Orofacial pain management: an update.

New treatments for orofacial pain have been developed in recent years. In the case of cluster headache, new drugs are now administered via the intranasal route, while in patients with chewing pain the topical application of capsaicin and the use of oral splints in combination with jaw movement exercises are the most widely used management approaches. In the case of neurogenic pain new anticonvulsivants have been introduced, with fewer side effects than carbamazepine.

A comparative study of direct mandibular nerve block and the Akinosi technique.

A study is made of 56 patients subjected to lower molar extraction, comparing the efficacy of the Akinosi technique as an alternative to direct or conventional mandibular nerve block in two groups of 28 subjects each. The parameters evaluated were pain in response to puncture, percentage positive aspiration, latency, pain during the intervention and complications. Patient pain in response to puncture was comparatively less intense and frequent with the Akinosi technique.

Periapical surgery of 31 lower molars based on the ultrasound technique and retrograde filling with silver amalgam.

The introduction of ultrasound root-end preparation for preparing apical cavities in periapical surgery has simplified surgery and facilitated retrograde filling with silver amalgam. The technique is particularly useful in application to molars in which root apex access is more difficult. A study was made comprising 31 patients subjected to periapical surgery of a total of 31 mandibular molars.

Hereditary epidermolysis bullosa. Dental management of three cases.

Hereditary epidermolysis bullosa (EB) is a mucocutaneous disorder characterized by the appearance of blisters and vesicles in response to minimum friction. The digestive mucosa is one of the most frequently affected regions--including the oral mucosa. Three types of EB have been established according to the histological level of the lesion.

Placement of endosseous implants in patients with oral epidermolysis bullosa.

Objective: To evaluate the feasibility of placing endosseous implants in patients with recessive dystrophic epidermolysis bullosa. This article reports on 4 patients subjected to follow-up.

Study Design: Implants were placed in 4 cases.

Ophthalmologic complications after intraoral local anesthesia with articaine.

A series of 14 cases of ophthalmologic complications after intraoral anesthesia of the posterior superior alveolar nerve is presented. The most commonly encountered symptoms were diplopia, mydriasis, palpebral ptosis, and abduction difficulties of the affected eye. In all cases, these effects occurred a few minutes after injection of the anesthetic, followed by complete resolution without sequelae on cessation of the anesthetic effect.

Orofacial manifestations of mixed connective tissue disease with an uncommon serologic evolution.

Mixed connective tissue disease is a multisystemic disorder with overlapping features of systemic lupus erythematosus, scleroderma, and polymyositis, and is differentiated from them by a high titer of antibody to ribonucleoprotein. Orofacial manifestations of mixed connective tissue disease include trigeminal neuralgia-like pain, neuropathy, features suggestive of Sjögren's syndrome, and lymphadenopathy. Our recent experience with one patient with trigeminal neuropathy, facial paralysis, Sjögren's syndrome, and aseptic meningitis as early manifestations of the disease, together with an uncommon serologic evolution, is described.

A clinical study of 205 patients with oral lichen planus.

Two hundred and five patients with oral lichen planus were divided into two groups: those with only reticular lesions (group 1) and those with atrophic-erosive lesions with or without concomitant reticular lesions (group 2). A comparative study of the two groups showed that the most commonly affected oral location in both was the buccal mucosa. Lesions of the tongue, gingiva, lip, and palate predominated in group 2.

[Psychiatric practice and dentistry: anthropological and clinical relations].

The authors establish the clinical and anthropological connections relative to the buccal patient. Although apparently the relationship between the psychiatrist and the patient is diametrically opposite to the relationship that a buccolic professional may have with a patient, however, the reflexion which is developed in the work shows, from a wholistic and anthropological perspective, that both professional activities are confluent when dealing with the conception of "sick patient". Two clinical cases illustrate the difficulties which, sometimes, appear in the relationship between the psychiatrist and the ondotologist.

[A morphometric study of 74 cases of oral lichen planus].

We have carried out a morphometric study of the lesions of 74 patients with oral lichen planus. We have found as important data that the parameters differentiating the reticulated clinical lesions from the atrophic or erosive lesions are the epithelial thickness and the length of the dermic papillae. On the other hand, we have seen no difference between both types of lesions as regards the quantity of infiltrate in the connective tissue.

Diphenylhydantoin-induced gingival overgrowth in man: a clinico-pathological study.

In a cross-sectional, epidemiological study of diphenylhydantoin-induced gingival overgrowth (DGO) in 60 epileptic patients, gingival lesion severity was statistically compared with other clinical, laboratory, and histopathological findings. Evident DGO was observed in 50% of patients, and positive correlations were detected between overgrowth severity and oral debris, calculus accumulation, plaque score, gingival inflammation, and probing depth. However, no valid correlation was observed between lesion and patient age, mouth breathing, daily drug dose, plasma diphenylhydantoin level, or duration of drug intake.

[Clinico-pathological study of oral mucoceles].

We present a clinical and histopathological study of 25 mucoceles of the oral cavity. Incidence was found to be greatest between age 10 and 20 (12 cases), with no significant differences in terms of sex. The lower lip was most frequently affected (17 cases), other locations being much less common.

[Facial pain of cardiac origin].

Two cases of anginal pain limited to the mandible with secondary radiation of the pain to the neck and clavicular region are presented. Although the pain was initially diagnosed as odontogenic in origin, further historial workup suggest the suspicion of referred pain from coronary insufficiency. Appropriate medical referral confirmed diagnostic suspicions.

Mental nerve neuropathy in systemic cancer. Report of three cases.

Mental nerve neuropathy (MNN), an uncommon neurologic symptom, was observed in three patients with cancer. In the first patient, MNN was the primary manifestation of an occult carcinoma of the lung. The second patient had bilateral MNN.

[Hematologic alterations and reduction in serum folate in epileptics treated with anticonvulsants].

A prospective study of the incidence of toxic hematologic effects of antiepileptic drugs was carried out in a series of 104 epileptic patients treated with phenytoin alone or combined with other drugs, and in 30 patients treated with other anticonvulsants. A slight decrease in hemoglobin values and a slight increase in mean corpuscular volume and mean corpuscular hemoglobin was observed in both groups. These changes are typical of the hyperchromatic megaloblastic anemias, although a statistically significant relationship between folates and hemoglobin could not be established.