tooth pulps results in statistically significant changes in mechanoreceptive field and response properties of low-threshold mechanoreceptive (LTM) brainstem neurons in trigeminal (V) subnucleus oralis. These effects were however reversible, and the statistically significant changes were apparent only for 1-2 weeks after the deafferentation procedure. The aim of this study was to examine the effects of a more extensive deafferentation involving both maxillary and mandibular pulps. In accordance with our earlier study, the pulps of the teeth were deafferented and, in a 'blind' design, the physiological properties of oralis LTM neurons were studied in each of these animals and compared with those from control, unoperated cats. Statistically significant changes in mechanoreceptive field and response properties were produced in these animals with both maxillary and mandibular quadrants deafferented and were similar to those documented in our earlier study involving deafferentation of only one quadrant. However, as well as occurring at 1-2 weeks after the deafferentation procedures, the changes were still apparent at 4 weeks following the deafferentation. In addition, we also documented that changes could be produced by a two-stage deafferentation procedure involving first the mandibular pulps and then, 3 weeks later, the maxillary pulps. These findings thus demonstrate that an extensive deafferentation procedure involving mandibular as well as maxillary tooth pulps can produce statistically significant changes in the physiological properties of V brainstem neurons of adult cats that may last at least 4 weeks postoperatively.

Action Potentials↗
PubMed1989

Masseter inhibitory periods and sensations upon electrical tooth-pulp stimulation in children and adults.

Sensations and masseter inhibitory periods (MIP) evoked by electrical tooth-pulp stimulation were recorded in 5 adults and 10 children. In the adult group there was always a sensation and it was usually associated with a two-phase MIP, with an early and a late component. Sensory detection in teeth with partially formed roots in the younger children (7-9 years old) was markedly reduced, and the MIP was mostly monophasic with a predominantly early component. In the older children with fully formed roots (10-12 years old) sensations did not differ from those in the adults, but the late MIP component occurred in significantly fewer trials (P less than 0.01). It is concluded that response to electrical tooth-pulp stimulation develops in the following stages: (1) early, oligosynaptic MIP, (2) sensation, and (3) the late, polysynaptic component of the MIP.

Adult↗
PubMed1989

Masseter inhibitory periods and sensations evoked by electrical tooth-pulp stimulation in subjects under hypnotic anesthesia.

Sensation and masseter inhibitory periods (MIP) to electrical tooth-pulp stimulation were recorded under hypnotic anesthesia and placebo to local anesthesia. In the first experiment, 8 subjects were tested for the effect of hypnotic anesthesia on sensory detection and MIP at non-painful stimulus levels (mean = 42.1 microA) and painful levels (mean = 86.5 microA). The percentage of detection for non-painful stimuli changed from 94.3% to 14.1% and for painful stimuli from 100% to 28%; both changes were significant (P less than 0.001). Hypnotic anesthesia blocked sensation without interrupting the initiation of the early component of the MIP, but did suppress its late component. In the second experiment, 8 subjects were tested for the perceived intensity of 5 levels of electrical tooth-pulp stimulation under hypnotic anesthesia and placebo. Sensory intensity was measured by the visual analog scale (VAS). Hypnotic anesthesia was significantly more effective than placebo (P less than 0.001) in reducing sensation. The differential effect of hypnotic anesthesia on the early and late component of the MIP lends further support to the hypothesis that hypnotic anesthesia operates primarily at suprasegmental, higher levels in the brain.

Adolescent↗