1/11. Sliding plates on complete dentures as a treatment of temporomandibular disorder: a case report.This work presents a case report of a woman, aged 62, who presented with signs and symptoms of temporomandibular disorder (TMD). The patient reported pain in the masticatory system and examination showed a reduction in the occlusal vertical dimension (OVD). She was treated with complete dentures incorporating a modification to the posterior regions developed by the authors and which were termed "sliding plates." Through analysis of photographs taken of the patient prior to the extraction of the patient's natural dentition, sliding plates were utilized to reestablish the OVD. The sliding plates also allowed for unrestricted eccentric mandibular movements, thereby accelerating the neuromuscular deprogramming and making it possible for the mandible to adopt a more physiologic position. The dentures reduced the pain and were well-accepted by the patient. Therefore, sliding plates may be of great benefit to completely edentulous patients with painful symptoms that result from alterations in the OVD and inappropriate condylar positioning.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/11. Unhealed extraction sites mimicking TMJ pain.A case of unhealed extraction sites in the mandible is described, including clinical, radiographic, and biopsy findings. The subject was treated for TMJ disease in the past but still had related signs and symptoms and facial pain.- - - - - - - - - - ranking = 5keywords = extraction (Clic here for more details about this article) |
3/11. Neuropathic orofacial pain. Part 2-Diagnostic procedures, treatment guidelines and case reports.Neuropathic orofacial pain can be difficult to diagnose because of the lack of clinical and radiographic abnormalities. Further difficulties arise if the patient exhibits significant distress and is a poor historian regarding previous diagnostic tests and treatments, such as somatosensory local anaesthetic blockade. Valuable information can be obtained by utilising the McGill Pain Questionnaire that allows the patient to choose words that describe the qualities of his/her pain in a number of important dimensions (sensory and effective). Basal pain intensity should be measured with the visual analogue scale, a simple instrument that can evaluate the efficacy of subsequent treatments. The dentist or endodontist can employ sequential analgesic blockade with topical anaesthetics and perineural administration of plain local anaesthetic to ascertain sites of neuropathology in the PNS. These can be performed in the dental chair and in a patient blinded manner. Other, more specific, tests necessitate referral to a specialist anaesthetist at a multidisciplinary pain clinic. These tests include placebo controlled lignocaine infusions for assessing neuropathic pain, and placebo controlled phentolamine infusions for sympathetically maintained pain. The treatment/management of neuropathic pain is multidisciplinary. Medication rationalisation utilises first-line antineuropathic drugs including tricyclic antidepressants such as amitriptyline and nortriptyline, and possibly an anticonvulsant such as carbamazepine, sodium valproate, or gabapentin if there are sharp, shooting qualities to the pain. mexiletine, an antiarrhythmic agent and lignocaine analogue, may be considered following a positive patient response to a lignocaine infusion. All drugs need to be titrated to achieve maximum therapeutic effect and minimum side effects. Topical applications of capsaicin to the gingivae and oral mucosa are a simple and effective treatment in two out of three patients suffering from neuropathic orofacial pain. Temporomandibular disorder is present in two thirds of patients and should be assessed and treated with physiotherapy and where appropriate, occlusal splint therapy. attention to the patient's psychological status is crucial and requires the skill of a clinical psychologist and/or psychiatrist with pain clinic experience. Psychological variables include distress, depression, expectations of treatment, motivation to improve, and background environmental factors. Unnecessary dental treatment to "remove the pain" with dental extractions is contraindicated and aggravates neuropathic orofacial pain.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
4/11. Sympathetic activity-mediated neuropathic facial pain following simple tooth extraction: a case report.This is a report of a case of sympathetic activity-mediated neuropathic facial pain induced by a traumatic trigeminal nerve injury and by varicella zoster virus infection, following a simple tooth extraction. The patient had undergone extraction of the right lower third molar at a local dental clinic, and soon after the tooth extraction, she became aware of spontaneous pain in the right ear, right temporal region, and in the tooth socket. At our initial examination 30 days after the tooth extraction, the healing of the tooth socket was normal; however, the patient had a tingling and burning sensation (dysesthesia) and spontaneous pain of the right lower lip and the right temporal region, both of which were exacerbated by non-noxious stimuli (allodynia). The patient also showed paralysis of the marginal mandibular branch of the facial nerve, taste dysfunction, and increased varicella zoster serum titers. A diagnostic stellate ganglion block (SGB) 45 days after the tooth extraction using one percent lidocaine markedly alleviated the dysesthesia and allodynia. These symptoms are characteristic of neuropathic pain with sympathetic interaction. The patient was successfully treated with SGB and a tricyclic antidepressant.- - - - - - - - - - ranking = 9keywords = extraction (Clic here for more details about this article) |
5/11. Oral and maxillofacial surgery in patients with chronic orofacial pain.PURPOSE: In this investigation, we evaluated a population of patients with chronic orofacial pain who sought treatment at a pain center in an academic institution. These patients were evaluated with respect to 1) the frequency and types of previous oral and maxillofacial surgery procedures, 2) the frequency of previous significant misdiagnoses, and 3) the number of patients who subsequently required surgical treatment as recommended by an interdisciplinary orofacial pain team. The major goal of this investigation was to determine the role of oral and maxillofacial surgery in patients with chronic orofacial pain. patients and methods: The study population included patients seen at the Center for Oral, Facial and head Pain at new york Presbyterian Hospital from January 1999 through April 2001. (120 patients; female-to-male ratio, 3:1; mean age, 49 years; average pain duration, 81 months; average number of previous specialists, 6). The patient population was evaluated by an interdisciplinary orofacial pain team and the following characteristics of this population were profiled: 1) the frequency and types of previous surgical procedures, 2) diagnoses, 3) the frequency of previous misdiagnoses, and 4) treatment recommendations made by the center team. RESULTS: There was a history of previous oral and maxillofacial surgical procedures in 38 of 120 patients (32%). Procedures performed before our evaluation included endodontics (30%), extractions (27%), apicoectomies (12%), temporomandibular joint (TMJ) surgery (6%), neurolysis (5%), orthognathic surgery (3%), and debridement of bone cavities (2%). Surgical intervention clearly exacerbated pain in 21 of 38 patients (55%) who had undergone surgery. Diagnoses included myofascial pain (50%), atypical facial neuralgia (40%), depression (30%), TMJ synovitis (14%), TMJ osteoarthritis (12%), trigeminal neuralgia (10%), and TMJ fibrosis (2%). Treatment recommendations included medications (91%), physical therapy (36%), psychiatric management (30%), trigger injections (15%), oral appliances (13%), biofeedback (13%), acupuncture (8%), surgery (4%), and Botox injections (1%) (Allergan Inc, Irvine, CA). Gross misdiagnosis leading to serious sequelae, with delay of necessary treatment, occurred in 6 of 120 patients (5%). CONCLUSIONS: Misdiagnosis and multiple failed treatments were common in these patients with chronic orofacial pain. These patients often have multiple diagnoses, requiring management by multiple disciplines. Surgery, when indicated, must be based on a specific diagnosis that is amenable to surgical therapy. However, surgical treatment was rarely indicated as a treatment for pain relief in these patients with chronic orofacial pain, and it exacerbated and perpetuated pain symptoms in some of them.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
6/11. Chronic inflammation and pain inside the mandibular jaw and a 10-year forgotten amalgam filling in an alveolar cavity of an extracted molar tooth.A 55-year-old woman, suffered from severe pain in her mandibular jaw for several years. A metallic artifact of about 2(3) mm was detected by a panorama radiography in an edentulous region with a surrounding inflammation in close contact to the canal of the mandibular nerve. Inflammated tissue with the central metallic inclusion was removed from the bone under local anesthesia and operation. Postoperatively, pain and missensitivity disappeared within 1 week. Although the patient had no macroscopically visible so-called amalgam tattoo, the metallic cube was identified as amalgam by the detection of mercury, silver, tin, copper, and zinc using energy dispersive X-ray analysis (EDX) in a scanning electron microscope (SEM). Nevertheless, brown to black pigments in the connective tissue matrix and inside histiocytes, fibroblasts, and multinucleated foreign giant cells of the surrounding inflammatory tissue were observed by light and electron microscopy. However, the elemental analysis by EDX in SEM or by electron energy loss spectroscopy in transmission electron microscope detected only silver, tin, and sulfur but no mercury in these precipitates and in the residual bodies of phagocytes. The presented case demonstrates a seldom complication of amalgam deposition in the tissue. The authors assume that the chronic pain results from a forgotten amalgam filling inside an alveole after extraction of a molar tooth, causing a chronic inflammation by resolving mercury and other toxic elements out of the metallic artifact.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
7/11. Treatment of muscle spasms with oral dantrolene sodium.A case of severe muscle spasms relieved by oral administration of dantrolene sodium is presented. The patient had undergone full-mouth extraction 2 days prior to onset of her spasms. The treatment consisted of intravenous diazepam followed by oral dantrolene sodium. The spasms lasted for approximately 10 days.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
8/11. Histological healing following surgical endodontics and its implications in case assessment: a case report.Following extraction of a symptomatic mandibular premolar which had been subjected to two periradicular surgical procedures, significant apical healing was identified histologically. The implications of these findings are discussed in relation to contemporary advocated treatment regimens, case assessment, and interpretation for success and failure.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
9/11. Osteocavitation lesions (Ratner bone cavities): frequently misdiagnosed as trigeminal neuralgia--a case report.The disorder termed osteocavitation lesion has been described in the literature since at least 1976. This disorder has often been misdiagnosed as trigeminal neuralgia or atypical facial pain, and, unfortunately, patients have either continued to suffer or inappropriate treatment or treatments have been prescribed in an attempt to rid the patient of this terrible pain disorder. These symptoms, which can be misinterpreted as trigeminal neuralgia, include a history of undiagnosed facial pain, a history of tooth extraction, the presence of trigger areas and normal radiographic findings. A confirmed diagnosis of osteocavitation lesion can be treated only with surgery.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
10/11. Periapical radiographs as an aid in diagnosing fractures of the mandibular angle.Various radiographic techniques are applied for diagnosing mandibular fractures. Standard radiographs used in the hospital to diagnose mandibular fractures have included lateral oblique, posteroanterior, and fronto-occipital (Towne) mandibular projections. If positive, the panoramic radiograph can be used as the sole radiograph. A case is reported of a unilateral fracture of the mandibular angle, which became evident about one month after extraction of the mandibular third molars. Neither the lateral oblique nor the panoramic projection revealed the fracture; however, periapical films showed the fracture through the extraction site.- - - - - - - - - - ranking = 2keywords = extraction (Clic here for more details about this article) |
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