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PubMed2006

Dental presentations of cluster headaches.

Cluster headache has been defined by the International Headache Society (IHS) as one of the primary headaches. A primary headache is a headache that has no other known cause, such as infection or trauma. Cluster headache is also listed as one of the trigeminal autonomic cephalalgias. These headaches are mediated by the trigeminal nerve with accompanying autonomic symptoms that may range from conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, and ptosis to eyelid edema. The IHS has described cluster headache as "attacks of severe, strictly unilateral pain that is orbital, supraorbital, temporal or in any combination of these sites, lasting 15 to 180 minutes." In the author's practice, as a dentist treating orofacial pain, patients with cluster headache have dental or midfacial complaints as a primary presentation. This paper introduces such presentations based on interviews with cluster headache patients, with the main purpose of having midfacial complaints considered as an important presentation to be added to the IHS diagnostic criteria for cluster headache.

Adult↗
PubMed1985

Initial tooth movement: force application and pain--a relationship?

Initial dental casts of 24 patients, who had previously completed a discomfort index card for the first 16 days following placement of a fixed appliance, were examined. A method is described whereby the anterior and overall crowding in the relevant dental arch was measured as a tooth/arch discrepancy index using the reflex metrograph. The crowding was measured in three dimensions as the discrepancy between the sum of the anatomic mesiodistal widths of the teeth and the actual mean arch shape canine to canine (3 to 3) and first molar to first molar (6 to 6) inclusive. An additional two-dimensional method using the best "goodness of fit" (least variance) of a parabolic arch shape for the mean arch length in the 6 to 6 crowding measurement is also described. The measurement accuracy of the reflex plotter was less than 0.12 mm. The method error for the crowding measurements expressed as root mean square (RMS) values was 0.97 mm for the anterior tooth/arch, 1.45 mm for the overall tooth/arch discrepancies, and 1.35 mm for the tooth/arch discrepancy based on the best fit of a parabolic curve. It is proposed that since the same bracket width and fully engaged arch wire type were used in every case, some relationship between the initial crowding that reflected the forces applied and the discomfort experienced by the patients might be expected. This was not found to be true. There was no correlation between the total discomfort experienced and the crowding measurements 3 to 3 or 6 to 6.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Symptomatology and clinical features of hypersensitive teeth.

Tooth hypersensitivity is associated with exposure of the dentine to the external environment of the mouth. This exposure can result from loss of enamel by processes including abrasion and erosion, or by denudation of the root surface as a result of gingival recession or periodontal treatments. Dentine hypersensitivity can be described as an adverse reaction or pain in one or more teeth resulting from either a thermal, chemical, bacterial or mechanical stimulus. Painful symptoms arising from exposed dentine are a common finding in adults and reportedly affect as many as one in every seven patients attending for dental treatment. Although predisposition to dentinal hypersensitivity is multifactorial, enamel loss as well as gingival recession may be more severe with advancing age. Because of the greater longevity of people who are also keeping their teeth longer, hypersensitivity is a growing concern. Clinical studies show that individuals with less than adequate plaque control experience more root hypersensitivity to air stimuli than others with better oral hygiene. Although plaque does not alter the pulpal threshold, i.e. has no effect on the pulp, it seems that microbial plaque has an effect on root sensitivity.

Dental Plaque↗
PubMed1990

Predictions of dental pain: the fear of any expected evil, is worse than the evil itself.

In a study of 40 subjects, who twice underwent extensive dental treatment, the relationships between expectations and experiences of pain and of anxiety were investigated. Inaccurate expectations were adjusted in the same way as observed in the laboratory. Especially anxious subjects expected more pain and anxiety than they experienced, and they appeared to need more experiences before their predictions became accurate. In the course of time, the expectations (and memories) of anxious subjects returned to their original more inaccurate level of prediction. The results suggest that the old schema is ultimately reinstated if disconfirmations are few and far between. Anxious subjects did not experience more pain, but they did experience more anxiety than fearless subjects. Detailed investigation of processes of change after disconfirmation showed that anxiety experienced during treatment is a factor that plays a part in maintaining the problem of inaccurate expectations and fear of treatment. Theoretical and clinical implications of these findings are discussed.

Adolescent↗
PubMed1993

Anxiety, pain and discomfort associated with dental treatment.

The aims of the study were to describe the level of anxiety and pain/discomfort associated with dental treatment in two samples (N = 1288 and N = 2382) representative of an adult population, and to assess the statistical effects of these variables on utilization of dental services (dental attendance measures, expenditure, and items of dental treatment received during the last year). The prevalence of high dental anxiety in the samples as measured by Corah's Dental Anxiety Scale, the Dental Fear Scale, and the Dental Anxiety Question was 4.2%, 7.1% and 5.4%, respectively. Rather large proportions of the respondents judged dental treatment to be painful or uncomfortable: between 20 and 30% rated their last dental visit as moderately painful or worse; about 60% reported having had at least one very painful experience, and 5-6% experienced dental treatment in general to be very painful. Dental anxiety was significantly related to pain reports (correlations in the 0.32-0.48 range). There were no differences between the youngest age group (15-19 yr) and the rest of the respondents in Study II with regard to dental pain ratings. Possible explanations for these findings are discussed. The effects of dental pain and anxiety on utilization measures, although attaining significance in several of the analyses, were generally weak. Both studies demonstrated few significant differences between individuals with high dental anxiety and the rest of the study samples with respect to type and extent of dental treatment received during the last year. Thus, these data seem to show that many dentally anxious patients seek out and undergo dental treatment despite high fear levels.

Adolescent↗
PubMedDate not supplied

A model of pain and anxiety associated with acute stressors: distress in dental procedures.

Many acute stressful experiences are not inherently very harmful, yet are associated with great pain and anxiety. The characteristics and experiences that the person brings to the situation are more important than any objective characteristics of the experience itself in determining how aversive the experience will be. Dental procedures are excellent examples of this type of stressor. Drawing primarily on the literature related to dental procedures, the present article discusses the nature of pain and anxiety in the face of an acute stressor, and presents the dispositional and situational factors that contribute to the perception of an acute stressor as aversive. A model is presented illustrating how the various factors interact. It is argued that, in addition to being descriptive, the model is also prescriptive of measures that may be taken to ameliorate the distress of persons subjected to acute stressors like dental procedures.

Arousal↗
PubMed1984

Pontomedullary raphe neurons: intracellular responses to central and peripheral electrical stimulation.

The responses of pontomedullary raphe neurons to electrical stimulation of the medullary reticular formation (MRF) and the mesencephalic ventral periaqueductal gray region (PAG) were studied using intracellular methods in chloralose-anesthetized cats. Single shock stimulation of PAG at the level of the trochelear nucleus evoked short latency, monosynaptic excitatory postsynaptic potentials (EPSPs) in antidromically identified raphe-spinal neurons. Similar large EPSPs were produced by medullary reticular stimulation of either side. The large majority of raphe-spinal neurons responded to sciatic nerve shock, and most responded to tooth pulp or forepaw shock as well; these responses were always bilateral. The responses of cells that could not be antidromically invaded from spinal cord were similar to those of raphe-spinal neurons, but tended to be more variable. Intracellular injection of horseradish peroxidase into electrophysiologically characterized cells revealed that most recordings were made from large and medium sized raphe neurons. These findings are discussed in the context of a potential role for pontomedullary raphe neurons in nociception.

Animals↗
PubMed1985

The pituitary inhibitory system: its role in pain perception.

The present study was designed to investigate the pain relief mechanism of electrical stimulation to the pituitary and the relationship between hypothalamic and pituitary analgesic mechanism through the observation of monkey behavior and characteristics of tooth pulp-evoked potentials. The results suggest that pituitary-stimulating analgesia should be differentiated from hypothalamic-stimulating effect. In view of the facts, the theory of the Pituitary Inhibitory System is proposed.

Analgesia↗
PubMed1985

Modification of dental pain and cutaneous thermal sensitivity by physical exercise in man.

The effect of physical exercise on dental pain thresholds, the release of pituitary stress hormones and thermal sensitivity of skin was tested in healthy human subjects. Different levels of exercise (100-300 W) at different pedal frequencies were produced by a cycle ergometer. Thermal limen (the interval between warm and cool thresholds) determined from glabrous hand, hairy forearm and leg was used as a parameter of thermal sensitivity. In all subjects the heart rate and blood pressure were increased with increasing work load. Dental pain thresholds were elevated at high work loads with a concomitant activation of pituitary stress hormone (especially growth hormone) release. Thermal limens at all 3 sites were increased work load, too, independent of the pedal frequency. The increase of thermal limen was most marked in the leg and least in the glabrous hand. The results indicate that physical exercise produces a non-segmental, load-dependent decrease of pain and thermal sensitivity with a concomitant activation of pituitary stress mechanisms. The magnitude of modification varies with skin region. Activation of inhibitory mechanisms at spinal levels via muscle and proprioceptive afferents, in a way suggested by the gate control theory of pain mechanisms, seems to have only a minor, if any, contribution to the present findings, since a higher pedal frequency did not produce a more marked decrease of sensitivity.

Adrenocorticotropic Hormone↗
PubMed1986

Hippocampal responses evoked by tooth pulp and acoustic stimulation: depth profiles and effect of behavior.

Averaged evoked potentials and unitary discharges in response to tooth pulp and acoustic click stimuli were recorded from the hippocampus of freely moving rats. The spatial distribution of evoked field responses to tooth pulp stimulation and acoustic clicks were identical. Averaged evoked potentials consisted of a large negative deflection (N1) preceded by a small positive potential (P1). The shortest latency N1 in response to tooth pulp stimulation was recorded from the middle third of the dentate molecular layer and the outer portion of apical dendrites of CA3 (27 ms). The peak latency of N1 was significantly longer (34 ms) in the stratum radiatum of CA1. Laminar profiles of N1 in the dentate gyrus and CA3 were similar to that evoked by electrical stimulation of the medial entorhinal afferents; in CA1 the depth profiles of the potentials were similar to the response profile evoked by the Schaffer collaterals. Largest amplitude P1 was obtained from above the pyramidal layer of CA1 and the hilus. Both sensory modalities were able to modify the discharge rate of neurons in all hippocampal regions. The amplitude of evoked field potentials and cellular responses were dependent upon both the ongoing behavior of the animal and the nature of its response to the stimulus. The largest amplitude evoked potentials were recorded during immobility and slow wave sleep. On the other hand, virtually no potentials were obtained during exploratory behaviors associated with theta EEG activity. The findings indicate that information about sensory stimuli can reach the hippocampus by two distinctive pathways: a short latency inhibitory input via the fimbria-fornix and a longer latency path via the entorhinal cortex. It is suggested that neuronal mechanisms involved in theta EEG block the sequential activation of the unidirectional entorhinal-hippocampal circuitry.

Afferent Pathways↗
PubMed1986

Influence of changes of tooth temperature on reflex and central activity evoked by stimulation of tooth pulp afferents.

The importance of the temperature of the dentine was studied in teeth prepared for electrical stimulation. During experiments with the mouth open, the temperature of teeth covered by cement was normal. The digastric EMG and the brainstem--evoked response following electrical stimulation of the tooth pulp as well as the threshold for eliciting a jaw-opening response remained constant throughout prolonged experiments. However, heat produced by the cement used to fixate the tooth electrodes could have damaged the tooth if the dentine temperature had exceeded 45 degrees C. A careful preparation of the tooth pulp by repeated application of thin layers of cement allowed an adequate preparation without damage to tooth pulp afferents.

Animals↗
PubMed1979

Atypical odontalgia.

Forty-four cases of odontalgia are described which are considered to be a painful migraine-like disturbance of the blood vessels of the dental pulp and periodontal membrane. The condition appears to be a manifestation of depression and other personality disorders and responds well to antidepressant drug therapy (75 per cent of the patients). The recognition and proper management of this atypical ondontalgia is of crucial importance in preventing unnecessary surgery.

Adult↗
PubMed1984

Possible role of central serotoninergic neurons in the development of dental pain and aspirin-induced analgesia in the monkey.

The effects of aspirin or 5-hydroxytryptamine (5-HT)-related drugs on the dental pain induced by electrical stimulation of tooth pulp afferent fibers were assessed in conscious monkeys. The electrical current required for producing jaw opening is referred to as the pain threshold. Both systemic (25 to 75 mg/kg, i.p.) or central (0.5 to 1.5 mg, third cerebral ventricle) administration of aspirin produced analgesia in monkeys. In addition, activation of central 5-HT receptors with central injection of either 5-HT or its precursor, 5-hydroxytryptophan, also produced analgesia. On the other hand, inhibition of central 5-HT receptors with central administration of either cyproheptadine (a blocking agent of 5-HT receptors), p-chlorophenylalanine (PCPA, an inhibitor of 5-HT synthesis) or 5,7-dihydroxytryptamine (5,7-DHT, a depletor of central 5-HT nerve fibers) produced an enhancement in pain sensitivity (or a decrease in pain threshold). Furthermore, the analgesia induced by aspirin was antagonized by pretreatment of monkeys with either cyproheptadine, PCPA, or 5,7-DHT. The results indicate that increases in the activity of central 5-HT neurons are associated with reduced dental pain and enhanced aspirin-induced analgesia, whereas decreases in the activity of those neurons correlate with dental hyperalgesia and diminished aspirin-induced analgesia in monkeys.

5,7-Dihydroxytryptamine↗
PubMed1981

An 18-month clinical evaluation of semiprecious and nonprecious alloy restorations.

SEM studies indicate that the control alloy, Minigold, WLW, and Litecast metals presented similar results in relation to marginal fit when proper techniques are followed. Clinical evaluation based on the criteria of gingival irritation, patient sensitivity, and abrasion demonstrated no statistically significant differences between the casting alloys tested and the control. The control alloy had significantly fewer restorations with tarnish and corrosion than either WLW or Litecast. There was no significant difference between the control alloy and Minigold in terms of tarnish and corrosion.

Alloys↗
PubMed1984

A review of the incidence of pain after an operation treatment visit: Part I.

This review presented some typically encountered painful sequellae from routine restorative dental treatment. A brief description of the importance of Tomes' processes and free nerve endings were mentioned also. This review should serve as a background for a clinical study concerning posttreatment pain that will be described in a later article.

Dental Restoration, Permanent↗