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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Atypical odontalgia describes atypical facial pain in apparently normal teeth. Unfortunately, dentists usually consider this diagnosis only after the failure of invasive treatment. Atypical odontalgia patients are typified by women in their mid-40s who complain of persistent pain in one or more premolar or molar teeth. They associate pain with dental procedures or trauma to the region. While the cause of atypical odontalgia is uncertain, deafferentation pain appears to be a plausible mechanism. This article reviews relevant aspects of this perplexing pain problem. To help avert the untimely diagnosis of atypical odontalgia, identifying inclusion criteria are presented.
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PMID:Atypical odontalgia. 129 61

The multifactorial nature of oral and facial pain was investigated by the collection of clinical and psychologic data from 312 patients with either dental pain, temporomandibular joint disorder, or atypical facial pain. Significant differences between the groups in gender and age distribution, muscle and joint pain, radiographic joint changes, number of remaining teeth, pain duration, and aspects of the patients' perception of pain were evident. In addition, discriminant function analysis clearly differentiated between the three groups on the basis of both clinical and psychologic variables, emphasizing the multifactorial nature of oral and facial pain.
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PMID:A multivariate study of patients with temporomandibular joint disorder, atypical facial pain, and dental pain. 143 75

The present study investigates the relationships between clinical pain relief, physiological and psychological parameters. Out of 50 patients with long-lasting musculoskeletal neck- and shoulder-pain treated with transcutaneous electrical nerve stimulation (TENS), 21 were selected and classified as responders (n = 13) or non-responders (n = 8). Tooth pain thresholds (PT) were measured before and after an experimental TENS treatment and the relative change in PT following the stimulation was calculated. Three psychometric self-inventories were administered: Zung Depression Scale, Spielberger's Trait Anxiety Scale and the Multidimensional Health Locus of Control Scale. Responders (R) and non-responders (NR) differed significantly from each other in the PT measurements as well as on the psychometric scales. NR exhibited higher levels of anxiety and depression, a more pronounced powerful other orientation and no change or a decrease in PT following TENS compared to R. These findings indicate relationships and interactions between physiological and psychological factors in patients with long-lasting pain.
Pain 1992 Dec
PMID:Relations between experimentally induced tooth pain threshold changes, psychometrics and clinical pain relief following TENS. A retrospective study in patients with long-lasting pain. 149 55

Dentinal sensitivity is a common complaint of patients. Removal of cementum or enamel leaves the dentin exposed allowing various stimuli to produce fluid movement through the dentinal tubules. These fluid movements are believed to activate pulpal sensory nerves leading to pain. Various therapeutic approaches have been investigated to treat this problem. Resins, fluoride compounds and oxalate solutions have been used to block the dentinal tubules. KNO3 and SrCl2 are active ingredients in desensitizing tooth pastes but neither compound reduces the permeability of dentine. The ability of various solutions to decrease hypertonic (3M NaCl) evoked nerve activity was tested in the canine teeth of anesthetized cats. Excitatory and desensitizing solutions were placed into a deep dentinal cavity prepared over the incisal pulp horn. An electrode used to record nerve activity was also placed into this deep cavity. KNO3 and other K+ ion containing solutions elicit a biphasic effect on nerve activity. Immediately following application of these solutions into the deep dentinal cavity there is a brief burst of high frequency spike activity. Following this brief period of excitation, the intradental nerves are silent and respond weakly to hypertonic NaCl. CaCl2 and other divalent cation solutions also inhibit hypertonic NaCl induced nerve activity, but have a weaker effect than that exerted by K+. These observations can be explained based on the effects of various ions on nerve excitability. Increasing the K+ ion concentration in the vicinity of the dentinal nerve terminal depolarize and activates the nerve fibers. Following a prolonged period of depolarization the action potential mechanism is inactivated. Divalent cation solutions stabilize the nerve membrane without changing the membrane potential. Desensitizing solutions do not decrease nerve activity by an effect on pulpal blood flow. This experimental model does not entirely explain the clinical action of these desensitizing agents. The role of inflammation in hypersensitivity and dental pain is currently being investigated.
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PMID:The role of selected cations in the desensitization of intradental nerves. 150 96

The arousal of the two components of pain (the first rapid or sharp pain and the second dull pain) are considered to be related to activation of A delta- and C-type nociceptive primary afferents, respectively. The same dichotomy of pain sensations may also exist in teeth, although due to the short distance between the site of stimulation and the brain the two sensations might not be as clearly separated as in stimulation of, for example, the extremities. The sensations evoked by stimulation of human teeth vary according to the type of the stimuli applied. Low-intensity electrical stimulation is able to induce non-painful (prepain) sensations. At high current intensities pain is evoked. Drilling, probing and air-drying of exposed dentin induce only pain. Most studies also indicate that thermal stimulation only induces painful sensations. The quality of dental pain can vary. Typically, dentinal stimulation of teeth with healthy pulps induces sharp pain. On the other hand intense heat stimulation can result in dull pain which radiates to a wider area of the face and jaws. This component of the stimulus-induced pain seems to share some characteristics of toothache associated with painful pulpitis. Single fibre recordings of intradental nerve activity in experimental animals have shown that in addition to A-fibres a considerable number of C-type primary afferents innervate the dental pulp. This is in accordance with the results of neuroanatomical studies, which indicate that 70-80% of pulpal axons in human, monkey, dog, and cat teeth are unmyelinated. Intradental A- and C-fibre groups seem to be functionally different and can be activated separately by certain external stimuli. Comparison of the response characteristics of the pulp nerve fibres and the sensations induced from human teeth indicate that: 1) A-fibres are responsible for the sensitivity of dentine and thus for the mediation of the sharp pain induced by dentinal stimulation, 2) Prepain sensations induced by electrical stimulation result from activation of the lowest threshold A-fibres some of which can be classified as A beta-fibres according to their conduction velocities. Comparison of the responses of the A beta- and A delta-fibres indicate that they belong to the same functional group, 3) Intradental C-fibres are activated only if the external stimuli reach the pulp proper. Their activation may contribute to the dull pain induced by intense thermal stimulation of the tooth and to that associated with pulpal inflammation.
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PMID:Role of intradental A- and C-type nerve fibres in dental pain mechanisms. 150 8

The purpose of this study is to report the incidence of post-restorative dental pain and analgesic usage in children. A questionnaire completed by parents was employed. The mean age of the patients was 8.1 years; and all patients were in the six- to thirteen-year-old range. Pain following routine restorative procedures was reported by 31.5 percent of the patients. Additionally, 52.9 percent of these patients required analgesic relief.
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PMID:The incidence of postoperative pain and analgesic usage in children. 153 41

Preoperative treatment with controlled-release ketoprofen or diclofenac was compared in 56 out-patients, for control of postoperative dental pain, following unilateral or bilateral surgical removal of lower third molars. Six patients were excluded due to non-compliance, leaving 50 evaluable patients. Patients were assessed by the dental surgeon, on the day of the operation and one week later, prior to removal of sutures. Additionally, patients completed a daily diary during the postoperative week. Following surgery, scores for graded dental pain, consumption of paracetamol, incidence of dental bleeding, dysphagia, sleep disturbance and trismus were similar for the two treatment groups. However, median pain scores were consistently elevated in the diclofenac group over those seen with the ketoprofen group. The four adverse events reported were all minor and posed no problem to patient management.
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PMID:Comparison of controlled-release ketoprofen and diclofenac in the control of post-surgical dental pain. 154 48

The purpose of the present study is to update the reader on atypical odontalgia and to present some preliminary data on the long-term follow-up of a subsample (n = 28) of these patients. Data based on 120 patients tend to support earlier findings that indicate that primarily women (81%) between the ages of 23 and 60 have this condition. Pain is generally localized in the teeth but may involve several areas of the oral cavity. On the basis of this larger sample size, the relationship between atypical odontalgia and migraine does not appear to be as strong as initially reported. Psychologic disturbance also may play a less significant role than initially thought. Follow-up data on 28 patients suggest that many patients will continue to experience episodes of pain. Antidepressant medication still appears to be the treatment of choice for this condition.
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PMID:Atypical odontalgia. Update and comment on long-term follow-up. 157 6

Neuronal activity in the spinal trigeminal subnucleus oralis in response to electrical tooth stimulation was recorded in the anaesthetized cat in order to compare the electrophysiological characteristics of the oralis neurons with those of subnucleus caudalis and interpolaris neurons recorded in previous studies. The most sensitive oralis neurons had lower thresholds and shorter latencies than the most sensitive caudalis and interpolaris neurons. The thresholds of the oralis neurons were lower and their strength-duration curves flatter than those depicting liminal dental pain in man but similar to those depicting liminal jaw reflexes in the cat. Noxious conditioning stimulus elevated the threshold of only 1 of 10 neurons tested. The converging input from the skin and oral mucosa was from low-threshold mechanoreceptors. The results indicate that the response properties of the subnucleus oralis neurons differ significantly from those of other spinal subnuclei. Human pain thresholds cannot be explained by the liminal response properties of oralis neurons. These neurons might be important in the mediation of liminal reflex events evoked by dental stimuli.
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PMID:Response characteristics of tooth pulp-driven postsynaptic neurons in the spinal trigeminal subnucleus oralis of the cat. 157 51

1. Single doses (500 and 1000 mg) of both buffered aspirin and aspirin tablets were compared with placebo in a randomised double-blind trial of parallel design in patients with postoperative pain after third molar surgery. 2. Only buffered aspirin 500 mg provided significant pain relief (P = 0.016) during the 5 h investigation period. 3. A significant correlation (P = 0.004) was observed between overall pain scores after the various aspirin treatments and aspirin esterase activity. 4. Buffered aspirin preparations afforded a slight advantage over aspirin tablets in the control of postoperative pain after third molar surgery. However, the duration of analgesia was short (approximately 2 h). 5. Aspirin esterase activity appears to be an important determinant of the drug's efficacy in postoperative dental pain.
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PMID:An evaluation of buffered aspirin and aspirin tablets in postoperative pain after third molar surgery. 157 68


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