Juliana Stuginski-Barbosa

Burning mouth syndrome responsive to pramipexol

Burning mouth syndrome (BMS) is characterized by burning discomfort or pain in otherwise normal oral mucosa. It is usually refractory. Treatment modalities are scarce. Herein we report one case of primary disabling BMS, previously refractory to multiple regimens, with complete and persistent improvement with pramipexol, a nonergot dopamine agonist which has high selectivity for dopaminergic D2 receptors. We discuss potential pathophysiological implications of our findings.

Signs of Temporomandibular Disorders in Migraine Patients: A Prospective, Controlled Study

ObjectivesTo identify signs of temporomandibular disorders and cervical pain in individuals with episodic and chronic (transformed) migraine (CM), relative to controls without headaches. MethodsIn this prospective, controlled, double-blind study, we examined 93 individuals divided in 3 groups: episodic migraine EM, (n=31), CM chronic migraine (n=34), and controls without migraine (n=28). We recorded signs of temporomandibular disorders, and of pain in the neck, after the protocol of Helkimo (1974). We calculated the odds ratio (OR) and confidence intervals (CI) of symptoms as a function of headache status. Data from all groups were paired and compared using the χ2 test. The level of significance was 5% in 2-tailed tests. ResultsRelative to controls, participants with EM and CM were significantly more likely to have tenderness in the masticatory muscles [controls=28%, migraine=54%, (OR=3.0, 95% CI=1.1-8.9), CM=73% (OR=6.9, 95% CI=2.3-21.2)], and in the temporomandibular joint [controls=25%, migraine=61%, (OR=4.7, 95% CI=1.5-14.5), CM=61% (OR=4.8, 95% CI=1.6-14.5)]. They were numerically (but nonsignificantly) more likely to have limited lateral jaw movements (CM=34%; EM=26%; NP=18%), joint sounds (CM=44%; EM=29%; NP=28%), and tenderness in neck muscles (CM=64%; EM=51%; NP=35%). ConclusionIn a tertiary care population, individuals with EM and CM are more likely to have tenderness at the temporomandibular joint and on the masticatory muscles, relative to controls. Studies are needed to investigate whether treatment of 1 disorder will improve the other.

Chronic Pain and Depression in the Quality of Life of Women With Migraine – A Controlled Study

Background.— Migraine is comorbid to depression and widespread chronic pain (WCP), but the influence of these conditions on the health‐related quality of life (HRQoL) of individuals with episodic (EM) and chronic migraine (CM) is poorly understood.

Additional effect of occlusal splints on the improvement of psychological aspects in temporomandibular disorder subjects: A randomized controlled trial

OBJECTIVE To measure the effect of occlusal splints as an additional treatment on psychological aspects in temporomandibular disorder patients. DESIGN A randomized controlled trial was performed comprising 60 adults diagnosed with masticatory myofascial pain according the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The participants were divided equally into 2 treatment groups, which received only counselling (Group 1) or occlusal splints in addition to counselling (Group 2). The assessments occurred at baseline and at 2 and 5 months after treatment. The outcomes were symptoms of anxiety and depression, as well as pain catastrophizing. Two-way ANOVA, Friedman and Mann-Whitney tests were used to perform the statistical analysis, considering a significance level of 5%. RESULTS In relation to the baseline assessment, 60% of the subjects had at least mild anxiety and 25% had at least mild depression, and the mean and standard deviation (SD) of pain catastrophizing was 2.41 (1.33) for Group 1 and 2.06 (1.04) for Group 2. Comparisons between baseline and the fifth-month evaluation showed an improvement in anxiety and depression symptoms only in Group 2 (p<0.05). Otherwise, there was a significant reduction in pain catastrophizing in both groups (p<0.05), with a mean (SD) of 1.14 (1.28) for Group 1 and 0.76 (0.82) for Group 2. CONCLUSION Minimally invasive strategies could provide an improvement in the psychological aspects of temporomandibular disorder patients, and the use of an occlusal splint seems to hasten the manifestation of these effects.

Contingent electrical stimulation inhibits jaw muscle activity during sleep but not pain intensity or masticatory muscle pressure pain threshold in self-reported bruxers: a pilot study

OBJECTIVE This study investigated the effect of contingent electrical stimulation (CES) on present pain intensity (PI), pressure pain threshold (PPT), and electromyographic events per hour of sleep (EMG/h) on probable bruxers with masticatory myofascial pain. STUDY DESIGN The study enrolled 15 probable bruxers with masticatory myofascial pain in 3 phases: (1) baseline EMG/h recording, (2) biofeedback treatment using a CES paradigm (active group, n = 7) or inactive device (control group, n = 8), and (3) posttreatment EMG/h recording. PI and PPT were assessed after each phase. Analysis of variance models were used to compare results at a 5% significance level. RESULTS Patients in the active group had 35% lower EMG/h in P2 and 38.4% lower EMG/h in P3, when compared with baseline. There were no differences in PI or PPT levels at any phase. CONCLUSIONS CES could reduce EMG activity associated with sleep bruxism in patients with masticatory myofascial pain but did not influence perceived pain.

Toothache referred from auriculotemporal neuralgia: case report

AIM To present a 52-year-old male patient who complained of intense pain of short duration in the region of the left external ear and in the ipsilateral maxillary second molar that was relieved by blockade of the auriculotemporal nerve in the infratemporal fossa. SUMMARY Extra- and intraoral physical examination revealed a trigger point that reproduced the symptoms upon finger pressure in the ipsilateral auriculotemporal nerve and in the outer auricular pavilion. The patients medical history was unremarkable. The maxillary left second molar tooth was not responsive to pulp sensitivity testing and there was no pain upon percussion or palpation of the buccal sulcus. Periapical radiographs revealed a satisfactory root filling in the maxillary left second molar. On the basis of the clinical signs and symptoms, the auriculotemporal was blocked with 0.5 mL 2% lidocaine and 0.5 mL of a suspension containing dexamethasone acetate (8 mg mL(-1)) and dexamethasone disodium sulfate (2 mg mL(-1)), with full remission of pain 6 months later. The diagnosis was auriculotemporal neuralgia. KEY LEARNING POINT Auriculotemporal neuralgia should be considered as a possible cause of nonodontogenic toothache and thus included in the differential diagnoses. The blockade of the auriculotemporal nerve in the infratemporal fossa is diagnostic and therapeutic. It can be achieved with a solution of lidocaine and dexamethasone.

Coronoid process hyperplasia: an unusual cause of mandibular hypomobility.

A large number of disorders affecting the masticatory system can cause restriction of mouth opening. The most common conditions related to this problem are those involving the temporomandibular joint (TMJ) and the masticatory muscles, when facial pain also is an usual finding. Congenital or developmental mandibular disorders are also possible causes for mouth opening limitation, although in a very small prevalence. Coronoid process hyperplasia (CPH) is an example of these cases, characterized by an excessive coronoid process growing, where mandibular movements become limited by the impaction of this structure on the posterior portion of the zygomatic bone. This condition is rare, painless, usually bilateral and progressive, affecting mainly men. Diagnosis of CPH is made based on clinical signs of mouth opening limitation together with imaging exams, especially panoramic radiography and computerized tomography (CT). Treatment is exclusively surgical. This paper presents a case of a male patient with bilateral coronoid process hyperplasia, initially diagnosed with bilateral disk displacement without reduction, and successfully treated with intraoral coronoidectomy. It is emphasized the importance of differential diagnosis for a correct diagnosis and, consequently, effective management strategy.

Management of painful temporomandibular joint clicking with different intraoral devices and counseling: a controlled study

Objective The benefit of the use of some intraoral devices in arthrogenous temporomandibular disorders (TMD) patients is still unknown. This study assessed the effectiveness of the partial use of intraoral devices and counseling in the management of patients with disc displacement with reduction (DDWR) and arthralgia. Materials and Methods A total of 60 DDWR and arthralgia patients were randomly divided into three groups: group I (n=20) wore anterior repositioning occlusal splints (ARS); group II (n=20) wore the Nociceptive Trigeminal Inhibition Clenching Suppression System devices (NTI-tss); and group III (n=20) only received counseling for behavioral changes and self-care (the control group). The first two groups also received counseling. Follow-ups were performed after 2 weeks, 6 weeks and 3 months. In these sessions, patients were evaluated by means of a visual analogue scale, pressure pain threshold (PPT) of the temporomandibular joint (TMJ), maximum range of motion and TMJ sounds. Possible adverse effects were also recorded, such as discomfort while using the device and occlusal changes. The results were analyzed with ANOVA, Tukey’s and Fisher Exact Test, with a significance level of 5%. Results Groups I and II showed improvement in pain intensity at the first follow-up. This progress was recorded only after 3 months in Group III. Group II showed an increased in joint sounds frequency. The PPT values, mandibular range of motion and the number of occlusal contacts did not change significantly. Conclusion The simultaneous use of intraoral devices (partial time) plus behavioral modifications seems to produce a more rapid pain improvement in patients with painful DDWR. The use of NTI-tss could increase TMJ sounds. Although intraoral devices with additional counseling should be considered for the management of painful DDWR, dentists should be aware of the possible side effects of the intraoral device’s design.

Quantitative methods for somatosensory evaluation in atypical odontalgia

A systematic review was conducted to identify reliable somatosensory evaluation methods for atypical odontalgia (AO) patients. The computerized search included the main databases (MEDLINE, EMBASE, and Cochrane Library). The studies included used the following quantitative sensory testing (QST) methods: mechanical detection threshold (MDT), mechanical pain threshold (MPT) (pinprick), pressure pain threshold (PPT), dynamic mechanical allodynia with a cotton swab (DMA1) or a brush (DMA2), warm detection threshold (WDT), cold detection threshold (CDT), heat pain threshold (HPT), cold pain detection (CPT), and/or wind-up ratio (WUR). The publications meeting the inclusion criteria revealed that only mechanical allodynia tests (DMA1, DMA2, and WUR) were significantly higher and pain threshold tests to heat stimulation (HPT) were significantly lower in the affected side, compared with the contralateral side, in AO patients; however, for MDT, MPT, PPT, CDT, and WDT, the results were not significant. These data support the presence of central sensitization features, such as allodynia and temporal summation. In contrast, considerable inconsistencies between studies were found when AO patients were compared with healthy subjects. In clinical settings, the most reliable evaluation method for AO in patients with persistent idiopathic facial pain would be intraindividual assessments using HPT or mechanical allodynia tests.

Refractory facial pain attributed to auriculotemporal neuralgia

IntroductionOne of the biggest challenge for the clinician is when thepatient still persists with complaints of orofacial pain, evenwith the adoption of well known and appropriate treatment.One of the reasons for this fact can be the misdiagnosis,very often in the field of orofacial pain, since the trigeminalsystem is frequently influenced by a diversity of differentneural inputs. The presence of systemic diseases affectingthe masticatory apparatus is also part of this scenario. Oneof this is a rare condition: auriculotemporal neuralgia (AN)[1].The aim of the present study was to report a case ofrefractory facial pain after successful temporomandibulardisorder (TMD) management, attributed to AN.Case reportA 43-year-old Caucasian female patient presented fortreatment of facial pain, with complaint of severe episodicpain in right face, ear and neck, first appeared 12 years ago,worsening in the last 3 months, with crisis of sharp andsevere pain. The patient was previously diagnosed withsleep bruxism, depression and insomnia.Physical examination revealed moderate pain uponpalpation of right temporomandibular joint (TMJ), super-ficial masseter, occipital and sternocleidomastoid muscles.A trigger point was found in right medium masseter musclereferring pain to the ipsilateral ear and TMJ. The maximummouth opening (MMO) with pain was 39 mm and no othersignificant signs were detected.Masticatory myofascial pain and cervicalgia were theinitial diagnosis and treatment consisted of advisement ofthe condition, counseling to avoid clenching her teethduring the day, hot packets and the nocturnal use of anocclusal stabilization splint in the upper jaw. The patientwas also referred to a psychologist, physician and physicaltherapist for management of depression, insomnia andcervicalgia.After 3 months, the patient reported a significantimprovement, with no pain upon muscle palpation orfunction, and the MMO was 46 mm. However, she com-plained of a paroxysmal, short-duration pain below theright TMJ and in the temporal region, triggered by MMOand mastication. Intraoral and radiographic exams wereunremarkable. Extra oral physical examination revealedthat the palpation of the right auriculotemporal nerveregion elicited a sharp pain familiar to the patient, whichextended from below TMJ to the temporal region.The hypotheses diagnosis was AN. The auriculotem-poral nerve was then blocked with 0.5 ml 2 % lidocaineand 0.5 ml of a suspension containing dexamethasonedisodium sulfate (2 mg/ml) and dexamethasone acetate(8 mg/ml) as follows: the needle is inserted below the TMJ,in the posterior margin of the head of the mandibleimmediately in front of the tragus, to a depth of 1–1.2 cm,at a horizontal 458 angle in the direction of the nose, with