J Orofac Pain
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To estimate the intra- and interrater reliability of current perception threshold (CPT) evaluation, especially within the infraorbital nerve territory (ION) and inferior alveolar nerve territory (IAN) of the orofacial region, and to characterize the CPTs of ION and IAN in the normal population. ⋯ Evaluation of CPTs within ION and IAN revealed good intra- and interrater reliability. The study also provided normative data of CPTs of ION, IAN, and the between-site and within-site ratios of CPTs of ION and IAN. This should prove useful in the diagnosis of orofacial neuropathy.
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To determine the degree to which the generic pain intensity rating (i.e., overall and without reference to a particular body site) of facial pain patients being seen in a specialty setting for facial pain is influenced by painful comorbidity in body parts other than the face. ⋯ The results of this study suggest that the maximum visual analog scale pain intensity score, observed in any body location, is a better reflection of the generic pain intensity rating than the corresponding score of the face. To avoid over-rating or underrating of facial pain intensity, patients should be instructed to provide site-specific pain intensity scores if painful comorbidity is present.
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Patients with different facial pain/headache pathologies usually complain of numerous accompanying symptoms relative to systemic dysfunctions or to the patient's personality characteristics. The purpose of this work was: (1) to determine the prevalence of accompanying symptoms in groups of patients with temporomandibular joint (TMJ) dysfunction and other types of facial pain or headache disorders, (2) to assess the patients' personality characteristics and anxiety levels, and (3) to see whether significant differences were found between the groups. ⋯ It is concluded that some types of headache and facial pain seem to correlate with the presence of a number of accompanying symptoms and with some changes in personality. These changes are particularly relevant in patients with chronic daily headache and facial pain disorder. In contrast, patients with TMJ intracapsular disorders tended to show a low prevalence of accompanying symptoms and a normal personality profile.
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The aim of this study was to determine the prevalence of pain that is related to temporomandibular disorders (TMD), gender differences, and perceived treatment need in children and adolescents at a public dental clinic in Linköping, Sweden. ⋯ Overall, TMD-related pain was more common in girls than in boys. A majority of children and adolescents who experienced pain once a week or more perceived a need for treatment. Seven percent of the examined subjects were diagnosed with TMD pain.
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Nerve signals arising from sites of tissue or nerve injury lead to long-term changes in the central nervous system and contribute to hyperalgesia and the amplification and persistence of pain. These nociceptor activity-induced changes are referred to as central sensitization. Central sensitization involves an increase in the excitability of medullary and spinal dorsal horn neurons brought about by a cascade of events, including neuronal depolarization, removal of the voltage-dependent magnesium block of the N-methyl-D-aspartate (NMDA) receptor, calcium entry into neurons, phosphorylation of the NMDA receptor, a change in the cell's excitability, and an increase in synaptic strength. ⋯ The latter exhibits changes very similar to those in the spinal dorsal horn, but the Vi/Vc zone likely is involved in autonomic nervous system processing and activation of the pituitary-adrenal axis. Descending systems are also an important component of the central sensitization process and provide the neural networks by which cognitive, attentional, and motivational aspects of the pain experience modulate pain transmission. These findings of nociceptor activity-induced neuronal plasticity have important clinical implications in the development of new approaches to the management of persistent pain.