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1.
  • Baad-Hansen, Lene, et al. (författare)
  • Intraoral somatosensory abnormalities in patients with atypical odontalgia : a controlled multicenter quantitative sensory testing study
  • 2013
  • Ingår i: Pain;154. - Elsevier. - 0304-3959. ; :154
  • Tidskriftsartikel (refereegranskat)abstract
    • Intraoral somatosensory sensitivity in patients with atypical odontalgia (AO) has not been investigated systematically according to the most recent guidelines. The aims of this study were to examine intraoral somatosensory disturbances in AO patients using healthy subjects as reference, and to evaluate the percent agreement between intraoral quantitative sensory testing (QST) and qualitative sensory testing (QualST). Forty-seven AO patients and 69 healthy control subjects were included at Universities of Washington, Malmö, and Aarhus. In AO patients, intraoral somatosensory testing was performed on the painful site, the corresponding contralateral site, and at thenar. In healthy subjects, intraoral somatosensory testing was performed bilaterally on the upper premolar gingiva and at thenar. Thirteen QST and 3 QualST parameters were evaluated at each site, z-scores were computed for AO patients based on the healthy reference material, and LossGain scores were created. Compared with control subjects, 87.3% of AO patients had QST abnormalities. The most frequent somatosensory abnormalities in AO patients were somatosensory gain with regard to painful mechanical and cold stimuli and somatosensory loss with regard to cold detection and mechanical detection. The most frequent LossGain code was L0G2 (no somatosensory loss with gain of mechanical somatosensory function) (31.9% of AO patients). Percent agreement between corresponding QST and QualST measures of thermal and mechanical sensitivity ranged between 55.6% and 70.4% in AO patients and between 71.1% and 92.1% in control subjects. In conclusion, intraoral somatosensory abnormalities were commonly detected in AO patients, and agreement between quantitative and qualitative sensory testing was good to excellent.
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2.
  • Pigg, Maria, et al. (författare)
  • Reliability of intraoral quantitative sensory testing (QST)
  • 2010
  • Ingår i: Pain;2. - Elsevier. - 0304-3959. ; :2
  • Tidskriftsartikel (refereegranskat)abstract
    • 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. This study evaluates intraoral sites for which no reliability trials have yet been published. Inter- and intra-examiner reliability of 13 QST measures at intra- and extraoral trigeminal sites were investigated. 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. 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. We conclude that inter- and intra-examiner reliabilities of most QST measures are acceptable for assessing somatosensory function in the orofacial region.
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3.
  • Pigg, Maria, et al. (författare)
  • Seven-year follow-up of patients diagnosed with atypical odontalgia : a prospective study
  • 2013
  • Ingår i: Journal of Orofacial Pain;27. - Quintessence. - 1064-6655. ; :27
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: To examine the long-term prognosis of 46 previously examined atypical odontalgia (AO) patients. METHODS: In 2002 and 2009, AO patients completed validated instruments measuring pain characteristics (pain frequency and intensity), physical functioning (Graded Chronic Pain Severity, GCPS) and emotional functioning (Symptoms Checklist, SCL-90R). The main outcome was global improvement. Baseline data on quantitative somatosensory testing and responsiveness to lidocaine injection were available for a subgroup of patients. Paired tests compared baseline and follow-up data, and logistic regression explored the possible prognostic value of baseline data. RESULTS: Data from 37 patients (80%) were obtained. Thirteen patients (35%; 95% confidence intervals [CI] 20.2%-52.5%) rated their overall pain status as significantly improved, 22 (60%; 95% CI 42.1%-75.3%) as a little improved or unchanged, and two patients (5%; 95% CI 0.7%-18.2%) as worse. Five patients (14%; 95% CI 4.5%-28.8%) were pain-free, indicated by a characteristic pain intensity score of 0. Average pain intensity decreased (from 5.7 ± 2.0 to 3.5 ± 2.4; P < .001). Pain frequency (P < .001) and GCPS (P < .001) also decreased, whereas SCL-90R scores remained unchanged and 26 of the 37 patients reported ongoing treatment. Low baseline pain intensity was the only factor predictive of favorable outcome. CONCLUSION: A third of the AO patients improved considerably over time, but for many of the patients, AO was a persistent and treatment-resistant condition.
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4.
  • Baad-Hansen, Lene, et al. (författare)
  • Chairside intraoral qualitative somatosensory testing: reliability and comparison between patients with atypical odontalgia and healthy controls
  • 2013
  • Ingår i: Journal of Orofacial Pain;2. - Quintessence. - 1064-6655. ; :2
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: To assess intraoral inter- and intraexaminer reliability of three qualitative measures of intraoral somatosensory function and to compare these measures between patients with atypical odontalgia (AO) and healthy controls. METHODS: Thirty-one AO patients and 47 healthy controls participated. Inter- and intraexaminer reliability was tested on a subgroup of 46 subjects (25 AO; 21 healthy). Sensitivity to touch, cold, and pinprick stimuli was evaluated on the painful gingival site and the corresponding contralateral site in AO patients, and bilaterally on the gingiva of the first maxillary premolars in controls. Patients were asked to report hypersensitivity, hyposensitivity, or normal sensitivity to stimuli on the painful site compared with the nonpainful site. Kappa values were calculated, and chi-square and Fisher's exact tests were used to compare frequencies between groups. RESULTS: Kappa values ranged between 0.63 and 0.75. The frequency of hypersensitivity to either modality was significantly higher in patients (29% to 61%) than in controls (9% to 17%) (P < .015), whereas reports of hyposensitivity were similar between groups (2% to 16%) (P > .057). Only 3.2% of the AO patients had no reports of abnormal sensitivity on any of the tests, compared with 59.6% of the healthy subjects (P < .001). CONCLUSION: Intraoral qualitative somatosensory testing can detect intraoral sensory disturbances in AO patients, and the reliability is sufficient for initial screening of orofacial somatosensory function.
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5.
  • Drangsholt, Mark, et al. (författare)
  • Quantitative Sensory Testing of Chronic Continuous Dentoalveolar Pain
  • 2010
  • Annan publikation (övrigt vetenskapligt)abstract
    • Objectives: Chronic continuous dentoalveolar pain (CCDAP) is a new term for chronic pain around teeth. Quantitative sensory testing (QST) has shown promise as a tool for studying mechanisms of pain conditions. Aims: 1) compare sensory parameter values in CCDAP patients and symptom-free controls; and 2) characterize the somatosensory profile of patients with CCDAP. Methods: The German Neuropathic Pain QST protocol of 13 somatosensory function tests was adapted for intraoral use. Cases with CCDAP from tertiary care clinics were tested along with symptom-free controls. QST was performed intra-orally on symptomatic facial gingiva, asymptomatic contralateral site, and non-trigeminal site (thumb). Means and standard deviations were compared between symptomatic and asymptomatic sites within cases and with controls. Results: Interim analyses of 17 controls and 13 cases showed a mean age of 37 years for controls and 55 for cases. At the thumb, significant differences (p < 0.05) between cases/controls were apparent for pressure pain threshold (PPT) 353 vs. 453 kPa; mechanical pain threshold (MPT) 75 vs. 161 mN; and cold pain threshold (CPT) 8.4 vs. 2.8 C, all showing cases more sensitive. At the painful gingival site, significant differences between cases/controls existed for: CPT 17.4 vs. 8.1 C; HPT 44 vs. 49 C; MPT 55 vs. 154 mN; and PPT 106 vs. 172 kPa. Non-painful parameters, such as cold and warm detection threshold were generally not significantly different between cases/controls at thumb and painful gingival sites. Among cases only, comparing painful to nonpainful side, MPT was 55 vs. 96 mN; mechanical pain sensitivity 4.7 vs. 3.0; PPT 106 vs. 122 kPa, all more sensitive on the painful site. Conclusions: These results suggest that CCDAP patients are more sensitive to multiple modalities of painful stimulation at both non-trigeminal and trigeminal sites, and may be exhibiting a trigeminal neuropathy with gain in function. Grant: NIHR21DE018768.
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6.
  • 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;4. - 0347-9994. ; :4
  • Annan publikation (övrigt vetenskapligt)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.
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7.
  • 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;4. - 0347-9994. ; :4
  • Annan publikation (övrigt vetenskapligt)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.
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8.
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9.
  • Pigg, Maria (författare)
  • Chronic intraoral pain - assessment of diagnostic methods and prognosis
  • 2011
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • The overall goal of this thesis was to broaden our knowledge of chronic intraoral pain. The research questions were: •What methods can be used to differentiate inflammatory, odontogenic tooth pain from pain that presents as toothache but is non-odontogenic in origin? •What is the prognosis of chronic tooth pain of non-odontogenic origin, and which factors affect the prognosis? Atypical odontalgia (AO) is a relatively rare but severe and chronic pain condition affecting the dentoalveolar region. Recent research indicates that the origin is peripheral nerve damage: neuropathic pain. The condition presents as tooth pain and is challenging to dentists because it is difficult to distinguish from ordinary toothache due to inflammation or infection. AO is of interest to the pain community because it shares many characteristics with other chronic pain conditions, and pain perpetuation mechanisms are likely to be similar. An AO diagnosis is made after a comprehensive examination and assessment of patients’ self-reported characteristics: the pain history. Traditional dental diagnostic methods do not appear to suffice, since many patients report repeated care-seeking and numerous treatment efforts with little or no pain relief. Developing methods that are useful in the clinical setting is a prerequisite for a correct diagnosis and adequate treatment decisions. Quantitative sensory testing (QST) is used to assess sensory function on skin when nerve damage or disease is suspected. A variety of stimuli has been used to examine the percep¬tion of, for example, touch, temperature (painful and non-painful), vibration, pinprick pain, and pressure pain. To detect sensory abnormalities and nerve damage in the oral cavity, the same methods may be possible to use. Study I examined properties of thermal thresholds in and around the mouth in 30 pain-free subjects: the influence of measurement location and stimulation area size on threshold levels, and time variability of thresholds. Thresholds for cold, warmth and painful heat were measured in four intraoral and two extraoral sites. Measurements were repeated 3 times over 6 weeks, using four sizes of stimulation area (0.125–0.81 cm2). The threshold levels were highly dependent on location but less dependent on measuring probe size and time variability was small, and this knowledge is important for the interpretation of QST results. Study II applied a recently developed standardized QST examination protocol (intended for use on skin) inside the oral cavity. Two trained examiners evaluated 21 pain-free subjects on three occasions over 1–3 weeks, at four sites—three intraoral and one extraoral. Most tests had acceptable reliability and the original test instruments and techniques could be applied intraorally with only minor adjustments. Study III examined the value of cone-beam computed tomography (CBCT) in pain investigations. Twenty patients with AO and 5 with symptomatic apical periodontitis (inflammatory tooth pain) participated. The results indicate that when AO is suspected, addition of CBCT can improve the diagnostic certainty compared to sole use of periapical and panoramic radiographs, especially because of the superior ability of CBCT to exclude inflammation as the pain cause. Study IV assessed the long-term prognosis of AO, and analyzed potential outcome predictors.. A comprehensive questionnaire including validated and reliable instruments was used to gather data on patient and pain charac¬teristics and pain consequences from 37 patients in 2002 and 2009. Thirty-five percent of the patients reported substantial overall improvement at follow-up, but almost all still had pain of some degree after many years. The initial high level of emotional distress was unchanged. Low baseline pain intensity predicted improvement over time.
10.
  • Pigg, Maria, et al. (författare)
  • Diagnostic yield of conventional radiographic and cone-beem computed tomographic images in patients with atypical odontalgia.
  • 2011
  • Ingår i: International Endodontic Journal;44. - Wiley. - 1365-2591. ; :44
  • Tidskriftsartikel (refereegranskat)abstract
    • Abstract AIM: To investigate whether the additional diagnostic yield of a cone-beam computed tomography (CBCT) examination over conventional radiographs in patients primarily suspected of having atypical odontalgia (AO) improves differentiation between AO and symptomatic apical periodontitis (SAP) in patients with severe chronic intraoral pain. METHODOLOGY: In this clinical study, 25 patients (mean age 54 ± 11 years, range 34-72) participated; 20 were diagnosed with AO and 5 with SAP. All patients were recruited from the clinics of the Faculty of Odontology, Malmö University. AO inclusion criteria were chronic pain (>6 months) in a region where a tooth had been endodontically or surgically treated, with no pathological cause detectable in clinical or radiologic examinations. SAP inclusion criteria were recurrent pain from a tooth diagnosed with apical periodontitis in clinical and radiographic examinations. Assessments comprised a self-report questionnaire on pain characteristics, a comprehensive clinical examination and a radiographic examination including panoramic and intraoral radiographs and CBCT images. The main outcome measure was periapical bone destruction. RESULTS: Sixty per cent of patients with AO had no periapical bone destructions detectable with any radiographic method. Overall, CBCT rendered 17% more periapical bone destructions than conventional radiography. Average pain intensity in patients with AO was 5.6 (± 1.8) on a 0-10 numerical rating scale, and average pain duration was 4.3 (± 5.2) years. CONCLUSION: Cone-beam computed tomography improves identification of patients without periapical bone destruction, which may facilitate differentiation between AO and SAP.
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