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Romero-Reyes M, Arman S, Teruel A, Kumar S, Hawkins J, Akerman S. Pharmacological Management of Orofacial Pain. Drugs 2023; 83:1269-1292. [PMID: 37632671 DOI: 10.1007/s40265-023-01927-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/28/2023]
Abstract
Orofacial pain is a category of complex disorders, including musculoskeletal, neuropathic and neurovascular disorders, that greatly affect the quality of life of the patient. These disorders are within the fields of dentistry and medicine and management can be challenging, requiring a referral to an orofacial pain specialist, essential for adequate evaluation, diagnosis, and care. Management is specific to the diagnosis and a treatment plan is developed with diverse pharmacological and non-pharmacological modalities. The pharmacological management of orofacial pain encompasses a vast array of medication classes and approaches. This includes anti-inflammatory drugs, muscle relaxants, anticonvulsants, antidepressants, and anesthetics. In addition, as adjunct therapy, different injections can be integrated into the management plan depending on the diagnosis and needs. These include trigger point injections, temporomandibular joint (TMJ) injections, and neurotoxin injections with botulinum toxin and nerve blocks. Multidisciplinary management is key for optimal care. New and safer therapeutic targets exclusively for the management of orofacial pain disorders are needed to offer better care for this patient population.
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Affiliation(s)
- Marcela Romero-Reyes
- Brotman Facial Pain Clinic, School of Dentistry, University of Maryland, 650 W. Baltimore St, 1st Floor, Baltimore, MD, 21201, USA.
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th Floor, Baltimore, MD, 21201, USA.
| | - Sherwin Arman
- Orofacial Pain Program, Section of Oral Medicine, Oral Pathology and Orofacial Pain, University of California, Los Angeles, School of Dentistry, Los Angeles, CA, USA
| | | | - Satish Kumar
- Department of Periodontics, Arizona School of Dentistry and Oral Health, A.T. Still University, Mesa, AZ, USA
| | - James Hawkins
- Naval Postgraduate Dental School, Naval Medical Leader and Professional Development Command, Uniformed Services University of the Health Sciences Postgraduate Dental College, Baltimore, MD, USA
| | - Simon Akerman
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th Floor, Baltimore, MD, 21201, USA
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Akhter F. Examining the Clinical Characteristics of Trigeminal Neuralgia at a Dental Hospital: A Prospective Study. Cureus 2023; 15:e34862. [PMID: 36923198 PMCID: PMC10010314 DOI: 10.7759/cureus.34862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 02/13/2023] Open
Abstract
Background and objective Trigeminal neuralgia (TN) is a paroxysmal shock-like neuropathic pain condition that causes sudden, typically unilateral, severe, brief, stabbing, and recurrent sensations in the distribution of one or more trigeminal nerve branches. Although the clinical profile of TN patients has been generally established, there has never been a study on the condition among the population of Northeast India. Furthermore, there is scarce research describing the clinical features of TN in patients who visit a dental college. In light of this, we conducted this study to assess the clinical characteristics and parameters of TN in an Indian population. Methods Medical records of 60 patients with TN were reviewed prospectively for patient demographics, characteristics of the pain, and treatment modalities. Results Of the 60 patients, 55% were male, and 45% were female. The peak incidence was found in the age range of 55-64 years. Pain occurred equally on the right and left sides of the face. The maxillary division of the trigeminal nerve was the most frequently affected (40%) region, followed by mandibular division (35%) and the combined maxillary and mandibular division alone (25%). Most patients described their attacks as shock-like (78.33%) and of spontaneous onset (86.67%). Conclusion In the present study, TN affected males more than females and occurred most frequently in patients aged 55-64 years. A comparative analysis of the pain characteristics between different age groups and genders is useful for the management of these patients.
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Affiliation(s)
- Fatema Akhter
- Surgical and Diagnostic Sciences, Dar Al Uloom University, Riyadh, SAU
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A Review on Autophagy in Orofacial Neuropathic Pain. Cells 2022; 11:cells11233842. [PMID: 36497100 PMCID: PMC9735968 DOI: 10.3390/cells11233842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022] Open
Abstract
Orofacial neuropathic pain indicates pain caused by a lesion or diseases of the somatosensory nervous system. It is challenging for the clinician to diagnose and manage orofacial neuropathic pain conditions due to the considerable variability between individual clinical presentations and a lack of understanding of the mechanisms underlying the etiology and pathogenesis. In the last few decades, researchers have developed diagnostic criteria, questionnaires, and clinical assessment methods for the diagnosis of orofacial neuropathic pain. Recently, researchers have observed the role of autophagy in neuronal dysfunction as well as in the modulation of neuropathic pain. On this basis, in the present review, we highlight the characteristics, classification, and clinical assessment of orofacial neuropathic pain. Additionally, we introduce autophagy and its potential role in the modulation of orofacial neuropathic pain, along with a brief overview of the pathogenesis, which in future may reveal new possible targets for treating this condition.
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Shinoda M, Imamura Y, Hayashi Y, Noma N, Okada-Ogawa A, Hitomi S, Iwata K. Orofacial Neuropathic Pain-Basic Research and Their Clinical Relevancies. Front Mol Neurosci 2021; 14:691396. [PMID: 34295221 PMCID: PMC8291146 DOI: 10.3389/fnmol.2021.691396] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/21/2021] [Indexed: 01/01/2023] Open
Abstract
Trigeminal nerve injury is known to cause severe persistent pain in the orofacial region. This pain is difficult to diagnose and treat. Recently, many animal studies have reported that rewiring of the peripheral and central nervous systems, non-neuronal cell activation, and up- and down-regulation of various molecules in non-neuronal cells are involved in the development of this pain following trigeminal nerve injury. However, there are many unknown mechanisms underlying the persistent orofacial pain associated with trigeminal nerve injury. In this review, we address recent animal data regarding the involvement of various molecules in the communication of neuronal and non-neuronal cells and examine the possible involvement of ascending pathways in processing pathological orofacial pain. We also address the clinical observations of persistent orofacial pain associated with trigeminal nerve injury and clinical approaches to their diagnosis and treatment.
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Affiliation(s)
- Masamichi Shinoda
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Yoshiki Imamura
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry, Tokyo, Japan
| | - Yoshinori Hayashi
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Noboru Noma
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry, Tokyo, Japan
| | - Akiko Okada-Ogawa
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry, Tokyo, Japan
| | - Suzuro Hitomi
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Koichi Iwata
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan
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Okayasu I, Komiyama O, Ayuse T, De Laat A. Effect of 8% lidocaine spray on the sensory and pain thresholds of the skin of the face and hands evaluated by quantitative sensory testing. J Dent Anesth Pain Med 2018; 18:361-365. [PMID: 30637346 PMCID: PMC6323040 DOI: 10.17245/jdapm.2018.18.6.361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 12/01/2022] Open
Abstract
Background Recently, we examined the effects of 2% lidocaine gel on the tactile sensory and pain thresholds of the face, tongue and hands of symptom-free individuals using quantitative sensory testing (QST); its effect was less on the skin of the face and hands than on the tongue. Consequently, instead of 2% lidocaine gel, we examined the effect of 8% lidocaine spray on the tactile sensory and pain thresholds of the skin of the face and hands of healthy volunteers. Methods Using Semmes-Weinstein monofilaments, QST of the skin of the cheek and palm (thenar skin) was performed in 20 healthy volunteers. In each participant, two topical sprays were applied. On one side, 0.2 mL of 8% lidocaine pump spray was applied, and on the other side, 0.2 mL of saline pump spray was applied as control. In each participant, QST was performed before and 15 min after each application. Pain intensity was measured using a numeric rating scale (NRS). Results Both the tactile detection threshold and filament-prick pain detection threshold of the cheek and thenar skin increased significantly after lidocaine application. A significant difference between the effect of lidocaine and saline applications was found on the filament-prick pain detection threshold only. NRS of the cheek skin and thenar skin decreased after application of lidocaine, and not after application of saline. Conclusion The significant effect of applying an 8% lidocaine spray on the sensory and pain thresholds of the skin of the face and hands can be objectively scored using QST.
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Affiliation(s)
- Ichiro Okayasu
- Department of Clinical Physiology, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Osamu Komiyama
- Department of Oral Function and Rehabilitation, Nihon University School of Dentistry at Matsudo, Japan
| | - Takao Ayuse
- Department of Clinical Physiology, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Antoon De Laat
- Department of Oral Health Sciences, KU Leuven, Belgium.,Department of Dentistry, University Hospital Leuven, Belgium
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Rai A, Kumar A, Chandra A, Naikmasur V, Abraham L. Clinical profile of patients with trigeminal neuralgia visiting a dental hospital: A prospective study. INDIAN JOURNAL OF PAIN 2017. [DOI: 10.4103/ijpn.ijpn_44_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Moana-Filho EJ, Bereiter DA, Nixdorf DR. Amplified Brain Processing of Dentoalveolar Pressure Stimulus in Persistent Dentoalveolar Pain Disorder Patients. J Oral Facial Pain Headache 2016; 29:349-62. [PMID: 26485382 DOI: 10.11607/ofph.1463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS (1) To determine the brain regions activated by dentoalveolar pressure stimulation in persistent dentoalveolar pain disorder (PDAP) patients, and (2) to compare these activation patterns to those seen in pain-free control subjects. METHODS A total of 13 PDAP patients and 13 matched controls completed the study. Clinical pain characteristics and psychosocial data were collected. Dentoalveolar mechanical pain thresholds were determined with a custom-made device over the painful area for patients and were used as the stimulation level during functional magnetic resonance imaging (fMRI) data acquisition. Control subjects received two stimulation levels over matched locations during fMRI scanning: one determined (as above) that evoked equally subjective pain ratings matching those of patients (subjective-pain match) and another nonpainful stimulation level matching the average stimulus intensity provided to patients (stimulus-intensity match). Clinical and psychosocial data were analyzed using independent samples t tests, Mann-Whitney U test, and Spearman rank-order correlation coefficient. fMRI data were analyzed using validated neuroimaging software and tested using a general linear model. RESULTS PDAP patients had greater anxiety (P<.0001) and depression scores (P=.001), more jaw function impairment (P<.0001), and greater social impact (P<.0001) than controls. No significant differences were found for brain activation spatial extent (PDAP X Controls subjective pain: P=.48; PDAP X Controls stimulus intensity: P=.12). Brain activations were significantly increased for PDAP patients compared to control subjects when matched to stimulus intensity in several regions related to the sensory-discriminative and cognitive components of pain perception, including the primary and secondary somatosensory cortices, inferior parietal lobule, insula, premotor cortex, prefrontal cortex, and thalamus. When matched to subjective pain ratings, increased brain activations were still present for PDAP patients compared to controls, although to a lesser extent. CONCLUSION The present results suggest that dentoalveolar pressure is processed differently in the brain of PDAP patients, and the increased activation in several brain areas is consistent with amplified pain processing.
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Goswami S, Ray S, Banu P, Sanyal R, Basu SM. Phantom tooth pain: The atypical facial pain. INDIAN JOURNAL OF PAIN 2015. [DOI: 10.4103/0970-5333.165817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Affiliation(s)
- Ichiro Okayasu
- Dept of Clinical Physiology, Nagasaki University Graduate School of Biomedical Sciences
| | - Takao Ayuse
- Dept of Clinical Physiology, Nagasaki University Graduate School of Biomedical Sciences
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Moon S, Lee SJ, Kim E, Lee CY. Hypoesthesia after IAN block anesthesia with lidocaine: management of mild to moderate nerve injury. Restor Dent Endod 2012; 37:232-5. [PMID: 23430216 PMCID: PMC3568644 DOI: 10.5395/rde.2012.37.4.232] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/08/2012] [Accepted: 10/08/2012] [Indexed: 11/20/2022] Open
Abstract
Hypoesthesia after an inferior alveolar nerve (IAN) block does not commonly occur, but some cases are reported. The causes of hypoesthesia include a needle injury or toxicity of local anesthetic agents, and the incidence itself can cause stress to both dentists and patients. This case presents a hypoesthesia on mental nerve area followed by IAN block anesthesia with 2% lidocaine. Prescription of steroids for a week was performed and periodic follow up was done. After 1 wk, the symptoms got much better and after 4 mon, hypoesthesia completely disappeared. During this healing period, only early steroid medication was prescribed. In most cases, hypoesthesia is resolved within 6 mon, but being aware of etiology and the treatment options of hypoesthesia is important. Because the hypoesthesia caused by IAN block anesthesia is a mild to moderate nerve injury, early detection of symptom and prescription of steroids could be helpful for improvement of the hypoesthesia.
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Affiliation(s)
- Sungjoo Moon
- Department of Conservative Dentistry, Yonsei University College of Dentistry, Seoul, Korea
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Krzyzanowska A, Avendaño C. Behavioral testing in rodent models of orofacial neuropathic and inflammatory pain. Brain Behav 2012; 2:678-97. [PMID: 23139912 PMCID: PMC3489819 DOI: 10.1002/brb3.85] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 07/10/2012] [Accepted: 07/13/2012] [Indexed: 11/12/2022] Open
Abstract
Orofacial pain conditions are often very debilitating to the patient and difficult to treat. While clinical interest is high, the proportion of studies performed in the orofacial region in laboratory animals is relatively low, compared with other body regions. This is partly due to difficulties in testing freely moving animals and therefore lack of reliable testing methods. Here we present a comprehensive review of the currently used rodent models of inflammatory and neuropathic pain adapted to the orofacial areas, taking into account the difficulties and drawbacks of the existing approaches. We examine the available testing methods and procedures used for assessing the behavioral responses in the face in both mice and rats and provide a summary of some pharmacological agents used in these paradigms to date. The use of these agents in animal models is also compared with outcomes observed in the clinic.
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Affiliation(s)
- Agnieszka Krzyzanowska
- Department of Anatomy, Histology and Neuroscience, Autonoma University of Madrid, Medical School Madrid, Spain
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12
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Okayasu I, Oi K. Case reports of orofacial pain - Burning mouth syndrome and Neuropathic pain. ACTA ACUST UNITED AC 2012. [DOI: 10.7144/sgf.18.204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Nixdorf D, Moana-Filho E. Persistent dento-alveolar pain disorder (PDAP): Working towards a better understanding. Rev Pain 2011; 5:18-27. [PMID: 25309718 DOI: 10.1177/204946371100500404] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
• New terminology, persistent dento-alveolar pain disorder (PDAP), and diagnostic criteria have been put forward to address the shortcomings of existing nomenclature, which are associated with unclear criteria. • Arriving at an accurate diagnosis of PDAP is based on excluding other possible aetiologies, and may involve different care providers. • Synthesis of published data suggests that PDAP has a frequency of occurrence following root canal therapy of around 1.6%. • The putative risk factors involved in PDAP are largely unknown, but seem to be similar to those being identified with other post-surgical chronic pain disorders. • The underlying mechanisms involved in the development of and/or perpetuating PDAP are unknown and the approach to treatment remains empiric in nature.
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Affiliation(s)
- Donald Nixdorf
- Division of TMD & Orofacial Pain and Department of Neurology, University of Minnesota, 515 Delaware Street SE, Minneapolis, MN 55455 USA
| | - Estephan Moana-Filho
- Center for Neurosensory Disorders, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
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Nixdorf DR, Drangsholt MT, Ettlin DA, Gaul C, De Leeuw R, Svensson P, Zakrzewska JM, De Laat A, Ceusters W. Classifying orofacial pains: a new proposal of taxonomy based on ontology. J Oral Rehabil 2011; 39:161-9. [PMID: 21848527 DOI: 10.1111/j.1365-2842.2011.02247.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We propose a new taxonomy model based on ontological principles for disorders that manifest themselves through the symptom of persistent orofacial pain and are commonly seen in clinical practice and difficult to manage. Consensus meeting of eight experts from various geographic areas representing different perspectives (orofacial pain, headache, oral medicine and ontology) as an initial step towards improving the taxonomy. Ontological principles were introduced, reviewed and applied during the consensus building process. Diagnostic criteria for persistent dento-alveolar pain disorder (PDAP) were formulated as an example to be used to model the taxonomical structure of all orofacial pain conditions. These criteria have the advantage of being (i) anatomically defined, (ii) in accordance with other classification systems for the provision of clinical care, (iii) descriptive and succinct, (iv) easy to adapt for applications in varying settings, (v) scalable and (vi) transferable for the description of pain disorders in other orofacial regions of interest. Limitations are that the criteria introduce new terminology, do not have widespread acceptance and have yet to be tested. These results were presented to the greater conference membership and were unanimously accepted. Consensus for the diagnostic criteria of PDAP was established within this working group. This is an initial first step towards developing a coherent taxonomy for orofacial pain disorders, which is needed to improve clinical research and care.
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Affiliation(s)
- D R Nixdorf
- Division of TMD & Orofacial Pain and Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
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Johnson NJ, Hanson LR, Frey WH. Trigeminal pathways deliver a low molecular weight drug from the nose to the brain and orofacial structures. Mol Pharm 2010; 7:884-93. [PMID: 20420446 DOI: 10.1021/mp100029t] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Intranasal delivery has been shown to noninvasively deliver drugs from the nose to the brain in minutes along the olfactory and trigeminal nerve pathways, bypassing the blood-brain barrier. However, no one has investigated whether nasally applied drugs target orofacial structures, despite high concentrations observed in the trigeminal nerve innervating these tissues. Following intranasal administration of lidocaine to rats, trigeminally innervated structures (teeth, temporomandibular joint (TMJ), and masseter muscle) were found to have up to 20-fold higher tissue concentrations of lidocaine than the brain and blood as measured by ELISA. This concentration difference could allow intranasally administered therapeutics to treat disorders of orofacial structures (i.e., teeth, TMJ, and masseter muscle) without causing unwanted side effects in the brain and the rest of the body. In this study, an intranasally administered infrared dye reached the brain within 10 minutes. Distribution of dye is consistent with dye entering the trigeminal nerve after intranasal administration through three regions with high drug concentrations in the nasal cavity: the middle concha, the maxillary sinus, and the choana. In humans the trigeminal nerve passes through the maxillary sinus to innervate the maxillary teeth. Delivering lidocaine intranasally may provide an effective anesthetic technique for a noninvasive maxillary nerve block. Intranasal delivery could be used to target vaccinations and treat disorders with fewer side effects such as tooth pain, TMJ disorder, trigeminal neuralgia, headache, and brain diseases.
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Affiliation(s)
- Neil J Johnson
- HealthPartners Research Foundation, Alzheimer's Research Center at Regions Hospital, Saint Paul, Minnesota 55101, USA
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Nixdorf DR, Moana-Filho EJ, Law AS, McGuire LA, Hodges JS, John MT. Frequency of nonodontogenic pain after endodontic therapy: a systematic review and meta-analysis. J Endod 2010; 36:1494-8. [PMID: 20728716 PMCID: PMC2941431 DOI: 10.1016/j.joen.2010.06.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 06/20/2010] [Accepted: 06/22/2010] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Little is known about ill-defined pain that persists after endodontic procedures, including an estimate of the problem's magnitude. We conducted a systematic review of prospective studies that reported the frequency of nonodontogenic pain in patients who had undergone endodontic procedures. METHODS Nonodontogenic pain was defined as dentoalveolar pain present for 6 months or more after endodontic treatment without evidence of dental pathology. Endodontic procedures reviewed were nonsurgical root canal treatment, retreatment, and surgical root canal treatment. Studies were searched in four databases electronically, complemented by hand searching. A summary estimate of nonodontogenic tooth pain frequency was derived using random-effects meta-analysis. RESULTS Of 770 articles retrieved and reviewed, 10 met inclusion criteria, and nine had data on both odontogenic and nonodontogenic causes of pain. A total of 3,343 teeth were enrolled within the included studies and 1,125 had follow-up information regarding pain status. We identified 48 teeth with nonodontogenic pain and estimated a 3.4% (95% confidence interval, 1.4%-5.5%) frequency of occurrence. In nine articles containing data regarding both odontogenic and nonodontogenic causes of tooth pain, 56% (44/78) of all cases were thought to have a nonodontogenic cause. CONCLUSIONS Nonodontogenic pain is not an uncommon outcome after root canal therapy and may represent half of all cases of persistent tooth pain. These findings have implications for the diagnosis and treatment of painful teeth that were previously root canal treated because therapy directed at the tooth in question would not be expected to resolve nonodontogenic pain.
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Affiliation(s)
- Donald R Nixdorf
- Division of TMD & Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA.
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Rodríguez-Lozano FJ, Sanchez-Pérez A, Moya-Villaescusa MJ, Rodríguez-Lozano A, Sáez-Yuguero MR. Neuropathic orofacial pain after dental implant placement: review of the literature and case report. ACTA ACUST UNITED AC 2010; 109:e8-12. [DOI: 10.1016/j.tripleo.2009.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 11/29/2009] [Accepted: 12/01/2009] [Indexed: 01/09/2023]
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Oshima K, Ishii T, Ogura Y, Aoyama Y, Katsuumi I. Clinical investigation of patients who develop neuropathic tooth pain after endodontic procedures. J Endod 2009; 35:958-61. [PMID: 19567314 DOI: 10.1016/j.joen.2009.04.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 04/11/2009] [Accepted: 04/13/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study aimed to determine the characteristics of patients with neuropathic tooth pain (NTP) who were selected from a group of patients who developed persistent pain after undergoing endodontic procedures. METHODS Of 271 patients who had chronic persistent pain that did not respond to previous endodontic procedures and were referred to the Endodontic Team of the Nippon Dental University Hospital, 16 patients (5.9%; mean age, 46.8 years; 13 women) who fulfilled the diagnostic criteria for NTP were recruited. The inclusion criteria for the patients were the presence of chronic persistent pain and other pain-related symptoms, despite the absence of major pathology. RESULTS Pain predominantly occurred in the maxilla (14 patients). In 10 patients (62.5%), NTP developed after retreatment. Daily application of tricyclic antidepressants produced pain relief in 11 patients (68.8%). CONCLUSIONS These results indicated that NTP is a rare type of chronic intractable endodontic pain and that careful diagnosis of NTP is important.
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Affiliation(s)
- Katsuo Oshima
- Endodontic Team, Nippon Dental University Hospital, Tokyo, Japan.
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Seadi Pereira PJ, Noronha Dornelles F, Santiago Santos D, Batista Calixto J, Bueno Morrone F, Campos MM. Nociceptive and inflammatory responses induced by formalin in the orofacial region of rats: effect of anti-TNFalpha strategies. Int Immunopharmacol 2008; 9:80-5. [PMID: 18957334 DOI: 10.1016/j.intimp.2008.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 09/30/2008] [Accepted: 10/03/2008] [Indexed: 01/19/2023]
Abstract
This study evaluated the effects of different anti-TNFalpha strategies on the nociceptive and inflammatory responses triggered by formalin in the rat orofacial region. Formalin injection (2.5%) into the right upper lip caused a nociceptive response that was biphasic, with the first phase observed between 0 and 3 min and the second phase between 12 and 30 min. Plasma extravasation induced by formalin was time-related and reached the peak at 360 min. The monoclonal antibody anti-TNFalpha (25 and 50 pg/lip) significantly inhibited the second phase of formalin-induced nociceptive behavior, while the first phase remained unaltered. The systemic treatment with the chimeric anti-TNFalpha antibody infliximab also caused a significant inhibition of the second phase. Interestingly, the local administration of infliximab (50 pg/lip) produced a significant reduction of both phases of formalin-induced nociception. In addition, the systemic pretreatment with the preferential inhibitor of TNFalpha synthesis thalidomide (25 and 50 mg/kg, p.o) promoted a marked reduction of the first and second phases of formalin-evoked nociception. The local administration of the monoclonal antibody anti-TNFalpha (25 and 50 pg/lip) or infliximab (50 pg/lip) markedly reduced the plasma extravasation induced by formalin. Otherwise, formalin-elicited plasma extravasation was not significantly affected by the systemic administration of either infliximab (1 mg/kg; s.c) or thalidomide (50 mg/kg, p.o). Present data suggest that blocking TNFalpha effects, through different pharmacological tools, could represent a good alternative to control orofacial inflammatory pain that is refractory to other drugs.
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