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PubMed1997

[Headache and teeth].

Headache, facial pain and toothache are poorly localized and irradiate in distant areas. Thus, toothache often causes facial pain and headache, but, in turn, it can also be mimicked by several forms of these disorders, in particular by a myoarthropathy of the masticatory system, a migraine, a tension-type headache, a neuropatic pain and a trigeminal neuralgia. The atypical odontalgia is a nonodontogenic form of toothache that is difficult to diagnose; therefore, it leads to a number of invasive dental procedures which normally worsen the pain condition. The atypical odontalgia can often be solely diagnosed by means of a diagnostic block. Headache and facial pain can also be caused by a myoarthropathy of the masticatory system. This disorder is often misdiagnosed, because the signs and symptoms are not pathognomonic, and they are frequently present also in healthy individuals. The disorder has a good prognosis, the therapy is generally simple and follows the treatment principles for chronic musculoskeletal disorders. The burning-mouth syndrome is an other poorly understood form of intraoral pain that occurs primarily in postmenopausal females. Several etiologic factors have been described, but treatment based on one or more of these factors is often ineffective. Spontaneous remission occurs in about half of the patients after several years.

Facial Pain↗
PubMed1984

Jaw involvement in American Burkitt's Lymphoma.

A total of 100 patients with American Burkitt's lymphoma (AMBL) (mean age, 15 years; M:F ratio 3:1; 3% black) have been treated at the National Cancer Institute since 1964. Eighteen of these had jaw involvement, 16 at presentation and 2 at relapse (mean age, 16 years; M:F ratio 1.6:1). None of these 18 patients was black. Of the 16 patients presenting initially with jaw tumors, 14 were first evaluated by their dentist; 8 were 16 years of age or older (adults) and 6 were younger than 16 years of age (children). Toothache and perioral numbness were the most frequent findings in adults, whereas toothache, loose teeth, intra-oral and extra-oral swelling were the most common complaints in children. Ten patients were treated with antibiotic therapy and/or dental extractions for presumed tooth infection. The distribution of jaw lesions was: unilateral mandibular (7), unilateral maxillary (4), bilateral mandibular (5), and four quadrants (2). Radiologic evaluation was abnormal in all 17 cases evaluated. Only three patients (all children) had disease limited to the jaw. Four of eight children and 3 of 10 adults are long-term survivors with a median follow-up of seven years (range, 2-15 years). American Burkitt's lymphoma with jaw involvement differs from African Burkitt's lymphoma (AFBL) with jaw involvement in a number of ways: (1) the incidence of jaw tumors in adults is similar to that in children; (2) the incidence of jaw tumors is not greater in males; (3) tumor is considerably more limited in extent with a single quadrant mandibular lesion being the most common presentation; and (4) clinical presentation also differs, with toothache and perioral numbness, uncommon in AFBL, being the most frequent complaints. These marked differences in the frequency and clinical characteristics of jaw tumor of AMBL and AFBL are consistent with other findings indicating that these diseases may differ phenotypically.

Adolescent↗
PubMed2004

Chronic orofacial pain among Korean elders: prevalence, and impact using the graded chronic pain scale.

The aims of this study were to investigate the prevalence of orofacial pain symptoms in the Korean elderly population, and to evaluate factors associated with orofacial pain and graded chronic pain. Of 4,342 Korean elders from the cohort of Korean National Interview Survey of Oral Health Status in 2000, telephone interviews were conducted on a stratified random sample of 1,032 people aged 55 years or older. Prevalence of five orofacial pain symptoms (jaw joint pain, face pain, toothache, oral sores, and burning mouth) in the past 6 months along with questions from the graded chronic pain scale were assessed by telephone using a structured questionnaire. The results suggested that the 6-month prevalence of joint pain (15.5%), face pain (9.3%), toothache (26.8%), oral sores (26.2%), and burning mouth (14.2%) in Korean elders were higher than in studies on Caucasian populations. Painful oral sores and burning mouth had higher prevalence for females than for males. Subjects with joint pain, burning mouth or toothache pain were more likely to report high levels of a pain-related disability compared with subjects not reporting those symptoms. There were no age group differences in pain intensity, but the older age group reported a higher number of disability days because of their pain. Chronic orofacial pain is a substantial health problem in the elderly population.

Aged↗
PubMed1999

Cancer pain and common pain: a comparison of patient-reported intensities.

PURPOSE/OBJECTIVES: To compare patient reports of present and worst cancer-related pain intensity to the recalled intensity of several commonly experienced types of pain. DESIGN: A secondary analysis on baseline data from patients with cancer pain. SETTING: Tertiary-care facilities and patients' homes. Patients were enrolled between 1988 and 1995. SAMPLE: Patients who were diagnosed with either primary lung cancer or cancer metastatic to bone, able to read and write English, over 18 years of age, and able to provide written informed consent. The sample of 125 patients was 62% male with a mean age of 60 years (SD = 11). METHODS: Patients completed the McGill Pain Questionnaire as a baseline measure in a pain research study. Investigators conducted comparisons among pain intensity scores reported for present pain intensity and worst cancer pain with the worst toothache, headache, and stomachache ever experienced using the Stuart test of marginal homogeneity. MAIN RESEARCH VARIABLES: Present cancer pain intensity and worst toothache, headache, and stomachache pain intensity. FINDINGS: Only 14% of the subjects reported that their present pain intensity was distressing, horrible, or excruciating, but 83% of them reported that their worst cancer pain was at these levels. The subjects reported that they experienced (a) significantly more intense pain with their worst toothache than either their present pain intensity (p < 0.001) or their worst cancer pain (p < 0.001), (b) significantly more intense pain with their worst headache than their present pain intensity (p < 0.001), and (c) significantly more intense pain with their worst stomachache than their present pain intensity (p < 0.001). In contrast, subjects reported that their worst cancer pain was significantly more intense than their worst headache (p = 0.047) or stomachache (p = 0.001). CONCLUSIONS: The findings suggest that present cancer pain is not only experienced at lower intensity levels than common pains, but at lower levels than expected by patients, their families, and the public. Consistent with common beliefs though, the worst cancer pain is severe and not adequately controlled for 9 out of 10 patients. IMPLICATIONS FOR NURSING PRACTICE: Healthcare professionals could use study findings to inspire hope in patients with lung cancer or bone metastasis and their families that present pain in cancer can be controlled successfully. Clinicians should devote greater efforts to relieve the worst cancer pain to levels achieved for the present pain experienced by people with cancer.

Adult↗
PubMed2003

[The buccal-dental health of drug addicts treated in the University hospital centre in Nice].

OBJECTIVE: Drug-addicts often suffer from rapidly progressive extensive dental decay. The objectives of this study were to determine the impact of illicit drugs on buccal and dental health and the use of illicit drugs for toothache. METHODS: Two groups of intravenous and non-intravenous drug-addicts were compared with two control groups of age matched non-addicted subjects. During a routine dental examination, medical and addictive history, periodontal and dental health and dental complaints were recorded. RESULTS: This study showed that intravenous heroin was responsible for rapidly progressive dental decay, even in four drug-addicts with satisfactory dental hygiene. Intravenous heroin users (14 women, 38 men, mean age 35) had a mean number of 10 missing and 10 decayed teeth, 6 of them to be extracted, and needed two dentures with 8 teeth each. Their masticatory function (45%) and smile did not permit normal alimentation or social life. Non-intravenous drug users (9 women, 29 men, mean age 26) had a mean number of one missing tooth and 4 decayed teeth to be treated. When compared to control groups, drug users of both categories exhibited more decayed teeth, reduced masticatory function and a lower periodontal health correlated with inadequate dental hygiene. Finally, 52% of heroin users and 21% of other illicit drug users admitted the use of illicit drugs as analgesics for toothache. CONCLUSION: The management of toothache should be proposed in the cessation protocols and dentures provided to intravenous drug-addicts, before any attempt at social reinsertion.

Adult↗
PubMed2005

Primary reason for tooth extraction in a Brazilian adult population.

PURPOSE: To identify the primary reasons for tooth extraction in a Brazilian adult population. MATERIALS AND METHODS: Interviews and oral examinations were conducted with 466 subjects aged from 18-76 years in the city of Maceió, Brazil. Frequency distributions, means and medians were calculated and the chi-square test was used to determine the level of significance. A logistic regression model was used to evaluate the variables associated with reasons for tooth extraction. RESULTS: Of the 466 extractions, 295 (63.3%) were due to dental caries, 61 (13.1%) due to periodontal disease, 56 (12.0%) for orthodontic reasons, 32 (6.9%) at the patient's request, 15 (3.2%) for pre-prosthetic reasons, four (0.9%) due to pericoronitis, two (0.4%) due to trauma and one (0.2%) for other reasons. Tooth extraction due to caries and other causes (excluding periodontal disease) shows a significant association with family income, toothache, type of health centre (public or private), educational level (P < 0.001) and marital status (P = 0.002). The logistic regression model has shown that patients undergoing treatment at a public health centre, those suffering from toothache or with an incomplete secondary education were more likely to lose their teeth due to caries, with educational level as the strongest indicator. For tooth extraction due to periodontal disease and other causes (excluding dental caries) the variables age, family income, type of health centre, tooth types (anterior or posterior), educational level (P < 0.001) and toothache (P = 0.006) were statistically significant, and age was the only associated variable in the logistic regression model. CONCLUSION: Dental caries was the main cause of tooth extraction in the study group, following tooth extraction due to periodontal disease.

Adolescent↗
PubMedDate not supplied

Updating a measure of dental anxiety: reliability, validity, and norms.

PURPOSE: The Corah Dental Anxiety Scale was introduced in 1969. Since then, changes in dental practice and language usage have dated the scale. The purposes of this study were to (1) slightly modify the scale, (2) assess its reliability and validity, and (3) develop norms for the revised version. The scale modifications recognized the roles of dental hygienists and female dentists in the dental office. Two variations of the first item also were constructed. One asked about going to the dentist "for a checkup¿; the other asked about going "because of a toothache." METHODS: The revised instrument was included in face-to-face interviews with 662 dentate adults living in the Detroit, Michigan, area. Reliability was estimated by Cronbach's alpha. Validity was examined by correlating the revised scale with another measure of dental anxiety and measures of conceptually related variables. RESULTS: Cronbach's alpha coefficient was 0.82 for the checkup version of the scale, 0.79 for the toothache version, and 0.82 for a scale including both variations of the first item, indicating adequate reliability. Dental anxiety correlated positively with history of dental problems (r = .13, .09, and .10 for the checkup, toothache, and combined versions, respectively), negatively with frequency of preventive dental visits (r = -.28, -.22, and -.25), and positively with another measure of dental anxiety (r = .61, .59, and .62), supporting the validity of the scales. CONCLUSIONS: The checkup version of the revised scale is recommended for future use. The Dental Anxiety Scale as modified continues to be a reliable and valid instrument 20 years after its introduction.

Adult↗
PubMed2006

Dental Discomfort Questionnaire for young children following full mouth rehabilitation under general anaesthesia: a follow-up report.

AIM: The aim of the present study was firstly to assess the persistence of pain related behaviours of the Dental Discomfort Questionnaire (DDQ) and secondly to complete a follow-up study to assess the effect of dental treatment on pain related behaviours in preschool children. METHODS: The 9-question DDQ instrument was used to assess dental pain related behaviours in a group of preverbal children. The test-retest analysis questionnaire was filled out twice by 44 parents on behalf of their referred child. For the follow-up study the questionnaire was filled out by 71 parents before and after all dental disease was completed. RESULTS: A strong correlation for the test-retest was found over a 2 month period before treatment. When the behaviour items were compared independently before and after treatment it appeared that after treatment all but one behaviour (i.e. bite with molar instead of teeth) was displayed less often. Overall, after treatment all children had a lower mean DDQ score. CONCLUSIONS: Dental treatment of children leads to reduced toothache related behaviours and subsequently to a better quality of life. The DDQ is a sensitive instrument to measure dental discomfort before and after restorative treatment if and when the follow-up period is short. The DDQ can possibly support healthcare providers, teachers and parents in their assessment of toothache in young children.

Analysis of Variance↗
PubMed1999

The tooth-worm: historical aspects of a popular medical belief.

The concept of a tooth-worm, which according to popular belief, caused caries and periodontitis, has existed in diverse cultures and across the ages. During the Enlightenment, however, the theory of the tooth-worm was assigned by medical doctors almost exclusively to superstition. Even so, the idea that toothache was caused by gnawing worms held on even into this century. There were many different ideas with regard to the appearance of tooth-worms. In England, for instance, it was thought that the tooth-worm looked like an eel. In Northern Germany, people supposed the tooth-worm to be red, blue, and gray and in many cases the worm was compared to a maggot. The gnawing worm was held responsible for many evils and, in particular, was blamed for toothache provoked by caries. The question is discussed of how the belief in the existence of the tooth-worm in former times can be explained. In popular medicine, numerous therapies were applied in order to eradicate the tooth-worm. In addition to the fumigations with henbane seeds, which allowed the "tooth-worm" to develop in the form of burst seeds, there were also magical formulas and oaths.

Arab World↗
PubMed2004

Intraoral neuropathy.

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.

Anticonvulsants↗
PubMed1989

Electronic thermography in the diagnosis of atypical odontalgia: a pilot study.

Atypical odontalgia (AO) is a dental condition that is usually diagnosed by exclusion after failure of multiple dental treatments. A functional definition of AO includes (1) continuous pain in and about a tooth or teeth, (2) pain present for longer than 4 months, (3) inadequate local cause (no abnormality detected on dental radiographs), and (4) anesthetic blockade gives equivocal relief of toothache. The purpose of this study was to assess the potential role of electronic thermography in the diagnosis of AO. Results from measurements of facial thermal symmetry indicated that normal subjects = 83.5%, AO group = 65.8% (p less than 0.01). Electronic thermography interpreted by thermography experts has promise as a diagnostic test for AO among patients with toothache for which the dentist can find no convincing dental explanation.

Adult↗
PubMed1987

Carriage rates of enterococci in the dental plaque of haemodialysis patients in Dublin.

The incidence of carriage of enterococci in dental plaque was determined in haemodialysis patients attending three clinics in the Dublin area either as outpatients or as hospitalised patients. Their carriage rates were compared with a University group comprising normal healthy students, academic staff, technicians and ancillary personnel and with a cohort of otherwise healthy toothache patients. The carriage rates among the staffs of the dialysis units also were examined. The overall carriage rates of enterococci of the University group, the toothache patient group, the haemodialysis patients and the dialysis unit staffs did not differ significantly from each other, ranging from 5%-20%. However, the dental plaque of a mainly hospitalised group of haemodialysis patients and their attendant staff at one clinic was colonised to a statistically significant higher degree with enterococci than that of the haemodialysis patients and the staff at the outpatient clinics, both separately and as combined patient and staff groups. Age, sex, a history of recent antibiotic therapy, and elapsed time since the last dental visit did not affect isolation rates to a significant extent. The commonest enterococcus isolated from subjects was Streptococcus faecalis, followed by its variety liquefaciens. Only one subject harboured Streptococcus durans in dental plaque. Ten of the 21 subjects yielding enterococci harboured two different enterococci in their plaque. The isolation of S. faecalis var liquefaciens alone or in combination with S. faecalis did not correlate with subject-history parameters. The findings obtained imply that antibiotic prophylaxis specifically against enterococci may be necessary only for a small number of haemodialysis patients in whom oral carriage of enterococci has been demonstrated bacteriologically.

Adolescent↗
PubMed1999

Health care utilization by older adults in response to painful orofacial symptoms.

The purpose of this study was to determine which specific attributes of painful orofacial symptoms serve as predictors of health care utilization in a population based sample of elderly subjects. Furthermore, we documented patterns of health care utilization selection by type of health care provider. To our knowledge, these specific utilization patterns have never before been reported in the pain literature. Telephone interviews were conducted with a stratified random sample of 1636 community dwelling older (65+) north Floridians. A total of 5860 households were contacted and screened, with 75.3% participating to the point where their eligibility for the study could be determined. The percentage of subjects reporting health care utilization for a specific symptom ranged from 62 to 32%. One or more health care visits were reported by at least 50% of those reporting symptoms of toothache pain, facial pain, jaw joint pain and burning mouth in the past 12 months. These rates suggest that elderly individuals are willing and able to seek health care for painful orofacial symptoms. We found that pain intensity was the best predictor of whether an elderly individual utilized health care or not, which suggests that some pain intensity threshold may exist at which health care seeking behavior is initiated. The overall number of visits was not predicted by pain intensity but by other qualities more associated with time or level of dysfunction caused by the symptom. We also found that elderly adults, typically seek care for toothache from a dentist and from physicians for painful orofacial symptoms not associated with the teeth or mouth. These decisions regarding the selection of a health care professional may, in part, be a function of financial and insurance considerations, anatomical site and perception of the role of dentistry in orofacial care.

Aged↗
PubMed2003

Perceived oral health: changes over 5 years in one Swedish age-cohort.

OBJECTIVES: The purpose of this study was to investigate if a change in the social gradients in perceived oral health occurred over a 5-year period, 1992-97, using a cohort population from two Swedish counties. METHODS: In 1992, a cross-sectional mail questionnaire was sent to all 50-year-old persons in two counties in Sweden, Orebro and Ostergötland, and altogether there were 8888 persons. In 1997, the same population was sent a new questionnaire. The cohort, comprising the same respondents from 1992 and 1997, was of 5363 persons. An index of perceived oral health was constructed out of three questionnaire variables: satisfaction with teeth, chewing ability and the number of remaining teeth. This index value was set as a dependent variable in a regression model. Reports of toothache were investigated in a separate logistic regression model. RESULTS: There were obvious social gradients in the perceived oral health index both in 1992 and in 1997. Marital status, foreign birth, education and occupation were all substantially related to the perceived oral health. The change in perceived oral health was analyzed. Almost half of the cohort (47.4%) showed no change at all. Those with increased and those with decreased health were rather evenly distributed on both sides, with 22.0% with better health in 1997 and 30.6% with worse health. Gender and education were related to toothache experience. CONCLUSION: Changes have been moderate in the perceived oral health in this cohort, despite the rather drastic changes in the remuneration of dental care during this study time. On the other hand, this also means that the social differences remain, despite the official goals of increased equity.

Cohort Studies↗
PubMed2004

Dental treatment in Medieval England.

Medieval (12th-14th century) medical literature suggests that care of the teeth was largely limited to non-invasive treatment. Cures, mainly for toothache and "tooth worm" were based on herbal remedies, charms and amulets. Bloodletting was advised for certain types of toothache. There is also documentary evidence for powders to clean teeth and attempts at filling carious cavities. Surgical intervention for oral cancer and facial fracture is also known. Post-operative infection and abscess formation can be identified and early forms of false teeth are mentioned.

Dental Care↗
PubMed1997

Motivation for dental hygiene in adolescents.

The aim of this study was to investigate the relation between some 'lifestyle' factors and motivation for toothbrushing in young people. Data from a questionnaire survey of 7770 children aged 14-15 years were analysed to obtain information about their main reason for toothbrushing, their toothbrushing frequency, smoking behaviour and social efficacy. In those who brushed their teeth less frequently, toothbrushing was performed more for cosmetic reasons, that is, having teeth that look and feel good and breath that smells fresh, in contrast to the avoidance of toothache and false teeth, which are health reasons. The more socially advantaged individuals were more inclined to brush their teeth to avoid toothache, and less for the sake of good appearance, compared with the more disadvantaged. Motivation for toothbrushing varied significantly with smoking behaviour, committed smokers were more inclined to brush for cosmetic reasons whereas those who had never smoked were more concerned to avoid dental problems. Similarly, those who had a current friend of opposite sex, and in males, those expressing confidence when meeting members of the opposite sex, brushed more for cosmetic reasons. In conclusion, different people perform their dental hygiene for quite different reasons. These findings need to be taken into account when instructing patients in personal dental care and formulating dental health messages.

Adolescent↗
PubMed2003

Incidence of endodontic treatment: a 48-month prospective study.

The purpose of this study was to determine the incidence of endodontic services provided to participants in a longitudinal cohort study. The "Florida Dental Care Study" was a prospective cohort study using a representative baseline sample of 873 dentate adults. An in-person interview and clinical dental exam were conducted at baseline, 24, and 48 months after baseline, with telephone interviews every 6 months between those times. Dental record information was abstracted afterward. Thirteen percent of participants received at least one endodontic procedure after baseline. Endodontic services constituted approximately 2% of all dental procedures performed. Conventional root canal therapy comprised 94% of the endodontic services and was approximately evenly distributed among anterior teeth, premolars, and molars. Retreatment and apicoectomy each accounted for 3% of the endodontic procedures. The most common self-reported reasons for the dental visit in which a root canal occurred were "toothache," "abscess," and "dental sensitivity." A significant percentage of persons received some type of endodontic treatment in this diverse adult sample. Dental abscesses or toothaches were the main reason(s) for endodontic treatment, but not all persons with these conditions during follow-up sought dental treatment of any variety.

Aged↗
PubMed1991

Analysis of an emergency dental service provided at a children's hospital.

An analysis was undertaken of the evening, weekend and public-holiday emergency dental service provided at the Royal Belfast Hospital for Sick Children during one calender year (1987). Dental emergencies accounted for 4% of all attendances during these periods at the Accident & Emergency Department. Toothache, with or without abscess, was the most frequent dental complaint (49%) and abscesses were most frequently associated with primary first molars. Acute trauma was the second most frequent dental complaint (39%) and traumatic injuries were most commonly caused by falls and bicycle accidents. Tooth displacement was was the most common dental injury of primary and permanent teeth. Complaints other than toothache, abscess or traumatic injury accounted for only 12% of dental emergencies.

Abscess↗