Bruce Blasberg

Oral mucosal disorders in denture wearers

Patients who wear dentures present with a variety of symptoms and abnormal intraoral findings. The advanced age of the average denture wearer and the nature of the denture-bearing mucosa appear to influence the nature of the problems. Superimposed infection with candidal organisms and traumatic lesions are the most commonly encountered abnormalities. Patients with symptoms but no intraoral changes frequently had a psychologic component to their complaint and did not improve after alteration of their dentures.

Psychiatric disorders associated with atypical facial pain.

Atypical facial pain (AFP) patients classically present with a chronic discomfort that is neither anatomic nor dermatomal in distribution. Neuropsychiatric assessment of 68 patients with AFP indicated that 46 (68%) had a specific psychiatric disorder by DSM-III criteria. A wide spectrum of psychiatric disorders was present. The authors emphasize that psychiatric assessment of patients with AFP should be an integral part in early assessments of this disorder, rather than relying on psychiatric opinions after extensive dental and other invasive procedures have been tried in vain and often to the detriment of the patient. Comments on the excellent prognosis in treating the psychiatric syndromes associated with AFP are made.

Ineffective dental and surgical treatment associated with atypical facial pain

Patients with atypical facial pain (AFP) are subject to ineffective dental and surgical procedures for their pain complaints. Twenty-one of fifty-eight patients (36.2 percent) with AFP had sixty-five dental and surgical treatments, with only one patient showing less pain as a result of the treatment. While the majority of patients (69 percent) with AFP suffered from a psychiatric illness, fourteen (24 percent) of the patients referred for AFP had a specific medical or dental disorder that was causal in their pain complaints. There is a trend for the AFP patient with a psychiatric diagnosis to receive more ineffective treatments than those AFP patients for whom a specific medical or dental diagnosis was made. Patients with AFP should receive conservative dental and medical treatment and a psychiatric assessment before dental and surgical procedures are contemplated.

Common Inflammatory Diseases of the Mouth

This review outlines our therapy for seven of the most common inflammatory diseases seen in our clinic for oral diseases over a 14-year period. We present several novel concepts, which we believe are valid. These include the adverse effect of oral habits on several diseases, such as glossodynia and lichen planus, and the proper and efTective treatment of aphthous stomatitis with oral antibiotics.

Tardive dyskinesia: an unrecognized cause of orofacial pain.

Tardive dyskinesia has not previously been discussed in the dental literature. It is a drug-induced movement disorder commonly involving the perioral and masticatory muscles. It can sometimes be a cause of orofacial pain. Two brief cases reports are provided as examples. Clinical features of tardive dyskinesia are presented to assist the dental practitioner in recognizing the syndrome. Suggestions for management are included.

The psychiatric referral in dentistry: Indications and mechanics

Psychiatric consultation is sometimes a part of the diagnostic evaluation of facial pain. The indications for referral arise out of the history. Several brief questions may indicate whether or not a psychiatric illness is present. Patients may hold beliefs or attitudes about their illness or about psychiatric treatment that make referral difficult. Successful referral depends on the relationship that the dentist establishes with the patient. Recommendations to facilitate the referral are presented.