1/9. The interdisciplinary approach to oral, facial and head pain.BACKGROUND: Chronic oral, facial and head pain is a common clinical problem, and appropriate diagnosis and management are a challenge for health care professionals. patients often will first seek the care of dentists because of the pain's localization in the oral cavity and surrounding structures. This article emphasizes the importance of establishing accurate diagnoses and conducting appropriate triage of the patient with complex orofacial pain. CASE DESCRIPTIONS: The authors present two case reports illustrating the complex nature of oral, facial and head pain, and the potential and actual pitfalls in management of this condition. These representative cases demonstrate how orofacial pain--which appears to be localized in the peripheral dental and oral structures--can have extremely complex etiologies involving other anatomical structures, the central nervous system and psychological factors. The reports point to the need for the expertise of a number of specialists in such cases. CLINICAL IMPLICATIONS: If the symptoms and clinical findings do not appear to be consistent with typical oral disease, or if standard treatments do not alleviate the pain, the dental clinician must consider other, more complex orofacial pain diagnoses. The dental professional should not hesitate to make referrals to key specialists or to members of an interdisciplinary team at a pain treatment center who have the expertise to appropriately diagnose and manage chronic oral, facial and head pain.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/9. Treatment of refractory facial pain diagnosed as atypical trigeminal neuralgia: a case report.This case report describes an effective treatment protocol, the healing process, and the recovery of the patient to a pain-free status after more than 25 years of failed treatment for facial pain. Features of this case report include: 1. A procedure to produce a phenomenon useful as a pathognomonic sign of autonomic nervous system neuropathy, as a determination of the location of the origin of pain, and as a monitoring device for the effectiveness of treatment. 2. A digital pressure intervention procedure that appears effective as a treatment modality to relieve pain and to effect healing. 3. A method to improve posture of the body affecting the relationship of the maxilla to the mandible, the dental occlusion, and the etiology of facial pain. 4. A description of the nature and intensity of the different levels of the pain experienced in the face from the most severe state of pain to a no-pain condition. 5. A diagnosis using a diagnostic term that has developed since the initial diagnosis of atypical trigeminal neuralgia in this case.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/9. Variable presentation of temporalis hypertrophy--A case report with literature review.A case of painful, initially bilateral, and then unilateral temporalis hypertrophy in a 33-year-old Caucasian woman is presented in a primary care setting; the aetiology of the hypertrophy was considered reactive in nature. Medical and supportive treatment was successful in providing symptomatic relief. Further treatment including an intramuscular botulinum injection was considered by the patient with a view to reduction of the chronic enlargement of her temporalis and masseter musculature. A review of the literature and previous treatment regimes is also presented.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/9. Orthopedic/orthodontic therapy for anterior disk displacement: unexpected treatment findings.Craniomandibular pain dysfunction (CMPD) is of increasing clinical concern to all fields of dentistry, especially orthodontics. One of the more common manifestations of CMPD is anterior disk displacement. Orthodontic/orthopedic treatment for anterior disk displacement using anterior repositioning of the mandible has been suggested by several clinicians as the treatment of choice. Returning the mandible back toward the original occlusion or habit centric has also been suggested by several reports. Functional jaw orthopedic (FJO) appliances would appear to be ideally suited for the treatment of anterior disk displacement due to the anterior repositioning nature of these appliances. In growing individuals, among other changes, the condyle is supposed to grow back into the fossa (which would serve as the walkback procedure). This article presents three young patients who had anterior disk displacement and posterior condylar displacement before treatment. Each patient was treated using a functional appliance and each patient ended treatment still having a posterior condylar displacement and anterior disk displacement. These findings were unexpected and no explanation is offered. This occurrence is rare in the author's practice (approximately 2-3%), but this is a real concern and the patients should be made aware of this possibility before starting treatment, so that their expectations are realistic. These enigmatic findings also emphasize the complexity of TMJ as well as FJO treatment and indicate the need for further research and study.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/9. Mandibular pain as the initial and sole clinical manifestation of coronary insufficiency: report of case.A case of anginal pain limited to the mandible with secondary radiation of the pain to the neck and clavicular regions is presented. Although the pain was initially diagnosed as odontogenic in origin, further historical workup suggested the suspicion of referred pain from coronary insufficiency. Immediate cardiac evaluation confirmed the nature of the pain as angina. Important aspects involved with differential diagnosis of referred anginal pain are also discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/9. Pain in the neck, face, and head. role of the consultation-liaison psychiatrist.The special nature of pain in the face, head, and neck is not emphasized in the psychiatric literature on chronic pain. Although chronic pain of all types and locations share many features the psychological and symbolic significance of the head in the development of self-esteem, body image, and interpersonal relationships often confers special characteristics of pain on this area. As psychiatric consultation is not likely to be requested for patients with head, face, and neck pain in the absence of blatant "psychiatric" problems, it behooves the psychiatrist to exercise his liaison functions to enhance patient care in the inpatient setting and to help physicians recognize the utility of early psychiatric assessment on an outpatient basis with patients not yet requiring hospitalization. A collegial relationship with internists, dentists, neurologists, and surgeons facilitates the psychiatrist's role as a "team participant," often more effective in providing brief diagnostic, therapeutic, and management recommendations for patients who are usually not psychologically-minded and reluctant to pursue ongoing psychiatric treatment. However, the consultation-liaison psychiatrist can play an important role in expanding his colleagues' awareness of the multiple meanings of pain and the accompanying illness behavior, provide pedagogic help in the interviewing or history-taking process, offer suggestions about psychopharmacologic and other drug treatment, and serve as a resource for appropriate referral to sources of a variety of chronic pain treatments, including biofeedback, acupuncture, and family consultation. To fulfill both his consultative and liaison functions, it is incumbent upon the psychiatrist to be knowledgeable as well about nonpsychiatric aspects of pain of the head, face, and neck. We must acknowledge also how much we yet do not know: for example, why the psyche "chooses" a locus of pain in the body; how an external (or internal) stimulus is converted via cognitive, neuroendocrine, enzymatic, and other pathways to a somatic representation; the biochemistry of pain reduction by naturally occurring and synthetic drugs; and what characteristics distinguish the continuously creative individual who sustains persistent pain with barely an utterance from another who may "cave in" to seemingly trivial distress that results in total invalidism.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/9. Orofacial pain resulting from ill-fitting dentures.The patient who presents to the physician with a history of facial pain can be a diagnostic challenge. The etiology can be elusive, and this problem is compounded by the subjective nature and the often multi-factorial causes of facial pain. The differential diagnoses to be considered include both local and systemic disorders such as neuropathy, myofascial pain, dentoalveolar pathoses, and psychological disturbances, among others. This paper presents the case of a patient with a history of left auricular pain that was managed for over 12 years with drug therapy with only limited success. A thorough head and neck evaluation revealed probable myofascial pain with a poorly occluding set of complete dentures as a potential etiology. Fabrication of a new set of dentures and modification of the patient's denture-wearing habits has produced an almost complete remission of the pain. This case demonstrates the importance of a dental consultation to rule out a possible oral-musculoskeletal and/or dental etiology in the management of the patient with facial pain.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/9. Management of chronic orofacial pain.The diagnosis and management of chronic orofacial pain can be difficult due to the multifactorial nature of the problem involving organic, psychological and social and cultural variables. The establishment of multidisciplinary pain clinics can assist the medical practitioner in both diagnosis and treatment. A review of 185 patients complaining of chronic orofacial pain is presented to show the main conditions diagnosed at a pain clinic.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/9. A biopsychological approach to temporomandibular joint pain and other chronic facial pain. Part II: Broadening of spectrum of treatments.The multidimensional nature of chronic pain often requires a variety of therapies, ranging from reassurance and relaxation training to invasive treatment. The high spontaneous rate of recovery in temporomandibular dysfunction can lead to overtreatment of a benign disorder. However, a tendency to undertreat chronic facial pain and malignant pain conditions also exists. In therapy-resistant chronic pain cases, alternative therapies merit consideration, even though they may generally be rejected by Western medicine as unscientific and no better than placebo. Working with chronic pain patients is demanding and fulfilling but can be wearing. Doctors, nurses and other staff involved in pain treatment should take part in supervision of therapeutic work, to prevent burn-out. This article offers guidelines for treatments rarely considered as routine therapy, and describes an extreme case of therapy-resistant chronic facial pain.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |