Atypical facial pain and other pain syndromes. Differential diagnosis and treatment

Knowledge of each differential diagnosis of prosopalgia is important to any neurosurgeon who treats facial pain. Pain control is possible with treatment specific to the diagnosis, including those forms of facial pain known to be the most difficult to treat. An outline for the management of atypical facial pain, anesthesia dolorosa, and postherpetic neuralgia is presented with a review of the correlative anatomy for each surgical procedure.

Rat odontogenic tumors associated with disturbed tooth eruption

Most odontogenic tumors occurring in rats have the appearance of immature or mature odontomas. The present brief paper describes two spontaneously occurring odontogenic lesions in rats; both had the appearance of complex odontomas. One was associated with a lesion that had the appearance of an odontogenic fibroma; the other occurred concomitant with a lesion that had the appearance of a cementoblastoma. Their possible relationship with disturbed eruption due to malocclusion is discussed.

Ophthalmic manifestations and complications of dental disease in dogs and cats

Ophthalmic manifestations of dental disease may occur in dogs and cats because of the proximity between posterior maxillary teeth and the orbit. Ophthalmic disorders may be diagnosed promptly, but the initiating dental disease may be overlooked. Inappropriate diagnosis and treatment of dental disease may result in loss of teeth, irreversible vision-threatening ophthalmic disease, or, ultimately, loss of the globe. When ophthalmic examination results are suggestive of a primary dental disorder, thorough examination of the maxillary teeth is imperative to diagnose appropriately the underlying dental disease. Therapy should include treatment of the dental disease and secondary ophthalmic disorders.

Nutrition, general health status and oral health status in hospitalised elders

Biological malnutrition was assessed and correlated with salivary flow rates and oral health in 99 elderly, hospitalised non-psychiatric patients. The indicators of protein malnutrition used were arm circumference and serum albumin level and the indicators of energy malnutrition the body mass-index and the triceps skin-fold thickness. Unstimulated and stimulated salivary flow rates were measured according to Sreebny et al. Of the patients, 40% showed severely and 46% moderately reduced serum albumin levels and the anthropometric measurements indicated malnutrition in about 50%. Unstimulated hyposialia (< or = 0.1 ml/min) and stimulated hyposialia (< or = 0.5 ml/min) were observed in 17% and 26.5%, respectively. Significant associations (P < or = 0.05) were found between stimulated/unstimulated hyposialia and biological malnutrition. There was a negative relationship between the number of masticatory movements until swallowing a standard biscuit and skin fold thickness (P < or = 0.05). Current weight loss and biological malnutrition were related to poor appetite (P < or = 0.05). The study has confirmed poor general and oral health status as well as protein-energy malnutrition among elderly hospitalised patients. This situation was associated with loss of appetite, reduced salivary flow rates and a certain impairment of masticatory function which could jeopardise the reversibility of malnutrition and lead to increased morbidity and mortality.

Medical care of the dental patient

The family physician frequently makes decisions relating to patients' dental health. The physician can address patients' concerns about tooth eruption or the adverse effects of mercury amalgam. Predisposing factors for dental disease, such as use of certain medications, existing medical conditions (e.g., xerostomia) and traumatic injury, often are first noted by the family physician. Dental emergencies, including abscess and avulsion, can be initially managed by the physician and then referred to the dentist. The physician can coordinate care with a dentist when a patient has dental trauma, requires medical management for a dental procedure or has a medical condition that increases the likelihood of dental disease.

[Value of the "Dentascanner"al in dento-maxillary diseases (infectious and cystic)]

MATERIAL AND METHODS

From July 1993 to April 1994, forty dentascans were performed at Bicetre Hospital, on an Elscint Elite Plus scanner for: chronic sinusitis (18 cases); cystic pathologies (8 cases); pre-operative assessment for dental implantation (14 cases).

RESULTS

Dentascan images permitted a precise analysis of dentomaxillary anomalies. In all cases they demonstrated the anatomical relationships of the lesions, permitting a determination of potential complications. In chronic sinusitis dental pathology was demonstrated including peri-apical granulomas or cysts breaks or elevations of the floor of the maxillary sinus, malplaced dental filling material in the maxillary antrum and fistula tracks. Among the 14 pre-operative assessments, four cases of infectious lesions were demonstrated, thereby counter-indicating dental implantation.

CONCLUSION

The dentascan appears to be very useful for dentomaxillary pathology by facilitating diagnosis and the formulation of treatment and operative strategies.

Etiologic aspects and orthodontic treatment of unilateral localized arrested tooth-development combined with hearing loss

In this study a case has been presented involving localized, arrested maxillary tooth development, asymmetric maxillary development, and unilateral loss of hearing. No similar case seems to have been described before. The orthodontic treatment comprised extraction of four permanent tooth germs in the maxilla and autotransplantation of mandibular teeth, followed by the use of fixed orthodontic appliances and a one-unit bridge restoration. Etiologic aspects are discussed. It is suggested that a severe attack of mumps that involved massive swelling of the parotid glands immediately after chicken pox and measles at the age of 4 to 5 years, may have resulted in a neurologic reduction of hearing and arrested tooth development. The teeth in which root development in relation to mumps does not appear to have been reported previously, whereas hearing loss after mumps has been reported. In the search for verification of this possible connection, children with arrested tooth development should be examined for reduction of hearing, and children with hearing loss after mumps ought to have their dental development checked.

Cervical necrotizing fasciitis: clinical manifestations and management

Forty-five cases of cervical necrotizing fasciitis are reported, and their clinical, bacteriologic, and therapeutic implications are considered. Fasciitis was of dental origin in 78% of cases, pharyngeal in 16%, and surgical or posttraumatic in 6%. The condition extended to the face in 22% of cases, to the lower part of the neck in 56%, and to the mediastinum in 40%. Soft-tissue cultures were positive in 78% of cases. Anaerobes were isolated along with aerobes in 49% of cases (mean, 2.2 isolates per patient) and in pure culture in 22%. Treatment included surgical debridement and drainage and the administration of antibiotics active against both anaerobic and gram-negative aerobic bacteria. Hyperbaric oxygen was used for adjunctive treatment. The bacteria involved did not affect clinical manifestations, extension, or mortality. The survival rate among our patients was 78%. Mortality was significantly higher among cases with mediastinal extension (44% vs. 7%; P < .01); thus the prompt recognition and drainage of sites of mediastinal extension are of critical importance. Other risk factors for death were an age of > 70 years, underlying diabetes, the development of septic shock within 24 hours after admission, and prolonged prothrombin time.

Primary tooth ankylosis: report of case with histological analysis

Two primary molars in infraclusion showing clinical and radiographic signs of ankylosis, were subject to histological examination by bright field and polarization microscopy. The roots revealed signs of ongoing resorptive and reparative processes and in some areas dentin with signs of resorption-or repair cementum-were fused with simple lamellar or osteonic bone. These results suggest that ankylosis of primary molars can result from a disturbance of root resorption, with repair processes prevailing over resorptive ones and leading to excessive deposition of bone besides cementum-as a consequence of bone-inductive properties of dentin.

Myths of dental-induced prosthetic joint infections

The overwhelming majority of orthopedists and dentists surveyed recommend antibiotic prophylaxis for dental procedures to prevent late prosthetic joint infection. It is time to stop this practice, which is not based on scientific evidence but rather on "myths" of prosthetic joint infections after dental procedures. The first myth is that there are close similarities between late prosthetic valve endocarditis and late prosthetic joint infection. The second myth is that dental treatment is the probable cause of a large percentage of prosthetic joint infections. The third myth is that results of animal experiments have shown that transient bacteremia due to dental procedures can cause prosthetic joint infections in humans. The fourth myth is that the benefits of antibiotic prophylaxis for patients with prosthetic joints outweigh the risks and costs. The fifth and final myth is that clinicians should recommend antibiotic prophylaxis before dental treatment for patients with prosthetic joints to protect themselves legally.

Multiple calcifying hyperplastic dental follicles

This article describes two additional examples of this unusual condition; two others were reported previously. The microscopic features are those of the hyperplastic dental follicles that occur in regional odontodysplasia. However, the teeth are not defective, as in regional odontodysplasia. This rare condition is sufficiently distinctive to be considered a pathologic entity.

Level of plasma proteins in patients with severe odontogenic infection and fever

Twenty patients complaining of acute dental infection were admitted to the hospital. Clinical examination, peak of daily temperature for every patient were recorded. Electrophoretic studies of plasma proteins of all patients revealed slight increase of mean value of some plasma proteins (albumin, and gamma globulins) and more pronounced increase of mean values of alpha 1, and alpha 2 and beta globulins. The temperature and plasma proteins returned to normal levels after antibiotics therapy and dental treatment.

Xerostomia, xerogenic medications and food avoidances in selected geriatric groups

OBJECTIVE

To study the relationship between complaints of xerostomia and salivary performance and food avoidances in four geriatric groups chosen to reflect a broad spectrum of individuals along the health-disease continuum. To determine whether xerogenic medications taken by these individuals could be associated with either complaints of xerostomia or with food avoidances.

DESIGN

Cross-sectional survey. Clinical examinations and interview.

SETTING

A VA dental clinic and a retirement home.

PATIENTS AND OTHER PARTICIPANTS

Subjects were 529 individuals older than 56 years of age, living both in institutions and in the community (average age 70 years). Two hundred eight persons were recruited from a VA Dental Clinic, 114 from a residential retirement home, and 132 from a nursing/long-term-care facility; 75 were from an acute care ward and had a diagnosis of a cerebral vascular accident or other neurological condition.

OUTCOME MEASURES

Prevalence of xerostomia, dental morbidity, salivary flow, and food avoidances.

RESULTS

About 72% of the subjects experienced xerostomia sometime during the day. Stimulated salivary flow was found to be significantly lower in individuals who complained of xerostomia than in those who did not. Fifty-five percent of participants reported using one or more xerogenic medications, with an 86% prevalence in the nursing/long-term-care facility. Individuals with xerostomia had difficulty in chewing and in starting a swallow and were significantly more likely to avoid crunchy foods such as vegetables, dry foods such as bread, and sticky foods such as peanut butter in their diets. Specific medications such as the inhalants ipratropium and triamcinolone and the systemic agents oxybutynin and triazolam could be statistically associated with xerostomia and/or low salivary flow, and/or specific food avoidances.

CONCLUSION

Xerostomia apparently affects the ability to chew and start a swallow. This leads to avoidance of certain foods, which raises the possibility that xerostomia could contribute to undernutrition in older persons. The topically applied ipratropium and triamcinolone and the systemic agents amitriptyline, oxybutynin and triazolam could be statistically associated with one or more complaints of xerostomia.

Treating ankylosed primary teeth in adult patients: a case report

When ankylosed primary teeth are retained beyond the mixed-dentition stage and the involved teeth are below the occlusal plane, occlusal and interproximal contacts can be restored to esthetic and functional anatomic contours. With the development of new, improved posterior composite resins that have greater wear resistance and stronger adhesive bonding systems for enamel and dentin, new opportunities for conservative, simple, and efficient esthetic and functional restorations are possible in selected retained ankylosed primary molars.

[Cervico-facial cellulitis of oral and dental origin: study of 26 cases at the Lomé University Hospital]

The authors report 26 cases of cervico-facial cellulitis of mouth and dental origin. They highlight the severity of those affections. The original entry is dental caries in 88.4% of cases. Adequate treatment consisting of a surgical drainage, a suppression of the original entry and antibiotherapy combining a penicillin, an aminoglycosid and metronidazol. Preventive therapeutic measures are prescribed.

[Infectious endocarditis induced by Actinobacillus actinomycetemcomitans. 8 new cases]

A commensal organism of the buccal cavity, Actinobacillus actinomycetemcomitans (AAC) has been responsible for at least four new cases of infectious endocarditis by year in France. This retrospective study was based on 90 new cases of infectious endocarditis by AAC, including 8 personal observations. One third of patients had no known cardiac disease before their infectious endocarditis, the portal of entry of which was usually dental. In cases of suspected infectious endocarditis, rapid and severe weight loss (43% of cases) and, less commonly, anicteric cholestasis (8%) should alert the physician for the possible pathological role of AAC. The echocardiographic appearances are non-specific. The diagnosis is confirmed on blood cultures but the organism grows slowly in CO2 enriched atmosphere. Initially, the course of the disease was favourable in one third of patients but, in two thirds of cases, complications were observed almost renal (26%), cardiac (24%) and neurological (18%). Two thirds of patients were cured by the time they were discharged whereas the remainder had sequellae, mainly valvular and neurological. The hospital mortality was 9%; late mortality was 6%. Therefore, the prognosis of AAC endocarditis, seems to be better than that of other bacteriological forms. A combination of cephalosporin and aminoside, or even a simple third generation cephalosporin antibiotic therapy for at least 4 weeks are usually effective. The complementary surgical indications are the same as for other forms of infectious endocarditis. Prophylaxis depends on strict prophylactic amoxicillin therapy for all cardiac patients at risk of infectious endocarditis before dental treatment and on good bucco-dental hygiene.

Oral health of pediatric AIDS patients: a hospital-based study

The prevalence of acquired immunodeficiency syndrome (AIDS) is steadily increasing among American children. The dental needs of these patients are significant. This study evaluated the oral health of forty children being treated for HIV-infection at the National Institutes of Health (NIH). Eight of twenty-two patients in primary dentition (36 percent) had baby bottle tooth decay (BBTD). These cases required extensive dental restoration usually under general anesthesia. Tooth development was delayed in 31 percent of patients. Candidiasis was the most common soft tissue abnormality, found in 35 percent of children. Preventive and therapeutic dental programs should be instituted to meet the special needs of pediatric AIDS patients.

An analysis of primary and contributing reasons for extraction of permanent teeth given by the dentist

The aim of the present study was to collect information about primary, secondary, and tertiary reasons that dentists gave for extracting permanent teeth and to determine whether and how dentist-associated characteristics might influence the relative emphasis on clinical diagnosis versus non-disease considerations given as reasons. A national random sample of Norwegian dentists (n = 500) recorded reasons for tooth extraction during a period of 2 weeks in 1988 (response rate, 70%). Nine hundred and eight-five teeth were extracted from 692 patients. Disease-/condition-related diagnoses topped the list for primary and secondary reasons for extraction, whereas patients' wishes, economy, and esthetics came to the forefront among tertiary reasons. Logistic regression analysis showed that the choice between clinical diagnosis and non-disease considerations as primary and secondary reasons for extraction was significantly but moderately influenced by variables associated with the dentist.

Relationship between palato-radicular grooves and localized periodontitis

A total of 404 maxillary lateral and central incisors were examined in a group of 101 individuals comprising 64 males and 37 females for the presence of palato-radicular groove (PRG). The methods used to document the presence of PRG situated at or apical to the cemento-enamel junction (CEJ) included clinical probing, flap operation and inspection with the aid of an enlarging oral mirror. PRGs were classified by location in the mesial, distal and midpalatal areas of affected teeth. The plaque index (P1I), gingival index (GI) and probing pocket depth (PPD) were recorded on the lingual aspect of the teeth examined. Those PRG with initial PPDs of > or = 4 mm and located at or apical to the CEJ were counted as PRG with PPD. The difference in the PRG location for teeth with and without PPDs was analyzed via the chi 2 test. The relationship between the presence of a PRG and the patients periodontal health and plaque accumulation were analyzed using the t-test.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental disease among alcoholic individuals: a comparative study of hospitalized patients

OBJECTIVE

To measure the presence and severity of dental disease, as assessed by physicians, among consecutively hospitalized alcoholic and nonalcoholic medical patients.

DESIGN

Descriptive cross-sectional study. Patients who had Michigan Alcoholism Screening Test (MAST) scores > or = 8 were identified as being alcoholic. Nonalcoholic patients were defined as individuals with MAST scores < or = 4. These patients were matched with alcoholic patients for gender and age (+/- 5 years). The decayed, missing, and filled teeth (DMF) score and its components were used as a measure of dental disease.

SETTING

General wards of internal medicine of a 1,000-bed urban teaching hospital in Lausanne, Switzerland.

RESULTS

Among patients aged 20-75 years, the mean DMF score was higher among alcoholic patients than among nonalcoholic patients (26 vs 23, respectively; p < 0.001). This difference was greater among patients aged 20-39 years (20 vs 14, respectively) than among those aged 60-75 years (29 vs 27, respectively). The positive association between alcoholism and dental disease (crude odds ratio, 2.24; 95% CI, 1.15-4.31) remained after sequential stratification for several confounding factors.

CONCLUSION

The study suggests that dental disease is frequent and severe in hospitalized medical patients and that alcoholism is an independent predictor of its severity. Routine assessment of dental disease by the physician is important for medical inpatients, especially among those who are alcoholic.

Oral health problems and involuntary weight loss in a population of frail elderly

OBJECTIVE

To evaluate whether poor oral health is a potentially reversible contributor to the development of significant involuntary weight loss in elderly rehabilitation patients.

DESIGN

Survey (cross-sectional study).

SETTING

Geriatric Rehabilitation Unit (GRU) of a Veterans Administration hospital.

PATIENTS

One hundred ten consecutive admissions to the GRU, of whom 99% were male and 80% were white. The average age of the study patients was 77 years.

MEASUREMENTS

At admission each patient completed a comprehensive medical, neuro-psychological, social, nutritional, and dental assessment. Previous weights were documented by review of old medical records. Involuntary weight loss was considered significant if it was greater than 5% of pre-weight-loss weight within 6 months or 10% of pre-weight-loss weight within 1 year. Of the 97 variables evaluated, the strongest predictors of significant involuntary weight loss prior to GRU admission were identified using univariate and multivariate (stepwise logistic regression) analyses.

RESULTS

The number of general oral problems was the best predictor of significant involuntary weight loss within 1 year prior to GRU admission, followed by household income, age, smoking status, adequacy of nutrient intake prior to admission, and education. When all six of the variables were included in the stepwise logistical regression analysis, the model had a sensitivity of 63.2%, a specificity of 91.1%, and overall predictive accuracy of 86.2%. The number of general oral problems was also a strong predictor of significant weight loss within 6 months prior to GRU admission.

CONCLUSIONS

Poor oral health may be an important contributing factor to the development of significant involuntary weight loss among the frail elderly. If this is true, it places even greater emphasis on the need for maintaining an optimal state of oral health in our elderly patients.