Im Praxis- und Klinikalltag wird der Zahnarzt regelmässig mit Patienten konfrontiert, die über Schmerzen im Gesicht klagen. Neben möglichen dentalen Ursachen können Erkrankungen aus anderen ...Fachgebieten, über die sich der Zahnarzt bewusst sein muss, verantwortlich für Gesichtsschmerzen sein. Eine genaue Schmerzanamnese ist daher ebenso wichtig wie eine gründliche klinische Untersuchung und die Einleitung gezielter diagnostischer Massnahmen, um dem Patienten schliesslich eine erfolgversprechende Therapie anbieten zu können. In diesem Artikel wird der Gesichtsschmerz aus der Perspektive der Fachbereiche Zahnmedizin, Neurologie und Neurochirurgie differenzialdiagnostisch erörtert, und es werden die unter- schiedlichen diagnostischen und therapeutischen Herangehensweisen erarbeitet. Ziel ist es, dem Patienten zeitraubende fehlgeleitete Therapien zu ersparen und ihn möglichst zeitnah einer effizienten, zielgerichteten Schmerztherapie zuzuführen, um die Entstehung einer Schmerzchronifizierung zu vermeiden.
Acute pain has a warning function and is necessary to survive. Conversely, chronic or recurrent pain is a pathological entity itself and has tremendous impact on the quality of life of the patients . ...Facial pain is very common and can have various causes. The trigeminal nerve innervates the face, and tumours along its intracranial way as well as peripheral injury can lead to facial pain. Also, infections and systemic diseases, like multiple sclerosis, may cause pain in the face, so can vascular compressions of the trigeminal or glossopharyngeal nerve. Detailed pain history is crucial in order to rule out other than dental reasons for facial pain before invasive dental therapy is initiated. A multidisciplinary approach and additional imaging modalities might be necessary to find the optimal treatment for the patient.
Psychological factors are not only important in patients with temporomandibular disorders (TMDs), but also in patients suffering from tooth loss and/or in those awaiting prosthodontic care with fixed ...or removable dentures as several authors emphasize. The purpose of the present prospective observational study was to compare prosthodontic outpatients of the Department of Prosthodontics at the University of Duesseldorf and patients seeking care at the TMD/Orofacial Pain Outpatient Clinic (TMD/OFPOC) at the same university with respect to sociodemographic data, self-reported somatic complaints, and psychological impairment.
A total of 234 patients received two self-administered questionnaires including the Symptom-Check-List. Complete data have been obtained from 65 prosthodontic outpatients and 60 patients of the TMD/OFPOC.
Results indicated statistically significant group differences regarding sociodemographic data and somatic complaints. Concerning the latter, in 11 of the 21 items, groups differed significantly and confirmed the absence of any mixing between the two outpatient clinics. Although the evaluation of psychological impairment revealed no significant group differences, in 21.9% of the prosthodontic outpatients and in 22.0% of the patients from the TMD/OFPOC, the extent of the determined psychological impairment was similar to that of psychotherapeutic outpatients; in 9.4% and 8.5% it was similar to that of psychotherapeutic inpatients, respectively.
Within the limitations of this study, in approximately one third of the evaluated patients of both the prosthodontic outpatient clinic and the TMD/OFPOC the psychological impairment reached values comparable to those of psychotherapeutic outpatients and psychotherapeutic inpatients. Therefore, the present findings emphasize the need to intensify the integration of psychosomatic aspects into dentistry and, in particular, to add psychological considerations to future German education plans.
Mandibular movement recording has long been established as the method for the physiological design of indirect dental restorations. Condylar movement recording is the basis for individual, ...patient-specific programming of partially or fully adjustable articulators. The settings derived from these recordings can generally be used in both traditional mechanical and electronic virtual articulators. For many years, condylar movement recordings have also provided useful information about morphological conditions in the temporomandibular joints (TMJs) of patients with masticatory system dysfunction based on the recorded movement patterns. The latest clinical application for recorded jaw-motion analysis data consists of functional monitoring of the patient as a diagnostic and surveillance tool accompanying treatment. Published parameters for the analysis of such recordings already exist, but a standardized and practicable protocol for the documentation and analysis of such jaw-movement recordings is still lacking. The aim of this article by a multicenter consortium of authors is to provide an appropriate protocol with the documentation criteria needed to meet the requirements for standardized analysis of computer-assisted recording of condylar movements in the future.
The aim of this study was to analyze the effect of occlusal modifications on the muscular activity of the masseter and anterior temporalis muscles. The study included 41 healthy dentate subjects who ...were examined in relation to the muscle activity of the masseter and anterior temporalis muscles recorded by surface electromyography (EMG) bilaterally in two different sessions. Occlusal plastic strips (thickness: 0.4 or 0.8 mm) were placed on different mandibular teeth to simulate different bite constellations (unilateral, bilateral transversal, and bilateral diagonal). Controlled by visual feedback, the subjects performed submaximum occlusion at 10% and 35% of maximum voluntary contraction (MVC). The activity ratios of the muscles were analyzed by two-way repeated measurement analysis of variance (ANOVA), and the reliability of muscle activity data was determined by intraclass correlation coefficient (ICC) analysis. The activity ratios of the masseter muscles were not significantly different under various biting conditions. In contrast, the anterior temporalis muscles showed significant differences (P < 0.001) between unilateral configurations and the other biting conditions (bilateral transversal or diagonal), in particular during biting at 10% MVC. In general, ICC values revealed low to moderate reliability of the measurements of muscle activity. Under controlled submaximum occlusal loading, the activity behavior of the masseter muscles remained stable, whereas the anterior temporalis muscles reacted differently to distinct occlusal biting configurations. The results support the assumption that the anterior temporalis muscles might operate as fine-tuning muscles when asymmetric bite force distributions occur, for instance during chewing, caused by food fragments between the teeth.
Medikamentöse Therapie bei Kiefergelenkschmerzen Hugger, Alfons; Schindler, Hans J.; Türp, Jens C. ...
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen,
2013, 2013-1-00, Letnik:
107, Številka:
4-5
Journal Article
Recenzirano
Die medikamentöse Behandlung von Kiefergelenkschmerzen zeigt deutliche Unterschiede zu entsprechenden Strategien bei der Behandlung von Kaumuskelschmerzen. Eine aktuelle systematische ...Literaturrecherche listet die verfügbaren Artikel über randomisierte kontrollierte Studien zum Thema Arthralgie der Kiefergelenke auf und bewertet diese. Auf der Basis der wenigen verfügbaren Studienartikel scheinen nichtsteroidale Antiphlogistika (NSA) wirksam zu sein, wobei Nebenwirkungen und Arzneimittelinteraktionen zu beachten sind. Die Schnelligkeit des Wirkungseintritts bei NSA scheint sich gegenüber anderen Therapiemaßnahmen zu unterscheiden und das Ausmaß der Nebenwirkungen kann durch die Wahl der Anwendungsform (orale versus topische Applikation) verringert bzw. verändert werden. Palmitoylethanolamid (PEA) als diätetisches Nahrungsmittel für spezielle medizinische Zwecke weist offenbar ebenfalls ein positives Potential bei der Behandlung der Kiefergelenkarthralgie auf, das durch weitere Studien einer Bestätigung bedarf.
Pharmacological interventions in temporomandibular joint (TMJ) pain differ from corresponding therapeutic interventions of jaw muscle (myofascial) pain. An actual systematic literature search lists and evaluates available articles on randomised controlled trials for treatment of arthralgia of the TMJ. On the basis of the few available trial reports, non-steroidal anti-inflammatory drugs (NSAIDs) seem to be effective, but side effects and drug interactions need to be considered. In relation to other therapeutic modalities, the rapidity of the onset of action of NSAIDs seems to be different, and the extension of side effects can be varied or reduced by changing the application route (oral versus topical). Palmitoylethanolamide (PEA) as dietary supplement for special medical purposes can apparently evoke positive therapeutic effects in TMJ arthralgia which need to be analysed in further studies.
Therapie von Kaumuskelschmerzen mit Okklusionsschienen Schindler, Hans J.; Hugger, Alfons; Türp, Jens C.
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen,
2013, 2013-1-00, Letnik:
107, Številka:
4-5
Journal Article
Recenzirano
Myofasziale Schmerzen der Kaumuskulatur sind die zweithäufigsten schmerzhaften Beschwerden im Kiefer-Gesichtsbereich. Wie unspezifische muskuloskelettale Schmerzen in anderen Körperregionen zeichnen ...sie sich durch eine multifaktorielle Genese aus. Ziel des Beitrags ist es, den aktuellen Wissensstand der Therapie mit oralen Schienen aufzuzeigen. Es wird belegt, dass diese Behelfe bei der überwiegenden Zahl der Patienten zu zufriedenstellender Schmerzlinderung bzw. Schmerzfreiheit im Kurz- und Langzeitverlauf führen. Bei Chronifizierung der Muskelschmerzen, die durch ausgeprägte psychosoziale Beeinträchtigungen gekennzeichnet sind, ist die Therapie mit Okklusionsschienen nur eingeschränkt wirksam. Innerhalb eines interdisziplinären Schmerzmanagements ist hier die schmerzpsychologische Betreuung dieser Patienten unerlässlich.
Myofascial masticatory muscle pain is the second most frequent pain-related complaint in the orofacial region. Like unspecific musculoskeletal pain in other body segments, masticatory muscle pain is characterised by a multifactorial aetiology. The aim of this article is to document the current knowledge about the therapy with oral splints. It is shown that in both the short and long term, oral appliances can achieve sufficient pain relief in the majority of patients. In chronic myofascial jaw pain associated with psychosocial impairment in patients, effectiveness of splint therapy is limited, though. Within an interdisciplinary pain management programme, additional involvement of a psychotherapist is essential.
The fourth part of this literature review on the clinical relevance of surface electromyography (EMG) of the masticatory muscles summarizes the results of clinical studies in patients with ...temporomandibular disorders (TMD), preferably randomized controlled trials, examining the impact of changes to the dynamic occlusion or the effects of occlusal splints and other treatment measures on electromyographic activity. Surface electromyography is a useful tool for neuromuscular functional analysis in the field of dentistry. In combination with a thorough history and detailed clinical examination, it is able to provide objective, documentable, valid and reproducible information about the individual functional status of the masticatory muscles if the user strictly adheres to the specific guidelines.
Pharmacological therapy of temporomandibular joint pain Hugger, Alfons; Schindler, Hans J; Türp, Jens C ...
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen,
2013, Letnik:
107, Številka:
4-5
Journal Article
Recenzirano
Pharmacological interventions in temporomandibular joint (TMJ) pain differ from corresponding therapeutic interventions of jaw muscle (myofascial) pain. An actual systematic literature search lists ...and evaluates available articles on randomised controlled trials for treatment of arthralgia of the TMJ. On the basis of the few available trial reports, non-steroidal anti-inflammatory drugs (NSAIDs) seem to be effective, but side effects and drug interactions need to be considered. In relation to other therapeutic modalities, the rapidity of the onset of action of NSAIDs seems to be different, and the extension of side effects can be varied or reduced by changing the application route (oral versus topical). Palmitoylethanolamide (PEA) as dietary supplement for special medical purposes can apparently evoke positive therapeutic effects in TMJ arthralgia which need to be analysed in further studies.
Increased resting electromyographic activity (EMG), reduced EMG during maximum voluntary clenching, and a shift to lower frequencies of the mean/median power frequency (MPF) of the EMG power spectrum ...have been reported for patients with temporomandibular disorder pain. It is unclear, however, whether these electrophysiological phenomena can be correlated with symptom improvement during the follow-up of myofascial pain patients in treatment. The objective of this study was to monitor the therapeutic effects of two different splint concepts (standard method and a complex splint procedure assisted by transcutaneous electrical nerve stimulation, TENS) for a period of 12 weeks, by use of clinical outcome criteria and EMG recordings. We tested the hypotheses that both measures evaluated will change in parallel during treatment and that the different splint concepts will result in no outcome differences between the variables studied. For two randomly selected groups, each containing 20 non-chronic myofascial pain patients, the clinical course after splint insertion was documented over a period of 12 weeks on the basis of pain and pain on palpation ratings, in parallel with EMG recording. Baseline values were monitored for matched healthy subjects. Although there was no correlation between the course of symptom improvement and significant changes in EMG data, MPF differed significantly (p < 0.05) between healthy subjects and patients. The therapeutic effects of splints of different clinical complexity differed significantly (p < 0.05) between the patient groups, in favor of the complex oral appliances, and substantial (p < 0.001) but temporary pain relief was achieved by additional TENS. For non-chronic myofascial TMD pain patients treated with splints, the course of symptom improvement is not paralleled by significant changes in EMG data. MPF can, however, be used to distinguish between healthy subjects and patients. Splints of different clinical complexity differ in their therapeutic effects in non-chronic myofascial TMD patients, and substantial temporarily limited pain relief can be achieved by additional muscle stimulation by TENS.
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