Ilana Eli

Antecedents of Burning Mouth Syndrome (Glossodynia)-Recent Life Events vs. Psychopathologic Aspects

Burning mouth syndrome-BMS (also known as glossodynia, glossalgia, glossopyrosis, or oral dysesthesia)-primarily affects middle-aged women. Many possible etiologies have been proposed to account for the syndrome; most are still unsubstantiated. One possible suggested etiology involves the presence of psychological components. In this study, 45 BMS patients and 45 age-, sex-, ethnic origin-, socio-economic status-, and education-matched control subjects were evaluated for their psychopathologic profile and existence of recent life events. All subjects were requested to complete the SCL-90 questionnaire and a Recent Life Changes questionnaire. The BMS patients scored significantly higher on all SCL-90 scales except one. A MANOVA test to evaluate the overall group effect was significant at the 0.0001 level. No differences between groups were found for recent life events. The data suggest that although BMS patients are subjected to elevated psychological stress, initiation of BMS symptoms is not necessarily correlated with stressful life events.

Correlates of Success and Failure in Behavior Therapy for Dental Fear

Extreme dental fear and avoidance are universal problems, with severe adverse effects on the patients oral health. Although behavior modification techniques were shown to be effective in the treatment of this problem, their success is by no means absolute. In the present article, the SCL-90 questionnaire was used for development of possible predictive measures for success and failure of behavior modification as a treatment for dental fear. Patients who failed in treatment through behavior modification were found to score significantly higher on the global score of Positive Symptom Distress Index (p < 0.01) and on individual subscales of somatization (p < 0.02) and psychoticism (p < 0.05) than patients who were treated successfully. The predictive value of chosen SCL-90 scales was 71%. The results suggest that use of SCL-90 may be valuable for the prediction of success and failure of behavior modification as a treatment for dental fear and avoidance.

Self-estimation of Oral Malodor

Bad breath (halitosis, oral malodor) is a common condition, usually the result of microbial putrefaction within the oral cavity. Often, people suffering from bad breath remain unaware of it, whereas others remain convinced that they suffer from foul oral malodor, although there is no evidence for such. The purpose of the present investigation was to determine whether objective self-measurement of oral malodors is possible. Each of 52 volunteers was asked to sample the odor from his/her mouth, tongue, and saliva. Results were compared with (i) self-assessments prior to (preconception) and following (post-measurement) self-measurements; (ii) odor judge scores; (iii) dental measurements (plaque index, gingival index, and probing depth); (iv) volatile sulphide levels; (v) salivary cadaverine levels; and (vi) intra-oral trypsin-like activity. Among the self-measurements, only saliva self-scores yielded significant correlations with objective parameters. Despite the partial objectivity of saliva self-estimates, subsequent post-measurement self-assessments failed to correlate with objective parameters. The results suggest that (i) preconceived notions confound the ability to score ones own oral malodors in an objective fashion; and (ii) partial objectivity can be obtained in the case of saliva self-measurement, presumably because the stimulus is removed from the body proper.

Self-reported Bruxism - associations with perceived stress, motivation for control, dental anxiety and gagging*

To examine possible associations between self-reported bruxism, stress, desirability of control, dental anxiety and gagging. Five questionnaires were distributed among a general adult population (402 respondents): the Perceived Stress Scale (PSS), Desirability of Control Scale (DC), Dental Anxiety Scale (DAS), Gagging Assessment Scale (GAS), and Bruxism Assessment Questionnaire. A high positive correlation between DAS and GAS (R = 0·604, P < 0·001) was found. PSS was negatively correlated with DC (R = -0·292, P < 0·001), and was positively correlated with GAS (R = 0·217, P < 0·001) and DAS (R = 0·214, P < 0·001). Respondents who reported bruxing while awake or asleep showed higher levels of GAS, DAS and PSS than those who did not. There were no differences between the bruxers and the non-bruxers (sleep and aware) with regard to the DC scores. The best predictors of awake bruxism were sleep bruxism (OR = 4·98, CI 95% 2·54-9·74) and GAS (OR = 1·10, CI 95% 1·04-1·17). The best predictors of sleep bruxism were awake bruxism (OR = 5·0, CI 95% 2·56-9·78) and GAS (OR = 1·19; CI 95% 1·11-1·27). Self-reported sleep bruxism significantly increases the odds for awake bruxism and vice versa. Tendency for gagging during dental care slightly increases the odds of both types of self-reported bruxism, but desirability of control is not associated with these phenomena.

Gender role expectations of pain is associated with pain tolerance limit but not with pain threshold

ABSTRACT Gender role expectations of pain (GREP) was suggested to predict sex differences in pain perception. Our aim was to explore sex differences in GREP and investigate its relationship with heat‐pain threshold (HPT) and heat‐pain tolerance limit (HPTL). University students (115 males, 134 females) filled the GREP questionnaire. HPT and HPTL were measured in a sample of 72 students. Additionally, GREP values of the present sample were compared with those of the original, American sample to explore possible cultural effects. Both males and females perceive themselves (and their own sex in general) to be less sensitive to pain and less willing to report of pain than the opposite sex. Males perceived themselves and other men, to endure pain relatively similar to women whereas females perceived themselves and other women as less endurable to pain than men. HPT was similar for the two sexes but males had higher HPTL than females. Within each sex, HPTL correlated mainly with selfs perception of pain sensitivity. The American and Israeli samples differed in that Israeli males and females presented stronger stereotypical views towards same and opposite sexes. Both males and females held stereotypical “macho” attitude towards themselves with regard to pain sensitivity and willingness to report of pain however only females held stereotypical, “macho” attitude towards themselves with regard to pain endurance. The sex differences in GREP and in HPTL and the correlations between GREP items and experimental thresholds suggest that the relationship between GREP and experimental pain is complex and sex‐specific. It also appears that GREP is affected by culture.

Detection of psychopathologic trends in glossodynia patients.

&NA; Glossodynia affects primarily middle‐aged women. Although many possible etiologies have been proposed for the syndrome, most have not been substantiated. In the present study 56 glossodynia patients were evaluated for their psychopathologic profile as reflected by the SCL‐90 questionnaire. The data show that glossodynia patients present a relatively high psychopathologic profile, especially on the scales of somatization and depression. Significant correlations were found between the intensity of pain experienced by the patients and some of the SCL‐90 scales (somatization, depression, anxiety, GSI and PSDI). No correlations were found between SCL‐90 scores and duration of symptoms, prevalence of symptoms per day and patients condition during the past year. Patients living alone were found to differ significantly from those living with a significant other (overall group effect significant at the 0.01 level). The data suggest that psychopathologic trends may be associated with glossodynia.

Treatment of Dental and Dental-Related Behavioral Dysfunctions in a Consultative Outpatient Clinic: A Preliminary Report

Abstract Dental and dental-related behavioral dysfunctions, such as dental anxiety or phobia, extreme gagging reflex, orofacial pain, rejection of prosthesis, glossal symptoms, and others, often cause severe problems during routine dental treatment. The multidisciplinary team of the Consultatory Outpatient Clinic for Behavioral Dysfunctions of the School of Dental Medicine, Tel-Aviv University, works toward creating a proper environment for the treatment of such patients and developing adequate therapeutic modalities. The philosophical approach of the treatment is reviewed, and various case histories are discussed.

THE COMPLAINT OF ORAL MALODOR : POSSIBLE PSYCHOPATHOLOGICAL ASPECTS

Oral malodor (halitosis) is a common concern in Western society.As with other human perceptions, emotional as well as cognitive variables play a major role in ones sensation and complaint. To study factors potentially associated with the complaint of oral malodor, periodontal and psychological evaluations were carried out on 38 subjects (66% female, mean age 43 years) with a complaint of oral malodor. Subjects underwent evaluation of their periodontal status, odor evaluation by an odor judge, and psychopathological symptom survey by means of the SCL-90 questionnaire. The patients self-rating of oral odor was significantly higher than the evaluation of an objective odor judge and was not associated with their periodontal status. The SCL-90 profile of subjects was relatively higher than that of an age- and gender-matched reference group of dental patients. The results suggest that the complaint of oral malodor may be related to psychopathological symptoms as recorded by the SCL-90 questionnaire.

Effect of intended treatment on anxiety and on reaction to electric pulp stimulation in dental patients.

Fear and anxiety are common emotional concomitants of acute pain that increase the perception of noxious events as painful. In the present study, 92 patients who were about to undergo various dental treatments (calculus removal, filling, root canal treatment, and extraction) were evaluated comparing the level of their dental anxiety and pain expectation from the intended treatment to their reaction to electric pulp stimulation. The data indicate that patients differ significantly in their dental anxiety levels and in their expectation to experience pain according to the following hierarchy (in descending order): extraction, root canal treatment, filling, and calculus removal. Anxiety and amount of pain expected from treatment correlated significantly with each other, but no simple correlations were found between anxiety and actual pain measures recorded after pulp stimulation.

A retrospective analysis of temporomandibular findings among Israeli‐born patients based on the RDC/TMD

The purpose of this study was to evaluate temporomandibular disorders (TMD) Axis I and II among Israeli-Jewish patients using the Hebrew version of the Research Diagnostic Criteria (RDC) for TMD and to compare the results with Swedish, United States, Asian and Israeli-Arab populations. The study consisted of 298 Israeli-born, Jewish patients (male/female ratio 3.5:1), arriving at an Orofacial Pain Clinic during the year 2001-2004. A complete clinical examination was carried out according to the RDC/TMD protocol. Axis I diagnoses: 65% of the Israeli-Jewish patients exhibited myofacial pain (Group I disorder), 38% disc displacement (Group II disorder) and 18% arthralgia, osteoarthritis or osteoarthrosis (Group III disorder). Axis II diagnoses: 20% of the patients scored severe depression and 35% scored somatization. Pain was reported in 82% of the patients (mean pain duration 35.7-33.8 months for women, 44.1 for men). Patients had an average disability score of 30.0 +/- 30.2. Chronic pain grade IV was present in 4% of the patients. Israeli-Jewish temporomandibular disorder patients showed results similar to those reported for other countries, further supporting the use of the RDC/TMD internationally as a reliable epidemiological tool. Globally, Axis I scores were similar, while Axis II scores were more susceptible to geographic/ethnic differences. Gender can influence Axis I and Axis II as well as possible gender specific association with socio-economic status. In future comparisons, men and women should be considered separately.