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After an extensive review of the dental literature, few articles were found related to pain and implantology. Management of orofacial pain has traditionally been a difficult challenge for the dental-medical profession. Patients may be afraid of dental pain, particularly in cases of dental implantology. Therefore, a study to obtain more conclusive data was developed. Taking into account that the perception of pain and the threshold of pain vary among individuals, a 2-year clinical study was established in private practice utilizing a verbal method (double-blind). The study was used to quantify sensory and affective aspects of pain associated with dental implantology on 75 patients in a private dental office. All of the implants were placed by the same clinician. Data were recorded following a Pain Data Sheet designed for this particular study. The aim of this study was to obtain different aspects of data as follows: 1) Fear of the dentist and fear of dental implant procedures utilizing a descriptive scale of 1 to 10, with 1 indicative of no fear. 2) Dental areas and ridges: Dental pain, pain in edentulous areas, and pain in the implanted area utilizing a scale of 0 to 8, with 0 indicative of no pain. 3) Function and pain: during mastication, swallowing, speech, yawning, opening, closing, and lateral excursions and indication of cervical pain or back pain, each calibrated by the presence or absence of pain. 4) Palpation and pain of the temporomandibular joint, the temporal muscle, the area of the pterygoid muscles, masseter muscle, and sternocleidomastoid muscle, all calibrated on the indication of presence or absence of pain. 5) Others: ear pain, neuralgia, headaches, edema, and hematoma, calibrated on the basis of presence or absence. The aforementioned factors were evaluated immediately before surgery and after surgery, at 24 hours, and during a follow up for a period of 2 years at intervals of 1 week; 1, 2, 3, 4, and 6 months; and 1 and 2 years after surgery. Also recorded were the uses of presurgical and postsurgical medication at the first and second surgical phases, age, sex, buccal opening, number and position of implants, previous dental experiences, and the psychological preparation for dental implant treatment. The results of the statistical analysis indicate no correlation between pain and dental implantology procedures, in a private dental practice, at the level of significance of P > .001.
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PMID:Pain and dental implantology: sensory quantification and affective aspects. Part I: At the private dental office. 1130 42

Rofecoxib is a selective cyclo-oxygenase (COX)-2 inhibitor which has little or no effect on the COX-1 isoenzyme at doses up to 1000 mg/day. Rofecoxib has greater selectivity for COX-2 than celecoxib, meloxicam, diclofenac and indomethacin. In well-controlled clinical trials, rofecoxib 12.5 to 500 mg/day has been evaluated for its efficacy in the treatment of osteoarthritis, acute pain and rheumatoid arthritis [lower dosages (5 to 125 mg/day) were generally used in the chronic pain indications]. In the treatment of patients with osteoarthritis, rofecoxib was more effective in providing symptomatic relief than placebo, paracetamol (acetaminophen) and celecoxib and was similar in efficacy to ibuprofen, diclofenac, naproxen and nabumetone. Overall, both the physician's assessment of disease status and the patient's assessment of response to therapy tended to favour rofecoxib. In patients with postsurgical dental pain, pain after spinal fusion or orthopaedic surgery, or primary dysmenorrhoea, rofecoxib provided more rapid and more sustained pain relief and reduced requirements for supplemental morphine use after surgery than placebo. Rofecoxib was more efficacious than celecoxib in patients with acute dental pain and pain after spinal fusion surgery, although celecoxib may have been used at a subtherapeutic dose. In comparison with traditional nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen, diclofenac and naproxen sodium, rofecoxib was similar in efficacy in the treatment of acute pain. Although naproxen sodium provided more rapid pain relief than rofecoxib in patients with primary dysmenorrhoea, the reverse was true after orthopaedic surgery: rofecoxib provided more rapid pain relief and less supplemental morphine was needed. Rofecoxib was as effective as naproxen in providing symptomatic relief for over 8700 patients with rheumatoid arthritis. Compared with traditional NSAID therapy, rofecoxib had a significantly lower incidence of endoscopically confirmed gastroduodenal ulceration and, in approximately 13,000 patients with osteoarthritis and rheumatoid arthritis, a lower incidence of gastrointestinal (GI) adverse events. Rofecoxib was generally well tolerated in all indications with an overall tolerability profile similar to traditional NSAIDs. The most common adverse events in rofecoxib recipients were nausea, dizziness and headache. In conclusion, rofecoxib is at least as effective as traditional NSAID therapy in providing pain relief for both chronic and acute pain conditions. Rofecoxib provides an alternative treatment option to traditional NSAID therapy in the management of symptomatic pain relief in patients with osteoarthritis. Initial data from patients with primary dysmenorrhoea and postoperative pain are promising and further trials may confirm its place in the treatment of these indications. Rofecoxib has also shown promising results in patients with rheumatoid arthritis and is likely to become a valuable addition to current drug therapy for this patient population. Importantly, rofecoxib is associated with a lower incidence of GI adverse events than traditional NSAIDs making it a primary treatment option in patients at risk of developing GI complications or patients with chronic conditions requiring long term treatment.
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PMID:Rofecoxib: a review of its use in the management of osteoarthritis, acute pain and rheumatoid arthritis. 1139 14

Parecoxib (parecoxib sodium) is an injectable pro drug of valdecoxib, which is a potent and selective inhibitor of cyclo-oxygenase-2. Intravenous (IV) or intramuscular (IM) parecoxib >20 mg has analgesic activity superior to that of placebo and similar to that of IV or IM ketorolac 30 or 60 mg well controlled trials in patients with postoperative dental pain (n = 304 to 457). In a well controlled trial (n = 202), IV parecoxib 20 or 40mg showed analgesic activity greater than that of placebo and IV morphine 4mg and similar to that of IV ketorolac 30 mg following gynaecological surgery Following orthopaedic surgery, the analgesic activity of IV parecoxib 20 or 40mg was similar to that of IV ketorolac 30 mg and superior to that of IV morphine 4 mg or placebo in well controlled trials (n = 175 and 208). IV parecoxib (40 mg twice daily for 7 days) produced significantly fewer gastrointestinal erosions and/or ulcers than ketorolac (15 mg 4 times a day for 5 days) in healthy volunteers in a well controlled trial; effects on upper gastrointestinal mucosa were similar for parecoxib and placebo. Parecoxib is well tolerated after dental, gynaecological or orthopaedic surgery. The most common adverse events irrespective of treatment (parecoxib, ketorolac or placebo) after dental surgery were nausea, alveolar osteitis, dizziness and headache. Nausea, abdominal pain, headache, abdominal fullness, dizziness, back pain, fever, hypoactive bowel sounds, vomiting, tachycardia, somnolence, abnor mal breath sounds and pruritus occurred in > or = 10% of parecoxib recipients after gynaecological surgery. Similar results were seen in placebo recipients.
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PMID:Parecoxib (parecoxib sodium). 1146 74

Traditionally, acupuncture is embedded in naturalistic theories that are compatible with Confucianism and Taoism. Such ideas as yin-yang, qi, dampness, and wind represent East Asian conceptual frameworks that emphasize the reliability of ordinary, human sensory awareness. Many physicians who practice acupuncture reject such prescientific notions. Numerous randomized, controlled trials and more than 25 systematic reviews and meta-analyses have evaluated the clinical efficacy of acupuncture. Evidence from these trials indicates that acupuncture is effective for emesis developing after surgery or chemotherapy in adults and for nausea associated with pregnancy. Good evidence exists that acupuncture is also effective for relieving dental pain. For such conditions as chronic pain, back pain, and headache, the data are equivocal or contradictory. Clinical research on acupuncture poses unique methodologic challenges. Properly performed acupuncture seems to be a safe procedure. Basic-science research provides evidence that begins to offer plausible mechanisms for the presumed physiologic effects of acupuncture. Multiple research approaches have shown that acupuncture activates endogenous opioid mechanisms. Recent data, obtained by using functional magnetic resonance imaging, suggest that acupuncture has regionally specific, quantifiable effects on relevant brain structures. Acupuncture may stimulate gene expression of neuropeptides. The training and provision of acupuncture care in the United States are rapidly expanding.
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PMID:Acupuncture: theory, efficacy, and practice. 1237 83

Acute bacterial rhinosinusitis is an infection of the nasal epithelium and paranasal sinus mucosa, usually caused in children by Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and, less frequently, group A Streptococcus species. The clinical diagnosis is based on daytime cough that may be worse at night or purulent rhinorrhea, or both, lasting at least 10 days, often worsening after a period of initial improvement after initial symptoms of the common cold, and often associated with facial or dental pain, facial fullness, or swelling, headache, and fever. Sinusitis is diagnosed clinically; radiographic evaluation is not indicated for diagnosis. When the disease persists despite treatment, or is complicated by potential intracranial or orbital extension, CT is the preferred imaging modality. Initial therapy should be amoxicillin in a high dosage (80-90 mg/kg/day). Treatment is generally for 10 to 14 days and for at least 7 days beyond the time of substantial improvement in symptoms. Complications of acute bacterial rhinosinusitis in children are rare.
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PMID:Management of acute bacterial rhinosinusitis. 1188 Jul 40

Temporal arteritis, the most common form of systemic vasculitis in adults, is a panarteritis that chiefly involves the extracranial branches of the carotid artery. The condition is illustrated in this article by the case of a 79-year-old woman with a dry cough, toothache, tongue infarction, and vision loss. The mean age of onset is 72 years and the disease rarely occurs in persons younger than 50 years. The most common presenting manifestations are headache, jaw claudication, polymyalgia rheumatica, and visual symptoms. Eighty-nine percent of patients have an erythrocyte sedimentation rate greater than 50 mm/h. However, about 40% of patients present with atypical manifestations, including fever of unknown origin, respiratory tract symptoms (especially dry cough), and large artery involvement. Familiarity with such unusual manifestations of temporal arteritis facilitates early diagnosis and treatment, thereby reducing the risk of vision loss.
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PMID:Temporal arteritis: a cough, toothache, and tongue infarction. 1223 25

Post-traumatic myofascial pain describes the majority of chronic head and neck pain seen in clinical practice. If conditions such as vascular headaches, neuropathic pain, degenerative cervical joint disease, and dental pain are excluded, myofascial tissues are directly or indirectly involved in all other forms of head and neck pain. The most common of these include temporomandibular disorders, neck pain such as whiplash-associated disorder, cervicogenic headaches, and tension-type headaches. The pathophysiology of these conditions is not widely understood; however, peripheral and central mechanisms appear to play a role.
Curr Pain Headache Rep 2002 Oct
PMID:Post-traumatic myofascial pain of the head and neck. 1220 49

Unilateral throbbing headaches may present similar signs and symptoms as dental pathology and are a diagnostic challenge for dental practitioners. Cases may be seen with a primary complaint of unilateral pain or referred by medical colleagues for exclusion of dental causes. In the present article the authors add a new case of hemicrania continua (HC), which is one such unilateral headache, and review the previously published cases. HC is relatively easy to treat since it responds completely to treatment with indomethacin. However, as is presented in this case, HC may masquerade as dental pain. Cases secondary to trauma, systemic disease, and nervous system pathology have been described in the literature, and the clinician must exclude these possible causes. A thorough knowledge of this entity is therefore essential.
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PMID:Hemicrania continua. 1245 33

An emergency. When treating a patient, relief of any acute pain is a priority. Such pain should be treated as an emergency, rapidly and effectively. Assessment is the first step Pain is a subjective phenomenon. Assessment of its intensity is the first step to its management. Regarding treatment The molecules that can be used for the treatment of acute pain in ambulatory patients can be classified into two categories, co-analgesics (antispasmodics and non-steroidal antiinflammatories) and pure analgesics classified by the WHO into three grades, although this classification presents certain limits. Nefopam is a central analgesic, with non-opiate action and, because of this inscribed by the WHO in the first grade, but with an analgesic capacity that corresponds to the substances of grade II analgesics. Its efficacy relies on medullar and/or supramedullar mechanisms. Via intramuscular injection The delay before action is of around 10 to 20 minutes and lasts for around 6 hours. The advantages of intramuscular nefopam are its analgesic capacity, its simplicity of use and its tolerance. The indications In ambulatory patients, Acupan is administered during acute arthritic pain, post-trauma and dental pain, renal colic, extremely severe migraine and headaches, dysmenorrhoea, and intense spasmodic colic.
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PMID:[The management of acute pain in ambulatory patients. The place of nefopam]. 1502 21

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.
Curr Pain Headache Rep 2004 Oct
PMID:Intraoral neuropathy. 1536 17


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