Luciana Alvarenga da Silva

Xerostomia and salivary flow in patients with orofacial pain compared with controls.

OBJECTIVES Pain in the orofacial region is frequently reported by patients in dental and medical offices. Facial pain, headache, masticatory abnormalities and other complaints often become chronic and may be associated with local disturbances, such as xerostomia and teeth abnormalities. The objective of this study was to investigate salivary flow and xerostomia in patients with orofacial pain. DESIGN This was a case-control study; we evaluated 82 patients with chronic orofacial pain compared with 56 healthy subjects using a Clinical Pain Questionnaire (pain characteristics, duration, intensity and descriptors), complete dental examination (including static and dynamic evaluation of the jaw) and a Xerostomia Inventory. The salivary flow was quantitatively evaluated. Data was compared through Pearsons chi-square, Fishers exact, analysis of variance (ANOVA) 1 factor and Mann-Whitney tests. RESULTS Patients often had temporomandibular disorder (TMD) (P=0.001) and pain during facial (P<0.001) and neck palpation (P=0.002). There were no differences in dental examination or other structural aspects of the jaw between the groups. There were more complaints associated with xerostomia in the study group, including burning sensation in the oral mucosa (P=0.003), in the throat (P=0.035) and in the stomach (P=0.050). Patients had lower salivary flow (P=0.008). CONCLUSIONS Orofacial pain patients need to be evaluated with regard to their salivary function, which was often found abnormal in this sample and may have contributed to the complaints of these patients. Assessing salivary flow and xerostomia may help in the treatment of chronic orofacial pain.

High prevalence of orofacial complaints in patients with fibromyalgia: a case–control study

OBJECTIVE The aim of this study was to investigate the orofacial complaints and characteristics of patients with fibromyalgia syndrome (FS) compared with controls. STUDY DESIGN We evaluated 25 patients diagnosed with FS compared with 25 gender- and age-matched controls by using a detailed clinical protocol for orofacial pain diagnosis and dental examination. RESULTS FS patients had a higher frequency of temporomandibular disorders (TMD), masticatory complaints, pain with mandibular movements, and pain upon palpation of the head and neck area. There were no significant differences related to the dental exam. CONCLUSIONS Orofacial complaints including TMD may be present either as symptoms of FS or as a comorbidity associated with this condition. A comprehensive evaluation of patients with FS is necessary to identify the need for specific treatments for orofacial complaints. Future studies, especially those with longitudinal design, should clarify whether a cause-effect relationship exists between orofacial complaints and fibromyalgia.

Human bocavirus in very young infants hospitalized with acute respiratory infection in Northeast Brazil

Abstract A cross-sectional study was carried out over a period of 12 months to investigate the occurrence of human bocavirus (HBoV) infection in infants hospitalized for respiratory infections in a teaching hospital in Salvador, Brazil, and to describe the clinical manifestations of this infection. Nasopharyngeal aspirates were collected from the children and immunofluorescence and polymerase chain reaction were performed to investigate the presence of respiratory viruses. HBoV was detected in 4 out of 66 patients. Two of the HBoV-positive infants were co-infected with other viruses. The principal clinical findings in HBoV-positive children were: nasal obstruction, catarrh, cough, fever and dyspnea. This study revealed HBoV infection in children aged <2 months, suggesting that the infection may occur at a very early age.

The role of xerostomia in burning mouth syndrome: a case-control study

OBJECTIVE To assess the efficacy of anti-xerostomic topical medication (urea 10%) in patients with burning mouth syndrome (BMS). METHOD Thirty-eight subjects diagnosed with BMS according to the International Association for the Study of Pain guidelines were randomized to either placebo (5% sodium carboxymethylcellulose, 0.15% methyl paraben, and 10% glycerol in distilled water qsp 100 g) or treatment (urea 10%) to be applied to the oral cavity 3-4 times per day for 3 months. The patients were evaluated before and after treatment with the following instruments: the EDOF-HC protocol (Orofacial Pain Clinic - Hospital das Clínicas), a xerostomia questionnaire, and quantitative sensory testing. RESULTS There were no differences in salivary flow or gustative, olfactory, or sensory thresholds (P>0.05). Fifteen (60%) patients reported improvement with the treatments (P=0.336). CONCLUSION In conclusion, there were no differences between groups, and both exhibited an association between reported improvement and salivation.

Quantitative sensory testing in fibromyalgia and hemisensory syndrome: comparison with controls

Fibromyalgia syndrome (FS) is a chronic painful condition with sensory, motor and affective dysfunctions. Few studies had investigated the trigeminal area, and little is known about its association with hemisensory syndrome, which is characterized by chronic pain restricted to hemibody. Our objective was to investigate sensorial abnormalities with quantitative sensory testing of patients with FS and patients with hemisensory syndrome, compared to controls. Thirteen patients diagnosed with FS according to the American College of Rheumatology, and 12 patients with hemisensory syndrome were evaluated and compared to 25 age–gender-matched controls. They were investigated with a quantitative sensory testing protocol including gustative, olfactory, cold, warm, touch, vibration, electric, deep and superficial pain thresholds and the corneal reflex evaluation. The patients had higher gustative thresholds for salty and bitter. In general, patients with FS had somatosensory thresholds higher than the controls; however, patients with hemisensory syndrome had only superficial pain thresholds increased, in both body sides and not only in the area affected by pain. Patients with hemisensory syndrome can be a subgroup of FS, different from nondermatomal somatosensory deficits which are characterized by chronic pain with hypoesthesia in hemibody. The bilateral hypoalgesia supports that pain pathways play a key role in this condition, with no compromise of other sensorial modalities.

Functional and sensory evaluation of patients with idiopathic trigeminal neuralgia: Comparison with controls

BACKGROUND Idiopathic trigeminal neuralgia (ITN) can be associated with orofacial and sensory comorbidities. OBJECTIVE To evaluate the masticatory functional and sensory characteristics of patients with ITN compared with controls. METHODS We enrolled 119 patients and 30 healthy controls. They were evaluated with a systematic protocol: clinical orofacial evaluation questionnaire; a systematic approach of the mandibular function and the investigation of musculoskeletal comorbidities by the research diagnostic criteria for temporomandibular disorders (RDC/TMD) and the Helkimo indexes; and quantitative sensory testing (corneal reflex and gustative, olfactory, thermal, mechanical and pain thresholds). RESULTS The study group had more loss of vertical dimension than the controls (p=0.011) and restriction of the maximum mouth opening (p=0.024); they had more pain on mandibular movements (p=0.001), limitation of mandibular function (p<0.001), masticatory discomfort (p<0.001) and myofascial pain (p=0.001). Occlusion Helkimo index was lower in controls than patients. The study group had high tactile (p=0.025), warm (p=0.020) and cold (p=0.003) thresholds. CONCLUSION ITN may cause severe mandibular limitations that can be associated with the pain episodes and with sensory abnormalities. These findings indicate the affection of small and large nerve fibers and support the neuropathic nature of ITN. Sensory alterations can be part of the natural history of ITN and can be associated with the previous treatments including medication. They cause a high impact in quality of life.

Facial somatosensorial evaluation in idiopathic trigeminal neuralgia.

Idiopathic trigeminal neuralgia (ITN) is identified by paroxysmal unilateral shock-like pain, distributed in one or more trigeminal branches, with clear diagnostic criteria based on history and clinical exams. Etiology and physiopathology remain obscure. Recently, abnormal expression of voltage-gated sodium channels had been described in these patients, suggesting that ITN could be a channelopathy1. Current diagnostic criteria do not include sensorial deficit; however, recent studies have shown that discrete abnormalities may be present in trigeminal territories2, which could be associated with the chronic evolution of such pain. There are no studies investigating patients nearly onset. A 64-year old, male, was diagnosed with ITN according to the criteria of the International Association for the Study of Pain (IASP)3. He was evaluated with a systematized protocol of facial sensitivity, which included the clinical exam and quantitative sensory testing: gustative thresholds, olfactory thresholds, quantitative salivary and somatosensorial evaluation; all trigeminal branches (front, cheek, and chin) were also evaluated bilaterally: thermal detection, mechanical detection, vibration detection, electric detection, and pain detection threshold. The patient did not have abnormalities in imaging exams (computed tomography or magnetic resonance) or any neurological deficits in the evaluation by the neurologist. Pain had started in the last two weeks. Until the moment of evaluation, the patient had not been prescribed for ITN and was not using any medication. There was a high sweet threshold and absence of identification of the salty taste. Mean salivary flow was 0.2363 g/min. There were differences between the facial sides in somatosensory thresholds: warm, mechanical, vibration, electric and pain (Figure). These thresholds were higher at the pain side (right), when compared to the left one at the three trigeminal branches, except for the cold threshold, which was lower at the pain than the opposite side. After the evaluation, carbamazepine was prescribed (400 mg/day) and after one week there was complete relieve of symptoms. These data suggest evidence for future studies, which support neuropathic mechanisms in ITN1, and the need to investigate patients in the early onset in order to verify the prevalence of these findings. Besides, there was a reduced gustative detection for some tastes, especially salty, which had already been described for ITN4 and supports central sensitization involved in the physiopathology of this disease since the beginning of onset. There is also in the literature the description of gustative stimuli as triggering factors for ITN in some patients5and the role of that must be understood.

The use of mini-tunnels and the effects of seasonality in the clonal propagation of Eucalyptus in a subtropical environment

Summary Environmental seasonality plays a key role in the physiological processes of root formation in vegetative reproduction for commercial cloning. The authors hypothesised that (1) subtropical climatic seasonality causes higher rates of Eucalyptus mini-cutting production and rooting during warmer months and (2) the use of mini-tunnels to cover the stumps (stools) providing cuttings would enhance these processes year round. This study evaluated the effects of seasonality and the use of mini-tunnels using eight clones of Eucalyptus spp. under subtropical environmental conditions over the course of a year. The production systems studied were (1) mini-stumps planted in a clonal hedge (control) under a retractable roof shelter and (2) mini-stumps planted inside mini-tunnels under the same shelter. Five parameters were evaluated: (1) the temperature in the two environments; (2) the production of mini-cuttings by the stumps; (3) foliar area of the cuttings at harvest; (4) the survival of cuttings after 30 days in the greenhouse with micro-sprinklers and (5) rooting of cuttings at 45 days from setting. The use of mini-tunnels increased air temperature, increased mini-cutting production by 53% and promoted a reduction in foliar area of the cuttings at harvest. Rooting was found to be greater in warmer months (summer and spring) with an overall mean rooting rate of 80% versus 68% during the colder months (autumn and winter). The hypothesis that mini-tunnels enhance rooting of the cuttings produced in them was only partially confirmed, as this technique improved rooting (from 76% to 85% for the control versus the mini-tunnel conditions, respectively) only during the warmer months.

Oral infections, comorbidities and sensory evidences in elderly: Cross-sectional study

BACKGROUND Oral infections affect the general health and overlap with chronic diseases due to infectious-immune mechanisms. On the other side, sensory abnormalities may be symptoms of this association. OBJECTIVE To evaluate the prevalence of oral infections, comorbidities, health parameters and sensory abnormalities in elderly patients. METHODS Thirty (30) elderly with mean age 70.4 yo, distributed according to ages were evaluated with a protocol that included demographics, comorbidities, medications, laboratory tests, blood pressure, heart rate, mini-mental state examination, clinical oral evaluation and systematized sensory testing (gustative, olfactory, thermal, mechanical and pain thresholds). Data were tabled and statistically analyzed. RESULTS Twenty-three (76.6%) subjects had chronic diseases that increased according to the age. Seventeen (56.7%) elderly were having medication. Mean probing pocket depth was 1.90mm±0.39mm, mean clinical attachment level was 0.76mm±0.54mm and mean gingival bleeding index was 29.10%±29.05%. All periodontal indexes increased with age (p <0.05) and were associated with comorbidities and use of medication. Patients with chronic diseases had more numbness and pricking sensations (p=0.031; p=0.000). Main sensory findings were: abnormal gustative and vibratory thresholds, which were associated with hematological parameters (blood count, cholesterol levels and glycaemia). Periodontal parameters were associated with facial cold threshold (p=0.000). CONCLUSION This study showed an association between systemic diseases, periodontal indexes and sensory thresholds. Sensory findings were associated with blood parameters and are potential tools for periodical health evaluation. Inflammatory or neural mechanisms need further investigation.

Correlação entre nasalância e nasalidade em crianças com hipernasalidade

OBJETIVO: estabelecer a correlacao entre medidas de nasalância e de nasalidade de fala apresentada por criancas com fissura labiopalatina operada. METODOS: estudo prospectivo, em que as gravacoes de audio de frases produzidas por 79 criancas (idade media 6,5 anos) falantes do portugues brasileiro foram julgadas auditivamente por tres fonoaudiologas. Medidas de nasalância obtidas simultaneamente as gravacoes audio tambem foram analisadas. As amostras de fala incluiram duas frases, uma constituida por [p] e outra por [b], em recorrencia. A concordância interjuizes foi obtida para as 158 frases (78,5% para [p] e 93,5% para [b]). A concordância intrajuizes tambem foi verificada para as frases duplicadas (82% para [p] e 86% para [b]). Os fonoaudiologos classificaram individualmente a nasalidade de fala das 158 frases utilizando uma escala de 4 pontos. Valores de nasalância destas mesmas frases foram calculados. Os valores medios da nasalidade de fala foram correlacionados como os escores de nasalância. RESULTADOS : valores medios de 1,53 e 1,52 (indicativo de hipernasalidade leve) foram obtidos para as frases [p] e [b], a partir dos julgamentos perceptivos. Os valores medios de nasalânciaforam 32% (frase [p]) e 39% (frase [b]). Embora significantes, houve correlacao baixa entre nasalidade e nasalância paraas duas frases (/p/;r= 0,31 p=0,004e /b/; r= 0,37 p=0,0007). CONCLUSAO: quando classificada como leve, a hipernasalidade de fala apresentada por criancas com fissura labiopalatinapode desfavorecer entre nasalância e nasalidade. Estimulos de fala mais longos e amostras representativas de graus mais elevados de hipernasalidade sao recomendados para futuros estudos.