Cause Of Orofacial Pain Research Articles

Orofacial pain: an enigma for diagnosis and treatment; a prospective clinical study

Objectives: The aim of this study was to determine most common cause of orofacial pain and gender distribution. Materials and Methods: This was a prospective study that included 200 patients that reported to our Department of Oral Medicine and Radiology with orofacial pain. Results: Out of 200 patients 130 (65%) were females and 70(35%) were males with age range of above 15 to 65 year. Temporomandibular disorders were most common cause orofacial pain .58 cases (29%) out of 200 were temporomandibular disorders with 38(19%) cases of females and 20(10%) cases of males followed by myofacial pain in 48% cases and least incidence of traumatic neuritis in 3% cases. Conclusion: Chronic orofacial pain is a diagnostic challenge and it is possible therefore to make a misdiagnosis Multidisciplinary OFP assessment ideally also includes psychometrics, pain profiling, quantitative sensory testing, haematology and imaging where indicated. Keywords: Orofacial pain, Neuropathic pain, Nociceptive pain, Somatosensory.

Orofacial pain evaluation in children.

Pain evaluation in children and its diagnosis are problems not always easy to solve. Children, because of their immaturity, are not always able to well communicate or to describe the clear characteristics of the disease by which they are affected. Moreover, they are often unable to report the real intensity of the pain they experience. These problems are related to their immature, not fully evolved psyche. Such problems can create difficulties to the physician who is called to examine and evaluate the origin of orofacial pain, as well as hesitation regarding when it could be necessary to start a drug therapy. Aim of this work is to propose the basic tools for the evaluation and measurement of pain that are better suitable for children, as these instruments can be used together with an accurate anamnesis and a meticulous examination, in order to formulate a precise differential diagnosis among the pathologies that affect the head and neck. A list of the most common painful diseases affecting this area is also presented. A systematic literature review about the methods for evaluation and measurement of pain in children was conducted. The commonly used scales of measurement were examined: VAS, VSN, CAS, FPS and the Oucher SCALE. The different pathologies of head and neck and their characteristics are described and the possible causes of orofacial pain have been divided into extracranial and intracranial, in order to easily direct diagnosis. Orofacial pain in children is an issue of great interest in consideration of its high frequency in paediatric dentistry. Its measurement and evaluation is possible despite the small compliance of paediatric patients. Thanks to the modern technique and knowledge this evaluation can be realistic and reproducible. Evaluation scales of pain are suitable at any age and skill of the child and, together with a careful anamnesis and a proper clinical examination, allow the clinician to conduct a precise differential diagnosis of the pain so as to set the ideal therapy for the little patient.

Botulinum toxin in the management of temporomandibular disorders- a systematic review

Background: Temporomandibular Disorder is a major cause of orofacial pain and is associated with significant morbidity and decrease in an individual's perceived quality of life.

Discovery of Novel Mechanisms for Idiopathic Pain Disorders Through Genome Wide Approaches

This presentation will introduce an overview of recent findings of genetic variants associated with chronic pain, focusing on recent discoveries from a large cohort study of painful temporomandibular disorders (TMD), the leading cause of orofacial pain. The Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study was designed to identify risk factors for development of TMD. Recognized as a complex condition with biological and psychosocial risk factors, TMD has also been shown to have a substantial genetic component. Dr. Smith will discuss genome‐wide and bioinformatics approaches that have revealed etiological mechanisms underlying TMD, representing novel pathways of vulnerability. This work has implicated genetic variation associated with the presence of chronic pain, as well as polymorphisms associated with intermediate phenotypes known to be major risk factors for TMD development. Data from stratified analyses indicate certain pathways may be distinct between sexes. To understand the functional significance of these novel discoveries, additional behavioral and bioinformatics studies have been performed that show convergent lines of evidence pointing to immunological as well as neurological mechanisms. The state of knowledge about genetic contributors to orofacial pain and its management will be summarized with an emphasis on how these findings may be applied for personalized and targeted treatment of pain.Support or Funding InformationThis work was supported by the National Institute of Dental and Craniofacial Research (NIDCR) grant number U01DE017018, and by a K12 Biomedical Researcher Development Scholarship in TMJD and Orofacial Pain (K12DE022793).This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Effectiveness of acupuncture, ozonio therapy and low-intensity laser in the treatment of temporomandibular dysfunction of muscle origin: a randomized controlled trial

Abstract Introduction One of the most common causes of orofacial pain is temporomandibular disorder (TMD). Objective The aim of this study was to compare the effectiveness of acupuncture, ozone therapy and laser therapy in the treatment of muscle TMD patients through a randomized controlled trial. Material and method Twelve professors and postgraduate students from the University of Passo Fundo, diagnosed with TMD, aged between 23 and 50 years old, of both sexes, were evaluated. Individuals were randomly divided into 3 groups: G1: laser therapy, G2: acupuncture, and G3: ozone therapy. TMD diagnostic questionnaires (RDC / TMD), Quality of Life Questionnaire (OHIP-14), Pain Scale (VAS) and maximum mouth opening were applied. Descriptive statistics and percentage were used for sample characterization, which were presented using absolute and relative frequency distributions. Qualitative variables were analyzed with Wilcoxon tests p≤0.05. Result There was no statistically significant difference between treatments. Regarding pain and maximum mouth opening, the groups showed no statistical difference when individually analyzed, but when compared in general, they did (p=0.002 and p=0.003). Conclusion It can be considered that all treatments were able to decrease pain and improve maximal opening capacity related to muscle TMD. It can also be concluded that the TMD-related quality of life, in relation to the pain variable, was generally effective when compared before and after the interventions.

The Periodontium as a Potential Cause of Orofacial Pain: A Comprehensive Review.

Introduction:Orofacial pain of periodontal origin has a wide range of causes, and its high prevalence and negative effect on patients' quality of life make intervention mandatory. This review provides a periodontological overview of the field of orofacial pain, focusing on the entities which involve the periodontal tissues and may be the cause of this pain or discomfort.Methods:The study comprised a literature search of these pathologies conducted in the MEDLINE/PubMed Database. Acute infectious entities such as gingival and periodontal abscesses are emergencies that require a rapid response. Periodontitis associated with endodontic processes, necrotizing periodontal disorders, desquamative gingivitis, gingival recession, and mucogingival herpetic lesions, cause mild to severe pain due to tissue destruction and loss. Other lesions that lead to periodontal discomfort include gingival enlargement and periodontal ligament strains associated with occlusal trauma, parafunctional habit and the impaction of food or foreign bodies.Conclusion:A range of therapeutic, pharmacological and surgical alternatives are available for the management of these injuries. However, the wide variety of causes of orofacial pain or periodontal discomfort may confuse the clinician during diagnosis and may lead to the wrong choice of treatment.

A lectin fraction from green seaweed Caulerpa cupressoides inhibits inflammatory nociception in the temporomandibular joint of rats dependent from peripheral mechanisms

Temporomandibular disorders are the second most common cause of orofacial pain mediated by inflammatory compounds, which in many cases leads to chronic orofacial pain. This study assessed the antinociceptive and anti-inflammatory effects of a lectin from the green seaweed Caulerpa cupressoides (CcL) on hypernociception inflammatory in TMJ of rats and investigated the involvement of different mechanisms. Rats received i.v. CcL 30 min prior to injection of flogistic agentes or 0.9% saline into the left TMJ. Pretreatment with CcL (0. 1; 1 or 10 mg/kg) promoted a reduction (p < 0.05) of inflammatory hypernociception induced by 1.5% Formalin along with inhibition of inflammatory plasma extravasation, cytokines levels, ciclooxigenase-2, and intercellular adhesion molecule (ICAM-1). CcL was able to inhibit the nociceptive response induced by 1.5% Capsaicin, suggesting that CcL has an antinociceptive effect, acting directly on the primary nociceptive neurons. CcL also inhibited the nociceptive response induced by Carrageenan (100 μg/TMJ) or Serotonin (5-HT) (225 μg/TMJ). In conclusion, the results demonstrate that administration of CcL has a potential antinociceptive and anti-inflammatory effect, with a mechanism that is partially dependent on TNF-α, IL-1β, COX-2 and ICAM-1 inhibition and independently from the cannabinoide and opioid system and NO/cGMP/PKG/K+ATP channel pathway.

Personality, coping and atypical facial pain. Case reports

BACKGROUND AND OBJECTIVES: Idiopathic facial pain is a chronic condition with unknown etiology and pathophysiology. Its diagnostic criteria depend on the exclusion of any somatic cause of orofacial pain. Several studies have investigated anxiety and depression, but there is a lack of publications about personality. The objective of this study was to describe three cases of patients with idiopathic facial pain that had their temperament and character evaluated in order to verify the relation between the findings with pain behavior and pain characteristics. The instruments used were a free interview and the Temperament and Character Inventory. CASE REPORTS: Case 1 was proactive and had high scores of cooperativity and self-transcendence correspondent to the well-coping behavior. On the other side, cases 2 and 3 showed similarities about their harm avoidance, novelty seeking and poor coping, correspondent to a self-protective insecure personality. CONCLUSION: These cases show the importance of personality assessment in order to determine coping strategies in complex chronic facial pain such as idiopathic facial pain.

Personality, coping and atypical facial pain. Case reports

ABSTRACT BACKGROUND AND OBJECTIVES: Idiopathic facial pain is a chronic condition with unknown etiology and pathophysiology. Its diagnostic criteria depend on the exclusion of any somatic cause of orofacial pain. Several studies have investigated anxiety and depression, but there is a lack of publications about personality. The objective of this study was to describe three cases of patients with idiopathic facial pain that had their temperament and character evaluated in order to verify the relation between the findings with pain behavior and pain characteristics. The instruments used were a free interview and the Temperament and Character Inventory. CASE REPORTS: Case 1 was proactive and had high scores of cooperativity and self-transcendence correspondent to the well-coping behavior. On the other side, cases 2 and 3 showed similarities about their harm avoidance, novelty seeking and poor coping, correspondent to a self-protective insecure personality. CONCLUSION: These cases show the importance of personality assessment in order to determine coping strategies in complex chronic facial pain such as idiopathic facial pain.

Therapeutic and Analgesic Efficacy of Laser in Conjunction With Pharmaceutical Therapy for Trigeminal Neuralgia.

Introduction: Trigeminal neuralgia (TN) is the most common neuralgia in the head and neck region and a common cause of orofacial pain. It is routinely treated with carbamazepine. Laser, acupuncture and radiofrequency are among other treatment modalities for this condition. This study sought to assess the efficacy of laser therapy in conjunction with carbamazepine for treatment of TN. Methods: A total of 30 patients who met the inclusion criteria were divided into 2 groups of cases and controls (n=15) by double blind randomized controlled clinical trial. All patients received 100 mg carbamazepine at baseline and another 100 mg after 2 days for pain control. In the case group, low level laser therapy (LLLT) was also performed in addition to pharmaceutical therapy. Sham laser was used in the control group instead of LLLT. Treatment was continued for 9 sessions (3 days a week). The intensity of pain was measured and compared in the 2 groups using visual analog scale (VAS) in 3 period. The qualitative variables among the groups were compared using the repeated measures analysis of variance (ANOVA). Results: The severity of pain was lower at the end of treatment in the case compared to the control group so this difference was statistically significant (P=0.003). The severity of pain decreased in both groups over time. Significant difference was noted in this regard between the 2 groups either (P=0.003). At the end of treatment pain intensity dropped in the intervention group from 6/8 to 1/2 and control group from 6/6 to 2/7. Conclusion: Laser therapy did add to the value of pharmaceutical therapy for treatment of TN. Both groups experienced significant improvement over time. So it is better to used laser complementary therapy to reduce side effects and the medicine dosage.

Use of Magnetic Neurostimulator Appliance in Temporomandibular Disorder

Temporomandibular disorder (TMD) is ranked the second leading cause of orofacial pain after toothache, and there is no effective standard treatment for all cases. Therefore, much research has been conducted in the therapeutic areas of TMD, such as acupuncture and electrotherapy, for this purpose. The aim of this research was to evaluate application of the neuromagnetic stimulator device Haihua model CD-9, used within the precepts of acupuncture in treating TMD-related pain symptoms and limited mouth opening. Analysis and discussion of this study were based on pain intensity index and range of mouth-opening evaluation before and after each session. Nine patients diagnosed with muscle TMD, referred by the surgery sector of Center Dental Specialties (CEO – I) in Piracicaba-São Paulo participated in this research. Considering the simplicity of the technique and good results obtained, use of this device is suggested as an additional therapeutic tool for relief of TMD symptoms.

Recent Tissue Engineering Advances for the Treatment of Temporomandibular Joint Disorders.

Temporomandibular disorders (TMDs) are among the most common maxillofacial complaints and a major cause of orofacial pain. Although current treatments provide short- and long-term relief, alternative tissue engineering solutions are in great demand. Particularly, the development of strategies, providing long-term resolution of TMD to help patients regain normal function, is a high priority. An absolute prerequisite of tissue engineering is to understand normal structure and function. The current knowledge of anatomical, mechanical, and biochemical characteristics of the temporomandibular joint (TMJ) and associated tissues will be discussed, followed by a brief description of current TMD treatments. The main focus is on recent tissue engineering developments for regenerating TMJ tissue components, with or without a scaffold. The expectation for effectively managing TMD is that tissue engineering will produce biomimetic TMJ tissues that recapitulate the normal structure and function of the TMJ.

Gum-Chewing and Headache: An Underestimated Trigger of Headache Pain in Migraineurs?

Tension-type headache and migraine are currently considered the second and third most frequent human diseases. Since a variety of conditions that involve the temporomandibular joint and chewing muscles are frequent causes of orofacial pain, the aim of this article was to review current published evidence about the potential relationship between gum-chewing and headache. A systematic electronic search performed on Medline, Scopus and Web of Science using the keywords "headache" or "migraine" and "chewing" allowed to finally identify 1 cross-sectional, 1 observational and 3 randomized studies, along with 3 case reports about the potential association between gum-chewing and headache. Despite the limited evidence, it seems reasonable to suggest that headache attacks may be triggered by gum-chewing in migraineurs and in patients with tension-type headache. Opposite results were obtained in non-migraineurs, since in none of these studies an increased prevalence of headache pain was reported after gum-chewing. Although larger randomized studies will be necessary to definitely establish the relationship between gum-chewing and headache across different populations, it seems cautionary to suggest that subjects with migraine or tension-type headache should avoid or limit gum-chewing in their lifestyle.

Epidemiology of orofacial pain: A retrospective study

Background: The orofacial pain is a pervasive situation either of somatic or psychological etiology arising from the structures supplied by the trigeminal nerve. Identifying the cause of orofacial pain goes a long way in diagnosis and treatment. Objectives: To evaluate the cause of pain among the subjects reporting to the dental college. Materials and Methods: A retrospective study was conducted on a group of patients with persistent facial pain with an ebb to respond properly to previous treatments were assigned to specialists associated with Department of Oral Medicine and Radiology and Oral and Maxillofacial surgery in Sri Rajiv Gandhi College of Dental Sciences and Hospital from March 2010-April 2011. Results: It was found that pulpitis was the most common cause of orofacial pain followed by periodontal pain. Neuralgias and TMJ disorders were the least likely cause. Conclusion: Multidisciplinary approaches and a biopsychosocial model of pain management are an essential adjunct to established evidence-based medical and surgical management of these conditions

The Evaluation of Head and Craniocervical Posture among Patients with and without Temporomandibular Joint Disorders- A Comparative Study.

Temporomandibular disorders (TMD) are the most common non-dental cause of orofacial pain with a multifactorial aetiology. To evaluate the head and craniocervical posture between individuals with and without TMD and its sub types by photographic and radiographic method. Thirty four TMD patients diagnosed according to Research Diagnostic Criteria for TMD's (RDC/TMD) and were divided into 2 groups: Group I (muscle disorder), Group II (disc displacement). Control group comprised of 34 age and sex matched subjects without TMD. Lateral view photographs were taken and the head posture angle was measured. Craniocervical posture was assessed on lateral skull radiograph with two angles (Craniocervical Angle, Cervical Curvature Angle) and two distances (Suboccipital Space, Atlas-Axis Distance). To compare the results, t-test was used with significance level of 0.05. Head posture showed no statistical significant difference (p > 0.05) between Group I, II and control group in both photographic and radiographic methods. The cervical curvature angle showed significant difference (p = 0.045) in Group I only. Atlas-Axis Distance was statistically significant in Group II (p = 0.001). The present study confirmed that there is a negative association of head posture and TMD whereas, cervical lordosis was present in Group I only.

A Novel Case of Orofacial Pain Treated by Dry Needling Technique - A Case Report

Temporomandibular disorders (TMDs) are a subgroup of orofacial pain which cause a significant public health problem affecting approximately 5-12% of the population. TMD is manifested by pain, joint sounds, and limitation in jaw movement, muscle tenderness and joint tenderness. Myogenous TMDs are characterized by pain and dysfunction that arise from pathologic and functional process in the masticatory muscles. Myofascial trigger points are one of the diagnostic criteria for the most common pain related TMDs. The current case report highlights the importance of considering the posture, locating the myofascial trigger point within the muscles and the effectiveness of Dry Needling Technique in resolving non-odontogenic causes of orofacial pain.

Evaluation of Salivary Cortisol and Anxiety Levels in Myofascial Pain Dysfunction Syndrome

BackgroundMyofascial pain dysfunction syndrome (MPDS), otherwise called myofascial pain is one of the most common temporomandibular disorders, which in turn is the most common cause of orofacial pain of non-dental origin. Its etiology is multifactorial and still poorly understood. Psychological factors have been shown to play a role in the etiology. The aim of the study was to evaluate the association between anxiety and salivary cortisol levels in patients with myofascial pain.MethodsTwenty patients suffering from myofascial pain were recruited as the study group. The same number of age and sex matched healthy individuals were taken as the control group. The salivary samples collected between 9-9:15 am from both groups were analyzed for cortisol levels with the competitive enzyme-linked immunosorbent assay method. Anxiety levels of 40 patients were measured using Hamilton's anxiety scale.ResultsThe mean serum cortisol level of the MPDS group showed a highly significant difference (p < 0.001) from the controls. The mean anxiety scores of the MPDS group showed a highly significant difference (p < 0.001) from the controls. A positive correlation was found between anxiety and the salivary cortisol levels in MPDS patients.ConclusionsThese findings suggest that anxiety plays a vital role in the etio-pathogenesis of MPDS; thus, besides pharmacological treatment, psychological support is also needed.

Role ofNMDAreceptors in the trigeminal pathway, and the modulatory effect of magnesium in a model of rat temporomandibular joint arthritis

Temporomandibular joint (TMJ) arthritis is a common cause of orofacial pain. In the present study, the modulatory effects of N-methyl-d-aspartate receptors (NMDA-Rs) and magnesium were investigated in TMJ arthritis hypernociception. Male Wistar rats received an intra-articular injection of carrageenan (Cg) in the TMJ, and mechanical hypernociception was measured. The NMDA-R antagonist, MK-801, and magnesium chloride (MgCl₂ ) were administered before arthritis induction. Magnesium deficiency was promoted by feeding rats a synthetic magnesium-free diet for 9 d before injection of Cg. The Cg induced mechanical hypernociception that lasted for 120 h. MK-801 inhibited this hypernociceptive state. MgCl₂ pretreatment prevented Cg-induced hypernociception and altered the nociceptive threshold in the absence of Cg. Magnesium deficiency increased hypernociception and induced spontaneous hypernociceptive behavior. TMJ arthritis increased the expression of mRNA for all NMDA-R subunits and immunostaining of phosphorylated NR1 (phospho-NR1). MgCl₂ inhibited expression of NR2B mRNA and phospho-NR1 immunostaining and increased expression of NR3 mRNA. Magnesium deficiency increased expression of both NR1 and NR3 mRNAs and phospho-NR1 immunostaining in the trigeminal subnucleus caudalis. We found that magnesium modulates nociceptive behavior and induces NMDA-R subunit rearrangement in the subnucleus caudalis. The present results may lead to a better understanding of central processing in the nociceptive trigeminal pathway and the development of new approaches to treat orofacial pain with a TMJ origin.

Phantom Tooth Pain: A Diagnostic Dilemma

Diagnosis is essentially the appraisal of the nature of a disease, based on the study of signs and symptoms. Patients with chronic oral or facial pain often present a diagnostic challenge to the practitioner. This paper is on the diagnosis and management of a case of chronic pain in the maxillary anterior region. The final diagnosis was made as phantom tooth pain. This case report illustrates the importance of having a thorough knowledge of both odontogenic and nonodontogenic causes of orofacial pain and stresses the need for careful diagnosis before rendering any treatment.

Prolotherapy: A new hope for temporomandibular joint pain

The most common cause of orofacial pain is the Temporomandibular Joint Disorder (TMD), a collective term used to describe a group of medical disorders causing temporomandibular joint (TMJ) pain and dysfunction. As the causes of TMD are varied and run the gamut from mechanical issues, such as disc degeneration and dislocation or erosion of the fibrocartilaginous surfaces of the condyle, fossa, and articular eminence, the treatment approaches for the chronic TMJ case are also quite varied. As surgery is considered a last resort for TMD, it is common for sufferers to seek out alternatives and one of the alternative treatments is 'Prolotherapy,' which is also known as Regenerative Injection Therapy. This article provides an overview of this new alternative therapy.