Cases reported "Facial Pain"

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1/6. Orofacial pain emerging as a dental specialty.

    The emerging field of orofacial pain was considered by the american dental association for full status as a new dental specialty. While the recognition of orofacial pain as a specialty was denied, the American Academy of Orofacial Pain plans to continue its efforts. Many recent advances in the neuroscience of orofacial pain have led to treatments that provide significant relief for patients with chronic orofacial pain disorders. However, access to this care has been limited, leaving many patients to suffer. dentists are generally supportive of the efforts to develop oral pain treatment into a specialty because the field will provide benefits for both dentists and their patients. A recent survey of 805 individuals who reported having a persistent pain disorder revealed that more than four out of 10 people have yet to find adequate relief, saying their pain is out of control--despite having the pain for more than five years and switching doctors at least once. "This survey suggests that there are millions of people living with severe uncontrolled pain," says Russell Portenoy, MD, president of the American Pain Society. "This is a great tragedy. Although not everyone can be helped, it is likely that most of these patients could benefit if provided with state-of-the-art therapies and improved access to pain specialists when needed." Development of the field of orofacial pain into a dental specialty has been moved primarily by the fact that historically, patients with complex chronic orofacial pain disorders have not been treated well by any discipline of healthcare. Recent studies of chronic orofacial pain patients have found that these patients have a higher number of previous clinicians and have endured many years with pain prior to seeing an orofacial pain dentist (see Figure 1). Complex pain patients and the clinicians who see them are often confused about who they should consult for relief of the pain. Treatment for those patients within the existing structure of dental or medical specialties has been inadequate, with millions of patients left suffering. Insurers are also confused with regard to reimbursement and may make decisions to exclude treatment for orofacial pain disorders under both dental and medical policies. However, dentistry has taken a leading role in healthcare to address the national problem of developing the field of orofacial pain into a dental specialty. A study of dentists and dental specialists has shown that there is a recognized need and broad support for developing this field into a specialty.
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2/6. iontophoresis: an effective modality for the treatment of inflammatory disorders of the temporomandibular joint and myofascial pain.

    The use of the iontophoresis modality for driving medications through the skin for treatment of certain TM dysfunction and myofascial pain dysfunction syndrome was first suggested by Gangarosa and Mahan in 1982. This paper introduces the iontophoresis technique for treatment of inflammatory and myofascial disorders of the craniomandibular system. The historical aspects of iontophoresis in medicine and dentistry is reviewed. As an aid to understanding the clinical applications of this method, a review of diagnostic classification of temporomandibular disorders and an in-depth review of the role of the inflammatory process are provided. The effect of inflammation on the synovial/lymphatic system is detailed. Reference is made to the advantages of iontophoresis over hypodermic injection. The basis materials and methods of use of the modality are shown along with a protocol for patient treatment. Several case studies are discussed with clinical observations given.
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keywords = dentistry
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3/6. Orthopedic/orthodontic therapy for anterior disk displacement: unexpected treatment findings.

    Craniomandibular pain dysfunction (CMPD) is of increasing clinical concern to all fields of dentistry, especially orthodontics. One of the more common manifestations of CMPD is anterior disk displacement. Orthodontic/orthopedic treatment for anterior disk displacement using anterior repositioning of the mandible has been suggested by several clinicians as the treatment of choice. Returning the mandible back toward the original occlusion or habit centric has also been suggested by several reports. Functional jaw orthopedic (FJO) appliances would appear to be ideally suited for the treatment of anterior disk displacement due to the anterior repositioning nature of these appliances. In growing individuals, among other changes, the condyle is supposed to grow back into the fossa (which would serve as the walkback procedure). This article presents three young patients who had anterior disk displacement and posterior condylar displacement before treatment. Each patient was treated using a functional appliance and each patient ended treatment still having a posterior condylar displacement and anterior disk displacement. These findings were unexpected and no explanation is offered. This occurrence is rare in the author's practice (approximately 2-3%), but this is a real concern and the patients should be made aware of this possibility before starting treatment, so that their expectations are realistic. These enigmatic findings also emphasize the complexity of TMJ as well as FJO treatment and indicate the need for further research and study.
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keywords = dentistry
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4/6. The misdiagnosis of temporomandibular disorders in lateral pharyngeal space infections--two case reports.

    Two cases of lateral pharyngeal space infections which were initially misdiagnosed as temporomandibular disorders (TMD) are presented and discussed. Such symptomatology as chronic facial pain, trismus and decreased inter-incisal opening provide many viable different diagnoses. It is important for the clinician to evaluate these different diagnoses in a logical manner. Conservative therapy is advised in the initial treatment of many TMDs, therefore other diagnoses with a greater potential for morbidity should be ruled in or out before the diagnosis of TMD is considered. The symptomatology of lateral space infections and the relevance of this entity to clinical dentistry are discussed.
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keywords = dentistry
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5/6. Comparison of two patients with similar facial pain complaints of dental and non-dental etiologies.

    The medical and lay communities have become more aware of the role of dentistry in the diagnosis and management of facial pain disorders. In some cases, the patient or physician may presume that a facial pain complaint is of odontogenic origin and seek the opinion of a dental practitioner. While the majority of facial pain complaints may be due to dental pathologies, some may also be due to non-dental causes. The diagnostic acumen of the dentist must include a basic understanding of non-dental causes for facial pain as well as those related to dentistry. The following case reports may serve to underscore this observation.
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keywords = dentistry
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6/6. lyme disease: considerations for dentistry.

    Although lyme disease has spread rapidly and it is difficult to diagnose, a review of the dental literature does not reveal many references to this illness. Dental practitioners must be aware of the systemic effects of this often multiorgan disorder. Its clinical manifestations may include facial and dental pain, facial nerve palsy, headache, temporomandibular joint pain, and masticatory muscle pain. The effects precipitated when performing dental procedures on a patient with lyme disease must also be considered. This study discusses the epidemiology and diagnosis of lyme disease, its prevention, and factors to consider when making a differential diagnosis. dental care of the patient with lyme disease and currently available treatments also are considered. Three case reports are presented.
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keywords = dentistry
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