Octavia Plesh

A comparison of masticatory function in patients with or without reconstruction of the mandible

The functional benefits of mandibular reconstruction following a composite resection remain unclear. Although microvascular surgical techniques have dramatically increased the predictability of bone and soft‐tissue reconstruction towards presurgical anatomic norms, the specific factors responsible for improved function remain controversial. Objective measures of masticatory function need to be more clearly determined before the predictability and efficacy of reconstructive approaches is established.

Axiographic tracings of temporomandibular joint movements

Three-dimensional condylar movements of 49 symptomatic and asymptomatic volunteers were recorded with a hinge axis tracing system axiograph during maximal opening, protrusion, and mediotrusion. The tracings displayed in sagittal and frontal planes were measured to evaluate biomechanics of the temporomandibular joint. The only differences in condylar tracings between symptomatic and asymptomatic groups were in the right joint, recorded in the sagittal plane during maximal opening, and the Bennett angle. The symptomatic group had a significantly longer condylar path and a smaller Bennett angle compared with the asymptomatic group. The results were interpreted as indications of adaptive morphologic instead of pathologic changes. The alterations in condylar tracings as an indicator of joint pathology should be considered cautiously.

Chronic pain in a biracial population of young women

&NA; This study investigated dimensions of chronic pain and temporomandibular disorders (TMDs) in a census tract sampling of African‐American and Caucasian young women enrolled (from racially congruent households) at ages 9–10 in the longitudinal multicenter National Heart Lung and Blood Institutes Growth and Health Study (NGHS). The present study, which examined participants at the California clinical NGHS center when they were 19–23 years old, investigates five commonly reported chronic pains: back, head, face/jaw, abdomen, and chest. Chronic pain grade (CPG) status based on pain self‐reports (frequency, duration, severity, and interference with usual activities) is reported for each of the five pain sites. Results show that chronic pain is common in this population of young women, although based on the CPG severity scores, only a small percentage is dysfunctional. Racial differences were not found for back, head, abdomen or chest pains. However, significant racial differences were found regarding facial pain and symptoms related to TMDs above and beyond socioeconomic status (SES) (lifetime prevalence: adjusted odds ratio (aOR)=2.14 and 95% confidence interval (CI)=1.40–3.31; 6 month period prevalence: aOR=2.03 and 95% CI=1.16–3.64). Not only were facial pain and jaw symptoms reported more frequently by Caucasians compared to African‐Americans controlling for SES, but they were also reported to have an earlier onset.

Self‐Reported Comorbid Pains in Severe Headaches or Migraines in a US National Sample

Aims.— To compare prevalence of self‐reported comorbid temporomandibular joint muscle disorder‐type, neck, back, and joint pains in people with severe headache or migraine; and analyze these self‐reported pains in the 2000‐2005 US National Health Interview Survey by gender and age for non‐Hispanic whites, Hispanics, and non‐Hispanic blacks (African Americans).

The relationship between chronic facial pain and a history of trauma and surgery

OBJECTIVE Because pain is the most commonly reported symptom of patients presenting to temporomandibular disorders clinics, it is important to identify factors that modify the perception or reality of such pain. The purpose of this study was to investigate the hypothesis that a patient with a history of trauma and/or non-temporomandibular joint surgery might be sensitized to pain and might report increased pain levels if a temporomandibular disorder later developed. STUDY DESIGN This was a retrospective study of 778 consecutive patients seen over a 1-year period in an Orofacial Pain Clinic. Study parameters included gender, lifetime number of self-reported traumas, lifetime number of non-temporomandibular joint operations, and location, intensity, frequency, and type of temporomandibular disorder-related pain. RESULTS There were significantly more women than men in the study (609 to 169). There was no relationship between numbers of previous traumas and non-temporomandibular joint operations and types of temporomandibular disorder. However, there were statistically significant relationships between the severity of facial pain and the frequency of facial pain as well as between the severity and frequency of joint pain and the number of traumas. There were also statistically significant associations between the severity and frequency of facial pain and the number of non-temporomandibular joint-related surgical procedures that the patient had undergone. CONCLUSIONS There is a relationship between a patients reported history of trauma and/or non-temporomandibular joint-related operations and the severity and frequency of facial and temporomandibular joint pain, should it develop. It is possible that such traumas and operations sensitize the patient in such a way that the pain of subsequent temporomandibular joint disorders is heightened.

Chronic Pain in a Biracial Cohort of Young Women

This is a longitudinal study of a large US biracial community cohort of 732 young women - 50% African-American and 50% Caucasian - specifically investigating incidence, remission, and progression of, as well as factors associated with common chronic pains (back, head, face, chest and abdomen). The results show back, head and abdominal pains were the most common, severe and persistent pains. Facial pain, although less common and severe, was the only pain presenting significant racial differences with Caucasians having higher prevalence, incidence and persistence; incidence per 1000 person-years was 58 for Caucasians and 18 for African-Americans while remission per 1000 person-years was 107 for Caucasians and 247 for African-Americans (p<0.05). Risk factors associated with incidence (I) differed from those associated with persistence(P), perhaps due to the young age and shorter pain duration in this population. Face pain incidence, but not persistence for example, was associated with student status, fatigue, perceived stress and general health. Depression does not seem to be associated with any of these pains. However, increased number of existing pain sites was related to subsequent increase chance of developing new pain (I) or maintaining the existing pain (P).

Deep and Superficial Masseter Muscle Blood Flow in Women

PURPOSE Although changes in blood perfusion have been described as being associated with temporomandibular disorder (TMD) myofascial pain, very little is known about blood flow levels in the deep and superficial masseter muscle. This study investigated blood flow in deep and superficial sites of six healthy female participants at baseline and during intermittent and continuous biting exercises and recovery. MATERIALS AND METHODS Blood flow was monitored unilaterally using a single-fiber probe laser Doppler flowmeter. The blood flow was continuously monitored at baseline and during two biting exercises: (a) intermittent at 25%, 50%, and 100% maximum voluntary bite force for 30 seconds each followed by 90 seconds rest between each biting level and (b) continuous biting at similar maximum voluntary bite force levels followed by 90 seconds rest. RESULTS There was significantly higher blood flow in the deep sites compared to the superficial sites (p < 0.001) and a significant increase in blood flow during biting compared to baseline (p < 0.001). There were no significant changes in blood flow among the three levels of biting, between the intermittent and continuous exercises, or from baseline blood flow compared to recovery. CONCLUSIONS This study showed regional differences in masseter muscle blood flow, perhaps related to differences in muscle fiber type and pattern of muscle fiber recruitment.

Chronic pain in the community: a survey in a township in Mthatha, Eastern Cape, South Africa

Abstract Background: Comprehensive information is needed on the epidemiology and burden of chronic pain in the population for the development of appropriate health interventions. This study aimed to determine the prevalence, severity, risk indicators and responses of chronic pain among adults in Ngangelizwe, Mthatha, South Africa. Method: A cross-sectional survey utilising structured interviews of a sample of adult residents was used. Interviews elicited information on socio-demographic characteristics, general health status, and the prevalence, duration, frequency, severity, activity limitation and impact of chronic pain. Results: More than 95% (n = 473) of the sampled adults participated in the study. Of these, 182 [38.5%, 95% confidence interval (CI): 36.3–42.5%] reported chronic pain in at least one anatomical site. The most common pain sites were the back and head. The median pain score was 5 on a scale of 0 to 10 [interquartile range (IQR) = 4–7] and the median number of sites of pain was 1 (IQR = 1–2). Female gender [odds ratio (OR) = 2.6, 95% CI: 1.7–3.9] and being older than 50 years of age (OR = 3.5, 95% CI: 2.6–4.1) were identified as risk indicators for chronic pain in the sample. Over 65% of respondents reported that they self-treated; 92.1% had consulted with a doctor or nurse, 13.6% consulted a traditional healer, and 34.5% consulted a pharmacist because of their pain. Despite this, over 50% reported that relief of their pain was transient. Conclusion: Chronic pain is a common general complaint in this community, but there is a need for focused attention on women and the elderly.

Pain as a reason for primary care visits: cross-sectional survey in a rural and periurban health clinic in the Eastern Cape, South Africa

Abstract Background: The burden of pain in primary care has not been described for South Africa. This study aimed to determine the prevalence of pain in primary care and to characterise pain among adult patients attending a rural and a periurban clinic in the Eastern Cape (EC) Province. Method: A cross-sectional descriptive survey was conducted among adult patients attending a rural and periurban clinic over four days. Consecutive patients were asked whether they were in the clinic because of pain and whether the pain was the major reason for their visit. Pain was characterised using an adaptation of the Brief Pain Inventory and the Pain Disability Index. The prevalence percentage and the 95% confidence interval (CI) of pain were estimated, and the relationship with demographic variables was determined at a significance level of P ≤ 0.05. Results: Seven hundred and ninety-six adult patients were interviewed, representing a response rate of 97.4%. Almost three-quarters (74.6%; 95% CI: 63.2–81.4%) reported visiting the clinic because of pain. Pain was the primary reason for 393 (49.4%; 95% CI: 32.1–61.0%) visits and was secondary in 201 (25.3%; 95% CI: 12.8–33.7%) visits. The common sites of pain were the head, back and chest. The median pain score was eight on a scale of 0–10 (interquartile range: 6–8). Respondents experienced limitations in a number of activities of daily living as a result of pain. Conclusion: Pain is a central problem in public primary care settings in the EC Province and must therefore be a priority area for primary care research. Strategies are needed to develop to improve pain management at primary care level in the province.

Immediately loaded implants in a patient with involuntary mandibular movements: A clinical report

Immediately loaded implant prostheses have been used to successfully rehabilitate completely edentulous arches. Risk factors for successful treatment have not included involuntary mandibular movements. The treatment was completed on a patient with a history of neuroleptic medications who had remaining mandibular teeth extracted and then developed involuntary mandibular movements. The patient was dissatisfied with a mandibular removable prosthesis and wanted a fixed prosthesis. The immediate implant loading of a complete arch fixed prosthesis was delivered, and the patient lost 3 of the 6 implants. The patient continued to have problems with her definitive prostheses as the symptoms of her involuntary mandibular movements worsened.