Charles J. Kowalski

Pain maps from facial pain patients indicate a broad pain geography.

Two hundred consecutive female patients, who were referred to a university-based facial pain clinic, were asked to mark all painful sites on sketches showing the contours of a human body in the frontal and rear views. The drawings were analyzed with transparent templates containing 1875 (frontal view) and 1929 (rear view) square cells of equal size. The average patient scored 71.8 cells in the frontal and 99.7 cells in the rear view (corresponding to 3.8% and 5.2% of the maximum possible scores). In individual patient drawings, however, up to 42.7% and 44.9% of all cells were marked. Only 37 cases (18.5%) exhibited pain that was limited to the trigeminal system. An analysis of the pain distribution according to the arrangements of dermatomes revealed three distinct clusters of patients: (1) pain restricted to the region innervated by the trigeminal nerves (n = 37); (2) pain in the trigeminal dermatomes and any combination involving the spinal dermatomes C2, C3, and C4, but no other dermatomes (n = 32); and (3) pain sites involving dermatomes in addition to the ones listed above (n = 131). Mean ages in the three clusters were 38.7, 35.5, and 37.5 years, respectively (p = 0.62, n.s.). Widespread pain existed for longer durations (median, 48 months) than conditions involving local and regional pain (median, 24 months) (p = 0.02, s.). Our findings showed that among a great percentage of persistent facial pain patients the pain distribution is more widespread than commonly assumed, and that the persistence of pain in the regional and widespread pain presentations is significantly greater than in cases with pain limited to the trigeminal system.

Chemoprophylaxis of prosthetic joint patients during dental treatment: A decision-utility analysis

A decision-analytic model and a cost effectiveness analysis was performed on 1 million hypothetic prosthetic joint patients undergoing dental treatment, to determine the most cost-effective strategy to prevent late prosthetic joint infections. The cost per quality-adjusted life-year saved (QALY) was determined for three preventive strategies: no prophylaxis, oral penicillin, and oral cephalexin. The UCLA Pain-Walking-Function-Activity Scale was used to obtain quality-of-life adjustments (utility assessment) for the study population. Costs were derived from 70 patients hospitalized between July 1, 1982, and June 30, 1986, at the UCLA Center for Health Sciences. The most cost-effective preventive strategy was the no prophylaxis alternative (

Differential diagnosis of adult male black and white populations.

196,500/QALY). However, by recommending a 1-day strategy of oral cephalexin only to those dental patients at high risk for late prosthetic joint infections rather than a 3-day regimen to all patients, the cost effectiveness improved from

Temporomandibular disorders--pain outside the head and face is rarely acknowledged in the chief complaint.

1.1 million/QALY to

Non-Normal Bivariate Distributions with Normal Marginals

446,100/QALY while maintaining a low risk of death (0.38 deaths per 10(6) dental visits).

In vivo Remineralization of Artificial Enamel Lesions by a Fluoride Dentifrice or Mouthrinse

Abstract No Abstract Available. From the Dental Research Institute and Veterans Administration Hospital, University of Michigan, Ann Arbor, Michigan.

In situ Remineralization of Subsurface Enamel Lesion after the Use of a Fluoride Chewing Gum

STATEMENT OF PROBLEM With diagnostic and therapeutic procedures being heavily influenced by the patients chief complaint, the question arises whether this information alone represents a solid basis for clinical action. PURPOSE The aim of this investigation was to assess the agreement between pain complaints and patient generated paper-and-pencil drawings of the distribution of pain in patients suffering from temporomandibular disorders. METHODS The study included 140 adult female patients with temporomandibular disorders. Pain drawings served as a standard, against which the oral reports were compared. In 40 (29%) of the patients, pain was limited to the head and face; in the remaining subjects, it exceeded the boundaries of these regions. Nine potential pain sites were distinguished (head, face, neck, shoulders, arms, chest, abdomen, back, and legs). Whenever one of these regions was part of the drawing or the pain complaint, it was counted. Sensitivity, specificity, and kappa indices were computed for each site. RESULTS Patients with pain limited to the head and face showed a close correspondence between pain report and drawing. On the other hand, patients with temporomandibular disorders with concomitant pain sites outside the head and face frequently did not mention these additional pain locations. This was reflected in low sensitivities (minimum: 0.00; maximum: 0.48) and low kappa values (minimum: -0.02; maximum: 0.19). CONCLUSIONS This study showed that the chief complaint frequently underestimates the real extent of pain involvement.

Tracking: Concepts, Methods and Tools

Examples of non-normal bivariate (multivariate) distributions with normal marginals [15, 16, 18] can be used in the classroom to (a) contrast the correlation/ regression structures of these distributions with that of the corresponding bivariate normal model [9, 10, 11, 12], (b) investigate the feasibility of employing coordinate transformations to normality as a prelude to analyses based on the assumption of joint normality [2, 13, 15, 16, 17, 18, 27] and (c) motivate the need for the development of multidimensional goodness-of-fit tests [2, 13, 16]. In addition, since most of the examples presented here are concerned with ways to generate distributions with arbitrary marginals, they can also be used to obtain a wide variety of non-normal bivariate (multivariate) distributions for these, and other, purposes [2, 11, 12, 13].

The Performance of Some Rough Tests for Bivariate Normality Before and After Coordinate Transformations to Normality

Acid-softened bovine enamel slabs were mounted in acrylic mandibular removable appliances and worn by 8 male subjects. Control slabs were worn for 4 days without exposure to topical fluoride agents. T

Age and Race as Factors in Craniofacial Growth and Development

In situ remineralization of early enamel lesions by a fluoride chewing gum was studied. Human enamel specimens with subsurface lesions were mounted in removable lower appliances for 6 adults. Subjects used a F-free dentifrice 3x/day and chewed five sticks/day for the F gum group (0.1 mg F/stick) or five sticks of sugarless gum. No gum was chewed for controls. Surface microhardness was performed on: (1) sound enamel; (2) lesions; (3) after intraoral exposure, and (4) after acid-resistance testing (ART). Separate specimens were etched and measured for F uptake and image analyses on microradiographs were performed for all regimens. delta Z values were calculated and converted to percent of mineralization. Values for F gum were significantly higher (p > 0.05) than non-F gum and controls for ART, percent remineralization, and F uptake up to 70 microns depth.