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da Silva AP, Sassi FC, de Andrade CRF. The effects of treatment timing on the management of patients with multiple facial fractures and on the self-perception of TMD recovery. Cranio 2024; 42:699-710. [PMID: 35257636 DOI: 10.1080/08869634.2022.2046910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the effects of time on the orofacial functions and on the self-perception of temporomandibular disorders (TMD) recovery in a population of patients with multiple facial fractures. METHODS Orofacial functions and self-perception of TMD recovery was verified in patients with midface and/or lower face fractures. Patients were divided according to the time between fracture reduction and the clinical assessments: 0-1 month (Group 1), 1-3 months (Group 2), and 15 >3 months (Group 3). RESULTS Patients in Group 1 presented a greater compromise of swallowing and mastication when compared to patients with older fractures (p = 0.015), whereas patients in Group 3 presented a poorer TMD recovery (TMJ pain: p = 0.010 and tinnitus: p = 0.004). CONCLUSION Delays in functional treatments involving the myofunctional orofacial system have a negative impact on the recovery of essential orofacial functions and on TMD symptoms..
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Affiliation(s)
- Amanda Pagliotto da Silva
- Division of Orofacial Myology, Hospital Das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Fernanda Chiarion Sassi
- Department of Physiotherapy, Speech-language and Hearing Science and Occupational Therapy, School of Medicine, University of São Paulo, Brazil
| | - Claudia Regina Furquim de Andrade
- Department of Physiotherapy, Speech-language and Hearing Science and Occupational Therapy, School of Medicine, University of São Paulo, Brazil
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2
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Thomas DC, Khan J, Ananthan S, Kalladka M. Systemic Factors Affecting Pain Management in Dentistry. Dent Clin North Am 2024; 68:725-737. [PMID: 39244253 DOI: 10.1016/j.cden.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
There are several factors that affect a patient's experience of pain. These include both local and systemic factors. The systemic factors that affect patients' dental and orofacial pain experience include, but not limited to, hormonal, nutritional, systemic infections, neurodegenerative, and autoimmune, among others. Comprehensive medical history is essential to delineate any possible systemic factors affecting pain experience. A thorough review of systems should form the foundation, since multiple factors can affect the prognosis of pain management. This would facilitate early recognition and trigger prompt referrals to the appropriate medical professionals. This helps to reduce the health care burden.
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Affiliation(s)
- Davis C Thomas
- Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ 07103, USA; Orofacial Pain and Temporomandibular Disorders, Eastman Institute of Oral Health, Rochester, NY 14620, USA
| | - Junad Khan
- Orofacial Pain and Temporomandibular Disorders, Eastman Institute of Oral Health, Rochester, NY 14620, USA
| | - Sowmya Ananthan
- Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ 07103, USA
| | - Mythili Kalladka
- Orofacial Pain and Temporomandibular Disorders, Eastman Institute of Oral Health, Rochester, NY 14620, USA.
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3
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Kilgariff JK, Fairless M. Displacement Injuries: Assessment and Management. Prim Dent J 2023; 12:47-56. [PMID: 38018680 DOI: 10.1177/20501684231213770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
This paper aims to aid clinicians in the assessment and immediate management of dental trauma displacement injuries to permanent teeth. Long term sequelae, the impact of such injuries, and the evidence-base for managing these are discussed.Clinical cases are provided to illustrate management challenges and highlight where further evidence-based guidance is needed. The role of the general dental practitioner in the immediate management and follow-up of traumatic dental injuries is outlined and sequelae, worthy of potential referral, described.
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Affiliation(s)
- Julie K Kilgariff
- Julie K. Kilgariff BDS, MFDS RCS(Ed), MRD(Endo) RCS(Ed), AFHEA Consultant in Endodontics, Dundee Dental Hospital & Research School, Dundee, UK
- Matthew Fairless BSc (Hons), BDS, MFDS RCS(Ed) Dental Core Trainee, Dundee Dental Hospital & Research School, Dundee, UK
| | - Matthew Fairless
- Julie K. Kilgariff BDS, MFDS RCS(Ed), MRD(Endo) RCS(Ed), AFHEA Consultant in Endodontics, Dundee Dental Hospital & Research School, Dundee, UK
- Matthew Fairless BSc (Hons), BDS, MFDS RCS(Ed) Dental Core Trainee, Dundee Dental Hospital & Research School, Dundee, UK
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4
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Cachemaille M, Geering S, Broome M. Cryoneurolysis of alveolar nerves for chronic dental pain: A new technique and a case series. Pain Pract 2023; 23:851-854. [PMID: 37243450 DOI: 10.1111/papr.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Chronic neuropathic dental pain has a poor prognosis with a low chance of significant spontaneous improvement. Local or oral therapies may be efficient, however short in terms of duration with potential side effects. Cryoneurolysis has been described to prevent acute postoperative pain or to treat some chronic pain conditions; however, application to dental orofacial pain has not been reported so far. CASE SERIES Following a positive diagnostic block on the corresponding alveolar nerve, neuroablation was performed using a cryoprobe on three patients suffering from persistent pain after a dental extraction and 1 after multiple tooth surgeries. The effect of treatment was assessed using a Pain Numeric Rating Scale (NRS) and determined by changes in medication dosage and quality of life at day 7 and 3 months. Two patients experienced more than 50% of pain relief at 3 months, 2 by 50%. One patient was able to wean off pregabalin medication, one decreased amitriptyline by 50%, and one decreased tapentadol by 50%. No direct complications were reported. All of them mentioned improvement in sleep and quality of life. CONCLUSION Cryoneurolysis on alveolar nerves is a safe and easy-to-use technique allowing prolonged neuropathic pain relief after dental surgery.
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Affiliation(s)
- Matthieu Cachemaille
- Pain Clinic, Hôpital de la Tour, Meyrin, Switzerland
- Department of Anaesthesiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Sébastien Geering
- Division of Oral and Maxillofacial Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Martin Broome
- Division of Oral and Maxillofacial Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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5
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Sharp LK, Solanki P, Boyer T, Vivo A, Kale I, Hughes AM, Gibson G, Jurasic MM, Evans CT, Suda KJ. A qualitative exploration of dentists' opioid prescribing decisions within U.S. veterans affairs facilities. Pain 2023; 164:749-757. [PMID: 35984367 PMCID: PMC10026830 DOI: 10.1097/j.pain.0000000000002759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT The U.S. Department of Veterans Affairs (VA) is the largest integrated healthcare system in the United States and provides dental care to approximately one-half million veterans annually. In response to the opioid crisis, the VA released several opioid risk mitigation strategies. Although opioid prescribing by VA dentists has decreased on the whole, the implementation experiences at the level of dentists remains unclear. Our objective was to explore the barriers and facilitators that affect opioid decision making for management of acute dental pain among VA dentists. Dentists practicing in the VA facilities with the highest and lowest volume of opioid prescriptions were recruited. Standardized qualitative interviews by telephone followed a semistructured guide designed around the Capability (C), Opportunity (O), Motivation (M), and Behaviour (B) model. Audio recordings were transcribed and independently double-coded using NVivo to identify potential targets for future guideline-based opioid interventions. Of 395 eligible general and specialty dentists, 90 (24.8%) completed an interview representing 33 VA facilities. Opportunities for prescribing opioids included 1) completion of dental procedures associated with acute dental pain, 2) caring for patients who presented with existing dental pain, and 3) responding to patient opioid requests. Capabilities included using resources (eg, electronic medical records), clinical judgement (eg, evaluation of medical history including medication use), communication skills, and ability to screen for opioid misuse. Motivation themes focused on alleviating patients' acute dental pain. Barriers and facilitators of opioid prescribing varied across facilities. The results can offer intervention targets for continued opioid risk mitigation efforts.
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Affiliation(s)
- Lisa K. Sharp
- Department of Pharmacy Systems Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Pooja Solanki
- Center of Innovation for Complex Chronic Healthcare, Edward Hines JR VA Medical Center, Hines, IL, United States
| | - Taylor Boyer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Amanda Vivo
- Center of Innovation for Complex Chronic Healthcare, Edward Hines JR VA Medical Center, Hines, IL, United States
| | - Ibuola Kale
- Center of Innovation for Complex Chronic Healthcare, Edward Hines JR VA Medical Center, Hines, IL, United States
| | - Ashley M. Hughes
- Department of Biomedical and Health Information Sciences, College of Allied Health, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL, United States
| | - Gretchen Gibson
- Veterans Health Administration, Office of Dentistry, Washington DC, United States, United States
| | - M. Marianne Jurasic
- VA Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
- Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, United States
| | - Charlesnika T. Evans
- Center of Innovation for Complex Chronic Healthcare, Edward Hines JR VA Medical Center, Hines, IL, United States
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Katie J. Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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6
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Monteiro CMC, Martins ACR, Reis A, de Geus JL. Effect of endodontic sealer on postoperative pain: a network meta-analysis. Restor Dent Endod 2023; 48:e5. [PMID: 36875812 PMCID: PMC9982236 DOI: 10.5395/rde.2023.48.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 01/11/2023] Open
Abstract
This systematic review and network meta-analysis aimed to answer the following focused research question: "Does the type of endodontic sealer affect the postoperative pain in patients who received endodontic treatment?" Different databases and grey literature were surveyed. Only one randomized controlled trial were included. The risk of bias in the studies was evaluated by using the Cochrane Collaboration's tool. A random-effects meta-analysis was conducted to compare the risk and intensity of postoperative pain. The quality of the body of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Out of 11,601 studies, 15 remained for qualitative analyses and 12 for meta-analysis. Seven studies were classified at high risk of bias, and 8 studies raised some concerns. No significant differences between the endodontic materials were observed in the direct comparisons, both in risk and in intensity of postoperative pain (pairwise comparisons with 2 studies: I2 = 0%; p > 0.05 and 8 studies: I2 = 23%; p > 0.05, respectively). The certainty of the evidence was graded as low or moderate. There was no difference in the risk and intensity of postoperative pain after filling with different endodontic sealers. Further systematic reviews should be conducted. Trial Registration PROSPERO Identifier: CRD42020215314.
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Affiliation(s)
| | | | - Alessandra Reis
- Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Juliana Larocca de Geus
- Department of Endodontics, Paulo Picanço School of Dentistry, Fortaleza, CE, Brazil.,Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
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7
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Efficacy of Music Intervention for Dental Anxiety Disorders: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020209. [PMID: 36837411 PMCID: PMC9961880 DOI: 10.3390/medicina59020209] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/03/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Objective To evaluate the effectiveness of music therapy for dental anxiety disorders. Methods In order to gather clinical randomized controlled trials comparing the effectiveness of music interventions to traditional oral manipulation in patients with dental anxiety disorders, computer searches of the electronic databases of Wanfang, CNKI, VIP, PubMed, Web of Science, ScienceDirect, Cochrane library, Scopus, and CINAHL were conducted. The search period covered from 23 December 2022, through to the development of the database. The Cochrane Handbook was used to assess the quality of the included literature, and two researchers independently conducted the literature screening and data extraction. Stata 17.0 and RevMan 5.3 were used to conduct the meta-analysis. Results The preoperative baseline levels of the music intervention group were similar to those of the control group (p > 0.05), according to the meta-analysis, and music intervention significantly decreased heart rate (I2 = 81.2%, WMD (95% CI): -7.33 (-10.07, -4.58), p < 0.0001), systolic blood pressure fluctuations (I2 = 85.6%, WMD (95% CI): -6.10(-9.25, 2.95), p < 0.0001), diastolic blood pressure (I2 = 79.7%, WMD (95% CI): -4.29(-6.57, -2.02), p < 0.0001) fluctuations, anxiety scores (I2 = 19.6%, WMD (95% CI): -9.04(-11.45, 6.63), p < 0.0001), and pain scores (I2 = 32.7%, WMD (95% CI): -7.64(-9.43, -5.85), p < 0.0001), as well as significantly lowered anxiety and pain levels and raised patients' cooperation rates (I2 = 0%, OR (95% CI): 3.03(1.24, 7.40), p = 0.02). Conclusions Music interventions are effective for dental anxiety disorders, but given the limitations of the study, more multicenter, large-sample, high-quality randomized controlled trials are needed to further validate the findings and obtain more objective and reliable clinical evidence.
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8
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Nair K, Bhat AR. Applications of Gene Therapy in Dentistry: A Review Article. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2023. [DOI: 10.1055/s-0042-1759711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AbstractGene therapy promises to possess a good prospect in bridging the gap between dental applications and medicine. The dynamic therapeutic modalities of gene therapy have been advancing rapidly. Conventional approaches are being revamped to be more comprehensive and pre-emptive, which could do away with the need for surgery and medicine altogether. The complementary base sequences known as genes convey the instructions required to manufacture proteins. The oral cavity is one of the most accessible locations for the therapeutic intervention of gene therapy for several oral tissues. In 1990, the first significant trial of gene therapy was overseen to alleviate adenosine deaminase deficiency. The notion of genetic engineering has become increasingly appealing as a reflection of its benefits over conventional treatment modalities. An example of how this technology may alter dentistry is the implementation of gene therapy for dental and oral ailments. The objective of this article is to examine the effects of gene therapy on the field of dentistry, periodontology and implantology. Furthermore, the therapeutic factors of disease therapy, minimal invasion, and appropriate outcome have indeed been taken into consideration.
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Affiliation(s)
- Karthika Nair
- Department of Periodontology, A B Shetty Memorial Institute of Dental Sciences, NITTE Deemed to be University, Mangaluru, Karnataka, India
| | - Amitha Ramesh Bhat
- Department of Periodontology, A B Shetty Memorial Institute of Dental Sciences, NITTE Deemed to be University, Mangaluru, Karnataka, India
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9
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Matsuda S, Itoi H, Ryoke T, Yoshimura H. How should clinicians assess acute dental pain?: A review. Medicine (Baltimore) 2022; 101:e31727. [PMID: 36397373 PMCID: PMC10662864 DOI: 10.1097/md.0000000000031727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022] Open
Abstract
Pain is the most common complaint in the dental field and may have a significant impact on the patients' quality of life. However, objective pain assessment is sometimes difficult, and medical and dental clinicians may encounter cases of pain in the head and neck region, making it difficult to establish differential diagnoses. This study aimed to review acute pain in clinical dentistry at each phase of dental procedures and discuss the current status and issues in the development of acute dental pain assessment methods in the future. Acute pain in clinical dentistry may differ in nature and modifying conditions of pain at each stage: before dental procedures, while visiting dentists, and during and after dental procedures. They are related to actual or potential tissue damage, and may be modified and aided by personal experiences, including psychological and social factors. With respect to the aging and multinational population and pandemic of infectious diseases, significant breakthroughs in the development of new pain scales without verbal descriptions are desirable. Furthermore, it is expected that a new pain scale that can be applied to acute pain in the head and neck regions, including the oral cavity, will be developed.
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Affiliation(s)
- Shinpei Matsuda
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Hayato Itoi
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Takashi Ryoke
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Hitoshi Yoshimura
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
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10
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Salinas Fredricson A, Krüger Weiner C, Adami J, Rosén A, Lund B, Hedenberg-Magnusson B, Fredriksson L, Naimi-Akbar A. The Role of Mental Health and Behavioral Disorders in the Development of Temporomandibular Disorder: A SWEREG-TMD Nationwide Case-Control Study. J Pain Res 2022; 15:2641-2655. [PMID: 36097536 PMCID: PMC9464023 DOI: 10.2147/jpr.s381333] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose There is a well-known association between mental and behavioral disorders (MBD) and temporomandibular disorder (TMD), although the association has not been established in population-based samples. This study aimed to investigate this relationship using national population-based registry data. Patients and Methods This case-control study used prospectively collected data from Swedish national registries to investigate exposure to MBD and the probability of developing TMD in all Swedish citizens with hospital-diagnosed or surgically treated TMD between 1998 and 2016. Odds ratios were calculated using conditional logistic regression adjusted for educational level, living area, country of birth, musculoskeletal comorbidity, and history of orofacial/neck trauma. Results A statistically significant association between MBD and TMD was found for mood affective disorders (OR 1.4), neurotic, stress-related and somatoform disorders (OR 1.7), behavioral syndromes associated with psychological disturbances and physical factors (OR 1.4), disorders of adult personality and behavior (OR 1.4), disorders of psychological development (OR 1.3), behavioral and emotional disorders with onset usually occurring in childhood and adolescence (OR 1.4), and unspecified mental disorder (OR 1.3). The association was stronger for TMD requiring surgery, with the strongest association in patients with disorders of psychological development (OR 2.9). No significant association was found with schizophrenia, schizotypal and delusional disorders, or mental retardation. Conclusion The findings indicate an increased probability of TMD among patients with a history of certain MBD diagnoses, and a stronger association with TMD requiring surgery, specifically repeated surgery. This highlights the need for improved preoperative understanding of the impact of MBD on TMD, as TMD and chronic pain itself may have a negative impact on mental health.
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Affiliation(s)
- Adrian Salinas Fredricson
- Public Dental Services, Folktandvården Stockholm, Eastmaninstitutet, Department of Oral and Maxillofacial Surgery, Stockholm, Sweden.,Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carina Krüger Weiner
- Public Dental Services, Folktandvården Stockholm, Eastmaninstitutet, Department of Oral and Maxillofacial Surgery, Stockholm, Sweden.,Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Annika Rosén
- Department of Clinical Dentistry, Division of Oral and Maxillofacial Surgery, University of Bergen, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Bodil Lund
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Medical Unit for Reconstructive Plastic and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Britt Hedenberg-Magnusson
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Public Dental Services, Folktandvården Stockholm, Eastmaninstitutet, Department of Orofacial Pain and Jaw Function, Stockholm, Sweden
| | - Lars Fredriksson
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Public Dental Services, Folktandvården Stockholm, Eastmaninstitutet, Department of Orofacial Pain and Jaw Function, Stockholm, Sweden
| | - Aron Naimi-Akbar
- Public Dental Services, Folktandvården Stockholm, Eastmaninstitutet, Department of Oral and Maxillofacial Surgery, Stockholm, Sweden.,Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Health Technology Assessment-Odontology (HTA-O), Malmö University, Malmö, Sweden
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11
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Chronic Orofacial Pain: Models, Mechanisms, and Genetic and Related Environmental Influences. Int J Mol Sci 2021; 22:ijms22137112. [PMID: 34281164 PMCID: PMC8268972 DOI: 10.3390/ijms22137112] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic orofacial pain conditions can be particularly difficult to diagnose and treat because of their complexity and limited understanding of the mechanisms underlying their aetiology and pathogenesis. Furthermore, there is considerable variability between individuals in their susceptibility to risk factors predisposing them to the development and maintenance of chronic pain as well as in their expression of chronic pain features such as allodynia, hyperalgesia and extraterritorial sensory spread. The variability suggests that genetic as well as environmental factors may contribute to the development and maintenance of chronic orofacial pain. This article reviews these features of chronic orofacial pain, and outlines findings from studies in animal models of the behavioural characteristics and underlying mechanisms related to the development and maintenance of chronic orofacial pain and trigeminal neuropathic pain in particular. The review also considers the role of environmental and especially genetic factors in these models, focussing on findings of differences between animal strains in the features and underlying mechanisms of chronic pain. These findings are not only relevant to understanding underlying mechanisms and the variability between patients in the development, expression and maintenance of chronic orofacial pain, but also underscore the importance for considering the strain of the animal to model and explore chronic orofacial pain processes.
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12
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Schuh CMAP, Benso B, Aguayo S. Potential Novel Strategies for the Treatment of Dental Pulp-Derived Pain: Pharmacological Approaches and Beyond. Front Pharmacol 2019; 10:1068. [PMID: 31620000 PMCID: PMC6759635 DOI: 10.3389/fphar.2019.01068] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/22/2019] [Indexed: 12/18/2022] Open
Abstract
The diagnosis and management of pain is an everyday occurrence in dentistry, and its effective control is essential to ensure the wellbeing of patients. Most tooth-associated pain originates from the dental pulp, a highly vascularized and innervated tissue, which is encased within mineralized dentin. It plays a crucial role in the sensing of stimuli from the local environment, such as infections (i.e. dental caries) and traumatic injury, leading to a local inflammatory response and subsequently to an increase in intra-pulp pressure, activating nerve endings. However, thermal, chemical, and mechanical stimuli also have the ability to generate dental pulp pain, which presents mechanisms highly specific to this tissue and which have to be considered in pain management. Traditionally, the management of dental pulp pain has mostly been pharmacological, using non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, or restorative (i.e. removal of dental caries), or a combination of both. Both research areas continuously present novel and creative approaches. This includes the modulation of thermo-sensitive transient receptor potential cation channels (TRP) by newly designed drugs in pharmacological research, as well as the use of novel biomaterials, stem cells, exosomes and physical stimulation to obtain pulp regeneration in regenerative medicine. Therefore, the aim of this review is to present an up-to-date account of causes underlying dental pain, novel treatments involving the control of pain and inflammation and the induction of pulp regeneration, as well as insights in pain in dentistry from the physiological, pharmacological, regenerative and clinical perspectives.
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Affiliation(s)
- Christina M. A. P. Schuh
- Centro de Medicina Regenerativa, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Bruna Benso
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Department of Physiology, Faculty of Medicine, Universidad Austral de Chile, Millennium Nucleus of Ion Channels Associated Diseases (MiNICAD), Valdivia, Chile
| | - Sebastian Aguayo
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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