R.M. Davies

Orofacial pain: just another chronic pain? Results from a population-based survey

&NA; Features of somatisation have been shown to predict the onset of widespread body pain. This study aims to determine to what extent persons with orofacial pain syndromes share these features and to what extent they are uniquely related to oral mechanical factors. We have conducted a population‐based cross‐sectional survey in the South‐East Cheshire area of the United Kingdom involving 2504 individuals aged 18–65 years. All participants completed a postal questionnaire which enquired about the occurrence of both orofacial pain and widespread body pain. It also enquired about potential risk factors for one or both conditions. In total, 473 subjects (23%) reported orofacial pain only, 123 (6%) widespread pain only, while 85 (4%) reported both. The number reporting both was significantly higher than would be expected if the symptoms were independent (P<0.001). Several oral mechanical factors were significantly associated with both orofacial pain and widespread body pain (grinding teeth, clicking jaw, missing teeth), while two (facial trauma, locking jaw) were specifically related to orofacial pain. Both pain syndromes were associated equally with high levels of psychological distress, indicators of somatisation and maladaptive response to illness. These results suggest that orofacial pain syndromes may commonly be a manifestation of the process of somatisation and the excess reporting of some local mechanical factors amongst persons with these symptoms, may not be uniquely associated with pain in the orofacial region.

Thermal effects of the Er:YAG laser on a simulated dental pulp: a quantitative evaluation of the effects of a water spray

OBJECTIVES To quantify the temperature increments in a simulated dental pulp following irradiation with an Er:YAG laser, and to compare those increments when the laser is applied with and without water spray. METHODS Two cavities were prepared on either the buccal or lingual aspect of sound extracted teeth using the laser. One cavity was prepared with water spray, the other without and the order of preparation randomised. Identical preparation parameters were used for both cavities. Temperature increments were measured in the pulp chamber using a calibrated thermocouple and a novel pulp simulant. RESULTS Maximum increments were 4.0 degrees C (water) and 24.7 degrees C (no water). Water was shown to be highly significant in reducing the overall temperature increments in all cases (p<0.001; paired t-test). None of the samples prepared up to a maximum of 135 J cumulative energy prepared with water spray exceeded that threshold at which pulpal damage can be considered to occur. Only 25% of those prepared without water spray remained below this threshold. DISCUSSION Extrapolation of the figures suggests probably tolerable limits of continuous laser irradiation with water in excess to 160 J. With the incorporation of small breaks in the continuity of laser irradiation that occur in the in vivo situation, the cumulative energy dose tolerated by the pulp should far exceed these figures. CONCLUSIONS The Er:YAG laser must be used in conjunction with water during cavity preparation. As such it should be considered as an effective tool for clinical use based on predicted pulpal responses to thermal stimuli.

OCCLUSAL CARIES DIAGNOSIS : AN IN VITRO HISTOLOGICAL VALIDATION OF THE ELECTRONIC CARIES MONITOR (ECM) AND OTHER METHODS

OBJECTIVES The aim of this in vitro study was to validate the use of the Electronic Caries Monitor (ECM) for the detection of enamel and dentinal caries on the occlusal surfaces of posterior teeth, and to compare it with visual examination, fibre-optic transillumination, conventional and digital bitewing radiography. METHODS One-hundred and three extracted posterior permanent teeth with no apparent occlusal cavitation were selected and examined using each system. Thirty teeth were re-examined with each system to assess repeatability. Each tooth was then serially sectioned and examined histologically for occlusal caries. RESULTS The occlusal surfaces of 25 teeth had caries in enamel and 37 had dentinal carious lesions. The sensitivity and specificity of the ECM were 0.78 and 0.80 for the diagnosis of occlusal dentinal lesions (cut-off = 0.391) and 0.65 and 0.73 for enamel lesions (cut-off = 0.501). The weighted kappa value for repeatability of the ECM was 0.68. Of the other diagnostic systems, visual examination provided the best combination of sensitivity and specificity, 0.24 and 0.97 for dentinal caries and 0.60 and 0.73 for enamel caries, respectively. CONCLUSION The ECM was the most accurate diagnostic tool for the in vitro diagnosis of early, non-cavitated occlusal lesions on posterior teeth.

Prevention. Part 4: Toothbrushing: What advice should be given to patients?

This paper examines and summarises the evidence to support the advice that GDPs should give their patients on toothbrushing. The strength of evidence is graded using a five-point hierarchical scale. Much of the evidence to support toothbrushing advice is relatively weak but the increasing number of high quality systematic reviews will gradually improve the strength of evidence to support effective programmes of preventive care. Clinicians can play an important role in maximising the benefits of toothbrushing with fluoride toothpaste for patients of all ages. This well-accepted health behaviour can, if implemented correctly, reduce the establishment and advance of the two major dental diseases.

Predictors of Outcome for Orofacial Pain in the General Population: a Four-year Follow-up Study

Orofacial pain is often persistent, but it is not clear why it lasts in some patients but not in others. We aimed to describe the natural course of orofacial pain in a general population sample over a four-year period and to identify factors that would predict the persistence of pain. A cross-sectional population-based survey was conducted in the United Kingdom, involving 2504 participants (participation rate 74%), of whom 646 (26%) reported orofacial pain. Overall, 424 (79% adjusted participation rate) of these individuals participated at the four-year follow-up, of whom 229 (54%) reported orofacial pain and 195 (46%) did not report such pain. Persistent orofacial pain was associated with females, older age, psychological distress, widespread body pain, and taking medication for orofacial pain at baseline. These findings may have implications for the identification and treatment of patients with orofacial pain.

Association between female hormonal factors and oro-facial pain: study in the community.

&NA; The aim of this study was to determine the relationship between the prevalence of oro‐facial pain (OFP) in the population and female hormonal factors. The cross‐sectional population study was conducted in a general medical practice in the north‐west of England. A random sample of 4000 adults aged 18–65 years were mailed questionnaires, of whom 2504 responded (adjusted participation rate 74%). Of these 1245 women provided information on both OFP and hormonal factors. For pre‐ or peri‐menopausal women, there was no relationship between oral contraceptive use and OFP (age‐adjusted relative risk (RR) 1.10; 95% confidence interval (CI) 0.81, 1.45), whilst a high score on a pre‐menstrual symptom questionnaire was associated with an age‐adjusted RR of 1.87 (95% CI 1.36, 2.57). Those who reported menstruating for 6 days or longer had moderate increase in risk of OFP (age‐adjusted RR 1.39; 95% CI 1.01, 1.91). In post‐menopausal women, there was a moderate relationship between hormone replacement therapy use and OFP (age‐adjusted RR 1.46; 95% CI 1.02, 2.08). For women overall, there was an increased risk of OFP in those who reported ever having had painful periods (age‐adjusted RR 1.47; 95% CI 1.20, 1.80), but no association was found with the number of children. This cross‐sectional community‐based study adds important information on the relationship between female hormonal factors and OFP. Women who report OFP are more likely to report symptoms associated with menstruation. This may indicate either the importance of hormones per se or identify a group of women who are more likely to report symptoms in general.

Toothbrushing Habits and Caries Experience

dental caries is strongly influenced by the way it is used. Recent studies [Chesters et al., 1992; Sjögren and Birkhed, 1993; O’Mullane et al., 1997] have reported that both brushing frequency and mouthrinsing after using toothpaste have an important effect on anticaries benefits. The aim of this study was to confirm the association between reported toothbrushing and rinsing behaviour and caries experience in adolescents from Manchester, UK. A total of 2,888 adolescents in the Manchester area, aged 15–16 years, who had used a toothpaste containing 1,000 ppm F during the previous 3 years participated. The caries experience of each individual was determined at the dentinal level using the visual criteria described by Downer [1975] and the diagnosis of approximal lesions was supplemented with fibre-optic transillumination (FOTI). Under supervision each participant completed a questionnaire which requested information on the frequency of brushing, amount of toothpaste used and rinsing behaviour. Independent sample t tests were used to compare mean DMFT values between different groups. A forward stepwise multiple regression model was fitted to DMFT, with the three toothbrushing variables for potential inclusion in the model. A probability of entry into the model was set at 0.05 and for exclusion 0.10. Short Communication

Periodontal disease in a Beagle dog colony

Abstract The histological and macroscopic features of periodontal disease were examined in 40 Beagle dogs, aged between 1 and 8 years. Subclinical gingivitis was associated with the presence of a few polymorphonuclear leucocytes within the sulcular and junctional epithelium and a mild inflammatory cell infiltration of the underlying connective tissue. In established gingivitis the junctional epithelium proliferated into the underlying connective tissue which was densely infiltrated by inflammatory cells mainly of the plasma cell type and large numbers of polymorphonuclear leucocytes accumulated between the sulcular epithelium and the subgingival deposits of bacterial plaque. The progressive destruction of the connective tissue attachment to the tooth was associated with migration of the junctional epithelium beyond the cement-enamel junction and loss of alveolar bone. The results suggest that the Beagle dog may be a useful research model for the further study of periodontal disease and its prevention.

The Prevalence and Severity of Fluorosis in Children Who Received Toothpaste Containing either 440 or 1,450 ppm F from the Age of 12 Months in Deprived and Less Deprived Communities

This study compared fluorosis in the upper central incisors of children from socially diverse backgrounds who had received either 440- or 1,450-ppm F toothpaste from 12 months of age. The children were resident in non-fluoridated districts in the north-west of England. They received either 440- or 1,450-ppm F toothpaste and advice regarding its use until the age of 5–6 years. Dental fluorosis (TF index) was assessed on digital images of dried teeth when the children (n = 1,268) were 8–10 years old. In the less deprived districts the prevalences of fluorosis (TF ≧0) for the 1,450- and 440-ppm F groups were 34.5 and 23.7% (p = 0.006). In the deprived districts the prevalences of fluorosis were 25.2 and 19.5% (p = 0.2). Overall the prevalences of TF ≧2 were 7 and 2.1% for the 1,450- and 440-ppm F groups and 2.2 and 0.2% for TF ≧3. These differences were statistically significant (p < 0.003). There was a strong association between the deprivation status of wards and fluorosis. Only 1 subject with a TF score of 3 was identified in the two most deprived quintiles of the Townsend score. It is concluded that careful targeting of programmes of this type to children living in high caries risk deprived communities carries only a small risk of aesthetically objectionable fluorosis (TF >2) whether low or high fluoride toothpastes are used. High fluoride (1,450 ppm F) toothpastes should not be provided on a community basis to very young children in less deprived communities.

A six-month clinical study of the effect of a pre-brush rinse on plaque removal and gingivitis.

The effect of a pre-brush rinse (Colgate Plax, Colgate UK) containing 0.03% triclosan (Irgacare MP, Ciba-Geigy Corp.) and 0.125% of a copolymer of methoxyethylene and maleic acid (Gantrez, ISP Corp.) on existing plaque and gingivitis over a 6-month period was compared to a matching placebo pre-brush rinse. The study was a double-blind, parallel design utilising 125 subjects, 117 of whom completed the 6-month period. Subjects rinsed twice daily for 60 seconds with 15 ml of their assigned pre-brush rinse. Immediately after rinsing, subjects brushed their teeth for 30 seconds with a fluoride dentifrice and a soft-bristled toothbrush. After 3 and 6 months, the levels of plaque and gingivitis were significantly lower in the triclosan/copolymer rinse group when compared with the placebo rinse group. The beneficial effects of the active rinse were particularly evident on the surfaces of teeth which are poorly cleaned by mechanical procedures. No side effects, such as staining, were observed or reported. The results indicate that the twice daily use of a pre-brush rinse containing triclosan and copolymer can provide significant adjunctive benefits to mechanical oral hygiene procedures