Chronic pain conditions and risk of suicidal behavior: a 10-year longitudinal co-twin control study

BACKGROUND

Understanding the relationship between chronic pain conditions and suicidal behavior-suicide attempt, other intentional self-harm, and death by suicide-is imperative for suicide prevention efforts. Although chronic pain conditions are associated with suicidal behaviors, these associations might be attributed to unmeasured confounding or mediated via pain comorbidity.

METHODS

We linked a population-based Swedish twin study (N=17,148 twins) with 10 years of longitudinal, nationwide records of suicidal behavior from health and mortality registers through 2016. To investigate whether pain comorbidity versus specific pain conditions were more important for later suicidal behavior, we modeled a general factor of pain and two independent specific pain factors (measuring pain-related somatic symptoms and neck-shoulder pain, respectively) based on 9 self-reported chronic pain conditions. To examine whether the pain-suicidal behavior associations were attributable to familial confounding, we applied a co-twin control model.

RESULTS

Individuals scoring one standard deviation above the mean on the general pain factor had a 51% higher risk of experiencing suicidal behavior (odds ratio (OR), 1.51; 95% confidence interval (CI), 1.34-1.72). The specific factor of somatic pain was also associated with increased risk for suicidal behavior (OR, 1.80; 95% CI, 1.45-2.22]). However, after adjustment for familial confounding, the associations were greatly attenuated and not statistically significant within monozygotic twin pairs (general pain factor OR, 0.89; 95% CI, 0.59-1.33; somatic pain factor OR, 1.02; 95% CI, 0.49-2.11) CONCLUSION: Clinicians might benefit from measuring not only specific types of pain, but also pain comorbidity; however, treating pain might not necessarily reduce future suicidal behavior, as the associations appeared attributable to familial confounding.

Direct observation and theory of trajectory-dependent electronic energy losses in medium-energy ion scattering

The energy spectrum associated with scattering of 100 keV H+ ions from the outermost few atomic layers of Cu(111) in different scattering geometries provides direct evidence of trajectory-dependent electronic energy loss. Theoretical simulations, combining standard Monte Carlo calculations of the elastic scattering trajectories with coupled-channel calculations to describe inner-shell ionization and excitation as a function of impact parameter, reproduce the effects well and provide a means for far more complete analysis of medium-energy ion scattering data.

"The dental cripple": a new approach to severe mandibular atrophy

We have found this use of the composite graft of the severely atrophic mandible to offer a very predictable successful technique for the "severe dental cripple". It is only with the advent of the osseointegrated implants that this technique really can be fully utilized. The inferior border grafting certainly addresses the issue of pathologic fracture, but without the use of implants, it would not enhance the prosthetic environment intraorally. By combining these grafting and implant techniques, we feel that this is not only a predictable surgical technique, but it also offers the advantages of less resorption, cleaner surgical incisions, and less interruption of prosthesis use during the healing phases (Figs. 7 & 8). We are continuing to follow the initial group of patients who have undergone this therapy, and the lack of resorption to date has been extremely encouraging.

Surgical approaches to mandibular condylar fractures: a review

BACKGROUND AND OBJECTIVES

The estimates of mandibular condyle fracture incidence lack consensus, as these fractures are frequently overlooked or misdiagnosed, resulting in adverse effects. The purpose of this article is to review the anatomy of the mandibular condyle and the surgical approaches currently available.

METHODS AND MATERIALS

Surgical treatment of mandibular condyle fractures remains controversial, due to the indications and difficulty with the associated vital structures. To aid in selecting the appropriate approach, the authors present a review of the mandibular anatomy and the approaches utilized, as reported in the literature and observed in the clinical practice of the authors.

RESULTS AND/OR CONCLUSIONS

In selecting the approach, the knowledge of the mandibular anatomy is vitally important. A survey found that the preauricular, submandibular, and intraoral approaches (in that order) were preferred. When treating the fractured mandibular condyle with open reduction and internal fixation, a thorough knowledge of the anatomy of vital structures, exercise of care, and careful dissection through the soft tissues will reduce the risk for morbidity.

Options for immediate reconstruction of the traumatized temporomandibular joint

The management of condylar fractures is one of the most controversial topics in the repair of the maxillofacial skeleton. An extensive volume of literature exists describing the various indications for a specific treatment of this injury. This article outlines the absolute and relative indications for an open procedure and describes three different modalities for the immediate reconstruction of the temporomandibular joint system. Three different case reports are used to illustrate the respective procedures--replacement of the temporomandibular joint with autologous rib graft, replacement of the temporomandibular joint with an alloplast, and vertical ramus osteotomy for repositioning of the condylar stump. The discussion section reviews the findings and preferences of various treatment modalities described in the literature, along with the advantages and disadvantages.

Intracranial schwannoma as atypical facial pain. Case report

Facial pain is a common complaint that leads those who have it to seek professional help. Often times, the general dentist is the first clinician that a patient consults because of a presumed odontogenic origin of the pain. Occasionally a small number of these patients will be found to have an intracranial tumor. The case reported here is one such patient who was diagnosed and treated for a seventh nerve schwannoma.

Ibuprofen controlled-release formulation. A clinical trial in dental impaction pain

This double-blind study compared a controlled-release formulation of ibuprofen 600 mg with three doses of regular ibuprofen 200 mg and three doses of codeine 30 mg. Patients who had dental impaction surgery received the controlled-release ibuprofen, codeine, or regular ibuprofen when postoperative pain reached moderate to severe intensity. At 4 and 8 hours after dose 1, patients who had initially received the controlled-release ibuprofen received a placebo, and those taking ibuprofen and codeine received their second and third doses of those drugs. All doses of study medication or placebo appeared identical for each treatment. Subjects made evaluations hourly for 12 hours in a diary. The controlled-release ibuprofen had a comparable onset to ibuprofen, a higher peak effect, and was significantly more effective than ibuprofen at hour 4; the controlled-release ibuprofen was significantly more effective than codeine for all hourly observations through hour 9. Ibuprofen was significantly better than codeine only through hour 3. The controlled-release ibuprofen had the lowest incidence of side effects and codeine the highest. The single dose of the controlled-release ibuprofen formulation appeared as efficacious as three regular doses of ibuprofen 200 mg over a 12-hour period.

Total temporomandibular joint reconstruction with a Delrin titanium implant

Numerous alloplastic materials have been used for partial or total reconstruction of the temporomandibular joint in patients with fibrous or bony ankylosis, severe degenerative joint disease, or traumatic deformity, and for reconstruction following tumor resection and corrective surgery following multiple arthroplasties. We have had initial success with the use of a polyoxymethylene (Delrin) condylar head affixed to a pure titanium mesh for these reconstructive procedures. This versatile prosthesis does not require use of a separate glenoid fossa prosthesis. The surgical technique, as well as a historical perspective on alloplastic total joint prostheses used to date, is described in several patients.

Magnetic resonance imaging in the diagnosis of trigeminal neuralgia

Trigeminal neuralgia is not a specific disease, but a symptom elicited by pathology involving the fifth cranial nerve. Advances in the field of magnetic resonance imaging (MRI) have made this the premier imaging modality in the diagnostic workup of trigeminal neuralgia. This article reviews the pertinent anatomy of the trigeminal nerve as well as the structural lesions that produce the symptoms of the condition. The advantages of MRI over other imaging methods are outlined, and the indications for obtaining this study are discussed.

Traumatically induced peripheral osteoma. Report of a case

Osteomas of the jaws are well-defined lesions that can present as an isolated finding or as part of a syndrome (e.g., Gardner's syndrome). The etiology of peripheral osteomas is somewhat controversial. Trauma has been implicated by several authors, and osteoma is presented here as a rather striking lesion with well-defined traumatic origins.

Surgical management of a patient with cleidocranial dysplasia: a case report

Cleidocranial dysplasia is associated with the formation of many supernumerary teeth which usually fail to erupt. In later life, cysts may form around the embedded teeth. The following report describes the management of such a case with a method which promotes satisfactory prosthodontic rehabilitation.

Synovial chondromatosis with cranial extension

Synovial chondromatosis is a benign arthropathy characterized by metaplasia in synovial membranes that can produce detached particles of cartilage. It occurs most often in the knee, hip, and elbow but has been reported in the temporomandibular joint. This is a rare presentation of synovial chondromatosis with glenoid fossa erosion and cranial extension.

Reversing intravenous sedation with flumazenil

This study was designed to evaluate the effects of flumazenil in reversing sedation from midazolam and meperidine after oral surgical procedures. Of the 35 patients entered, efficacy was evaluated in 33 and safety in 34. Patients were tested for sedation, psychomotor skills, and memory during a 3-hour period and at a 24-hour follow-up. Flumazenil almost totally reversed the effects of sedation for approximately 2 hours, after which some loss of effect was observed. A number of central nervous system-related side effects were observed in the flumazenil group, but none of these was considered serious. One patient in the flumazenil group had an episode of hypotension that precluded further testing.

Total lower face bony rejuvenation

The technique of using a composite cadaver-autogenous bone graft for treatment of the severely atrophic mandible has been utilized in six patients. The full benefit of this technique can only be realized with the concomitant use of osseointegrated implants. The initial work of Marx has provided the basis for this reconstructive technique. Early follow-up to date is encouraging in that this procedure should help to avoid the severe resorption encountered with intraoral superior border grafting. It also avoids the need for a secondary soft-tissue procedure such as vestibuloplasty with skin grafting and lowering of the floor of the mouth. Patients tend to have an easier acceptance of this technique because they are not forced to endure long periods when they cannot wear any prosthesis, as was the case with the intraoral technique. Besides the obvious functional improvement in these patients, we have noted a marked psychologic change based on an improvement in self-image and self-perception. With the final construction of the prosthesis, there are improvements in the vertical dimension of the lower face. Results to date have been extremely encouraging and long-term follow-up will continue.

Desmoplastic fibroma of the mandible

Desmoplastic fibromas of the facial skeleton are the bony counterparts to the soft-tissue desmoid tumors and are almost exclusively confined to the mandible. The diagnosis should be considered whenever a rapidly increasing swelling with little functional disability is noted in the mandible. Historical, clinical, radiologic, and histologic findings must be correlated to establish the correct diagnosis. Every effort must be made to distinguish these lesions from well-differentiated fibrosarcomas. An illustrative case is presented. The treatment of desmoplastic fibromas affecting the facial skeleton should be conservative. Curettage is recommended for small tumors. Wide resections with reconstruction should be reserved for larger lesions and for those that have recurred after conservative treatment.

Facial trismus and myofascial pain associated with infections and malignant disease. Report of five cases

Five cases of facial pain and limited jaw opening, which include two infections, two primary carcinomas, and one metastatic carcinoma, each imitating TMJ dysfunction, are presented. These cases emphasize the importance of (1) a thorough working knowledge of the differential diagnosis of facial pain and limited jaw opening; (2) a complete evaluation, including a review of an adequate medical history as well as a full head and neck examination; and (3) the ability to make use of diagnostic radiographs, including computerized tomography.

Surgical-orthodontic management of an unerupted maxillary incisor

Satisfactory functional and esthetic results were attained, with proper consideration of surgical, periodontal, and orthodontic principles in the treatment of a patient with an unerupted maxillary central incisor. Gingival attachment was maintained and integrity of the dental arch was restored.