| 1. |
- Engfalk, Paul, et al.
(författare)
-
Influence of intra- and extraoral sites and size of stimulation area on thermal detection and pain threholds. A methodological study
- 2007
-
Ingår i: Swedish Dental Journal. - 0347-9994. ; 31:4
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Aim: This study compared cool detection thresholds, warm detection thresholds and heat pain thresholds at intra- and extraoral locations and measured the influence of spatial summation. Material and Methods: Thirty healthy individuals (15 females and 15 males), mean age 24.9 years, range 20-31 years) participated in the study. Thresholds for warm detection (WDT), cool detection (CDT) and heat pain threshold (HPT) were measured using a thermotester (MSA–Modular sensory Analyzer, Somedic). The intraoral thermode was custom-made with a 9x9mm square surface. The average of three measurements was recorded. Four intraoral sites (gingival regions 24 and 34, tip of the tongue, lower lip) and two extraoral sites (infraorbitalis, thenar) were measured in each participant. To measure spatial summation, five acrylic covers (tip areas: 0.81 cm2, 0.50 cm2, 0.28cm2, 0.125cm2, 0 cm2) were made to fit the thermode. Five measurements on the tip of the tongue were averaged for each acrylic cover. Results: Of the extraoral sites, the cold detection threshold was significantly higher and the heat pain threshold was significantly lower at the infraorbitalis than at the thenar. Of the intraoral sites, the cold detection threshold was significantly lower at the tongue than at any of the other intraoral locations; the heat pain threshold was significantly lower on the tip of the tongue than on the lower lip. Warm detection and heat pain thresholds rose slightly with increasing thermode size, and this association was more pronounced than for cold detection thresholds. Conclusion: Temperature thresholds differed significantly between several anatomic sites, and the association between size of stimulation area and temperature thresholds was weak.
|
|
| 2. |
- Pigg, Maria, et al.
(författare)
-
A comparative analysis of MRI, CBCT and conventional radiography in patients with atypical odontalgia and symptomatic apical periodontitis : preliminary results
- 2006
-
Ingår i: Swedish Dental Journal. - 0347-9994. ; 30:4, s. 173-174
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Aim: Atypical odontalgia(AO) is a chronic pain condition located in the teeth and jaws. It has been suggested, that AO is best regarded as a neuropathic pain condition, but knowledge regarding the etiology, diagnostics, and management of AO is not yet satisfactory. This pilot study evaluates the clinical usefulness of more recently developed imaging methods for intraoral pain conditions. The aim is to compare the diagnostic findings using magnetic resonance imaging(MRI) and cone beam computed tomography(CBCT) with the findings from conventional radiography in patients with atypical odontalgia(AO) and symptomatic apical periodontitis(SAP). Material and methods: 12 patients (9 F, 3 M) mean age 50,25 years, range 36 - 63 years participated in the study. The patients were referred to the Orofacial Pain Unit or the Department of Endodontics, Faculty of Odontology, Malmö University. Inclusion criteria for AO were chronic pain (>6 months) located in a region where a tooth had been endodontically or surgically treated, pain with no pathological cause detectable in clinical or radiological examinations. For SAP, the inclusion criteria were recurrent pain from a tooth diagnosed with apical periodontitis in a clinical and radiographic examination. Ten of the patients in the study were diagnosed with AO and two with SAP. The patients were clinically assessed with a qualitative somatosensory examination, a dental examination, an examination of the masticatory system(RDC/TMD), and panoramic and intraoral radiographs. A questionnaire was used to gather information about pain characteristics, psychosocial status(SCL-90), and quality of life. Besides these measures, each patient underwent a CBCT(3D-Accuitomo, J Morita Co) examination and a MRI(Siemens Sonata Vision 1.5 T) examination with and without contrast enhancement. Contrast was enhanced by injections of Magnevist (469 mg/ml, Schering Nordiska). Bone destruction, sclerosis, and signs of inflammation were the main parameters studied. Results: In the preliminary results, average pain intensity was 6.3 on a numerical rating scale(NRS) and average pain duration was 3,6 years. 83% exhibited somatosensory abnormalities. Bone destruction not visible in the intraoral and panoramic radiographs was detected with CBCT in 40% (4/10) of the patients diagnosed with AO, and signs of inflammation were detected in the MRIs of 20% (2/10) of the patients diagnosed with AO. Conclusion: Preliminary findings indicate that CBCT and MRI can provide additional information to conventional radiography in the diagnosis of intraoral orofacial pain. Further studies with larger sample sizes of AO and SAP patients are necessary to determine the clinical relevance of these findings.
|
|
| 3. |
- Pigg, Maria, et al.
(författare)
-
Intraoral temperature detection and pain thresholds. Reliability, influence of time and size of stimulation area.
- 2007
-
Ingår i: Swedish Dental Journal. - 0347-9994. ; 31:4
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Aim To investigate the reliability and influence of time and size of the stimulation area on cold detection, warm detection, and painful heat thresholds. Methods Thirty healthy individuals (15 females and 15 males, mean age 24.9 years, range 20–31 years) participated in the study. The subjects were recruited among Malmö University students. Thresholds for warm detection (WDT), cool detection (CDT), and heat pain (HPT) were measured using a thermotester (MSA - Modular Sensory Analyzer, Somedic®). The intraoral thermode was custom-made with a 9 x 9-mm square surface (0.81cm2). Four acrylic tips that could be attached to the top of the thermode were made (tip areas: 0.50 cm2, 0.28 cm2, 0.125 cm2, and 0.00 cm2). Baseline temperature was set at 37.0°C, and the temperature change rate at 1.0°C/s. Patients were instructed to push a stop-button when the threshold was reached. The average of three measurements was recorded. The stimuli were repeated at 4–6-s intervals. Participants were examined on three occasions: at baseline, after 2 weeks (2w), and after 6 weeks (6w). Measurements were made on the tip of the tongue. Two operators who had been calibrated in the investigation method made the measurements. Results Reliability: Acceptable to excellent reliability (test-retest) was found for cool detection thresholds (ICC 0.51), warm detection thresholds (ICC 0.48), and heat pain thresholds (ICC 0.88). Influence of time: Significant differences were found for some measurements made at 2- and 6-week intervals. For cold detection thresholds, measurement differences between baseline and the 2- and 6-week follow-ups were significant (p<0.05); for warm detection thresholds, differences between baseline and the 6-week follow-up were significant (p<0.05); for heat pain thresholds, differences between baseline and the 2- and (p<0.05) and 6-week (p<0.01) follow-ups were significant. Influence of stimulation area: Thresholds for cold detection, warm detection, and painful heat all decreased with increasing stimulation area, but the association was weak. Conclusions Measurements of cool detection, warm detection, and painful heat thresholds on the tip of the tongue with Somedic’s MSA have acceptable to excellent reliability. Threshold measurements varied considerably over a 6-week period. Spatial summation on the tip of the tongue was small.
|
|
| 4. |
- Pigg, Maria, et al.
(författare)
-
Reliability of intraoral quantitative sensory testing (QST)
- 2009
-
Ingår i: Swedish Dental Journal. - 0347-9994. ; 33:4, s. 222-223
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Aim The prevalence of orofacial pain is reported to be around 20%. The most common location is intraoral, including recurrent and persistent pain conditions. Clinical signs and symptoms have been reported to overlap between nociceptive and neuropathic pain conditions, leading to difficulties in differential diagnosis. Somatosensory changes are important clinical features of neuropathic pain, and a comprehensive clinical examination including orofacial as well as qualitative and quantitative somatosensory examinations has been recommended for chronic intraoral pain investigations. The German Research Network on Neuropathic Pain (DFNS) has recommended a protocol with 13 quantitative sensory testing (QST) measures for detecting somatosensory abnormalities. Reliability is an important scientific property and has been adequately tested for cutaneous QST, but not for intraoral sites. The aim of this study was to evaluate the inter-examiner and intra-examiner (test-retest) reliabilities of the DFNS protocol at intra- and extraoral trigeminal sites. Material and methods Twenty-one healthy volunteers from Malmö University, Malmö, Sweden (13 women and 8 men, mean age 40.4 years, range 24–71) participated. Two independent examiners previously trained in the DFNS QST protocol examined the participants using the entire protocol. Each participant was examined twice on the same day, once by each examiner (inter-examiner reliability). After 1–3 weeks, one examiner re-examined all participants (intra-examiner reliability). The measurements were made on the skin of the right cheek, the tip of the tongue, and bilaterally on the gingival mucosa of the upper premolar region. The intraclass correlation coefficient (ICC) or kappa was used to calculate variations. Results Most tests had acceptable to excellent inter-examiner (ICC 0.41–0.89) and intra-examiner (ICC 0.43–0.87) reliability. For each test, inter- and intra-examiner reliabilities at intra- and extraoral sites were similar. No significant differences between right and left sides were found intraorally. Conclusion We conclude that inter- and intra-examiner reliabilities of most QST measures according to the DFNS protocol are acceptable for assessing somatosensory function in the orofacial region.
|
|
