| 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. |
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| 10. |
- List, Thomas, et al.
(författare)
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A new protocol to evaluate the effect of topical anesthesia
- 2014
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Ingår i: Anesthesia Progress. - : Allen Press. - 0003-3006 .- 1878-7177. ; 61:4, s. 135-144
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Tidskriftsartikel (refereegranskat)abstract
- This double-blind, placebo-controlled, randomized cross-over clinical experimental study tested the reliability, validity, and sensitivity to change of punctuate pain thresholds and self-reported pain on needle penetration. Female subjects without orofacial pain were tested in 2 sessions at 1- to 2-week intervals. The test site was the mucobuccal fold adjacent to the first upper right premolar. Active lidocaine hydrochloride 2% (Dynexan) or placebo gel was applied for 5 minutes, and sensory testing was performed before and after application. The standardized quantitative sensory test protocol included mechanical pain threshold (MPT), pressure pain threshold (PPT), mechanical pain sensitivity (MPS), and needle penetration sensitivity (NPS) assessments. Twenty-nine subjects, mean (SD) age 29.0 (10.2) years, completed the study. Test-retest reliability intraclass correlation coefficient at 10-minute intervals between examinations was MPT 0.69, PPT 0.79, MPS 0.72, and NPS 0.86. A high correlation was found between NPS and MPS (r = 0.84; P < .001), whereas NPS and PPT were not significantly correlated. The study found good to excellent test-retest reliability for all measures. None of the sensory measures detected changes in sensitivity following lidocaine 2% or placebo gel. Electronic von Frey assessments of MPT/MPS on oral mucosa have good validity.
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| 11. |
- 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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| 12. |
- 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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| 13. |
- Pigg, Maria, et al.
(författare)
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A comparative analysis of magnetic resonance imaging and radiographic examinations of patients with atypical odontalgia
- 2014
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Ingår i: Journal of oral & facial pain and headache. - : Quintessence. - 2333-0384 .- 2333-0376. ; 28:3, s. 233-242
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To examine (1) the occurrence of magnetic resonance imaging (MRI) signal changes in the painful regions of patients with atypical odontalgia (AO) and (2) the correlation of such findings to periapical bone defects detected with a comprehensive radiographic examination including cone beam computed tomography (CBCT). METHODS: A total of 20 patients (mean age 52 years, range 34 to 65) diagnosed with AO participated. Mean pain intensity (± standard deviation) was 5.6 ± 1.8 on a 0-10 numerical rating scale, and mean pain duration was 4.3 ± 5.2 years. The inclusion criterion was chronic pain (> 6 months) located in a region with no clear pathologic cause identified clinically or in periapical radiographs. In addition to a clinical examination and a self-report questionnaire, the assessments included radiographic examinations (panoramic, periapical, and CBCT images), and an MRI examination. Changes in MRI signal in the painful region were recorded. Spearman's rank correlation between radiographic and MRI findings was calculated. RESULTS: Eight of the patients (40%) had MRI signal changes in the pain region. The correlation to radiographic periapical radiolucencies was 0.526 (P = .003). Of the eight teeth displaying changes in MRI signal, six showed periapical radiolucency in the radiographs. CONCLUSION: MRI examination revealed no changes in the painful region in a majority of patients with AO, suggesting that inflammation was not present. MRI findings were significantly correlated to radiographic findings
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| 14. |
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| 15. |
- Pigg, Maria
(författare)
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Chronic intraoral pain - assessment of diagnostic methods and prognosis
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)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.
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| 16. |
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| 17. |
- Pigg, Maria, et al.
(författare)
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Diagnostic yield of conventional radiographic and cone-beem computed tomographic images in patients with atypical odontalgia
- 2011
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Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 12:44, s. 1092-1101
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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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| 18. |
- 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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| 19. |
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| 20. |
- Pigg, Maria, et al.
(författare)
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Orofacial thermal thresholds : time-dependent variability and influence of spatial summation and test site
- 2011
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Ingår i: Journal of Orofacial Pain. - : Quintessence. - 1064-6655 .- 1945-3396. ; 25:1, s. 39-48
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate time-dependent variability and influence of test site and stimulation area size on intraoral cold detection, warmth detection, and heat pain thresholds. Methods: Thirty healthy volunteers (15 women and 15 men) participated. Six extra- and intraoral sites were examined, and cold detection, warmth detection, and heat pain thresholds were measured. Time variability and influence of spatial summation were also studied at one site-the tip of the tongue-three times over a 6-week period. One-way ANOVA for repeated measures and paired sample t test compared mean values and SD within and between sites for all thresholds. Results: Several between-site differences were significant (P < .05). Lowest intraoral thresholds for all stimuli were measured at the tongue site, and at the tongue, thresholds for warmth detection and heat pain, but not cold detection, decreased with increasing size of stimulation area (P < .05). Overall, thresholds at the tongue site varied nonsignificantly over time (P > .05). Conclusion: Test site affects orofacial thermal thresholds substantially, whereas time variability and spatial summation on the tongue appear to be modest.
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| 21. |
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| 22. |
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| 23. |
- 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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| 24. |
- 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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| 25. |
- Svensson, Peter, et al.
(författare)
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Guidelines and recommendations for assessment of somatosensory function in oro-facial pain conditions - a taskforce report
- 2011
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Ingår i: Journal of Oral Rehabilitation. - : Blackwell Publishing Ltd.. - 1365-2842 .- 0305-182X. ; 5:38, s. 366-394
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Tidskriftsartikel (refereegranskat)abstract
- Summary The goals of an international taskforce on somatosensory testing established by the Special Interest Group of Oro-facial Pain (SIG-OFP) under the International Association for the Study of Pain (IASP) were to (i) review the literature concerning assessment of somatosensory function in the oro-facial region in terms of techniques and test performance, (ii) provide guidelines for comprehensive and screening examination procedures, and (iii) give recommendations for future development of somatosensory testing specifically in the oro-facial region. Numerous qualitative and quantitative psychophysical techniques have been proposed and used in the description of oro-facial somatosensory function. The selection of technique includes time considerations because the most reliable and accurate methods require multiple repetitions of stimuli. Multiple-stimulus modalities (mechanical, thermal, electrical, chemical) have been applied to study oro-facial somatosensory function. A battery of different test stimuli is needed to obtain comprehensive information about the functional integrity of the various types of afferent nerve fibres. Based on the available literature, the German Neuropathic Pain Network test battery appears suitable for the study of somatosensory function within the oro-facial area as it is based on a wide variety of both qualitative and quantitative assessments of all cutaneous somatosensory modalities. Furthermore, these protocols have been thoroughly described and tested on multiple sites including the facial skin and intra-oral mucosa. Standardisation of both comprehensive and screening examination techniques is likely to improve the diagnostic accuracy and facilitate the understanding of neural mechanisms and somatosensory changes in different oro-facial pain conditions and may help to guide management.
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| 26. |
- Wolf, Eva, et al.
(författare)
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Antibiotikabehandling vid endodontiska infektioner
- 2014
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Ingår i: Tandläkartidningen. - : Tandläkarförbundet. - 0039-6982. ; 106:4, s. 76-78
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Tidskriftsartikel (refereegranskat)abstract
- Enligt aktuella nationella riktlinjer (Socialstyrelsen 2012) bör tandvården i första hand erbjuda antibiotikabehandling endast till personer med symtom på grund av apikal parodontit, där infeltionen kring rotspetsen visar på spridning och där personens allmäntillstånd är påverkat. Vid symtomatisk tand då infektionen inte tillfredsställande kan avlägsnas, till exempel då patienten inte kan gapa eller då rotkanalen inte är tillgänglig för infektionsbehandling kan sys- temisk antibiotika ordineras i avvaktan på att endodontisk behandling eller extraktion är möj- lig. Syftet med förskrivningen är då att begränsa spridning av befintlig infektion eller hindra progression av sjukdomen. När allmäntillståndet är påverkat är antibiotikabehandling indicerad eftersom detta är ett tecken på infektionsspridning. För exartikulerade och replanterade permanenta tänder har systemisk antibiotikabehandling tidigare rekommenderats, för att eventuellt underlätta den parodontala läkningen och minska risken för rotresorption. I en senare systematisk översikt har man inte kunnat påvisa några entydiga positiva effekter av detta. Utöver detta rekommenderas lokal antibiotikabehandling av roten före replantering av tand med oavslutad rotutveckling för att öka chanserna för revaskularisering.
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