Persistent Toothache Despite Multiple Dental-related Treatments: How Could this Be?

Patients with recurrent or persistent dentoalveolar pain usually believe that endodontic treatment or extracting a tooth will alleviate it, and most cannot conceive that the pain might not be tooth related. Understanding that dental procedures of any kind will be ineffective when a tooth-related pathology is ruled out and that a nonodontogenic etiology best explains the "toothache" pain goes against their beliefs. In this article, we present an overview of basic concepts to help manage such cases by briefly outlining possible causes of nonodontogenic pain as well as diagnostic pitfalls that may lead to questionable treatments.

Relationship Between Disease Characteristics and Oral Radiologic Findings in Systemic Sclerosis: Results From a Canadian Oral Health Study.

Objective: Systemic sclerosis (SSc; scleroderma) is associated with a wide periodontal ligament (PDL) and mandibular erosions. We investigated the clinical correlates of SSc with these radiologic abnormalities.

Methods: Subjects from the Canadian Scleroderma Research Group cohort underwent detailed radiologic examinations.

The Canadian Systemic Sclerosis Oral Health Study IV: oral radiographic manifestations in systemic sclerosis compared with the general population.

Objective: The aim of this study was to compare oral radiologic abnormalities associated with systemic sclerosis (SSc) against abnormalities in the general population.

Study Design: Patients with SSc and healthy controls were enrolled in a multi-site cross-sectional study. Included in the radiology examination were a panoramic radiograph, four bitewings, and an anterior mandibular periapical radiograph.

Relationship between disease characteristics and orofacial manifestations in systemic sclerosis: Canadian Systemic Sclerosis Oral Health Study III.

Objective: Systemic sclerosis (SSc; scleroderma) is associated with decreased saliva production and interincisal distance, more missing teeth, and periodontal disease. We undertook this study to determine the clinical correlates of SSc with these oral abnormalities.

Methods: Subjects were recruited from the Canadian Scleroderma Research Group cohort.

The Canadian systemic sclerosis oral health study II: the relationship between oral and global health-related quality of life in systemic sclerosis.

Objective: Both oral and global health-related quality of life (HRQoL) are markedly impaired in SSc. In this study we aimed to determine the degree of association between oral HRQoL and global HRQoL in SSc.

Methods: Subjects were recruited from the Canadian Scleroderma Research Group registry.

The Canadian systemic sclerosis oral health study: orofacial manifestations and oral health-related quality of life in systemic sclerosis compared with the general population.

Objective: The aim of this study was to compare oral abnormalities and oral health-related quality of life (HRQoL) of patients with SSc with the general population.

Methods: SSc patients and healthy controls were enrolled in a multisite cross-sectional study. A standardized oral examination was performed.

Orofacial injuries due to trauma following motor vehicle collisions: part 2. Temporomandibular disorders.

Temporomandibular disorders (TMDs) following motor vehicle collisions (MVCs) may result from direct orofacial trauma but also occur in patients with whiplash-associated disorder (WAD) without such trauma. TMDs may not be identified at the time of first assessment, but may develop weeks or more after the MVC. TMDs in WAD appear to occur predominantly in females and can be associated with regional or widespread pain.

Orofacial injuries due to trauma following motor vehicle collisions: part 1. Traumatic dental injuries.

Dental providers must determine the presence of orofacial injury, and diagnose and treat dental and orofacial outcomes of trauma caused by motor vehicle collisions. Determination of causation and relation to the trauma is indicated. Dental trauma includes concussion, subluxation and dislocation of teeth, and fracture of teeth and maxillofacial bone, in addition to soft tissue injury that may cause ecchymosis, hematoma and laceration or abrasion.

Quality of life and oral function following radiotherapy for head and neck cancer.

Background: Multiple oral complaints occur following radiotherapy for oropharyngeal cancer, but the frequency and severity of symptoms of dysfunction and discomfort are not well understood. The purpose of this investigation was to assess the quality of life, oral function, and oral symptoms following radiotherapy.

Methods: A general quality of life survey (the European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire QLQ-C30), with an added oral symptom and function scale was mailed to 100 patients more than 6 months following radiotherapy.

A comparison of TMD patients with or without prior motor vehicle accident involvement: treatment and outcomes.

The influence of previous trauma in the management of patients with temporomandibular disorders (TMD) is controversial. The objectives of this study were to compare treatment regimens and outcomes in motor vehicle accident trauma-related versus nontrauma-related TMD patients. Files of 50 trauma and 50 matched nontrauma TMD patients were reviewed.

Effect of impact and injury characteristics on post-motor vehicle accident temporomandibular disorders.

Objectives: The objective of this study was to assess the potential effects of motor vehicle accident impact and injury characteristics on post-motor vehicle accident temporomandibular disorders in terms of presenting signs and symptoms, diagnoses, treatment regimens, and outcomes.

Study Design: A retrospective chart review of 50 patients with post-motor vehicle accident temporomandibular disorders from a private oral medicine practice was undertaken. Various demographic data and data related to temporomandibular disorders and motor vehicle accident impact and injury characteristics were collected.

A comparison of TMD patients with or without prior motor vehicle accident involvement: initial signs, symptoms, and diagnostic characteristics.

The role of trauma in the etiology of temporomandibular disorders (TMD) is controversial. The objectives of this study were to compare presenting signs, symptoms, and diagnoses in patients who had motor vehicle accident trauma-related TMD to patients who had nontrauma-related TMD. Files of 50 trauma and 50 matched nontrauma TMD patients were reviewed.

Temporomandibular disorders, headaches, and neck pain after motor vehicle accidents: a pilot investigation of persistence and litigation effects.

Statement Of Problem: There is a lack of long-term follow-up studies that involve post-motor vehicle accident temporomandibular disorders and compensation.

Purpose Of Study: The purposes of this retrospective pilot study were (1) to assess patients who had previously been treated for temporomandibular disorders after motor vehicle accidents to determine the nature of their symptoms in terms of jaw, head, and neck pain and jaw dysfunction and (2) to determine whether there was a difference in the pain and dysfunction between those who had settled and those who had not settled their insurance claims.

Material And Methods: Thirty previously treated patients with temporomandibular disorders after motor vehicle accidents were questioned by telephone regarding litigation status and current jaw, head, and neck pain and jaw dysfunction symptoms.

Motor vehicle accidents and TMDS: assessing the relationship.

Patients involved in a motor vehicle accident, or MVA, may experience signs and symptoms suggesting temporomandibular joint or masticatory muscle injury. Because there are no published clinical studies assessing the potential relationship among reported variables suggesting injury, examination findings, and crash impact and postural variables, the authors gathered data from 219 patients identifying TMD after an MVA. The results suggest that TMJ or masticatory muscle injury may be associated with varying postural characteristics and impact events, including speed, direction of impact and vehicular damage.

Temporomandibular disorders, headaches, and neck pain following motor vehicle accidents and the effect of litigation: review of the literature.

A literature review concerning the relationships between motor vehicle accidents and temporomandibular disorders, whiplash, headache, neck pain, and litigation was undertaken. The review shows that many patients recover or resume work prior to settlement, but most unsuccessfully treated patients do not generally recover following the settlement of legal claims; the postinjury problems are not strictly psychologic. Litigating patients and nonlitigating patients are often not dramatically different in most important regards (including pain and return to work), with litigating patients deserving the same treatment as other patients with chronic pain.

Early oral changes following bone marrow transplantation.

This study assessed and analyzed the early oral changes following chemoradiotherapy and bone marrow transplantation. The most notable changes involved mucosal color (white and red), atrophy, vascularity, ulceration, increased salivary viscosity and xerostomia, and the patients' subjective complaints of dryness and oral pain. The ventral tongue, buccal and labial mucosa, and marginal gingiva manifested the most notable changes, while the palate was least affected.

Electric pulp testing with examination gloves.

The electric pulp test (EPT) is a valuable diagnostic aid in assessing the vitality of the dental pulp; however, its use with the operator wearing examination gloves is controversial. In this study, 15 female and 15 male subjects had two different clinically sound teeth tested with an Analytic Technology digital electric pulp tester, both with and without latex examination gloves being worn by the operator. Statistically significant differences between EPT results for the same teeth with the operator's hands being gloved and ungloved were noted.

The heat resistance of a data-encoded ceramic microchip identification system.

Samis introduced the concept of the Dentify system of personal identification. In this system, ceramic microchips embossed with metallic intelligence data are placed in teeth under dental restorations. This paper describes the results of an in vitro study aimed at testing the heat resistance qualities of this identification system when placed in teeth.

The heat resistance of a ceramic identification device.

Identification of human remains by the teeth is a widely accepted forensic procedure. At present the principle dental technique used for identification of the dead is the post-mortem comparison method which involves a comparison of post-mortem dental findings and any available ante-mortem records. This study describes the results of an in vitro incineration investigation testing the heat resistance qualities of metallic intelligence data encoded on microchips comprising part of the Dentify system of identification.