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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The heading craniomandibular disorders covers a wide range of abnormal and pathologic conditions accompanied by orofacial pain and impaired mandibular function, the masticatory muscles and the temporomandibular joints being the structures most frequently involved. Prevalences of severe craniomandibular disorders accompanied by headache and facial pain urgently in need of treatment are 1-2% in children, about 5% in adolescents, and 5-15% in adults, with higher values in women than in men. With respect to physiology and ergonomics, masticatory muscles are comparable to other human skeletal muscles, e.g. of shoulder, neck and lower back. Therefore these muscles share pathogenesis, symptoms and signs of muscular disorders caused by prolonged, low-level static contractions or intermittent isometric contractions at higher levels. Since the same elements of performance in the masticatory muscles are influenced by occlusal factors, they link the development of muscular fatigue, discomfort and pain to the dental occlusion. Furthermore, changes of the occlusal surfaces, e.g. due to dental treatment, may influence the performance of the masticatory muscles, and consequently interfere with local muscular function.
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PMID:Craniomandibular disorders and masticatory muscle function. 155 1

One hundred-eight questionnaires were mailed to Pain and Headache Centers evenly spread throughout Italy to evaluate the current status of pain clinics and therapy. Sixty-three centers (58.3%) responded: fifty-two (82.5%) were Pain Clinics, while eleven (17.5%) were Headache Clinics. Approximately half of the clinics were run by anesthesiologists (43.3%), followed by neurosurgeons (15%), and neurologists (10%). The Pain Team involved up to 26 members (average number: 7), with representatives from anesthesiologists (71.4%), psychologists and psychiatrists (52.4%), neurologists (36.5%), specialists in internal medicine (23.8%), and neurosurgeons (20.6%). The outpatient pain clinic made up the great majority of the respondents (80.9%), whereas the in-patient service for both emergency and elective pain treatment was available in twenty-six centers (41.3%). A total of 49.445 patients (average number: 810) were treated in a period of one year. Pain syndromes most frequently treated (mean incidence) were (a) cancer pain (39.0%); (b) chronic primary headache (37.3%); (c) non-oncologic extra-cephalic pain (37.0%); and (d) orofacial pain (17.2%). A multidisciplinary team approach was used by 65% of the respondents. Treatment modalities most frequently used were drugs (mean utilization index, MUI: 138), followed by anesthesiological methods (MUI: 70), neuroaugmentive procedures (MUI: 51), psychiatric and psychophysiological methods (MUI: 33), and neurosurgical procedures (MUI: 28). Mean percent immediate and long-term treatment successes (pain relief 50%) were the following: (a) cancer pain (74.7-63.3%): (b) non-oncologic pain (66.7-50.3%); (c) chronic primary headache (64.2-52.6%); and (d) orofacial pain (64.2-52.5%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The current status of pain clinics in Italy: a questionnaire survey. 252 Apr 13

A brief review of the literature related to migraine headaches is presented. Information is presented on the epidemiology and diagnostic criteria of migraine headaches and is followed by a discussion on the problems inherent in the current classification system. Previously proposed vascular mechanisms of common migraine are discussed in the light of recent non-supporting data and a possible link between common migraine and orofacial pain dysfunction syndromes is proposed. The role of oral behavioural patterns and related muscular/temporomandibular joint problems are advanced as probable factors related to common migraine. The discussion focuses on the need to distinguish classic from common migraine headache sufferers in assessment and treatment outcome studies, as well as suggesting future avenues of research.
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PMID:Common migraine: a review and proposal for a non-vascular aetiology. 354 Feb 39

A self-administered questionnaire consisting of 21 questions, diagrams for chief pain location, and a digital pain scale was used prospectively to sort 92 patients with orofacial pain into three categories: (1) musculoligamentous (ie, temporomandibular disorders); (2) neurologically based (ie, migraine, trigeminal neuralgia, tension-type headache, cluster headache, and atypical facial pain); and (3) dentoalveolar pain. Sensitivity, specificity, as well as negative and positive predictive values suggest that this questionnaire may be used reliably to identify patients with orofacial pain that fits the above-described pain categories without prior knowledge of the clinical diagnosis. Digital pain scale findings indicated that on presentation, pain level could not be correlated with any particular pain category, but when using this scale to describe past pain experience, patients with neurologically based pain selected the highest digital pain scale values up to six times more frequently than patients with musculoligamentous or dentoalveolar pain. Patients with musculoligamentous or dentoalveolar pain selected the lowest digital pain scale values up to 15 times more frequently than those with neurologically based pain. Although this questionnaire may be used for initial categorization of pain, there is still no substitute for a thorough history and clinical examination.
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PMID:Differentiation between musculoligamentous, dentoalveolar, and neurologically based craniofacial pain with a diagnostic questionnaire. 767 Apr 23

Indomethacin-responsive headaches can present in the orofacial region. According to the classification of headache by the International Headache Society, indomethacin-responsive headaches include chronic paroxysmal hemicrania, hemicrania continue, benign cough headache, benign exertional headache, and sharp, short-lived headache pain syndrome. The mechanism by which indomethacin produces its therapeutic effects in these headache disorders remains speculative. A review of indomethacin-responsive headaches and eight cases in which the presenting symptom was orofacial pain are reported. Because these headache disorders are rare but may present as facial pain, they should be considered in the differential diagnosis of orofacial pain. A comprehensive evaluation prior to performing irreversible treatments is essential when an idiopathic facial pain presents to the dental clinician.
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PMID:Benign indomethacin-responsive headaches presenting in the orofacial region: eight case reports. 899 27

The diagnostic process for the orofacial pain patient is often perplexing. Compounding the process of solving a diagnostic mystery is the multiplicity of etiologic factors. The propensity for Lyme disease to present with symptoms mimicking dental and temporomandibular disorders makes the task even more complex. It is hoped that the reader is cognizant of the fact that a pathologic process of dental structures--the teeth and their attachments to the mandible and maxilla, the temporomandibular joints, masticatory musculature, and vascular supply and sensory innervation of the oromandibular anatomy--may also be the source of facial pain. Although unique, similar complaints may also be manifestations of other causes, including pain associated with Lyme disease. The informed and fastidious clinician does not overlook these possibilities when evaluating the headache and facial pain patient. The clinician should be equipped with the knowledge and minimal armamentarium to evaluate the patient appropriately. To paraphrase from Sherlock Holmes, we must first eliminate the impossible, whatever is left is the truth, no matter how unlikely. A differential diagnosis must be achieved based on clinical experience, unbiased observations, and probability.
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PMID:Differentiation of orofacial pain related to Lyme disease from other dental and facial pain disorders. 914 82

The dental profession faces educational, scientific, and ethical challenges in orofacial pain and headache. Past educational deficiencies are being addressed with guidance and recommendations from the AADS, the ADA, and the AAOP. With education and further research, many dental ethical questions in TMD will be resolved. The educational process must continue with a solid foundation in scientific basis provided in university settings. The appropriate use of TMD diagnostic machines, treatment modalities, and management of perpetuating factors such as sleep will evolve with the new knowledge of scientific discovery. These are some of the many challenges of orofacial pain and headache disorders that warrant special consideration.
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PMID:Special considerations in orofacial pain and headache. 914 87

Temporomandibular disorders are a complex group of conditions which are common causes of orofacial pain and are frequently associated with headaches. Because a wide variety of diseases can ultimately cause symptoms that result in dysfunction of the masticatory system, it is important for the clinician to establish an accurate diagnosis and rule out any serious neurologic pathology. Serious extra-articular conditions often can simulate the nonspecific symptoms of a temporomandibular joint disorder. A careful history and clinical examination of the head, neck, and cranial nerves are important in establishing a differential diagnosis. Diagnostic imaging and consultation with specialists in several disciplines are often necessary to establish an accurate diagnosis and develop an appropriate therapeutic regimen.
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PMID:Temporomandibular disorders: what the neurologist needs to know. 947 16

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.
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PMID:Paroxysmal hemicrania. Case studies and review of the literature. 972 85

One hundred and ninety-three patients with varying occlusal discrepancies were diagnosed as having TM disorders with orofacial pain. They were divided into five groups with similar clinical symptomatology. There were 84 patients with clicking, 45 with headaches, 13 with neckaches, 39 with tenderness in the TMJ bilaterally and masticatory muscles and 12 with uncomfortable occlusal relationships. All were given an anterior deprogrammer to wear for a period of one week in order to relax the masticatory muscles and allow the jaw to return to a physiologic position. The follow-up occlusal device therapy varied according to clinical symptoms. The group with clicking wore anterior repositioning orthopedic devices to recapture the displaced articular disc, followed by a gradual return to a centric relation position. The other groups wore centric relation appliances providing even posterior cusp tip contacts and anterior guidance. All patients wore the appliances for varying periods, up to one year, with monthly adjustments. The clinical symptoms significantly decreased, and all but 4 patients who had to be treated surgically, had the malocclusion corrected at the same treatment position of the centric relation appliances that were worn for one year. The results suggest that short-term occlusal device therapy is effective as an interim method towards the correction of occlusal discrepancies, but should be followed by a final treatment that will maintain the jaw in an asymptomatic and physiologic position. Four-year re-evaluations revealed no reoccurrence of chronic symptoms after finalization treatment.
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PMID:The effect of non-surgical management of TM disorders. 959 57


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