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PubMed1995

[The limits of conservative care in pedodontics].

Despite progress in the decrease of caries by means of many preventive dental programs, children's teeth of poor socio-economic groups are still strongly affected. The well known role of children's teeth in oro-facial growth and harmony, as well as in the development of functions as chewing, speaking or phonation and swallowing, has justified their preservation during all their functional periods. Several conservative therapies allow to reach this purpose. However, extensive dental caries, difficulty to get child tooth infection under control, injuries on permanent tooth germs and child's general health deficiency, can limit preservation of infected teeth, leading to their extraction.

Algorithms↗
PubMed1995

Cause, incidence, and prevention of trauma to teeth.

The cause, incidence, and prevention of trauma to teeth are highlighted from a contemporary aspect. Causative factors have become more diverse, and the incidence of trauma has become almost equal in both sexes. Newer areas identified include domestic violence, enhanced sporting activities, and an increase in adverse societal manifestations. Prevention, with a focus on education and awareness of diverse populations, is discussed.

Accidents↗
PubMedDate not supplied

Craniomandibular/temporomandibular/cervical implications of a forced hyper-extension/hyper-flexion episode (i.e., whiplash).

Clinicians now appreciate the full chain of tissue damage of the interconnecting muscles, tendons, ligaments and fascia: this compromised linkage from the skull through the suboccipital musculature to the cervical spine and anterior/posterior cervical muscles, from the check-rein ligaments and muscles extending from the skull and maxilla to the mandible, from the suprahyoid musculature connecting the mandible through to the hyoid bone, from the hyoid through the infrahyoid to the supporting shoulder girdle, all contribute to damaged interconnecting matrices. Consequently, unresolved tissue damage in any of this linkage becomes mutually provocative during function to any part of the linkage. Diagnostics, therefore, must necessarily include examination of this total linkage; similarly, eventual treatment protocols must resolve tissue damage in all of this interconnecting linkage if treatment is to be successful beyond palliative applications. The influence of an angular component in any such trauma must be emphasized; force vectors then attack the craniomandibular/temporo-mandibular/cervical complex where it is most vulnerable, at the most restrictive parameters of functional mobility. Thus, the angular component brings an exponential increase in tissue damage potential to all of the craniomandibular/temporomandibular/cervical complex. Finally, if we are to treat the occlusion of these victims intelligently, we must understand the effects of this trauma on the 'whole body', and not just focus singularly on the restoration or the malocclusion or the TMJoint problem. There are lessons to be learned from this acute trauma which provide valuable insights into the diagnosis of chronic pain patients. If these victims do not come to us for help immediately following the acute trauma episode, but arrive in our offices months or years later, our clinical examinations must include head and neck mobility or functional restrictions, observations of the patients' gait, other residual postural deficits, et al. Failure to implement these observations in our clinical examination will ultimately compromise our treatment success. As a final note, an axiom to bear in mind when studying the function of the musculoskeletal system is that when muscle is put into an adversarial relationship with bone, muscle always wins! Example #1: Compare a lateral cervical radiograph taken on the day of a rearend collision to one completed five months later; if tissue damage is unresolved, there will inevitably be a loss of lordotic curve of the cervical spine with a kyphosis at C-4, C-5!; Example #2: If a patient has developed a parafunctional habit like bruxism using pathological forces over a long period of time, the clinician will inevitably observe antigonial notching on the mandible at the masseter insertion! Although at first glance integrating these precepts into our examination protocols may appear to complicate matters, it actually makes our tasks easier and allows us to provide more comprehensive services for our patients. Those of us who are "functionally aware", will always be three steps ahead of the field in functional orthopedics or functional orthodontics. Let me conclude with a premise I learned many years ago from a very learned Osteopath, Dr. John Harakal, of Fort Worth, Texas: "If, as a clinician, you are able to put the body into a position to heal, it will heal itself."

Cervical Vertebrae↗
PubMed2000

Phantom tooth pain: a new look at an old dilemma.

UNLABELLED: The aim of this paper is to review the current knowledge of phantom tooth pain, a neuropathic facial pain disorder, thought to result from peripheral nerve injury. Phantom tooth pain is a deafferentation pain disorder of persistent toothache in teeth that have been denervated (usually by root canal treatment) or pain in the area formerly occupied by teeth prior to their extraction. The pain usually extends to the facial structures adjacent to tissues that have undergone deafferentation. The clinical characteristics, differential diagnosis, epidemiology, and treatment of phantom tooth pain are reviewed. Suggestions for further research include the need for controlled treatment trials and modification of current criteria. CONCLUSIONS: Phantom tooth pain has much in common with other phantom pain disorders. In the absence of controlled clinical trials specifically directed to phantom tooth pain, treatment should be guided by standards used for other neuropathic pain disorders. Revised diagnostic criteria for phantom tooth pain are proposed.

Journal Article↗