| 1. |
- Baad-Hansen, Lene, et al.
(författare)
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Chair-side intraoral somatosensory examination in patients with atypical odontalgia and healthy subjects
- 2012
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Chair-side intraoral somatosensory examination in patients with atypical odontalgia and healthy subjects L Baad-Hansen, M Pigg, S Elmasry Ivanovic, H Faris, T List, M Drangsholt, P Svensson Aim of investigation: In patients with persistent orofacial pain, assessment of somatosensory function is recommended. A chair-side qualitative examination with good reliability revealing signs of hyper-/hyposensitivity to touch, cold and painful pinprick stimulation may be performed. The aim of this multicenter study was to compare three qualitative measures of intraoral somatosensory function between patients with atypical odontalgia (AO) and healthy subjects. Methods: 31 AO patients (6 male, 25 female; mean age: 54±13) and 47 healthy age- and sex-matched controls (15 male, 32 female: mean age: 47±12) were recruited from Malmö University (Sweden), University of Washington (USA) and Aarhus University (Denmark). In AO patients, sensitivity to touch, cold, and pinprick stimuli was evaluated on the buccal gingiva adjacent to the painful site and the corresponding contralateral ‘mirror-image’ gingival site. In healthy subjects, tests were performed bilaterally on the buccal gingiva adjacent to the first maxillary premolars. Patients were asked to report hyper-, hypo-, or normo-sensitivity/- algesia to touch, cold and painful stimuli on the painful site compared with the contralateral site; healthy subjects were asked to compare sensitivity between sides. Χ2-tests were used to analyze differences in frequency of hyper-, hyposensitivity or normosensitivity between groups. Results: The frequency of subjectively reported normosensitivity to all stimulus modalities were significantly lower in patients (23-58%) than in healthy subjects (68-91%), P<0.001. Frequency of hypersensitivity to all modalities were significantly higher in patients (29-61%) than in controls (9-17%), P<0.015, whereas reports of hyposensitivity were similar between groups (2-16%), P>0.054. Conclusion: A quick and simple chair-side evaluation of intraoral somatosensory function can detect intraoral sensory disturbances in AO patients, mainly in the form of hyper-sensitivity. These tests may be useful in the initial screening of patients with persistent orofacial pain.
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| 2. |
- Baad-Hansen, Lene, et al.
(författare)
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Chairside intraoral qualitative somatosensory testing : reliability and comparison between patients with atypical odontalgia and healthy controls
- 2013
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Ingår i: Journal of Orofacial Pain. - : Quintessence. - 1064-6655 .- 1945-3396. ; 27:2, s. 165-170
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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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| 3. |
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| 4. |
- Baad-Hansen, Lene, et al.
(författare)
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Intraoral somatosensory abnormalities in patients with atypical odontalgia : a controlled multicenter quantitative sensory testing study
- 2013
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Ingår i: Pain. - : Elsevier. - 0304-3959 .- 1872-6623. ; 154:8, s. 1287-1294
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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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| 5. |
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| 6. |
- Baad-Hansen, Lene, et al.
(författare)
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Reliability of intraoral quantitative sensory testing (QST) in patients with atypical odontalgia and healthy controls : a multicenter study
- 2014
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Reliability of intraoral quantitative sensory testing (QST) in patients with atypical odontalgia and healthy controls – a multicenter study The reliability of a comprehensive intraoral quantitative sensory testing (QST) protocol has not been examined systematically in patients with chronic orofacial pain. Also, the reliability of QST z-scores has not been reported. Aim of Investigation: The aim of the present multi-center study was to examine test-retest and inter-examiner reliability of intraoral QST measures in terms of absolute values and z-scores as well as within-session coefficients of variation (CV) values in patients with atypical odontalgia (AO) and healthy pain-free controls. Methods: Fourty-five AO patients and 68 healthy controls were subjected to bilateral intraoral gingival QST and unilateral extraoral QST (thenar) on three occasions (twice on one day by two different examiners and once approximately one week later by one of the examiners). Interclass correlation coefficients and kappa values for inter-examiner and test-retest reliability were computed. Results: Most of the standardized intraoral QST measures (absolute values and z-scores) showed fair to excellent inter-examiner (9-12 of 13 measures) and test-retest (7-11 of 13 measures) reliability. Furthermore, no robust differences in reliability measures or within-session variability (CV) were detected between AO patients and the healthy reference group. Conclusions: These reliability results in chronic orofacial pain patients support earlier suggestions based on data from healthy subjects that intraoral QST (absolute values as well as z-scores) is sufficiently reliable for use as a part of a comprehensive evaluation of patients with somatosensory disturbances or neuropathic pain in the trigeminal region.
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| 7. |
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| 8. |
- Drangsholt, Mark, et al.
(författare)
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Quantitative Sensory Testing of Chronic Continuous Dentoalveolar Pain
- 2010
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)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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| 9. |
- El-Masry Ivanovic, Susanne, et al.
(författare)
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PRELIMINARY REPORT OF RELIABILITY OF QUANTITATIVE SENSORY TESTING (QST) IN PATIENTS WITH PERSISTENT IDIOPATHIC DENTOALVEOLAR PAIN
- 2010
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Ingår i: Abstracts of the 13th World Congress of Pain. - : IASP (International Association for the Study of Pain and Omnipress).
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The German Network for Neuropathic Pain (DFNS) has recommended a protocol with 13 quantitative sensory testing (QST) measures for detection of somatosensory abnormalities. We have recently reported that the reliability of intraoral QST in healthy subjects is acceptable for most QST measures. This study investigated the inter- and intra-examiner reliability of 13 intraoral QST measures at the painful site and pain-free control site in patients with persistent idiopathic dentoalveolar pain. Methods: Seven female patients (61 ± 14 years) with atypical odontalgia (AO), a chronic continuous dentoalveolar pain (CCDAP) condition, have so far been included in this ongoing study. The average AO pain was 6.3 ± 2.4 assessed on a 0-10 numerical rating scale (NRS). Two trained, blinded examiners examined the patients using the DNFS QST protocol. Each patient was examined twice on the same day, once by each examiner (inter-examiner reliability). After 1-2 weeks, one examiner examined all patients again (intra-examiner reliability). The parameters tested were: thresholds for detection of cold (CDT) and warmth (WDT), pain on cold (CPT) and heat (HPT), thermal sensory limen (TSL) and paradoxical heat sensations during this procedure (PHS); thresholds for mechanical detection (MDT) and pain (MPT), vibration detection (VDT) and pressure pain (PPT); mechanical pain sensitivity (MPS), dynamic mechanical allodynia (DMA) and wind-up ratio (WUR) for pinprick pain were also recorded. All testing was made at the buccal gingiva adjacent to the painful tooth (P) and at a corresponding contralateral gingival site (CO). The skin of the right hand (thenar) was also tested. Intraclass correlation coefficient (ICC) for continuous variables and kappa value for categorical variables (PHS, DMA) were used to calculate correlations ICC <0.4 was considered poor; 0.4-0.59 fair; 0.6-0.75 good; and >0.75 excellent agreement, and for Kappa: ≤ 0.2 poor; 0.21-0.40 fair; 0.41-0.60 moderate; 0.61-0.80 good; and 0.81-1.00 excellent agreement. Results: On CO site, intra-examiner reliability was excellent for MPS, DMA and VDT; fair-good for CDT, TSL, MPT and WUR; poor for HPT, MDT and PPT. Inter-examiner reliability: excellent for DMA and VDT; fair-good for CDT, TSL, MPT and MPS; poor for WDT, CPT, HPT, MDT, WUR and PPT. On P site, intra-examiner reliability was excellent for MPS, VDT and PPT; fair-good for WDT, TSL, MDT and WUR; poor for CDT, CPT, HPT, DMA and MPT. Inter-examiner reliability: fair-good for CDT, CPT, MDT, MPT, MPS, VDT and PPT; poor for WDT, TSL, PHS, HPT, DMA and WUR. Conclusions: This initial assessment of the inter- and intra-examiner reliability of intraoral QST measures shows, that most are acceptable for assessment of somatosensory function in patients with persistent idiopathic dentoalveolar pain.
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| 10. |
- Nilsson, Ing-Marie, et al.
(författare)
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Headache and Co-morbid Pains Associated with TMD Pain in Adolescents
- 2013
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Ingår i: Journal of Dental Research. - : Sage Publications. - 0022-0345 .- 1544-0591. ; 92:9, s. 802-807
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Tidskriftsartikel (refereegranskat)abstract
- This case-control study evaluated the association of headache and other co-morbid pain with temporomandibular disorder (TMD) pain in adolescents and explored the temporal co-variance of headache and TMD pain. In a population-based sample of 12- to 19-year-olds, 350 patients with self-reported TMD pain and 350 healthy age- and sex-matched individuals were mailed questionnaires. Descriptive statistics, 95% CI, and OR analyses-logistic regression models with TMD pain as the outcome variable and adjusted for age and gender-were used for the analysis of individuals' responses. Headache, whether defined as once a week or more (OR = 6.6) or as moderate or severe (categorical), was significantly related to TMD pain. Severe headache (vs. mild) showed stronger associations with TMD (OR = 10.1) than between moderate and mild headache (OR = 5.5). Neck (OR = 4.0) and back (OR = 2.6) pain was also significantly related to TMD pain. When participants were grouped according to headache onset and TMD pain, the highest association between headache and TMD pain was found in the subgroup "Headache onset before TMD pain" (OR 9.4). In conclusion, headache appears to be independently and highly associated with TMD pain in adolescents. Neck pain and somatic complaints were also significantly associated with TMD pain. Headache seems to precede TMD pain in many adolescents with pain.
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| 11. |
- Nilsson, Ing-Marie, et al.
(författare)
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Impact of temporomandibular disorder pain in adolescents : differences by age and gender
- 2009
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Ingår i: Journal of Orofacial Pain. - : Quintessence. - 1064-6655 .- 1945-3396. ; 23:2, s. 115-122
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To evaluate the impact of temporomandibular disorder (TMD) pain by age and gender in adolescents, with assessments of this impact specifically on school absence, medication consumption, perceived need for treatment, jaw function limitation, depressive symptoms scores and somatic complaints, and graded chronic pain scale. METHODS: In a population-based sample, a mailed questionnaire was sent to 350 patients with self-reported TMD pain (group 1) and 350 healthy age- and sex-matched individuals (group 2) aged 12 to 19 years 2 to 4 weeks after their annual dental examination. The groups were divided into younger (age 12 to 15) and older (age 16 to 19) groups. Descriptive statistics and 95% confidence intervals were used, and chi-square and t-tests were calculated for analyzing group differences. Odds ratios were estimated using logistic regression. RESULTS: As expected, groups 1 and 2 differed significantly in most variables related to psychosocial and behavioral factors. For adolescents reporting TMD pain once a week or more, no gender or age differences in pain intensity were seen. Jaw function limitation, depressive symptoms scores, somatic complaints, graded chronic pain, and perceived need for TMD treatment were all significantly higher in girls than in boys. Older girls reported higher analgesic consumption and school absences than older boys. CONCLUSION: Girls reporting TMD pain had significantly greater impact on behavioral and psychosocial factors than boys. Almost one third of older girls, compared to one out of 10 older boys, reported school absences and analgesic consumption because of their TMD pain.
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| 12. |
- Nilsson, Ing-Marie, et al.
(författare)
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Impact of Temporomandibular Disorder Pain in Adolescents: Differences by Age and Gender
- 2009
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Ingår i: Journal of Orofacial Pain. - 1064-6655 .- 1945-3396. ; 23:2, s. 115-122
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To evaluate the impact of temporomandibular disorder (TMD) pain by age and gender in adolescents, with assessments of this impact specifically on school absence, medication consumption, perceived need for treatment, jaw function limitation, depressive symptoms scores and somatic complaints, and graded chronic pain scale. Methods: In a population-based sample, a mailed questionnaire was sent to 350 patients with self-reported TMD pain (group 1) and 350 healthy age- and sex-matched individuals (group 2) aged 12 to 19 years 2 to 4 weeks after their annual dental examination. The groups were divided into younger (age 12 to 15) and older (age 16 to 19) groups. Descriptive statistics and 95% confidence intervals were used, and chi-square and t-tests were calculated for analyzing group differences. Odds ratios were estimated using logistic regression. Results: As expected, groups I and 2 differed significantly in most variables related to psychosocial and behavioral factors. For adolescents reporting TMD pain once a week or more, no gender or age differences in pain intensity were seen. Jaw function limitation, depressive symptoms scores, somatic complaints, graded chronic pain, and perceived need for TMD treatment were all significantly higher in girls than in boys. Older girls reported higher analgesic consumption and school absences than older boys. Conclusion: Girls reporting TMD pain had significantly greater impact on behavioral and psychosocial factors than boys. Almost one third of older girls, compared to one out of 10 older boys, reported school absences and analgesic consumption because of their TMD pain. J OROFAC PAIN 2009;23; 115-122
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| 13. |
- Nilsson, Ing-Marie, et al.
(författare)
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Incidence and temporal patterns of temporomandibular disorder pain among Swedish adolescents
- 2007
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Ingår i: Journal of Orofacial Pain. - : Quintessence. - 1064-6655 .- 1945-3396. ; 21:2, s. 127-32
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To estimate the incidence of temporomandibular disorder (TMD) pain among Swedish adolescents by age and gender and to describe the temporal patterns of TMD pain.METHODS: This 3-year longitudinal study was carried out at all Public Dental Service clinics in a Swedish county from 2000 to 2003. All individuals aged 12 to 19 years in the county who visited the clinics for annual examinations were eligible for the study.RESULTS: Overall, the incidence of TMD pain among all adolescents was 2.9% annually among 2,255 participating adolescents. Incidence among girls was significantly higher than in boys, 4.5% versus 1.3%, respectively. Incidence increased with age in girls and boys, although less so in boys (3.0% to 6.9% versus 1.7% to 2.6%). These adolescents were re-examined annually for 3 years, and a fluctuating pattern of TMD pain was common. Overall, 11.4% of all subjects reported TMD pain on at least 1 occasion; 88.6% of the cohort remained pain-free. Of those reporting TMD pain, 4.7% could be defined as intermittent cases, 3.1% were single-incident cases, 0.9% were recurrent cases, and 0.9% had continuing pain for 1 or 2 years.CONCLUSION: The incidence of self-reported TMD pain among Swedish adolescents aged 12 to 19 years increased with age, particularly among girls. The pattern of pain in most adolescents fluctuated over time. Less than 1% of the cohort had continued pain over each year, and the majority of these subjects were girls.
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| 14. |
- Nilsson, Ing-Marie, et al.
(författare)
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Incidence of temporomandibular disorders and pain among adolescents in a Swedish county
- 2007
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Ingår i: Journal of Orofacial Pain. - 1064-6655 .- 1945-3396. ; 21:2, s. 127-132
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To estimate the incidence of temporomandibular disorder (TMD) pain among Swedish adolescents by age and gender and to describe the temporal patterns of TMD pain. METHODS: This 3-year longitudinal study was carried out at all Public Dental Service clinics in a Swedish county from 2000 to 2003. All individuals aged 12 to 19 years in the county who visited the clinics for annual examinations were eligible for the study. RESULTS: Overall, the incidence of TMD pain among all adolescents was 2.9% annually among 2,255 participating adolescents. Incidence among girls was significantly higher than in boys, 4.5% versus 1.3%, respectively. Incidence increased with age in girls and boys, although less so in boys (3.0% to 6.9% versus 1.7% to 2.6%). These adolescents were re-examined annually for 3 years, and a fluctuating pattern of TMD pain was common. Overall, 11.4% of all subjects reported TMD pain on at least 1 occasion; 88.6% of the cohort remained pain-free. Of those reporting TMD pain, 4.7% could be defined as intermittent cases, 3.1% were single-incident cases, 0.9% were recurrent cases, and 0.9% had continuing pain for 1 or 2 years. CONCLUSION: The incidence of self-reported TMD pain among Swedish adolescents aged 12 to 19 years increased with age, particularly among girls. The pattern of pain in most adolescents fluctuated over time. Less than 1% of the cohort had continued pain over each year, and the majority of these subjects were girls.
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| 15. |
- Nilsson, Ing-Marie, et al.
(författare)
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Prevalence of temporomandibular pain and subsequent dental treatment in Swedish adolescents
- 2005
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Ingår i: Journal of Orofacial Pain. - : Quintessence. - 1064-6655 .- 1945-3396. ; 19:2, s. 144-150
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To assess the prevalence of temporomandibular disorder (TMD) pain in Swedish adolescents and related TMD treatment by dentists. Methods: All youth aged 12–19 years in Östergötland County were eligible to participate in the investigation, which took place at public dental clinics during annual examinations in 2000. The subjects were asked two questions: 1) Do you have pain in your temples, face, jaw joint, or jaws once a week or more? or 2) Do you have pain when you open your mouth wide or chew, once a week or more? Two hundred dental records of patients with TMD pain and 100 records of patients with documented dental caries were randomly selected from the population. A comparison of treatment for TMD pain and caries was assessed from these records. Results: Among the 28,899 youths participating, 4.2% reported TMD pain. The prevalence increased with age, and a significant difference was seen between boys (2.7%) and girls (6.0%) (P<0.001). In 43% of the patients with TMD pain, the TMD condition was noted in the record. TMD-related treatment was given to 34% of patients with TMD pain in dental clinics, whereas 100% of the patients with caries received restorative treatment. The most common treatment modalities for the TMD group were information about TMD and occlusal splints. Conclusion: The prevalence of self-reported TMD pain was relatively low, increased in age, and was more common in girls than boys. One-third of the patients with TMD pain received some form of TMD treatment in the dental clinics.
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| 16. |
- Nilsson, Ing-Marie, et al.
(författare)
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The reliability and validity of self-reported temporomandibular disorder pain in adolescents
- 2006
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Ingår i: Journal of Orofacial Pain. - : Quintessence. - 1064-6655 .- 1945-3396. ; 20:2, s. 138-44
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To evaluate the reliability and validity of self-reported pain associated with temporomandibular disorders (TMD) in adolescents and to determine how this validity may change over time. The authors' hypothesis was that self-reported pain can be used to reliably and accurately detect adolescents with TMD pain.METHODS: One hundred twenty adolescents, 60 with self-reported TMD pain and 60 age- and gender-matched controls without TMD pain, were examined twice. At the first examination at a Public Dental Service clinic, self-reported TMD pain was recorded for each patient. At the second examination, a clinical examination was completed, blind to the patients' self-report of pain symptoms, after which self-reported TMD pain was again recorded. The clinical examination was based upon the Research Diagnostic Criteria for TMD (RDC/TMD). Self-reported TMD pain in this investigation was based upon the subjects' responses to 2 questions: (1) Do you have pain in your temples, face, temporomandibular joint (TMJ), or jaws once a week or more? and (2) Do you have pain when you open your mouth wide or chew once a week or more?RESULTS: Test-retest reliability of .83 (kappa) was found for the 2 questions. The sensitivity was .98 (95% CI, .90 to 1.0) and specificity was .90 (95% CI, .81 to .95) for comparison of assessments made on the same day. Sensitivity was .96 (95% CI, .85 to .99) and specificity .83 (95% CI, .72 to .90) for assessments made 2 to 4 weeks apart.CONCLUSION: Very good reliability and high validity were found for the self-reported pain questions. A short time interval between the screening question and examination slightly increased the accuracy of the measure. In adolescent populations, the questions in this study can be used to screen for TMD pain.
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| 17. |
- Pigg, Maria, et al.
(författare)
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7-year follow-up of patients with persistent idiopathic dentoalveolar pain : preliminary results
- 2010
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Persistent idiopathic facial pain (intraoral dentoalveolar subset), earlier described as atypical odontalgia (AO), is a chronic continuous dentoalveolar pain (CCDAP) condition commonly suggested to involve neuropathic pain mechanisms. The longterm prognosis of neuropathic pain conditions is generally not favorable, but has been insufficiently studied in intraoral pain patients. Aim: The aim of this prospective study was to examine the long-term prognosis of CCDAP (AO). Methods: We have earlier described the characteristics of 46 consecutive patients diagnosed with AO (List et al. 2007). Follow-up data on 27 of these patients have so far been collected and are included in this report. In 2002 and 2009, the patients completed validated questionnaires and instruments including pain and disability characteristics (pain frequency, characteristic pain intensity (CPI), average pain intensity (0-10 numerical rating scale, NRS) and graded chronic pain severity (GCPS)); psychological status (SCL-90 according to the RDC/TMD: depression and non-specific physical symptoms scores); ongoing treatment and a global improvement rating. Baseline and follow-up data were compared using paired samples t-test at 5 % significance level. Results: 23 women and 4 men were included (mean age 64, range 38-80 years). Pain frequency: 67% reported continuous pain at baseline and 33% at follow-up (p = .03). Occasional pain was reported by 0% at baseline compared to 19% at follow-up (p = .02). CPI scores (mean ± SD) decreased from baseline (59 ± 18) to follow-up (40 ± 25; p = .001). Also, average pain intensity decreased from baseline (5.6 ± 2.0) to follow-up (3.6 ± 2.5; p=.001). A >30 % pain reduction was seen for 24 % of the patients, 1-30 % pain reduction for 40 %, unchanged pain for 24 %, and 12 % reported increased pain. GCPS: Fewer patients scored Grade III-IV at follow-up (7.4 %) than at baseline (29.6 %; p=0.031). Grade 0 was 0% at baseline and 11.1 % at follow-up (p = .083). SCL-90 scores reported by the AO patients for depression at follow-up was: 39% severe, 26% moderate and 42% normal, and for non-specific physical symptoms 62% severe, 11% moderate and 27% normal with no significant differences between baseline and follow-up (p > .5). Global improvement: 54% rated their overall pain status as improved, 42% as unchanged and 4% as worse. Ongoing treatment was use of occlusal splints (41%); analgesics, tranquilizers and sedatives (all 22%); antidepressants (15%); physiotherapy (11%); and gabapentin or pregabalin (both 7%). Conclusions: The preliminary data suggest that a majority of CCDAP (AO) patients improve over time and experience pain reduction of some degree. Psychological status does not change accordingly, and a number of patients report unchanged or even increased pain. The objective of future analysis of this material will be to identify positive and negative predictors for persistent pain.
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| 18. |
- Pigg, Maria, et al.
(författare)
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A 7-year follow-up of patients with atypical odontalgia (AO)
- 2011
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background and Aim: Atypical odontalgia (AO) is a severe chronic dentoalveolar pain condition with a prevalence of about 3% after endodontic treatment. The etiology is suggested to involve neuropathic pain mechanisms, possibly deafferentation of primary sensory neurons in dental pulp. Prior to correct diagnosis, patients with AO frequently undergo multiple and repeated endodontic treatments because of unresolved pain. The aim of this prospective study was to examine the long-term prognosis of AO. Methods: The study included 43 patients diagnosed with AO. Baseline (2002) and follow-up (2009) data were collected by means of validated questionnaires and instruments including pain frequency, characteristic pain intensity (CPI 0—100 score), average pain intensity (0—100 numerical rating scale), graded chronic pain severity (GCPS), psychological status (depression and non-specific physical symptoms scores of the SCL-90R according to the RDC/TMD) and a global improvement rating (PGIC). Baseline and follow-up data were compared using paired samples t-test at 5% significance level. Results: 37 patients (86%) responded; 31 women and 6 men (mean age 63, range 38—81 years). 62% reported continuous pain at baseline and 27% at follow-up (p=.001); 0% at baseline and 16% at follow-up had occasional pain (p=.012). CPI scores decreased from baseline 61±19 to follow-up 39±25 (p<.001). Average pain also decreased, from 5.7±2.0 to 3.5±2.4 (p<.001). 11% had GCPS scores indicating high disability at follow-up compared to 32% at baseline (p=.003). 14% at follow-up and 0% at baseline reported no disability (p=.023). SCL-90R depression scores and non-specific physical symptoms scores showed no significant differences between baseline and follow-up, but remained high. 54% of the patients rated their global status as improved, 41% as unchanged and 5% as worse at follow-up. Conclusion: We conclude that a majority of AO patients experience pain reduction of some degree over time. Psychological status does not change accordingly.
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| 19. |
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| 20. |
- Pigg, Maria, et al.
(författare)
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Do somatosensory abnormalities and responsiveness to local anesthesia in the pain region predict long-term outcome in patients with persistent dento-alveolar pain disorder (PDAP)?
- 2012
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aim of investigation: Persistent dento-alveolar pain disorder (PDAP) is the suggested new name of an enigmatic condition often described as atypical odontalgia, characterized by severe and continuous pain in the teeth and jaws and possibly associated with neuropathic pain mechanisms. In a recent 7-year prospective study, regression analysis found that neither unresponsiveness to peripheral lidocaine injection nor the presence of unspecified somatosensory abnormalities in the pain region could predict pain persistence in PDAP over time. The present study aimed to further explore the relationship between long-term outcome and (i) specified somatosensory abnormalities in the pain region and (ii) the responsiveness to peripheral lidocaine injection, both assessed at baseline. Methods: 43 patients diagnosed with PDAP were followed from 2002 (baseline) to 2009 (follow-up). The long-term outcome measure was overall improvement over time, measured by the 7-point Patient Global Impression of Change (PGIC) scale. The ratings ‘very much improved’ or ‘much improved’ were considered clinically relevant improvement. Quantitative sensory testing (QST) profiles included 9 measures assessing (i) thermal and mechanical function (normo-, hypo-, or hyperfunction), and (ii) signs of central sensitization (CS) (present/absent). Lidocaine injection in the pain area was double-blinded and placebo-controlled, and effective anesthesia was defined as ≥50% reduction in pain 30 min after administration. Descriptive statistics and logistic regressions analyzed the relationship between long-term outcome (PGIC), baseline patient somatosensory characteristics, and baseline lidocaine responsiveness. Results: Follow-up data were available for 37 patients, of which data on both QST profiles and responsiveness to lidocaine injection were available for 26 (70%). 8/26 patients (31%) experienced clinical improvement in their overall pain situation over time. 21/26 patients (81%) had at least one sensory abnormality. Stratified into subgroups, 9 patients (35%) had signs of CS only (represented by gain in windup ratio and/or dynamic mechanical allodynia to brush or vibration stimulus); 6 (23%) had CS + hypofunction in mechanical or thermal perception; 4 (15%) had CS + hyperfunction in mechanical and/or thermal perception and 2 (8%) displayed only hypofunction in mechanical and/or thermal perception. None of the subgroups were associated with overall improvement over 7 years (OR 0.250–0.875, P=0.317–0.923). Average pain before lidocaine injection was 41 mm VAS (SD 25). 30 minutes after injection, 12/26 patients (46%) experienced a ≥50% pain reduction. Effective pain relief from lidocaine was not associated with overall improvement over time (OR 1.25, P=0.793). When QST profiles and lidocaine responsiveness were combined, no possible combination could predict overall improvement (P=0.998–1.0). Conclusion: No predictive value for the long-term outcome of patients with PDAP was found for (i) somatosensory abnormalities revealed by QST, (ii) the responsiveness to peripheral lidocaine injection in the painful region, or (iii) the combination of these. The results should be interpreted with caution due to study design and relatively small sample size, but suggest that these parameters are not strongly associated with long-term outcome as measured by the PGIC instrument.
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- Pigg, Maria, et al.
(författare)
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Reliability of intraoral quantitative sensory testing (QST)
- 2009
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Ingår i: Swedish Dental Journal. - 0347-9994. ; 33:4, s. 222-223
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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.
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| 24. |
- Pigg, Maria, et al.
(författare)
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Reliability of intraoral quantitative sensory testing (QST)
- 2010
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Ingår i: Pain. - : Elsevier. - 0304-3959 .- 1872-6623. ; 148:2, s. 220-226
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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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| 25. |
- Pigg, Maria, et al.
(författare)
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Seven-year follow-up of patients diagnosed with atypical odontalgia : a prospective study
- 2013
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Ingår i: Journal of Orofacial Pain. - : Quintessence. - 1064-6655 .- 1945-3396. ; 27:2, s. 151-164
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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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| 26. |
- Svensson, Peter, et al.
(författare)
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Neurosensory testing of orofacial pain in the dental clinic
- 2012
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Ingår i: The Journal of the American Dental Association (1939). - : American Dental Association. - 0002-8177 .- 1943-4723. ; 143:8, s. e37-e39
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Tidskriftsartikel (refereegranskat)abstract
- CONCLUSIONS Traumatic nerve injuries are associated with distinct changes in somatosensory function. Clinicians need to know that such aberrant sensations are normal when treating patients who have neuropathic pain. Simple neurosensory testing can reveal the extent of such somatosensory changes, and the results of more sophisticated QST methods might be a way to study the mechanisms of orofacial pain
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